Limited_Source_Justification_-_FBO.gov.docx

LIMITED SOURCE JUSTIFICATION

Pursuant to FAR 8.405-6

1. Identification of the Agency and the Contracting Activity

Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS)

Contracting Officer’s Representative: Keely Ireland (410)786-7160 Center for Medicare

Contracting Officer: Mark Smolenski (410) 786-0175 Office of Acquisition and Grants Management (OAGM)

2. Nature and/or Description of Action Being Approved

This justification for limited source contracting supports a logical follow-on award to Acumen, LLC (Acumen) to provide support in monitoring sponsors that provide the Part D benefits’ compliance with CMS’ Best Available Evidence (BAE) policy and to support the reporting of Part D performance measures reflecting the Low Income Subsidy (LIS) Match Rate between CMS and sponsor files. The original task order (HHSM-500-2009-00107G) was awarded competitively using the GSA Mission Oriented Business Integrated Services (MOBIS) schedule.

The period of performance for the proposed logical follow-on task order will be January 15, 2013 through January 14, 2014. The work to be performed under this task order will be a completion effort. The estimated value of the delivery order is approximately $590,000.

3. Description of the Supplies or Services Required to Meet the Agency's Needs

The Medicare Prescription Drug Benefit Program was enacted into law on December 8, 2003, in section 101 of the Medicare Prescription Drug, Improvement and Modernization act of 2003 (MMA) and is codified in §§ 1860D-1 through 1860D-42 of the Social Security Act (the Act). Section 101 of the MMA amended Titles XVIII of the Act by re-designating Part D as Part E and inserting new Part D, which establishes the Voluntary Prescription Drug Benefit Program (hereinafter referred to as “Part D”).

Sponsors that provide the Part D benefits must meet certain requirements for providing these benefits to their enrollees. One such requirement, specified in § 1860D-14(c)(1)(B) of the Act, is to provide a cost-sharing subsidy to Part D eligible individuals who are full-benefit dual eligible individuals or recipients of supplemental security income (SSI). Sponsors are also required to provide access to Part D drugs at a reduced low-income subsidy (LIS) cost-sharing level when presented with acceptable evidence of LIS eligibility [Best Available Evidence (BAE)], even if the sponsor’s systems and CMS’ systems do not yet reflect that eligibility. Sponsors must update their own systems to reflect the LIS status indicated by the BAE and, if necessary, must submit a request to CMS so that the agency’s systems can be updated as well. These requirements apply to all beneficiaries who are “deemed” subsidy eligible (including full benefit Medicare/Medicaid eligibles, partial dual eligibles, and people receiving SSI). The requirements to accept evidence of LIS eligibility and update the sponsor’s system based on that evidence applies as well to beneficiaries who must apply and are awarded LIS by the Social Security Administration (SSA).

Given the importance of these LIS requirements to ensure that incorrectly high premiums and/or co-payments do not pose an undue financial burden and barrier to access to pharmaceutical care for these fragile beneficiaries, CMS, in addition to developing the BAE policy, has developed LIS performance measures to calculate the match rate between CMS and sponsor files on LIS beneficiaries and benefit levels

4. Identification of Justification Rationale

FAR 8.405-6(b) (2) provides for the restriction of competition when the required work is a logical follow-on to an original GSA schedule delivery order that was competitively awarded. This proposed task order to Acumen is a logical follow-on to an original GSA MOBIS schedule task order that was competitively awarded to Acumen on September 8, 2009.

Acumen possesses unique historical knowledge of what is needed to monitor sponsors’ compliance with CMS’ BAE policy and to support the reporting of Part D performance measures reflecting the LIS Match Rate between CMS and sponsor files. Specifically, Acumen’s procedures for providing sponsors with the LIS Match Rate reports, the analysis and trouble shooting of the reports, and the longitudinal experience with Match Rate issues place Acumen in a unique position for continuing the LIS Match Rate project through January 2014.

Acumen has gained expertise in the ability to analyze and interpret documentation submitted by sponsors for the Best Available Evidence project. Acumen has improved their skills in determining whether documentation is acceptable or unacceptable, according to CMS guidelines, for proving a beneficiary’s low-income subsidy status. Specifically, Acumen’s staff is trained on the forms of BAE CMS accepts from the 50 states’ and the District of Columbia’s Medicaid and public assistance programs. This historical knowledge allows Acumen to seamlessly continue the project through January 2014.Acumen has identified and strengthened areas of weakness and made recommendations on ways to further advance and expand the monitoring project.

5. A Determination by the Ordering Activity Contracting Officer that the Order Represents the Best Value

In accordance with FAR 8.404(d), the ordering activity is not required to make a separate determination of fair and reasonable pricing as GSA has already determined rates for services offered at hourly rates under schedule contracts to be fair and reasonable. In accordance with FAR 8.405-2(d), however, CMS will evaluate Acumen’s proposed pricing and level of effort and mix of labor projected to perform the task order. In addition, CMS will use the independent government cost estimate along with historical pricing data to ensure that this logical follow-on procurement strategy represents the best value to the government. Prior to execution of this proposed logical follow-on task order, the Contracting Officer will make a fair and reasonable determination.

6. A Description Of The Market Research Conducted Among Schedule Holders and the Results Or A Statement For The Reasons Market Research Was Not Conducted

The original GSA task order was competed among three GSA MOBIS contractors in 2009. Since the original award was in accordance with competitive procedures, and based on this requirement for continued services, a logical follow-on is justified since the incumbent is performing well. Thus, no market research was conducted.

7. Any Other Facts Supporting the Justification

N/A. Please see the information provided in Sections 3 and 4 of this document.

8. Actions the Agency May Take to Remove or Overcome Any Barriers to Competition

If there is a continued need for this work after the logical follow-on task order concludes, this requirement will be competed.

9. Recommendation/Approval

For the reasons stated above, it is therefore recommended that a logical follow-on task order be non-competitively negotiated with Acumen.