Staff Augmentation Services

State of Maine Procurement Justification Form PJF Page 1 of 2 Rev. 3/3/2020 This form must accompany all contract requests and sole source requisitions (RQS) over $5,000 submitted to the Division of Procurement Services. INSTRUCTIONS: Please provide the requested information in the white spaces below. All responses (except signatures) must be typed; no hand-written forms will be accepted. See the guidance document posted with this form on the Division of Procurement Services website (Forms page) for additional instructions. PART I: OVERVIEW Department Office/Division/Program: DHHS Office of MaineCare Services Department Contract Administrator or Grant Coordinator: Shawn Belanger Arlene Jones (If applicable) Department Reference #: OMS-21-300 Amount: (Contract/Amendment/Grant) $1,866,116.65 Advantage CT / RQS #: CT 10A 20210526000000003392 CONTRACT Proposed Start Date: 5/1/2021 Proposed End Date: 6/30/2022 AMENDMENT Original Start Date: Effective Date: Previous End Date: New End Date:

GRANT Project Start Date: Grant Start Date: Project End Date: Grant End Date: Vendor/Provider/Grantee Name, City, State: Change Healthcare Pharmacy Solutions, Inc. Augusta, ME Brief Description of Goods/Services/Grant: Staff Augmentation Services PART II: JUSTIFICATION FOR VENDOR SELECTION Mark an “X” before the justification(s) that applies to this request. (Check all that apply.) A. Competitive Process G. Grant B. Amendment H. State Statute/Agency Directed X C. Single Source/Unique Vendor I. Federal Agency Directed D. Proprietary/Copyright/Patents J. Willing and Qualified E. Emergency K. Client Choice F. University Cooperative Project L. Other Authorization PART III: SUPPLEMENTAL INFORMATION Please respond to ALL of the following: 1. Provide a more detailed description and explain the need for the goods, services or grant to supplement the response in Part I. The purpose of this agreement is to procure a highly skilled, experienced, and qualified agency to provide recruitment of Resources and payroll functions for several Units at the Department’s Office of MaineCare Services (OMS) and Office of Aging and Disability Services (OADS). The Provider shall provide staff augmentation services in support of the Department. Work duties of the supplied staff are related to prior authorization, care management, provider enrollment, Value-Based Purchasing, Pharmacy Helpdesk, HIV Waiver Services, classification updates, clinical review, policy and legislative research, transportation and claims DocuSign Envelope ID: 5456AE75-11DF-49C2-8B0C-DFE5FD813AFEDocuSign Envelope ID: DCE4BD1A-3AED-4AB6-93C8-869DEA3D79BC State of Maine Procurement Justification Form PJF Page 2 of 2 Rev. 3/3/2020 PART III: SUPPLEMENTAL INFORMATION adjustment services. 2. Provide a brief justification for the selected vendor to supplement the response in Part II. The staff provided under this Agreement have specific knowledge of OMS systems and operations. Loss of these resources would result in significant compliance and issues affecting services to Medicaid members. As resources leave from this contract, the Department will use existing staffing contracts to fill those vacancies. 3. Explain how the negotiated costs or rates are fair and reasonable; or how the funding was allocated to grantee. This is an ongoing service contract, and rates are the same as previous contracts. 4. Describe the plan for future competition for the goods or services. The Department issued RFP 202010160 Staff Augmentation in late 2020. All new resource needs plus vacancies that occur under this contract will be filled by the awarded Bidder, US Tech Solutions, under that RFP. PART IV: APPROVALS Signature of requesting Department’s Commissioner (or designee): By signing below, I signify that I approve of this procurement request. Printed Name: Date: Signature of DAFS Procurement Official: Printed Name: Date: DocuSign Envelope ID: 5456AE75-11DF-49C2-8B0C-DFE5FD813AFE Aug-31-2021Jim Lopatosky DocuSign Envelope ID: DCE4BD1A-3AED-4AB6-93C8-869DEA3D79BC Jaime Schorr 9/10/2021