Attach J-21 ModelCDACSubcontract.doc

Section J, Attachment J-21 Model

SUBCONTRACT

BETWEEN [QIO] AND BUCCANEER DATA SERVICES, LLC

“Abstraction of Clinical Data from Medicare Beneficiary Medical Records as Required by Section 1154 of the Social Security Act”

ARTICLE I – PARTIES TO THE AGREEMENT

This subcontract agreement is entered into between [Insert Name of Quality Improvement Organization], as the prime contractor, herein after referred to as ‘the QIO (Quality Improvement Organization), and Buccaneer Data Services, LLC, as the subcontractor, herein after referred to as ‘the CDAC’ (Clinical Data Abstraction Center). This subcontract agreement is entered into in accordance with the terms and conditions of the QIO’s and CDAC’s prime contract with the Centers for Medicare & Medicaid Services (CMS) which are incorporated by reference.

ARTICLE II - PURPOSE

The CDAC shall obtain Medicare beneficiary medical records from providers on behalf of the QIO and abstract clinical data from the records as required by CMS for the purpose as set forth in section 1154 of the Social Security Act. However, the CDAC shall not perform any QIO review functions as identified in section 1154. The specific administrative activities to be performed for the QIO by the CDAC are described in Attachments 1.

ARTICLE III - PAYMENT FOR SERVICES

For administrative efficiencies, payment for all services performed by the CDAC as part of this subcontract shall be reimbursed by the requestor of the services. The services to be reimbursed are described in Attachment 1.

ARTICLE IV - DURATION OF AGREEMENT

The period of performance for this subcontract shall be from the date of signing until the completion date of the QIO's contract with CMS or the completion date of the CDAC contract with CMS, whichever comes first. This agreement may be extended, modified, or terminated by CMS upon written notice to the signatory parties. In the event that CMS terminates the CDAC, or directs the QIO to terminate the CDAC subcontract, costs flowing from the termination shall be reimbursed by CMS to the extent allowable under the prime contracts with CMS. In the event that CMS determines that some or all of the CDAC's termination costs are unallowable, the QIO shall have no legal obligation to pay such costs to the CDAC. If the CDAC disagrees with CMS's determination, it may seek to recover such costs pursuant to the Disputes clause of its contract with CMS.

ARTICLE V - QIO DATA CONFIDENTIALITY REQUIREMENTS

The information contained in the Medicare beneficiary medical records is confidential information and is protected and restricted by Section 1160 of the Social Security Act and the implementing regulations at 42 Code of Federal Regulations part 480. The CDAC shall ensure the confidentiality and security of medical record information and data through the abstraction process, from receipt of the medical records by the CDAC to release or destruction of the medical records in accordance with the preceding provisions. The CDAC shall consider all medical records and clinical data abstracted as QIO data, and as such, this data is not releasable, except as provided by statute and implementing regulations.

All issues related to disclosing/releasing QIO data shall not be acted upon by the CDAC but shall promptly be referred to [Insert Name of QIO contact].

ARTICLE VI - PERFORMANCE DISAGREEMENTS

Disagreements related to CDAC and/or QIO performance activities in this subcontract, which cannot be resolved between the QIO and the CDAC, should be brought to the attention of the CMS CDAC Project Officer, the QIO Project Officer and the appropriate Contracting Officer(s) for resolution. The CDAC and the QIO must proceed diligently with performance of the subcontract pending resolution of the disagreement by CMS. If the resolution proposed by CMS is not satisfactory to both parties, CMS may decide to provide an opportunity for the parties to seek a resolution using an agreed upon Alternative Disputes Resolution process (ADR).

If a performance disagreement results in a QIO or a CDAC incurring financial liability, the QIO or the CDAC may request financial relief from the CMS Contracting Officer to the extent allowable under their respective prime contracts with CMS. In the event that either party (QIO or CDAC) is dissatisfied with the CMS Contracting Officer decision, either party may seek resolution through the Disputes clause contained in the respective prime contract with CMS.

ARTICLE VII - SIGNATURES

For the QIO:

Typed

Name

Signature

Title

Chief Executive Officer or Executive Director

Date

For the CDAC:

Typed

Name

Signature

Title

CDAC Project Director

Date

ATTACHMENT 1 -- STATEMENT OF WORK

A.

Clinical Data Abstraction

The CDAC shall request medical records on behalf of the QIO from Medicare providers. The CDAC shall abstract clinical data from the medical records or another source as required by its CMS prime contract and/or the QIO. These data shall be collected using the CMS approved data abstraction application/tool. The clinical data shall be collected by the CDAC and distributed appropriately to each QIO through QNet exchange unless otherwise directed by CMS Project Officer or CMS shall direct the CDAC to distribute the data directly to another party authorized by CMS.

B.

Medical Record Status Alerts

If requested, the CDAC will provide the QIO with information regarding non-receipt of requested medical records as described in CMS contract HHSM-500-2006-00032C. The QIO/CDAC point of contact for this activity is found below in part C.

C.

Requests for Medical Record Status

If the QIO requests a verbal or electronic response to a medical record status inquiry, the CDAC shall respond within 1 business day of the inquiry. If the QIO is requesting a written response, the CDAC shall respond within 5 business days of the inquiry. The contacts for medical record status requests are:

Name or Position Title Tel Number

For the QIO:

Information Systems POC:

For the CDAC:

D.

Miss-Mailed Medical Records or Photocopying/Mailing Vouchers from Hospitals

Mail intended for the QIO or the CDAC, which is miss-mailed by a provider, shall be forwarded to the correct party within 5 business days of receipt.

E.

Mailing Medical Records

In accordance with CMS contract HHSM-500-2006-00032C, some of the medical records that the CDAC abstracts shall be mailed to the QIO. These records shall be mailed by the CDAC to the QIO in accordance with the schedule established by the QIO, CMS and the CDAC.

F.

Verification and Payment of Hospital Incurred Photocopying/Mailing Expenses

For states other than waiver states, the CDAC shall reimburse providers for costs of photocopying and either reimburse or provide postage for the mailing of medical records that are received by the CDAC. For informational purposes, the CDAC shall provide the QIOs that request the information, with a monthly report reflecting the expenses paid to providers for medical records photocopying and mailing.

The QIO shall maintain an up to date list of providers in PRS.

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