Attachment J-5a QASP TMEP2 DRAFT.pdf

HT9402-26-R-0001 TMEP2

Quality Assurance Surveillance Plan 1 August 2026

Defense Health Agency

Quality Assurance Surveillance Plan (QASP) TRICARE Medicare Eligible Program 2nd Generation

(TMEP2)

Contract Number: HT9402-26-R-0001

1. Purpose

This Quality Assurance Surveillance Plan (QASP) is a government-determined document used to determine if the contractor’s performance meets the performance standards contained in the contract.

The QASP establishes procedures on how the assessment/inspection process will be conducted and provides the detailed process for continuous oversight, including:

What will be monitored How monitoring will take place

Who will conduct monitoring How monitoring efforts and results will be documented

The contractor is responsible for implementing and delivering performance that meets contract standards using its Internal Quality Management (QM)/Quality Improvement (QI) Program Plan (CDRL P010). This QASP provides the structure for the Government’s surveillance of the contractor’s performance and their actions to assure contract standards are met. It is the Government’s responsibility to be objective, fair, and consistent in evaluating contractor performance.

This QASP is not part of the contract, nor is it intended to duplicate the contractor’s QM/QI Program Plan. This QASP is a living document. Flexibility in the QASP is required to allow for an increase or decrease in the level of surveillance necessary based on contractor performance.

The Government will provide a copy of the QASP to the contractor to facilitate open communication. In addition, this QASP should recognize that unforeseen or uncontrollable circumstances might occur that are outside the control of the contractor.

2. Authority

Authority for issuance of this QASP is provided under Part 46 of the Federal Acquisition Regulation, Inspection of Services clauses, which provides for inspection, acceptance and documentation of the service called for in the contract or order. This acceptance is to be executed by the contracting officer or a duly authorized representative.

3. Roles and Responsibilities

The following personnel shall oversee and coordinate surveillance activities.

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 ensure that the contractor receives impartial, fair, and equitable treatment under this contract.

The CO shall also determine the final assessment of the contractor’s performance.

Additionally, the CO shall include a requirement in the quality assurance surveillance plan to revalidate all key personnel annually to determine whether the contractors meet the labor categories specified in the contract.

The CO shall maintain documentation in the contract files that demonstrates their review and approval of initial and replacement contractor employees in key personnel positions.

The CO shall include a requirement in information technology service contracts QASPs to review a sample of non‑key personnel quarterly to determine whether the contractor personnel meet the labor categories specified in the contract.

Contracting Officer’s Representative (COR) – The COR is responsible for providing continuous technical oversight of the contractor’s performance. The COR uses the QASP to conduct the oversight/surveillance process. The COR shall keep a Quality Assurance file that accurately documents the contractor’s actual performance. The purpose is to ensure that the contractor meets the performance standards contained in the contract. The COR is responsible for reporting early identification of performance problems to the CO.

The COR is required to provide an annual performance assessment to the CO which will be used in documenting past performance. The QASP is the primary tool for surveillance of the contractor’s quality program and helps the COR to document contractor performance. The COR is not empowered to make any contractual commitments or to authorize any contractual change on the Government’s behalf.

4. Performance Requirements and Method of Surveillance

4.1. Contract Surveillance

The goal of the QASP is to ensure that contractor performance is effectively monitored and documented. The COR’s contribution is their professional, non-adversarial relationships with the CO and the contractor, which enables positive, open and timely communications. The foundation of this relationship is built upon objective, fair, and consistent COR evaluations of contractor performance against contract requirements. The COR uses the methods contained in this QASP to ensure the contractor is in compliance with contract requirements. The COR function is responsible for a wide range of surveillance requirements that effectively measure and evaluate the contractor’s performance. Additionally, this QASP is based on the premise that the contractor, not the government, is responsible for management and actions to successfully meet the terms of the contract.

4.2. Surveillance Matrix

The attached Surveillance Matrix provides the list of performance objectives and standards that must be performed by the contractor (see Attachment J-5). This matrix details the method of surveillance the COR will use as well as frequency to validate and inspect these performance elements. Inspection of each element will be documented in the COR’s file.

DFARS 222.17 mandates Government surveillance to ensure contractor compliance with Combatting Trafficking in Persons (CTIP). The CTIP sample checklist from PGI 222.17 will be used for surveillance. See the DoD CTIP website for more details.

Performance objectives define the desired outcomes. Performance Standards define the level of service required under the contract to successfully meet the performance objective. The inspection methodology defines how, when, and what will be assessed in measuring performance. The Government performs surveillance, using this QASP, to determine the quality of the contractor’s performance as it relates to the performance element standards.

4.3. Performance Rating Definitions

The performance ratings below reflect definitions at FAR 42.1503 Table 42-1. The COR will use these ratings to evaluate the quality of contractor’s performance.

Performance

Rating Definition

Exceptional Performance meets contractual requirements and exceeds many to the government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory Performance does not meet most contractual requirements, and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Note 1: Plus or minus signs may be used to indicate an improving (+) or worsening (-) trend insufficient to change the evaluation status.

Note 2: N/A (not applicable) should be used if the ratings are not going to be applied to a particular area for evaluation.

4.4. Methods of Surveillance

The methods of evaluating contractor compliance may vary depending on the tasks specified by the contract. The COR is responsible for selection of the method(s) to be used and the specific detailing of the methods(s). In determining the evaluation method, the COR should consider what the contract specifically calls for, how performance can be observed, and if the method of surveillance is adequate to assure the required level of performance has been achieved. In making this determination, the COR will also consider the contractor’s QM/QI Program Plan.

This section describes the available methods to be used in verifying the contractor’s compliance with the contract requirements. Periodic (scheduled or non-scheduled) performance assessments will be accomplished utilizing a combination of assessment methods and metrics as identified in Appendix 1 that contains performance objectives, performance indicators, and frequencies and monitoring methods extracted from the sections of the contract. The Government will employ the various surveillance methods described below.

4.4.1. Contractor Self Reporting

The Government will use the contractor’s reports as part of its surveillance process for monitoring the performance of contract requirements. The content, format, and frequency of reports to be generated by the contractor are described in the Contract Data Requirements Lists (CDRLs) and in the TRICARE Manuals. The Contractor is responsible for notifying the Government of any self-identified issues and risks to contract performance.

4.4.2. Periodic Performance Reviews

Open and frequent communication between the Government and the contractor is essential for successful performance. Interaction between the two parties is a key as aspect of contract monitoring. Various types of performance reviews will be utilized to keep performance on course, measure performance levels, monitor existing issues, and make adjustments as necessary. Performance reviews will also contribute to maintaining contractor focus on critical program areas. Performance reviews include various types of communication:

Operational Meetings: Recurring or Ad Hoc meetings with Government resources and the contractor’s counterparts, to monitor operations, identify emerging issues and track issue resolution.

Contract Briefings/Program Reviews: Meetings with Government CO, COR(s) and appropriate contractor leadership to perform a comprehensive review of contractor performance, discuss contractual issues, and provide updates on the major issues and corrective actions. The Government will identify specific agenda items, but the contractor may offer suggestions. These meetings will be held in person to the greatest extent possible, to foster engagement and communication between the Government and the contractor.

The exact frequency and format of these meetings will be determined by the Government based on contractual and programmatic needs, in consultation with the contractor.

4.4.3. Customer Input

The Government may receive customer (e.g. beneficiaries, internal Government staff) input about the quality of services performed under the contract. These inputs maximize the Government’s resource potential and are considered in regular assessments as they may identify contractor process improvement opportunities or required corrective actions.

The Government will validate any input before corrective action is required by the contractor.

4.4.4. Government Reporting

Government reports will also be utilized to monitor performance of contract requirements and verify data self-reported by the contractor. Such Government reports will be used in the assessment of contractor performance where indicated in Section H and for any other uses identified by the Government.

4.4.5. Government-Conducted Audits

To verify the data, provide in the contractor’s reports and review other aspects of performance, the Government will conduct periodic audits over the duration of the contract. Such audits may be performed at the contractor’s place of performance or virtually, with the contractor providing the relevant information required for the audit.

Audits may be conducted as a routine aspect of monitoring contractor performance or in response to specific issues identified through other surveillance methods.

4.4.6. Other Government Contractors

The DHA will use the results of review/audit activities conducted by other Government contractors to assist in monitoring performance of this contract. These review/audit activities include but are not limited to:

a) Claims Audit Review Services, as described in Section H of the contract.

Review results include the number of claims with payment errors and other types of processing or reporting errors.

4.4.7. Incentive Calculations

Contract includes several positive and negative incentives for managing contract performance. These are assessed by reviewing the associated data and performing calculation as described in Section H.

4.4.8. Performance Guarantees

The Contract includes several Performance Guarantees. These will be evaluated and assessed based on the Surveillance Matrix and Section H.

5. Performance Reporting

5.1. Corrective Action Report (CAR)

Describes how discrepancies are reported and resolved (see sample CAR).

5.2. Customer Complaint Form

(See sample customer complaint form).

5.3. Performance Assessment Report (PAR)

(See sample customer PAR).

CORRECTIVE ACTION REPORT (CAR)

(If more space is needed, use reverse and identify by number)

1. CONTRACTOR 2. CONTRACT NUMBER 3. TYPE OF SERVICES

4. FUNCTIONAL AREA 5. SUSPENSE DATE 6. CONTROL NUMBER

7. DEFICIENCY MAJOR MINOR

FINDING:

FINDING IMPACT:

Please respond with a written corrective action plan that details the corrective action of the cited deficiency, the cause of the deficiency, and actions taken to prevent recurrence by Suspense Date in Block 5. If date was not entered in Block 5, the contractor is not required to provide a response.

8. QUALITY ASSURANCE PERSONNEL (COR)

TYPED NAME AND GRADE

SIGNATURE AND DATE

9. ISSUING AUTHORITY

TYPED NAME AND GRADE

SIGNATURE AND DATE

10. COR RESPONSE TO CONTRACTOR CORRECTIVE ACTION AND ACTION TAKEN TO PREVENT RECURRENCE

11. COR DETERMINATION

ACCEPTED REJECTED

12. CLOSE DATE

CUSTOMER COMPLAINT RECORD

DATE/TIME OF COMPLAINT

SOURCE OF COMPLAINT

ORGANIZATION BUILDING NUMBER INDIVIDUAL PHONE NUMBER

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE/TIME CONTRACTOR INFORMED OF COMPLAINT

ACTION TAKEN BY CONTRACTOR

RECEIVED/VALIDATED BY

PERFORMANCE ASSESSMENT REPORT (PAR)

(If more space is needed, use reverse and identify by number)

1. CONTRACT/TASK ORDER NUMBER 2. CONTRACTOR 3. TYPE OF SERVICES

4. QUALITY ASSURANCE PERSONNEL (COR) SIGNATURE AND DATE

5. COR PHONE

6. SUSPENSE DATE

I. PERFORMANCE

7. DEFICIENCY (CHECK ALL BOXES THAT APPLY)

NEW

REPEAT

NO DEFICIENCY NOTED

8. SERVICES SUMMARY or PWS PARAGRAPH ITEM REVIEWED

9. BRIEF DESCRIPTION OF DEFICIENCY (IF DEFICIENCY BOX WAS

CHECKED)

10. DETAILED PERFORMANCE ASSESSMENT

II. CONTRACTOR VALIDATION

11. CONTRACTOR REPRESENTATIVE CONCUR NON-CONCUR 12. CORRECTIVE ACTION ESTIMATED COMPLETION DATE

13. CONTRACTOR REPRESENTATIVE CORRECTIVE ACTION AND PREVENTION OF RECURRENCE OR REASON FOR NON-CONCURRENCE OF

COR CITED DEFICIENCY

III. ACTION CORRECTED

14. CONCUR NON-CONCUR COR SIGNATURE AND DATE

15. COR REMARKS (REQUIRED)

16. CONTRACTOR REPRESENTATIVE REMARKS