WTCHP Health Program Support Bridge Contract Extension   2

The Centers for Disease Control and Prevention intends to award a Cost Plus Fixed Fee modification to KARNA LLC, contract # 75D30122C12989.

The WTC Health Program serves a population of more than 110,000 responders and certified eligible survivors from the attacks on
9/11/2001 in New York City, the Pentagon and Shanksville, PA. The Health Program Services (HPS) contract sits at the center of a
portfolio of contracts responsible for providing annual medical monitoring exams, medical treatment, and pharmacy benefits,
coordinating benefits for other health insurances for survivors, recouping funds owed to the government by workers comp and
health insurers, and evaluations of the program to determine its efficiency and effectiveness. As the HPS contractor, Karna maintains all member demographic/eligibility data files in a data warehouse where the claims adjudication/authorization system also sits, that processes nearly $400 million in medical and pharmacy claims annually.
Karna operates the provider enrollment system, which assures the appropriate licensing and credentialing of the New York
Metropolitan Area (NYMA) provider network serving the nearly 80,000 members assigned to the Clinical Centers of Excellence. They operate the call center for members and providers, as well as the mail/fax center that receives enrollment applications and sends out letters on behalf of the program. Lastly, Karna provides the analytics function, conducting or providing data to those who do QA/QC, Fraud/Waste/Abuse analysis, utilization management and trends analysis.
This modification is required to prevent a lapse in healthcare support and services for the World Trade Center Health Program. This
need comes in response to a contract protest of the Third-Party Administrator (TPA) contract 75D301-22-C-12975 awarded on
05/31/2022. The TPA contract was meant to replace the contract services currently being provided through this bridge contract
75D301-22C-12989 due to expiration of the previous contract.
This modification will encompass time to complete litigation and ensure for a sufficient transition period to the new contractor,
whether by commencing services under the awarded contract or after re-solicitation and award of a new contract.
A lapse in services will cause harm to members of the World Trade Center Health Program. Specifically, if HPS services are paused, the following would occur (approximate volume of impact is based on December 2022 data):
1. Members (3,500/month) and providers (1,100/month) would not be able to get in touch with the Program to escalate their health
concerns. If providers/members are not able to escalate their concerns with Program, members will not receive proper care if they
have enrollment issues, have a bill, if they are getting sick etc. Although some Program staff have direct phone and fax lines, there
are no central, switchboard-type numbers to allow for access.
2. Enrollment applications sent to the Program would not be processed (500/month), and members deemed to be eligible for the
Program (475/month) would not have their monitoring and screening benefits turned on. This would mean that members' ability to
receive monitoring and screening through the Program would be delayed. Because Survivor applicants (~70% of all applicants)
require symptoms to become eligible for the Program, this delay would result in sick people not receiving the healthcare benefits
that they need and are entitled to have through the Zadroga Act.
3. Certification requests would not be processed (2000/month), so members deemed to have WTC-related health conditions (1700/
month) would not have their treatment benefits activated. This would mean members with health conditions related to their 9/11
exposure would not be able to receive the treatment benefits that they need and are entitled to have through the Zadroga Act.
4. Medical claims submitted to the Program would not be able to be adjudicated nor paid (~55,000/month). This would mean that
providers would not be paid timely, which not only results in non-compliance with the Prompt Payment Act but could result in
provider attrition (meaning fewer services provided to members) or members receiving inappropriate bills if providers charge
members instead.
5. The Program only provides medically necessary care for WTC-related conditions; this means that any break in services could result in members not being able to receive medically necessary healthcare.
To prevent the above harms, which could result with a lapse in services, Karna will continue providing limited health care delivery
services to ensure WTC Health Program members have access to quality, cost-effective care in a manner consistent with the
requirements of the Zadroga Act, the Prompt Payment Act, FICA and HIPPA laws and regulations. This Health Program Services
(HPS) contract continues all the HPS services currently being provided to the Program and includes enhanced services to provide
the highest quality of third-party administrator functions. These critical program functions and services include a large New York
metropolitan area network of dedicated providers for monitoring exams and treatment, member services and claims adjudication
and payment services. In supporting the Program, the HPS contractor works closely with CDC/NIOSH, the WTC Health Program
administering agency, and its contractors, including the Clinical Centers of Excellence (CCEs); the Data Centers (DCs); the Pharmacy Benefits Manager (PBM); the Nationwide Provider Network (NPN); the Pharmacy Benefit Manager (PBM; the Health Program Evaluation contractor (HPE); the Comprehensive Cost Avoidance, Coordination of Benefits and Recovery (CCA) contractor; and other federal and non-federal stakeholders as directed.
The periods of performance are:
Option Period 2 (6/1/2023 11/30/2023)
Option Period 3 (12/1/2023 5/31/2024)
Option Period 4 (6/1/2024 11/30/2024)
Separately Priced Line Item Transition Services (12 Months)
Karna will be responsible for continuing the essential services during the contract period starting June 01, 2023, and as needed during litigation and/or re-solicitation, not to exceed the option periods of performance indicated above. Once transition can begin, a separately priced line item, Transition services (non severable) will be exercised and run for 12 months until transition is completed. Karna will provide services to ensure there is no lapse in services during this extension and transition period.

This contract action is for supplies or services for which the Government intends to solicit and negotiate with only one source under the authority of FAR 6.302-1 and 41 U.S.C.3304(a)(1). Interested persons may identify their interest and capability to respond to the requirement or submit proposals.

This notice of intent is not a request for competitive proposals; however, all proposals/responses received within fifteen (15) days of the issuance of this notice will be considered by the government. A determination by the government not to compete this proposed contract modification based upon responses to this notice is solely within the discretion of the Government. Information received will normally be considered solely for the purpose of determining whether to conduct a competitive procurement. Any proposal/response shall be emailed to Contract Specialist at vgj6@cdc.gov by 5:00 PM EST on 04/15/2023.

AMENDMENT 1: The purpose of this amendment is to change the period of performances per below.

The anticipated periods of performance if all Options are exercised are:

Option Period 2 06/01/2023 05/31/2024 (twelve (12) months)

Option Period 3 06/01/2024 05/31/2025 (twelve (12) months)

Option Period 4 06/01/2025 11/30/2025 (six (6) months)

Separately Priced Line Item Transition Services (12 Months)

This contract action is for supplies or services for which the Government intends to solicit and negotiate with only one source under the authority of FAR 6.302-1 and 41 U.S.C.3304(a)(1). Interested persons may identify their interest and capability to respond to the requirement or submit proposals.

This notice of intent is not a request for competitive proposals; however, all proposals/responses received by 05/10/2023 of the issuance of this notice will be considered by the government. A determination by the government not to compete this proposed contract modification based upon responses to this notice is solely within the discretion of the Government. Information received will normally be considered solely for the purpose of determining whether to conduct a competitive procurement. Any proposal/response shall be emailed to Contract Specialist at vgj6@cdc.gov by 5:00 PM EST on 05/10/2023.