SSJ VISN 1 Home Oxygen Interim 11-4-21 Approved.pdf

DEPARTMENT OF VETERANS AFFAIRS

Justification and Approval (J&A)

For Other Than Full and Open Competition (>SAT)

Acquisition Plan Action ID: 36C241-22-AP-0327

1. Contracting Activity: Department of Veterans Affairs, VISN 1, All Medical Centers

The U.S. Department of Veterans Affairs, Network Contracting Office NCO 1 proposes the following justification for an interim contract for the rental of home oxygen medical equipment and the provision of respiratory services on a basis of other than full and open competition for the VISN 1 Prosthetics Service Line. The proposed interim contract will have a six-month period of performance (7 Dec 2021 – 6 June 2022) with one six-month option. The total dollar value of the proposed interim contract is $9,950,000.00 if the option is exercised.

There were some unanticipated impacts to the milestone for the long-term solution which included the consolidation of the VISN 1 Durable Medical Equipment (DME) services requirement with Home Oxygen/Respiratory Services. Additionally, recent regulation changes require separating funding sources and contract line items for home oxygen supplies and respiratory therapy services. This will require additional time to analyze and implement in the solicitation and resultant contract. To ensure continued coverage for current and anticipated patients, an interim contract is required.

2. Nature and/or Description of the Action Being Processed:

The nature of the requirement is the ability to award an interim contract for the rental of home oxygen medical equipment and the provision of respiratory services based upon the current VISN 1 Home Oxygen Interim Contract (36C24121D0004, 7 Dec 2020 – 6 Dec 2021) that sets a specific rental price for the oxygen delivery systems, the provision of respiratory services and ancillary supplies in the VA New England Healthcare System.

This proposed interim contract is for a period of six months with 1 option to extend for six additional months, while the long-term solution (5 Year Indefinite Delivery Indefinite Quantity (IDIQ) contract) is solicited, evaluated, and awarded. This will also allow for the transitional period if necessary. A new contract will require up to 180 days to transition all patients into their database, deliver & setup oxygen medical equipment and accomplish required inventories. The transition period will require the incumbent contractor to work with the contractor awarded the long-term solution should they be different. Since this requirement is direct patient care, ongoing services are required.

This proposed interim contract will allow for continued services and avoid interruption of services to our Veteran patients.

3. Description of Supplies/Services Required to Meet the Agency’s Needs:

The Department of Veterans Affairs (VA) has an ongoing program for the rental of oxygen medical equipment, the provision of respiratory services and ancillary supplies for 3,932 oxygen patients and 27,526 CPAP/BiPAP/ASV/APAP patients. The contract vendor will furnish home oxygen and respiratory equipment, ancillary supplies, ventilator set-up and follow-up services, conduct in-home pulmonary assessments and re-assessments by respiratory therapists, set-up/provision of travel oxygen equipment, set-up/complete/report overnight oximetries and provide documentation of patient education.

The contract will provide for the following goods and services:

1) Rental of Oxygen Equipment.

2) Initial starts of oxygen by trained staff/patient service technicians and/or respiratory therapists.

3) Recurring oxygen patient visits/pulmonary assessments by respiratory therapists.

4) Recurring oxygen patient visits by patient service technicians for maintenance of the equipment.

5) Initial starts of ventilators and cough assists by respiratory therapists.

6) Recurring ventilator and cough assist patient visits/pulmonary assessments by respiratory therapists.

7) Provision of patient education.

8) Set-up and provision of travel oxygen equipment.

9) Set-up and pickup of overnight oximetry equipment, and report overnight oximetry results

10) Initial starts of CPAP/BiPAP/ASV/APAP by trained respiratory therapists

11) Recurring CPAP/BiPAP/ASV/APAP patient visits/assessments by respiratory therapists

12) Maintenance/Secure Storage of VA-purchased CPAP/BiPAP/ASV/APAP equipment.

13) Ancillary Supplies (Humidifiers, masks, tubing, etc.) as prescribed.

As stated above, this requirement is direct patient care and ongoing services are required. This proposed interim contract will allow for continued services. Interruption of services is not an option.

The incumbent contractor (Community Surgical Supply of Toms River, Inc.) has been providing the services required under the current contract for the past year; there is no transitional period required.

The current contract expires on 6 Dec 2021. This acquisition is expected to result in a firm fixed Price Indefinite Delivery/Indefinite Quantity interim contract from 7 Dec 2021 through 6 June 2022 with 1

– six-month option to extend. The realistic estimated dollar value is $829,166.66 per month, for a total estimate of $9,950,000.00 for the entire life of the interim contract.

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

(X) (1) Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements per 41 USC §3304(a)(1) as implemented by FAR 6.302-1.

5. Demonstration that the Contractor’s Unique Qualifications or Nature of the Acquisition Requires the Use of the Authority Cited Above (applicability of authority):

This contract is being procured on a sole source basis because the long-term solution (Five Year Indefinite Delivery/Indefinite Quantity (IDIQ) contract) has yet to be awarded. The services required are direct patient care services which cannot be interrupted.

Awarding to a contractor other than the incumbent would require the contractor to acquire a significant amount of warehouse space, spare oxygen tanks, vehicles to transport the oxygen tanks, and support staff to deliver and administer care. The ongoing COVID-19 pandemic has caused severe shortages in oxygen tanks as well as raw materials required to manufacture vehicles. The pandemic has also caused labor shortages in the transportation and respiratory therapy sectors of the workforce. A contractor other than the incumbent will face serious challenges procuring the necessary goods and services required to deliver care under this contract in a timely manner or at a fair and reasonable price.

The cost to the government/VISN 1 Prosthetics and Sensory Aids would be prohibitive without a contract – the contract Statement of Work (SOW) requires the vendor to provide/repair/store/set-up patient-ready oxygen equipment in emergent and non-emergent situations, as well as document that the patient/family understands the proper operation of the item(s) according to set time requirements.

If there was no contract, the VA cannot provide continuity of care through single orders. The government would be required to solicit for vendors who can provide the required services, forcing the government to pay extra for this immediate service and delaying patient care. The government would also not have a place to store the CPAP/BiPAP/ASV/APAP equipment for patients in the community, some of which require significant space. The government would be forced to pay another vendor to store the equipment in the community while the vendor with the knowledge of the equipment would pick it up and install. The contract SOW states the vendor is not paid for the storage of the CPAP/BiPAP/ASV/APAP (and some VA-owned ventilators) equipment and has a set charge for the set-up and assessment of the respiratory patients.

Patient care will be adversely impacted without a contract – inpatient discharges will be delayed without a vendor able to deliver and set-up the required home respiratory equipment for the patient to safely reside in the home without inpatient services. The CPAP/BiPAP/ASV/APAP (and some VA-owned ventilators and cough assists) equipment is purchased by the Government. The items require delivery, installation, storage, and routine service/refurbishment to veteran patients served by its eight medical centers and its associated outpatient clinics. The total number of patients at each VA site is subject to change but VISN-wide is over 3,900 oxygen patients and 27,000 CPAP/ BiPAP/ASV/APAP patients.

Accordingly, Community Surgical Supply of Toms River, Inc. is the only firm capable of providing the supplies and services described in item 3 above without the Department of Veterans Affairs experiencing substantial duplication of cost that could not be expected to be recovered through competition and unacceptable delays in fulfilling its requirements.

The period to be covered by this contract will be 7 Dec 2021 through 6 June 2022 with one – six-month option to extend. The Department of Veterans Affairs reserves the unilateral right to exercise option, subject to availability of funds.

6. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable:

Competition is available; however, the risk is too great to Veteran patients. It is only practicable to solicit from the incumbent contractor for the purposes of the interim contract. This is because it would take another contractor several months to acquire the needed warehouse space, spare oxygen tanks, vehicles, and other consumables required to successfully perform on the contract.

Supply chain issues and labor shortages caused by the COVID-19 pandemic will further exacerbate this problem. Awarding to another contractor will delay the delivery of Home Oxygen services to thousands of Veterans in VISN 1.

The incumbent contractor currently has the required warehouse space, oxygen equipment, vehicles, and support staff (respiratory staff, patient service technicians and administrative staff) to successfully perform on this contract. Additionally, the incumbent has been performing satisfactorily on the current interim contract and understands how to effectively deliver Home Oxygen and other Respiratory Care services to a very large catchment area.

7. Determination by the CO that the Anticipated Cost to the Government will be Fair and Reasonable:

The Contracting Officer determines the pricing will be fair and reasonable based upon a comparison of the prices to the Independent Government Estimate and historical pricing for the same or similar service. The incumbent contractor has not increased the cost of services provided and has continuously offered and applied the 5% discount per month for timely payments which has saved the Government a significant amount of money.

8. Description of the Market Research Conducted and the Results, or a Statement of the Reasons Market Research Was Not Conducted:

Related market research was conducted using VIP, SAM, SBA, GSA, and other searches based on NAICS code 532283. Community Surgical Supply is an actively registered vendor in SAM through 9 June 2022. The required services are not available under mandatory or other awarded contracts.

9. Any Other Facts Supporting the Use of Other than Full and Open Competition:

The incumbent currently has the warehouse space throughout the VISN to store the Government supplied CPAPs, ventilators, cough assists, and supplies in addition to their own equipment and supplies required to perform the contract. The incumbent has sufficient inventory of concentrators and cylinders and has the ability to fill them timely. Due to the current pandemic this equipment has been increasingly difficult to obtain. Additionally, all employees have access to Patient Information and must complete mandatory training Privacy and Information Security Training via the Government’s training site, TMS, prior to performing work. All Community Surgical Supply employees have completed this training.

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

Community Surgical Supply of Toms River, Inc., the incumbent, did reply positively regarding their interest in the contract. They are a Large Business under the applicable NAICS 532283.

11. A Statement of the Actions, if any, the Agency May Take to Remove or Overcome any Barriers to

Competition before Making subsequent acquisitions for the supplies or services required:

The government is anticipating a 6-month contract (with the potential for one (1) six-month option) with the incumbent so that the 5-year IDIQ contract can be competed in accordance with the Federal Acquisition Regulations. The 6-month option will only be exercised in the event of a protest or additional time necessary to transition to a new contractor as necessary.

12. Requirements Certification: I certify that the requirement outlined in this justification is a Bona Fide Need of the Department of Veterans Affairs and that the supporting data under my cognizance, which are included in the justification, are accurate and complete to the best of my knowledge and belief.

Name: Alexander Dowgiallo, MA Date Title: COR, VISN 1 Prosthetics Health System Specialist Facility: VISN 1 – VA New England HCS

November 4, 2021

13. Approvals in accordance with the VHAPM Part 806.3 OFOC SOP:

a. Contracting Officer or Designee’s Certification (required): I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief.

James Paulette Date Contracting Officer Network Contracting Office 1

b. One Level Above the Contracting Officer (Required over SAT but not exceeding $750K): I certify the justification meets requirements for other than full and open competition.

Tammy Fox Date Division Chief

Network Contracting Office 1

c. VHA RPO HCA Review and Approval: I have reviewed the foregoing justification and find it to be complete and accurate to the best of my knowledge and belief and recommend approval (if over $75 million) or approve ($750K to $75 million) for other than full and open competition.

Joseph Maletta Date Executive Director RPO East Head of Contracting Activity https://dvagov.sharepoint.com/sites/VHAProcurement/VHAPM/VHAPM_Part_806.3.aspx