QASP.pdf

Medicare and Medicaid QASP

Effective Date: 12/19/2022 Revision: 03 Page 1 of 6

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):

• Assigned Contract Specialist: (CS)

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

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. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

Revision: 03 Page 2 of 6

Assigned COR(s): See COR Delegation Memo

c. Other Key Government Personnel - N/A

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QUALITY ASSURANCE SURVEILLANCE PLAN

Nursing Home Care

No. Paragraph in PWS

Indicator/Performance Standard

Standard for

Quality Level

Acceptable Quality Level

Method of Surveillance

Incentive

1 (C)(12) Nursing Home shall provide VA with copies of all State / Federal licensures, certifications, and investigations reports when requested.

100% 100% Periodic Reviews and spot checks

Positive past performance rating

2 (C)(13) The Contractor shall cooperate in developing plans of corrective action according to outlined criteria in the Performance Work Statement.

100% 100% Periodic Reviews and spot checks

Positive past performance rating

3 (C)(16) Notice of veteran being hospitalized within 72 hours and notice of any veteran death within 24 hours

100% 95% Periodic Reviews and spot checks

Positive past performance rating

4 (C)(18) Notice of all reportable events on VA contract veterans and all facility sentinel events within 24 hours.

100% 100% Periodic reviews

Positive past performance rating

5 (C)(20) All medical records concerning the veteran's care in the nursing home a) will be

100% 100% Periodic Reviews and spot checks

Positive past performance rating

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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

Positive Past Performance Ratings.

6. METHODS OF QA SURVEILLANCE

Various methods exist to monitor performance.

a. DIRECT OBSERVATION

1 See “Methods of Surveillance,” paragraph 6 of this QASP, for additional methods of monitoring performance.

readily accessible to VA, and b) within acceptable standards and practice.

6 (C)(24) Invoices shall be timely and accurate for all items billed.

100% 95% -100% Periodic Reviews and spot checks

Positive past performance rating

7 (C)(25) The Contractor shall immediately notify the Contracting Officer if a Change of Ownership (CHOW) occurs.

100% 95% -100% Periodic Reviews and spot checks

Positive past performance rating

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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:

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 COR 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, the COR/VA Coordinator shall document the discussion and place it in the COR/VA Coordinator’s file. In order to assure that the contractor receives impartial, See above Acceptable Quality Level & Method of Surveillance located in QASP

Revision: 03 Page 6 of 6 fair, and equitable treatment under this contract, the COR will work with the contractor to increase performance to an acceptable level.

When the CO determines formal written communication is required, the COR/VA Coordinator 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 COR/VA Coordinator.

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 COR 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.

The COR and CO shall meet with the contractor as needed to assess performance and provide a written assessment.

Signature – Contractor

Signature Contracting Officer Representative (COR)/VA Coordinator

Signature – Contracting Officer

Various methods exist to monitor performance.