QASP-Home Oxygen .1.docx

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Washington, DC Home Oxygen Federal contract opportunity
Solicitation number
36C24521Q0407
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 5

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36C24521Q0407 0001.docx DOCX document
Questions to solicitation 36C24521Q0407.docx DOCX document
P07 Wage Determination 15-4281.txt TXT text file
CONTRACTOR CERTIFICATION Attachment 3.docx DOCX document
CONTRACTOR RULES OF BEHAVIOR Attachment 4.docx DOCX document
Attachment 5 PAST PERFORMANCE QUESTIONAIRE 36C24521Q0407.docx DOCX document
36C24521Q0407 08052021.pdf PDF

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Quality Assurance Surveillance Plan (QASP) The contractor will be evaluated in accordance with the following:

For: Washington, DC VA Medical Center Home Oxygen Services Contract Description: Provision of home oxygen care services to eligible Veterans at the Washington VA Medical Center.

The contractor will be evaluated in accordance of the following:

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 through contract modification. 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 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: Crystal Hinton

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.

Assigned COR:

Organization or Agency: VA

3. CONTRACTOR REPRESENTATIVES

The following employee(s) of the contractor serve as the contractor’s program manager(s) for this contract.

Primary:

(add signature)

Attachment 2

Page 19 of 19 Version 0001 Dated 05/8/2021

4. PERFORMANCE STANDARDS

The contractor is responsible for performance of ALL terms and conditions of the contract. CORs will provide contract progress reports quarterly to the CO reflecting performance on this plan and all other aspects of the resultant contract. The performance standards outlined in this QASP shall be used to determine the level of contractor performance in the elements defined. Performance standards define desired services. The Government performs surveillance to determine the level of Contractor performance to these standards.

The Performance Requirements are listed below in Section 6. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the standard and assign a rating. At the end of the performance period, these ratings will be used, in part, to establish the past performance of the contractor on the contract.

5. 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.

a. DIRECT OBSERVATION. Direct observation by VA personnel during visits to warehouse facilities as well as Veteran homes

b. PERIODIC INSPECTION. Inspections will be conducted both scheduled and unscheduled.

c. VALIDATED USER/CUSTOMER COMPLAINT: Complaints received from customers reported to contractor and VA will be logged and submitted to the contractor for immediate resolution/corrective action. Contract will monitor complaints monthly and report to the COR on a quarterly basis.

d. RANDOM SAMPLING: Option to be used in reviewing vendor employee and Veteran folders to ensure proper documentation is being maintained.

e. VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR: Receipt/evaluation of reports required in Performance Work Statement, Attachment D.

f. Other: Patient home inspection, patient satisfaction/complaints, monthly review of invoices for accuracy, timeliness of equipment delivery, accuracy of required documentation submitted, and adherence to Joint Commission Standards.

6. QASP PERFORMANCE REPORT DATE: August 05, 2020

Measures
PWS

Reference Performance Requirement

Standard
Acceptable Quality Level
Surveillance

Method Met AQL/DID NOT MEET AQL-

CPAR RATING/ADD COMMENTS

New Patient Set-ups
11, 12 A-F
Contractor shall report unsafe conditions observed in the home and precludes the installation of oxygen service to include fire safety hazards, oxygen safety hazards, patient abuse by family or caregivers or any instance that places the patient or the contractor’s staff in immediate danger.

Contractor shall provide written documentation of any home where smoke alarms not present and fully functional

At time of set-up and written documentation by 1 business day
95%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR:
Electric Service
11
The Contractor shall check the safety of the electrical outlets in the beneficiary's home prior to installing any electrical item
Within 24 hours for safety hazards involving electrical services
100%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR:
Refusal of Services
19 F
Contractor shall report refusal (Against Medical Advice-AMA) of oxygen equipment or supplies prescribed by the VA
Verbal report within 1 hours and signed form within 10 business days of the following month
100%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR:
Patient Visits
19 (L) (3)
Contractor shall report patient who is non-compliant with safety guidelines set forth in education and orientation material or risk of self-harm or harm or to others
At time of visit and in writing within 1 business day
100%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR:
Home Visit Documentation
25.(A)
The Contractor shall provide completed progress reports of home visits performed by the Contractor’s staff
By 10th business day of the month following service
95%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR:
Periodic Equipment Evaluation
25.(A)
The Contractor shall have a CRT/RRT visit the patient to reassess equipment compliances, educational needs, etc. for Home Oxygen Patients at least once annually and monthly for Patients on ventilators and quarterly visits to tracheostomy patients
Within 5 business days of visit
95%
RANDOM SAMPLING

Emergency Services

19.(F)
The Contractor shall inform the Home Oxygen personnel within one

(1) business day of a sentinel event (as defined by the Joint Commission) that occurs during the performance of this contract that involves DC VAMC beneficiaries.

Within 24 hours. Life threatening situations (i.e. 911, police, etc.) shall be reported to the proper authorities immediately.
100%

VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR

Customer Satisfaction Report
19(B)
The Contractor shall collect satisfaction data from VA contracted patients and their families on a quarterly basis in accordance with Joint Commission standards
Within the 5th working day at the conclusion of the quarter
100%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR
Infection Control Report
19(K)
The Contractor shall collect, trend, and report on data related to the Contractor’s Infection Control Program
Within the 5th working day at the conclusion of the quarter
100%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR
Periodic Performance Review Report
9.1
The Contractor shall provide a written, quarterly report addressing all Joint Commission Standards for improving organizational performance
Within the 5th working day at the conclusion of the quarter
95%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR
Emergency Patient Safety Reports
19(D)
The Contractor shall provide the following emergent Patient safety reports throughout the contract period; Sentinel Event, Refusal of Service, Patient Abuse or Neglect, Non-compliant Behavior
Initial notification shall be within one business day of when the Contractor is aware of the event or issues with a follow-up official report within 5 business days
100%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR
Thermal Fuses
9(A)
Thermal fuses must be provided for all patients on home oxygen therapy unless there is a documented clinical contraindication
100%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR AND RANDOM SAMPLING
Patient Compliance
19(L)6
Contractor shall provide notice that a patient has not been available for the quarterly visits.
Within two (2) workdays of the 2nd consecutive attempted contact for visit.
100%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR
Employee Certification
41(A-E)
Contractor shall provide the COR with documentation competency of those individuals providing patient instruction and of the orientation training of contract staff
Quarterly
100%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR – PERIODIC INSPECTION
Home Visit Compliance
38
VA shall conduct home visits to observe contractor’s compliance with set-up/delivery of home O2 pursuant with contract requirements, veteran’s compliance with Home O2 program requirements on at least five Veterans on the program
Quarterly
100%

DIRECT OBSERVATION PERIODIC INSPECTION

Traveling Veterans
26
The vendor will arrange for all travel oxygen needs.
As authorized by COR or representative
100%
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR
Site Visit
45
VA shall conduct site visits of Contractor’s facility to observe contractor’s compliance with contract requirements
Quarterly
100%
PERIODIC INSPECTION - DIRECT OBSERVATION - RANDOM SAMPLING

7. CPAR RATINGS ASSIGNED TO QASP ITEMS:

Metrics and methods are designed to determine rating for a given standard and acceptable quality level. The following ratings shall be used (Reference: CPARS User Manual https://www.cpars.gov/pdfs/CPARS-Guidance.pdf p. A2-1):

EXCEPTIONAL:
Performance meets contractual requirements and exceeds many to the

Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Note: To justify an Exceptional rating, you should identify multiple significant events in each category and state how it was a benefit to the GOVERNMENT. However a singular event could be of such magnitude that it alone constitutes an Exceptional rating. Also there should have been NO significant weaknesses identified.

VERY GOOD:
Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Note: To justify a Very Good rating, you should identify a significant event in each category and state how it was a benefit to the GOVERNMENT. Also there should have been NO significant weaknesses identified.

SATISFACTORY:
Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Note: To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract. Also there should have been NO significant weaknesses identified.

MARGINAL:
Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.
Note: To justify Marginal performance, you should identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the GOVERNMENT. A Marginal rating should be supported by referencing the management tool that notified the contractor of thecontractual deficiency (e.g. Management, Quality, Safety or Environmental Deficiency Report or letter).
UNSATISFACTORY:
Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.
Note: To justify an Unsatisfactory rating, you should identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the GOVERNMENT. However, a singular problem could be of such serious magnitude that it alone constitutes an unsatisfactory rating. An Unsatisfactory rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g. Management, Quality, Safety orEnvironmental Deficiency Reports, or letters).

8. DOCUMENTING PERFORMANCE

a. The Government shall document positive and/or negative performance. Any report may become a part of the supporting documentation for any contractual action and preparing annual past performance using CONTRACTOR PERFORMANCE ASSESSMENT REPORT (CPAR).

b. If contractor performance does not meet the Acceptable Quality level, the CO shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the CO shall document the discussion and place it in the contract file. When the COR and the CO determines formal written communication is required, the COR shall prepare a Contract Report (CR), and present it to CO. The CO will in turn review and will present to the contractor's program manager for corrective action.

The contractor shall acknowledge receipt of the CR in writing. The CR will specify if the contractor is required to prepare an action plan to document how the contractor shall correct the identified issue and avoid a recurrence. The CR will also state how long after receipt the contractor has to present this action plan to the CO. The Government shall review the contractor's action plan. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance and the acceptability of the Contractor’s action plan.

Any CRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO. See Sample CR on following page.

9. COR AND CONTRACTOR ACKNOWLEDGEMENT OF QASP

SIGNED:

(sign here)

COR NAME/TITLE

SIGNED:

CONTRACTOR NAME/TITLE DATE

CONTRACT REPORT

1. CONTRACT NUMBER
2. REPORT NUMBER FOR THIS ISSUE
3. TO: (Contracting Officer)
4. FROM: (Name of COR)

5. DATES

a. CR PREPARED

b. RETURNED BY CONTRACTOR:
c. ACTION COMPLETE

6. Issue Identified: (Describe in detail. Include reference to PWS Directive; attach continuation sheet if necessary.)

7. SIGNATURE OF COR
Date:
8. SIGNATURE OF CONTRACTING OFFICER
Date:
9a. TO (Contracting Officer)
9a. FROM (Contractor)

10. CONTRACTOR RESPONSE AS TO CAUSE AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable quality control program procedures or new procedures. Attach continuation sheet(s) if necessary.)

11. SIGNATURE OF CONTRACTOR REPRESENTATIVE
Date:

12. GOVERNMENT EVALUATION.

13. GOVERNMENT ACTIONS

14. CLOSE OUT

NAME
TITLE
SIGNATURE
DATE

CONTRACTOR NOTIFIED

COR

CONTRACTING OFFICER

Page 21 of 21 Version 0004 Dated 6/19/2017

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