Immpact Subscription

DocuSign Envelope ID: 68114878-C26F-49A9-AB2B-FF158CD58B76 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. Department-Office/Division/Program: Oh Adil DHHS/Maine Center for Disease Control and Prevention Department Contract Administrator or Grant.Coordinator: Shawn Belanger Melanie Boucher (If'applicable). Department Reference #: CD0-23-5130 Proposed Start.Date: Original: Start Date: Amount: =! CT 10A (Contrac/Amendment/Grant) | 4,898.00 Advantage CT ROS #: | 59991214000000001675 10/1/2022 Proposed End Date: 9/30/2023 Effective Date: a AMENDM

ENT a Previous: End Date: New End:Date: Project Start-Date: Grant:Start Date: oe. Project End Date: Vendor/Provider/Grantee Name; City, State: HeaithInfoNet New Gloucester, ME Grant. End Date: Brief Description of Goods/Services/Grant: ImmPact Subscription PART Il: JUSTIFICATION FOR VENDOR SELECTION Mark an "X" before the justification(s) that applies to this request, (Check all that apply) O | A.-Competitive Process O |G. Grant O/B: Amendment QO) | He -State:Statute/Agency Directed & | C.- Single Source/Unique Vendor. O [Federal Agency Directed O |-De-Proprietary/Copyright/Patents O J: Willing and.Qualified O |. Emergency. O |.Ke Client Choice OO | F.: University.Cooperative Project 0 /:Ee Other Authorization REV 10/49/2021 Page 1 of 2 DocuSign Envelope ID: 68114878-C26F-49A9-AB2B-FF158CD58B76 5/24/2023 Joseph Zrioka, Director of IT Procurement Procurement Justification Form (PJF) Please respond to ALL of the questions in the following sections. PART lll: SUPPLEMENTAL INFORMATION 4; Provide 'a more detailed description and:explain the need: for the goods, services or grant to supplement the response in Part: The purpose of this agreement is to continue the subscription for a data analytics tool (referred to as the MaineCare Analytics Platform (MAP) for the Department's Maine Center for Disease Control and Prevention (MCDCP). This tool is used by MCDCP to reduce unnecessary emergency department utilization and streamline care coordination. The MAP is a custom tool, developed and owned by the Provider that provides information from doctors and hospital systems throughout Maine that is an integral part of the MCDCP staff workflow. 2: Provide a brief justification for the selected. vendor to supplement the response in Part Il. Reference the. RFP. number, if-applicable. The Provider is Maines state-designated health information exchange (HIE). The Provider has developed a unique relationship with doctors, hospitals, and other providers throughout Maine to share important health information and improve patient care. The Provider has coordinated with HBI Solutions, a leader in predictive analytics and performance analysis solutions, to customize 13 risk models using real-time clinical data from Maines HIE. The Department chose to implement the Provider's proprietary predictive analytics platform for the Vaiue-Based Purchasing Program and other MaineCare programs. 3... Explain how the negotiated costs or rates are fair and reasonable; or how the funding was allocated to grantee. This agreement provides for a continuation of existing services and tools at the previously negotiated subscription rate. 4. Describe the plan. for future-competition for the goods or-services. The Department does not intend to RFP this service. PART IV: AMERICAN RESCUE PLAN ACT (ARPA) / MAINE JOBS & RECOVERY PLAN (MJRP) Does this request utilize ARPA/MJRP- funds? 1 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 Department's Commissioner. (or designee): Typed Name; Signature of DAF: Procurement Official: Typed Name: Date: REV 10/21/2021 Page 2 of 2 el Ariole EA813178102243C... 2023-05-24T13:08:36-0700 Digitally verifiable PDF exported from www.docusign.com