36C25620R0024-005.doc

Quality Assurance Surveillance Plan

Gulf Shores Adult Day Health Care Facility

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) will provide a systematic method to evaluate performance for the stated Indefinite Quantity Contracts.

This QASP will explain 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 will 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.

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. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

2. Government Roles and Responsibilities

The following personnel shall oversee and coordinate surveillance activities.

a. Contracting Specialist (CO) - The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the agreement 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 agreement. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

· Assigned Contracting Specialist: Network Contracting Office 16 (NCO16) Sharrion Brackens Young

· Organization or Agency: U.S. Department of Veterans Affairs

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. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

Assigned COR(S): Latesha Tanise McInnis, MSW, LCSW, COR 228-523-4716

c. Other Key Government Personnel – N/A

3. Contractor Representatives

The following employees of the contractor serve as the contractor’s program manager for this agreement.

a. Program Manager – Mark Klumpke 228-388-1723.

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

QUALITY ASSURANCE SURVEILLANCE PLAN

Nursing Home Care

5. Incentives/RATING STANDARDS Continuation of VA Contract and placement of veterans under VA pay at facility will be based on meeting, or not meeting performance standards.

6. Methods of QA Surveillance

Various methods exist to monitor performance:

a. DIRECT OBSERVATION AT MONTHLY SITE VISITS

b. INITIAL INSPECTIONS

c. VALIDATED USER/CUSTOMER COMPLAINTS

d. ANNUAL INSPECTIONS

e. PLAN OF CARE MEETINGS

7. Ratings Metrics and methods are designed to determine if performance meets, or does not meet Contract Adult Day Health Care Program standards and acceptable quality level. The Contract Adult Day Health Care Program VA National Handbook will be used, and Contract Performance Work Statement will be used to determine ratings and performance.

8. DOCUMENTING PERFORMANCE

Vendors must sign up and utilize the VA’s Health Share Referral manager HSRM ( Records Sharing), by using the outlined steps:

1. Community providers are asked to attend the HSRM Introductory Training.

2. This event occurs every Tuesday from 1-2 PM EST on VHA TRAIN. If community providers do not already have a VHA TRAIN account, they will be asked to quickly create one first. Information about this Introductory Training is available in the attached Community Provider Information Sheet. Please note that the primary audience for HSRM is administrative staff and other staff who actively process incoming VA referrals, so physicians and practitioners may not need to attend.

3. After attending the Introductory Training, each staff member who would like HSRM access will create an ID.me account. The instructions for registering for an ID.me account are attached.

4. One POC for the community provider will fill out the end-user tracker form, attached, with information about all staff who would like HSRM access.

5. The POC will send this completed end-user tracker form to the HSRM Community Provider Help Desk at HSRMSupport@va.gov. This Help Desk is also available by phone at 1-844-293-2272, Monday- Friday 8AM- 6 PM.

a. ACCEPTABLE Performance

The Government shall document positive OR NEGATIVE performance. Any report may become a part of the supporting documentation for any contractual action. Document used will be the COR Quarterly Contract Evaluation Report.

b. UNACCEPTABLE performance When unacceptable performance occurs, the COR shall work with the Contracting Specialist (CO) 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. In order to assure that the contractor receives impartial, fair, and equitable treatment under this agreement, the COR will work with the contractor to increase performance to an acceptable level.

When the COR and CO determines formal written communication is required, the COR and CO shall prepare a Contract Discrepancy Report (CDR) and present it to the contractor's program manager.

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 any contractual action deemed necessary by the CO.

9. Frequency of Measurement

a. Frequency of Measurement.

During contract performance, the COR will quarterly analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

b. Frequency of Performance Assessment Meetings.

The COR shall meet with the contractor as needed to assess performance and shall provide a written assessment.

Latesha Tansie McInnis, LCSW, COR Signature – Contracting Officer Representative

Signature – Contractor -Gulf Shores � See “Methods of Surveillance,” paragraph 6 of this QASP, for additional methods of monitoring performance.