36C26119Q0714-004.doc

Quality Assurance Surveillance Plan (QASP) Project Title: Residential Substance Abuse Treatment Program Contract Number: <Upon award, Government will enter contract number> Contract Description: VA Pacific Island Health Care System’s Health Care will contract with a residential program for the treatment of substance abuse. Services will include board, room, treatment, case management and coordination of treatment with the referring program. This program will be located on Oahu, Hawaii.

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:

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

Contracting Officer’s Technical Representative (COTR) – The COTR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COTR shall keep a quality assurance file. The COTR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

Assigned COTR:

c.

Other Key Government Personnel -

3.

Contractor Representatives

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

a.

Program Manager – b.

Other Contractor Personnel – 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 A2,A3,A4,A5 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).

Quality Assurance Surveillance Plan (QASP)

Performance Standards Task

Task Reference Performance

Indicator

Quality

Level Score

90,95, 100% Surveillance method

2..1.1 Staff

Licensing

100%

Periodic Site Review of current licenses of appropriate practitioners maintained by personnel.

Random Sampling

Staff

Training

Periodic Site Review of individual training history logs maintained by personnel.

Random Sampling

Technical Direction

Referrals

Contractor shall maintain a written referral (hard copy, fax, or secured e-mail) signed by the authorizing VA staff.

Periodic Site Review of referred veteran files for authorization.

2.2.3

Therapeutic and Rehabilitative Services

Treatment Plan

80%

Periodic Site Review of referred veteran files for treatment plan.

Therapeutic and Rehabilitative Services

Group Service

80%

Periodic Site Review of program attendance documentation.

Random Sampling

Therapeutic and Rehabilitative

Services

Individual Counseling

Periodic Site Review of documentation of individual counseling sessions.

Random Sampling

4.3

VA Coordination Collaboration

2.2.4.1 Absences

Contractor shall communicate regularly with VA staff to ensure proper coordination of care, services and resources for the benefit of the veteran. Included a brief summary of veterans progress and current status at the time of discharge.

Communication shall also occur promptly in the event of an incident at the contractor site including if veteran is absent from services.

Periodic review with VA staff on communication and Site data review on discharge data.

Random Sampling

Facility

4.8.2 Fire and Safety, Health Codes

Periodic VA and Site review.

5.

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

a.

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

Invoicing

Collaboration b.

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

Referral Training Referrals Treatment Plan Individual Counseling Fire Safety

Nutrition/Food Service c.

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.)

Reporting and Consumer Satisfaction d.

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.)

Veteran Safety e.

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

Referral

Training

Treatment Plan

Group Counseling

Individual Counseling f.

Analysis of contractor's progress reports.

Veteran outcomes and self reporting of satisfaction with services and treatment.

6.

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:

7.

DOCUMENTING PERFORMANCE

a.

ACCEPTABLE PERFORMANCE (100% Rating) The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

b.

UNACCEPTABLE PERFORMANCE (70% Rating) When unacceptable performance occurs, the COTR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COTR shall document the discussion and place it in the COTR file.

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

8.

Frequency of Measurement a.

Frequency of Measurement.

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

b.

Frequency of Performance Assessment Meetings.

The COTR shall meet with the contractor quarterly to assess performance and shall provide a written assessment.

Signature – Contractor Program Manager

Signature – Contracting Officer’s Technical Representative

Attachments:

1. Contract Performance Report

Contract Discrepancy Report

Attachment 1

Contract Performance Report

1.

Contract Number: <insert number> 2.

Prepared by: (Name of COTR) Patrick Maher 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.>

5.

Performance Rating (in accordance with QASP, paragraph 6):

Signature – Contracting Officer’s Technical Representative Date

Attachment 2 Contract Discrepancy Report (CDR) TO: (Contractor Program Manager or onsite representative) <insert name> FROM: (Name of COTR) 1.

Contract Number: <insert number> 2.

Date and time observed discrepancy:

3.

Discrepancy/Problem/Issue:

4.

Corrective action plan:

5.

A written corrective action plan <is/is not> required. <If a written corrective action plan is required include the following.> The written Corrective Action Plan will be provided to the undersigned not later than <# days after receipt of this CDR.>

Signature – Contracting Officer’s Technical Representative Date

Received by:

Signature – Contracting Program Manager or Onsite Representative Date

Distribution:

<Name & Title - Contracting Officer>

SHAPE \* MERGEFORMAT

<The COTR may initiate a CDR at any time, including whenever the number of monthly recorded defects for a performance standard exceeds the allowable number of defects; anytime unacceptable performance is determined critical in nature and requires formal corrective action; and whenever an unfavorable trend is detected in contractor performance.>