Comprehensive Care for Joint Replacement (CJR) Payment Reconciliation Task Order
Overview
Buyer
Place of Performance
NAICS
PSC
Set Aside
Original Source
Timeline
Qualification Details
Fit reasons
- NAICS alignment with historical contract wins in similar service areas.
- Scope strongly matches core technical capabilities and delivery model.
Risks
- Past performance thresholds may require one additional teaming partner.
- Potential clarification needed on staffing minimums before bid/no-bid.
Next steps
Validate eligibility requirements, assign capture owner, and schedule partner outreach to confirm teaming strategy before submission planning.
Quick Summary
The Centers for Medicare and Medicaid Services (CMS), under the Department of Health and Human Services, has issued a Justification for an Exception to Fair Opportunity for the Comprehensive Care for Joint Replacement (CJR) Payment Reconciliation acquisition. This justification supports a sole-source modification to an existing contract with Mathematica, Inc., for an additional three-month option period. The action is valued at $156,693 and is cost-neutral, reallocating existing funds.
Scope of Work
This modification specifically covers appeal-related activities for the CJR Payment Reconciliation model, necessitated by delayed data availability. The services provided by Mathematica, Inc. are crucial for the timely resolution of beneficiary and hospital appeals and will conclude the task order.
Contract & Timeline
- Type: Sole-Source Modification (Justification for Exception to Fair Opportunity)
- Contractor: Mathematica, Inc.
- Value: $156,693 (cost-neutral reallocation)
- Duration: Additional three-month option period
- Set-Aside: Not applicable (sole-source justification)
- Published: March 26, 2026
Justification
The rationale for this sole-source award is based on Mathematica's unique institutional knowledge, specialized expertise, and established processes for calculating target prices and reconciliation payments within the CJR model. CMS determined that transitioning these critical appeal-related activities to a new contractor would result in significant duplication of costs, unacceptable delays, and substantial risks to the timely resolution of appeals.
Additional Notes
This action is intended to finalize the current task order, ensuring continuity and efficiency in the CJR Payment Reconciliation process without incurring new costs.