Attachment_J-9A_Sample_Survey_Contractor_Subcontract_Agreement.docx

Attachment J-9A Sample Survey Contractor Subcontract/Agreement

SURVEY SUBCONTRACT

BETWEEN [QIO] AND TBD/Survey Contractor In order to accomplish the survey requirements in Statement of Work of the BFCC-QIO, the BFCC-QIO shall contact and execute a subcontract with TBD for performance period August 1, 2014 to July 31, 2015. The Survey Contractor (TBD) will act as a subcontractor to the BFCC-QIO under the BFCC-QIO contract and shall conduct and complete the surveys.

Specifically, this subcontract shall provide for the exchange of information for the surveys that will be used by the BFCC-QIO to improve the BFCC-QIOs process of providing technical assistance and quality improvement to providers, practitioners, and patients and as described in Section C of the BFCC-QIO SOW. Data derived from the BFCC-QIO shall be aggregated, de-identified of provider and practitioner-specific information, and provided to CMS or CMS’ contractors by the BFCC-QIO for further analysis.

The BFCC-QIO’s agreement shall bind the Survey Contractor (TBD) to the same level of confidentiality as the BFCC-QIO and to the disclosure regulations that apply to quality review studies (QRS) under 42 CFR Part 480.140. Any confidential data provided by the BFCC-QIO to the Survey Contractor (TBD) shall be maintained and disposed of in accordance with 42 CFR 480 and procedures outlined in the QIO Manual. This directed subcontract is for reasons of efficiency, continuity and comparability of data and review.

SUBCONTRACT PERIOD OF PERFORMANCE

The Survey Contractor (TBD) period of performance for this subcontract is made effective from August 1, 2014 and shall expire July 31, 2015

DATA HANDLING REQUIREMENTS

All the survey data and information provided by the BFCC-QIO to the Survey Contractor (TBD) under this subcontract is confidential and is protected and restricted by Section 1160 of the Social Security Act and the QIO confidentiality regulations at 42 CFR Part 480 and 48CFR Subpart 324.70 together with 48 CFR 352.224-74.

The Survey Contractor (TBD) shall ensure the confidentiality and security of all data and information obtained from the BFCC-QIO.

All data and information received by the Survey Contractor (TBD) under this subcontract shall be destroyed at the end of the contract period. The Survey Contractor (TBD) shall submit a statement to the BFCC-QIO certifying the data and information obtained under this subcontract was destroyed.

The Survey Contractor (TBD) has no authority to disclose or release to outside parties any data or information obtained from the BFCC-QIO. The Survey Contractor (TBD) shall consider all data obtained from the BFCC-QIO that meets the definition of quality review study (QRS) information as defined in 42 CFR Part 480.101 as such and will not disclose or release any of this data to CMS or a CMS designee except as authorized under 42 CFR Part 480.140.

CONTRACTING PARTIES CONTACT INFORMATION

Subcontract shall stipulate that the QIO and the Survey Contractor (TBD) provide one another the following contact information, and provide updated information within 1 business day of any change of personnel or any other change that would require a change in any part of the point of contract information. At a minimum, contact information shall include for each party (QIO and the Survey Contractor (TBD)) the primary business POC's and technical POC's name, address, office phone number, office FAX number and business email address.

Further Mandatory Requirements for Subcontractor Survey Contractor (TBD) and obligations of the BFCC-QIO The subcontract shall provide that the BFCC-QIO shall submit the requested information to the Survey Contractor (TBD) through secured data transmission.

Deliverables: Refer to Schedule F and Section C Data Submission The Survey Contractor (TBD) and the BFCC-QIO shall exchange data by electronic means using HCQIS Qnet Exchange or other appropriate secure mechanism agreed upon by the BFCC-QIO and the Survey Contractor (TBD).

Contact Information for the Survey Contractor (TBD)