36C26119Q0340-002.docx

QUALITY ASSURANCE SURVEILLANCE PLAN

For: Inpatient Hemodialysis Services

Contract Number: VA261-X-XXXX

Contract Description: The Contractor shall provide hemodialysis, dialysis and other services as follows: Emergency/acute hemodialysis treatments performed at the VA Intensive Care Unit (ICU) and inpatient ward, chronic hemodialysis at the VA for inpatients, and extended daily dialysis for inpatients in the ICU. It is the intent of this contract that the majority of services will be provided at the VA utilizing Contractor-owned and maintained equipment. The Contractor will provide staff to perform this coverage as follows: all days of the week, all tours of duty, to include weekends and holidays.

Contractor’s 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.

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 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: XXXXXX Organization or Agency: VISN 21 Network Contracting Office (NCO)

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: Peggy Morris (916) 843-9196; Peggy.Morris3@va.gov

3. CONTRACTOR REPRESENTATIVES

The following employees of the Contractor serve as the Contractor’s program manager for this contract.

a. Program Manager – XXXXX

b. Other Contractor Personnel – XXXX

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 Standards, paragraph 8.3.1. in the Performance Work Statement (PWS), includes performance standards. The government shall use these standards to determine Contractor performance and shall compare Contractor performance to the Acceptable Quality Level (AQL).

Reference Performance Requirement

Method Met AQL/DID NOT MEET AQL-

CPAR RATING/ADD COMMENTS

5. INCENTIVES

The Government shall use Exercise of Option Period (s) or possible permanent position at Medical Center as incentives. Incentives shall be based on exceeding, meeting, or not meeting performance standards.

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.

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

b. USER SURVEY. (Combines elements of validated user complaints and random sampling. Random survey is conducted to solicit user satisfaction. May also generate inspections and sampling.)

c. PERIODIC SAMPLING. (Variation of random sampling. However, sample is only taken when a problem/deficiency is suspected. Sample results are applicable only for the specific work inspected. Since sample is not entirely random, it cannot be applied to total activity performance.)

d. RANDOM SAMPLING. (Designed to evaluate performance by randomly selecting and inspecting a sample of cases.

e. Analysis of Contractor's time sheets/invoices/ reports. (Evaluate cost, schedule, etc.)

8. 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:

Ratings will be based on a 5 level rating scale including; Outstanding= 100%, Above Average= 80%, Average= 75%, Below Average= 65%, and Unsatisfactory= 60%or less. Any marks below average could be cause for a possible negative performance outcome.

9. DOCUMENTING PERFORMANCE

a. ACCEPTABLE PERFORMANCE

The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

b. UNACCEPTABLE PERFORMANCE

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

When the CO determines formal written communication is required, the 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.

10. FREQUENCY OF MEASUREMENT

a. Frequency of Measurement.

During contract performance, the COR will periodically 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 quarterly to assess performance and shall provide a written assessment.

Signature – Contractor Program Manager

Signature – Contracting Officer’s Representative