All Reports

Ensure that annual reports to Congress include the steps VA is taking to improve the onboard timeline for facilities for which the duration of the onboarding process exceeds the metrics laid out in the Veterans Health Administration’s time-to-hire model, or successor model, as required by section 3008(b) of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020.

Track facilities’ supply chain personnel vacancies as part of the quality control reviews and take appropriate action.

Develop guidelines that define when facility supply chain management problems require additional interventions and then routinely identify them for network director action.

Ensure facility and network directors work with the Procurement and Logistics Office on a plan to identify resources and milestones to resolve identified supply chain management problems for identified facilities.

Direct the program office to develop a process to provide resources when needed to help networks and facilities resolve persistent supply chain management deficiencies, including those identified in this report.

Continue Procurement and Logistics Office efforts to automate tracking that will accurately capture and monitor all quality control review results, corrective action plans, and implementation of those plans.

Update the Procurement and Logistics Office audits of the quality control program to apply risk‑based sampling, evaluate action plan sufficiency and implementation, and use the results to continuously improve quality control review guidance and requirements.

Improve vulnerability management processes to ensure plans of action and milestones are created for vulnerabilities that cannot be mitigated within OIT timelines.

Implement a more effective system life-cycle process to ensure network devices are running operating systems that are configured to approved baselines and free of vulnerabilities.

Implement a process to verify that when employees are terminated, all their accounts are disabled.

Ensure network segmentation controls are applied to all network segments with special-purpose systems.

Implement a process to retain database logs for a period consistent with VA’s record retention policy.

Instruct the Office of Finance to review the $14 million retained by the medical centers to ensure these funds were, or will be, spent in accordance with all applicable VA policies and federal laws.

Require the Office of Finance to strengthen controls over designated specific purpose funds so that Veterans Integrated Service Network chief financial officers can account for all the distributed funds and make certain that the funds are used for the intended purpose.

Define the roles and responsibilities of the appropriate assistant under secretaries, program office staff, and regional and medical center staff in the implementation and monitoring of the substance use disorder hiring initiative and ensure the relative priority of the initiative is communicated; hiring progress is monitored; possible hiring challenges are addressed to the extent possible; and actions are taken as needed to meet the goals of the hiring initiative.

Establish a mechanism to monitor progress of the Digital GI Bill platform implementation under the renegotiated contract to avoid additional costs and delays.

Communicate regularly with the Digital GI Bill platform contractor to ensure that the project’s integrated master schedule or other master scheduling plan is consistently updated to reflect all schedule changes for external dependencies.

Develop strategies to address critical path failures to provide a clear timeline of further implementation activities.

The Veterans Crisis Line Director determines the optimal ratio of supervisors to frontline staff needed, makes the best efforts to ensure the ratio is maintained, and takes action as warranted.

The Veterans Crisis Line Director ensures supervisors and staff are aware of postvention resources and monitors for compliance.

Require the Office of Integrated Veteran Care and Pharmacy Benefits Management Services to improve community provider compliance when prescribing special-authorization drugs and being responsive to VA pharmacy inquiries. This should include consideration of electronic system capabilities to attach medical justifications, allow community providers to have real-time access to VA’s formulary when prescribing drugs, and enable two-way communication between community providers and VA pharmacists electronically.

Task the Office of Integrated Veteran Care to train community providers on the VA formulary and implement a process to improve tracking of training completion and community providers’ compliance with VA guidance on submitting prescriptions for special-authorization drugs.

Direct Pharmacy Benefits Management Services to update its dashboard to more accurately capture special-authorization drug request processing times and provide the Office of Integrated Veteran Care access to this information for contract management purposes.

Instruct Pharmacy Benefits Management Services to require that VA pharmacy personnel document community care prescriptions for special-authorization drugs in the veteran’s medical record (in consults when applicable or medical notes) when the pharmacy receives the prescription and make clear that the 96-hour processing time is a requirement for these types of drug requests.

Require Pharmacy Benefits Management Services to routinely remind pharmacists that they are responsible for reporting a community provider to the medical facility’s community care office when the provider does not comply with VA documentation requirements for special-authorization drug requests.

Charge facility community care offices to work with pharmacy personnel to report when they receive information from VA pharmacists that community providers did not comply with VA’s documentation requirements for special-authorization drugs. Reporting mechanisms can include submitting Potential Quality Issue Referral reports or Health Care Quality Concern reports to third-party administrators.

Direct Pharmacy Benefits Management Services to standardize requirements for how VA pharmacists code drug requests from community providers in the electronic system that were canceled, rejected, or removed to help VHA determine if corrective actions need to be taken on processes, contract terms, or guidance.

The Secretary of Veterans Affairs considers incorporating environmental stewardship values into the goals of the Climate- and Sustainability-Focused Federal Workforce priority action in the VA Sustainability Plan to align with Executive Order 14057.

The Under Secretary for Health evaluates the facility-level Green Environmental Management System program manager position, and determines the position’s responsibilities, if any, in the implementation of the VA Sustainability Plan.

The Under Secretary for Health considers broadening the scope of training, education, and engagement of Veterans Health Administration’s workforce to include and incorporate environmental stewardship values.

The Under Secretary for Health encourages continued efforts by the Veterans Health Administration National Anesthesia Service to track and reduce greenhouse gas emissions from inhalational anesthetics and considers evaluation and implementation of a comprehensive waste anesthetic gas mitigation strategy, in pursuit of the VA Sustainability Plan’s priority action goal of achieving net-zero greenhouse gas emissions by 2045.

The Under Secretary for Health considers the relative merits of single-use versus reusable medical devices and evaluates current Veterans Health Administration policy that prohibits the repurposing of single-use medical devices by VA medical centers to increase landfill waste diversion.

Ensure all community dentists who provide dental care to veteran patients are notified and periodically reminded of the preauthorization requirements for any changes to treatment plans.

Conduct expanded postpayment reviews to identify and recover payments for unauthorized dental procedures.

Monitor VA dentists to make sure they include required dental procedure codes, not only general descriptions or Standardized Episodes of Care, on referrals to identify the procedures community dentists are authorized to perform.

Review the current contract language and determine if there is a need to clarify the third-party administrators’ claims adjudication responsibilities in its contracts to include the identification of unauthorized dental procedures and adjudication of possible denials of payment or implement controls within VA that will perform this adjudication function for dental claims.

Enable the Office of Finance’s automated payment system to deny payment for community dental services if the procedure codes on the dental claims do not fall within the Standardized Episodes of Care on the referral.

Update guidance mandating use of an effective date builder for rating veterans service representatives to consider earlier effective dates when granting entitlement to individual unemployability.

Develop standardized language and prioritize incorporation into the Veterans Benefits Management System to assist rating veterans service representatives in addressing all required information/elements within an individual unemployability rating narrative.

Establish additional system controls to ensure rating veterans service representatives address competency when individual unemployability has been awarded based solely on a mental condition.

Update the Veterans Benefits Administration’s procedures manual to ensure consistency among staff and clarify the language needed to satisfy the analysis requirement when granting entitlement to individual unemployability benefits.

Develop practical learning exercises for rating veterans service representatives related to individual unemployability for Virtual and In-Person Progression training.

Require rating veterans service representatives and veterans service representatives to process and demonstrate individual unemployability claim competency on veterans’ claims.

Evaluate the workload distribution methods for individual unemployability claims to increase claims processing consistency and knowledge retention.

Implement controls to allow for the capability to identify and monitor potential scheduling delays and to ensure family preferences are being met at national cemeteries.