JA P2E Bridge Final Redacted.pdf

Justification and Approval for Other Than Full and Open Competition

1. Contracting Activity: Department of Veterans Affairs Office of Procurement Acquisitions and Logistics Strategic Acquisition Center (SAC) 10300 Spotsylvania Ave, STE 400 Fredericksburg, VA 22408

2. Nature and/or Description of the Action Being Processed:

This Justification and Approval (J&A) for Other Than Full and Open Competition is executed by the Strategic Acquisition Center (SAC), on behalf of the Department of Veterans Affairs (VA). The activity proposes to negotiate a non-competitive award (sole source) “Bridge Contract” with Availity L.L.C, for the procurement of Clearing House Services to Support Paper-Based Health Claims and Associated Medical Documentation (P2E). The anticipated award number for this action is 36C10G-21-D-0020. In accordance with Federal Acquisition Regulation, Subpart 6.302-2 Unusual and compelling urgency that the Government would be seriously injured unless the agency is permitted to limit the number of sources from which it solicits bids or proposals, full and open competition need not be provided.

The award period is noted below:

BASE PERIOD: 04/01/21 – 09/29/2021 (Six Months)

The new award requirement is combination of Paper-Based Health Claims and Associated Medical Documentation (P2E )services referenced in this justification and the Clearing House Services to Support Health Care Electronic Data Interchange (EDI) supported in a similar contract. The Strategic Acquisition Center conducted a competitive procurement via Federal Business Opportunities (FBO) in June 2020. The procurement was awarded in December 2020 and subsequently protested. The Integrated Product Team is currently taking corrective action against the protest. The delay in awarding the competitive procurement has created unforeseen delays in continued service.

EDIP2E services are a critical function to the entire VA business model in which services cannot be interrupted, thus necessitating this bridge contract and the possible six-month period of performance.

The current contract 36C10G-21-D-0003 is a firm-fixed price/Indefinite Delivery Requirements contract awarded with a period of performance of a three-month base period and a three- month option periods, which expires on March 31, 2021. The services have been awarded sole source in order to prepare for new requirement vehicle to support the Department of Veterans Affairs.

The contractor provides all services related to receiving paper claims and/or paper medical documentation from community healthcare providers, in a single location, converting these documents to the appropriate HIPAA-compliant EDI transactions and sending these documents to VA’s contracted clearinghouse, Change Healthcare, as EDI transactions. Over 17 million paper conversion transactions have been processed in the last six months of FY20.

36C10G-21-D-0003 was initiated on October of FY21. The current contract was a sole source contract awarded on October 1, 2020 with one option period. The single option period has been exercised and ends on March 31, 2021.

Availity, LLC. is solely responsible for the P2E process and is therefore, the contractor to only partial requirements of the newly contemplated competitive requirement that will combine P2E and Electronic Data Interchange (EDI).

Availity, LLC. is currently providing P2E services which has been vetted through Agency level IT, HIPAA, and security processes.

The historical overview of the subject requirement is provided below:

Contract Number Period of Performance Authority VA249-17-D-0190 Base Year: 06/09/2017 – 06/08/2018

Option Period 1: 06/09/2018 – 06/08/2019 Option Period 2: 06/09/2019 – 08/31/2019 6 Month Extension: 09/01/2019 – 02/29/2020

36C10G-20-D-0010 Base Period: 03/01/2020 - 05/31/2020 (three months) Option Period 1: 06/01/2020 – 07/31/2020 (two months) Option Period 2: 08/01/2020 – 08/31/2020 (one month) Option Period 3: 09/01/2020 – 09/30/2020 (one month)

6.302-1

36C10G-21-D-0003 Base Period: 10/01/2020 – 12/31/2020 (Three Months) Option Period 1: 01/01/2021 – 03/31/2021 (Three Months)

6.302-2

36C10G-21-D-0020 (Pending approval of J&A)

Base Period: 04/01/21 – 09/29/2021 (Six Months) 6.302-2

3. Description of Supplies/Services Required to Meet the Agency’s Needs (including the estimated value):

VHA OCC receives EDI through a single contracted clearinghouse Change Healthcare, which provides batch file deliveries twice daily. Paper claims and supporting documentation are received locally at the medical centers across the country or, for family members’ claims at the Health Administration Center in Denver, CO. VHA OCC employs contracting resources utilizing a single national location that will receive paper-based submissions and convert these submissions to electronic formats and transmit these submissions via EDI to its contracted clearing house. The estimated award for this acquisition is approximately $4,410,060.78 spread over a six-month period. If the replacement procurement is awarded sooner than anticipated, the $4,410,060.78 estimate value may decrease accordingly based upon the spend rates in the respective period of performance.

4. An identification of statutory authority permitting other than full and open competition:

The statutory authority permitting other than full and open competition is 41 U.S.C. §3304(a)(2) as implemented by the Federal Acquisition Regulation (FAR) Subpart 6.302-2 entitled, “Unusual and Compelling Urgency.”

5. Demonstration that the Contractor’s Unique Qualifications or Nature of the Acquisition Requires the Use of the Authority Cited Above (applicability of authority):

The incumbent has successfully processed 17 million paper to electronic transactions during its most recent six months of FY21 for VHA OCC veterans’ services. The incumbent currently receives paper documentation from 121 VA medical centers and all centers have been educated to the process. The incumbent offers an exceptional resource of services and capabilities needed to complete the requirements of this acquisition. Accordingly, the award to Availity, LLC will allow for the continuity of providing the services required without VHA OCC experiencing unacceptable delays in fulfilling its requirements and avoiding a lapse in services. The Clearinghouse services provided by Availity, LLC has been deemed by the Mission Act of 2018 to be an essential service to the Veterans (i.e. the requirement to promptly pay providers). Paper claims and supporting documentation are submitted via this contract to VA’s contracted resources utilizing a single national location that will receive paper-based submissions and convert these submissions to electronic formats and transmit these submissions via EDI to its contracted clearinghouse. This contract serves as a clearinghouse for community providers to submit claims for payment to the VA. If these services do not continue, VA will have no way to receive these claims for payment and will be unable to pay providers. If providers are not paid, services to Veterans will discontinue. This is a direct impact to Veterans’ care.

6. Description of efforts made to ensure that offers are solicited from as many potential sources as is practicable, including whether a notice was or will be publicized as required by FAR Subpart 5.2 and, if not, which exception under 5.202 applies:

In accordance with FAR Subpart 6.302-2, Unusual and Compelling Urgency an attempt to seek offers from as many sources has been accomplished for the follow-on requirement. A notice shall be posted on Beta.SAM.Gov, formerly FBO in accordance with FAR Part 5.

7. Determination by the CO that the Anticipated Cost to the Government will be Fair and Reasonable:

No award shall be made until the Contracting Officer determines the cost to the Government to be fair and reasonable. This determination will be based on a comparison of current contract pricing, past proposal submissions (if available), other information made available, and an Independent Government Cost Estimate, etc.

The Government’s intention is to award solely on the basis of achieving pricing, which is the same, or less, than the current award’s pricing.

8. Description of the Market Research Conducted and the Results, or a Statement of the Reasons Market Research Was Not Conducted:

Market research was conducted and Availity, LLC and has been determined to be a responsible source with respect to their performance on the current contract. A review of their Representations and Certifications was conducted in the System for Award Management (SAM) and Availity, LLC they are not an excluded entity.

9. Any Other Facts Supporting the Use of Other than Full and Open Competition:

The current competitive procurement award was protested. It is in the agency’s best interest to award the long-term effort as soon as possible to allow for possible ramp up of new vendors and is in the process of procuring these services on a competitive basis. This sole source bridge contract will support continuity of service until such time as action may be taken by OCC and the contracting office to finalize the long- term competitive procurement.

10. Listing of Sources that Expressed, in Writing, an Interest in the Acquisition:

Availity LLC 5555 Gate Parkway Suite 110 Jacksonville, FL 32256

11. A Statement of the Actions, if any, the Agency May Take to Remove or Overcome any Barriers to Competition before Making subsequent acquisitions for the supplies or services required:

The bridge contract is to provide necessary time to award the Clearing House to Support Health Care Electronic Data Interchange (EDI) requirement. Currently, the follow-on acquisition which will combine the EDI requirement with the Paper-Based Health Claims and Associated Medical Documentation requirements..