P03 JA-Rehabilitation Program Accreditation Services 01.21.21.pdf

DEPARTMENT OF VETERANS AFFAIRS

Justification and Approval

For Other Than Full and Open Competition

1. Contracting Activity:

Department of Veterans Affairs, Office of Acquisition Operations, Strategic Acquisition Center, 10300 Spotsylvania Avenue, Suite 400, Fredericksburg, VA 22408.

2. Description of the Action being Approved:

The Strategic Acquisition Center, on behalf of Veterans Health Administration (VHA) requests approval of a sole source procurement of Rehabilitation Program Accreditation Services. This effort is proposed to be awarded to the Commission on Accreditation of Rehabilitation Facilities (CARF or “the Contractor”), 6951 E Southpoint Rd., Tucson, AZ 85756. This requirement is proposed as a single-award Firm-Fixed-Price, indefinite delivery, indefinitely delivery (IDIQ) National Requirements Contract for one (1) base year and four (4) one (1)-year option periods.

3. Description of Supplies or Services:

VHA is committed to providing specialized treatment and quality rehabilitation care to Veterans with disabilities, including but not limited to Veterans with spinal cord injury, blindness, traumatic brain injury, amputation, serious mental illnesses, and those who are homeless or needing vocational rehabilitation, community support services, and/or psychosocial rehabilitation and recovery services. This commitment drives the desire to achieve accreditation to ensure VHA Rehabilitation Programs meet the unique needs of these populations. The accreditation process is a complex system of related and interdependent activities, which enable VHA Rehabilitation Programs to maintain ongoing compliance with regulatory standards that demonstrate the delivery of safe, high quality rehabilitative care.

The Contractor provides all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform Accreditation of VHA Rehabilitation Programs, as defined in the Performance Work Statement.

The objective of this contract is to supply accreditation services for VHA Rehabilitation Programs (medical rehabilitation, behavioral health services, employment and community service programs, and vision rehabilitation services). Achieving and maintaining Rehabilitation Program accreditation is consistent with one of VHA strategies to “continuously improve the quality and safety of health care for Veterans” and recognition that VHA Rehabilitation Programs meet recognized standards of quality and safety.

The services under this contract include the surveying and evaluation of rehabilitation components identif ied within the VHA health care system. The Contractor must provide an independent, peer review system of accreditation that is widely recognized by federal agencies, state governments, major insurers, and leading professional rehabilitation groups, as well as by consumer and advocacy organizations. The accreditation standards used by the Contractor must be consumer-focused, field-driven standards for rehabilitation developed in the areas of medical rehabilitation, behavioral health, and employment and community services, and vision rehabilitation services. Surveyors used by the Contractor must be experts in the field of rehabilitation and must be fully engaged in the delivery or administration of rehabilitation services. Surveys provided by the Contractor must be in-depth and provided at the level of the individual program with a focus on the Veteran receiving rehabilitation care. Rehabilitation accreditation standards should be able to be used in program development and quality improvement and enhance the use of outcomes management to affirm the efficient delivery of rehabilitation services.

This requirement covers accreditation for VHA Rehabilitation Programs. Programs that fall under this requirement include accreditation of medical rehabilitation, behavioral health services, employment and community service programs, and vision rehabilitation services. The estimated ceiling for this contract action is $15,375,335.30.

4. Statutory Authority Permitting Other than Full and Open Competition:

The statutory authority permitting other than full and open competition is 41 USC §3304(a)(1), as implemented by FAR 6.302-1 entitled, “Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements.”

(X) (1) Only One Responsible Source and No Other Supplies or Services Will Satisfy

Agency Requirements per FAR 6.302-1;

( ) (2) Unusual and Compelling Urgency per FAR 6.302-2;

( ) (3) Industrial Mobilization, Engineering, Developmental or Research Capability or Expert Services per FAR 6.302-3;

( ) (4) International Agreement per FAR 6.302-4 ( ) (5) Authorized or Required by Statute FAR 6.302-5;

( ) (6) National Security per FAR 6.302-6;

( ) (7) Public Interest per FAR 6.302-7;

5. Demonstration Rational Supporting Use of Authority Cited Above:

Per VHA Directive 1170.01, it is VHA policy that health care facilities providing rehabilitation care to our nation’s Veterans maintain ongoing compliance with regulatory standards that demonstrate the provision of safe, high-quality rehabilitative care.

To fulf ill the services outlined in the contact, the Rehabilitation Program Accreditation Services vendor is required to:

1. Provide accreditation services for applicable rehabilitative programs at individual VHA facilities, including approximately 583 Behavioral Health Programs, 642 Employment and Community Services/Vision Rehabilitation Programs, and 208 Medical Rehabilitation programs.

2. Provide accreditation for the following programs: medical rehabilitation, behavioral health services, employment and community service programs, and vision rehabilitation services.

The nature of this acquisition requires a single vendor to provide rehabilitation program accreditation services. A sole-source acquisition ensures standardization/consistency of rehabilitation program accreditation requirements, the survey process, and accreditation follow-up across the VA enterprise and within individual facilities. CARF is uniquely qualif ied to provide accreditation services for all VHA programs requiring accreditation.

After extensive market research (as described in Section 8), it was found that CARF is the only known entity that can meet VHA’s requirements to accredit the full scope of services provided by VHA Rehabilitation programs. During our Market research, other vendors in the marketplace were identif ied to provide accreditation services as detailed in the market research section, however, they did not provide services to meet all criteria required in the contract listed above. Specifically, alternative vendors did not provide accreditation services of all programs required to evaluate rehabilitation programs throughout the VHA enterprise (medical rehabilitation, behavioral health services, employment and community service programs, and vision rehabilitation services). CARF is the only known vendor that provides accreditation services for Rehabilitation Programs as required in this contact.

This requirement was previously awarded under contract #36C10G18C0053 Firm-Fixed- Price (FFP) requirement using full and open competition to the Commission on Accreditation of Rehabilitation Facilities (CARF) from February 1, 2018 to January 31, 2021. CARF was the only vendor to respond to the Request for Proposals (RFP).

Additionally, program office research and RFI results confirmed the market remains unchanged.

6. Efforts to Obtain Competition

Market research was conducted as described in Section 8 of this document. During market research conducted by the Program Office, other vendors in the marketplace were identif ied as providing accreditation services, however review of vendor websites identif ied these vendors did not provide the full scope of service to meet all criteria of this contract. Specifically, alternative vendors do not provide accreditation services of all programs required to evaluate rehabilitation programs throughout the VHA enterprise (medical rehabilitation, behavioral health services, employment and community service programs, and vision rehabilitation services).

A search of the GSA e-Library using “Rehabilitation Accreditation” keyword search revealed only one result (CARF).

A search of VIP.VETBIZ.VA.GOV revealed zero (0) Service-Disabled Veteran Owned Small Businesses (SDVOSBs) or Veteran Owned Small Businesses (VOSBs) under the NAICS 813920 with the Keyword Search of “Rehabilitation Accreditation”.

A market research/acquisition package document check was performed in order to follow Kingdomware Technologies, Inc. v. United States Supreme Court ruling. As a result of check (NAICS 813920) , 109 SDVOSBs or VOSBs were identif ied, however, none provided rehabilitation program accreditation services per individual website reviews.

On October 9, 2020 a Request for Information (RFI) for Rehabilitation Program Accreditation Services for the Department of Veterans Affairs was publicized on beta.SAM.gov to gauge market availability of capable and responsible vendors that can successfully satisfy this requirement. CARF was the only vendor that responded by the October 23, 2020 RFI deadline. A Special Notice of Intent to Sole Source was issued on January 12, 2021. We do not anticipate anyone other than CARF to respond. Based upon market research conducted, this requirement is Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements.

7. Fair and Reasonable Determination:

In accordance with FAR 15.404-1(b) (2) (v), the Contracting Officer is responsible for using whatever price analysis techniques that will ensure a fair and reasonable price. The Contracting Officer utilized the previous contract and added inflation (3%) to establish an acceptable range for price determination. Additionally, historical pricing and the Independent Government Cost Estimate (IGCE) was reviewed and these will be utilized to determine a fair and reasonable price.

8. Market Research:

Market Research was conducted July 16, 2020 to October 23, 2020 by the Program Office. Market research included internet searches to identify appropriate rehabilitation accreditation services available in the marketplace. Other vendors in the marketplace were identif ied as providing accreditation services. However, website review revealed alternate vendors did not provide the full scope of service to meet all criteria of this contract. Specifically, alternative vendors do not provide accreditation services of all programs required to evaluate rehabilitation programs throughout the VHA enterprise (medical rehabilitation, behavioral health services, employment and community service programs, and vision rehabilitation services).

Other Accreditation Vendors Reviewed:

1. American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)

2. Accreditation Association for Ambulatory Health Care (AAAHC)

3. Accreditation Commission for Health Care (ACHC)

4. American Board for Certif ication in Orthotics, Prosthetics & Pedorthics (ABC)

5. Board of Certif ication/Accreditation, International (BOC)

6. Center for Improvement in Healthcare Quality (CIHQ)

7. Community Health Accreditation Program

8. The Compliance Team, "Exemplary Provider Programs"

9. DNV GL Healthcare

10. The Intersocietal Accreditation Commission (IAC)

11. Healthcare Facilities Accreditation Program (HFAP)

12. Healthcare Quality Association on Accreditation (HQAA)

13. Institute for Medical Quality (IMQ)

14. The Joint Commission (TJC)

15. National Committee for Quality Assurance (NCQA)

16. Utilization Review Accreditation Commission (URAC)

17. Council on Accreditation (COA)

A search of the GSA e-Library using “Rehabilitation Accreditation” keyword search revealed only one result (CARF).

A search of VIP.VETBIZ.VA.GOV revealed zero (0) Service-Disabled Veteran Owned Small Businesses (SDVOSBs) or Veteran Owned Small Businesses (VOSBs) under the NAICS 813920 with the Keyword Search of “Rehabilitation Accreditation”. An additional market research/acquisition package document check was performed under NAICS of 813920 with no “key words” limitation in order to comply with the requirements of 38 USC 8127. As a result of check, 109 SDVOSBs and VOSBs were identif ied, however, none provided rehabilitation program accreditation services per individual website reviews.

In conclusion, the market analysis revealed there are no SDVOSBs or VOSBs capable of performing the rehabilitation accreditation services required. The Commission on the Accreditation of Rehabilitation Facilities (CARF) is the only known entity that can meet VHA’s requirements to accredit VHA Rehabilitation Programs. Although other vendors perform healthcare accreditation services, they do not provide all services required to evaluate rehabilitation programs throughout the VHA enterprise (medical rehabilitation, behavioral health services, employment and community service programs, and vision rehabilitation services).

9. Other Facts:

The complexity in transition with awarding to another accreditation vendor is related to implementing new vendor-specific accreditation standards and requirements as well as accreditation processes. Current accreditation standards and requirements applied within VHA, ensuring the highest standard of care is being delivered, are proprietary of CARF.

Contract award to an alternative vendor will result in the immediate loss of all CARF accreditation accessories and support, resulting in lack of needed resources to maintain previous practice standards and quality patient care.

The transition will result in a lapse in accreditation status, as currently CARF accreditation would expire at the end of each organization’s survey cycle. The anticipated lapse in accreditation status as well as the transition needed to alter VHA practice, including changes in organizational policy to prescribe VHA expectation to accommodate new accreditation standards, presents a vulnerability for enterprise-wide decreased quality of care, treatment, and services, directly impacting patient outcomes and organizational performance.

10. Listing of Sources that Expressed, in Writing, an Interest in the Acquisition:

On October 9, 2020 a Request for Information (RFI) for Rehabilitation Program Accreditation Services for the Department of Veterans Affairs was publicized on beta.SAM.gov to gauge market availability of capable and responsible vendors that can successfully satisfy this requirement. CARF was the only vendor that responded by the October 23, 2020 RFI deadline.

11. Actions to Overcome Barriers to Competition:

CARF has accredited VHA rehabilitation programs for many years, consistently meeting all VHA required elements for rehabilitation programs accreditation. At present, no market changes have occurred to result in competition that meets all elements required by VHA.

As CARF accreditation confers VHA’s rehabilitation programs provide care that meets national safety and quality standards, we will maintain our present strategy of continual/frequent monitoring for new competition within the marketplace, and monitor changes in policy and/or regulatory guidelines for any changes that will allow for an alternative in obtaining and maintaining rehabilitation program accreditation.

12. Certification:

Technical and Requirements Certif ication: In accordance with FAR Subpart 6.303-1(c) and 6.303-2(c), I certify that the requirement outlined in this justif ication is a Bona Fide Need of the Department of Veterans Affairs and that the necessary supporting data under my cognizance, which are included in the justif ication and support my recommendation for other than full and open competition, are accurate and complete to the best of my knowledge and belief.

Kate Gagliardi Date Director, External Accreditation Services and Programs Office of Quality, Safety, and Value (VACO)

Procuring Contracting Officer Certif ication: In accordance with FAR Subpart 6.303-2(b) (12), I hereby certify that this justif ication is accurate and complete to the best of my knowledge and belief.

TWILLIE L. CURRY III Date Contracting Officer, Acquisition Services Division 4A Office of Procurement Acquisitions and Logistics (OPAL) Strategic Acquisition Center (SAC) U.S. Department of Veterans Affairs

TWILLIE L CURRY 698373

Digitally signed by TWILLIE L CURRY 698373 Date: 2021.01.21 12:26:53 -05'00'

Kate Gagliardi 151190 Digitally signed by Kate Gagliardi 151190 Date: 2021.01.21 12:57:31 -05'00'