Justification and Approval - 071420 FINAL Redacted.pdf

JUSTIFICATION AND APPROVAL

FOR OTHER THAN FULL AND OPEN COMPETITION

PURSUANT TO FAR SUBPART 6.302-1(a)(2)

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

2. Description of Action:

The proposed action is to execute "out of scope" modifications to firm-fixed-price contracts, 36C791- 19-D-0004; 36C791-19-D-0005 and 36C791-19-D-0006 with Optum Public Sector Solutions, Inc.

(Optum) (large business) 800 King Farm Blvd, Ste 500, Rockville, MD 20850. The scope of this modification implements Section 112 of the VA, Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018. The Veterans Community Care Program (VCCP) includes specific healthcare elements that pertain to the Veterans Health Administration (VHA) delivering medical care to Veterans. Section 112 of the MISSION Act, as codified in 38 U.S.C.

§ 8159, Paying Out of Network Providers, establishes that the Secretary shall take reasonable efforts to enter into a contract, agreement, or other arrangement with a provider described in subsection (a) to ensure that future care and services authorized by the Secretary and furnished by the provider are subject to such a contract, agreement, or other arrangement. This modification implements the guidance and timeline to compensate an Out of Network provider who is not a party to the contract, agreement, or other arrangement furnishes hospital care, a medical service, or an extended care service to eligible Veterans.

3. Description of Supplies or Services:

Paying Out of Network Providers compensates a provider who is not a party to the contract, agreement, or other arrangement furnishes hospital care, a medical service, or an extended care service to eligible veterans enrolled in the healthcare system throughout Regions 1 - 3, encompassing 36 States and U.S Territories (Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York, New Jersey, Delaware, Maryland, Pennsylvania, District of Columbia, West Virginia, Virginia, North Carolina, Ohio, Kentucky, Indiana, Illinois, Missouri, Kansas, Nebraska, Iowa, Wisconsin, Michigan, Minnesota, North Dakota, South Dakota, Oklahoma, Arkansas, Louisiana, Tennessee, Mississippi, Alabama, Georgia, South Carolina and Florida, Puerto Rico and U.S. Virgin Islands). The total estimated value for each Region is for a combined estimated value of

4. Statutory Authority:

The statutory authority permitting other than full and open competition is 41 U.S.C.3304(a)(1) as implemented by the Federal Acquisition Regulation (FAR) Subpart 6.302-1(a)(2) entitled, "Only one responsible source and no other supplies or services will satisfy agency requirements."

5. Rationale Supporting Use of Authority Cited Above:

In accordance with 38 U.S.C §8159 SEC. 112 Paying Out of Network Providers, “If, in the course of furnishing hospital care, a medical service, or an extended care service authorized by the Secretary and pursuant to a contract, agreement, or other arrangement with the Secretary, a provider who is not a party to the contract, agreement, or other arrangement furnishes hospital care, a medical service, or an extended care service that the Secretary considers necessary, the Secretary may compensate the provider for the cost of such care or service.” The authority for procuring this effort is 38 U.S.C. 8153, Sharing of Healthcare Resources; and 48 CFR Part 873, Simplified Acquisition Procedures for Healthcare Resources.

In accordance with FAR Subpart 6.302-1(a)(2), Optum is the only reasonable source to implement the MISSION Act Section 112 Paying Out of Network Providers requirement. Optum currently has proprietary systems (Optum Provider Network) in place that will be utilized for this requirement to ensure continuity throughout Regions 1 - 3.

6. Efforts to Obtain Competition:

Market research was conducted as set forth in paragraph 8 of this document, and those efforts did not yield any additional sources that can meet the Government's requirements. There is no competition anticipated for this acquisition.

This justification will be published on Contract Opportunities under beta.sam.gov page in accordance with FAR 6.305(c).

7. Determination of Fair and Reasonable Price:

In accordance with FAR Subpart 13.106-3, the CO will ensure fair and reasonable pricing utilizing one or a combination of methods prescribed in 13.106-3(a)(2)(i-viii) before making any award.

8. Market Research:

Market research was conducted to ensure no other contractor could fulfil the Paying Out of Network Providers requirement. VetBiz databases (IAW VAAR 810.001-70) was queried on June 12, 2020 using keywords "managed healthcare" and NAICS code 52114, VetBiz resulted in total of 8 Service- Disabled Veteran Owned Small Businesses (SDVOSBs) and Veteran Owned Small Businesses (VOSB). Each contractor's website was reviewed, and it was determined that the contractors’ capability narratives were not within the scope of this requirement. Additionally, GSA e-library databases query (IAW VAAR 810.001-70) was queried on June 12, 2020 using keywords "managed healthcare" and NAICS code 524114, this search resulted in 19 vendors under the title Professional Services Schedule, Category 520 15. The published schedules were reviewed, and it was determined that the contractors’ capabilities were not within the scope of this requirement. A query of the Dynamic Small Business Search (DSBS) database was completed on June 12, 2020 using NAICS code 524114 and key words “managed healthcare” resulted in no contractors. Furthermore, the Federal Procurement Data System (FPDS) was searched on June 12, 2020 using keyword “managed healthcare” and NAICS 542114 which resulted in no vendors identified within the search criteria.

9. Any other facts supporting this justification:

In June of 2018, the MISSION Act of 2018 law was passed in order to give Veterans greater access to health care in VA facilities and the community, expand benefits for caregivers, and improve VA's ability to recruit and retain the best medical providers. The original contract was not designed with the MISSION Act of 2018 in mind and, as a result, the contract must be modified. VHA is home to the United States' largest integrated health care system consisting of 152 medical centers, over 850 community-based outpatient clinics, community living centers, Vet Centers and Domiciliaries.

Together, these health care facilities and the more than 53,000 independently licensed health care practitioners who work within them, provide comprehensive healthcare to more than 8.3 million Veterans each year. VHA provides methods to access community based medical care to eligible Veterans when VA facilities are not available. Federal laws, which set forth eligibility criteria, govern the use of community based medical care and other policies that specify when and why care may be used. Prior approval for treatment in the community is required for community based medical care unless the medical event is an emergency. VHA continues to spend over $10 billion per year purchasing healthcare services in the community, through a variety of methods to include fee-for-service, individual provider agreements as authorized by law, local contracts and national contracts.

Any delay in the procurement of the MISSION Act Section 112 Paying Out of Network Providers requirement would greatly impact the quality and continuity of medical care and services throughout the VA network.

Optum Public Sector Solutions, Inc., was ultimately awarded contracts 36C791-19-D-0004; 36C791- 19-D-0005 and 36C791-19-D-0006, known as the Care in the Community Network (CCN) contracts for Regions 1 - 3 in December 2018 and will have established healthcare delivery for Regions 1, 2 and 3 by June 22, 2020. The requirement was originally solicited under the policy in effect at that time. Had the agency canceled the requirement and/or delayed negotiations in June 2018, the risk of not having a supporting contract in place ahead of the CCN award would have been catastrophic. If the supporting acquisitions for the CCN contracts were not awarded in a timely manner, then the operation of the United States' largest integrated health care system would have been crippled. To mitigate this risk, the agency determined it was in the best interest of 8.3 million Veterans to continue with award.

10. Listing of interested sources:

Optum Public Sector Solutions, Inc. (Optum) 800 King Farm Blvd, Ste 500 Rockville, MD 20850

11. Actions to Increase Competition:

At this time there are no other actions that can be taken to increase competition. The requirement for Paying Out of Network Providers , and related services are consistent with the VCCP authorized by the MISSION Act of 2018. The Government will continue to conduct market research to ascertain if there are changes in the marketplace that would enable future actions to be competed. All future requirements will be handled on a case-by-case basis to determine any future acquisition strategy.

12. Technical and Requirements Certification:

I certify that the supporting data under my cognizance, which is included in this justification, is accurate and complete to the best of my knowledge and belief.

Name: Tom Grahek, Director Date:

Title: Provider Relations & Services Signature:________ _________

13. Procuring Contracting Officer Certification:

I hereby determine that the proposed contract action will represent the best value to the Government and certify that this justification is accurate and complete to the best of my knowledge and belief.

Name: Lori A. Smith Date:

Title: Contracting Officer, Director Signature:__________________

Approval

Upon the basis of the above justification, I hereby approve, as advocate for competition for the procuring activity, the solicitation of the proposed procurement described herein using other than full and open competition, pursuant to the authority of 41 U.S. Code 3304(a)(1).

Donald Jones Date SAC Advocate for Competition Competition Advocate Tracking Number _________

7/14/2020

DJ039

THOMAS A.

GRAHEK

684709

Digitally signed by

THOMAS A. GRAHEK

684709 Date: 2020.07.14 13:48:03 -04'00'

Lori A. Smith 692430

Digitally signed by Lori A. Smith 692430 Date: 2020.07.14 14:32:45 -04'00'

Donald J. Jones 926524

Digitally signed by Donald J.

Jones 926524 Date: 2020.07.14 14:48:08 -04'00'