ATT002 - SurvivorCCE_QASP_final_v3.docx

World Trade Center (WTC) Health Program Quality Assurance Surveillance Plan (QASP) Publish Date: Month Day, Year Most Recent Revision Date: Month Day, Year

I. Introduction This performance-based Quality Assurance Surveillance Plan (QASP) sets forth the procedures and guidance that the World Trade Center Health Program (”Program”) will use in evaluating the technical performance of the corresponding Performance Work Statement (PWS), contract no. [CONTRACT ID] (the “Contract”), in accordance with the terms and conditions of the Contract.

II. Objective The purpose of this QASP is to serve as a proactive tool for the Program to evaluate the quality of [AWARDED VENDOR]’s (the “Contractor”) performance during Sustainment and to help identify, avoid, and mitigate unacceptable or deficient contractor performance. This document provides a framework and methodology for the Program to evaluate the quality of the Contractor's performance, including the performance of any and all agents or subcontractors. The information provided in this QASP identifies minimum acceptable quality levels (AQLs) to be consistently maintained by [AWARDED VENDOR] throughout the period of performance after Start of Healthcare Delivery (SHCD). Not every PWS task has a corresponding performance standard in the QASP, and some performance standards in the QASP are associated with more than one PWS task.

This QASP describes the structure of the Program’s surveillance activities of contractor performance during the period of sustainment. Sustainment is defined as starting after Start of Healthcare Delivery and continuing through transition-out, until the start of healthcare delivery of the successor contract. The QASP details how and when the Program will monitor, evaluate, and document key tasks of contractor performance. Though the QASP highlights key performance indicators that will be monitored on a regular basis, the Program will also perform additional surveillance activities to ensure adherence to all PWS requirements, including for those that do not have a corresponding QASP metric.

The primary goals of this QASP are to:

· Bring structure and organization to the Program’s monitoring and surveillance of key tasks/services and deliverables under the above contract;

· Indicate key tasks and deliverables that will be regularly assessed against established performance standards;

· Establish AQLs;

· Describe the evaluation methods and processes that will be used by the Program during surveillance activities; and

· Guide the Program’s surveillance efforts to ensure acceptable performance by the Contractor.

This QASP will be used to assist in monitoring contractor activities and during inspection and acceptance of contract deliverables. The QASP is intended to be a “living” document and reviewed as performance warrants The Program may propose to change elements of the QASP throughout the lifetime of the contract. Any such proposed changes would be communicated by the Program to the Contractor and formalized through a contractual modification.

This QASP sets forth the minimum performance standards and AQLs for the Contractor, focusing on the assessment of whether the Contractor achieves desired outcomes relative to contract requirements. In contrast, the Contractor’s Quality Assurance Plan in the Contract Management Plan (CMP) and the Contractor’s Quality Assurance chapter of the Operations Manual describe how the Contractor will ensure quality of services at or above the AQLs.

If a QASP AQL or performance standard of the contract is not met, the Contractor is expected to propose, upon request from the Contracting Officer Representative (COR) or Contracting Officer, a corrective action plan (CAP) to improve performance to meet the relevant AQL. The CAP shall include the Contractor personnel responsible for implementing the CAP; a description of the activities and steps the Contractor is undertaking to improve performance to meet the relevant AQL; the timeline and milestones for CAP activities; the resources required for the CAP; and reporting cadence and format on CAP activities. The Contracting Officer Representative (COR) and Program will review the proposed CAP. Upon the Government’s approval of the CAP, the COR or Contracting Officer will provide written approval to the Contractor. Thereafter, the Contractor shall implement the CAP upon receipt of COR or Contracting Officer approval of the Contractor’s CAP. If and once the Contractor’s performance is improved under the CAP to meet the relevant AQL or performance standard of the contract, the Government may, at its discretion, consider the CAP complete and closed. The Government reserves the right to require another CAP should performance for a QASP metric subsequently fail again to meet the relevant AQL following the implementation and completion of an earlier CAP.

If a QASP AQL or performance standard of the contract is not met, the Contractor’s deficient performance will be documented in the Contractor’s Contractor Performance Assessment and Reporting System (CPARS) performance evaluation. Positive performance will also be similarly documented in its CPARS evaluation.

III. QASP Elements

a. Performance Standard The performance standard column describes the Program’s quality expectations of the Contractor in performing the tasks listed in the Performance Work Statement.

Though the Program recognizes that some tasks will be performed exclusively by the Contractor’s agents and subcontractors, all contractor performance will be evaluated holistically such that the Prime Contractor is responsible for all performance outcomes.

b. Acceptable Quality Levels (AQLs) AQLs are the minimum performance threshold(s) that the Program will accept for each outlined performance standard. The Contractor shall meet AQLs and performance standards of the contract. Services that fail to meet the relevant AQL are nonconforming.

In accordance with paragraph (a) of the clause at Federal Acquisition Regulation (FAR) section 52.246-5, Inspection of Services-Cost-Reimbursement, incorporated by reference in Section I of the Contract, the Government may require reperformance of nonconforming services at no additional fee to the contract. If reperformance will not correct the defects or is not possible, the Government may seek an equitable fee reduction or adequate consideration for acceptance of nonconforming services, in addition to any other rights and remedies available to the Government.

c. Surveillance Method The Program will oversee the Contractor’s adherence to AQLs through various methodologies including but not limited to; sampling, documenting, testing, and reporting reviews; formal evaluations, reviews, and assessments (FERAs); and general observation. The frequency of surveillance is at the Government’s discretion; frequency is determined based on the relative risks in potential contractor non-compliance. Periodic sampling may also be leveraged during ad hoc reviews, where a sample is taken when a problem/deficiency is suspected.

Primary methods of QASP surveillance include, but are not limited to, the following:

· Observation: Program assesses and observes contract performance in real time.

· Periodic Inspection: Program reviews data available to the Program and evaluates outcomes on a periodic basis.

· Contractor Reporting: Contractor provides data related to the performance standard, and the Program reviews the Contractor’s reporting to determine if the AQL is met.

The performance standards, acceptable quality levels, and methods of surveillance outlined in the tables below will support the Program in its assessment of contractor performance during the Sustainment phase starting after Start of Healthcare Delivery (SHCD) and continuing through transition-out, until the start of healthcare delivery of the successor contract.

1. CONTRACT AND SYSTEM MANAGEMENT

PWS Reference(s): Section 4.2; Section 4.9

4.9.1

Contractor Reporting

2. MEMBER SERVICES

PWS Reference(s): Section 4.5

3. HEALTH BENEFIT ADMINISTRATION

PWS Reference(s): Section 4.6

a) 1+ times within the first four weeks of assignment to the CCE and

b) 3+ times within the first three months of assignment to the CCE.

4.6.1

Contractor Reporting

a) Usage of Program’s current WTC-3 form Positive attestation of disease-exposure linkage, with signature and date within 60 days of submission to the Program.

4. CARE COORDINATION AND CASE MANAGEMENT

PWS Reference(s): Section 4.7

100% of Case Manager outreach attempts occur within maximum outreach timeline.[footnoteRef:4] [4: As of January 2025, standard outreach timelines are 1-2 weeks and maximum outreach timelines are 1-2 months. Refer to the Program’s Case Management acuity requirements for current timelines. ]

Contractor Reporting

Random Sampling

4.3

100% of referrals are made to providers who are in the CCE Provider Network.

Contractor Reporting Periodic Inspection Random Sampling

5. CLAIMS SUBMISSION AND PAYMENT

PWS Reference(s): Section 4.8

a) Within 6 months for claims that don’t require COB

b) Within 12 months for claims that require COB[footnoteRef:6] [6: Program Requirements for Coordination of Benefits can be found in the Policy and Procedures for Coordination of Benefits for Treatment Costs for Non-Work-Related, Certified WTC-Related Health Conditions: Coordination with Health Insurance at https://www.cdc.gov/wtc/policies.html#payer-guidance. ]

99% of external provider claims are approved, denied, or pended within 10 business days of being posted in the claims portal and 99% of pended claims are resolved within 30 business days from the pend date.

Periodic Inspection

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