Draft_QASP_non-FECA_PBM_9_9_21_0001.pdf

For: Office of Workers’ Compensation Programs (OWCP) non-FECA Pharmacy Benefits Management (PBM) Contract Number: < upon award, enter contract number>

Contract Description: < enter contract description >

Contractor’s name: < upon award, enter contractor name > (hereafter referred to as the contractor).

1. Purpose This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

• What will be monitored?

• How monitoring will take place?

• Who will conduct the monitoring?

• How monitoring efforts and results will be documented?

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance. In addition, the QASP should recognize that unforeseen and uncontrollable situations may occur.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Updates shall ensure that the QASP remains a valid, useful, and enforceable document. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

The following FAR clauses may apply depending on contract type:

52.246-4 Inspection of Services – Fixed-Price,

2. Government Roles and Responsibilities The following personnel shall oversee and coordinate surveillance activities.

a. Contracting Officer (CO) - The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Assigned CO: Jubner Severe

Organization or Agency: <enter organization or Agency name>

Telephone: <enter number>

Email: <enter address>

b. Contracting Officer’s Representative (COR) - The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. At the conclusion of the contract or when requested by the CO, the COR shall provide documentation to the CO. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf. The contractor shall refer any changes they deem may affect contract price, terms, or conditions to the CO for action.

Assigned COR:

Telephone:

Email:

c. Other Key Government Personnel -

Title:

Telephone:

Email:

3. Contractor Representatives The following employees of the contractor serve as the contractor’s Contract Manager and Task Manager for this contract. <Communication should occur with them during QASP development. It will help if they review the draft QASP and accept the final version.>

a. Contract Manager - <upon award, enter name>

b. Task Manager - <upon award, enter name>

c. Other Contractor Personnel - <upon award, enter name or delete these lines if not applicable>

Title: <enter title>

4. Performance Standards

Performance standards define desired services. The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these standards.

The Performance Requirements Summary Matrix, paragraph <enter number> in the Performance Work Statement includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL). The matrix from the PWS is attached as Technical Exhibit 1.

5. Incentives The Government shall use <insert award fee, incentive fee, past performance, or other method> as incentives.

Incentives shall be based on exceeding, meeting, or not meeting performance standards. Information about incentives can be found in <insert section or paragraph> of the contract.

6. Methods of QA Surveillance Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP.

Regardless of the surveillance method, the COR shall always contact the contractor's task manager or on-site representative when a defect is identified and inform the manager of the specifics of the problem. The COR, with assistance from the CO, shall be responsible for monitoring the contractor’s performance in meeting a specific performance standard/AQL.

< Place the performance standard(s) after the description of the method. Delete any methods that are not required.>

DIRECT OBSERVATION. (Can be performed periodically or through 100% surveillance.)

<Insert performance standard(s) or delete this method.>

MANAGEMENT INFORMATION SYSTEMS (MIS). (Evaluates outputs through the use of management information reports. Best used for general surveillance and may need to be supplemented by periodic inspections.)

<Insert performance standard(s) or delete this method.>

PERIODIC INSPECTION. (Uses a comprehensive evaluation of selected outputs. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.)

<Insert performance standard(s) or delete this method.>

USER SURVdic and 100% inspections.)

<Insert performance standard(s) or delete this method.>

VALIDATED USER/CUSTOMER COMPLAINTS. (Relies on the user of the service to identify deficiencies. Complaints are then investigated and validated. Highly applicable to services provided in quantity and where quality is highly subjective.) EY. (Combines elements of validated user complaints and random sampling. Random survey is conducted to solicit user satisfaction. Appropriate for high quantity activities that have historically been satisfactory. May also generate perio

<Insert performance standard(s) or delete this method.>

100% INSPECTION. (Evaluates all outputs. Most applicable to small quantity, but highly important services. May be used where there are written deliverables and stringent requirements such as tasks required by law, safety, or security.)

<Insert performance standard(s) or delete this method.>

PERIODIC SAMPLING. (Variation of random sampling. However, sample is only taken when a deficiency is suspected. Good follow-up to MIS analysis. Sample results are applicable only for the specific work inspected.

Since sample is not entirely random, it cannot be applied to total activity performance.)

<Insert performance standard(s) or delete this method.>

RANDOM SAMPLING. (Designed to evaluate the outputs of the award requirement by randomly selecting and inspecting a statistically significant sample. Highly recommended for large quantity repetitive activities with objective and measurable quality attributes.)

<Insert performance standard(s) or delete this method.>

PROGRESS OR STATUS MEETINGS.

<Insert performance standard(s) or delete this method.>

ANALYSIS OF CONTRACTOR'S PROGRESS REPORTS. (Evaluate cost, schedule, etc.)

<Insert performance standard(s) or delete this method.>

PERFORMANCE REPORTING. (Evaluate metrics for a specific time period. Develop metrics or use metrics found in MIS.)

<Insert performance standard(s) or delete this method.>

Surveillance results may be used as the basis for actions (to include payment deductions) against the contractor.

In such cases, the Inspection of Services clause in the Contract becomes the basis for the CO’s actions.

5. Ratings Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:

EXCEPTIONAL: Performance significantly exceeds contract requirements to the Government’s benefit.

SATISFACTORY: Performance meets contractual requirements.

UNSATISFACTORY: Performance does not meet contractual requirements.

6. Documenting Performance

a. ACCEPTABLE PERFORMANCE

The Government shall document positive performance. A report template is attached. Any report may become a part of the supporting documentation for fixed fee payments, award fee payments, or other actions.

b. UNACCEPTABLE PERFORMANCE.

When unacceptable performance occurs, the COR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and place it in the COR file.

When the COR determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to the contractor's task manager or on-site representative. A CDR template is attached to this QASP.

The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the COR. The Government shall review the contractor's corrective action plan to determine acceptability.

Any CDRs may become a part of the supporting documentation for contract payment deductions, fixed fee deductions, award fee nonpayment, or other actions deemed necessary by the CO.

7. Frequency of Measurement

a. FREQUENCY OF MEASUREMENT.

During contract/order performance, the COR shall take periodic measurements, daily, weekly, monthly or annually, as specified in the AQL column of the Performance Standards Summary Matrix, and shall analyze whether the negotiated frequency of measurement is appropriate for the work being performed.

b. FREQUENCY OF PERFORMANCE ASSESSMENT MEETINGS.

The COR shall meet with the contractor monthly to assess performance against AQLs, and shall provide an annual written assessment in CPARS.

Prepared by

Signature – Contracting Officer’s Representative

TECHNICAL EXHIBIT 1

Performance Requirements Summary

The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success. As necessary, DOL reserves the right to modify the method of surveillance based on the agency’s needs and the contractor’s performance.

Performance Objective

Standard/Deliverable Performance Threshold (This is the maximum error rate. It could be “zero deviation from standard.”)

Method of Surveillance (and who performs) (e.g. 100% inspection by COR)

1.12 Post-Award

Orientation and Kick-Off Meeting

The contractor shall work with the Government to coordinate and facilitate the kickoff meeting, provide meeting agenda and work plan that identifies all tasks, resources utilized (i.e., number, labor category, and description), deliverables to be completed, and the corresponding timetable/delivery dates. Location:

Department of Labor, Office of Workers’ Compensation Programs, 200 Constitution Ave NW, Washington, DC 20210.

Tentative Participants: COR, Contracting Officer (CO)/Contract Specialist (CS).

Within 10 business days after contract start.

100% inspection:

OWCP COR

OWCP PM or designee

1.15 Onboarding

Key Personnel

Appoint and electronically notify the COR of the names and contact information of its authorized Contractor Program Manager (PM), who shall be the primary interface with the DOL COR on current PBM contract performance, and an alternate PM to serve in the primary PM role when the primary is unavailable.

Appoint and electronically notify the COR of the names and contact information of clinical staff supporting the contract, including a Lead Clinical Pharmacist (Pharm.D.), a Lead FWA Expert, and a Technical Manager.

Within 5 business days after contract start.

100% inspection:

OWCP COR

1.15 Staffing Plan

for Personnel

Chart/matrix showing ALL proposed personnel (including outside consultants or Subject Matter Experts) by task and by hours. The contractor should clearly specify the role and responsibilities of each proposed staff and discuss the qualifications of the individuals proposed for specific tasks.

Personnel includes; Pharmacists, FWA Experts, call support, information technology support, data analytic support, Pharmacy and Therapeutics Committee, Medical Director, and other staff.

Within 30 days after contract start.

100% inspection:

OWCP COR

OWCP PM or designee

5.2.1 Pharmacy

Networks and Provider Enrollment Database

List of all network retail and mail order pharmacies and access to a provider enrollment database.

Initial list and database available within 15 days after contract start and periodically as the network changes.

100% inspection:

OWCP COR

5.3 Customer

Support

Telephone number for the program, and identification of a URL. Toll-free telephone customer support available 24 hours per day, 7 days per week, and 365 days per year 99% of the time.

Within 30 days after contract start.

100% inspection:

OWCP COR

OWCP PM or designee

5.3.1 Customer

Support

Develop and provide monthly customer support reports to OWCP COR submitted by the third Wednesday of the month for the previous calendar month. Reports should provide performance data to indicate number of calls, length of calls, types of services provided, hold times, and number of dropped calls.

The specific format and content of

Within 30 days after contract start.

100% inspection:

OWCP COR

these reports shall be developed by the contractor and approved by OWCP.

5.3.4 Welcome

Packet

First draft of the welcome packet including a welcome letter, benefit card, information about the pharmacy and DME programs.

Within 30 days after contract start.

100% inspection:

OWCP COR

5.3.4 Welcome

Packet

Mail welcome packet including a welcome letter, benefit card, information about the pharmacy and DME programs to claimants.

Within 90 days after contract start and as new claimants are eligible.

100% inspection:

OWCP COR

OWCP PM or designee

5.3.4 Automated

Process for Image Transfer

Completed process, including completed testing, for automated image transfer into claimant case files.

Within 90 days after contract start.

100% inspection:

OWCP COR

5.5 Processing

Claims

Ingest eligibility files and begin processing claims for eligible claimants as a third party provider through OWCP’s current pharmacy system.

Within 90 days after contract start, and as new claimants are identified.

100% inspection:

OWCP COR

OWCP PM or designee

5.5.9 Mailroom Fully functional mailroom. Within 180 days after contract start.

100% inspection:

OWCP COR

5.8.5 Reporting

and Data

Provide an internet based reporting tool.

Within 180 days after contract start.

100% inspection:

OWCP COR

OWCP PM or designee

5.8.3 Reporting

and Data

Provide a data warehouse or equivalent.

Within 180 days after contract start.

100% inspection:

OWCP COR

5.8.5 Reporting

and Data

Provide all formalized reports. Within 180 days after contract start and periodically as determined by OWCP.

100% inspection:

OWCP COR

OWCP PM or designee

5.10.9 Authorization and Stakeholder Portals

Provide a specification document detailing the functionality of the Prior Authorization Portal.

Within 120 days after contract start.

100% inspection:

OWCP COR

5.10.1 Authorization and Stakeholder Portals

Provide a fully functional Prior Authorization Portal.

Within 180 days after contract start.

100% inspection:

OWCP COR

OWCP PM or designee

5.10.9 Authorization and Stakeholder Portals

Provide a specification document detailing the functionality of a Claimant Stakeholder Web Portal and a Provider Stakeholder Web Portal.

Within 120 days after contract start.

100% inspection:

OWCP COR

5.10.9 Authorization and Stakeholder Portals

Provide a fully functional Claimant Stakeholder Web Portal and a Provider Stakeholder Web Portal.

Within 180 days after contract start.

100% inspection:

OWCP COR

OWCP PM or designee

5.10.7 Authorization and Stakeholder Web Portals

Provide a payment file in a format determined by OWCP.

Within 180 days after contract start.

100% inspection:

OWCP COR

5.6.3 Fee Schedule Provide an OWCP approved method

for defining brand and generic drugs.

Within 90 days after contract start.

100% inspection:

OWCP COR

OWCP PM or designee

5.6.4 Fee Schedule Provide an OWCP approved definition

or a list of specialty drugs.

Within 90 days after contract start and updated as needed.

100% inspection:

OWCP COR

5.11.2 Formulary

Management

Provide names and degrees of members of the Pharmacy and Therapeutics Committee. Disclose any financial interests in drug manufacturing companies.

Within 30 days after contract start and updated as needed.

100% inspection:

OWCP COR

OWCP PM or designee

5.11.1 Formulary

Management

Provide draft P&T progress report template and clinical recommendations and pharmacoeconomic analysis template for OWPC approval.

Within 30 days after contract start.

100% inspection:

OWCP COR

5.11.1 Formulary

Provide quarterly P&T progress reports at least 4 times a year.

On the first business day after January 1.

April 1, July 1, and October 1 of each year.

100% inspection:

OWCP COR

OWCP PM or designee

5.11.5 Formulary

Management

Provide a drug formulary for OWCP approval.

Within 90 days after contract start and updated as needed.

100% inspection:

OWCP COR

5.11.6 Formulary

Fully implement the drug formulary for bill processing.

Within 180 days after contract start and updated as needed.

100% inspection:

OWCP COR

OWCP PM or designee

5.11.4 Formulary

Management

Written notice for approval by OWCP at least 15 days prior to implementation of any formulary change.

Periodically when needed.

100% inspection:

OWCP COR

5.11.6 Formulary

Written notice to adversely implacted claimants, designated respresentatives, prescribing physicians, and participating pharmacies at least 45 days prior to implementation of any formulary change.

Periodically when needed.

100% inspection:

OWCP COR

OWCP PM or designee

5.12.1 PBM Drug

Utilization Review

Provide a specification document detailing the functionality of point of sale edits.

Within 120 days after contract start and regularly as new edits and functionality is developed.

100% inspection:

OWCP COR

5.12.1 PBM Drug

Utilization Review

Deploy point of sale editing. Within 180 days after contract start.

100% inspection:

OWCP COR

OWCP PM or designee

5.12.1 PBM Drug

Utilization Review

Provide a specification document detailing the functionality of the prior authorization process.

Within 120 days after contract start.

100% inspection:

OWCP COR

OWCP PM or designee

5.12.1 PBM Drug

Utilization Review

Provide a specification document detailing the processes of concurrent, retrospective and clinical drug utilization review.

Within 120 days after contract start.

100% inspection:

OWCP COR

OWCP PM or designee

5.15.1 System

Testing

Provide a Requirements Traceability Matrix, testing plan and testing cases associated with all available systems

Within 90 days after contract start.

100% inspection:

OWCP COR

Meetings with the

DOL

COR/OWCP, and Program Management Officials

Discuss the progress of the PBM with the DOL COR, Branch of Medical Standards and Operations (BMSO) PM and program management officials no less than quarterly, and as needed, per request by the DOL COR. These meetings may be scheduled by either the COR or the assigned BMSO PM.

Meetings may take place in person, during on-site visits or via Skype and/or conference calls.

No less than 4 times per contract period, but up to 15 times per contract period as requested by

DOL COR.

100% inspection:

OWCP COR

OWCP PM or designee

Enhanced Quality Control

Develop and implement internal quality control procedures that produce timely, accurate, complete and relevant data, which meet the full requirements of this performance work statement. An evaluation of the PBM system will be conducted to make sure that efficient and effective management processes remain in place and that data are handled in a secure manner and protected to meet all the individual program laws and Privacy Act requirements as well as DOL information security requirements. The contractor shall ensure that information is maintained consistent with all Privacy Act requirements, and shall ensure that its information security safeguards are consistent with OWCP policies and practices. Where applicable, the contractor shall ensure that data is handled in a manner that is compliant with security measures that HIPAA rules may require.

30 days from contract start.

100% inspection:

OWCP COR

Work Plan/Project Plan and Milestones

Develop a work plan/project plan and milestones for implementing elements of the PWS.

Project plan and milestones for implementing within 30 days after contract start.

100% inspection for each project plan and milestone.

OWCP COR

Implementation Complete implementation of all elements of the PWS.

Implementation within 180 days after contract award.

100% inspection:

OWCP COR

Progress Reports and Management Information Reports

Develop and provide monthly progress reports to OWCP COR. Reports shall include key performance metrics associated with the requirements in the PWS. In general, the contractor shall include summary information that includes operational aspects of all PBM services provided, grouped by program. The contractor shall submit a draft progress report template for review and approval by OWCP. The OWCP COR and the PBM Manager shall agree on the scope, content, and format of these reports. Reports shall be submitted to the OWCP COR by the third Wednesday of the month for the previous calendar month. In the event of a holiday or closure due to inclement weather or executive order, reports shall be due the next business day.

In addition to the monthly progress reports outlined above, the contractor shall implement a secure, internet-based reporting tool for use by authorized OWCP program staff to generate management reports on an ad hoc basis.

Draft progress report templates within 30 days after contract award.

Monthly reports no less than 12 times per year on the third Wednesday of the month for the previous month 98% of the time.

Random sampling:

5.6.5Fee Schedule Development and Modifications

Develop and provide documents that contain pricing for generic and brand name drugs for both point of sale and mail order pharmacy, and compounded drugs. The specific format and content of these reports shall be developed by the contractor and approved by OWCP.

Develop and provide documents that identify the pricing methodology for drugs, and DME. The specific format and content of these reports shall be developed by the contractor and approved by OWCP.

Draft fee schedule document templates within 30 calendar days after contract award.

Draft pricing methodology document templates within 30 calendar days after contract award.

100% inspection:

OWCP COR

5.14.7 Durable

Medical Equipment

The contractor shall ensure all bills/invoices for payment are proper, accurate, complete and timely in order to facilitate the timely processing and prompt payment of medical bills. The contractor shall also be registered in OWCP’s Medical Bill Processing System and Electronic Funds Transfer (EFT) System in order to expedite bill processing per OWCP’s Medical Bill Processing Procedures.

All bills/invoices must be submitted timely and contain proper, accurate and complete information in order to be deemed proper for payment in accordance with OWCP’s Fee Schedule, Medical Bill Processing Procedures and the Prompt Payment Act.

The minimum acceptable level is no less than 100%.

Medical Bill Processing System validation report(s).

1.9 Security

Requirements

Submit completed System Security Plan to Government ISO for review.

First review when 1/3 of the document is completed and then every 2 weeks until completed.

Government Information Security Officer

Submission of completed document by the 120th day after contract start.

1.9 Security

Requirements

Allow document review and system access, and assist government evaluator in performing the Controls Assessment for the necessary systems.

By the 160th day after contract start.

Independent security assessor

508 Testing i. Accessibility test results based on the required test methods - With an explanation for any false positives

ii. Documentation of features provided to help achieve accessibility and usability for people with disabilities.

iii. Documentation of core functions that cannot be accessed by persons with disabilities.

iv. Documentation on how to configure and install the ICT item to support accessibility.

One week prior to go live date

Government Information Security Officer

5.5.1 Processing

Claims

Provide technical design documentation for the interface with OWCP Bill Pay system

Within 60 days after contract start.

OWCP COR

and BMSR PM

Deliverables Schedule

Deliverable

Frequency

Medium/ Format

Submit To Report templates for government approval prior to Implementation within 150 days after contract start

Electronically with updates as needed

COR and Project Management Office (PMO) for approval iterations due as needed until final government approval

Implementation Work Plan for government approval, including testing plan, test case scenarios plan, customer service plan, and milestone schedule within 30 days after contract start iterations due as needed until final government approval

Electronically with updates as needed

COR and Project Management Office (PMO) for approval

5.15 Implementation Test Case

Scenarios for government approval within 120 days after contract start

Electronically COR and Project Management Office (PMO) for approval iterations due as needed until final government approval

5.15.3 Fully-functional web portal(s)

for use by OWCP stakeholders and customers 24 hours per day, 7 days per week, and 365 days per year within 180 days after contract start for government approval prior to Implementation

System may require updates as needed.

Electronically with updates as needed

COR and Project Management Office (PMO) for government acceptance testing and approval available to all stakeholders

5.8.2 Fully-functional, secure

internet-based reporting tool(s) for use by authorized OWCP program staff to generate standard and custom reports within 180 days after contract start for government approval prior to Implementation

Monthly data updates by 3rd Wednesday of each month after Implementation

Electronically COR and Project Management Office (PMO) for government acceptance testing and approval available to management information reports users

Fully-functional system within 150 days after contract start for government approval prior to Implementation

Electronically COR and Project Management Office (PMO) for government acceptance testing and approval

Available to all stakeholders

1.5 Implementation. within 180 days after contract

start

Go-Live Available to all stakeholders

5.8.5 Management Information Reports 3rd Wednesday of each month after Implementation electronically with most recent data as of prior month end available to management information reports users

5.8.5 Status report of background

investigations for contract support staff.

3rd Wednesday of each month after contract award

Electronically with most recent data as of prior month end

COR(s)

5.8.5 Summary data report of DEEOIC and

DCMWC cases, reflecting the number of cases in which PBM services were provided, clearly identifying the type of service, including, but not limited to pharmacy benefits, first-fill benefits, diagnostic testing, DME, and customer support

3rd Wednesday of each month after Implementation ad hoc reports within 5 business days from date of request electronically with most recent data as of prior month end available to management information reports users

5.8.6 Report on any cost savings achieved

with the PBM, including actual and cost avoidance savings on medical costs ad hoc reports within 5 business days from date of request electronically with most recent data as of prior month end available to management information reports users

5.5.13 Retention, maintenance and availability

of complete and accurate bill payment and financial reporting history, with 20 ad hoc reports available per quarter

Maintain daily updates.

Ad hoc reports within 5 business days from date of request electronically with most recent data as of current date available to management information reports users

5.8.5 Timely and accurate reports including

the tracking/monitoring of program utilization, cost savings, and performance metrics against program goals ad hoc reports within 5 request electronically with most recent data as of prior month end available to management information reports users

5.8.5 Reports and statistics for quality

reviews.

request electronically with most recent data as of prior month end available to management information reports users

5.11.1 P&T progress report template and

clinical recommendations and pharmacoeconomic analysis template for OWCP approval within 30 days after contract start

Electronically COR and Project Management Office (PMO) for approval

5.5.8 Provide formulary for OWCP approval within 90 days after contract

Electronically with most recent updates as needed

COR and Project Management Office (PMO) for approval

5.11.1 P&T progress reports 3rd Wednesday of each quarter, on or after January 1, April 1, July 1, October 1, for the prior quarter activities electronically with most recent data as of prior quarter end available to management information reports users

5.11.2 Clinical recommendations and

pharmacoeconomic analysis reports as needed, not less than 10 business days following government request

Electronically available to management information reports users

5.6 Draft fee schedule change document

template and DME/DT pricing methodology change document template.

within 30 days after contract start iterations due as needed until final government approval

Electronically COR and Project Management Office (PMO) for approval

5.6.5 Fee schedule and pricing methodology

comparison reports no later than 5 business days after the Contractor proposes change to the fee schedule or DME/DT pricing methodology

Electronically COR and Project Management Office

(PMO)

5.11.4 Written notice to OWCP prior to

implementation of any formulary or formulary change at least 15 days prior to implementing any formulary or formulary change

Electronically COR and Project Management Office (PMO) for approval

5.11.6 Written notice to adversely impacted

claimants, designated representatives, representative payees, prescribing physicians, and participating pharmacies of formulary changes.

at least 45 days prior to implementing any formulary or formulary change

Written notice Adversely impacted claimants, designated representatives, representative payees, prescribing physicians, and participating pharmacies

Monthly customer support progress reports 3rd Wednesday of each month request

Electronically with most recent updates as of prior month end

COR and Project Management Office

(PMO)

5.3.4 Welcome packet designs, including

benefit cards within 90 days after contract start iterations due as needed until final government approval

Electronically with most updates as needed

COR and Project Management Office (PMO) for approval

5.3.4 Initial welcome packets, including benefit

cards

Within 90 days after contract start

Hard copy All existing and applicable beneficiaries

5.3.4 Monthly report of welcome packets, including at least number of packets distributed by program and language, number of returned packets, and timeliness of distribution.

3rd Wednesday of each month after Implementation

Electronically COR and Project Management Office (PMO) for approval

1.9.6 System Security Plan (SSP) and Security

Assessment templates for government approval, including milestone schedule within 30 days after contract

Electronically in Government-provided format with most recent updates as needed

Government Information Security Officer (ISO) for approval

QASP

QUALITY ASSURANCE SURVEILLANCE PLAN

Version – May 2018

1.9.6 Completed SSP and Security Assessment

results within 150 days after contract start for government approval prior to Implementation

Electronically Government Information Security Officer (ISO) for approval

QASP

QUALITY ASSURANCE SURVEILLANCE PLAN

Version – May 2018

Performance Report

1. CONTRACT NUMBER: <insert number>

2. Prepared by: (Name of COR) <insert name>

3. Date and time of observation:

4. Observation:

<Examples of items to include in a report are:

- Method of surveillance.

- How frequently you conducted surveillance.

- Surveillance results.

- Number of observations.>s

Prepared by: <Enter COR’s name>

Signature – Contracting Officer’s Representative Date