VA Health Care:

Reporting of Spending and Workload for Mental Health Services Could Be Improved

GAO-10-570: Published: May 28, 2010. Publicly Released: May 28, 2010.

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The Department of Veterans Affairs (VA) provides, or pays for, a range of mental health services for veterans. To effectively manage resources and ensure access to eligible veterans, VA needs complete spending and workload information for mental health services. This information is also important for congressional oversight GAO was asked to examine VA's mental health spending and workload. In this report, GAO examined for fiscal year 2009 (1) VA's spending for mental health services and (2) VA's workload for mental health services. GAO examined VA's reporting of mental health spending and workload data for fiscal year 2009 in its fiscal year 2011 congressional budget justification and whether VA reported these data in any other publicly available report. GAO analyzed additional mental health spending and workload data and interviewed VA officials.

VA reported in its fiscal year 2011 congressional budget justification spending about $4.4 billion on mental health services in fiscal year 2009 in VA settings primarily used for providing mental health services. However, VA had additional spending in fiscal year 2009 for mental health services that VA did not report as mental health spending in its budget justification or in any other publicly available report. Specifically, VA did not report as mental health spending the amounts it spent for those mental health services that it (1) paid non-VA providers to provide in community settings and (2) provided in VA settings not primarily used for providing mental health services, such as nursing homes. VA also did not report as mental health spending the amount it spent for counseling services to address mental health issues provided by VA Vet Centers. Although VA did not report this spending information, VA does determine its spending for mental health services provided by non-VA providers and for outpatient mental health services provided in VA settings not primarily used for providing mental health services. According to VA officials, VA spent an additional $269 million for these services in fiscal year 2009. VA does not have complete spending information for inpatient hospital mental health services provided by mental health providers in VA settings not primarily used to provide mental health services nor does it have spending information for counseling services to address mental health issues provided by Vet Centers. In fiscal year 2009, VA provided mental health services to about 1.22 million unique patients in VA settings primarily used for providing mental health services. However, VA did not report this information in its fiscal year 2011 congressional budget justification or in any other publicly available report. VA officials said that the number of unique patients is not available until after VA's budget justification is published. Additionally, VA did not report other workload information that it has on (1) the number of encounters for outpatient services and the average daily census for each of its inpatient hospital, residential, and domiciliary services provided in VA settings primarily used for providing mental health services and (2) the workload for mental health services provided in other settings--community settings for which VA paid non-VA providers to provide mental health services and VA settings not primarily used for providing mental health services. VA also did not report the workload for counseling services to address mental health issues provided by Vet Centers, but VA is able to estimate its workload for these services. VA's reporting of mental health spending and workload does not give Congress a complete overview of VA's mental health services and limits information available for congressional oversight of VA's mental health services. Reporting additional mental health spending and workload information could enhance information available for congressional oversight.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: In response to our report, VA concurred with this recommendation and said it would include the number of encounters and average daily census by type of service for Mental Health services provided in VA settings primarily used for providing mental health services in its fiscal year 2012 budget submission. In 2011, VA implemented this recommendation by including the number of encounters and average daily census by type of service for Mental Health services provided in VA settings primarily used for providing mental health services in its fiscal year 2012 budget submission.

    Recommendation: To enhance information available for congressional oversight and use by stakeholders on VA's spending and workload for mental health services, the Secretary of Veterans Affairs should include workload information, including number of encounters and average daily census, by type of service, for mental health services provided in VA settings primarily used for providing mental health services with its presentation of mental health spending in its annual congressional budget justification.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: In its response to our report, VA concurred with this recommendation and stated that it will include spending and workload information, including the number of encounters and average daily census for Mental Health services that VA pays non-VA providers to deliver in community settings in a separate annual report soon after the information becomes available. In 2011, VA partially implemented this recommendation by including workload information, including the number of encounters and average daily census, for mental health services that VA paid non-VA providers to deliver in community settings in its annual congressional budget justification. In 2012, VA completed its implementation of this recommendation by including spending information for the mental health services that it paid non-VA providers to deliver in community settings in its fiscal year 2013 budget submission.

    Recommendation: To enhance information available for congressional oversight and use by stakeholders on VA's spending and workload for mental health services, the Secretary of Veterans Affairs should include spending and workload information, including number of encounters and average daily census, for mental health services that VA pays non-VA providers to deliver in community settings in its annual congressional budget justification, or in a separate, annual, publicly available report soon after the information becomes available.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: In its response to our report, VA concurred with this recommendation and stated that it will include spending and workload information, including the number of encounters and average daily census for Mental Health services provided in VA settings not primarily used for providing mental health services in a separate annual report soon after the information becomes available. In 2012, VA implemented this recommendation by including spending and workload information, including the number of encounters and average daily census, for mental health services provided in VA settings not primarily used for providing mental health in its fiscal year 2013 budget submission.

    Recommendation: To enhance information available for congressional oversight and use by stakeholders on VA's spending and workload for mental health services, the Secretary of Veterans Affairs should include spending and workload information, including number of encounters and average daily census, for mental health services provided in VA settings not primarily used for providing mental health services in its annual congressional budget justification, or in a separate, annual, publicly available report soon after the information becomes available.

    Agency Affected: Department of Veterans Affairs

  4. Status: Closed - Not Implemented

    Comments: In its response to our draft, VA did not concur with this recommendation and did not indicate that they intend to implement this recommendation. VA provided updated information on its response to the recommendation in September 2011 in which it stated that it planned to provide this information on its website by November 2011. As of July 2014, VA officials had not included this information on its website. Further, in July 2014, VA officials told us that VA did not intend to implement this recommendation.

    Recommendation: To enhance information available for congressional oversight and use by stakeholders on VA's spending and workload for mental health services, the Secretary of Veterans Affairs should include workload information, including number of visits, for counseling services to address mental health issues provided by Vet Centers in its annual congressional budget justification, or in a separate, annual, publicly available report soon after the information becomes available.

    Agency Affected: Department of Veterans Affairs

  5. Status: Closed - Not Implemented

    Comments: In its response to our draft, VA did not concur with this recommendation and did not indicate that they intend to implement this recommendation. VA provided updated information on its response to the recommendation in September 2011 in which it stated that it planned to provide this information on its website by November 2011. As of July 2014, VA officials had not included this information on its website. Further, in July 2014, VA officials told us that VA did not intend to implement this recommendation.

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to identify ways of incorporating spending information for Vet Center counseling services that address mental health issues in VA's annual congressional budget justification or in a separate, annual, publicly available report soon after the information becomes available.

    Agency Affected: Department of Veterans Affairs

 

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