Standards for public agencies

2020 Edition

Performance and Quality Improvement (PA-PQI) 7: Contract Monitoring and Quality Improvement

The agency monitors, evaluates, and enhances the quality and effectiveness of services purchased from other provider organizations or independent contractors.

Interpretation

Contracting of services does not relieve the public agency of their responsibility to ensure that high quality, effective services are being delivered. Contract monitoring practices ensure contracted providers are in compliance with applicable law and regulation, providing high quality services, achieving identified deliverables, and meeting desired outcomes. 
 

Interpretation

Public agencies must have a well-defined monitoring process that is laid out in its contract monitoring procedures. For state-administered agencies, this includes identifying the role of regional offices in implementing each of the contract monitoring and quality improvement activities identified in this Core Concept. For example, when case responsibility is shared by the regional office or when the contract originates at the regional office, it may be appropriate for the region to be more directly involved in contractor monitoring and quality improvement.
 
2020 Edition

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Purpose

 An agency-wide performance and quality improvement system effectively engages staff, persons served, and other stakeholders in advancing the agency’s mission and achieving strategic goals through continuous, integrated, data-driven efforts to improve service delivery and administrative practice. 
1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed administration and management infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
County/Municipality Administered Agency, State Administered Agency (Central Office) or other Public Entity
  • Contract monitoring procedures
  • Sample of three contract monitoring plans
  • Contract monitoring tools and scoring mechanisms 
  • Information provided to contractors 
  • Sample of three contractor improvement plans
  • Sample of three contractor progress reports
State Administered Agency (Regional Office)
  • No Self-Study Evidence
County/Municipality Administered Agency, State Administered Agency (Central Office) or other Public Entity
  • See contracts in PA-PQI 6 
  • Additional contract monitoring plans
  • Documentation of technical assistance to contracted providers
  • Training curricula for contract manager(s) 
  • Sample of three job descriptions for contract manager(s) 
  • Documentation tracking contract managers’ completion of required trainings
State Administered Agency (Regional Office)
  • Documentation of reporting/information sharing between the region and the central office regarding the quality of services from contracted providers
County/Municipality Administered Agency, State Administered Agency (Central Office) or other Public Entity
  • Interviews may include:
    1. Agency leadership
    2. In-house counsel
    3. Contract manager(s)
    4. PQI personnel
    5. Contracted providers
State Administered Agency (Regional Office)
  • Interviews may include: 
    1. Regional Director
    2. PQI personnel
    3. Contracted providers

 

PA-PQI 7.01

Written contracts contain all significant terms and conditions in accordance with applicable law.

Interpretation

 
“Significant terms” can include, as appropriate to the type of contract:
  1. roles and responsibilities of participating agencies;
  2. services to be provided;
  3. service authorization including eligibility criteria;
  4. provisions and/or requirements for provider training and technical assistance, as necessary;
  5. duration of contract including delineation of follow-up services;
  6. policies and procedures for sharing information including access to case record provisions;
  7. methods for resolving disputes;
  8. utilization management protocols;
  9. performance and quality improvement responsibilities;
  10. a plan and procedure for timely payment and consequences for failure to pay;
  11. documentation necessary for, and means of reporting to, funding or oversight bodies; 
  12. required levels of insurance; and
  13. conditions for termination of the contract.
NA Contracting is managed by an external department.

 

PA-PQI 7.02

The agency integrates contract monitoring into its performance and quality improvement activities by developing a plan for monitoring contractor progress that:
  1. is developed in partnership with the provider and tailored to the service being provided;
  2. establishes goals and performance measures for service quality, consumer satisfaction, and outcomes; 
  3. specifies monitoring activities including frequency and responsible parties;
  4. establishes specific requirements for provider participation in performance and quality improvement activities including qualitative and quantitative data reporting and corrective action; 
  5. outlines how performance data will be  monitored and reported out; and 
  6. establishes mechanisms for ongoing, regular communication between the public agency and the contracted provider. 

Interpretation

In regards to element (d), the collection, analysis, and distribution of contract monitoring data should be aligned with the agency’s performance and quality improvement system, ensuring that incoming data is used to inform continuous quality improvement of purchased services.
Examples: In regard to element (e), in addition to sharing findings with relevant staff within the public and private agency, the agency may also wish to tailor reports for additional stakeholder groups that have an impact on, or vested interest in, performance achievement such as the public, courts, provider networks, citizen review boards, and legislators.

Examples: Monitoring activities include, but are not limited to:
  1. review of performance reports from contracted providers to track progress and identify trends/concerns;
  2. case reviews;
  3. meetings; and
  4. visits to the program.

 

PA-PQI 7.03

Contracted providers receive information on:
  1. agency mission, principles, logic models, and system-wide performance indicators;
  2. relevant service-delivery policies and procedures;
  3. relevant federal and state requirements;
  4. technical assistance procedures; 
  5. the conflict resolution and provider appeal process; and
  6. other information necessary to establish consistent practice and policy implementation. 
NA Contracting is managed by an external department.
Examples: Technical assistance can include providing the support needed to:
  1. use the information management system for data reporting; 
  2. understand how data will be used to track performance;
  3. ensure service continuity and quality; and
  4. support implementation of system-wide practice initiatives.

 

PA-PQI 7.04

Systems are in place to collect and respond to contractor performance concerns identifed by public agency staff at all levels, including frontline staff and supervisors, and when areas of concern are identified, the agency:
  1. develops an improvement plan in conjunction with the contractor;
  2. ensures contractor follow-up and remediation; and
  3. terminates contracts if contractors do not comply with improvement action/remediation plans.

 

PA-PQI 7.05

A qualified staff member is assigned to oversee and monitor each contract and is trained and supervised on: 
  1. facilitating partnership and collaboration;
  2. understanding and using data collection and monitoring tools;
  3. the relationship between the PQI system, contract monitoring, and quality service delivery;
  4. report writing; and
  5. contract requirements.

Interpretation

 When monitoring responsibilities are spread across divisions, personnel should work collaboratively to ensure their efforts are aligned, findings are shared, and duplication of effort is minimized.