Lance's Corner

GAO Highlights Problems in VA Community Care Program

Aug 29, 2024

Per the notice below, the United States Government Accountability Office (GAO) is highlighting problems it found with the United States Veterans Administration (VA) Community Care Program.

A Veterans’ Program Meant to Help Increase Access to Health Care May Struggle to Do So

Improving veterans’ access to health care is a top priority for the Department of Veterans Affairs, which started the Veterans Community Care Program in 2019 to do just that.  The program allows veterans to make appointments with local health care providers when they can’t receive care from a VA facility or would have to travel too far for care.  In recent years, the Veterans Community Care Program has grown rapidly, raising concerns about its oversight.  And veterans have complained about long wait times and other delays when trying to schedule appointments through it.  Today’s WatchBlog post looks at our recent work on these issues and plans to address them.

Stethoscope on US flag

Wait times and delays getting mental health and other specialty care appointments

Even though veterans can receive care outside of the Veterans Health Administration (VHA) system, VHA still coordinates the appointments and makes referrals under the Community Care Program.  But in our work, we found that veterans may face delays in scheduling certain appointments—like those for mental health and other specialty care.

Mental health care.  The demand for mental health care has grown, including among veterans.  The VA has struggled to meet this demand at its facilities and within the Community Care Program.  In June, we sat down with GAO’s Alyssa Hundrup—an expert on veterans’ health care—to learn more about this issue and our report on it.  Alyssa told us that there is a national shortage of mental health care providers, which has also affected veterans’ access.  She said that in general, veterans are supposed to be able to have mental health appointments within 30 days.  However, on average, it may take more than 14 days from the time a referral is made to even schedule an appointment through a Community Care.  Listen to our interview with GAO’s Alyssa Hundrup below.

Specialty care.  Specialty care include things like diagnostic testing, specialized treatments, and consultations with specialists such as cardiologists.  Scheduling these appointments quickly may help with early detection and treatment of health conditions and symptoms.  In 2023, we reported that veterans may wait longer for VHA facilities to schedule specialty care appointments through the Community Care Program.  We found that VHA had set timeliness standards for scheduling these appointments.  But it wasn’t analyzing available scheduling information to know whether VHA facilities that schedule these appointments were able to meet those time frames.  We made several recommendations to improve VHA’s efforts and it has taken some action to address them.  For example, VHA has analyzed information about the timeliness of appointments and established a goal for each VHA facility to reduce the number of days it takes to schedule appointments for specialty care.  Learn more about its efforts in our report.

As the Community Care Program grows, VA should strengthen oversight

The Community Care Program provides health care to 2.8 million veterans—a number that has grown rapidly over the years.  Contract spending on this program has also grown by 40% to meet this demand.  This growth has added to the complexity of overseeing the program to ensure veterans are able to access the timely care they need.

Bar chart showing growth in Community Care obligations between FY 2018 and 2023

But when we looked at how VA has responded to this growth, we found gaps that weakened its oversight of the contractors who connect veterans with community care.  For example, in our new report out this month, we found that program staff don’t have clearly defined procedures, such as how to track and communicate problems about things like contractor performance and operational issues.  This limits VA’s ability to respond to issues and solve them.  We also found that VA eliminated its contract program manager position.  This could ultimately reduce VA oversight of these large contracts and impact the quality of the care provided to veterans.  VA is taking some steps to improve contractor oversight.  But it does not have a formal process for documenting lessons learned.  VA is currently preparing to award a new set of community care contracts.  Without taking steps to address the issues above, VA risks continued contract oversight challenges.  Learn more by reading our August report.

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc