J_2_QASP_non-FECA_PBM_62921.docx

QASP

For: Office of Workers’ Compensation Programs (OWCP) non-FECA Pharmacy Benefits Management (PBM) Contract Number: < upon award, enter contract number> Contract Description: < enter contract description > Contractor’s name: < upon award, enter contractor name > (hereafter referred to as the contractor).

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. In addition, the QASP should recognize that unforeseen and uncontrollable situations may occur.

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. Updates shall ensure that the QASP remains a valid, useful, and enforceable document. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

The following FAR clauses may apply depending on contract type:

52.246-4 Inspection of Services – Fixed-Price, 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 shall 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 CO: Jubner Severe Organization or Agency: <enter organization or Agency name> Telephone: <enter number> Email: <enter address>

b. Contracting Officer’s Representative (COR) - The COR is 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. At the conclusion of the contract or when requested by the CO, the COR shall provide documentation to the CO. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf. The contractor shall refer any changes they deem may affect contract price, terms, or conditions to the CO for action.

Assigned COR TBD Telephone:

Email:

c. Other Key Government Personnel - Title:

Telephone:

Email:

Contractor Representatives The following employees of the contractor serve as the contractor’s Contract Manager and Task Manager for this contract. <Communication should occur with them during QASP development. It will help if they review the draft QASP and accept the final version.>

a. Contract Manager - <upon award, enter name> Telephone: <enter number> Email: <enter address>

b. Task Manager - <upon award, enter name> Telephone: <enter number> Email: <enter address>

c. Other Contractor Personnel - <upon award, enter name or delete these lines if not applicable> Title: <enter title> Telephone: <enter number> Email: <enter address>

Performance Standards

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

The Performance Requirements Summary Matrix, paragraph <enter number> in the Performance Work Statement includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL). The matrix from the PWS is attached as Technical Exhibit 1.

Incentives The Government shall use <insert award fee, incentive fee, past performance, or other method> as incentives. Incentives shall be based on exceeding, meeting, or not meeting performance standards. Information about incentives can be found in <insert section or paragraph> of the contract.

Methods of QA Surveillance Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP.

Regardless of the surveillance method, the COR shall always contact the contractor's task manager or on-site representative when a defect is identified and inform the manager of the specifics of the problem. The COR, with assistance from the CO, shall be responsible for monitoring the contractor’s performance in meeting a specific performance standard/AQL.

< Place the performance standard(s) after the description of the method. Delete any methods that are not required.> DIRECT OBSERVATION. (Can be performed periodically or through 100% surveillance.)

<Insert performance standard(s) or delete this method.> MANAGEMENT INFORMATION SYSTEMS (MIS). (Evaluates outputs through the use of management information reports. Best used for general surveillance and may need to be supplemented by periodic inspections.)

<Insert performance standard(s) or delete this method.> PERIODIC INSPECTION. (Uses a comprehensive evaluation of selected outputs. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.)

<Insert performance standard(s) or delete this method.> USER SURVEY. (Combines elements of validated user complaints and random sampling. Random survey is conducted to solicit user satisfaction. Appropriate for high quantity activities that have historically been satisfactory. May also generate periodic and 100% inspections.)

<Insert performance standard(s) or delete this method.> VALIDATED USER/CUSTOMER COMPLAINTS. (Relies on the user of the service to identify deficiencies. Complaints are then investigated and validated. Highly applicable to services provided in quantity and where quality is highly subjective.)

<Insert performance standard(s) or delete this method.> 100% INSPECTION. (Evaluates all outputs. Most applicable to small quantity, but highly important services. May be used where there are written deliverables and stringent requirements such as tasks required by law, safety, or security.)

<Insert performance standard(s) or delete this method.> PERIODIC SAMPLING. (Variation of random sampling. However, sample is only taken when a deficiency is suspected. Good follow-up to MIS analysis. Sample results are applicable only for the specific work inspected. Since sample is not entirely random, it cannot be applied to total activity performance.)

<Insert performance standard(s) or delete this method.> RANDOM SAMPLING. (Designed to evaluate the outputs of the award requirement by randomly selecting and inspecting a statistically significant sample. Highly recommended for large quantity repetitive activities with objective and measurable quality attributes.)

<Insert performance standard(s) or delete this method.>

PROGRESS OR STATUS MEETINGS.

<Insert performance standard(s) or delete this method.> ANALYSIS OF CONTRACTOR'S PROGRESS REPORTS. (Evaluate cost, schedule, etc.)

<Insert performance standard(s) or delete this method.> PERFORMANCE REPORTING. (Evaluate metrics for a specific time period. Develop metrics or use metrics found in MIS.)

<Insert performance standard(s) or delete this method.> Surveillance results may be used as the basis for actions (to include payment deductions) against the contractor. In such cases, the Inspection of Services clause in the Contract becomes the basis for the CO’s actions.

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:

Documenting Performance

a. ACCEPTABLE PERFORMANCE The Government shall document positive performance. A report template is attached. Any report may become a part of the supporting documentation for fixed fee payments, award fee payments, or other actions.

b. UNACCEPTABLE PERFORMANCE.

When unacceptable performance occurs, the COR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and place it in the COR file.

When the COR determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to the contractor's task manager or on-site representative. A CDR template is attached to this QASP.

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 COR. The Government shall review the contractor's corrective action plan to determine acceptability.

Any CDRs may become a part of the supporting documentation for contract payment deductions, fixed fee deductions, award fee nonpayment, or other actions deemed necessary by the CO.

Frequency of Measurement

a. FREQUENCY OF MEASUREMENT.

During contract/order performance, the COR shall take periodic measurements, daily, weekly, monthly or annually, as specified in the AQL column of the Performance Standards Summary Matrix, and shall analyze whether the negotiated frequency of measurement is appropriate for the work being performed.

b. FREQUENCY OF PERFORMANCE ASSESSMENT MEETINGS.

The COR shall meet with the contractor monthly to assess performance against AQLs, and shall provide an annual written assessment in CPARS.

Prepared by Signature – Contracting Officer’s Representative

TECHNICAL EXHIBIT 1

Performance Requirements Summary

The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success. As necessary, DOL reserves the right to modify the method of surveillance based on the agency’s needs and the contractor’s performance.

Performance Objective (the service required—usually a shall statement)

Tentative Participants: COR, Contracting Officer (CO)/Contract Specialist (CS).

OWCP PM or designee

OWCP PM or designee

No less than 4 times per contract period, but up to 15 times per contract period as requested by DOL COR.

100% inspection: OWCP COR OWCP PM or designee

OWCP PM or designee

Project plan and milestones for implementing within 15 business days after contract award.

100% inspection for each project plan and milestone.

OWCP COR

OWCP PM or designee

1.6 Implementation Complete implementation of all elements of the PWS.

Implementation within 180 days after contract award.

100% inspection: OWCP COR OWCP PM or designee

Where applicable, the PBM reports should include summary information for the calendar month and cumulative information for the calendar/fiscal/chargeback year with the ability to drill down for additional detail, which enables OWCP management to make decisions about the PBM.

Monthly reports no less than 12 times per year on the third Wednesday of the month for the previous month 98% of the time.

Random sampling: OWCP PM or designee

In addition to the monthly progress reports outlined above, the contractor shall implement a secure, internet-based reporting tool for use by authorized OWCP program staff to generate management reports on an ad hoc basis.

Solicitation No. 1605C3-21-R-00011 DOL/ Office of Workers’ Compensation Programs (OWCP) Non-FECA Pharmacy Based Management Service

Develop and provide quarterly progress reports on the efforts of the Pharmacy and Therapeutics Committee (P&T) as they relate to developing and maintaining one or more evidence-based formularies.

Develop and provide clinical recommendations and DUR policies, pharmacoeconomic analysis, and DUR POS development reports as needed, and no less than 5 business days prior to meetings with OWCP to discuss recommendations.

Develop and provide formal monthly progress reports on POS DUR approval/denial decision statistics by the contractor’s staff.

Pharmacy and Therapeutics Committee provide draft progress report templates and initial formulary within 90 days after contract award.

Quarterly P&T reports on the first business day after January 1, April 1, July 1, and October 1 of each year 98% of the time.

Clinical recommendations and DUR policies pharmacoeconomic analysis, and DUR POS development reports as needed and no less than 7 calendar days prior to meetings with OWCP 98% of the time.

Monthly progress reports on POS DUR approval/denial decision statistics Random sampling: OWCP PM or designee

Develop and provide documents that identify the pricing methodology for drugs, and DME. The specific format and content of these reports shall be developed by the contractor and approved by OWCP.

Draft fee schedule document templates within 30 calendar days after contract award.

Draft pricing methodology document templates within 30 calendar days after contract award.

100% inspection: OWCP COR OWCP PM or designee

Monthly reports no less than 12 times yearly, on the third Wednesday of the month for previous month 98% of the time.

Ad hoc reports within 5 business days from the date of request 98% of the time.

Proposed interactive website prototype within 30 days after contract award.

Website active and useable no later than 90 days after contract award. Website must be available and operational 24 hours per day, 7 days per week, and 365 days per year 98% of the time.

User questions received through the web portal shall be responded to within 24 hours, or if research is required, within 48 hours 98% of the time.

Welcome packet designs within 30 days after contract award.

Welcome packets, including benefit cards to all existing and applicable beneficiaries within 60 days after contract award.

Monthly reports must include at least the number of welcome packets distributed by language, number of returned packets, and Periodic surveillance and validated customer complaints: OWCP PM or designee.

Develop and provide monthly customer support reports to OWCP COR submitted by the third Wednesday of the month for the previous calendar month. Reports should provide performance data to indicate number of calls, length of calls, types of services provided, hold times, and number of dropped calls. The specific format and content of these reports shall be developed by the contractor and approved by OWCP.

Web Portal Support: Provide a government-approved, interactive website in both English and Spanish with information regarding the contractor, retail and mail-order pharmacy, DME program, and other services offered by the contractor. Health care professionals and claimants must be able to perform routine tasks as outlined in Section 5.1.4.2 of the PWS and must be able to submit specific questions to the contractor through the portal.

Welcome Packets: Design and develop a welcome packet in both English and Spanish, for approval by OWCP, that includes a welcome letter, benefit card, information about the pharmacy and DME programs, and available services, including the mail order pharmacy program and encourages the use of generic drugs over multi-source and single-source brand-name drugs.

Provide a welcome packet to each new claimant on the eligibility file no later than one business day after receipt of the eligibility file.

Provide proposed changes to welcome packet contents or format to OWCP for approval prior to implementation.

timeliness of distribution, no less than 12 times yearly, on the third Wednesday of each month for the previous month 98% of the time.

Assessment of Contractor’s detailed explanation of Recruitment efforts.

Deliverable

Frequency # of Copies

Medium/Format

Submit To

and BMSR PM

and BMSR PM

and BMSR PM

and BMSR PM

and BMSR PM

and BMSR PM

and BMSR PM

and BMSR PM

and BMSR PM

and BMSR PM

monthly reports no less than 12 times yearly, on the third Wednesday for each month for the previous month ad hoc reports within 5 business days from the date of request 98% of the time

and BMSR PM

monthly reports no less than 12 times yearly, on the third Wednesday of each month for previous month ad hoc reports within 5 business days from the date of request

Microsoft® Office 2013 programs and agreed

upon by OWCP

per quarter as requested by

DOL

and BMSR PM monthly reports no less than 12 times yearly, on the third Wednesday of each month for the previous month ad hoc reports within

5 business days from the date of request

monthly reports no less than 12 times yearly, on the third Wednesday of each month for the previous month ad hoc reports within 5 business days from the date of request

monthly reports no less than 12 times yearly, on the third Wednesday of each month for previous month ad hoc reports within 5 business days from the date of request

monthly data updates no less than 12 times yearly, on the third Wednesday of each month for previous month

with Microsoft® Office 2013 programs and

agreed upon by OWCP analysis template for

OWCP approval.

contract

award with Microsoft® Office 2013 programs and agreed upon by OWCP

with Microsoft® Office 2013 programs and

agreed upon by OWCP

each year

98% of the time

2.8.4 Provide clinical

recommendations and

DUR policies, pharmacoeconomic analysis, and DUR POS

analysis reports in the with Microsoft® Office 2013 programs and approved template as agreed upon by OWCP needed.

7 calendar days prior to meetings with

# of Copies

Medium/Format

Submit To

OWCP 98%

of the time

and BMSR PM

and BMSR PM

and BMSR PM

and BMSR PM

2.10.1 Provide draft plan for telephone

support resources and within 30 business days after contract

point font, created in a program compatible

OWCP COR

# of Copies

Medium/Format

Submit To

with Microsoft® Office 2013 programs and agreed upon by OWCP

and BMSR PM

and BMSR PM

and BMSR PM

and BMSR PM

Submission of completed document by the 120th day after contract award.

and BMSR PM

and BMSR PM

and BMSR PM

Performance Report

1. CONTRACT NUMBER: <insert number>

2. Prepared by: (Name of COR) <insert name>

3. Date and time of observation:

4. Observation:

<Examples of items to include in a report are:

- Method of surveillance.

- How frequently you conducted surveillance.

- Surveillance results.

- Number of observations.>s

Prepared by: <Enter COR’s name>

QUALITY ASSURANCE SURVEILLANCE PLAN

Version – May 2018