Limited Source Justification - IDR Support.pdf

FEDERAL SUPPLY SCHEDULE LIMITED-SOURCES JUSTIFICATION

Acquisition Title: Independent Dispute Resolution Technical Assistance Support Agency: CMS/CCIIO Acquisition Year: FY 2022 Author: Josh Annas and Mark Smolenski

1. Description of Action:

Nature

• __X_ New Requirement

• ____ Follow-On Order

• ____ Modification of Existing Purchase Order / Contract Number

Contract Type

• ____ Firm-Fixed Price

• __X__ Time and Materials

• ____ Cost Plus Fixed Fee (CPFF)

• ____ Term

• ____ Completion

• ____ Cost Plus Award Fee (CPAF)

• ____ Other: ___________

Projected Cost / Price: $8,000,000 Funding Source (s): 7457: Certification & Data Collection for Certifying Entities

Name of Proposed Contractor(s):

Index Analytics

2. Description of Supplies or Services:

The estimated value of the proposed action, including all options, is:

$8,000,000

The Consolidated Appropriations Act of 2021 became Public Law No: 116-260 on December 27, 2020. It's a $1.4 trillion omnibus spending agreement that encompasses many different provisions. Two acts within the law apply to The Centers for Medicare and Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO): Division BB, Title I, "No Surprises Act." and Title II, "Transparency." These provisions in Titles I & II require CMS to (1) Develop policy to further define the details of the provision, (2) Implement operational processes and technical functionality to support operations of the provisions, and (3) coordinate across HHS (e.g., with ASPE) and with Department of Labor, and Department of Treasury according to the legislation. CMS is seeking a contractor to provide technical assistance (operational, policy, professional services) expertise to support certified Independent Dispute Resolution entities (IDREs) to resolve disputes in a timelier fashion. The contractor will document and share observations and patterns regarding the dispute cases to aid CMS in refining its programmatic guidance and supporting systems. In supporting this effort, the contractor shall: provide timely technical assistance to IDR Entities (IDREs) in order to triage, prioritize, and address the backlog of disputes; share lessons learned and identify and recommend areas for improvement to assist IDREs in resolving disputes in a timely fashion; develop a performance management framework and productivity metrics to monitor dispute handling for continuous improvement and greater efficiency; and provide insights and recommendations to help CMS improve its information system support, policy guidance, and program oversight.

3. Authority:

__X__:ORDER AGAINST FSS: Authority of the Multiple Award Schedule Program, Title III of the Federal Property and Administrative Services Act of 1949 (41 U.S.C. 251, et seq.); Title 40 U.S.C. 501, Services for Executive Agencies; and Section 803 of the National Defense Authorization Act of 2002 (PL 107-107) and implemented by FAR 8.405-6. Mark the applicable exception and for each discuss how the cited authority applies in accordance with FAR 8.405-6(c)(2)(iv).

___X_: An urgent and compelling need exists, and following the procedures would result in unacceptable delays (FAR 8.405-6(a)(1)(i)(A));

The No Surprises Act (the Act) was enacted as part of the Consolidated Appropriations Act, 2021, div. BB, tit. I, P.L. 116-260 (Dec. 27, 2020). Due to deadlines in Section 103, Congress has directed CMS to fast track implementation. The urgent and compelling need for a Limited Source Justification is due to compliance with statutory and regulatory deadlines and by the unanticipated high volume of IDR disputes that have been filed since IDR entities began accepting them on April 15, 2022. Since that time, the number and nature of the IDR dispute requests received is approaching an untenable threshold past which some IDR entities will not be able to conduct their duties per their certification agreements with CMS. It was originally estimated by CMS that approximately 17,000 dispute requests would be received in calendar year 2022. By late July 2022, however, CMS has already received over 30,000 dispute requests and the data suggest that this trend will continue for the foreseeable future. It is not unlikely that CMS could receive approximately 100,000 dispute requests this year.

This represents an increase of over 500% of what was originally anticipated. With 10 IDR entities, CMS projected that each would receive approximately 1,700 disputes for the entire year. To-date, at least half of the IDR entities have already received this number in the approximately 3.5 months since the IDR process began. The IDR entities and CMS were not prepared to support this level of volume and this contract action is part of a multi-pronged strategy to address that challenge. The support envisioned in this action will bring much needed relief to these parties and help ensure that the program can continue, and continue successfully. Without the immediate award of this Independent Dispute Resolution Technical Assistance Support contract, the IDR process has a significantly higher risk of not meeting it’s statutory and regulatory goals.

4. Market Research:

Index Analytics is currently doing similar work for CMS and has performed at a high level. In addition, CMS has reviewed their past performance reports with the agency as well as their corporate capabilities and find, in both instances, they demonstrate high likelihood that they can fulfill our requirements and perform successfully.

5. Actions to Increase Competition:

If there is a need to continue this work after the period of performance ends, this work will be competed. The only reason this current work is not being competed is due to the extremely short timeframe in which the work under the contract needs to be implemented.

6. Any other facts supporting the justification:

N/A.

Approvals:

1. Program Office Certification: This is to certify that portions of this justification have been developed by the undersigned program office personnel, including supporting information and/or data verifying the Government’s minimum needs, schedule requirements and other rationale, which form the basis for this Limited Source Justification.

Contracting Officer Representative (COR) / Date

Program/Project Manager (P/PM) / Date

Best Value Determination. By my signature below, after review of the relevant documents, I have determined that the order subject to this Limited-Sources Justification represents the best value for the Government as set forth in FAR 8.404(d),and constitutes a fair and reasonable price. The basis for my determination is as follows:

This task order will be awarded under Index Analytic’s GSA Schedule. Per FAR 8.404(d), GSA has already determined the prices of supplies and fixed-price services, and rates for services offered at hourly rates, under schedule contracts to be fair and reasonable. Furthermore, quoted pricing for this work will be reviewed by subject matter experts to verify the labor mix and number of labor hours quoted will allow the contractor to successfully complete the work.

2. Contracting Officer Certification: This is to certify that the justification for the proposed acquisition has been reviewed and that to the best of my knowledge and belief, the information and/or data provided to support the rationale and recommendation for approval, is accurate and complete.

Contracting Officer / Date

OAGM Approvals

I hereby confirm the circumstances described above apply and approve the Limited Source Justification.

OAGM Division Director / Date

OAGM Group Director / Date

3. Head of Contracting Authority (HCA) Approval I hereby confirm the circumstances described above apply and approve the Limited Source Justification.

HCA Name / Date

4. CMS Competition Advocate (CA) Approval I hereby confirm the circumstances described above apply and approve the Limited Source Justification.

N/A___________________________________________________ Name / Date

5. Senior Procurement Executive (SPE) Approval Based on the foregoing justification, I hereby approve the procurement of (state supplies/services being procured) on an other than full and open competition basis pursuant to the authority of (state the full statutory authority and FAR cite and title, consistent with paragraph 4, e.g. 41 U.S.C. 253(c)(1)), as implemented by FAR 6.302-1), subject to the availability of funds, and provided that the services herein described have otherwise been authorized for acquisition.

N/A_________________________________________________ Name / Date

For: