36C26318Q9634-002.docx

QUALITY ASSURANCE SURVEILLANCE PLAN

For: Minneapolis VAHCS WHEELCHAIR SERVICES Contract Number: TBD (Upon award, Government will enter contract number) Contract Description: Wheelchair Van Service Contractor’s name: TBD (Upon award, Government will enter Contractor identification)

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: TBD Organization or Agency: Department of Veterans Affairs, VHA

b. Contracting Officer’s Representative (COR) - The COR is responsible for 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: Matthew Anderson

c. Other Key Government Personnel: Administrative Contracting Officer, TBD

3. CONTRACTOR REPRESENTATIVES

The following employees of the contractor serve as the Contractor’s Program Manager for this contract.

a. Program Manager – Enter Name after award

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 Government shall use the matrix below to determine Contractor performance and shall compare Contractor performance to the Acceptable Quality Level (AQL).

MVAHCS GROUND AMBULANCE SERVICE MATRIX

assessment for each person listed on the ambulance service Annual signed proficiency statement for each person on file performed by Medical Director or designee

continuing education or advanced training for all drivers and medical personnel Periodic enrollment as required by local and state government but shall not be more than 2 years

Quality Control Plan Service Request log Annually review the call log for service request information as required by the Contractor’s Quality Plan specified in the Statement of Work.

incidents must be investigated, confirmed All incidents are investigated, confirmed and resolved within 1 week

5. INCENTIVES

The Government shall use Acceptable Past Performance Rating 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 in the above matrix chart for the administration of this QASP.

a. PERIODIC INSPECTION. (Evaluates outcomes on a periodic basis. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.) ID number 1, 2, 3, 4, 5, and 6

b. VALIDATED USER/CUSTOMER COMPLAINTS. (Relies on the patient to identify deficiencies. Complaints are then investigated and validated.)

c. 100% INSPECTION. (Evaluates all outcomes.) ID number 7

7. 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:

See percentage AQL level in matrix for acceptable performance. Less than stated percentage is considered unacceptable.

8. 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.

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 semi-annually to assess performance and shall provide a written assessment.

<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