Attachment G.11 - DRAFT_QASP_2021_08_13.pdf

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

TEMPLATE

Issued: November 11, 2016

TABLE OF CONTENTS

INTRODUCTION

Purpose Performance Management Approach Performance Management Strategy

ROLES AND RESPONSIBILITIES

The Contracting Officer The Contracting Officer’s Technical Representative

IDENTIFICATION OF REQUIRED PERFORMANCE STANDARDS/QUALITY LEVELS

METHODOLOGIES TO MONITOR PERFORMANCE

Surveillance Techniques Customer Feedback Acceptable Quality Levels

QUALITY ASSURANCE DOCUMENTATION

The Performance Management Feedback Loop Monitoring Forms

ANALYSIS OF QUALITY ASSURANCE ASSESSMENT

Determining Performance Reporting Reviews and Resolution

PERFORMANCE REQUIREMENTS SUMMARY

ATTACHMENT 2: SAMPLE QUALITY ASSURANCE MONITORING FORM

QUALITY ASSURANCE SURVEILLANCE PLAN

(QASP)

INTRODUCTION

This quality assurance surveillance plan (QASP) is pursuant to the requirements listed in the performance work statement (PWS) entitled [insert name of services]. This plan sets forth the procedures and guidelines [insert name of government monitoring/surveillance activity] will use in ensuring the required performance standards or services levels are achieved by the contractor.

Purpose The purpose of the QASP is to describe the systematic methods used to monitor performance and to identify the required documentation and the resources to be employed. The QASP provides a means for evaluating whether the contractor is meeting the performance standards/quality levels identified in the PWS and the contractor’s quality control plan (QCP), and to ensure that the government pays only for the level of services received.

This QASP defines the roles and responsibilities of all members of the integrated project team (IPT), identifies the performance objectives, defines the methodologies used to monitor and evaluate the contractor’s performance, describes quality assurance documentation requirements, and describes the analysis of quality assurance monitoring results.

Performance Management Approach The PWS structures the acquisition around “what” service or quality level is required, as opposed to “how” the contractor should perform the work (i.e., results, not compliance). This QASP will define the performance management approach taken by [insert name of program office/monitoring activity] to monitor and manage the contractor’s performance to ensure the expected outcomes or performance objectives communicated in the PWS are achieved.

Performance management rests on developing a capability to review and analyze information generated through performance assessment. The ability to make decisions based on the analysis of performance data is the cornerstone of performance management; this analysis yields information that indicates whether expected outcomes for the project are being achieved by the contractor.

Performance management represents a significant shift from the more traditional quality assurance (QA) concepts in several ways. Performance management focuses on assessing whether outcomes are being achieved and to what extent. This approach migrates away from scrutiny of compliance with the processes and practices used to achieve the outcome. A performance-based approach enables the contractor to play a large role in how the work is performed, as long as the proposed processes are within the stated constraints. The only exceptions to process reviews are those required by law (federal, state, and local) and compelling business situations, such as safety and health. A “results” focus provides the contractor flexibility to continuously improve and innovate over the course of the contract as long as the critical outcomes expected are being achieved and/or the desired performance levels are being met.

Performance Management Strategy The contractor is responsible for the quality of all work performed. The contractor measures that quality through the contractor’s own quality control (QC) program. QC is work output, not workers, and therefore includes all work performed under this contract regardless of whether the work is performed by contractor employees or by subcontractors. The contractor’s QCP will set forth the staffing and procedures for self-inspecting the quality, timeliness, responsiveness, customer satisfaction, and other performance requirements in the PWS. The contractor will develop and implement a performance management system with processes to assess and report its performance to the designated government representative.

The contractor’s QCP will set forth the staffing and procedures for self-inspecting the quality, timeliness, responsiveness, customer satisfaction, and other performance requirements in the PWS. This QASP enables the government to take advantage of the contractor’s QC program.

1.3.2 The government representative(s) will monitor performance and review performance reports furnished by the contractor to determine how the contractor is performing against communicated performance objectives. The government will make determination regarding incentives based on performance measurement metric data and notify the contractor of those decisions. The contractor will be responsible for making required changes in processes and practices to ensure performance is managed effectively.

ROLES AND RESPONSIBILITIES

The Contracting Officer The contracting officer (CO) is responsible for monitoring contract compliance, contract administration, and cost control and for resolving any differences between the observations documented by the [insert title of government authority for performance management:

"contracting officer's representative (COR)," "contracting officer's technical representative (COTR)," "administrative contracting officer (ACO)," "quality assurance representative (QAR),” or "program manager (PM)"] and the contractor. The CO will designate one full-time [insert COR, COTR] as the government authority for performance management. The number of additional representatives serving as technical inspectors depends on the complexity of the services measured, as well as the contractor’s performance, and must be identified and designated by the

CO.

The Contracting Officer’s Technical Representative The contracting officer’s technical representative (COTR) is designated in writing by the CO to act as his or her authorized representative to assist in administering a contract. COTR limitations are contained in the written appointment letter. The COTR is responsible for technical administration of the project and ensures proper government surveillance of the contractor’s performance. The COTR is not empowered to make any contractual commitments or to authorize any contractual changes on the government’s behalf. Any changes that the contractor deems may affect contract price, terms, or conditions shall be referred to the CO for action. The COTR will have the responsibility for completing QA monitoring forms used to document the inspection and evaluation of the contractor’s work performance. Government surveillance may occur under the inspection of services clause for any service relating to the contract.

IDENTIFICATION OF REQUIRED PERFORMANCE STANDARDS/QUALITY LEVELS

The required performance standards and/or quality levels are included in the PWS and in Attachment 1, “Performance Requirements Summary.” [Adjust the following sentences to reflect the instant acquisition.] If the contractor meets the required service or performance level, it will be paid the monthly amount agreed on in the contract. If the contractor exceeds the service or performance level, it is eligible to receive an incentive or award fee as stated in the contract.

Failure to meet the required service or performance level will result in a deduction from the monthly amount.

METHODOLOGIES TO MONITOR PERFORMANCE

Surveillance Techniques In an effort to minimize the performance management burden, simplified surveillance methods shall be used by the government to evaluate contractor performance when appropriate. The primary methods of surveillance are (include those that apply) Random monitoring, which shall be performed by the COTR/COR designated inspector.

100% Inspection – Each month, the COTR/COR, shall review the generated documentation and enter summary results into the Surveillance Activity Checklist.

Periodic Inspection – COTR/COR typically performs the periodic inspection on a monthly basis.

Customer Feedback The contractor is expected to establish and maintain professional communication between its employees and customers. The primary objective of this communication is customer satisfaction.

Customer satisfaction is the most significant external indicator of the success and effectiveness of all services provided and can be measured through customer complaints.

Performance management drives the contractor to be customer focused through initially and internally addressing customer complaints and investigating the issues and/or problems but the customer always has the option to communicate complaints to the [insert CO, COR, COTR], as opposed to the contractor.

Customer complaints, to be considered valid, must set forth clearly and in writing the detailed nature of the complaint, must be signed, and must be forwarded to the COTR/COR. The COTR/COR will accept those customer complaints and investigate using the Quality Assurance Monitoring Form – Customer Complaint Investigation, identified in Attachment 3.

Customer feedback may also be obtained either from the results of formal customer satisfaction surveys or from random customer complaints.

Acceptable Quality Levels The acceptable quality levels (AQLs) included in Attachment 1, Performance Requirements Summary Table, for contractor performance are structured to allow the contractor to manage how the work is performed while providing negative incentives for performance shortfalls. For certain critical activities such as those involving [insert names of any critical services], the desired performance level is established at 100 percent. Other levels of performance are keyed to the relative importance of the task to the overall mission performance at [insert name of government activity receiving services].

QUALITY ASSURANCE DOCUMENTATION

The Performance Management Feedback Loop The performance management feedback loop begins with the communication of expected outcomes. Performance standards are expressed in the PWS and are assessed using the performance monitoring techniques shown in Attachment 1.

Monitoring Forms The government’s QA surveillance, accomplished by the [insert COR, COTR, ACO, QA, or PM], will be reported using the monitoring forms in Attachments 2 and 3. The forms, when completed, will document the government’s assessment of the contractor’s performance under the contract to ensure that the required results [insert service or quality levels] are being achieved.

The [insert COR, COTR, ACO, QAR, or PM] will retain a copy of all completed QA surveillance forms.

ANALYSIS OF QUALITY ASSURANCE ASSESSMENT

Determining Performance Government shall use the monitoring methods cited to determine whether the performance standards/service levels/AQLs have been met. If the contractor has not met the minimum requirements, it may be asked to develop a corrective action plan to show how and by what date it intends to bring performance up to the required levels. [insert when appropriate:

Failure to meet the AQL may result in a deduction from the monthly payment, using the deduction percentages shown in Attachment 1. Likewise, if the contractor exceeds the performance standards, an incentive or award fee will be paid, in accordance with the incentive fee or award fee plan included in the contract.]

Reporting At the end of each month, the [insert title of person who will prepare the report – COR, COTR, ACO, QAR, or PM] will prepare a written report for the [insert title of government representative responsible for overall monitoring of performance – COR, COTR, ACO, QAR, or PM] summarizing the overall results of the quality assurance surveillance of the contractor’s performance. This written report, which includes the contractor’s submitted monthly report and the completed quality assurance monitoring forms (Attachment 2), will become part of the QA documentation. It will enable the government to demonstrate whether the contractor is meeting the stated objectives and/or performance standards, including cost/technical/scheduling objectives.

Reviews and Resolution

The [insert title of government representative responsible for overall monitoring of performance – COR, COTR, ACO, QAR, or PM] may require the contractor’s project manager, or a designated alternate, to meet with the [insert CO, ACO, COR, COTR, QAS, or PM] and other government IPT personnel as deemed necessary to discuss performance evaluation. The [insert CO, ACO, COR, COTR, QAR, or PM] will define a frequency of in-depth reviews with the contractor, including appropriate self-assessments by the contractor;

however, if the need arises, the contractor will meet with the [insert COR, COTR, ACO, QAR, or PM] as often as required or per the contractor’s request. The agenda of the reviews may include:

Monthly performance assessment data and trend analysis Issues and concerns of both parties Projected outlook for upcoming months and progress against expected trends, including a corrective action plan analysis Recommendations for improved efficiency and/or effectiveness [insert if appropriate: Issues arising from the performance monitoring processes]

The QAR must coordinate and communicate with the contractor to resolve issues and concerns regarding marginal or unacceptable performance.

The [insert COR, COTR, ACO, QAR, or PM] and contractor should jointly formulate tactical and long-term courses of action. Decisions regarding changes to metrics, thresholds, or service levels should be clearly documented. Changes to service levels, procedures, and metrics will be incorporated as a contract modification at the convenience of the PCO/ACO.

ATTACHMENT 1. PERFORMANCE REQUIREMENTS SUMMARY

Required Services

Tasks/Deliverabl es

Performance Standards

Acceptabl e Quality

Levels

Methods of

Surveillance

Incentive (Positive and/or Negative)

(Impact on Contractor Payments)

Section: …… Monthly Report - Submit a monthly report of scheduled, completed, and outstanding tasks for each task within the task order PWS.

Additionally per each task total core and hours beyond core worked in addition to leave taken will be identified. Reports shall be provided no later than 7 days upon conclusion of the month for which services were received.

100% of reports accurately depict current status for each service within the task order PWS

100% of reports are received timely.

95% File/Project/Documenta tion reviews, periodic inspections, and random, observations, customer complaints submitted via Contract Discrepancy Report

(CDR).

Positive Incentive:

Satisfactory record of task order performance in Contractors Performance and Assessment Review System (CPARS).

Negative Incentive:

Issuance of CDR

Unsatisfactory record of task order performance in

CPARS.

Section:…. Recorded and/or transcribed meeting notes to at a minimum include date, time, participants, meeting minutes, and follow-up items for each meeting.

Meeting notes shall be provided no later than 1 day after the meeting.

100% of meeting notes whereas the meeting addressed all required talking points and accurately.

100% of reports are received timely.

100% File/Project/Documenta tion reviews, periodic inspections and random, observations, customer complaints submitted via Contract Discrepancy Report

(CDR).

Positive Incentive:

Satisfactory record of task order performance in Contractors Performance and Assessment Review System (CPARS).

Negative Incentive:

Issuance of CDR

Unsatisfactory record of task order performance in

CPARS.

Performance Objective

PWS Para. Performance Threshold Surveillance Method

Defect and Remedy

1. Operation and Management

C.3.1 CCE

Contract Management

C.3.14 Deliverables

Responsiveness of communication:

acknowledge requests and provide initial responses by the next business day

Timely submission and quality of deliverables:

submit high-quality products within the provided timeframe

Timely reporting of budget spent and projection that is consistent with invoices submitted for cost reimbursement

Transition report

Routine and random review correspondence and deliverables records.

Thorough review of budget reports and invoice, with supporting documents (including staffing list, quarterly and monthly).

Two (2) late responses or rejection of invoices during a six (6)-month period will lower the contractor performance rating.

Three (3) late submissions per six

(6) months will require a corrective action plan.

2. Pharmacy Benefits Management

(PBM)

C.3.6 Pharmacy Benefits Management

Operations Manual reflects the appropriate protocols and procedures to be in compliance with the Program’s Administrative Manual on managing the pharmacy benefit.

Prior authorizations for pharmacy products are appropriately justified and recorded for audit.

Transition report

Review of the Operations Manual for the pharmacy management section.

Random records review to verify administrative record of member eligibility for specific pharmacy benefits

Thorough review of contract deliverables and reports supporting invoicing:

- PBM section of the Operations Manual (initial and annual updates)

- Monthly and semi-annual reports supporting the infrastructure cost for PBM.

Absence of an appropriate pharmacy management section in the Operation Manual requires an immediate corrective action plan.

Absence of records indicating appropriate member-specific pharmacy utilization review and approval requires immediate correction and ongoing process quality auditing.

3. Member’s Valid Complaints about Care, C.3.7 Member Services

WTC Health Program should receive no more than two (2) valid*

Transition report

Monthly Report

Three (3) valid complaints per six (6) months will lower the

Services or Staff complaints from members about contractor performance during a quarter.

*“Valid” means that WTC Health Program has sought input from the contractor and confirmed that the complaint is real and has merit.

Random records review contractor performance rating.

Six (6) valid complaints per six (6) months will require a corrective action plan.

NIOSH will apply this standard with consideration to the size of the member population.

4. Intensive Case Management Services

C.3.7 Intensive Case Management and Care Coordination

Intensive Case Management (ICM) Operations Plan is aligned with Program’s definition of Intensive Case Management

- Current (within 4 months) Plan of Care is on file for each member receiving ICM services review for member-specific Plan of Care for members receiving ICM services

Thorough review of contract deliverables and reports supporting invoicing:

- ICM

Operations Plan (initial and annual updates)

Monthly and semi-annual reports supporting the infrastructure cost for ICM

Absence of the ICM Operations Plan requires an immediate corrective action plan.

Absence of a Plan of Care for a member receiving ICM services requires correction and assurance of appropriate internal process QA.

Trend of invoicing for ICM services that are not sufficiently supported will result in a corrective action plan

5. Maintain Monitoring Exam Provider Network

C.3.4 Healthcare Provider Network

Ensure all service-rendering providers are appropriately credentialed and trained, and are enrolled in the WTC Health Program’s Provider Network before NPN approves claims for submission.

The NPN shall maintain a current list of providers and no more than 1% of claims shall be denied due to the

Transition report

Overpayment recovery report

Random monitoring/ periodic inspection as agreed upon between contractor and WTC Health Program

Credentialing and training records

Any failure to meet the QA check is immediately rectified by the NPN. Two (2) consecutive reports of failing to meet the QA measure will result in a corrective action plan and/or lower performance rating.

provider not being enrolled due to NPN error.

Denied claims records due to providers not enrolled.

6. External Provider Network Adequacy

C.3.4 Health care Provider Networks

Each month, a minimum of 90% of NPN members will have to travel no more than 30 miles to the closest provider and a minimum of 95% of national members will have to travel no more than 75 miles to the closest provider.

Mileage will be calculated based on contractor’s process which is the shortest distance on available roadways.

Overpayment recovery report

Claims records Member complaints Random records review

Two consecutive reports below the performance standard may require a written corrective action plan approved by the Program.

Failure to meet the performance standards as specified in the agreed-upon corrective action plan may result in a lower contractor performance rating.

7. Provide Summary Reports to Physical Exam Physicians

C.3.2 Monitoring and Initial Health Evaluations

The contractor shall ensure that the physician who conducts the physical examination always has a copy of the summary report in time to review it before conducting the responder’s physical examination. This shall be met a minimum of 99% of the time.

Transition report

Random monitoring/ periodic inspection as agreed upon between contractor and WTC Health Program.

Two consecutive reports below the performance standard may require a written corrective action plan approved by the Program.

Failure to meet the performance standards as specified in the agreed-upon corrective action plan may result in a lower contractor performance rating.

8. HIPAA

Compliance and Business Associate Agreement

C.3.8.2 HIPAA

Compliance and Business Associate Agreement

All incidents (suspected breaches) by either the NPN or their subcontractors will be reported to the CO, COR, and WTC Health Program HIPAA Privacy and Security Officers within 10 business days of discovery 100% of the time. The NPN shall institute controls to ensure there is no more than one (1) incident a quarter. HIPAA training for employees required

Transition report

Member complaints

100% inspection and random monitoring/ periodic inspection

Random records review

One (1) or more high/medium risk incident(s) or two (2) or more late incident reports within a quarter may require a corrective action plan and/or lower performance rating.

An excessive number of incidents of any risk level within a calendar year may require a corrective action plan and/or lower performance annually at minimum. rating. .

9. Controlling the Use of Diagnostic Services

C.3.2.

Monitoring and Initial Health Evaluations

The Contractor shall comply with Program policy, procedure, and technical guidance regarding the use of the “diagnostic plan” for medical and pharmacy services outside of treating a certified health condition 100% of time.

Transition report

Random monitoring/ periodic inspection as agreed upon between contractor and WTC Health Program

Claim records

If any of the three (3) performance thresholds are not met for two (2) consecutive reports, it will result in a lower performance rating. If two (2) of the performance thresholds are not met in a reporting period, a corrective action plan is required.

10. Acquiring previous medical records

C.3.2 Monitoring and Initial Health Evaluations

Each month, request signature of members for needed medical records release forms 100% of the time;

request records from previous providers within three (3) days of contractor receiving properly completed and signed release form (copies are acceptable) 98% of the time; follow-up with previous providers within 15 days 98% of the time.

Transition report

Random monitoring/ periodic inspection as agreed upon between the contractor and WTC Health Program

If any of the three (3) performance thresholds are not met for two (2) consecutive reports, it will result in a lower performance rating. If two (2) of the performance thresholds are not met in a reporting period, a corrective action plan is required.

11. Transfer Process Turnaround Time

C.3.7.9 Member Transfers

95% of transfers shall be completed within 30 days

Transition report

Member complaints performance standard may require a written corrective action plan approved by the Program.

Failure to meet the performance standards as specified in the agreed-upon corrective action plan may result in a lower contractor performance rating.

12. Initial Exam Appointment Turnaround Time

C.3.2 Monitoring and Initial Health Evaluations

75% of initial exams (IHE for new survivors or initial monitoring for overdue transfers) shall occur within 6 months of the member being

Transition report

Steering Committee Report on Retention

Two consecutive reports below the performance standard may require a written corrective action plan approved deemed eligible for program participation.

For calculation purposes, this shall include those members who have completed the initial exam, not counting those members who decline or delay services, or for which the contractor has made no contact after a minimum of 6 contact attempts within the 60 days.

by the Program.

Failure to meet the performance standards as specified in the agreed-upon corrective action plan may result in a lower contractor performance rating.

13. Monitoring Exam Appointment Turnaround Time

C.3.2 Monitoring and Initial Health Evaluations

65% of monitoring exams shall occur no later than 18 months from the member’s last exam date. For calculation purposes, this shall include those members who have completed the exam, not counting those members who decline or delay services, or for which the contractor has made no contact after a minimum of 6 contact attempts within the 60 days.

Transition report

Steering Committee Report on Retention

Two consecutive reports below the performance standard may require a written corrective action plan approved by the Program.

Failure to meet the performance standards as specified in the agreed-upon corrective action plan may result in a lower contractor performance rating.

14. Member Certification Notification Turnaround Time

C.3.2 Monitoring and Initial Health Evaluations

95% of members shall be notified within 5 business days of certification decision

Transition report

Member complaints

Claim records performance standard may require a written corrective action plan approved by the Program.

Failure to meet the performance standards as specified in the agreed-upon corrective action plan may result in a lower contractor performance rating.

15. Treatment and Diagnostic Appointment Turnaround Time

C.3.3 Cancer Screening, Diagnostic and Treatment Services

For members electing to receive treatment, 90% of initial appointments shall occur within 45 days of

Transition report

Member complaints performance standard may require a written corrective acquiring member availability. For calculation purposes, this will exclude appointments made by the contractor to accommodate members’ schedules that result in scheduling beyond 30 days.

Claim records action plan approved by the Program.

Failure to meet the performance standards as specified in the agreed-upon corrective action plan may result in a lower contractor performance rating.

16. Review, approve, and submit the appropriate claims

C.3.5 Claims Submission and Payment

The Timely Filing Limits for claims submitted from external providers will be:

* 15 months for claims without Coordination of Benefits [COB] (previously 12 months)

* 18 months for claims with COB (previously 15 months) Internal Claims The TFLs for claims submitted from internal providers will be:

* For non-COB claims:

(1) 95% submitted within 3 months of the dates of service (previously 30 days)

(2) 100% submitted within 6 months of the dates of service (previously 60 days)

* 18 months for claims with COB (previously 15 months) Guidance

Overpayment recovery report

Random monitoring/ periodic inspection as agreed upon between the contractor and WTC Health Program

Random records review

TFLs are intended to ensure that all claims are submitted within specified time frames in order for the WTC Health Program to track health care expenditures for budget planning. If claims are submitted after the TFLs, the claims will be denied.

An appeal to override the TFL may be approved in limited circumstances however, these appeals create inefficiency in claims processing. WTC Health Program will track, by contractor

Two consecutive reports below the performance standard may require a written corrective action plan approved by the Program.

Failure to meet the performance standards as specified in the agreed-upon corrective action plan may result in a lower contractor performance rating.

Claims which the government approves an override for Timely Filing will not be counted against this performance objective.

submission, TFL override appeals to determine if corrective action plans are needed.

17. Claims Processing Turnaround Times

C.3.5 Claims Submission and Payment

Clean claims will be submitted to the HPS processor within 10 days of receipt a minimum of 99% of the time. For disputed claims (claims requiring manual review), claims will be submitted to the claims processor within 30 days of receipt a minimum of 99% of the time.

Transition report

Overpayment recovery report

Random records review

Two consecutive reports below the performance standard may require a written corrective action plan approved by the Program.

Failure to meet the performance standards as specified in the agreed-upon corrective action plan may result in a lower contractor performance rating.

18. COB C.3.5 Claims Submission and Payment

The contractor will apply COB to diagnostic and treatment claims as appropriate for Survivors in the NPN.

Transition report

Overpayment recovery report

Monthly claims dashboard

Random records review

Trend of claim submissions for services where COB has not been performed will result in a corrective action plan

19. Member Services Inquiry Response Rate

C.3.1.7 Quality Assurance and Internal Audits

The contractor shall respond to member services inquiries within 2 business days 95% of the time and within 10 days 99% of the time.

Transition report

Member complaints

Random records review

Two consecutive reports below the performance standard may require a written corrective action plan approved by the Program.

Failure to meet the performance standards as specified in the agreed-upon corrective action plan may result in a lower contractor performance rating.

20. Submit Fraud Waste and Abuse Report

C.3.1.6 Fraud, Waste and Abuse

The semi- annual Fraud Waste and Abuse Report shall be submitted no later than 30 days from the end of the quarter 100% of the

Transition report

Member complaints

Random

One (1) late submission per twelve (12) months will require an immediate corrective action plan.

time records

21. Conduct Quality Assurance Internal Audits

C.3.1.7 Quality Assurance and Internal Audits

Internal quality assurance audit approaches align with an approved and current Quality Assurance Plan (QAP) are aligned with Program’s guidance and Administrative Manual.

The findings from Technical Guidance for Quality Assurance and Internal Audits and Summary of Services and Requirements Selected for Inspection shall be reported semi-annually within 45 days from the end of the reporting period.

Transition report

Site assessment Ongoing monitoring and evaluation

Thorough review of contract deliverables and semi-annual report

Random records review

Absence of the QAP requires an immediate corrective action plan.

One (1) late submission per twelve (12) months will require an immediate corrective action plan.

22. FECA and Medicare rates

C.3.3 Diagnostic and Treatment Services

Provide representative samples of claims for professional claims that document the costs billed versus the cost paid FECA. The goal is to monitor the cost and ensure cost-control and within Program’s guidelines.

Transition report

Random records review

Lack of documentation and sufficient quality control requires an immediate corrective action.

One (1) late submission per reporting period will require an immediate corrective action plan.

ATTACHMENT 2: SAMPLE QUALITY ASSURANCE

MONITORING FORM

SERVICE and STANDARD:

SURVEY PERIOD:

SURVEILLANCE METHOD (Check):

Random Sampling 100% Inspection Periodic Inspection Contract Discrepancy Report (CDR).

LEVEL OF SURVEILLANCE (Check):

Monthly Quarterly As needed

PERCENTAGE OF ITEMS SAMPLED DURING SURVEY PERIOD: ______ %

ANALYSIS OF RESULTS:

Observed Service Provider Performance Measurement Rate: ______% Service Provider’s Performance (Check): Meets Standards Does Not Meet Standards Narrative of Performance During Survey Period:

PREPARED BY: ___________________________________ DATE: _________________