36C26119Q0704-009.docx

QUALITY ASSURANCE SURVEILLANCE PLAN

For: Pharmacy Benefits Management Services, VA Central California Health Care System (VACCHCS), Fresno, CA Contract Number: < Upon award, Government will enter contract number> Contract Description: This contract is to provide Pharmacy Benefit Management Services. These services shall entail the Contractor providing a network of licensed pharmacies to ensure filling urgent/emergent prescriptions, screening and counseling services for VA eligible beneficiaries. The contract is between VHA, as a health plan, and the contractor, for the purpose of reimbursing the contractor a set price for prescriptions filled at the patient’s request for which the VA beneficiary patient will not be charged. It is not a contract for the purpose of directly filling prescriptions or dispensing medications. It is a financial management services contract.

Contractor’s name: <Enter your company 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:

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: <Upon award, Government will enter name.> Organization or Agency: Department of Veterans Affairs, Office of Acquisition and Materiel Management

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: <Upon award, Government will enter name.>

3. CONTRACTOR REPRESENTATIVES

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

a. Program Manager - <Enter name.>

b. Other Contractor Personnel - <Enter name(s) or delete these lines if not applicable> Title: <Enter title(s) or delete these lines if not applicable.>

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 Contractor shall perform the services at the acceptable levels as identified in the chart below. Results of the quality assurance surveillance shall be evaluated recorded as part of past performance documentation and shall have a direct effect on future modifications and possible contracts with this agency.

5. INCENTIVES

The Government shall use <Exercise of Option Period and past performance and/or any other incentive that was proposed in your solution.> 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. shall be performed periodically or through 100% surveillance

b. PERIODIC INSPECTION. (Evaluates outcomes on a periodic basis. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.)

c. 100% INSPECTION. (Evaluates all outcomes.)

7. 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 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 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.

After award, both the contractor’s Program Manager and the COR shall sign this document.> Signature – Contractor Program Manager Signature – Contracting Officer’s Technical Representative

QULALITY ASSURANCE SERVELLANCE PLAN TABLE

Scope