Health Insurance Marketplace Navigator Services

REV 11/18/2021 Page 1 of 2 PROCUREMENT JUSTIFICATION FORM (PJF) 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 intranet site (Forms page) for additional instructions. PART I: OVERVIEW Department Office/Division/Program: Department of Health and Human Services / Office of the Health Insurance Marketplace Department Contract Administrator or Grant Coordinator: Jeanne Garza / Brianne Carrero (If applicable) Department Reference #: COM-21-5500B Amount: (Contract/Amendment/Grant) Amend $450,000.00 Total $1,000.000.00 Advantage CT / RQS #: CT 10A 20201028000000001331 CONTRACT Proposed Start Date: Proposed End Date: AMENDMENT Original Start

Date: 11/1/2020 Effective Date: 11/1/2022 Previous End Date: 10/31/2022 New End Date: 6/30/2023 GRANT Project Start Date: Grant Start Date: Project End Date: Grant End Date: Vendor/Provider/Grantee Name, City, State: Western Maine Community Action, East Wilton, ME Brief Description of Goods/Services/Grant: Provide Health Insurance Marketplace Navigator Services for Maine residents, and small businesses and employees seeking health insurance coverage PART II: JUSTIFICATION FOR VENDOR SELECTION Check the box below for the justification(s) that applies to this request. (Check all that apply.) A. Competitive Process G. Grant B. Amendment H. State Statute/Agency Directed 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 Competitive Award Adjustment DEPARTMENT OF ADMINISTRATIVE AND FINANCIAL SERVICES iy DIVISION OF PROCUREMENT SERVICES Rsv wu he) BENNO} Procurement Justification Form (PJF) REV 11/18/2021 Page 2 of 2 Please respond to ALL of the questions in the following sections. PART III: SUPPLEMENTAL INFORMATION 1. Provide a more detailed description and explain the need for the goods, services or grant to supplement the response in Part I. OHIM is required by federal regulations to operate a Navigator program to provide outreach and enrollment assistance to consumers. The purpose of this Amendment is to extend the period to allow the outreach operations which are especially relevant this year as the Department prepares for the transitions in coverage eligibility that will result from the end of the federal public health emergency. 2. Provide a brief justification for the selected vendor to supplement the response in Part II. Reference the RFP number, if applicable. Through RFP 202007118, an Evaluation Team reviewed the Bidders Qualifications and Experience, Proposed Services, and Cost Proposal in awarding the contract to the only provider to submit a proposal. Period Start Date End Date Initial Period of Performance 11/1/2020 10/31/2021 Renewal Period #1 11/1/2021 10/31/2022 3. Explain how the negotiated costs or rates are fair and reasonable; or how the funding was allocated to grantee. The costs and rates of this vendor were considered fair and reasonable and the best value for the Department. 4. Describe the plan for future competition for the goods or services. The Department intends to competitively procure these services (OC20222) with a contract start date of 7/1/2023 PART IV: AMERICAN RESCUE PLAN ACT (ARPA) / MAINE JOBS & RECOVERY PLAN (MJRP) Does this request utilize ARPA/MJRP funds? Yes If Yes, please attach the approved Business Case(s). No If No, proceed to Part V. PART V: APPROVALS The signatures below indicate approval of this procurement request. Signature of requesting Departments Commissioner (or designee): Typed Name: Debra Downer, Deputy Director for Competitive Procurement Date: Signature of DAFS Procurement Official: Typed Name: Date: Jan-03-2023 Kathy Paquette 1/26/2023 DocuSigned by: 5DC6307B8558482... DocuSigned by: 41C2BA36FAF44CD...