D.1 Attachment 1 Quality Assurance Surveillance Program Medicaid.docx

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

· What will be monitored.

· How monitoring will take place.

· Who will conduct the monitoring.

· How monitoring efforts and results will be documented.

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

2. GOVERNMENT ROLES AND RESPONSIBILITIES

The following personnel shall oversee and coordinate surveillance activities.

a. Contracting Officer (CO) - The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

· Assigned Contracting Officer (CO): Wendy Duval

· Assigned Contract Specialist: Brian Stephen

· Organization or Agency: U.S. Department of Veterans Affairs

b. The CNH Personnel/Social Worker designated by the CO as a Contracting Officer Representative (COR) shall be responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

c. Other Key Government Personnel - Assigned COR(S):

Jennifer Waler station/city Administrative Officer, Geriatrics and Extended Care VA Southern Oregon Rehabilitation Center & Clinics Telephone: (541) 826-2111 Ext. 3970 Email: jennifer.waler@va.gov Fax: (541) 830-7527

Blanca Renzi Administrative Officer Contract Officer Representative (COR) Office of Community Care Roseburg VA Health Care System Phone: 541-440-1000 Ext: 27812

Jennifer Drenner, LCSW Portland VA Medical Center Community Nursing Home Program Supervisor Contracting Officer Representative II 360-409-3525 fax: 360-737-1434

QUALITY ASSURANCE SURVEILLANCE PLAN

Nursing Home Care

Incentive

3. CONTRACTOR REPRESENTATIVES

The following employees of the contractor serve as the contractor’s program manager for this contract.

a. Program Manager – As assigned by facility

b. Other Contractor Personnel - As assigned by facility

4. PERFORMANCE STANDARDS

Performance standards define desired services. The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these standards.

5. INCENTIVES/RATING STANDARDS

Incentives shall be based on exceeding, meeting, or not meeting performance standards.

6. METHODS OF QA SURVEILLANCE

Various methods exist to monitor performance.

a. DIRECT OBSERVATION

b. PERIODIC INSPECTION

c. USER SURVEY

d. VALIDATED USER/CUSTOMER COMPLAINTS

e. INSPECTION

f. PERIODIC SAMPLING

g. RANDOM SAMPLING

h. PROGRESS OR STATUS MEETINGS

i. ANALYSIS OF CONTRACTOR’S PROGRESS REPORTS

7. RATINGS

Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:

See above Acceptable Quality Level & Method of Surveillance located in QASP

8. DOCUMENTING PERFORMANCE

a. ACCEPTABLE PERFORMANCE

The Government shall document positive OR Negative performance. Any report may become a part of the supporting documentation for any contractual action.

b. UNACCEPTABLE PERFORMANCE

When unacceptable performance occurs, the Authorized VA medical center personnel shall work with the Contracting Officer (CO) who will inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case, Authorized VA medical center personnel shall document the discussion and place it in the Authorized VA medical center personnel file’s. In order to assure that the contractor receives impartial, fair, and equitable treatment under this contract, Authorized VA medical center personnel will work with the contractor to increase performance to an acceptable level.

When the CO determines formal written communication is required, the Authorized VA medical center personnel and CO shall prepare a Contract Discrepancy Report (CDR) and present it to the contractor's program manager.

The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the Authorized VA medical center personnel. The Government shall review the contractor's corrective action plan to determine acceptability.

Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO.

9. FREQUENCY OF MEASUREMENT

a. Frequency of Measurement.

During contract performance, the and the CO will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

b. Frequency of Performance Assessment Meetings.

Authorized VA medical center personnel and CO shall meet with the contractor as needed to assess performance and provide a written assessment.

Signature – Contractor

Signature Authorized VA medical center personnel

Signature – Contracting Officer

Effective Date: 3/15/2025 Revision: 04 Page 1 of 5