QASP - MEDICAID - FINAL.pdf

QUALITY ASSURANCE SURVEILLANCE PLAN- MEDICAID

Nursing Home Care Services

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 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 Contracting Officer: [NAME, PHONE]

• Assigned Contract Specialist: [NAME, PHONE]

• 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.

• Assigned COR(S): [NAME, PHONE]

c. Other Key Government Personnel - [As Assigned]

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

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

No. Paragraph in PWS

Indicator/Performance

Standard

Standard for

Quality

Level

Method of

Surveillance1

Incentive

1 (C)(9) Nursing Home shall provide VA with copies of all State / Federal licensures, certifications, and investigations reports when requested.

100% Annual Review Positive past performance rating

2 (C)(10) The Contractor shall cooperate in developing plans of corrective action according to outlined criteria in the

Performance Work

Statement.

100% Periodic Reviews and spot checks

Positive past performance rating

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

3 (C)(13) Notice of all reportable events on VA contract veterans and all facility sentinel events within 24 hours or immediately the first business day after a weekend or holiday.

100% Periodic reviews Positive past performance rating

4 (C)(15) All medical records concerning the veteran's care in the nursing home

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

100% Periodic Reviews and spot checks

Positive past performance rating

5. INCENTIVES/RATING STANDARDS

Incentives shall be based on exceeding, meeting, or not meeting performance standards.

6. METHODS OF QA SURVEILLANCE

Various methods may be used to monitor performance:

a. DIRECT OBSERVATION

b. PERIODIC INSPECTION

c. VA CNH TEAM REVIEW OF STATE/FEDERAL SUMMARY REPORT AND RELATED DOCUMENTS.

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. Quality Oversight includes monthly monitoring by CNH Staff and Annual CNH Team

Quality of Care Review.

8. DOCUMENTING PERFORMANCE

a. ACCEPTABLE PERFORMANCE

The Government shall document positive OR NEGATIVE performance using the current version of the “Exclusionary Review Form for VA Community Nursing Home (CNH). 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 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. In order to assure that the contractor receives impartial, fair, and equitable treatment under this contract, the COR will work with the contractor to increase performance to an acceptable level.

9. FREQUENCY OF MEASUREMENT

During contract performance, the COR will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

Signature – Contractor

Signature – Contracting Officer Representative

See above for Acceptable Quality Level & Method of Surveillance located in QASP