Attachment J.19 - Quarterly Staffing Report Template.xlsx
XLSX spreadsheet 19 KB Posted
- Solicitation number
- 75D301-22-R-72142
About this file
This document includes a quarterly staffing report template and details of a solicitation for the World Trade Center Health Program Clinical Centers of Excellence. The staffing report template requires contractors to submit vacancy and new hire information on a quarterly basis, including start dates, facility codes, billing categories, employee names, and subcontractor status.
The solicitation seeks proposals to establish and operate Clinical Centers of Excellence to provide healthcare services to 9/11 responders and survivors. Services include contract management, quality assurance, member services and outreach, care coordination and case management, program communications, administering healthcare like monitoring and treatment, and coordinating benefits with other insurance. Proposers must collect and maintain clinical and operational data. The cost-reimbursement contracts are for a minimum of five years. The agency will use a best-value tradeoff method and anticipates making award by January 2023. Questions must be submitted by email template only.
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Text version
Sheet1 Quarterly Staffing Report for Option Period: XXXX Dates (xx/xx/xx - xx/xx/xx)
| Contract #: (enter contract number) Fringe Rate_______ Approved FTE_____ | ||||||||||
| Note: List vacancies at the top of the spreadsheet, followed by New Hires in Red text, and list subcontractors at bottom of spreadsheet | ||||||||||
| Start Date | Vacancy Date | Facility | Activity Codes | WTC Billing Labor Category | Employee Name | Sub-Contractor (Y/N) | Salary | % of Effort | Comments | |
| 0 |
Sheet2
| Activity Code | WTC Billing Labor Category | |
| 4.1 Contract Management (Directors only for this activity) | Administrative Assistant | |
| 4.1.1 Training | Administrative Coordinator | |
| 4.1.1.1 Training Reporting | Benefits Coordinator | |
| 4.1.2 Staffing Requirements | Case Management | |
| 4.1.2.1 Staffing Report and Wages Report | Claims/Billing Manager | |
| 4.1.3 Coordination and Participation | Claims/Billing Specialist | |
| 4.1.4 Change Request (CR), Documentation, and Control Log | Clinic Manager | |
| 4.1.5 Technical Guidance Document Compliance | Data Analyst | |
| 4.1.6 Records Management | Deputy Director | |
| 4.1.7 Risk and Issue Management | Director | |
| 4.1.8 Fraud Waste and Abuse Compliance | Finance Specialist | |
| 4.1.9 Quality Assurance Plan | yes | Information Technology |
| 4.1.9.1 Quality Assurance Internal Audit Report | no | Medical Assistant |
| 4.2 Systems | Medical Records Coordinator | |
| 4.2.1.2 Member Records | Member Services Coordinator | |
| 4.2.2 Cost Tracking and Invoicing | Member Services Manager | |
| 4.2.3 Operations Manual | Nurse | |
| 4.3.1 Member Services | Nurse Manager | |
| 4.3.2 Member Enrollment and Initial Contact | Pharmacist | |
| 4.3.3 Member Retention | Physician | |
| 4.3.4 Transfers | Physician Assistant | |
| 4.3.5 Disruptive member and Member in Crisis Protocol | Project Coordinator | |
| 4.3.6 Benefits Counseling | Psychiatrist | |
| 4.3.6.1 Social Benefits Functions | Psychologist | |
| 4.3.6.2 Assistance with Workers Compensation and other Healthcare Benefits | Pulmonologist | |
| 4.3.7 Communication | Quality Assurance | |
| 4.3.7.1 Translation and Interpretive Services | Revised Title | |
| 4.3.7.2 Retention Activities for Current Members | Social Worker | |
| 4.3.7.3 Outreach and Education for Prospective Members | ||
| 4.3.7.4 Establish Formal Mechanism for Consulting with Representative of Eligible Populations | ||
| 4.3.8 Administering Health Benefits | ||
| 4.3.8.1 Responsibilities of the Medical Director | ||
| 4.3.8.1.1 External Providers | ||
| 4.3.8.2 Responsibilities of the Mental Health Director | ||
| 4.3.8.3 Monitoring and Initial Health Evaluations | ||
| 4.3.8.3.1 Initial Health Evaluations | ||
| 4.3.8.3.2 Annual Monitoring Exam | ||
| 4.3.8.3.3 General Administration for AME/IHE | ||
| 4.3.8.4 Diagnostic Services | ||
| 4.3.8.6 Cancer Screening | ||
| 4.3.8.7 Certifications | ||
| 4.3.9 Medical Treatment for Certified Conditions | ||
| 4.3.9.1 Authorization of Services | ||
| 4.3.9.3 Prior Authorization] | ||
| 4.3.9.4 CCE Medical Reviews | ||
| 4.3.9.5 Medical Appeals | ||
| 4.3.9.6 Telehealth Services | ||
| 4.3.9.7 Disaster Preparedness and Public Health Emergencies | ||
| 4.4 Comprehensive Care Management (do not use, select sub-category) | ||
| 4.4.1 Case Management and Care Coordination | ||
| 4.4.1.1 Intensive Case Management | ||
| 4.4.2 Utilization Management | ||
| 4.4.3 Inpatient Hospital stays | ||
| 4.4.4 Lifestyle Medicine | ||
| 4.5 Claims submission and Payment | ||
| 4.5.1 Legally allowable fee schedule | ||
| 4.5.2 Billing for Health Plan Benefits | ||
| 4.5.3 Claims Appeals | ||
| 4.5.4 Coordination of Benefits (Survivor Cohort Only) | ||
| 4.6 Pharmacy Services | ||
| 4.6.1 Member Education | ||
| 4.6.2 Covered Medication and Restrictions | ||
| 4.6.3 Review of Data | ||
| 4.6.4 Compliance with State and Federal Law | ||
| 4.6.5 Retrospective Reviews and Reporting | ||
| 4.6.6 Pharmacy Benefits Quality Assurance and Reporting | ||
| 4.7.1 Provider Network | ||
| 4.7.2 Licensing and Insurance | ||
| 4.8 Transitioning Out | ||
| 5.1 Data Management Plan | ||
| 5.2 Data Transfer | ||
| 6 Performance Metrics | ||
| 6.1 Quality Assurance Surveillance Plan | ||
| 9 Deliverables | ||
| 10 Subcontracting | ||
| 11 HIPAA COMPLIANCE AND BUSINESS ASSOCIATE AGREEMENT | ||
| 12 Information Security | ||
| 12.1 Adequate Security | ||
| 12.2 Cyber Incident Reporting Requirement | ||
| 12.3 Cyber Incident Report | ||
| 12.4 Media Preservation and Protection | ||
| 12.5 Audit and Accountability (information security) | ||
| 12.6 Information Security Continuous Monitoring | ||
| 12.7 Access to Additional Information or Equipment Necessary for Forensic Analysis | ||
| 12.8 Cyber Incident Damage Assessment Activities | ||
| 12.9 CDC/NIOSH Safeguarding and Use of Contractor Attributional/Proprietary Information (do not use) | ||
| 12.1 Use and Release of Contractor Attributional/Proprietary Information Not Created By or For CDC/NIOSH (Do not use) | ||
| 12.11 Use and Release of Contractor Attributional/Proprietary Information Created By or For CDC/NIOSH (do not use) | ||
| 12.12 Use and Release of Contractor Attributional/Proprietary Information Created By or For CDC/NIOSH (do not use) | ||
| 12.13 Other Safeguarding or Reporting Requirements | ||
| 12.14 Subcontracts |
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