Justification for an Exception to Fair Opportunity FAR Part 16.5_Redacted.pdf

CUI

Control Number: FY26-0974

Controlled by: Defense Health Agency (DHA) Controlled by: USAMRAA CUI Category(ies): Source Selection Limited Dissemination Control: (FEDCON) POC: (Corey A. Black, Contracting Officer)

CUI

(Source Selection Information - See FAR 2.101 and 3.104-4)

1 JUNE 2026

Justification for an Exception to Fair Opportunity Revolutionary Federal Acquisition Regulation (FAR) Overhaul (RFO) Part 16.507-6

Identification of the Agency and Contracting Activity: This Justification and Approval (J&A) is prepared by the Defense Health Agency (DHA), DHA Contracting Activity (DHACA), Healthcare Contracting Division–South (HCD-S). The requiring activity is the Healthcare Optimization (HCO) Branch within the DHA Health Care Operations Directorate. HCO is acquiring urgent and essential referral management services for 4 Air Force Military Treatment Facilities (MTFs) located throughout the continental United States (CONUS) Alaska

Nature and/or Description of Action being Approved: A new bridge firm-fixed-price task order is required under the Defense Health Agency Medical Q-Coded Services Support–Next Generation (MQS2-NG) multiple-award contract for small business concerns. The bridge task order will ensure the uninterrupted provision of essential Referral Management Services while a bid protest concerning the underlying task order is pending before the Government Accountability Office (GAO).

Pursuant to the Competition in Contracting Act, 31 U.S.C. § 3553(d), and FAR 33.104(c), performance of the protested task order must be suspended during the pendency of the protest.

Specifically, 31 U.S.C. § 3553(d)(3)(A)(ii) and FAR 33.104(c)(1) require the contractor to immediately suspend performance and any related activities that could result in additional obligations being incurred by the United States under the protested task order.

Any interruption in Referral Management Services would create an immediate and unacceptable risk to patient care and healthcare operations. These services support the coordination of care for more than 9 million beneficiaries across 4 Air Force MTFs located throughout CONUS Alaska Even a brief lapse in service could impair referral processing, disrupt continuity of care, delay access to medically necessary services, and adversely affect critical clinical and administrative functions across the affected MTFs.

Accordingly, immediate interim coverage is necessary to prevent irreparable harm to ongoing operations, continuity of care, and mission-essential healthcare functions.

CUI

Source Selection Information - See FAR 2.101 and 3.104-4

3 16 September 2026 facilities. Although a prior contractor may have previously performed these services, that contractor is not one of the mandatory MQS2-NG vendors, and transitioning performance back to that source would require an unacceptable period of administrative turnover, workforce coordination, and operational re-establishment that would likely prevent immediate full performance. That risk is increased because the current requirement is being performed under new performance requirements, defined in a substantially distinct Statement of Objectives, to which the current contractor has already aligned its oversight, workflows, and performance response processes, and pursuant to which is now fully performing. Based on transition experience, performance standards are typically not fully met during transition periods, and further disruption would reasonably be expected to result in substandard performance until the incoming workforce and management structure are fully established.

The DHA operates and manages a worldwide healthcare system delivering medical services to more than nine million eligible beneficiaries, including active-duty personnel, their families, and retirees during both peacetime and wartime. As part of the transition to a single, cohesive Military Health System (MHS), the DHA has integrated MTFs from the Air Force, Army, and Navy. When a beneficiary requires specialty care beyond the scope of their primary care provider, they must receive a formal referral. The RMC is the critical operational link in this process:

Clinical Coordination: The RMC advises patients on their benefits, coordinates with referring providers, and collaborates with the MCSC to ensure referral accuracy.

Resource Optimization: The RMC facilitates the "recapture" of care by directing patients to in-house MTF specialty services when capacity exists, optimizing the utilization of military healthcare resources.

Continuity of Care: The RMC tracks referrals to closure and ensures that external specialty treatment results are successfully returned and integrated into the patient’s official electronic health record.

A lapse in RMS coverage across these 4 legacy-Air Force MTFs would have immediate, severe, and compounding consequences for the MHS mission:

Compromised Patient Safety and Care Access: Without RMC staff, the referral pipeline will collapse. Patients requiring urgent specialty care will experience severe delays in receiving authorizations, directly compromising clinical outcomes and patient safety.

Referral management and appointing are time-sensitive, no-fail medical support functions. Urgent referrals must be processed within two hours, other referrals within one business day, and routine appointing actions within required timeliness standards. When contract performance introduces delays, gaps, or degradations in referral processing, appointing, or clinical record retrieval, beneficiary care can be delayed beyond standard, including care for patients with serious conditions requiring specialized treatment. In addition, when records and results are not timely returned to the ordering provider, continuity of care is disrupted, and clinical decisions may be made without complete information.

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Source Selection Information - See FAR 2.101 and 3.104-4

4 16 September 2026

Degraded Active-Duty Readiness: The RMS program is vital for maintaining the health and deployability of active-duty service members. Delays in coordinating specialized care will directly impact the DoD’s operational readiness and expeditionary medicine capabilities.

Financial Inefficiency: Without active referral management, the MTFs will lose the ability to recapture care within the direct care system. This will force a massive influx of patients into the civilian private sector care network, resulting in significantly higher, unbudgeted costs for the Government.

Administrative Failure: The sheer volume of daily referrals across 4 MTFs cannot be absorbed by existing military personnel. A lapse in services will halt the standardization of appointing processes, severely degrade patient satisfaction, and cause administrative backlogs that will take months to resolve.

These services have been performed through this contract vehicle for more than 10 years and are relied upon by the supported military treatment facilities as the operational means of executing this mission. There is no readily available organic backup workforce capable of immediately assuming these duties at the scale required. Most TRICARE Operations and Patient Administration offices do not have trained civilian personnel available to perform these functions, and active-duty personnel at legacy-Air Force military treatment facilities are already assigned to other responsibilities. Reallocating military personnel across 4 locations to assume this requirement would present significant feasibility and mission-impact concerns. For these reasons, a change in contractor at this time would create unacceptable risk to timely patient care, continuity of operations, and mission performance.

Accordingly, to prevent a catastrophic failure of the healthcare delivery mission and to safeguard the health of nine million beneficiaries, awarding this urgent short-term bridge task order to Cognito, LLC is the only practical and responsible course of action to guarantee uninterrupted support while the protest is pending.

6. Market Research: While other MQS2-NG small business vendors possess the general capability to perform these services under normal competitive conditions, only the incumbent vendor can continue performance without a break in service. Awarding this short-term bridge to any other source would directly result in unacceptable delays, administrative failure, and severe clinical risk to military beneficiaries

7. Other Facts:

a. Procurement History:

(1) Is this a new requirement? No, current Contract HT001525D9021 Task Order HT940826FE040 would resume upon resolution of protest and lifting of suspension.

(2) If 7.a.(1) is No, was the action just prior to this one competed? No, the action prior to this action was awarded under bridge contract HT940826CE011 IAW RFO 6.103-1, Only one responsible source to Prairie Quest, Inc.

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Source Selection Information - See FAR 2.101 and 3.104-4

5 16 September 2026

b. Additional Information: None.

8. Actions to Remove or Overcome any Barriers to Competition: While the immediate urgency of this requirement precludes competition for this short-term bridge action, the underlying requirement was fairly competed among MQS2-NG vendors and a task order was awarded to the offeror whose proposal was deemed to represent the best value to the Government. HCD-S is committed to promoting full and open competition to the maximum extent practicable. The following actions are being taken to overcome barriers to competition:

Resolution of the Post-Award Protest: The primary barrier to competition for this immediate requirement is the statutory stay of performance resulting from the post-award protest on Contract HT001525D9021 Task Order HT940826FE040. HCD-S, in coordination with agency legal counsel, is actively working to resolve this protest as expeditiously as possible. Once the protest is resolved and the stay is lifted, HCD-S will immediately transition the services to the competitively awarded task order.

Prior Competitive Award: The underlying requirement was already successfully and competitively competed among the multiple-award MQS2-NG small business contract holders. This demonstrates the Agency's commitment to competitive procurement. This bridge action is strictly a temporary, risk-mitigation measure to maintain clinical continuity and patient safety while the competitive process is legally resolved.

Limiting the Scope and Duration of the Bridge: To ensure that competition is not unnecessarily restricted, HCD-S will limit this bridge action's period of performance to the minimum time necessary to resolve the protest and execute a transition. The task order will also include appropriate bilateral termination clauses to allow the Government to transition to the competitively awarded task order immediately upon resolution of the protest.

Future Acquisitions: For subsequent and future requirements of this nature, HCD-S will continue to utilize competitive multiple-award contract vehicles, such as MQS2-NG, to foster robust competition, secure fair and reasonable pricing, and provide opportunities for small business participation

CUI

Source Selection Information - See FAR 2.101 and 3.104-4

6 16 September 2026

9. Technical and Requirements Certification:

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

Ryan S. Lindgren Contracting Officers Representative IRMAC Branch-Healthcare Optimization Division

10. Legal Review:

I have reviewed this justification and have found it to be legally sufficient.

Jessica Volsey Office of General Counsel

11. Contracting Officer Certification:

Fair and Reasonable Cost Determination: I hereby determine the anticipated cost to the Government for this contract action will be fair and reasonable when compared to current pricing that was awarded as fair and reasonable under Task Order HT940826FE040.

I certify this justification is accurate and complete to the best of my knowledge and belief.

Corey A. Black Contracting Officer Healthcare Contracting Division-South

Source Selection Information - See FAR 2.101 and 3.104-4 7 16 September 2026

Review

I have reviewed this justification and find it adequate to support the exception to fair opportunity.

Concurrence

Diana Stewart Chief of the Contracting Office Healthcare Contracting Division-South

Approval

Based on the foregoing justification, I hereby approve the procurement of Referral Management Services with an estimated total dollar value of $15,016,287.84 on an exception to fair opportunity basis pursuant to the authority of RFO 16.507-6(b)(1): “The agency need for the supplies or services is so urgent that providing a fair opportunity would result in unacceptable delays”, subject to availability of funds, and provided that the supplies or services herein described have otherwise been authorized for acquisition.

Hillary M. Lewis Competition Advocate DHA Contracting Activity