MSI JA OY3-OY4 FINAL.pdf

JUSTIFICATION FOR AN EXCEPTION TO FAIR OPPORTUNITY

Acquisition T itle: Consolidated Appropriations Act (CAA) Modification to the Marketplace System Integrator (MSI) Task Order Agency: Centers for Medicare & Medicaid Services (CMS) Acquisition Year: 2023 Author: Christopher Coutin

1. Description of Action:

A. Nature

a. ____ New Requirement

b. ____ Follow-On Order

c. __X__ Modification of Existing Task Order Number HHSM-500-2016-00015I/

75FCMC20F0004 - to add services to the final two option periods (July 2022 – July 2023 and July 2023 - July 2024)

B. Order Against

a. (HHSM-500-2016-00015I) Strategic Partners Acquisition Readiness Contract

(SPARC) Indefinite Delivery Indefinite Quantity (IDIQ) C. Contract Type

a. __X__ Firm-Fixed Price

b. ____ T ime and Materials

c. __X__ Cost Plus Fixed Fee (CPFF)

i. __X__ Term

ii. ____ Completion

d. ____ Cost Plus Award Fee (CPAF)

e. ____ Other: ___________

D. Projected Cost / Price of contract (Base & All Options): $342,976,758.85 ________

E. The total estimated value of the proposed sole source action (for modifications only):

______$13,984,024.00____

F. Funding Source (s): 0007452 - T itles I (No Surprise Act) and II_(Transparency)

G. ____: Basis for Approval (Far 6.303-1(d)

__X__: Individual Basis

____: Class Basis

2. Description of Supplies or Services:

Booz Allen Hamilton (BAH) provides Information Technology (IT ) operational support and supports CMS with oversight of the Exchange systems’ components through monitoring, coordination, collaboration, and communication in coordination with the eXchange Operations Center (XOC), business stakeholders, security, and program operations through the scope of the MSI task order. It also includes integration work for the Marketplace Exchange, which supports healthcare provided by Affordable Care Act (ACA).

CMS awarded the competitive task order to BAH on July 23, 2020.

The Consolidated Appropriations Act (CAA, the Act) of 2021 became Public Law No: 116-260 on December 27, 2020. CAA is a $1.4 trillion omnibus spending agreement that encompasses many different provisions. Two acts within the law apply to CMS’ Center for Consumer Information and Insurance Oversight (CCIIO): Division BB, T itle I, "No Surprises Act"; and T itle II, "T ransparency." These two provisions require work to support healthcare provided to all commercially insured patients that provides much broader coverage and Information Technology (IT ) needs than just healthcare obtained through the health insurance exchanges. The Act contains a large number of disparate requirements for insurance reporting, process attestation, and federal operations which are undergoing regulatory development.

In 2021, CMS lacked sufficient information regarding how MSI would be responsible for integrating the IT supporting the CAA. CMS determined that adding CAA related work to the MSI order was necessary to help CMS meet the implementation dates set in the CAA. Since this was determined as out of scope, CMS executed a Justification and Approval (J&A) on September 3, 2021 approving the addition of the CAA work to Option Period I and II of the order. The J&A stated that CMS would execute a separate, competitive procurement to continue the CAA integration work effective in July 2023.

Previously, CMS stated the CAA has a number of provisions which are going through regulatory development, and the process of discovery has uncovered additional system integration which makes it more difficult to separate the system integration needs of the CAA from the ACA at this time. CMS continues to identify significant overlaps regarding the integration support MSI provides to CAA and Marketplace Exchange, and the CAA ruling is now understood to be an amendment to the ACA provisions that govern CCIIO’s systems. CMS believes these overlaps will persist for the remainder the MSI order. The following examples demonstrate the challenges posed by pulling the CAA work out of the

MSI:

Under the CAA, consumers will call in to CMS to file complaints about particular healthcare provider billing practices. This provision is fairly narrow, and CMS anticipated that we could incorporate those consumer calls into our service desk. This would have allowed us to use a single IT infrastructure. However, discovery led to a realization that we must attempt to address broader complaints and route those complaints to appropriate help desks across different government agencies. This approach requires a more extensive type of long-term integration; and

CMS now understands there are many interdependencies and mutual effects between the CAA and ACA and Marketplace work. One provision of the CAA requires reporting of prescription drug pricing information. The law describes this collection as happening from “plans” which are largely outside of the ACA requirements. However, it was determined that a less burdensome way to accomplish the collection would be at the level of the insurance companies who are covered by, and tracked under, the ACA. Additionally, certain elements of CAA required data that could be obtained from Pharmacy Benefit Managers who are covered under the ACA. These overlaps require integrated data and reporting structures.

In the aforementioned J&A, CMS stated it would recompete CAA work by the end of Option Period II (July 2022) of the current order. The Contracting Officer has decided against recompeting CAA work for the following reasons:

1. Previously, CMS had limited details concerning CAA work and its integration within CCIIO programs, and made the decision to recompete CAA work after Option Period II of the MSI order. CMS has implemented CAA work using existing Marketplace systems. The CAA integration work involves integrating CAA system changes among the Marketplace IT systems;

2. Having a second systems integration contractor tasked with only CAA work will result in duplicative work and will create greater inefficiencies within the CCIIO Marketplace. Other CCIIO contractors supporting the CCIIO Marketplace will also directly incur additional costs through incorporating this new contractor into their workflows; and

3. The government and its stakeholders will have a greater probability of service disruptions if the MSI Contractor role is bifurcated into two separate contracts designated as CAA-only and Non-CAA Systems Integrator.

CMS desires to roll the CAA work into the overall Marketplace services integration for the remainder of the task order (Option Periods III and IV which run from July 2023 - July 2024 and July 2024 – July 2025 respectively). The work will continue to cover insurance oversight, Marketplace operations, and private insurance operations utilizing CCIIO-provisioned systems across the private insurance markets.

3. Authority and Rationale:

The Contracting Officer shall give every awardee a fair opportunity to be considered for a delivery/task order exceeding $3,500 unless one of the following statutory exceptions applies. FAR 16.505(b)(2). Mark the applicable exception:

___ The agency need for the supplies or services is so urgent that providing a fair opportunity would result in unacceptable delays [FAR 16.505(b)(2)(i)(A)];

X__Only one awardee is capable of providing the supplies or services required at the level of quality required because the supplies or services are unique or highly specialized [FAR 16.505(b)(2)(i)(B)];

The Act contains a large number of disparate requirements for insurance reporting, process attestation, and federal operations. By Tri-Agency agreement, CMS is undertaking virtually the entire IT build associated with these efforts, which will affect not only marketplace and non-marketplace private insurers, but will also require outreach and engagement with the population of the Employee Retirement Income Security Act of 1974 (ERISA) and self-insured plans which is estimated to number above 1.5 million firms.

Since the CAA integration work involves integrating CAA system changes among the Marketplace IT systems, CMS has determined it is not feasible or effective to separate CAA systems integration work from the ACA and repackage it under a separate procurement. BAH is currently serving in this role and has all necessary personnel, knowledge, and skills to operate as the System Integrator for this work. Separating this work from the MSI contract would create a duplicative contract, and additional program burden. A new contractor would not benefit the Government and would significantly increase the operational risk in meeting the legislative timeline set forth. Furthermore, the amount of time and effort necessary to bring a contractor up to BAH’s operational effectiveness will not meet the Government’s current need.

____ The order must be issued on a sole-source basis in the interest of economy and efficiency because it is a logical follow-on to an order already issued under the contract, provided that all awardees were given a fair opportunity to be considered for the original order [FAR 16.505(b)(2)(i)(C)]; or

___ It is necessary to place the order to satisfy a minimum guarantee [FAR 16.505(b)(2)(i)(D)].

____ A statute expressly authorizes or requires that the purchase be made from a specified source. [FAR 16.505(b)(2)(i)(E)].

4. Provide a statement of the actions, if any, the agency may take to remove or overcome any barriers that led to the exception to fair opportunity before any subsequent acquisition for the supplies or services is made:

When CMS executed the J&A last year to add the CAA work to the MSI, CMS believed the CAA integration work would involve integrating newly developed CAA IT systems. CMS believed that once its emergent CAA related integration tasks were completed, that it would then competitively procure its CAA integration needs. CMS has leveraged its Marketplace IT systems to serve CAA requirements. For the reasons discussed above, CMS believes it is reasonable to continue to obtain its CAA integration needs through the MSI order through its completion. CMS plans to competitively procure its future systems integration requirements during the last option period of the BAH order. As part of this upcoming procurement, CMS will perform market research and outreach to ensure that there are no unreasonable barriers to competition.

5. State any other facts supporting the justification:

None.

Approvals:

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 for Exceptions to Fair Opportunity, which form the basis for this 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 Justification represents the best value for the Government as set forth in FAR 16.505(b)(2)(ii)(B)(5), and constitutes a fair and reasonable price. The basis for my determination is as follows:

I will perform a cost analysis evaluation of the separate cost elements and profit to determine a fair and reasonable price for the effort.

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

Additional OAGM Approvals:

I hereby confirm the circumstances described above apply and approve the justification for Exceptions to Fair Opportunity.

OAGM Division Director / Date

OAGM Group Director / Date

Head of Contracting Activity (HCA) Approval I hereby confirm that the circumstances described above apply and approve this Justification for Exception(s) to Fair Opportunity.

HCA Name / Date

Competition Advocate Approval I hereby confirm that the circumstances described above apply and approve this Justification for Exception(s) to Fair Opportunity.

______N/A_____________________________________________ Name / Date

OGC Legal Review

_____N/A______________________________________________ Name / Date

Office of Small and Disadvantaged Business Utilization

______N/A_____________________________________________ Name / Date

Senior Procurement Executive (SPE) Approval I hereby confirm the circumstances described above apply and approve the Justification for Exceptions to Fair Opportunity.

______N/A___________________________________________ SPE Name / Date

For: