D01 QUALITY SURVEILLANCE PLAN.pdf

Task

ID

Indicator

Standard Acceptab le

Quality Level

Method of Surveillance

Incentive

CONTRACTO R

QUALITY

REVIEW

1.

Facility is adequate to meet the criteria for providing services to the veterans; plan includes private and conf idential group and individual counseling areas. Area is easily accessible to the physically challenged.

Federal Standards for counseling regulations

100%

Yearly Site visit performed by COR’s

Exercise of

Option periods.

Client appointment book, charts, and client-related information are locked in a secure location.

VA HIPPA and

Privacy Regulations are adhered to

100% Yearly Site visit performed by COR’s

The contractor has reported and submitted for approval, any proposed changes in personnel providing services under the current contract to the contracting of f icer through the COTR.

Contractor follows Regulations indicated in the Statement of Work

100% Yearly Site visit performed by

COR’s

The contractor submits monthly bills in arrears no later than 5 working days of the following month.

Contractor follows Regulations indicated in the Statement of Work

80% Yearly Site visit performed by COR’s

5. Initial counseling sessions are scheduled within 3 working days f rom the date the contractor receives the VA Form 10-5565b authorizing visits.

Contractor follows Regulations indicated in the Statement of Work

90% Yearly Site visit performed by COR’s

VA Form 10-5565b, Authorization for Initial Visits and if appropriate, additional blocks of visits are present.

Contractor follows Regulations indicated in the Statement of Work

100% Yearly Site visit performed by COR’s

The contractor submits initial assessments and counseling plans.

Updated counseling plans are submitted to COTR one week prior to scheduling next block of visits.

Contractor follows Regulations indicated in the

Statement of Work

100%

Yearly Site visit performed by

COR’s

Progress notes, verif ication forms and billing dates correspond.

Contractor follows

Regulations indicated in the Statement of Work

100% Yearly Site visit performed by COR’s

Verif ication of Service forms are signed by the client and are forwarded to the COTR. Copies can be maintained in the client’s f ile.

Contractor follows Regulations indicated in the

Statement of Work

100% Yearly Site visit performed by COR’s

Client records are maintained in a structured format and contain assessment and counseling plans.

Contractor follows Regulations indicated in the Statement of Work

100% Yearly Site visit performed by COR’s

Client progress notes are present, dated, signed, and show client movement in relation to counseling goals.

Contractor follows

Regulations indicated in the

Statement of Work

100% Yearly Site visit performed by

COR’s

At least 50% of the membership of the group to which an individual is referred for counseling must be Vietnam theater veterans or Post Vietnam War zone veterans.

Contractor follows Regulations indicated in the Statement of Work

50%

Yearly Site visit performed by COR’s

Clients who cannot be counseled by the contractor are referred appropriately.

Look for clients with complicated medical or psychiatric problems.

Consultation is performed with the COTR and is documented in the veteran’s file.

Contractor follows Regulations indicated in the Statement of Work performed by COR’s

Clients’ presenting with homicidal or suicidal potential are reviewed with the COTR immediately and is documented in the veteran’s f ile.

Contractor follows Regulations indicated in the

Statement of Work

100% Yearly Site visit performed by COR’s

Follow-up contact is made within 60 days af ter the last contact with the client and is documented in the client f ile.

Contractor follows Regulations indicated in the Statement of Work

80% Yearly Site visit performed by COR’s

The contractor immediately notif ies the

COTR when a signif icant other’s veteran is no longer being seen under this program.

Contractor follows

Regulations indicated in the

Statement of Work

80% Yearly Site visit performed by

COR’s

A closing summary is present for inactive clients fully documenting the degree of success or lack thereof , of counseling plan or goals and prognosis.

Contractor follows Regulations indicated in the Statement of Work

100% Yearly Site visit performed by COR’s

Client f iles are placed in inactive status af ter 90 days of inactivity unless there are clinical reasons to keep the f ile active.

Contractor follows Regulations indicated in the Statement of Work

80% Yearly Site visit performed by COR’s

Contractor conducts periodic assessment of the ef fectiveness in providing services to clients and conducts an on-going self -assessment and evaluation of their performance.

Contractor follows Regulations indicated in the

Statement of Work

70%

Yearly Site visit performed by COR’s

CONTRACTOR

PHYSICAL

ENVIRONMENT

The contractor is located in a neighborhood that is considered “safe” and compatible with the veterans and their family readily keeping appointments.

Contractor follows Regulations indicated in the

Statement of Work

100% Yearly Site visit performed by COR’s

Contractor exterior complies with all policies and regulations required by VA lease property.

Contractor follows Regulations indicated in the Statement of Work

100% Yearly Site visit performed by COR’s

Contractor exterior is clean, neat, and presentable (building paint, repair, grounds, grass, shrubs, parking lots, sidewalks, etc.).

Contractor follows

Regulations indicated in the performed by

COR’s

Contractor interior complies with all policies and regulations required of VA lease property.

Contractor follows Regulations performed by COR’s

Contractor interior is clean and presentable (carpets, windows, window coverings, paint, wallpaper, etc.).

Contractor follows Regulations performed by COR’s