VA DISABILITY EXAMS: Improved Performance Analysis and Training Oversight Needed for Contracted Exams

What GAO Found

The Veterans Benefits Administration (VBA) has limited information on whether contractors who conduct disability compensation medical exams are meeting the agency’s quality and timeliness targets. VBA contracted examiners have completed a growing number of exams in recent years (see figure). VBA uses completed exam reports to help determine if a veteran should receive disability benefits. VBA reported that the vast majority of contractors’ quality scores fell well below VBA’s target—92 percent of exam reports with no errors—for the first half of 2017. Since then, VBA has not completed all its quality reviews, but has hired more staff to do them. VBA officials acknowledged that VBA also does not have accurate information on contractor timeliness. VBA officials said the exam management system used until spring 2018 did not always retain the initial exam report completion date, which is used to calculate timeliness. In spring 2018, VBA implemented a new system designed to capture this information. GAO-19-13: Published: Oct 12, 2018. Publicly Released: Nov 8, 2018

VBA monitoring has addressed some problems with contractors, such as reassigning exams from contractors that did not have enough examiners to those that did. However, the issues GAO identified with VBA’s quality and timeliness information limit VBA’s ability to effectively oversee contractors. For example, VBA officials said they were unable to track the timeliness of exam reports sent back to contractors for corrections, which is needed to determine if VBA should reduce payment to a contractor. The new system implemented in spring 2018 tracks more detailed data on exam timeliness. However, VBA has not documented how it will ensure the data are accurate or how it will use the data to track the timeliness and billing of corrected exam reports. VBA also has no plans to use the new system to analyze performance data to identify trends or other program-wide issues. Without such plans, VBA may miss opportunities to improve contractor oversight and the program overall.

A third-party auditor verifies that contracted examiners have valid medical licenses, but VBA does not verify if examiners have completed training nor does it collect information to assess training effectiveness in preparing examiners. While VBA plans to improve monitoring of training, it has not documented plans for tracking or collecting information to assess training. These actions could help ensure that VBA contractors provide veterans with high-quality exams and help VBA determine if additional training is needed.

Why GAO Did This Study

In 2016, VBA awarded 12 contracts to five private firms for up to $6.8 billion lasting up to 5 years to conduct veterans’ disability medical exams. Both VBA contracted medical examiners and medical providers from the Veterans Health Administration perform these exams, with a growing number of exams being completed by contractors. Starting in 2017, VBA contracted examiners conducted about half of all exams. GAO was asked to review the performance and oversight of VBA’s disability medical exam contractors.
This report examines (1) what is known about the quality and timeliness of VBA contracted exams; (2) the extent to which VBA monitors contractors’ performance; and (3) how VBA ensures that its contractors provide qualified and well-trained examiners. GAO analyzed the most recent reliable data available on the quality and timeliness of exams (January 2017 to February 2018), reviewed VBA and selected contract documents and relevant federal laws and regulations, and interviewed agency officials, exam contractors, an audit firm that checks examiners’ licenses, and selected veterans service organizations.

What GAO Recommends

GAO recommends VBA (1) develop a plan for using its new data system to monitor contractors’ quality and timeliness performance, (2) analyze overall program performance, (3) verify that contracted examiners complete required training, and (4) collect information to assess the effectiveness of that training. The Department of Veterans Affairs agreed with GAO’s recommendations.
View Report (PDF)

694986

VA: Actions Needed to Address Employee Misconduct Process and Ensure Accountability

Employee misconduct at VA’s medical facilities can have serious consequences for veterans. We looked at how VA deals with employee misconduct and found several opportunities for improvement. For example:

VA doesn’t always maintain required files and documents for adjudication, suggesting that employees may not have received due process.

VA officials found guilty of misconduct sometimes received a lesser punishment than recommended or no punishment.

Whistleblowers were 10 times more likely than their peers to receive disciplinary action within a year of reporting misconduct.

 Why GAO Did This Study

VA provides services and benefits to veterans through hospitals and other facilities nationwide. Misconduct by VA employees can have serious consequences for some veterans, including poor quality of care. GAO was asked to review employee misconduct across VA. This report reviews the extent to which VA (1) collects reliable information associated with employee misconduct and disciplinary actions, (2) adheres to documentation-retention procedures when adjudicating cases of employee misconduct, (3) ensures allegations of misconduct involving senior officials are reviewed according to VA investigative standards and these officials are held accountable, and (4) has procedures to investigate whistle-blower allegations of misconduct; and the extent to which (5) data and whistle-blower testimony indicate whether retaliation for disclosing misconduct occurs at VA.
GAO analyzed 12 information systems across VA to assess the reliability of misconduct data, examined a stratified random sample of 544 misconduct cases from 2009 through 2015, analyzed data and reviewed cases pertaining to senior officials involved in misconduct, reviewed procedures pertaining to whistle-blower investigations, and examined a nongeneralizable sample of whistle-blower disclosures from 2010 to 2014.

What GAO Found

The Department of Veterans Affairs (VA) collects data related to employee misconduct and disciplinary actions, but fragmentation and data-reliability issues impede department-wide analysis of those data. VA maintains six information systems that include partial data related to employee misconduct. For example, VA’s Personnel and Accounting Integrated Data system collects information on disciplinary actions that affect employee leave and pay, but the system does not collect information on other types of disciplinary actions. The system also does not collect information such as the offense or date of occurrence. GAO also identified six other information systems that various VA administrations and program offices use to collect specific information regarding their respective employees’ misconduct and disciplinary actions. GAO’s analysis of all 12 information systems found data-reliability issues—such as missing data, lack of identifiers, and lack of standardization among fields. Without collecting reliable misconduct and disciplinary action data on all cases department-wide, VA’s reporting and decision making on misconduct are impaired.
VA inconsistently adhered to its guidance for documentation retention when adjudicating misconduct allegations, based on GAO’s review of a generalizable sample of 544 out of 23,622 misconduct case files associated with employee disciplinary actions affecting employee pay. GAO estimates that VA would not be able to account for approximately 1,800 case files. Further, GAO estimates that approximately 3,600 of the files did not contain required documentation that employees were adequately informed of their rights during adjudication procedures—such as their entitlement to be represented by an attorney. The absence of files and associated documentation suggests that individuals may not have always received fair and reasonable due process as allegations of misconduct were adjudicated. Nevertheless, VA’s Office of Human Resource Management does not regularly assess the extent to which files and documentation are retained consistently with applicable requirements.
VA did not consistently ensure that allegations of misconduct involving senior officials were reviewed according to investigative standards and these officials were held accountable. For example, based on a review of 23 cases of alleged misconduct by senior officials that the VA Office of Inspector General (OIG) referred to VA facility and program offices for additional investigation, GAO found VA frequently did not include sufficient documentation for its findings, or provide a timely response to the OIG. In addition, VA was unable to produce anydocumentation used to close 2 cases. Further, OIG policy does not require the OIG to verify the completeness of investigations, which would help ensure that facility and program offices had met the requirements for investigating allegations of misconduct. Regarding senior officials, VA did not always take necessary measures to ensure they were held accountable for substantiated misconduct. As the figure below shows, GAO found that the disciplinary action proposed was not taken for 5 of 17 senior officials with substantiated misconduct.
Action Proposed in Department of Veterans Affairs (VA) Office of Accountability Review’s Legacy Referral Tracking List Compared with Final Action Taken

Action Proposed in Department of Veterans Affairs (VA) Office of Accountability Review’s Legacy Referral Tracking List Compared with Final Action Taken

*Adverse action.
As a result of June 2017 legislation, a new office within VA—the Office of Accountability and Whistleblower Protection—will be responsible for receiving and investigating allegations of misconduct involving senior officials.
VA has procedures for investigating whistle-blower complaints, but the procedures allow the program office or facility where a whistle-blower has reported misconduct to conduct the investigation. According to the OIG, it has the option of investigating allegations of misconduct, or exercising a “right of first refusal” whereby it refers allegations of misconduct to the VA facility or program office where the allegation originated. VA does not have oversight measures to ensure that all referred allegations of misconduct are investigated by an entity outside the control of the facility or program office involved in the misconduct, to ensure independence. As a result, GAO found instances where managers investigated themselves for misconduct, presenting a conflict of interest.Data and whistle-blower testimony indicate that retaliation may have occurred at VA. As the table below shows, individuals who filed a disclosure of misconduct with the Office of Special Counsel (OSC) received disciplinary action at a much higher rate than the peer average for the rest of VA in fiscal years 2010–2014.
Data and whistle-blower testimony indicate that retaliation may have occurred at VA. As the table below shows, individuals who filed a disclosure of misconduct with the Office of Special Counsel (OSC) received disciplinary action at a much higher rate than the peer average for the rest of VA in fiscal years 2010–2014.

Comparison of Adverse Disciplinary Action Taken for Nonanonymous Department of Veterans Affairs (VA) Employees Who Reported Wrongdoing and Those Who Did Not, 2010–2014
Employee category Percentage for whom adverse actions were taken
Prior to disclosure Year of disclosure Year after disclosure
Individuals who filed a disclosure 2 10 8
Rest of VA 1 1 1

Additionally, GAO’s interviews with six VA whistle-blowers who claim to have been retaliated against provided anecdotal evidence that retaliation may be occurring. These whistle-blowers alleged that managers in their chain of command took several untraceable actions to retaliate against the whistle- blowers, such as being denied access to computer equipment necessary to complete assignments.

What GAO Recommends

GAO makes numerous recommendations to Veterans Affairs to help enhance its ability to address misconduct issues.
GAO recommends, among other things, that the Secretary of Veterans Affairs

  • develop and implement guidance to collect complete and reliable misconduct and disciplinary-action data department-wide; such guidance should include direction and procedures on addressing blank fields, lack of personnel identifiers, and standardization among fields;
  • direct applicable facility and program offices to adhere to VA’s policies regarding misconduct adjudication documentation;
  • direct the Office of Human Resource Management to routinely assess the extent to which misconduct-related files and documents are retained consistently with applicable requirements;
  • direct the Office of Accountability and Whistleblower Protection (OAWP) to review responses submitted by facility or program offices to ensure evidence produced in senior-official case referrals demonstrates that the required elements have been addressed;
  • direct OAWP to issue written guidance on how OAWP will verify whether appropriate disciplinary action has been implemented; and
  • develop procedures to ensure (1) whistle-blower investigations are reviewed by an official independent of and at least one level above the individual involved in the allegation, and (2) VA employees who report wrongdoing are treated fairly and protected against retaliation.

GAO also recommends, among other things, that the VA OIG

  •  revise its policy and require verification of evidence produced in senior-official case referrals.

VA concurred with nine recommendations and partially concurred with five. In response, GAO modified three of the recommendations. The VA OIG concurred with one recommendation and partially concurred with the other. GAO continues to believe that both are warranted. GAO modified three of the recommendations. The VA OIG concurred with one recommendation and partially concurred with the other. GAO continues to believe that both are warranted.
https://www.gao.gov/products/GAO-18-137

Employee misconduct at VA’s medical facilities can have serious consequences for veterans. We looked at how VA deals with employee misconduct and found several opportunities for improvement. For example:VA doesn’t always maintain required files and documents for adjudication, suggesting that employees may not have received due process.VA officials found guilty of misconduct sometimes received a lesser punishment than recommended or no punishment.Whistleblowers were 10 times more likely than their peers to receive disciplinary action within a year of reporting misconduct.

Unwarranted Medical Reexaminations for Disability Benefits VA OIG 17-04966-201

Why the OIG Did This Review

The OIG conducted this review to determine whether Veterans Benefits Administration (VBA) employees required disabled veterans to submit to unwarranted medical reexaminations.1
VBA employees have authority to request reexaminations for veterans “whenever VA determines there is a need to verify either the continued existence or the current severity of a disability,” and when there is no exclusion from reexamination.2 While reexaminations are important in the appropriate situation to ensure taxpayer dollars are appropriately spent, unwarranted reexaminations cause undue hardship for veterans. They also generate excessive work, resulting in significant costs and the diversion of VA personnel from veteran care and services.

What the Review Found

VBA employees did not consistently follow policy to request reexaminations only when necessary.3 The OIG team reviewed a statistical sample of 300 cases with reexaminations from March through August 2017 (review period) and found that employees requested unwarranted medical reexaminations in 111 cases. Based on this sample, the review team estimated that employees requested unwarranted reexaminations in 19,800 of the 53,500 cases during the review period (37 percent). VBA employees requested reexaminations for veterans whose cases qualified for exclusion from reexamination for one or more of the following reasons:

  • Over 55 years old at the time of the examination, and not otherwise warranted by unusual circumstances or regulation
  • Permanent disability and not likely to improve
  • Disability without substantial improvement over five years
  • Claims folders contained updated medical evidence sufficient to continue the current disability evaluation without additional examination
  • Overall combined evaluation of multiple disabilities would not change irrespective of the outcome of reexamining the particular condition
  • Disability evaluation of 10 percent or less
  • Disability evaluation at the minimum level for the condition4

The review team estimated that during the six-month review period, VBA spent $10.1 million on unwarranted reexaminations—$5.3 million involving Veterans Health Administration clinicians and $4.8 million involving VBA contractors.5 The review team estimated that VBA would waste $100.6 million on unwarranted reexaminations over the next five years unless it ensures that employees only request reexaminations when necessary.
In assessing the unnecessary burdens for veterans, the review team estimated that VBA required 19,800 veterans to report for unwarranted medical reexaminations during the review period. Reinforcing the needlessness of the reexaminations, approximately14,200 veterans experienced no change to their disability evaluations because of their reexamination. The review team estimated that the reexaminations resulted in proposed benefit reductions for about 3,700 veterans.6 At the conclusion of the review period, these proposed reductions remained subject to a final decision and an appeal process; therefore, the OIG did not make a determination on whether the reductions were justified.7 Unwarranted reexaminations also created unnecessary work for Veterans Affairs employees, which reduced VBA’s capacity to process benefits claims and the Veterans Health Administration’s (VHA’s) capacity to provide healthcare services.

Why This Occurred

Prior to requesting that a veteran appear for a medical reexamination, VBA policy requires a Rating Veterans Service Representative (RVSR) to review the veteran’s claims folder and determine whether the reexamination is needed (pre-exam review).8 The pre-exam review serves as an internal control to prevent unwarranted reexaminations. The review team estimated, however, that 15,500 of 19,800 unwarranted reexaminations (78 percent) lacked a pre-exam review by an RVSR, indicating that VBA management routinely bypassed this internal control. Instead, VA Regional Office (VARO) managers routed these cases directly to a Veterans Service Representative (VSR) for scheduling the reexamination.
VARO managers explained that routing cases directly to VSRs was consistent with guidance from the Executive in Charge for VBA. The guidance recommends that tasks not directly related to making a disability rating decision should not be assigned to an RVSR. The Executive in Charge confirmed that the VARO managers’ interpretation was consistent with his expectations. He explained to the review team that RVSR capacity is limited, and therefore an RVSR should not spend time on activities that do not directly relate to making rating determinations. Reinforcing the Executive in Charge’s mandate, VBA redesigned its employee performance standards in 2017. This revision resulted in RVSRs earning work credit for rating decisions but not for other transactions, such as canceling an unwarranted reexamination.
Bypassing the pre-exam review caused unwarranted reexaminations. VARO managers routed the work to VSRs who lacked the training and experience necessary to make accurate determinations about whether a reexamination was warranted. Determining whether a reexamination is necessary is an RVSR responsibility; however, VSRs were tasked with making this determination. VBA employees and managers stated that determining the necessity of a reexamination requires specialized knowledge, including the ability to review medical evidence. Similarly, 14 of the 24 VSRs interviewed told the review team that they were unfamiliar with the criteria for determining whether a reexamination was necessary.
VBA also did not invest in developing alternative internal controls to compensate for the lack of a pre-exam review. VBA could add features to the Veterans Benefits Management System (VBMS) to prevent the scheduling of reexaminations in cases that meet the exemption criteria, such as information system automation. VBA has not implemented these features in VBMS due to reported competing technology priorities and a lack of funding. In September 2017, VBA took initial steps and implemented a technology strategy designed to reduce unnecessary work by identifying and canceling work items for veterans age 55 or older that would have resulted in unwarranted reexaminations. This effort resulted in the one-time elimination of approximately 45,000 reexaminations. VBA plans to implement additional one-time cancellations in the future, and VBMS automation is scheduled for FY 2019 or later.
Finally, VBA’s quality assurance processes did not measure whether VBA employees requested reexaminations only when necessary, nor did these processes evaluate whether an RVSR conducted a pre-exam review as required by VBA policy.

What the OIG Recommended

The OIG made four recommendations to the Under Secretary for Benefits:

  • Establish internal controls sufficient to ensure that a reexamination is necessary prior to employees ordering it, and modify VBA procedures as appropriate to reflect these improved business processes.
  • Take steps to prioritize the design and implementation of system automation reasonably designed to minimize unwarranted reexaminations.
  • Enhance VBA’s quality assurance reviews to evaluate whether employees correctly requested reexaminations and to categorize unwarranted reexaminations as errors.
  • Conduct a special focused quality improvement review of cases with unwarranted reexaminations to understand and redress the causes of any avoidable errors.

Management Comments

The Under Secretary for Benefits concurred with three of the four recommendations, and concurred in principle with the fourth recommendation. The Under Secretary for Benefits provided acceptable action plans for all four recommendations. The OIG will monitor VBA’s progress and follow up on implementation of the recommendations until all proposed actions are completed.
The Under Secretary for Benefits also provided technical comments related to this report. The OIG considered those comments and made clarifications where applicable.

1 VBA also refers to medical reexaminations as routine future examinations.

2 38 CFR §3.327, Reexaminations.

3 The relevant policy is found in M21-1 Adjudication Procedures Manual, Part III, Subpart iv, Chapter 3, Section B, Topic 2, Determining the Need for Review Examinations.

4 VBA relies on these objective criteria to identify disabilities that are unlikely to improve and therefore do not merit the expense and burden of reexamination.

5 The review team estimated the cost of unwarranted reexaminations using the results of the team’s statistical sample claims review. See Appendix C for more information on the statistical sampling methodology and results.

6 The review team did not project cost savings based on the 3,700 veterans with proposed reductions because the reductions were only proposals—not final reductions. When VBA makes a final decision, the proposed reduction amount may be changed, or there may be no reduction at all.

7 The review team estimated the number of veterans who had proposed benefits reductions using the results of the team’s statistical sample. Some reexaminations resulted in increases to veterans’ benefits, but the small sample size prevented the review team from making a statistical projection to estimate the value of all increases during the review period.

8 M21-1 Adjudication Procedures Manual, Part III, Subpart iv, Chapter 3, Section C, Topic 2, Control of Future Examinations. For this report, the OIG defines the required RVSR review prior to a reexamination request as the Pre-exam Review.

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Top 10 VA Disability Claims Posts for 2017

 

VA Math, Confusing, Right? Calculate Your Final Rating Percentage!

Estimated reading time: 9 minutes We usually have a calculator on this page to add your disability percentages up. Ours broke, but we found this easy one

VA C&P Exam – Do’s and Don’ts – VA Compensation Pension Exam

The following is written from a VA C&P Examiners’ perspective relating to psychiatric exams. It is a good guideline for all exams but I only did psych exams. I’ve been examined by the VA for multiple problems and this is my format when I go to be examined.


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Can a 100 percent Disabled Veteran Work and Earn an Income?

You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons after being rated 100% disabled.

Common Claimed VA Service Connected Disabilities

Click on any disability to find discussions related to that disability. Learn something new. Common Disabilities claimed as service connected disability. These links will take you to relevant articles and posts on the subject.


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VA Disability Compensation Claims

Administrative practice and procedure Alcohol abuse Alcoholism Case law Claims Day care Dental health Department of Veterans Affairs Disability Disability benefits Drug abuse Government contracts Government procurement Grant programs-health Grant programs-veterans Health care Health facilities Health professions Health records Homeless IU Medical research Mental health programs Military Military personnel Nursing homes Posttraumatic stress disorder ptsd Reporting and recordkeeping requirements SAS sleep apnea TDIU Tinnitus Travel and transportation expenses Uncategorized Unemployability United States Department of Veterans Affairs va claims veteran Veterans veterans affairs Veterans Affairs disability Veterans benefits for post-traumatic stress disorder in the United States Veterans Health Administration Vietnam

Requesting A Copy of Your VA Claims Folder (C-File)

VA Claims Folders, the infamous C-File We can not stress enough how important it is to: View your VA Claims Folder at the Veterans Affairs regional office (find your Regional VA Office here) Call the VA at 1-800-827-1000 and request an appointment to view your C-File (VA Claims Folder).


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eBenefits Development Letter Sent

Development letters are sent in the early stages of your claim. It acknowledges your claim and asks for additional evidence if you have any. The VA is legally required to send this letter to you. The letter may ask for things that aren’t applicable to your case, like buddy statements, or it may ask for things you’ve already submitted, like medical records.

4 Things Veterans Should Know about VA Sleep Apnea Disability Claims

From Chris Attig Veterans Law Blog “I get asked more questions about how to file and win a Veterans Affairs sleep apnea disability claim than almost any other topic in all of VA Benefits Law.” [Reprinted here with permission from Veterans Law Blog] True story. And I’ve been getting asked these questions for years.

6 Reasons to Keep Pursuing VA Claims and Appeals – AFTER you reach 100%

Do not to pursue a rating % as your goal in your VA Claims and Appeals …. instead seek to service connect every disability that resulted from your military service.

10 Tips to Help You Keep the VA Compensation and Pension Exam (C&P exam) in Perspective

” I encouraged you to keep the VA compensation and pension exam in perspective. What is that Perspective? Honestly, it comes down to recognizing that the purpose of the C&P Exam is NOT to convince the doctor that your injury is service-connected, but to let him or her conduct their exam and draw their conclusion.


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Audit of the Timeliness and Accuracy of Choice Payments Processed Through the Fee Basis Claims System – Dec 2017


This report covers the audit of payments made through VA’s Fee Basis Claims System (FBCS), encompassing claims paid via that payment process from November 1,  2014  through  September 30, 2016. A subsequent report will contain the results of an audit conducted to assess VA’s processing of payments through a “bulk payment” process during 2016 and 2017.
The Executive Summary is below followed by a link to the full report.
Why We Did This Audit
Public Law 113-146 (August 7, 2014), Veterans Access, Choice, and Accountability Act of  2014 (VACAA), Section 101(o), requires the Inspector General of the Department of Veterans Affairs to issue a report to the Secretary of VA within 30 days after the Secretary’s determination that 75 percent of the amounts deposited in the Veterans Choice Fund established by VACAA (the “Choice Fund”) have been exhausted.1 The report was to address “the results of an audit of the care and services furnished under this section to ensure the accuracy and timeliness of payments by the Department for the cost of such care and services, including any findings and recommendations of the Inspector General.”
This report covers the audit of payments made through VA’s Fee Basis Claims System (FBCS), encompassing claims paid via that payment process from November 1,  2014  through  September 30, 2016. A subsequent report will contain the results of an audit conducted to assess VA’s processing of payments through a “bulk payment” process during 2016 and 2017.

Background

On August 7, 2014, following well-publicized issues regarding delays in accessing care at VA medical centers (particularly in Phoenix, Arizona), Congress enacted VACAA, which set forth a broader program (the “Choice Program”) to enable eligible veterans to obtain medical care from providers in their communities.2 Congress appropriated $10 billion to the Choice Fund to be spent on care and expenses specifically authorized under VACAA, including $300 million for administrative expenses associated with establishing and maintaining the Choice Program. VACAA required VA to implement key portions of the Choice Program within 90 days, and veterans began using the Choice Program by November 2014.
VA’s Office of Community Care (OCC), which is part of the Veterans Health Administration (VHA) and is under the leadership of the Deputy Under Secretary for Health for Community Care, is responsible for the administration and operation of the Choice Program.3 VA’s Patient-Centered Community Care program (PC3) is a nationwide program for delivering care in the community established in 2013. In October 2014, VA amended the PC3 contracts with Third
1 The VA Office of Inspector General, pursuant to the requirement in Public Law 113-146, released on September 12, 2017 to the Secretary of Veterans Affairs a memorandum titled “Accuracy and Timeliness of Payments Made Under the Choice Program Authorized by the Veterans Access, Choice, and Accountability Act.”
2 Public Law 113-146 (August 7, 2014), Veterans Access, Choice, and Accountability Act of 2014. Eligibility for Choice is based on specific criteria relating to wait times for appointments and distance from the nearest medical facility, and these eligibility requirements have been modified on occasion by statute and regulation.
3 OCC, the group managing Choice, was known as the Chief Business Office until October 2016, when it reorganized into the Office of Community Care. Regardless of time frame, this group will be referred to as “OCC.”
Party Administrators (TPA) Health Net Federal Services LLC (Health Net) and TriWest Healthcare Alliance Corporation (TriWest) to include administration of the Choice Program, including establishing provider networks, scheduling appointments, receiving medical documentation, and making payments for medical care on behalf of VA.
Under the PC3/Choice contracts, VA makes payments to the TPAs, not the providers. The TPAs are responsible for paying their providers. VA reimburses the TPAs for payments the TPAs make to providers for veterans’ medical care obtained through the Choice Program. TPAs’ billings are submitted to OCC electronically, and then processed by VA’s Financial Services Center (FSC) in Austin, Texas. During the period of review for this audit, the FSC processed Choice claims using FBCS.

What We Did

Choice payment data were obtained from VA’s Central Fee Files and statistically sampled for each TPA. Our audit included Choice claims processed in FBCS for payment to the TPAs from November 1, 2014 through September 30, 2016. We did not audit bulk Choice medical  payments processed outside of FBCS,4 Choice administrative payments, or payments for Hepatitis C and other non-Department care that used Choice Program funding.
We reviewed a sample of payment transactions from the approximately $649 million paid to Health Net ($69 million) and TriWest ($580 million) from November 1, 2014 through September 30, 2016, via FBCS.5 We reviewed the PC3/Choice contracts and interviewed officials from OCC, FSC, the Denver Acquisition and Logistics Center, Health Net, and TriWest. We used a third-party vendor to evaluate medical claims in our audit sample to determine if the Medicare rates applied were correct.

What We Found

We estimated that from November 1, 2014 through September 30, 2016, payment errors were made on approximately 224,000 of 2.0 million Choice claims (12 percent)6 paid via FBCS.
These errors were of the following types:
Payment rate – Payments made on claims that did not use the appropriate Medicare or contract adjusted rate 4PC3/Choice contracts were modified in March through November 2016 to allow VCPBYPASS (payments for Choice medical claims that were not submitted to Veterans Affairs by the TPAs due to missing medical documentation) and Expedited payments for Choice medical care to TPAs. We refer to these transactions as “bulk payments” for the purpose of our report. Because these bulk payment processes were not in place when this review was planned, a second audit was started in April 2017 to address the accuracy of payments under the bulk payment process.
5FBCS is the current claims processing system used for processing and payment by VHA of claims authorized under
the non-VA Care Program which does not include PC3 or Choice claims.
6All payment error rates presented in this report are based on projections for a randomly selected sample; see Appendix C Statistical Sampling Methodology for more details.
Other Health Insurance (OHI) – Payments made on claims that were not adjusted for the amount OHI was responsible to pay the provider
Duplicate – Payments for medical claims that were submitted and paid more than once
Pass-Through – Payments where the amount the TPAs billed and were paid was more than the TPA paid the provider
We estimated that OCC payments to TPAs for approximately 1.0 million of 2 million claims   (50 percent) were  made  in  excess  of  the  30-day  Prompt  Payment  Standard  from  November 1, 2014 through September 30, 2016.
We also estimated that Health Net took 47 days on average to pay its  providers  from  November 1, 2014 through September 30, 2016. TriWest averaged 39 days to pay its providers for the same period.

Why This Occurred

The U.S. Government Accountability Office’s Standards for Internal Control in the Federal Government (Green Book) defines internal control standards for Federal Government agencies through five components consisting of 17 key principles necessary to produce an effective internal control system. In our review of the OCC Choice payment process, we found several internal control weaknesses in the payment process that contributed to the errors discussed in this report. We concluded that OCC did not design an effective internal control system for the  Choice payment process and did not appropriately follow these internal control principles:

  • Create clear written policy for the payment of claims
  • Ensure access to quality information is available for payment processing staff
  • Use a well-designed information system to address the risk of overpaying medical claims
  • Establish monitoring activities to ensure internal controls are working

OCC’s payments averaged 37 days to Health Net and 36 days to TriWest. These payment delays occurred because OCC did not accurately estimate the amount of staff necessary to process Choice claims through their Service Level Agreement with FSC. In addition, although VACAA requires VA to meet the timeliness standards of the Prompt Payment Act in paying the TPAs, the PC3/Choice contracts do not specify a timeliness standard applicable to the TPAs for their payments to providers.7
7 Public Law 113-146 (August 7, 2014) Veterans Access, Choice, and Accountability Act of 2014 (VACAA), Section 105(b)(1) and (2). VACAA requires VA to establish a claims processing system that complies with all requirements of the Prompt Payment Act, 5 CFR part 1315 – Prompt Payment.

What Resulted

OCC failed to comply with VACAA regulations when it established payment processing systems that did not function efficiently and have proper controls to ensure payment accuracy. TPAs improperly billed OCC, and OCC made an estimated 224,000 payment errors when paying the TPAs because OCC did not have in place an effective internal control system for the Choice payment process to ensure Choice payment accuracy. These payment errors resulted in an estimated overpayment of about $39 million during our period of review.
OCC did not implement an efficient claims processing system for Choice claims or adequately estimate staffing levels in the Service Level Agreement with FSC so that resources could be allocated in advance to deal with the Choice claims volume demand. Without such a system, OCC will continue to be at risk of late payments and penalty interest charges. Additionally, until OCC adds a standard for Choice payment timeliness to the PC3/Choice contracts for Health Net and TriWest, OCC will not have a control in place to enforce timely payments to Choice providers.

What We Recommended

We made these recommendations to the Executive in Charge, Veterans Health Administration:

  • Develop and issue written payment policies to guide staff processing medical claims received from TPAs as well as establish expectations and obligations for the TPAs that submit invoices for
  • Ensure payment processing staff have access to documentation from the TPAs verifying amounts paid to providers to ensure the TPAs are not billing VA more than they paid the provider for medical
  • Ensure VHA payment processing staff have access to accurate data regarding veterans’ OHI coverage and establish appropriate processes for collecting payments from these health insurers.
  • Ensure the new payment processing systems used for processing medical claims from TPAs have the ability to adjudicate reimbursement rates accurately and to ensure duplicate claims are not
  • Ensure VA performs post-payment audits on a periodic basis to determine if payments made to TPAs for medical care are
  • Ensure OCC staff and members of VA’s Office of General Counsel continue to work collaboratively with relevant government authorities to review and determine an appropriate process for
  • Ensure VHA has sufficient claims processing capacity to timely meet and process expected claim volume from the
  • Ensure that future contracts with TPAs contain payment timeliness standards for the processing of claims from health care

Agency Comments

The Executive in Charge, Office of the Under Secretary for Health, concurred with our findings and agreed that a full review of payments made under the Veterans Choice Program  and recovery of all identified overpayments is essential. The Executive in Charge stated that VHA has already taken action to identify past duplicate payments and prevent future duplicate payments to TPAs beginning in July 2017 and plans to continue working collaboratively with the Office of Inspector General (OIG) and all other relevant government stakeholders to ensure that Choice payments are thoroughly reviewed and all overpayments are recovered.
The Executive in Charge concurred with Recommendations 1, 3, 5, 6, 7, and 8 and concurred in
principle with Recommendations 2 and 4. Regarding Recommendations 2 and 4, VHA will address the documentation requirement in the upcoming Community Care Network contract.  The Executive in Charge’s planned corrective actions are acceptable. The OIG will monitor VHA’s progress and follow up on the implementation of our recommendations until all proposed actions are completed.
[pdf-embedder url=”https://hadit.com/wp-content/uploads/2018/01/VAOIG-15-03036-47.pdf”]

VA Contracting: Improvements in Buying Medical and Surgical Supplies Could Yield Cost Savings and Efficiency

[no_toc]Last year VA launched a new program to streamline purchasing supplies for their medical centers.
As GAO lays out what the VA needed to do for the program to be successful

  • A strong strategic plan
  • Stable leadership
  • Good communications
  • Stakeholder buy-in

GAO found Veterans Affairs was missing these elements when it launched the program; as a result, the program has yet to achieve key goals of cost savings and greater efficiency.

https://www.gao.gov/products/GAO-18-34
Highlights from the report:

What GAO Found

The Department of Veterans Affairs (VA) established the Medical Surgical Prime Vendor-Next Generation (MSPV-NG) program to provide an efficient, cost-effective way for its facilities to order supplies, but its initial implementation was flawed, lacked an overarching strategy, stable leadership, and sufficient workforce that could have facilitated medical center buy-in. VA developed requirements for a broad range of MSPV-NG items with limited clinical input. As a result, the program has not met medical centers’ needs, and usage remains far below VA’s 40 percent target. VA also established cost avoidance as a goal for MSPV-NG, but currently only has a metric in place to measure broader supply chain cost avoidance, not savings specific to MSPV-NG. Also, starting in June 2015, VA planned to award competitive contracts for MSPV-NG items, but instead, 79 percent were added using non-competitive agreements. (See figure.) This was done primarily to meet VA’s December 2016 deadline to establish the formulary, the list of items available for purchase through MSPV-NG.

Total Number of Items by Award Type on MSPV-NG Formulary, Jan. 2017

Total Number of Items by Award Type on MSPV-NG Formulary, Jan. 2017
The roll-out of MSPV-NG ran counter to practices of leading hospitals that GAO spoke with, which highlighted key steps, such as prioritizing supply categories and obtaining continuing clinician input to guide decision-making. VA has taken steps to address some deficiencies identified in the first phase of implementation and is considering a new approach for this program. However, until VA addresses the existing shortcomings in the MSPV-NG program, such as the lack of medical center buy-in, it will face challenges in meeting its goals.
Medical centers often rely on emergency procurements to obtain routine goods and services—some of which could be made available at lower cost via MSPV-NG. Sixteen of the 18 contracts in GAO’s sample were not competed, which puts the government at risk of paying more. For instance, one medical center procured medical gas on an emergency basis through consecutive non-competitive contracts over a 3-year period. VA policy clearly defines emergency actions; however, inefficiencies in planning, funding, and communication at the medical centers contributed to emergency procurements, resulting in the contracting officers quickly awarding contracts with no competition.

Why GAO Did This Study

VA medical centers spend hundreds of millions of dollars annually on medical supplies and services. In December 2016, VA instituted a major change in how it purchases medical supplies—the MSPV-NG program—to gain effectiveness and efficiencies.
GAO was asked to examine VA’s transition to the MSPV-NG program and its use of emergency procurements. This report assesses the extent to which (1) VA’s implementation of MSPV-NG was effective in meeting program goals, and (2) VA awards contracts on an emergency basis. GAO analyzed VA’s MSPV-NG requirements development and contracting processes, and identified key supply chain practices cited by four leading hospital networks. GAO also reviewed a non-generalizable sample of 18 contracts designated in VA’s database as emergency procurements with high dollar values; and met with contracting, logistics, and clinical officials at 6 medical centers, selected based on high dollar contract obligations in fiscal years 2014-2016 and geographic representation.

What GAO Recommends

GAO is making 10 recommendations, including that VA expand clinician input in requirements development, calculate MSPV-NG cost avoidance, establish a plan for awarding future competitive contracts, and identify opportunities to strategically procure supplies and services frequently purchased on an emergency basis. VA agreed with GAO’s recommendations.

VA failed to report 90% of potentially dangerous medical providers, GAO confirms

[no_toc]

We aren’t asking for state of the art care, we are asking for quality competent care.

History doesn’t repeat but it often rhymes, how many times must our service be so devalued. Do we not deserve to receive the quality care we were promised, is the nations word no good to it’s own veterans. That should not be a stretch, it shouldn’t be that hard.

GAO found VA officials slow to investigate performance concerns of certain doctors. In 8 of 9 cases, VA failed to report docs who did not meet health care standards.

Highlights from the article

  • VA fails to report 90% of poor performing docs to national and state databases.
  • VA slow to investigate performance concerns.
  • VA failed to report docs who didn’t meet healthcare standards.
  • Concerns ranged from unsafe or inconsistent practices to incorrectly recording patient visits.
  • In one case a doc who had resigned while under investigation wasn’t reported and later hired by a non-VA hospital, not that surprising the doc was disciplined for the same conduct 2 years later at his/her new job.

Read the whole story be informed and outraged and share it with veterans. I’ve included the GAO report below the article link.
https://www.usatoday.com/story/news/politics/2017/11/27/va-failed-report-90-potentially-dangerous-medical-providers-gao-confirms/890582001/

VA HEALTH CARE:

Improved Policies and Oversight Needed for Reviewing and Reporting Providers for Quality and Safety Concerns GAO-18-63: Published: Nov 15, 2017. Publicly Released: Nov 27, 2017.

Fast Facts

The Department of Veterans Affairs requires its medical centers to review a doctor’s care if quality or safety concerns arise. If VA medical center officials decide a doctor should no longer provide care to veterans, they are required to inform hospitals and other health care entities by reporting to a national database and to the states where the doctor is licensed.

However, at the 5 VA medical centers we reviewed, we found that these reviews were not always timely. We also found that VA officials did not report 8 of the 9 doctors who should have been reported.

GAO recommends Veterans Affairs improve oversight of clinical care reviews and reporting.

Highlights

What GAO Found

Department of Veterans Affairs (VA) medical center (VAMC) officials are responsible for reviewing the clinical care delivered by their privileged providers—physicians and dentists who are approved to independently perform specific services—after concerns are raised. The five VAMCs GAO selected for review collectively required review of 148 providers from October 2013 through March 2017 after concerns were raised about their clinical care. GAO found that these reviews were not always documented or conducted in a timely manner. GAO identified these providers by reviewing meeting minutes from the committee responsible for requiring these types of reviews at the respective VAMCs, and through interviews with VAMC officials. The selected VAMCs were unable to provide documentation of these reviews for almost half of the 148 providers. Additionally, the VAMCs did not start the reviews of 16 providers for 3 months to multiple years after the concerns were identified. GAO found that VHA policies do not require documentation of all types of clinical care reviews and do not establish timeliness requirements. GAO also found that the Veterans Health Administration (VHA) does not adequately oversee these reviews at VAMCs through its Veterans Integrated Service Networks (VISN), which are responsible for overseeing the VAMCs. Without documentation and timely reviews of providers’ clinical care, VAMC officials may lack information needed to reasonably ensure that VA providers are competent to provide safe, high quality care to veterans and to make appropriate decisions about these providers’ privileges.
GAO also found that from October 2013 through March 2017, the five selected VAMCs did not report most of the providers who should have been reported to the National Practitioner Data Bank (NPDB) or state licensing boards (SLB) in accordance with VHA policy. The NPDB is an electronic repository for critical information about the professional conduct and competence of providers. GAO found that

  • selected VAMCs did not report to the NPDB eight of nine providers who had adverse privileging actions taken against them or who resigned during an investigation related to professional competence or conduct, as required by VHA policy, and
  • none of these nine providers had been reported to SLBs.

GAO found that officials at the selected VAMCs misinterpreted or were not aware of VHA policies and guidance related to NPDB and SLB reporting processes resulting in providers not being reported. GAO also found that VHA and the VISNs do not conduct adequate oversight of NPDB and SLB reporting practices and cannot reasonably ensure appropriate reporting of providers. As a result, VHA’s ability to provide safe, high quality care to veterans is hindered because other VAMCs, as well as non-VA health care entities, will be unaware of serious concerns raised about a provider’s care. For example, GAO found that after one VAMC failed to report to the NPDB or SLBs a provider who resigned to avoid an adverse privileging action, a non-VA hospital in the same city took an adverse privileging action against that same provider for the same reason 2 years later.

Why GAO Did This Study

Nearly 40,000 providers hold privileges in VHA’s 170 VAMCs. VAMCs must identify and review any concerns that arise about the clinical care their providers deliver. Depending on the findings from the review, VAMC officials may take an adverse privileging action against a provider that either limits the care a provider is allowed to deliver at the VAMC or prevents the provider from delivering care altogether.
GAO was asked to review VHA processes for reviewing concerns about providers’ clinical care. This report examines, among other things, selected VAMCs’ (1) reviews of providers’ clinical care after concerns are raised and VHA’s oversight of these reviews, and (2) VAMCs’ reporting of providers to the NPDB and SLBs and VHA’s oversight of reporting. GAO visited a non-generalizable selection of five VAMCs selected for the complexity of services offered and variation in location. GAO reviewed VHA policies and files from the five selected VAMCs, and interviewed VHA, VISN, and VAMC officials. GAO also evaluated VHA’s practices using federal internal control standards.

What GAO Recommends

GAO is making four recommendations, including for VA to direct VHA to require VAMCs to document reviews of providers’ clinical care after concerns are raised, develop timeliness requirements for these reviews, and ensure proper VISN oversight of such reviews as well as timely VAMC reporting of providers to the NPDB and SLBs. VA concurred with GAO’s recommendations and described steps it will take to implement them.

Recommendations for Executive Action

Recommendation: The Under Secretary for Health should specify in VHA policy that reviews of providers’ clinical care after concerns have been raised should be documented, including retrospective and comprehensive reviews. (Recommendation 1)
Recommendation: The Under Secretary for Health should specify in VHA policy a timeliness requirement for initiating reviews of providers’ clinical care after a concern has been raised. (Recommendation 2)
Recommendation: The Under Secretary for Health should require VISN officials to oversee VAMC reviews of providers’ clinical care after concerns have been raised, including retrospective and comprehensive reviews, and ensure that VISN officials are conducting such oversight with the required standardized audit tool. This oversight should include reviewing documentation in order to ensure that these reviews are documented appropriately and conducted in a timely manner. (Recommendation 3)
Recommendation: The Under Secretary for Health should require VISN officials to establish a process for overseeing VAMCs to ensure that they are reporting providers to the NPDB and SLBs, and are reporting in a timely manner. (Recommendation 4)
As of this writing these were still open issues, click here to find the latest status.
The full report is available here.

VA Inspector General: Improper wait list used for Colorado vets’ mental health care


As some of you may know there are 3 kinds of lies, lies, damn lies and statistics and the VA uses them all.
Once again we can thank a whistleblower for bring this to our attention.
Even with CHOICE in place due to the VA creating fake wait lists to make their numbers look better than they were and damn the veterans who suffer.
It continues at the Denver Veterans Affairs and we’ve lost at least one veteran that we know about.
“Rep. Mike Coffman, said in an interview that the local VA’s behavior reminded him of the 2014 VA scandal in Phoenix. Investigators there found that at least 35 patients died while waiting for care and medical staff falsified records to make it seem veterans were being seen promptly.”

“At the end of the day it’s the veterans who suffer,” said Rep. Mike Coffman

Read the Full Story:

VA: Improper wait list used for Colo. veterans

DENVER (AP) – A watchdog arm of the U.S. Department of Veterans Affairs said Thursday that the agency’s Denver-area hospital violated policy by keeping improper wait lists to track veterans’ mental health care. Investigators with the VA Office of Inspector General confirmed a whistleblower’s claim that staff kept unauthorized lists instead of using the department’s official wait list system.

Have you tried going to the Vet Center ? I did and I’m glad.



I haven’t been to the Vet Center in a few years. My therapist there transferred and I moved to the civilian sector. The transition from one to the other was about as seamless as I could have hoped for thanks to my Vet Center therapist. She set me up for success with my new therapist and with myself. I had been in regular therapy since 1991 in California but in 1998 I moved to Missouri and a psych doc recommended I try the Vet Center.
The atmosphere and attitude was far removed from the hospital setting. I felt like even if they weren’t happy to see me they were polite enough to look like they were and I was cool with that.
It made a real difference for me, it might be worth it for you … If you are eligible (see below) and in need check for the closest Vet Center here.

Here’s a little history

The Vet Center Program was established by Congress in 1979 out of the recognition that a significant number of Vietnam era vets were still experiencing readjustment problems.  Vet Centers are community based and part of the U.S. Department of Veterans Affairs.  In April 1991, in response to the Persian Gulf War, Congress extended the eligibility to veterans who served during other periods of armed hostilities after the Vietnam era.  Those other periods are identified as Lebanon, Grenada, Panama, the Persian Gulf, Somalia, and Kosovo/Bosnia.  In October 1996, Congress extended the eligibility to include WWII and Korean Combat Veterans. The goal of the Vet Center program is to provide a broad range of counseling, outreach, and referral services to eligible veterans in order to help them make a satisfying post-war readjustment to civilian life.  On April 1, 2003 the Secretary of Veterans Affairs extended eligibility for Vet Center services to veterans of Operation Enduring Freedom (OEF) and on June 25, 2003 Vet Center eligibility was extended to veterans of Operation Iraqi Freedom (OIF) and subsequent operations within the Global War on Terrorism (GWOT).  The family members of all veterans listed above are eligible for Vet Center services as well. On August 5, 2003 VA Secretary Anthony J. Principi authorized Vet Centers to furnish bereavement counseling services to surviving parents, spouses,  children and siblings of service members who die of any cause while on active duty, to include federally activated Reserve and National Guard personnel.

Services

Readjustment counseling is a wide range of psycho social services offered to eligible Veterans, Service members, and their families in the effort to make a successful transition from military to civilian life.  They include:

  • Individual and group counseling for Veterans, Service members, and their families
  • Family counseling for military related issues
  • Bereavement counseling for families who experience an active duty death
  • Military sexual trauma counseling and referral
  • Outreach and education including PDHRA, community events, etc.
  • Substance abuse assessment and referral
  • Employment assessment & referral
  • VBA benefits explanation and referral
  • Screening & referral for medical issues including TBI, depression, etc.

Veterans Center Eligibility

Any Veterans and active duty Service members, to include members of the National Guard and Reserve components, who:

  • Have served on active military duty in any combat theater or area of hostility*

  • Experienced a military sexual trauma;

  • Provided direct emergent medical care or mortuary services, while serving on active military duty, to the casualties of war, or;

  • Served as a member of an unmanned aerial vehicle crew that provided direct support to operations in a combat zone or area of hostility.

  • Vietnam Era veterans who have accessed care at a Vet Center prior to January 1, 2004

    Vet Center services are also provided to family members of Veterans and Service members for military related issues when it is found aid in the readjustment of those that have served. This includes bereavement counseling for families who experience an active duty death.

Service in combat theater or area of hostility to include but not limited to:

  • World War II (including American Merchant Marines)
  • Korean War
  • Vietnam War
  • Lebanon
  • Grenada
  • Desert Storm/ Desert Shield
  • Bosnia
  • Kosovo
  • Operations in the former Yugoslavia area
  • Global War on Terrorism
  • Operation Enduring Freedom
  • Operation Freedom’s Sentinel
  • Operation Iraqi Freedom
  • Operation New Dawn

Oct. 2017 VA Federal Register Announcements

Application for Cash Surrender or Policy Loan: Agency Information Collection Activity October 30, 2017

The Application for Cash Surrender or Policy Loan solicits information needed from Veterans to apply for cash surrender value or policy loan on their insurance. The information on this form is required by law, 38 USC 1906 and 1944, 38 CFR 6.115, 6.116, 6.117, 8.27, 6.100, 6.101, and … Continue Reading.

Veterans Health Benefits Handbook Questionnaire: Agency Information Collection Activity October 30, 2017

Veterans’ Health Benefits Handbook is available to all enrolled Veterans. The Handbook contains general eligibility and benefits information and, most importantly, information specific to the Veteran. VHA seeks approval for this collection to provide Veterans an opportunity to provide anonymous … Continue Reading

Advisory Committee on Disability Compensation: Notice of Meeting October 30, 2017

The purpose of the Committee is to advise the Secretary of Veterans Affairs on the maintenance and periodic readjustment of the VA Schedule for Rating Disabilities. The Committee is to assemble and review information relating to the nature and character of disabilities arising during service … Continue Reading.

Survey of Healthcare Experiences of Patients (SHEP): Agency Information Collection Activity October 30, 2017

Survey of Health Experience of Patients (SHEP) has been developed to measure patient satisfaction in the Veterans Health Administration and has been used in its present form since 2008. The mission of the Veterans Health Administration (VHA) is to provide high-quality medical care to eligible … Continue Reading

Claim, Authorization Invoice for Prosthetic Items Services: Agency Information Collection Activity Under OMB ReviewOctober 29, 2017

VA, through its VHA, administers medical services established by law. Title 38 USC Section 1701(6) includes prosthetic items within the scope of medical services. Title 38 USC Section 3901, 3902, 3903, 3904, and 1162 authorize the Secretary to provide each person eligible for an automobile … Continue Reading.

Notice of Meeting; National Research Advisory Council October 27, 2017

The agenda will include scientific presentations on animal research, mental health, rehabilitation, and a facility tour. Additional presentations will include: Balancing research challenges, an overview of the animal research program from the ChiefThe Department of Veterans Affairs (VA) gives … Continue Reading about Notice of Meeting; National Research Advisory Council.

Report of Income From Property or Business: Agency Information Collection October 25, 2017

Abstract A claimant’s eligibility for Pension or Parents’ Dependency and Indemnity Compensation (DIC) is determined, in part, by the claimant’s countable income. VA Form 21P-4185 is used to gather the information that is necessary to determine a claimant’s countable income received from rental property … Continue Reading about Report of Income From Property or Business: Agency Information Collection.

PRA Submission Describes the Nature of the Information Collection and its Expected Cost and Burden; it Includes the Actual Data Collection Instrument: Agency Information Collection Activity Under OMB Review October 25, 2017

Under the authority of 38 USC 3720(a)(5) and (6), the Department of Veterans Affairs (VA) acquires properties for sale to the general public utilizing a private Service Provider. The Service Provider utilizes private listings and sales brokers to sell VA properties. In compliance with the … Continue Reading 

State Application for Interment Allowance Under 38 USC Chapter 23: Agency Information Collection Activity October 25, 2017

VA Form 21P-530A is used to gather necessary information to determine whether a State is eligible for interment allowances for eligible veterans buried in a State Veteran’s cemetery. Without this information, VA would be unable to correctly determine eligibility and pay benefits … Continue Reading

Extension of the Presumptive Period for Compensation for Gulf War Veterans October 24, 2017

VA is issuing this final rule to affirm its adjudication regulations regarding compensation for disabilities resulting from undiagnosed illnesses suffered by veterans who served in the Persian Gulf War. This amendment is necessary to extend the period during which disabilities associated with … Continue Reading about Extension of the Presumptive Period for Compensation for Gulf War Veterans

VA National Veterans Sports Programs and Special Events October 24, 2017

Veterans who are enrolled for VA health care may apply to participate in therapeutic rehabilitation programs such as the National Veterans Wheelchair Games, National Veterans Golden Age Games, National Veterans Creative Arts Festival, National Veterans TEE Tournament, National Disabled Veterans … Continue Reading about VA National Veterans Sports Programs and Special Events.

Requirements for Interest Rate Reduction Refinancing Loans: Agency Information Collection Activity Under OMB Review October 24, 2017

Requirements for Interest Rate Reduction Refinancing Loans. OMB Control Number: 2900-0601. Type of Review: Extension of a currently approved collection In compliance with the Paperwork Reduction Act (PRA) of 1995, this Notice announces that the Loan Guaranty Service, Department of Veterans Affairs, … Continue Reading about Requirements for Interest Rate Reduction Refinancing Loans: Agency Information Collection Activity Under OMB Review

Veterans Mortgage Life Insurance Inquiry: Agency Information Collection Activity October 24, 2017

Veterans Benefits Administration, Department of Veterans Affairs (VA), is announcing an opportunity for public comment on the agency’s proposed collection of certain information. Under the Paperwork Reduction Act (PRA) of 1995, Federal agencies are required to publish Notice in the Federal … Continue Reading about Veterans Mortgage Life Insurance Inquiry: Agency Information Collection Activity

Advisory Committee on Cemeteries and Memorials, Amended Notice of Meeting October 23, 2017

VA gives Notice under the Federal Advisory Committee Act that a meeting of the Advisory Committee on Cemeteries and Memorials will be held on October 31-November 1, 2017. The meeting sessions will take place at the Jefferson Barracks Medical Center, 1 Jefferson Barracks Drive, Building 56, St. … Continue Reading about Advisory Committee on Cemeteries and Memorials, Amended Notice of Meeting

Notice of Availability of a Record of Decision for a Replacement Robley Rex Department of Veterans Affairs Medical Center, Louisville, Kentucky October 20, 2017

VA announces the availability of the Record of Decision (ROD) for the siting, construction, and operation of a new campus to replace the existing Robley Rex VA Medical Center (VAMC) and three community-based outpatient clinics in Louisville, Kentucky. VA considered comments received on the Draft … Continue Reading about Notice of Availability of a Record of Decision for a Replacement Robley Rex Department of Veterans Affairs Medical Center, Louisville, Kentucky.

Cooperative Studies Scientific Evaluation Committee; Notice of Meeting October 19, 2017

Veterans Affairs gives notice under the Federal Advisory Committee Act that the Cooperative Studies Scientific Evaluation Committee will hold a meeting on December 13, 2017, at the American Association of Airport Executives, 601 Madison Street, Alexandria, VA. The meeting will begin at 8:30 a.m. and … Continue Reading about Cooperative Studies Scientific Evaluation Committee; Notice of Meeting

Veterans Affairs Disaster Resilience Survey of Community-Dwelling Veterans October 19, 2017

Veterans Health Administration, Department of Veterans Affairs (VA), is announcing an opportunity for public comment on the agency’s proposed collection of certain information. Under the Paperwork Reduction Act (PRA) of 1995, Federal agencies are required to publish notice in the Federal … Continue Reading about VA Disaster Resilience Survey of Community-Dwelling

Application of Surviving Spouse or Child for REPS Benefits October 19, 2017

VBA, VA, is announcing an opportunity for public comment on the agency’s proposed collection of certain information. Under the Paperwork Reduction Act (PRA) of 1995, Federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information… Continue Reading about Application of Surviving Spouse or Child for REPS Benefits.

Agency Information Collection Activity Under OMB Review: Living Will and Durable Power of Attorney for Health Care October 19, 2017

VA Form 10-0137, VA Advance Directive: Durable Power of Attorney for Health Care and Living Will, is the Department of Veterans Affairs (VA) recognized legal document that permits VA patients to designate a health care agent and/or specify preferences for future health care. The VA Advance Directive

Veterans Mortgage Life Insurance-Coverage Amendment October 19, 2017

This document amends Department of Veterans Affairs (VA) regulations governing the Veterans’ Mortgage Life Insurance (VMLI) program in order to provide VMLI-eligible individuals the option to lower their premiums by purchasing less than the minimum coverage amount required under the current VA

Agency Information Collection Activity Under OMB Review: Statement of Dependency of Parent(s) October 17, 2017

8 USC 102 requires that income and dependency must be determined before benefits may be paid to or for a dependent parent. Regulatory authority is found in 38 CFR 3.4 and 38 CFR 3.250. Information is requested by this form under the authority of 38 USC 501(a)(2). VA Form 21P-509 is used

Accelerated Payment Verification of Completion: Agency Information Collection Activity Under OMB Review October 17, 2017

VA Form 22-0840 allows VA claimants to certify that they received an accelerated payment and how such payment was used. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.

Veterans Rural Health Advisory Committee; (Amended) Notice of Meeting October 17, 2017

The purpose of the Committee is to advise the Secretary of Veterans Affairs on rural health care issues affecting Veterans. The Committee examines Programs and policies that impact the delivery of VA rural health care to Veterans and discusses ways to improve and enhance VA access to rural health

Veterans Affairs New Hampshire Vision 2025 Task Force; Notice of Meeting October 17, 2017

The purpose of the Subcommittee is to develop a comprehensive set of options and recommendations to develop a future vision of what VA must do to best meet the needs of New Hampshire Veterans. The recommendations will be reviewed by the SMAG, and then those final recommendations will be forwarded

Prosthetic and Rehabilitative Items and Services October 16, 2017

VA proposes to revise its medical regulations related to providing prosthetic and rehabilitative items as medical services to veterans. These revisions would reorganize and update the current regulations related to prosthetic and rehabilitative items, primarily to clarify eligibility for prosthetic

Employees Whose Association With For-Profit Educational Institutions Poses No Detriment to Veterans October 16, 2017

Start PreambleDepartment of Veterans Affairs.Notice of intent; withdrawal of Notice. The Department of Veterans Affairs (VA) published a Notice of intent and request for comments in the Federal Register on September 14, 2017. This document withdraws the Notice of intent and requests for comments

Report of Medical, Legal, and Other Expenses Incident to Recovery for Injury or Death October 12, 2017

Information is requested by this form under the authority of 38 USC 1503. Regulatory authority is found in 38 CFR 3.262, 3.271, and 3.272. A claimant’s eligibility for Pension is determined, in part, by countable family income and certain deductible expenses. VBA uses VA Form 21P-8416b to gather

Application for Individualized Tutorial Assistance October 11, 2017

VA Form 22-1990t for Tutorial assistance is a supplementary allowance payable monthly for up to 12 months. The student must be training at one-half time or more in a post-secondary degree program, and must have a deficiency in a unit course or subject that is required as part

Application for United States Flag for Burial Purposes October 11, 2017

VA Form 27-2008 is used for family members and/or next-of-kin to apply for a burial flag.Veterans Benefits Administration, Department of Veterans Affairs (VA), is announcing an opportunity for public comment on the proposed collection of certain information by the agency. Under the Paperwork

Application for Work Study Allowance; Student Work-Study Agreement (Advance Payment); Extended Student Work-Study Agreement; Student Work-Study Agreement October 11, 2017

VA uses the VA Forms 22-8691, 22-8692, 22-8692a, and 22-8692b collecting information to determine the individual’s eligibility for the work-study allowance, the number of hours the individual will work, the amount payable, whether the individual desires an advance payment, and whether the individual

Veterans Affairs Prevention of Fraud, Waste, and Abuse Advisory Committee; Notice of Meeting October 10, 2017

  The agenda will include briefings from the Deputy Secretary of VA, the Advisory Committee Management Office, the Office of General Counsel, presentations on VA’s programs, and an overview of committee objectives, committee business, and activities. The Department of Veterans Affairs (VA)

Application for Exclusion of Children’s Income

A veteran’s or surviving spouse’s rate of Improved Pension is determined by family income. Normally, income of children who are members of the household is included in this determination. However, children’s income may be excluded if it is unavailable or if consideration of that income would cause

Veterans Affairs Acquisition Regulation (VAAR) Part 813, Simplified Acquisition Procedures October 10, 2017

This request for an extension covers the competitive acquisition of commercial and non-commercial goods or services conducted under the simplified acquisition procedures of FAR Part 13 and VAAR Part 813 that exceed $25,000. The collection of procurement information is an integral part of the Federal

Advisory Committee on Cemeteries and Memorials, Notice of Meeting October 10, 2017

The Committee is to advise the Secretary of Veterans Affairs on the administration of national cemeteries, soldiers’ lots and plots, the selection of new national cemetery sites, the erection of appropriate memorials, and the adequacy of Federal burial benefits. The Committee will make recommendations

Time Record (Work Study Program) October 10, 2017

VA Form 22-8960 is a time sheet report used by a supervisor and an eligible individual to record and report the number of hours completed by the trainee. The form should be submitted after the trainee completes at least 50 hours of work. VA uses the data collected to ensure that the amount

Veterans Research and Health Advisory Committee; Notice of Meeting October 10, 2017

 The agenda will include updates from Department leadership, the Assistant Deputy Under Secretary for Health for Policy and Services, Director Office of Rural Health and Committee Chairman, as well as presentations on general health care access.The Department of Veterans Affairs (VA) … Continue Reading about Veterans Research and Health Advisory Committee; Notice of Meeting

Supplemental Income Questionnaire (for Philippine Claims Only) October 10, 2017

Eligibility to benefits may be established based on service in the Philippine Scouts, Commonwealth Army of the Philippines, or recognized guerrilla organizations (38 USC 107). Title 38 USC 1521, 1541, and 1542 provide for payment of Pension to eligible veterans, surviving spouses, and … Continue Reading about Supplemental Income Questionnaire (for Philippine Claims Only)

Information Regarding Apportionment of Beneficiary Award October 5, 2017

VA Form 21-0788 is used to collect the information that is necessary to determine whether an apportionment may be authorized and the reasonable amount that may be awarded. Without this collection of information, VA would be unable to properly authorize apportionments of compensation and Pension… Continue Reading about Information Regarding Apportionment of Beneficiary Award

Joint Biomedical Laboratory Research and Development and Clinical Science Research and Development Services Scientific Merit Review Board Notice of Meetings October 5, 2017

VA gives Notice under the Federal Advisory Committee Act that the subcommittees of the Joint Biomedical Laboratory Research and Development and Clinical Science Research and Development Services Scientific Merit Review Board (JBL/CS SMRB) will meet from 8 a.m. to 5 p.m. on the dates indicated below … Continue Reading about Joint Biomedical Laboratory Research and Development and Clinical Science Research and Development Services Scientific Merit Review Board Notice of Meetings

Under OMB Review: Decision Ready Claims (DRC) Exam Review October 5, 2017

VA Form 21-0985 will be used to identify the condition(s) that a veteran would like VA to schedule a contract examination for in support of his/her Decision Ready Claim. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a … Continue Reading about Under OMB Review: Decision Ready Claims (DRC) Exam Review

General Release for Medical Provider Information to the Department of Veterans Affairs (Veterans Affairs) and Authorization and Consent To Release Information to the Department of Veterans Affairs October 5, 2017

VA Forms 21-4142 will be used to authorize the disclosure of information to the VA, and 21-4142a will be used to gather the necessary information to request medical provider information to the VA. An agency may not conduct or sponsor, and a person is not required to respond to a collection of … Continue Reading about General Release for Medical Provider Information to the Department of Veterans Affairs (VA) and Authorization and Consent To Release Information to the Department of Veterans Affairs.

Under OMB Review: Acquisition Regulation (VAAR) Construction Provisions and Clauses October 5, 2017

This collection of information contains the following six collections of information for the following Department of Veterans Affairs Acquisition Regulation (VAAR) clauses: (1) VAAR clause 852.236-72, Performance of Work by the Contractor, requires contractors awarded a construction contract … Continue Reading about Under OMB Review: Acquisition Regulation (VAAR) Construction Provisions and Clauses.

Authority of Health Care Providers To Practice Telehealth October 2, 2017

Proposed rule. VA proposes to amend its medical regulations by standardizing the delivery of care by VA health care providers through Telehealth. This rule would ensure that VA health care providers provide the same level of care to all beneficiaries, irrespective of the State or location in a State … Continue Reading about Authority of Health Care Providers To Practice Telehealth.