All Reports

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For future acquisitions that involve stakeholders from multiple offices, establish governance to ensure all relevant administrations and staff offices are represented in key decision roles.

For future acquisitions, establish and implement a process to promote stakeholders’ understanding of system capabilities and support buy-in.

Complete the hiring actions necessary to staff the Office of Acquisition and Logistics Project Management Office.

Resolve key Integrated Financial and Acquisition Management System challenges and ongoing concerns identified by officials from the Office of Acquisition, Logistics, and Construction and the Office of Acquisition and Logistics before further deployment of the acquisition module.

The Under Secretary for Health requires facilities to review designated time for Maternity Care Coordinator caseload, and assigned collateral duties, to determine if additional staffing resources are needed to support Veterans Health Administration Maternity Care Coordination, and takes action as appropriate.

The Under Secretary for Health reviews timeliness of facility community care maternity care referrals to ensure timely access for routine and expedited (high-risk and late term) referrals, and takes action as appropriate.

Ensure Veterans Benefits Administration staff use improved methodologies similar to the Office of Inspector General’s review to identify eligible veterans, readjudicate claims, and send outreach letters to potential Nehmer class members who could qualify for retroactive benefits under the National Defense Authorization Act.

Ensure claims processors at screening sites understand the need to identify any claims that may warrant readjudication by meeting the Nehmer consent decree and subsequent court orders.

Update the standard operating procedures to have staff consider whether veterans’ medical records show a diagnosis of the now-covered herbicide-related diseases at the time of any prior disability benefits claim before January 1, 2021, regardless of whether a current claim is for a disease recognized by the National Defense Authorization Act.

Ensure facility staff place all orders for eligible items through the Medical/Surgical Prime Vendor program, including those that are identified as on back order.

Implement tracking mechanisms for back orders to assist the facilities in not obtaining excess supplies.

Ensure that logistics staff receive training and use the Prime Vendor Conversion and Recommendation Tool to identify commonly purchased open market items and convert those items to Medical/Surgical Prime Vendor purchases.

Identify and implement an efficient way to transfer product list updates to the inventory ordering system.

In collaboration with the Strategic Acquisition Center, identify a VA-owned system for staff to check product information, such as availability and pricing, and ensure applicable facility staff are aware of this location.

Implement a standardized, routine review of open market purchases.

Ensure that reporting tools are effective and consistently applied, and that reported issues are resolved.

Ensure that logistics staff receive relevant Medical/Surgical Prime Vendor program guidance and training.

Ensure the product list includes items that facilities need and regularly purchase so the Veterans Health Administration can expand the savings and benefits the Medical/Surgical Prime Vendor program offers.

Establish a plan to use VA’s cost accounting system information to identify alternative ways to reduce costs, enhance efficiency, and inform business decisions as identified by VA financial policy.

Ensure healthcare system staff responsible for labor cost and workload mapping are responding in a timely manner to the results of managerial cost accounting audits and correcting all identified issues.

Consider a plan to align VA North Texas Health Care System financial management practices with federal financial accounting standard practices. This could include using cost information for performance measurement, budgeting, and cost control, and making economic choices.

Ensure that healthcare system staff are made aware of policy requirements and the responsible finance office conducts monthly reviews and reconciliations on all open obligations for financial validity and take appropriate actions as required by VA Financial Policy, vol. 2, chap. 5, “Obligations” (2020), updated May 2023.

Consult with Office of General Counsel and Office of Acquisitions, Logistics and Construction to determine if any further actions are necessary, including contract modifications, to remedy and prevent future purpose statute and bona fide needs rule violations.

Establish controls to ensure cardholders comply with record retention requirements, confirm approving officials and cardholders review purchases for VA policy compliance, and ensure contracting is used when it is in the best interest of the government.

Require cardholders to submit a request for ratification for any unauthorized commitments identified.

Develop and implement a plan to ensure data accuracy and reliability in the Generic Inventory Package in accordance with Veterans Health Administration policy.

Continue to develop and implement processes to ensure all necessary reports are monitored routinely and appropriate steps are taken to ensure all supply chain performance measures are maintained in compliance with policy.

Obtain an inventory of locally managed databases, perform configuration compliance scans, provide the facility with a copy of the scan results, and monitor the facility’s remediation efforts.

Implement a process to verify system owners review user account access to locally managed databases.

Implement effective system life-cycle processes to ensure network devices meet standards mandated by the VA Office of Information and Technology Configuration Control Board.

Develop and approve an authorization to operate for the special-purpose systems.

Include system personnel during the security categorization process to ensure that all necessary information types are considered when determining the security categorization for special-purpose systems.

Implement controls to ensure the accuracy of user locations supporting the Lynx Duress system.

Implement the appropriate physical security controls to restrict and monitor access to the facility, its server room, and communication closets.

Implement and monitor emergency power and uninterruptible power supplies in all communication closets.

Implement grounding equipment in all communication closets.