36C26119Q1026-005.docx

D.1 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

The contractor will be evaluated in accordance with the following:

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.

*Note. The QASP is not a part of the contract. Its sole use is to monitor contractor performance.

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:

Organization or Agency: Network Contracting Office (NCO) 21

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:

Organization or Agency: VA Central California Health Care System

3. CONTRACTOR REPRESENTATIVES

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

a. Program Manager - Enter name, if any

b. Other Contractor Personnel - Enter name(s) of the providers.

4. PERFORMANCE STANDARDS

The contractor is responsible for performance of ALL terms and conditions of the contract. CORs will provide contract progress reports quarterly to the CO reflecting performance on this plan and all other aspects of the resultant contract. The performance standards outlined in this QASP shall be used to determine the level of contractor performance in the elements defined. Performance standards define desired services. The Government performs surveillance to determine the level of Contractor performance to these standards.

The Performance Requirements are listed below in Section 6. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the standard and assign a rating. At the end of the performance period, these ratings will be used, in part, to establish the past performance of the contractor on the contract.

5. 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. Direct observation shall be performed periodically or through 100% surveillance. Analysis of the referral paperwork and Veterans health care record which is sent by referring parties, including interagency, and self-referrals. Analysis of the entry and exit reports sent to the COR from the Contractor. (Evaluates outcomes on a quarterly basis)

· Total Number of Veterans Served

· Discharge Outcomes (e.g. # or % of veterans discharged to more stable housing, increased income/ benefits, occupancy, etc.)

b. PERIODIC INSPECTION. Inspections scheduled and reported annually per COR delegation or as needed.

c. VALIDATED USER/CUSTOMER COMPLAINTS. Complaints from veterans served, and agency personnel shall be passed to the Contractor’s quality control inspector (QCI) for correction.

d. RANDOM SAMPLING. Verification and/or documentation provided by Contractor. The contractor shall be expected to utilize nightly sign-in bed logs for the purpose of verifying a Veteran’s attendance in the program on a daily basis. These logs are to be submitted to the VA Liaison monthly, along with invoices reflecting total bed nights for a given month and the corresponding amount that the Contractor is owed, to ensure accuracy in billing practices. All excused and unexcused absences will be clearly documented on the monthly attendance log including reason for any excused absence (e.g. medical needs). No payment will be made without the nightly sign-in bed logs and invoice having first been approved by the identified VA Liaison or designee.

6. PERFORMANCE MEASURES

Performance measures are comprised of performance indicators (some characteristic of a deliverable that can be measured) and performance measures (a mark, measure or benchmark that government personnel use as a point of comparison when evaluating contractor performance). The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these measures.

Perform Outreach at VA or community sites 3 x per month to ensure appropriate occupancy and document outreach efforts

· Sign-in logs

· Informal review of outreach events

The Government may, at its discretion, choose any time, announced or unannounced, to have VA personnel inspect the Contracted Program’s records.

Increased Income (eligible Veterans): Contracted Program will provide counseling on means and methods to increase Veteran income through a variety of avenues such as SSI, NSC pension, GA and employment opportunities. Counseling may be performed internally or externally.

Counseling or referral records must be kept for both internal counseling and for meetings Veterans participate in off-site.

Employment assistance:

Contracted Program will provide a referral to EDD and assist Veteran by providing a job search log with leads when available.

1. 100% of eligible Veterans will be referred for NSC pension, SSI benefits, and any other financial benefits.

2. 100% of eligible Veterans will be referred for employment

3. 50% of Veterans will have a Financial Plan developed within 90 days of admission

4. 50% of Veterans will participate in ongoing financial planning groups or individual case management with a focus on increasing income

· Care Plan reviews

· Records of Bank Statements

· Award letters from SSI and VA

The Government may, at its discretion, choose any time, announced or unannounced, to have VA personnel inspect the Contracted Program’s records.

5. 50% of Veterans will participate in employment related activities, such as job fairs, resume writing workshop with a focus on obtaining employment.

Case Management:

Contracted Program will provide individual case management and/or professional counseling, including counseling on stabilizing housing, increasing income and increased access to medical /mental health treatment through the VA or other agencies. The goals of case management may also focus on developing successful living patterns, maintaining an acceptable level of personal hygiene and grooming, and achieving a more adaptive level of psychosocial functioning, upgraded social skills, and improved personal relationships.

1. 100% of Veterans who remain in the program 72 hrs will have an intake and written Care Plan.

2. 75% of Veterans will engage in individual case management meetings 3 x per month; all Care Plans are documented in the client’s file.

· Care Plan reviews

· Interview with Veterans

The Government may, at its discretion, choose any time, announced or unannounced, to have VA personnel inspect the Contracted Program’s records.

Group Activities:

Examples include permanent housing search groups, financial management classes, group therapy, social skills training, Alcoholics Anonymous, Narcotics Anonymous, vocational counseling and physical activities as appropriate. The focus of these groups will be to provide Veterans assistance in developing successful living patterns, maintaining an acceptable level of personal hygiene and grooming, and to achieving a more adaptive level of psychosocial functioning, upgraded social skills, and improved personal relationships.

· Care Plan reviews

The Government may, at its discretion, choose any time, announced or unannounced, to have VA personnel inspect the Contracted Program’s records.

Permanent Housing Education provided to Veterans regarding how to obtain low cost housing

1. 75% of Veterans will be educated about how to obtain a free credit report

2. 75% of Veterans will be educated about “”Tenant Portfolio”

3. 75% of Veterans will participate in educational activities 2 x per month

Discharge Planning:

Contracted Program’s case managers will provide assistance with discharge planning for every Veteran. Housing needs will be assessed within five days of admission and resources coordinated for discharge to a successful community placement. Securing permanent housing will be the discharge goal for every Veteran.

1. 95% of Veterans will have their housing needs assessed and documented within 5 days of admission.

2. 75% of Veterans will be provided permanent housing search options and education at least twice per month. Such searches may take place during, or in addition to, case management meetings. These housing searches will be documented in the charts of clients.

· Care Plan reviews

· Interview with Veterans

· Review of monthly activity calendar

· NEPEC data

The Government may, at its discretion, choose any time, announced or unannounced, to have VA personnel inspect the Contracted Program’s records.

VA Coordination:

Contracted Program will provide collaboration with the VA program staff by conducting a meeting 2-4 times per month. These meetings will be held by Contracted Program Staff and VA program staff to discuss how to coordinate services to clients enrolled in the program, outreach needs, and program development. In addition to working collaboratively with VA clinical staff, the Contracted Program will submit accurate billing to VA Payment Center by the 7th of each month.

Procedure for daily accountability: Veterans to sign in daily during their stay for accountability. Sign- in sheets to be verified by program staff, signed and returned to VA staff for billing verification. Procedure for intakes:

No admissions will be approved without consent of VA Liaison who will determine eligibility of Veteran prior to admission.

1) ROI to be signed and eligibility determined by VA staff prior to admission

2) Admission information to be provided to VA staff within 24 business hours of admission. Confirmation email and paperwork to be faxed.

Procedure for discharges:

VA staff to be notified of discharge within 24 business hours. Confirmation email followed by discharge paperwork.

Unexcused Absence:

Veterans MUST be discharged after 24 hours if they have not received prior approval to leave program for that timeframe. Case

1. VA staff will document meetings with contract program staff and keep any notes in administrative file.

2. Contracted Program will submit accurate billing to the VA Payment Center by the 7th of each month.

3. 95% of Veterans admitted will have prior approval by VA Staff

4. 100% will have signed ROI in case management files

5. 100% of Veterans sign in daily to receive payment for that day

6. 85% of Veterans who are discharged will be reported to the VA within 24 business hours of discharge

7. 100% of all Veterans discharges will have HOMES discharge paperwork completed within 72 business hours of discharge

8. 100% of critical incidents related to assault, suicidality and death will be reported within 24 business hours

9. 90% of all other critical incidents are to be reported to VA Staff within 24 business hours

· SOW compliance

· BEPEC data

· Review of incident reports

· Review of HR documentation (CPRS)

· Invoices

· Sign-in logs

· Documentation in Care Plan

· Care Plan reviews

The Government may, at its discretion, choose any time, announced or unannounced, to have VA personnel inspect the Contracted Program’s records.

managers will inform VA staff of any unexcused absence within 24 business hours.

Excused Absences:

Veterans may be granted an excused absence on a case by case basis. Payment will only be made for the first 48 hours of an excused absence. Excused absences are defined as hospitalization, incarceration, visit to family, work related issue pre-approved. Any excused absence after 24 business hours will not be billed to the VA. Unexcused absences are not paid for by the VA.

Incident Reporting:

Program staff to report to VA staff incidents within 24 business hours.

Timeliness of Response Contractor will have a dedicated phone line for VA . Return calls from the program are expected within 4 hours during business hours Monday through Friday.

INCIDENTS DEFINED AS:

Falls Assault (to Vet or Staff) Elderly/Dependent Adult Abuse or Neglect Sexual Assault Fire- Patient involved Medical Emergency- 911 Calls Hospitalization Sexual Assault Suicide Suicide Attempt Homicide Death Infectious control (bed bugs, TB, etc.)

Active Substance Abuse Observation/Possession of weapons

7. CPAR RATINGS ASSIGNED TO QASP ITEMS:

Metrics and methods are designed to determine rating for a given standard and acceptable quality level. The following ratings shall be used (Reference: CPARS User Manual https://www.cpars.gov/pdfs/CPARS- Guidance.pdf p. A2-1):

Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Note: To justify an Exceptional rating, you should identify multiple significant events in each category and state how it was a benefit to the GOVERNMENT. However, a singular event could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.

Note: To justify a Very Good rating, you should identify a significant event in each category and state how it was a benefit to the GOVERNMENT. Also, there should have been NO significant weaknesses identified.

Note: To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract. Also, there should have been NO significant weaknesses identified.

Note: To justify Marginal performance, you should identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the GOVERNMENT. A Marginal rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g. Management, Quality, Safety or Environmental Deficiency Report or letter).

Note: To justify an Unsatisfactory rating, you should identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the GOVERNMENT. However, a singular problem could be of such serious magnitude that it alone constitutes an unsatisfactory rating. An Unsatisfactory rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g. Management, Quality, Safety or Environmental Deficiency Reports, or letters).

8. DOCUMENTING PERFORMANCE

a. The Government shall document positive and/or negative performance. Any report may become a part of the supporting documentation for any contractual action and preparing annual past performance using CONTRACTOR PERFORMANCE ASSESSMENT REPORT (CPAR).

b. If contractor performance does not meet the Acceptable Quality level, the CO shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the CO shall document the discussion and place it in the contract file. When the COR and the CO determines formal written communication is required, the COR shall prepare a Contract Report (CR), and present it to CO. The CO will in turn review and will present to the contractor's program manager for corrective action.

c. The contractor shall acknowledge receipt of the CR in writing. The CR 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 CR will also state how long after receipt the contractor has to present this corrective action plan to the CO. The Government shall review the contractor's corrective action plan to determine acceptability. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance and the acceptability of the Contractor’s corrective action plan.

d. Any CRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO. See Sample CR on the following page.

9. COR AND CONTRACTOR ACKNOWLEDGEMENT OF QASP

SIGNED:

COR NAME/TITLE DATE

SIGNED:

CONTRACTOR NAME/TITLE DATE

CONTRACT REPORT

5. DATES

6. Issue Identified (Describe in detail. Include reference to PWS Directive; attach continuation sheet if necessary.)

10. CONTRACTOR RESPONSE AS TO CAUSE AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable quality control program procedures or new procedures. Attach continuation sheet(s) if necessary.)

11. SIGNATURE OF CONTRACTOR REPRESENTATIVE

Date:

12. GOVERNMENT EVALUATION.

13. GOVERNMENT ACTIONS

14. CLOSE OUT

CONTRACTOR NOTIFIED

COR

CONTRACTING OFFICER