LSJ Posting MATS Program - 4-19-22.pdf

FEDERAL SUPPLY SCHEDULE LIMITED-SOURCES JUSTIFICATION

Acquisition Title: Marketplace Assister Technical Support (MATS) Program

Agency: Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS)

Acquisition Year: 2022 (APP 220315)

Author(s): Contracting Officer�s Representative (COR), Jabaar Gray and Contracting Officer, Matthew Waskiewicz

1. Description of Action:

Nature:

New Requirement Follow-On Order Modification of Existing Purchase Order / Contract Number (GS-00F-313CA/ 75FCMC19F0018)

Contract Type:

Firm-Fixed Price T ime and Materials

Cost Plus Fixed Fee (CPFF) Term Completion Cost Plus Award Fee (CPAF) Other: ___________

Projected Cost / Price: $1 , 00,000 Funding Source (s):

Project #: Funding Source Name:

001954 Complex Casework 007457 Certification & Data Collection for Certifying Entities 001941 Retroactive Enrollments & Enrollment Reconciliation 001955 Qualified Health Plan (QHP) Management, Oversight & Certification 001933 Enrollment T raining and Technical Assistance

Name of Proposed Contractor(s): General Dynamics Information Technology, Inc. (GDIT) Street Address: 3150 Fairview Park Drive City, State, Zip: Falls Church, VA 22042

2. Description of Supplies or Services:

The estimated value of the proposed action, including all options, is $14,900,000

Period of Performance of Services:

Current Period of Performance Proposed Period of Performance

Period: Date Range: Period: Date Range:

Base Period February 22, 2019 � June 16, 2020 Base Period February 22, 2019 � June 16, 2020

Option Period 1 March 22, 2020 � April 30, 2021 Option Period 1 March 22, 2020 � April 30, 2021

Option Period 2 April 6, 2021 � April 5, 2022 Option Period 2 April 6, 2021 � April 5, 2022

Transition Out: January 5, 2022 - April 5, 2022 Option Period 3* April 6, 2022 � February 21, 2023

Option Period 4* February 22, 2023 � February 21, 2024

Transition Out: November 23, 2023 � February 21, 2024

*This J&A supports the modification of an existing task order for the addition of two option periods such that the total period of performance totals 60 months or 5 total years.

Task Order Value:

Current Task Order Value Proposed Task Order Value

Period: Amount: Period: Amount:

Base Period $6,691,328 Base Period $6,691,328

Option Period 1 $7,104,625 Option Period 1 $7,104,625

Option Period 2 $11,749,540 Option Period 2 $11,749,540

Transition Out: $75,782* Option Period 3 $ , 00,000

Option Period 4 $ , 00,000

Transition Out: $75,782*

Total: $25,621,275 Total: $40,445,493

*Transition out (optional) was negotiated and included at task order award.

Description of Services:

This limited source justification supports a modification to task order GS-00F-313CA/ 75FCMC19F0018 awarded to General Dynamics Information Technology, Inc. to provide CMS with services in support of the Marketplace Assister Technical Support (MATS) Program. The task order was awarded competitively using the GSA Schedule Financial and Business Solutions (FABS), which has since been consolidated under the GSA Multiple Award Schedule (MAS).

The twenty-two-months of performance proposed to be added via this modification will consist of one twelve-month option period and one 10-month option period. The total period of performance (if both options are exercised) will be from April 6, 2022 through February 21, 2024.

The purpose of the (MATS) program is to provide in-person assisters with the technical support services that will help enable assisters to facilitate enrollment into insurance coverage through the Affordable Care Act (ACA). The Centers for Medicare & Medicaid Services (CMS) believe that these services are necessary to improve the preparedness and resources available to in-person assisters as they work with consumers.

Consumers applying for coverage through the Marketplace are able to receive application assistance from in-person assisters. In-person assisters help consumers obtain eligibility determinations and help them through plan selection, thus increasing the number of consumers with health insurance coverage. One of the primary functions of in-person assisters is to facilitate enrollment into healthcare coverage by obtaining a determination for advanced payment of premium tax credit, cost-sharing reductions, Medicaid, CHIP, and the Basic Health Program from the Marketplace. In order to facilitate these processes, in-person assisters require training that provides a basic set of knowledge of health insurance and various forms of coverage as well as an introduction into the mechanics of obtaining Marketplace Eligibility and Enrollment determinations. Additionally, assisters need an array of resources to rely upon to ensure that they are adequately prepared to support consumers as quickly as possible. These resources may include but are not limited to a set of written instructions that document Standard Operating Procedures (SOPs), consumer guides on specific operation areas, as well as in depth trainings on specific eligibility and enrollment policy topics.

Similar to the protections afforded by the ACA, Congress recognized the need for stronger consumer and stakeholder protections related to pricing and billing in health care and passed T itle I (No Surprises Act) and T itle II (Transparency) of Division BB of the Consolidated Appropriations Act, 2021, collectively referred to throughout as the No Surprises Act (NSA). The NSA was signed into law on December 27, 2020, and established new protections for consumers related to price transparency and surprise billing in health care. For example, plans and issuers are required to provide an Advance Explanation of Benefits prior to scheduled services to include, among other things, a good-faith estimate of the cost of the service. They must also offer price comparison information to allow enrollees to compare the cost sharing for items and services furnished by any participating provider. And, it introduces new requirements on providers to ask about the individual�s insurance coverage status and provide a good-faith estimate of the expected charges when an individual schedule an item or service. Additionally, CMS must establish a patient-provider dispute resolution process for uninsured individuals who are billed substantially more than estimated charges.

The NSA also takes significant steps to end surprise billing by building on existing provisions that require group health plans and issuers of group and individual health insurance coverage to cover emergency services without prior authorization, and at the same cost sharing for out-of-network services that applies to in-network services. The legislation also sets forth methodologies for determining the out-of-network rate that plans and issuers must pay providers, including air ambulance providers, for claims subject to surprise billing protections.

If the plan or issuer and provider cannot agree on an amount during a 30-day negotiation period, the parties may choose to enter an independent dispute resolution (IDR) process that GDIT is actively developing a digital build through MATS� existing Salesforce Customer Relations Management (CRM) platform.

system to ingest information from CMS� Marketplace Information Technology Group�s (MITG) ServiceNow (SNOW) call center into the MATS Salesforce CRM in order to create an electronic IDR complaint system of record. To further support this effort, GDIT will also need to work with CSG to design, develop, and implement a No Surprises Help Desk (NSHD) call center functionality to successfully help IDR participants navigate this new complaint system process.

3. Authority:

ORDER AGAINST FSS: Authority of the Multiple Award Schedule Program, T itle III of the Federal Property and Administrative Services Act of 1949 (41 U.S.C. 251, et seq.); T itle 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).

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

GDIT has a demonstrated track record and proven successful past experience as the MATS program contractor. The original task order was a base period plus two (2) option periods and CCIIO requires continuation of existing services to ensure successful completion of current and new program operations, and most importantly the work in progress related to the implementation of the NSA.

CMS recently modified this task order to charge GDIT with establishing a patient-provider dispute resolution process for uninsured individuals who are billed substantially more than estimated charges. Furthermore, if the plan or issuer and provider cannot agree on an amount during a 30-day negotiation period, CMS requires that the parties may choose to enter an independent dispute resolution (IDR) process that GDIT is actively developing a digital build through CMS� existing MATS Salesforce Customer Relations Management (CRM) platform.

As a result of the recent NSA implementation efforts, CMS and GDIT are currently in the middle of designing, developing, and implementing the digital IDR process for consumers and providers. Segments of this digital development will soon go-live in the beginning of calendar year 2022. However, this and other interdependent platform builds will require significant changes over the next 22 months as CMS and the federal tri-departments (HHS, Treasury and Labor) define and refine how these processes and platforms must perform.

In an effort to maximize efficiencies, CMS is leveraging GDIT �s current Salesforce platform development expertise and experience under this task order (GS-00F-313CA/ 75FCMC19F0018) in order to fulfill its Congressionally mandated NSA platform development time frames and needs. Unfortunately, this task order is currently set to expire on April 5, 2022 well before successful implementation is possible. CMS has determined that the current period and current task order will end before GDIT can complete development of the current IDR platform. As such, a 12-month Option Period 3 and 10-month Option Period 4 have been included in this request to align with the estimated completion of this NSA related work.

In addition to the urgent statutorily mandated NSA/IDR platform development schedule, CMS recently tasked

An item peculiar to one manufacturer can be a particular brand name, product, or a feature of a product, peculiar to one manufacturer). A brand name item, whether available on one or more schedule contracts, is an item peculiar to one manufacturer. (FAR 8.405-6(b);

GDIT with building the technical solution for a No Surprises Help Desk (NSHD), including a scalable call center. The help desk must be fully operational in the first quarter of the 2022 calendar year. For this effort, GDIT must collaborate with CMS stakeholders over the next six to eight months to stand up the technical call center solution. Conducting a competition and potentially transitioning this work in the middle of standing up and launching a national call center introduces significant risk to CMS� charge under the NSA. In addition, because the NSA is a novel law, CMS cannot forecast with certainty the number of inquiries and complaints it will receive or how they may fluctuate in the coming months. CMS will need consistent technical support with the ability to expand the call center solution rapidly based on incoming volumes. For these reasons, transitioning the MATS program presents significant risks to CMS�s ability to effectively implement NSA requirements within Congressionally mandated deadlines.

Only one source is capable of providing the supplies or services required at the level or quality required because the supplies or services are unique or highly specialized (FAR 8.405-6(a)(i)(B)); or

In the interest of economy and efficiency, the new work is a logical follow-on to an original Federal Supply Schedule order provided that the original order was placed in accordance with the applicable Federal Supply Schedule ordering procedures. The original order or BPA must not have been previously issued under sole-source or limited sources procedures (FAR 8.405-6(a)(1)(i)(C)); or

Market Research:

The original GSA task order (GS-00F-313CA/75FCMC19F0018) was competed on GSA eBuy amongst all GSA Financial and Business Solutions (FABS) contractors in 2018. 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. Therefore, ordering activities are not required to make a separate determination of fair and reasonable pricing, except for a price evaluation as required by 8.405-2(d). Based on GDIT �s strong track record of performance with this work, CMS believes that GDIT is still capable of completing this work to ensure successful implementation of this important NSA related work. The Contracting Officer will ensure the level of effort, mix of labor proposed, and total price is reasonable for the modification.

Actions to Increase Competition:

At the completion of the new 5-year period of performance, it is anticipated that the NSA work will be successfully implemented such that a competitive procurement can be conducted without risk to CMS� compliance with the statute.

Any other facts supporting the justification:

Not applicable. Please see sections 3, 4, and 5 of this J&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:

GDIT has been performing work under this program since 2016. GSA has already determined pricing to be reasonable, however CMS will evaluate the pricing that is submitted against the current task order and Independent Government Cost Estimate (IGCE) that the program staff produce . The evaluation of the quote against those items will enable CMS to make a fair and reasonable determination of the contractor�s pricing.

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.

Mark Smolenski - OAGM Division Director / Date

Juanita Wilson - OAGM Group Director / Date

2. Contracting Officer Certification: This is to certify that the justification for the proposed acquisition has

3. Head of Contracting Activity (HCA) Approval

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

Derrick Heard - HCA / Date

4. CMS Competition Advocate (CA) Approval

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

N/A � contract action is < $15 million

CA Name / Date

5. OGC Legal Review

N/A � contract action is < $75 million

Name / Date

6. Office of Small and Disadvantaged Business Utilization

N/A � contract action is < $75 million

Name / Date

7. 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 � contract action is < $75 million

Name / Date