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<SPECIAL PROJECT LETTERHEAD>
<SPECIAL PROJECT LOGO>
KIDNEY COMMUNITY EMERGENCY RESPONSE (KCER) PROGRAM
MONTHLY STATUS REPORT – <MONTH> <YEAR>
| Contract Name: <NAME> | Reporting Period: <Month> <Year> | | | |
| Project Director: | | <NAME> | Date Submitted: | <Month Date>, <Year> |
| CEO, ESRD Program: | | <NAME> | | |
| CMS Contracting Officer: | <NAME> | | | |
Issues Needing Executive Intervention
· Ex. Currently, there are no items identified that need executive intervention.
Key Accomplishments Performed during the Period
· Ex. Planned and facilitated an Annual KCER Summit in conjunction with CMS Quality Net Conference.
Key Milestones for Next Period
· Ex. [Date] Provided presentation and exhibited at the national HHS/ASPR meeting
| STATUS KEY |
| TREND FROM PREVIOUS MONTH |
| Controlled |
| Caution |
| Critical |
| Not Started |
| Complete |
| Improved |
| Stable |
| Declined |
| None/minor issues or risks; proceeding as planned |
| At risk; plan in place to avoid getting off track or pending a CMS decision |
| Off track; needs intervention |
| Project has not started as of yet; not applicable |
| All deliverables within the subtask have been completed |
| Improving and expected to remain so |
| No changes but not expected to need escalation outside of project team |
| Worsening and may need executive intervention to resolve |
Overall Contract Performance Assessment
| Topic |
| Status/ Trend |
| Comments and Concerns |
Overall Status & Trending
Contract Management
| Topic |
| Status/ Trend |
| Comments and Concerns |
Overall Contract Management
Scope Adherence
Contract Team Communication
Contract Change Management
Contract Budget
Deliverables (list for reporting month)
| Subtask |
| Deliverable # |
| Date Submitted |
| Date Approved by COR |
| Details/Comments |
Individual Task Assessment
Task 1 – National Lead for the KCER Program
Subtask 1.A. Develop, Implement, Maintain, and/or Enhance the Existing Infrastructure of the KCER Program to Ensure Efficient and Effective Operations
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 1.B. Develop and Implement a Strategic Plan
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 1.C. Internal Quality Control Program
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 1.D. Establish KCER Team and Committee Structure
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Task 2 – Foster Patient and Family Engagement in Emergency/Disaster Planning and Management at the National Level
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 2.A. Develop and Recruit Members for a National KCER Patient and Family Engagement Learning and Action Network (N-KPFE-LAN)
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 2.B. Convene the N-KPFE-LAN
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Task 3. Emergency and Disaster Education/Technical Assistance for ESRD Networks, Dialysis Facilities, and Patients
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 3.A. Provision of Emergency and Disaster Education/Technical Assistance for ESRD Networks
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 3.B. Provision of Emergency and Disaster Education/Technical Assistance for Dialysis Facilities
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 3.C. Provision of Emergency and Disaster Education/Technical Assistance for Dialysis Patients
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 4. KCER Responsibilities for Emergency/Disaster Management
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 4.A. KCER Responsibilities in the Hazard Mitigation and Preparedness Phase
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 4.B. KCER Responsibility in the Emergency/Disaster Response Phase
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 4.C. KCER Responsibilities in the Emergency/Disaster Recovery Phase
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Task 5. Treatment and Medicine Recall Notification
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Task 6. Maintain a Centralized Website for the KCER Program
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 6.A. Internet Presence—Maintaining Government Standards
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 6.B. Establish, Maintain, and Enhance an Emergency/Disaster Resource Library—Facilitate Exchange of ESRD Network, Dialysis Facility, and Patient Information, Tools, Resources, and Other Materials
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Task 7. Plan and Facilitate a National KCER Summit
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 7.A. Establish a Planning Committees
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 7.B. Development and Implementation of KCER Summit
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 7.C. Evaluation of KCER Summit
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Subtask 7.D. Post Summit Responsibilities
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
Task 8. Provide Emergency and Disaster Expertise and Leadership for the CMS ESRD Network Program
Status/Trend
| Risks and Mitigation Actions |
| · |
| Next Month’s Action Items |
| · |
Notes
| Next Month’s Action Items |
| · |
Notes
Scheduled Milestones
| Milestone |
| Due Date(s) |
| Current Forecast |
| Status |
Monthly Status Report Appendices
The CMS COR/GTL as well as the KCER Program Director shall be consulted as to what data and/or supplementary documentation should be included in each Monthly Status Report’s Appendix section.
Kidney Community Emergency Response Program Monthly Status Report – <Month>
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