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    Subject Term: "Veterans affairs"

    51 publications with a total of 155 open recommendations including 15 priority recommendations
    Director: Debra A. Draper
    Phone: (202) 512-7114

    5 open recommendations
    Recommendation: The Undersecretary for Health should develop and implement a process to accurately count all physicians providing care at each medical center, including physicians who are not employed by VHA. (Recommendation 1)

    Agency: Department of Veterans Affairs: Veterans Health Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Undersecretary for Health should develop and issue guidance to the VAMCs on determining appropriate staffing levels for all mission-critical physician occupations. (Recommendation 2)

    Agency: Department of Veterans Affairs: Veterans Health Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Undersecretary for Health should ensure that when multiple offices issue similar productivity data on physician occupations, any methodological differences are clearly communicated and guidance is provided on how to interpret and reconcile the data. (Recommendation 3)

    Agency: Department of Veterans Affairs: Veterans Health Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Undersecretary for Health should establish a system-wide method to share information about physician trainees to help fill vacancies across VAMCs. (Recommendation 4)

    Agency: Department of Veterans Affairs: Veterans Health Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Undersecretary for Health should conduct a comprehensive, system-wide evaluation of the physician recruitment and retention strategies used by VAMCs to determine their overall effectiveness, identify and implement improvements, ensure coordination across VHA offices, and establish an ongoing monitoring process. (Recommendation 5)

    Agency: Department of Veterans Affairs: Veterans Health Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Brown Barnes, Cindy S
    Phone: (202) 512-7215

    3 open recommendations
    Recommendation: The Secretary of Veterans Affairs should direct the Assistant Secretary for Human Resources and Administration and the Under Secretary for Benefits to review and update all relevant policies and guidance to reflect the agency's requirement that employees' hours teleworked be recorded in VATAS.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Veterans Affairs should direct the Assistant Secretary for Human Resources and Administration and the Under Secretary for Benefits to communicate that telework hours should be recorded in VATAS to VBA regional office employees.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Veterans Affairs should direct the Assistant Secretary for Human Resources and Administration and the Under Secretary for Benefits to develop a process to monitor the quality of data and to ensure that employees' telework hours are recorded accurately and completely in VATAS.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Lori Rectanus
    Phone: (202) 512-2834

    3 open recommendations
    Recommendation: To manage the mail program more effectively, the Secretary of Veterans Affairs should develop and document a plan to source contracts for mailing equipment in a more strategic manner. Such strategic contract sourcing should enable facilities to obtain equipment to track mail volume and expenditure data more consistently and to maximize cost savings.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To manage the mail program more effectively, the Secretary of Veterans Affairs should update VA Directive 6340 to incorporate agency-wide goals and performance measures for mail operations.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To manage the mail program more effectively, the Secretary of Veterans Affairs should determine and document the authority and responsibilities of the agency and administration-level mail managers to enable them to improve management and oversight of mail operations.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Rebecca Shea
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: To ensure that the financial benefits of EULs that the Department of Veterans' Affairs reports in its annual Consideration Report on the EUL program are transparent and reliable, the Secretary should revise its Enhanced-Use Leasing Post Transaction Handbook (Handbook 7454) and specify that VA will: (1) Report consistently the enhanced services benefits from its EULs separately from other financial benefits that directly affect VA's budget, and (2) Include an explanation in its reporting on estimated EUL enhanced services that its estimates may not adequately capture all benefits of the EUL project and that certain costs associated with providing such benefits that are incurred by parties outside VA are not included in the analysis.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Melissa Emrey-Arras
    Phone: (617) 788-0534

    3 open recommendations
    Recommendation: To help ensure VHA medical examiners are prepared to conduct the Gulf War general medical exam, the Secretary of Veterans Affairs should direct the Under Secretary for Health to require medical examiners to complete training, such as the 90-minute Gulf War Illness web-based course, before conducting these exams.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA agreed this recommendation and stated it has plans to address it. Specifically, VA said it plans to make its 90-minute web-based training course mandatory for its medical examiners who conduct Gulf War Illness exams.
    Recommendation: To provide more complete information to veterans whose Gulf War Illness claims are denied, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to update guidance to require that decision letters indicate whether Gulf War Illness medical issues were evaluated under both a presumptive and direct service connection method.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA agreed this recommendation and stated it has plans in place to address it. Specifically, VA noted it would improve how it communicates decisions to veterans and is in the process of updating its guidance to the regional offices to clarify the language required for its Gulf War Illness decision letters.
    Recommendation: To increase the likelihood of making progress toward developing a single case definition of Gulf War Illness, the Secretary of Veterans Affairs should direct the Under Secretary for Health to prepare and document a plan to develop a single case definition of Gulf War Illness. This plan should include near- and long-term specific actions, such as analyzing and leveraging information in existing datasets and identifying any areas for future research to help VA achieve this goal.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA agreed this recommendation and stated it has plans to address it. Specifically, VA noted it would convene a group of subject matter experts to work on a plan - as described in our report - to establish a single case definition of Gulf War Illness.
    Director: David A. Powner
    Phone: (202) 512-9286

    4 open recommendations
    Recommendation: To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to identify performance metrics and associated targets for the goals and objectives in the department's IT strategic plans, including the Information Resources Management strategic plan and the Health Information Strategic Plan, as they relate to the delivery of health IT and the VHA mission.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In comments on our report, VA concurred with our recommendation and described planned coordination with the Office of Information and Technology and the Veterans Health Administration to develop or revise and maintain performance metrics that support the strategic and health information technology goals and objectives. The department plans to revise performance metrics to align to new goals and objectives by June 2018.
    Recommendation: To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to ensure that the department-level investment review structure is implemented as planned and that guidance on the IT governance process is documented and identifies criteria for selecting new investments, and reselecting investments currently operational at VHA.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In comments on our report, VA concurred with our recommendation and provided meeting minutes for its Portfolio Investment Management Board and a document describing the proposed alignment and interdependencies between the 11 governance boards. We will continue to monitor the implementation of the proposed relationships and review any additional guidance issued that further describes the process used by the governance boards for selecting and reselecting information technology investments.
    Recommendation: To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to identify additional performance metrics to align with VHA's core business functions, and then use these metrics to determine the extent to which the department's IT systems support performance of VHA's mission.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In comments on our report, VA concurred with our recommendation. In addition, the department outlined steps it intends to take to address our recommendation. These steps include developing a set of core metrics to provide continuous input into investment portfolio decisions and establishing a methodology for ensuring that information technology investments are aligned to business needs and that expected outcomes are defined prior to making the investments. The department plans to complete this work by September 2018. We will continue to monitor VA's progress on these efforts.
    Recommendation: To assist VA in improving key IT management processes to ensure that investments support the delivery of health care services, the Secretary of Veterans Affairs should direct the Under Secretary for Health and the Chief Information Officer to ensure that unmet IT needs identified by key program areas--pharmacy benefits management, scheduling, and community care--are addressed appropriately and that related business functions are supported by IT systems to the extent required.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In comments on our report, VA concurred with our recommendation. The department has described its intention to ensure that unmet information technology needs for the pharmacy benefits management, scheduling, and community care program areas are addressed appropriately during fiscal year 2018 budget formulation. We will follow-up with VA to ascertain what needs have been addressed, closed, or reprioritized for each program office during fiscal year 2018.
    Director: Wise, David J
    Phone: (202) 512-2834

    3 open recommendations
    Recommendation: To improve VA's ability to plan for and facilitate the alignment of its facilities with veteran needs, the Secretary of Veterans Affairs should direct the appropriate offices and administrations to address identified limitations to the SCIP process, including limitations to scoring and approval, and access to information.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA partially concurred with this recommendation. In their 60-day letter dated August 3, 2017, VA noted that it has made process changes in those areas that it concurred with. This includes both access to information, improving communication and timing of SCIP results, and lessoning the administrative burden of providing SCIP documents to SCIP users. For fiscal year (FY) 2018 SCIP, including the projects that were funded, the results were provided prior to the 2018 budget release, and prior to the development of SCIP 2019 business cases. In the past, these results were not released to planners until after the budget was publicly released. In addition, the threshold for inclusion of projects into the SCIP process was raised from $1 M to $3M for the Veterans Health Administration (VHA) nonrecurring maintenance (NRM) projects. This was done to lessen the administrative burden and provide more flexibility to the field to manage their operational needs. Although VA has made some progress towards this recommendation, they have not satisfied the full intent. Specifically, VA has not yet made changes to improve the visibility and prioritization of sequenced projects or the scoring and approval process. VA noted that it disagreed that the SCIP scoring and approval process introduces subjectivity through the use of its business cases, but we will follow up over the next year to see if they made any changes that would help address this portion of the recommendation.
    Recommendation: To improve VA's ability to plan for and facilitate the alignment of its facilities with veteran needs, the Secretary of Veterans Affairs should direct the appropriate offices and administrations to assess the value of VAIP's facility master plans as a facility-planning tool. Based on conclusions from the review, either 1) discontinue the development of VAIP's facility master plans or 2) address the limitations of VAIP's facility master plans.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In its 60-day letter dated August 3, 2017, VA noted that its VAIP facility master plans have been discontinued while VA pursues a congressionally-directed National Realignment Strategy, which will last a minimum of 18 months. VA will be evaluating service delivery opportunities in each contiguous United States (CONUS) market, to improve the networks of complementary community care providers, best coordinate Veteran healthcare, and move certain components of care into the community when appropriate. Once a National Realignment Plan is submitted and approved by Congress, future facility master plans will be adjusted accordingly, and incorporate pertinent information. Such information will include community care realignment opportunities. We will follow-up with VA to obtain additional information regarding this recommendation.
    Recommendation: To improve VA's ability to plan for and facilitate the alignment of its facilities with veteran needs, the Secretary of Veterans Affairs should direct the appropriate offices and administrations to develop and implement a mechanism to evaluate VISN and facility communication efforts with stakeholders to ensure that these communication efforts are working as intended and align with guidance and best practices.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In its 60-day letter dated August 3, 2017, VA noted that it has created a standard operating procedure (SOP) to follow when planning/implementing a facility mission change and/or realignment. The SOP provides guidance for facilities to implement evaluation tools to measure the return on their communications investment in sharing information with stakeholders, including after action reports, media monitoring tools, and direct feedback from target audiences. A mechanism for sharing best practices has been established for implementation in moving forward with local communications. We are in the process of obtaining further documentation from VA to support that this evaluation mechanism ensures that communication efforts are aligned with guidance and best practices.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    5 open recommendations
    including 1 priority recommendation
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to ensure development of a timely, detailed workforce plan for recruiting, hiring and training new hires. In particular, this plan should: (1) include detailed steps and timetables for updating training curriculum (such as preparing decisions in a virtual environment) and ensuring office space (such as telework guidance); and (2) incorporate risk mitigation strategies that consider how the timing of recruitment and training dovetails with uncertain time frames for implementing a new appeals process.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA took additional steps to recruit, hire, manage space and train additional FTEs to address appeals workloads. However, detailed workforce plans would help ensure timely hiring and proper supports and training. We will close this recommendation when VA provides documentation of its actions and related guidance in several areas: agency telework plan; case adjudication in an virtual environment; status of hiring for FY17; hiring goals for FY18; space management plan indicating how FY17 and FY18 hiring will be accommodated; and plans for ongoing training for remote teleworkers.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to develop a schedule for IT updates that explicitly addresses when and how any process reform will be integrated into new systems and when Caseflow will be ready to support a potential streamlined appeals process at its onset.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation. In July 2017, VA reported its latest actions to address this recommendation, including documentation of the 6-month road map. However, we continue to believe that while the agile process can help mitigate risks and avoid cost overruns and delays, VA should define schedules beyond 6 months. Such planning allows VA to take additional steps to consider the scope of potential changes required by a new appeals process and have a broad plan in place to ensure that all aspects of the new process are adequately supported by Caseflow.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to conduct additional sensitivity analyses based on the assumptions used in projection models to more accurately estimate future appeals inventories and timeliness. In doing so, consider running additional analyses on how these factors, in conjunction with one another, may affect the timeliness and cost of deciding pending appeals.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation, noting that it plans to refine the model on a regular basis. However, we continue to believe that additional analyses of potential hiring options and of the compounded effect of assumptions that VA identified is consistent with sound practices and will help the agency anticipate and plan for different contingencies. In addition, as VA goes forward with appeals process reform and begins to collect real-time data, these data could improve modeling accuracy and serve as a valuable management tool. VA also noted plans to analyze, update and refine the model. We will consider closing this recommendation when VA completes these efforts and provides documentation of plans for modeling inventories and resource needs.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to develop a more robust plan for closely monitoring implementation of process reform that includes metrics and interim goals to help track progress, evaluate efficiency and effectiveness, and identify trouble spots.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA agreed in principle with this recommendation. However, to fully implement it, VA needs to develop a monitoring plan with metrics and interim goals for implementing appeal process reform. Although VA agreed that developing such a plan is valuable for monitoring the implementation of process reform, VA also stated that it considered this recommendation complete and noted that preparing such a detailed plan depends on appeals reform legislation being enacted. While we recognize that VA cannot assume to know the exact provisions that may be included in future enacted legislation, we consider having a more robust monitoring plan - for example, that includes metrics and interim goals to help track implementation progress, evaluate efficiency and effectiveness of the reformed process, and identify trouble spots - to be essential to the successful implementation of a new appeals process.
    Recommendation: To better understand whether appeals process reform, in conjunction with other efforts, has improved timeliness, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate to develop a strategy for assessing process reform--relative to the current process--that ensures transparency in reporting to Congress and the public on the extent to which VA is improving veterans' experiences with its disability appeals process.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation and reported on its plans to measure veteran wait times as well as use customer satisfaction surveys to measure the success of the new appeals process. However, while we agree that metrics based on the different options could be valuable for VA, the Congress, and the public, we disagree that VA's focus on measuring timeliness by option is in the best interest of the veteran. Because veterans may pursue more than one option under VBA, the Board or both, we believe that VA's approach does not take into account the veteran's perspective of how long it took for them to receive a final appeal decision. Metrics from the veterans' overall perspective would complement, not replace, metrics for VBA, the Board, and each option. The absence of such metrics raises questions as to how the agency will ensure appropriate resources are devoted to managing appeals under the new versus old process, or intended results are achieved as the new process is implemented. Further, while the legislation requires VA to report a number of metrics, the agency still needs to implement the legislation. We will consider closing this recommendation when VA develops a plan for collecting metrics consistent with this recommendation.
    Director: Dave Wise
    Phone: (202) 512-5731

    3 open recommendations
    including 1 priority recommendation
    Recommendation: To improve VA's management of medical-facility construction projects and its accountability and to allow for more informed decision making by Congress and VA, the Secretary of Veterans Affairs should establish a mechanism to monitor the extent that major facilities projects are following guidelines on change orders' time frames and design changes.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: GAO reviewed VA's 60 day letter and identified that VA did not address the part of GAO?s recommendation that is intended to help VA ensure that information on the reasons for change orders is collected to better inform managers whether guidelines regarding changes are being followed on construction projects. Consequently, in May 2017, GAO requested that VA provide documentation indicating that its current system collects the necessary information on change order processing timeframes for managers to ensure compliance with processing time guidelines. GAO will continue to monitor and update the status of this recommendation.
    Recommendation: To improve VA's management of medical-facility construction projects and its accountability and to allow for more informed decision making by Congress and VA, the Secretary of Veterans Affairs should develop an activation cost estimate for the Denver project that is reliable and conforms with best practices as described in the GAO Cost Estimating and Assessment Guide.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In its 60-day letter to Congress, VA said that it had analyzed its Activation Cost Budget Model (ACBM), which VA uses to estimate activation costs for new medical facilities, and its activation funding process, to improve cost forecasting and management of the activations process. VA said that it has modified ACBM to better support funding estimates and began using it in February 2017. GAO will continue to monitor and update the status of this recommendation.
    Recommendation: To improve VA's management of medical-facility construction projects and its accountability and to allow for more informed decision making by Congress and VA, the Secretary of Veterans Affairs should clarify Office of Construction and Facilities Management (CFM) policies to require that: (1) all projects have an integrated master schedule to ensure that the integrated master schedules include and link all construction and activation activities, and (2) the policies on integrated master schedule for projects managed by CFM and USACE are consistent.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In its 60-day letter to Congress, VA said that it is clarifying its policy and standard operation procedure on developing and maintaining an integrated master schedule. VA will also develop a standard operation procedure specifically for projects that the U.S. Army Corps of Engineers (USACE) is managing for VA. GAO will continue to monitor and update the status of this recommendation.
    Director: Cindy Brown Barnes
    Phone: (202) 512-7215

    3 open recommendations
    Recommendation: To improve VA's ability to accurately track employees' use of official time, the Secretary of Veterans Affairs should direct the Assistant Secretary for Human Resources and Administration to increase efforts to ensure timekeepers at all facilities receive training and consistent guidance on recording official time in VATAS.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA stated that the Office of Labor Management Relations (LMR) has revised its policy to include specific directions to human resource offices to begin recording official time in the VA Time and Attendance System (VATAS) once VATAS has been implemented at their respective facilities. We will considering closing this recommendation when the agency provides documentation that this has been done.
    Recommendation: To improve VA's ability to accurately track employees' use of official time, the Secretary of Veterans Affairs should direct the Assistant Secretary for Human Resources and Administration to standardize the methods used by facilities for determining the amount of official time used prior to the agency-wide implementation of VATAS by encouraging facilities to rely on time and attendance records when calculating the amount of official time used at the facility level.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA stated that the Office of Human Resources and Administration plans to develop a memo directing facilities to rely on time and attendance records when calculating the amount of official time used at the facility level. We will consider closing this recommendation when the agency has provided documentation that they have completed this effort.
    Recommendation: To improve VA's ability to accurately track employees' use of official time, the Secretary of Veterans Affairs should direct the Assistant Secretary for Human Resources and Administration to, in preparation for the full implementation of VATAS, take steps to transition from using the LMR system to VATAS to collect and compile information on the amount of official time used agency-wide.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA stated that the Office of Labor Management Relations (LMR) will transition from using the LMR Official Time Tracking System to collect and compile data on official time and will coordinate with the Financial Services Center to use VATAS to create a report on the agency-wide use of official time. We will consider closing this recommendation when the agency has completed this effort.
    Director: Wise, David J
    Phone: (202) 512-2834

    2 open recommendations
    Recommendation: To improve VA's supportive-housing EUL program and meet the needs of homeless veterans, the Secretary of Veterans Affairs should direct the Office of Asset Enterprise Management to clearly and completely document the selection process for all supportive-housing EULs from pre-development through completion of VA's development phase in keeping with internal control standards and VA policy.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: On September 19, 2017, an official from VA's Office of Capital Operations and Program Service said that the Office of Asset Enterprise Management (OAEM) is working with the Office of Information and Technology to ensure that the Enhanced Use Lease (EUL) Directive, Handbook, and Attachments are 508 compliant. This requirement is the last step in VA's internal process to certify and publish the updated EUL Directive and Handbook. Once OAEM receives an estimate when this process will be completed, VA will provide GAO a status update with the expected completion date for the updated EUL Directive and Handbook.
    Recommendation: To improve VA's supportive-housing EUL program and meet the needs of homeless veterans, the Secretary of Veterans Affairs should direct the Office of Asset Enterprise Management to update its EUL policy to (1) address the current authority for developing supportive-housing; and (2) specify how to identify properties for supportive-housing EULs to meet the needs of homeless veterans.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: On September 19, 2017, an official from VA's Office of Capital Operations and Program Service said that the Office of Asset Enterprise Management (OAEM) is working with the Office of Information and Technology to ensure that the Enhanced Use Lease (EUL) Directive, Handbook, and Attachments are 508 compliant. This requirement is the last step in VA's internal process to certify and publish the updated EUL Directive and Handbook. Once OAEM receives an estimate when this process will be completed, VA will provide GAO a status update with the expected completion date for the updated EUL Directive and Handbook.
    Director: Randall B. Williamson
    Phone: (202) 512-7114

    2 open recommendations
    including 1 priority recommendation
    Recommendation: To improve care for women veterans, the Secretary of Veterans Affairs should direct the Under Secretary for Health to strengthen the environment of care inspections process and VHA's oversight of this process by expanding the list of requirements that facility staff inspect for compliance to align with VHA's women's health handbook, ensuring that all patient care areas of the medical facility are inspected as required, clarifying the roles and responsibilities of VA medical facility staff responsible for identifying and addressing compliance, and establishing a process to verify that noncompliance information reported by facilities to VHA Central Office is accurate and complete.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of June 2017, VA has taken some actions to address this recommendation, but additional actions are needed to fully implement it. We will update the status of this recommendation when we receive additional information from VA.
    Recommendation: To improve care for women veterans, the Secretary of Veterans Affairs should direct the Under Secretary for Health to monitor women veterans' access to key sex-specific care services--mammography, maternity care, and gynecology--under current and future community care contracts. For those key services, monitoring should include an examination of appointment scheduling and completion times, driving times to appointments, and reasons appointments could not be scheduled with community providers.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: As of June 2017, VHA still lacks data and performance measures for the availability under Choice of sex-specific care, such as mammograms, maternity care, or gynecology. In contrast, for another VA care in the community program, PC3 (a program that the Choice third party administrators also administer) VHA collects data and has performance measures to evaluate women veterans' access to mammography and maternity care. To fully implement this recommendation, VHA needs to extend the collection of data to include care delivered through the Choice Program and other community care programs and establish related performance measures.
    Director: Debra A. Draper
    Phone: (202) 512-7114

    3 open recommendations
    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to define the roles and responsibilities of VAMCs in operationalizing VHA's strategic goals and objectives; this could be accomplished by establishing roles and responsibilities for VAMCs similar to how VHA defines roles and responsibilities for VISNs in VHA Directive 1075 and by developing guidance for VAMCs similar to guidance developed for VISNs.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: According to officials, VHA's Office of Policy and Planning continues to routinely communicate that all components of the organization should align their activities and resources to VA's 2014-2020 strategic goals and objectives, the MyVA Priority and Management Initiatives, and to the five VHA Priorities for Strategic Action. VHA's Office of Policy and Planning has also developed and disseminated Strategic Principals for Operational and Programmatic Decision Making, which was intended to provide a set of unifying principles for operational and programmatic decision-making. In its September 2017 update, VHA provided GAO with a copy of its draft FY 2018-2019 Operational and Modernization Plan. VHA is also in process of developing an Operational Planning Worksheet that is intended to provide instructions, definitions and examples to help create meaningful tactics, identify accountable leads, and document relevant interdependencies and requirements across the organization for VAMCs, VISNs and Program Offices. In its September 2017 update, VHA also noted that the National Leadership Council Strategic Planning Summit was held in June 2017, and that the focus of the summit was to ensure a clear understanding of the five VA/VHA priorities and how to operationalize the priorities at all levels of the organization. According to officials, VHA also held its National Planning Training (NPT) in August 2017 and the training was designed around the five VA/VHA priorities with a significant emphasis on clarifying the roles and responsibilities of VA Health Care Systems, VISNs and Program Offices in operationalizing the five priorities. According to officials, presentations incorporated the five priorities and a discussion on the various operational roles across the organization. VHA also noted that an online discussion board was opened at the conclusion of each NPT session with discussion questions specific to clarifying implementation responsibilities for the five VA/VHA priorities and other strategic initiatives. GAO has requested that VHA provide documentary evidence of these activities to support closure of this recommendation.
    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to consistently develop strategies that can be used by VISNs and VAMCs to operationalize VHA's goals and objectives, ensuring that they clearly link directly to VHA's goals and objectives.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: According to officials, VHA held its annual National Leadership Council Strategic Planning Summit in June 2017, during which NLC members and other strategic thinkers representing Program Office and VA Health Care Systems identified a set of strategies and milestones that link to and support operationalizing the five VA/VHA priorities. According to officials, these 16 strategies and milestones serve as the initial framework for operational planning at the VA Health Care System, VISN, and Program Office levels. VHA has provided evidence that it is currently developing its 2018 modernization and operational planning guidance, which is expected to link VA's strategic goals and objectives to the modernization plan and the five VA/VHA priorities. The guidance is also expected to require program offices, VISNs, and VAMCs to submit plans that articulate tactics and milestones and identify requirements that clearly link organizational activities back to operationalizing strategies and accomplishing priorities and goals. According to officials, the next phase of operational planning will occur at the VA Senior Leaders' Business Meeting, during which VA Health Care System, VISN, and Program Office leaders will further detail plans by identifying the tactics and requirements each will implement to operationalize the strategies and achieve the priorities, including identifying individuals that will be responsible for leading implementation of tactics. According to officials, VHA will initiate the final phase of operational planning following this meeting. During this final phase, VHA expects to disseminate its operational plan, and guidance, to VISNs and Program Offices with guidance to work with their subcomponents (VAMCs and other divisions) to finalize details in support of the operational plan. Following, the VISNs and Program Offices are expected to return their plans to VHA's Office of Policy and Planning to be incorporated into VHA's final modernization and operational plan. According to officials, VHA's Office of Policy and Planning has also continued to work very closely with the VA Office of Enterprise Integration to link VHA's strategies and measures with VA's draft 2018-2024 goals, objectives, strategies and measures to ensure consistency and alignment in planning and operationalization. According to officials, these linkages will enable VHA and VA to monitor and report progress on achieving the five VA/VHA priorities.
    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to develop an oversight process to assess progress made in meeting VHA's strategic goals and objectives, including feedback on how well activities and programs are contributing to achieving these goals and objectives.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In its 60-day update, VHA notified GAO that performance plans for senior executives will be updated to include requirements to provide oversight to assure that day-to-day activities on initiatives and programs are consistent with organizational goals, objectives and priorities. Furthermore, VHA informed GAO that executive performance, and performance of the organizations they lead, will be assessed using periodic review of performance against established organizational metrics associated with priorities, and annual performance plans of senior executives. In its 60 day update, VHA also notified GAO that VHA's Office of Policy and Planning will monitor implementation on a periodic basis to identify when initiatives or programs are progressing appropriately or at risk of not achieving goals and objectives in accordance with priorities. In VHA's August 2017 update on open recommendations, officials noted that VHA has also developed an internal Healthcare Operations Dashboard--which provides immediate and daily information regarding veterans' health care access, including wait times, productivity, and utilization--and an externally-facing Access and Quality in VA Healthcare web site--which provides veterans, caregivers, and other stakeholders with tools to view access and quality performance for specific VA facilities. According to VHA officials, both VA and VHA are monitoring strategic programs and activities to identify barriers that may impede progress towards the achievement of goals and objectives, which can then be elevated to leadership, as appropriate. In VHA's September 2017 update, officials also noted that VHA's Office of Policy and Planning and Office of Strategic Integration are coordinating the monitoring and quarterly reporting of progress on achievements related to the five VA/VHA priorities and the supporting strategies. According to officials, Priority and Strategy leads have been identified and are responsible for reporting operational progress and for managing any challenges that slow or prevent operationalization. According to officials, progress on all strategies and priorities is being reported at the VHA senior leaders morning meeting on a routine basis. GAO has requested that VHA provide documentary evidence of these activities to support closure of this recommendation.
    Director: Cary Russell
    Phone: (202) 512-5431

    3 open recommendations
    Recommendation: To better position combatant commanders to implement the requirements of DOD Instruction 4715.19 if burn pits become necessary and to assist in planning for waste disposal in future military operations, the Secretary of Defense should direct the combatant commanders of U.S. Africa Command, U.S. European Command, U.S. Pacific Command, and U.S. Southern Command to establish implementation policies and procedures for waste management. Such policies and procedures should include, as applicable, specific organizations within each combatant command with responsibility for ensuring compliance with relevant policies and procedures, including burn pit notification, and, when appropriate, monitoring and reporting on the use of burn pits.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To better understand the long-term health effects of exposure to the disposal of covered waste in burn pits, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology, and Logistics to, in coordination with the Secretary of Veterans Affairs, specifically examine the relationship between direct, individual, burn pit exposure and potential long-term health-related issues. As part of that examination, consider the results of the National Academies of Sciences, Engineering, and Medicine's report on the Department of Veteran Affairs registry and the methodology outlined in the 2011 Institute of Medicine study that suggests the need to evaluate the health status of service members from their time of deployment over many years to determine their incidence of chronic disease, with particular attention to the collection of data at the individual level, including the means by which that data is obtained.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To better understand the long-term health effects of exposure to the disposal of covered waste in burn pits, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology, and Logistics to take steps to ensure United States Central Command and other geographic combatant commands, as appropriate, establish processes to consistently monitor burn pit emissions for unacceptable exposures.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Elizabeth Curda
    Phone: (202) 512-7114

    1 open recommendations
    including 1 priority recommendation
    Recommendation: In order to ensure that veterans receive quality care from qualified physicians, the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop and implement a comprehensive oversight strategy that includes ongoing monitoring and evaluations of the contractors' verification of PC3 and Choice physicians' credentials, as well as VHA staff's review of Choice physicians. VHA's oversight should include reviewing documentation and assessing whether the contractors' plans for improving their processes for Choice credentials verification are effective.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: In June and July 2017, the Veterans Health Administration (VHA) completed separate audit evaluations of both contractors' verification of Patient-Centered Community Care (PC3) and Choice physicians' credentials. This supplements the ongoing monitoring that VHA already had in place for routinely and independently checking the credentials for a sample of PC3 and Choice providers. However, as of October 2017, VHA has not yet implemented a strategy to oversee VHA staff's review of Choice physicians through the VHA Choice Provider Agreement program.
    Director: Michele Mackin
    Phone: (202) 512-4841

    8 open recommendations
    Recommendation: In order to ensure universal usage and reduce duplicate work, the Secretary of Veterans Affairs should direct the Office of Acquisition and Logistics (OAL) to work with the National Acquisition Center to develop a plan for adding functionality to the Electronic Contract Management System (eCMS) that will alleviate the need for National Acquisition Center contracting officers to enter obligations for high-tech medical equipment into two different data systems.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In providing comments on this report, VA concurred with this recommendation but has not yet taken actions necessary to implement it. However, in its letter to OMB and the Congress, VA stated that it plans to pursue a new financial and contracting systems that will be interoperable.
    Recommendation: In order to ensure that VA's procurement data is complete and accurate, the Secretary of Veterans Affairs should direct the Office of Acquisitions and Logistics to develop policies and procedures to ensure that obligations made through prime vendor orders--such as medical-surgical orders--are consistently captured in eCMS.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In providing comments on this report, VA concurred with this recommendation but has not yet taken actions necessary to implement it. In its letter to OMB and the Congress, VA noted an April 2016 policy that requires monthly reporting of orders to contracting officers, but additional guidance and processes are required to implement this policy.
    Recommendation: In order to ensure that contracting officers have clear and effective policies as soon as possible, the Secretary of Veterans Affairs should direct the OAL to identify measures to expedite the revision of the Veterans Affairs Acquisition Regulation (VAAR), which has been ongoing for many years, and the issuance of the VA Acquisition Manual.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In providing comments on this report, VA concurred with this recommendation but has not yet taken any actions necessary to implement it. However, in its letter to OMB and the Congress, VA stated that it anticipated that the updated VAAR would be issued by December 2018.
    Recommendation: To help contracting officers use current policy that is in effect in the period before the updated VAAR and VA Acquisition Manual are released, the Secretary of Veterans Affairs should direct OAL to take interim steps to clarify its policy framework, including establishing and adhering to set time frames for completing the process of reviewing all Information Letters, and either rescinding them or reissuing updated policy through Procurement Policy Memoranda.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In providing comments on this report, VA concurred with this recommendation but has not yet completed the actions necessary to implement it. In its letter to OMB and the Congress, VA stated that some Information Letters are still awaiting review and rescission or reissuance.
    Recommendation: To address remaining ambiguities in roles and customer relationships, the Secretary of Veterans Affairs should direct the Office of Acquisition, Logistics, and Construction to assess whether additional policy or guidance is needed to clarify the roles of VA's national contracting organizations, beyond that provided in its March 2013 memorandum outlining the current structure.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In providing comments on this report, VA concurred with this recommendation but has not yet taken any actions necessary to implement it. However, in its letter to OMB and the Congress, VA stated that it planned to issue updated guidance on roles for its national contracting organizations.
    Recommendation: To facilitate consolidation of similar requirements and leverage buying power across medical centers within VISNs, the Secretary of Veterans Affairs should direct VHA Procurement and Logistics to conduct a review of VISN-level strategic sourcing efforts, identify best practices, and, if needed, issue guidance.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In providing comments on this report, VA concurred with this recommendation. In July 2017, Veterans Health Administration officials stated that they would take further action to collect and disseminate best practices, which they estimate will be complete by late 2017.
    Recommendation: The Secretary of Veterans Affairs should direct the Senior Procurement Executive to issue guidance to the Heads of Contracting Activity to focus internal compliance reviews on ensuring that required contract documents are properly prepared and documented.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In providing comments on this report, VA concurred with this recommendation. In its letter to OMB and the Congress, VA stated that it is beginning coordination between the Senior Procurement Executive (SPE) and its Heads of Contracting Activity (HCA) on using the findings of OMB A-123 reviews to focus its contract compliance reviews. The SPE and HCA developed a memorandum of understanding for this effort in late 2016, but VA has not yet provided information on any new guidance to focus compliance reviews.
    Recommendation: To maximize compliance with mandatory national contracts during the transition to the new medical-surgical prime vendor (MSPV) process, the Secretary of Veterans Affairs should direct the Strategic Acquisition Center (SAC) and VHA Procurement and Logistics to take steps to ensure that: (1) SAC has mechanisms in place to collect and monitor transaction data to determine the extent to which Veterans Integrated Service Networks (VISNs) and their medical centers are complying with the requirement to use national contracts. (2) They establish achievable time frames for eliminating the ability for ordering officers to directly order Federal Supply Schedule items from the MSPV catalog once SAC awards national contracts for these items and monitor progress on an ongoing basis. (3) The ordering interfaces developed by the prime vendors clearly distinguish and prioritize standardized national contracts over items on Federal Supply Schedule contracts.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In providing comments on this report, VA concurred with this recommendation. VA has taken steps to monitor compliance with mandatory national contracts. However, VA has not yet established achievable timeframes for replacing Federal Supply Schedule items made available through non-competitive agreements its new Medical-Surgical Prime Vendor program, nor has it taken steps to distinguish these items from competitive national contracts in the ordering interface.
    Director: Valerie C. Melvin
    Phone: (202) 512-6304

    8 open recommendations
    Recommendation: To assist VA in sustaining an IT workforce with the necessary knowledge, skills, and abilities to execute its mission and goals, the Secretary of Veterans Affairs should direct the Chief Information Officer to track and review OI&T historical workforce data and projections related to leadership retirements.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and reported that OI&T's Human Capital Management Office (HCM) had completed a succession planning project that encompassed all senior leadership and included data review and risk assessment for each position. VA also stated that OI&T tracks the gains and losses associated with its leadership positions and provided this information for fiscal year 2016. However, the department has not provided documentation that supports the assertion that historical and projected OI&T leadership retirement data was presented and discussed as part of the succession planning project and did not provide data on projected retirements for OI&T's leadership positions. Additionally, the department stated that OI&T HCM has the ability to project retirement eligibility but has not provided documentation to support this assertion. It is important that VA tracks and reviews its OI&T historical workforce data and forecasts its leadership retirements to avoid being unprepared to effectively respond to vacancies in key leadership positions.
    Recommendation: To assist VA in sustaining an IT workforce with the necessary knowledge, skills, and abilities to execute its mission and goals, the Secretary of Veterans Affairs should direct the Chief Information Officer to identify IT skills needed beyond the current fiscal year to assist in identifying future skills gaps.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and reported that Information Technology Workforce Development (ITWD) will produce reports that identify skill gaps and will contain long-term recommendations that show the types of IT skills each organization needs to increase and which proficiency level targets need the most emphasis. As of July 2017, VA stated that ITWD reviewed, and updated where needed, the fiscal year 2017 competencies within each OI&T competency model role in order to align the models to the OI&T Transformation initiative. According to the department, the resulting updates support learning solutions that sustain and accelerate OI&T's transformation. Additionally, VA stated that 85 percent of OI&T staff completed a validated competency self-assessment and provided the OI&T fiscal year 2017 Training Gap Analysis Report which shows the strengths and gaps of OI&T by organization, trends between fiscal years 2016 and 2017, findings, next steps, and recommended actions for the next fiscal year. The department also stated that ITWD held meetings to review skill gap and learning solution reports. VA provided these reports and they present the top gaps and strengths, key findings, and next steps to address the skill gaps. While the department has taken these actions, its OI&T Training Gap Analysis Report does not identify IT skills needed beyond fiscal year 2017.
    Recommendation: To assist VA in establishing comprehensive and documented processes that reflect system development and acquisition best practices, the Secretary of Veterans Affairs should direct the Chief Information Officer to revise OI&T's documented processes related to project planning, to include (1) estimating the level of effort that will need to be expended for work products and tasks, and (2) making adjustments to the project plan to reconcile differences between estimated and available resources.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and stated that OI&T is documenting changes to processes related to project planning as it transitions from PMAS to the Veteran-Focused Integration Process (VIP). According to VA, the VIP processes will lead to better requirements elaboration and prioritization, increasing significantly the accuracy of estimates related to level of effort. Additionally, the department stated that by using short Agile sprints, the project team will be able adjust the project plan frequently to reconcile differences between estimated and available resources. As of July 2017, VA stated that all projects have transitioned to the VIP, which ensures they are incorporating the Agile methodology into the project lifecycle. According to the department, the latest version of its VIP Guide incorporates the use of daily scrum and weekly scrum of scrum meetings that can be used to frequently adjust the project plan to reconcile differences between estimated and available resources. VA stated that the project planning processes will continue to evolve beyond July and expects to complete its actions in response to this recommendation by the end of fiscal year 2017.
    Recommendation: To assist VA in establishing comprehensive and documented processes that reflect system development and acquisition best practices, the Secretary of Veterans Affairs should direct the Chief Information Officer to revise OI&T's documented processes related to requirements management, to include identifying changes to be made to plans and work products as a result of requirements baseline changes.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and reported that OI&T is revising its documentation related to requirements management as part of the transition to the Veteran-Focused Integration Process (VIP). According to VA, requirements will be tracked using the IBM Rational Tools Suite, which will be able to provide a snapshot of the original baseline and all captured changes in the form of an audit trail that captures the history of requirement changes. As of July 2017, the department stated that all projects have transitioned to the VIP and requirements baselines and subsequent changes are tracked in the Rational Tools Suite. VA also reported that efforts in fiscal year 2017 to consolidate all mandatory architectural, design, and process methodologies into a single library of requirements were successful, which resulted in combining the full body of requirements. Additionally according to the department, versioning of the requirements will allow the office to trace specific versions of individual requirements and their evolution by time period and project inheritance. VA stated that it expects to complete its actions in response to this recommendation by the end of fiscal year 2017.
    Recommendation: To assist VA in establishing comprehensive and documented processes that reflect system development and acquisition best practices, the Secretary of Veterans Affairs should direct the Chief Information Officer to revise OI&T's documented processes related to risk management, to include (1) determining costs and benefits of implementing the risk mitigation plan for each risk and (2) collecting performance measures on risk handling activities.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and reported that the IBM Rational Tools Suite will be used to manage risks and issues. According to VA, the tools suite will allow requirements to be linked to risks, which will provide traceability; teams will be able to track and report steps taken to mitigate risks; and an audit trail will show the history of changes made to each risk. The department also reported that the Office of Privacy and Risk will establish risk mitigation strategies for OI&T. As of July 2017, VA stated that risks data capture has been developed as a standardized process and that data on project and program risks in the Rational Tools Suite is aggregated and prepared for use to verify aggressive management, and will be included in enterprise reporting. The department stated that work is underway with the Performance Management Office and that OI&T expects to complete its actions in response to this recommendation by the end of fiscal year 2017.
    Recommendation: To assist VA in establishing comprehensive and documented processes that reflect system development and acquisition best practices, the Secretary of Veterans Affairs should direct the Chief Information Officer to revise OI&T's documented processes related to project monitoring and control, to include the 10 best practices that were missing from the guidance.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and reported that implementation of the Veteran-Focused Integration Process (VIP) and Agile processes within OI&T will address eight of the ten best practices related to project monitoring and control that were missing from its guidance. In regard to monitoring the knowledge and skills of project staff, OI&T's IT Workforce Development (ITWD) group collects and analyzes competency assessment data, which is used in requirements gathering meetings with OI&T leaders. According to VA, during these meetings organizational needs and next steps are discussed in detail. Additionally, the department's latest version of its VIP Guide states that the product team should be cross-functional and include all skills needed to deliver a product. Further, the department reported that data management activities, issues, and impacts will be managed using VIP, Agile, and IBM Rational Tools Suite. According to its VIP Guide, OI&T expects that all products follow the Agile product management process and use the Rational Tools Suite to manage scheduled product sprints and backlog, product requirements, risks and issues, and product planning and engineering documentation, among others. Also, VA stated that Agile methodologies will require stakeholders to be involved in the daily scrum meetings, user acceptance testing, and acceptance of deliverables, which will address stakeholders being involved regularly and documenting the results of stakeholder involvement status reviews. According to the VIP Guide, the Agile development methodologies require development teams to meet often with stakeholders to ensure transparency and foster a collaborative work environment. Additionally, the department stated that critical decision events are using Rational based data assessments to report on level of satisfaction of project controls and process compliance requirements. Further, according to the VIP Guide, the Product Owner will have a key role in the decision-making process during the development of the product and will be able to regularly express concerns and/or approvals to best meet user satisfaction. The department stated that critical decision events are being held at the portfolio level, and action items from these events are being tracked. VA provided meeting minutes from critical decision events that were held in October and December 2016. The December 2016 meeting minutes identified action items and the status of those items. Although VA has taken actions to address the majority of best practices related to project monitoring and control, the department's new VIP process does not include two practices that call for (1) tracking expended effort and (2) monitoring the utilization of staff and resources. Until OI&T's documented processes for project monitoring and control fully reflect best practices, the office is at risk that its projects will not achieve expected results.
    Recommendation: To assist VA in establishing comprehensive and documented processes that reflect system development and acquisition best practices, the Secretary of Veterans Affairs should direct the Chief Information Officer to revise OI&T's documented processes related to process and product quality assurance, to include (1) documenting a description of the quality assurance reporting chain and defining how objectivity will be ensured, and (2) periodically reviewing open noncompliance issues and trends with management that is designated to receive and act on them.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and reported that the implementation of the Veteran-Focused Integration Process (VIP), Agile processes, and the Rational Toolset within OI&T will address process and product quality assurance. According to VA, as a part of VIP, the Product Owner is engaged from intake through project completion, which will ensure that the quality of the product is maintained throughout the life cycle. Additionally the department reported that the process of periodically reviewing open non-compliance issues and trends with management that is designated to receive and act on them will be accomplished through CIOStat meetings held with OI&T senior leadership. VA also reported that the Rational Quality Manager tool is used to automate routine testing activities to identify non-compliance issues and trends. As of July 2017, the department stated that the Product Owner is beginning to have a stronger role on the project team, which enables them to assist in all types of issues, including quality assurance. VA also stated that Release Agents develop and distribute Release Readiness Reports, which provide a status of all release requirements and of traceability among requirements, deliverables, and test results. VA expects to complete its actions in response to this recommendation by the end of fiscal year 2017.
    Recommendation: To assist VA in establishing comprehensive and documented processes that reflect system development and acquisition best practices, the Secretary of Veterans Affairs should direct the Chief Information Officer to revise OI&T's documented processes related to project scheduling, to include the 9 best practices that were missing from the guidance and revise the documented processes where the guidance was contrary to best practices.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and reported that the implementation of VIP and Agile processes within OI&T will address five of the nine best practices related to project scheduling that are missing from its guidance. According to VA, business and compliance requirements will be captured during the planning phase and maintained in the IBM Rational Tools Suite to manage scheduled project/product builds and backlog which will allow the project to more accurately maintain the schedule baseline, capture all schedule changes, and provides an audit trail of all the changes. Additionally, the department reported that the IBM Rational Tools Suite connects requirements, change orders, test cases, and test results in order to have full traceability in a closed loop system. VA also noted that the use of short development builds within Agile increases the probability of successful adherence to the schedule; and Agile provides the flexibility to make schedule changes using the backlog to prioritize requirements. As of July 2017, VA stated that Project Build Planning sessions capture and prioritize all backlog items with high level activities captured in the VIP Dashboard; and that each project task receives an estimated duration. The department also stated that the project team commits to a high level scope for each build and then the scope is solidified and committed to in detail at each Sprint Plan. According to VA, at the end of each sprint the Product Owner accepts or rejects the product of what was committed to at Sprint Planning. The department also stated that there is a high-level commitment at the Critical Decision 1 meeting; that each build gets committed to at a more granular level; and that sprint planning includes establishing a firm commitment for exactly what will be completed during the sprint. The department further stated that part of the Agile process being used by OI&T removes rigid, mandatory constraints as long as project teams follow compliance epics. Additionally, the department reported that because of the use of Agile methodology, if a task is critical today, the project team can reprioritize and address the needs of the project immediately. According to VA, Agile supports both sustainment and development projects, by allowing changes to the project backlog to address high priority functionality. VA also stated that Agile allows flexibility to shift from one build to another based on priorities and to shift backlog items based on VIP Triad priorities. Additionally, according to the department, risks are managed in the Rational Tools Suite and impediments are raised and escalated during daily scrums and scrum of scrum calls. The VIP Guide indicates that product teams are required to make timely updates to the VIP Dashboard regarding schedule and that the Rational Tools Suite will be used to manage and administer source control and baselines; manage risks and issues; and manage scheduled product sprints and backlogs. However, the VIP Guide does not include practices to (1) document that each project task should receive a duration estimate; (2)require that the project schedule be traceable horizontally and vertically; (3) sequence all activities; and (4) confirm that the critical path is valid. Until OI&T's documented processes for developing schedules fully reflect best practices, the office is at risk that schedules created for its projects will not be reliable.
    Director: David A. Powner
    Phone: (202) 512-9286

    5 open recommendations
    Recommendation: To effectively measure 18F's performance, the Administrator of GSA should direct the Commissioner for the Technology Transformation Service to ensure that goals and associated performance measures are outcome-oriented and that performance measures have targets, including (1) performance measures and targets tied to fully recovering program costs; and (2) goals, performance measures, and targets for how the program will achieve its mission after September 2016.

    Agency: General Services Administration
    Status: Open

    Comments: The General Services Administration (GSA) agreed with, and has begun to take steps to implement, this recommendation. Specifically, GSA developed a quarterly performance report for fiscal year 2017 that includes an outcome-oriented goal for 18F as well as associated performance measures and targets. According to a Technology Transformation Service official, GSA plans to expand its quarterly performance report for fiscal year 2018 to reflect additional 18F goals and performance measures, including measures tied to fully recovering program costs. We will continue to evaluate GSA's progress in implementing this recommendation.
    Recommendation: To effectively measure 18F's performance, the Administrator of GSA should direct the Commissioner for the Technology Transformation Service to assess actual results for each performance measure.

    Agency: General Services Administration
    Status: Open

    Comments: The General Services Administration (GSA) agreed with, and has begun to take steps to implement, this recommendation. Specifically, GSA developed a quarterly performance report for fiscal year 2017 that includes an outcome-oriented goal for 18F as well as associated performance measures with targets. Additionally, GSA has assessed actual results of the performance measures for the first two quarters of fiscal year 2017. According to a Technology Transformation Service official, GSA plans to expand its quarterly performance report for fiscal year 2018 to include additional 18F goals and performance measures. We will continue to evaluate GSA's progress in implementing this recommendation.
    Recommendation: To effectively measure performance, prioritize USDS's resources, and ensure that CIOs play an integral role in agency digital service teams, the Director of the Office of Management and Budget should direct the Federal Chief Information Officer to ensure that all goals and associated performance measures are outcome-oriented and that performance measures have targets.

    Agency: Executive Office of the President: Office of Management and Budget
    Status: Open

    Comments: The Office of Management and Budget (OMB) generally agreed with, and has begun to take steps to implement, this recommendation. Specifically, in its December 2016 report to Congress, OMB developed three goals for U.S. Digital Service (USDS): (1) rethink how the federal government builds and buys digital services; (2) expand the use of common, platforms, services, and tools; and (3) bring top technical talent into public service. In addition, OMB established performance measures with targets for its third goal and for each of the program's major projects. However, OMB has not established performance measures for the first two USDS goals. Further, the program's third goal is not outcome-oriented. We will continue to evaluate OMB's progress in implementing this recommendation.
    Recommendation: To effectively measure performance, prioritize USDS's resources, and ensure that CIOs play an integral role in agency digital service teams, the Director of the Office of Management and Budget should direct the Federal Chief Information Officer to assess actual results for each performance measure.

    Agency: Executive Office of the President: Office of Management and Budget
    Status: Open

    Comments: The Office of Management and Budget (OMB) generally agreed with, and has begun to take steps to implement, this recommendation. Specifically, in its December 2016 report to Congress, OMB assessed the results of performance measures for one of the U.S. Digital Service (USDS) program's goals--bring top technical talent into public service--and for each of the program's major projects. However, OMB has not established performance measures for the other two USDS goals--rethink how the federal government builds and buys digital services; and expand the use of common, platforms, services, and tools. We will continue to evaluate OMB's progress in implementing this recommendation.
    Recommendation: To effectively measure performance, prioritize USDS's resources, and ensure that CIOs play an integral role in agency digital service teams, the Director of the Office of Management and Budget should direct the Federal Chief Information Officer to update USDS policy to clearly define the responsibilities and authorities governing the relationships between CIOs and the digital service teams and require existing agency digital service teams to address this policy. In doing so, the Federal Chief Information Officer should ensure that this policy is aligned with relevant federal law and OMB guidance on CIO responsibilities and authorities.

    Agency: Executive Office of the President: Office of Management and Budget
    Status: Open

    Comments: The Office of Management and Budget (OMB) generally agreed with, and has begun to take steps to implement, this recommendation. In particular, OMB updated its digital service team policy to require that teams appropriately inform their chief information officers (CIO) regarding U.S. Digital Service (USDS) projects. However, the policy does not describe the responsibilities or authorities governing the relationships between CIOs and digital service teams. We will continue to evaluate OMB's progress in implementing this recommendation.
    Director: Sager, Michelle A
    Phone: (202) 512-6806

    1 open recommendations
    Recommendation: The Administrator of General Services, in consultation with the STOC, should develop a travel data management approach, including common reporting formats that would provide GSA with more consistent travel cost data allowing GSA to compare travel costs across federal agencies. GSA could also include in this data management approach the planned implementation of the shared services model that would allow agencies to share a wide range of travel services with each other. This process could reduce both administrative costs and burden to the government and enable data-driven decision making.

    Agency: General Services Administration
    Status: Open

    Comments: According to GSA officials, GSA will take the following actions: (1) conduct a rest program to determine the opportunities and barriers for creating a reliable, standardized data repository containing government-wide travel spending data (pending OMB Director approval); (2) develop and test, in coordination with volunteer agencies and the GSA City Pairs Program personnel, an airfare savings dashboard to assimilates data from multiple sources and provides information on savings and opportunities for additional airfare savings by agencies; (3) publish an FTR Bulletin that identifies 5 core travel Key Performance Indicators that all agencies should use to improve travel management via standardized data; and (4) Identify and promote consistent adaptation of standardized default configurations of air and lodging choices within all E-Gove Travel Service 2 systems. As of August 2017, according to agency officials, they expect to implement this recommendation by the end of September 2017.
    Director: Shea, Rebecca
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: To enhance transparency and allow for more informed decision making related to VA's major medical facility leases, the Secretary of Veterans Affairs should annually assess how VA has benefited from flexibilities afforded by leasing its major medical facilities and use information from these assessments in its annual capital plans.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: On September 30, 2016, VA reported to GAO that as VA develops its fiscal year 2018 Budget Request to Congress, the Department will continue assessing the benefits of its major medical lease program and will include the related documentation in its capital budget request.
    Director: Marie A. Mak
    Phone: (202) 512-4841

    8 open recommendations
    Recommendation: To help identify opportunities for cost savings, the Secretary of the Department of Defense should direct the Office of Defense Procurement and Acquisition Policy to issue guidance or instruction to help ensure that components make reasonable efforts to analyze component-level purchase card spend patterns to identify areas for possible savings.

    Agency: Department of Defense
    Status: Open

    Comments: In providing comments on this report, the agency concurred with this recommendation and stated that the department will issue guidance to help ensure that components make reasonable efforts to analyze component-level purchase card spend patterns to identify areas of potential savings. In September 2016, DOD issued guidance asking its components to analyze purchase card spend for potential cost savings and to consider broader application of cost savings opportunities across the department. We will continue to follow up with DOD to determine what steps have been taken to communicate findings.
    Recommendation: To help identify opportunities for cost savings, the Secretary of the Department of Energy should take reasonable steps to regularly analyze agency-wide purchase card spend patterns to identify areas such as high-use vendors or frequently purchased commodities for further analysis.

    Agency: Department of Energy
    Status: Open

    Comments: The agency concurred with this recommendation and has begun implementation of a Spend Analytics Database to support capture and analysis of data on agency-wide spending patterns. The department has compiled data and begun testing the new databases to determine if useful reports can be generated to assist agency-wide purchase card spending analysis.
    Recommendation: To ensure that good practices are shared within agencies, the Secretaries of Defense, Veterans Affairs, the Interior, Homeland Security, and Energy, and the Environmental Protection Agency should develop guidance that encourages local officials to examine purchase card spend patterns to identify opportunities to obtain savings and to share information on such efforts. Where applicable, we further recommend that these agencies determine the feasibility for broader application of these efforts across the agency or organization.

    Agency: Department of Homeland Security
    Status: Open

    Comments: The department concurred with this recommendation and updated its purchase card manual November 2016 to encourage components to perform additional spend analysis for the identification of strategic sourcing opportunities, but it is unclear how results of analysis will be communicated for broader application across the agency. The department is also working with industry partners to increase the level of shared data for purchase card transactions and will develop a plan to communicate these data across the agency to support information sharing and increases strategic sourcing opportunities.
    Recommendation: To ensure that good practices are shared within agencies, the Secretaries of Defense, Veterans Affairs, the Interior, Homeland Security, and Energy, and the Environmental Protection Agency should develop guidance that encourages local officials to examine purchase card spend patterns to identify opportunities to obtain savings and to share information on such efforts. Where applicable, we further recommend that these agencies determine the feasibility for broader application of these efforts across the agency or organization.

    Agency: Department of Defense
    Status: Open

    Comments: In providing comments on this report, the agency concurred with this recommendation and stated that guidance that encourages local examination of purchase card spend patterns to identify opportunities for cost savings will be developed. In September 2016, DOD issued guidance asking its components to analyze purchase card spend for potential cost savings and to consider broader application of cost savings opportunities across the department. The guidance also asked components and services to report the results of these analysis to purchase card management officials. We will continue to follow up with DOD to determine what steps have been taken to communicate findings.
    Recommendation: To ensure that good practices are shared within agencies, the Secretaries of Defense, Veterans Affairs, the Interior, Homeland Security, and Energy, and the Environmental Protection Agency should develop guidance that encourages local officials to examine purchase card spend patterns to identify opportunities to obtain savings and to share information on such efforts. Where applicable, we further recommend that these agencies determine the feasibility for broader application of these efforts across the agency or organization.

    Agency: Department of Energy
    Status: Open

    Comments: The agency concurred with this recommendation and will update its guidance, policy, and procedures to encourage local officials to examine purchase card spend patterns to identify opportunities to obtains savings and to share information on such efforts. Revisions were under review by the department in August 2017.
    Recommendation: To ensure that good practices are shared within agencies, the Secretaries of Defense, Veterans Affairs, the Interior, Homeland Security, and Energy, and the Environmental Protection Agency should develop guidance that encourages local officials to examine purchase card spend patterns to identify opportunities to obtain savings and to share information on such efforts. Where applicable, we further recommend that these agencies determine the feasibility for broader application of these efforts across the agency or organization.

    Agency: Department of the Interior
    Status: Open

    Comments: The department partially concurred with this recommendation, agreeing that it would be useful to perform analysis of purchase card spend patterns to identify opportunities for savings. However, rather than issue guidance, it will encourage its bureau charge card leads to use available tools to extract and share data with buyers and program managers. The department will also encourage bureau program and acquisition managers to share spend data across regional boundaries to identify potential opportunities to negotiate lower costs for commonly used items.
    Recommendation: To ensure that good practices are shared within agencies, the Secretaries of Defense, Veterans Affairs, the Interior, Homeland Security, and Energy, and the Environmental Protection Agency should develop guidance that encourages local officials to examine purchase card spend patterns to identify opportunities to obtain savings and to share information on such efforts. Where applicable, we further recommend that these agencies determine the feasibility for broader application of these efforts across the agency or organization.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The department concurred with our recommendation and plans to develop guidance and implement strategic sourcing for all purchasing requirements to include purchase cards. Additionally the department will update purchase card policy to encourage agency officials to analyze spend patterns to identify opportunities to obtain savings and share information on these efforts. Further, the agency has developed a quarterly report to identify the top merchants receiving payment through the purchase card program in order to assist officials in identifying opportunities for strategic sourcing.
    Recommendation: To ensure that good practices are shared within agencies, the Secretaries of Defense, Veterans Affairs, the Interior, Homeland Security, and Energy, and the Environmental Protection Agency should develop guidance that encourages local officials to examine purchase card spend patterns to identify opportunities to obtain savings and to share information on such efforts. Where applicable, we further recommend that these agencies determine the feasibility for broader application of these efforts across the agency or organization.

    Agency: Environmental Protection Agency
    Status: Open

    Comments: The agency provided comments indicating its concurrence with this recommendation, noting that it looks forward to opportunities to benchmark with other agencies and share information on approaches taken to identify opportunities which led to positive strategic sourcing outcomes.
    Director: Randall B. Williamson
    Phone: (202) 512-7114

    1 open recommendations
    including 1 priority recommendation
    Recommendation: To help provide reasonable assurance that VHA achieves its long-term goal of modernizing its claims processing system, the Secretary of Veterans Affairs should direct the Under Secretary for Health to ensure that the agency develops a sound written plan that includes the following elements: (1) a detailed schedule for when VHA intends to complete development and implementation of each major aspect of its new claims processing system; (2) the estimated costs for implementing each major aspect of the system; and (3) the performance goals, measures, and interim milestones that VHA will use to evaluate progress, hold staff accountable for achieving desired results, and report to stakeholders the agency's progress in modernizing its claims processing system.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: As of June 2017, VHA's Office of Community Care is in the process of consolidating VA's community care programs, and as part of this process it plans to transition to a third party administrator for the purposes of claims processing. While an active procurement is underway, VHA still needs to develop a written plan to fully implement this recommendation. VHA's written plan must include details about the schedule, cost estimates, performance goals, and interim milestones associated with transitioning to a third party administrator for the purposes of processing claims for VA community care.
    Director: Williamson, Randall B
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To develop and maintain medical sharing expertise within the network contracting offices, the Secretary of Veterans Affairs should direct the Under Secretary for Health to create a plan for increasing the retention of contracting officers that work in medical sharing teams.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In March 2017, VHA reported that it is working on creating a plan for increasing the retention of contracting officers that work in medical sharing teams. The Medical Sharing Office (MSO) has taken several steps including conducting research on possible ways to minimize or eliminate steps within its existing plan and expanding the number of topical training provided virtually network contracting offices to develop competency in VHA Health Care 1102 staff. In addition, VHA reported they are developing a training schedule to ensure newly deployed interns have received the training and resource to successfully conduct health care contracts if they are assigned to health care resources team and continuing to collaborate with the field to ensure awareness of MSO support and assistance.
    Recommendation: To ensure VHA effectively communicates with its affiliates regarding SSACs, the Secretary of Veterans Affairs should direct the Under Secretary for Health to reach out to all of its affiliates, identify any concerns, and determine the most effective method of communicating with affiliates regarding SSAC development.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In March 2017, the VHA reported that it plans to have an Academic Affiliate Contracting Forum on August 15-16, 2017 in Nashville, TN or Dallas, TX for VHA staff responsible for health care contracts and University affiliates. The purpose of the Forum is to strengthen and advance the collaborative partnership for providing service to Veterans; share perspectives; and enhance awareness about processes, procedures and tools that will help make contracting processes faster and easier for all parties.
    Director: David A. Powner
    Phone: (202) 512-9286

    6 open recommendations
    Recommendation: To ensure that agencies are provided with more complete guidance for contracts for cloud computing services, the Director of OMB should include all ten key practices in future guidance to agencies.

    Agency: Executive Office of the President: Office of Management and Budget
    Status: Open

    Comments: We are following up with OMB on its service level agreement (SLA) guidance to agencies.
    Recommendation: To help ensure continued progress in the implementation of effective cloud computing SLAs, the Secretary of Defense should direct the appropriate officials to ensure key practices are fully incorporated for cloud services as the contracts and associated SLAs expire. These efforts should include updating the Department of Defense memorandum on acquiring cloud services and current Defense Acquisition Regulations System to more completely include the key practices.

    Agency: Department of Defense
    Status: Open

    Comments: We are following up with DOD on updating their service level agreement (SLA) guidance.
    Recommendation: To help ensure continued progress in the implementation of effective cloud computing SLAs, the Secretaries of Health and Human Services, Homeland Security, Treasury, and Veterans Affairs should direct appropriate officials to develop SLA guidance and ensure key practices are fully incorporated as the contract and associated SLAs expire.

    Agency: Department of Homeland Security
    Status: Open

    Comments: We are following up with DHS on the finalization of its service level agreement (SLA) guidance.
    Recommendation: To help ensure continued progress in the implementation of effective cloud computing SLAs, the Secretaries of Health and Human Services, Homeland Security, Treasury, and Veterans Affairs should direct appropriate officials to develop SLA guidance and ensure key practices are fully incorporated as the contract and associated SLAs expire.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: We are following up with HHS on their service level agreement (SLA) guidance.
    Recommendation: To help ensure continued progress in the implementation of effective cloud computing SLAs, the Secretaries of Health and Human Services, Homeland Security, Treasury, and Veterans Affairs should direct appropriate officials to develop SLA guidance and ensure key practices are fully incorporated as the contract and associated SLAs expire.

    Agency: Department of the Treasury
    Status: Open

    Comments: We are following up with Treasury on their service level agreement (SLA) guidance.
    Recommendation: To help ensure continued progress in the implementation of effective cloud computing SLAs, the Secretaries of Health and Human Services, Homeland Security, Treasury, and Veterans Affairs should direct appropriate officials to develop SLA guidance and ensure key practices are fully incorporated as the contract and associated SLAs expire.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: We are following up with VA on their service level agreement (SLA) guidance.
    Director: Dave Wise
    Phone: (202) 512-2834

    2 open recommendations
    including 1 priority recommendation
    Recommendation: To improve the quality and transparency of data entered into FRPP as GSA transitions the database to a platform that would enable greater government-wide use, the Administrator of GSA, in consultation with OMB and federal agencies, should (1) assess the reliability of FRPP data by determining how individual agencies collect and report FRPP data for each FRPP field, including any supplemental guidance used by agencies to comply with government-wide FRPP data definitions as part of the annual certification of FRPP data; (2) analyze the differences in collecting and reporting practices used by these agencies; and (3) identify and make available to FRPP users the limitations of using FRPP data, in the context of how the data are intended to be used in real property decision making and to measure real property performance across agencies and update federal guidance to address limitations, as needed.

    Agency: General Services Administration
    Status: Open
    Priority recommendation

    Comments: GSA partially agreed with the recommendation noting that it has limited resources to fully analyze and map the data relative to FRPP data definitions, and that it is the responsibility of individual agencies to ensure reliability of the data and compliance with FRPP definitions. As of October 2016, GSA has taken some action to implement this recommendation. GSA told us it has made progress by conducting an in-depth survey in June 2106 focusing on several data elements including: replacement value, status, owned and otherwise management operating costs, repair needs, utilization, and lease costs. The survey asked agencies questions regarding the processes/resources used to source and compile these data elements from agency IT systems as well as internal agency guidance. GSA received responses from 24 agencies and stated it plans to complete its initial analysis of the survey in the fall of 2016 and indicate limitations of these data elements. GSA plans to conduct a series of working group meetings with agencies to conduct an in depth review of the survey results and to develop a set of recommendations for the Federal Real Property Council. GSA said these recommendations may include, but are not limited to, altering data dictionary definitions, sharing best or common practices for reporting these data elements, and sharing the limitations on the use of these data elements. Based on the working group outcomes and input from the Federal Real Property Council and OMB, GSA plans to produce a white paper on these topics by the latter part of 2017.
    Recommendation: To enhance the usefulness of the National Strategy for managing federal real property government-wide, the Director of OMB should expand the National Strategy to further address long-standing real property management challenges by: (1) expanding the scope to include maintenance and repair needs; (2) articulating planned actions and identifying alternative approaches, including alternative-funding mechanisms, to address underlying causes of the real property problems; (3) ensuring that performance measures at the agency level inform the overall progress of the National Strategy; and (4) determining the government-wide costs, benefits, and risks by leveraging agencies' long-term capital plans and identifying approaches to optimally manage that risk.

    Agency: Executive Office of the President: Office of Management and Budget
    Status: Open

    Comments: When we confirm the actions that OMB has taken in response to this recommendation, we will provide updated information.
    Director: Debra A. Draper
    Phone: (202) 512-7114

    1 open recommendations
    including 1 priority recommendation
    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to monitor the full amount of time newly enrolled veterans wait to be seen by primary care providers, starting with the date veterans request they be contacted to schedule appointments. This could be accomplished, for example, by building on the data collection efforts currently being implemented under the "Welcome to VA" program.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: In March 2016, GAO recommended that VA monitor the full amount of time newly enrolled veterans wait to be seen by primary care providers, starting with the date veterans request they be contacted to schedule appointments. VA concurred with this recommendation, and in June 2017, reported to GAO that it had taken actions to address this recommendation. Specifically, VA indicated that it revised an internal report to help identify and document all newly enrolled veterans and monitor their appointment request status. The report is intended to enable VHA and its medical centers to oversee the enrollment and appointment process by tracking the following timeframes: (1) application to enrollment, (2) enrollment to initial contact, (3) initial contact to primary care appointment, and (4) total time from application from appointment. However, VA also indicated in its response that it does not have data that captures application dates for all newly enrolled veterans. As a result, this report cannot be used to consistently monitor the full amount of time these veterans wait to be seen by primary care providers. To fully implement this recommendation VA needs to capture the application date for all newly enrolled veterans. Upon receiving further information about how and when VA plans to capture this information, we will assess whether VA's actions are sufficient to warrant closure of this recommendation.
    Director: Andrew Sherrill
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To increase accountability for program performance, the Secretary of VA should establish measures to report on program outcomes for Post-9/11 GI Bill OJT and apprenticeship programs, including considering relevant data sources and seeking legislative authority to gain access to data, if necessary.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) agrees that program performance metrics should be developed to report on program outcomes. In March 2016, VBA officials said that VBA's Education Service is working with DoD, ED, and the Consumer Financial Protection Bureau to determine the feasibility of collecting and publishing post-graduation data to include data for OJT and apprenticeship programs. The target completion date was June 1, 2016.
    Director: David Wise
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: The Administrator of the General Services Administration should develop a legislative proposal to enhance accountability for government-wide implementation of the Act. GSA should consider including the following in its proposal: (1) establishing authorities for a single agency to monitor and enforce implementation of the Act; (2) establishing agency responsibilities for reporting progress on implementation of the Act; (3) establishing agency responsibilities for assessing employee skill levels related to the Act and identifying training that allows employees to develop and retain skills required by the Act; and (4) establishing an interagency group to further government-wide collaboration on implementation of the Act.

    Agency: General Services Administration
    Status: Open

    Comments: In response to our recommendation, GSA agreed to work with other agencies to evaluate whether additional legislative changes would improve the speed and efficiency of implementation. In October 2017, GSA informed us they intend to submit a legislative proposal to Congress as part of the FY 2019 budget process. We will continue to monitor GSA actions.
    Director: Michele Mackin
    Phone: (202) 512-4841

    1 open recommendations
    Recommendation: To ensure consistent implementation and documentation of actions relating to interagency agreements, the Secretary of Veterans Affairs should ensure that planned training on interagency agreements reaches the full range of program and contracting officials, particularly those who only occasionally award interagency agreements.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with this recommendation, and developed training based on the revised policy on interagency agreements issued in October 2016. GAO requested information in June 2017 on how VA will ensure this training reaches the full range of program and contracting officials, but as of September 2017 we have not yet received these details.
    Director: Frank Rusco
    Phone: (202) 512-3841

    15 open recommendations
    Recommendation: To help agencies more consistently perform their oversight responsibilities and oversee contractors' measurement and verification activities, the Secretary of Energy should direct FEMP to monitor agencies' oversight of ESPC projects that agencies have awarded using the DOE contract vehicle, including whether agencies witnessed the contractors' measurement and verification activities and reviewed and certified acceptance of the measurement and verification report.

    Agency: Department of Energy
    Status: Open

    Comments: As of December 2016, we were working with DOE officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on the effects of changing circumstances on the performance of their ESPC portfolios, the Secretaries of Defense, Energy, and Veterans Affairs; the Attorney General; and the Administrator of the General Services Administration should establish a process to systematically evaluate their ESPC projects--including baseline assumptions about facilities' energy use, utility prices, and interest rates--to determine how their ESPC portfolios are performing and the extent to which they are achieving expected savings. Agencies could consider conducting such evaluations either after a certain number of years, or in response to events, such as changes in utility prices or market interest rates, or appropriations becoming available that could be used for modifications or terminations.

    Agency: Department of Defense
    Status: Open

    Comments: In comments on a draft of this report, DOD partially concurred with this recommendation. As of December 2016, we were working with DOD officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on the effects of changing circumstances on the performance of their ESPC portfolios, the Secretaries of Defense, Energy, and Veterans Affairs; the Attorney General; and the Administrator of the General Services Administration should establish a process to systematically evaluate their ESPC projects--including baseline assumptions about facilities' energy use, utility prices, and interest rates--to determine how their ESPC portfolios are performing and the extent to which they are achieving expected savings. Agencies could consider conducting such evaluations either after a certain number of years, or in response to events, such as changes in utility prices or market interest rates, or appropriations becoming available that could be used for modifications or terminations.

    Agency: Department of Energy
    Status: Open

    Comments: As of December 2016, we were working with DOE officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on the effects of changing circumstances on the performance of their ESPC portfolios, the Secretaries of Defense, Energy, and Veterans Affairs; the Attorney General; and the Administrator of the General Services Administration should establish a process to systematically evaluate their ESPC projects--including baseline assumptions about facilities' energy use, utility prices, and interest rates--to determine how their ESPC portfolios are performing and the extent to which they are achieving expected savings. Agencies could consider conducting such evaluations either after a certain number of years, or in response to events, such as changes in utility prices or market interest rates, or appropriations becoming available that could be used for modifications or terminations.

    Agency: Department of Justice
    Status: Open

    Comments: In comments on a draft of this report, the Department of Justice agreed with the recommendation. As of December 2016, we were working with Department of Justice officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on the effects of changing circumstances on the performance of their ESPC portfolios, the Secretaries of Defense, Energy, and Veterans Affairs; the Attorney General; and the Administrator of the General Services Administration should establish a process to systematically evaluate their ESPC projects--including baseline assumptions about facilities' energy use, utility prices, and interest rates--to determine how their ESPC portfolios are performing and the extent to which they are achieving expected savings. Agencies could consider conducting such evaluations either after a certain number of years, or in response to events, such as changes in utility prices or market interest rates, or appropriations becoming available that could be used for modifications or terminations.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In comments on a draft of this report, the Department of Veterans Affairs agreed with the recommendation. As of December 2016, we were working with Department of Veterans Affairs officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on the effects of changing circumstances on the performance of their ESPC portfolios, the Secretaries of Defense, Energy, and Veterans Affairs; the Attorney General; and the Administrator of the General Services Administration should establish a process to systematically evaluate their ESPC projects--including baseline assumptions about facilities' energy use, utility prices, and interest rates--to determine how their ESPC portfolios are performing and the extent to which they are achieving expected savings. Agencies could consider conducting such evaluations either after a certain number of years, or in response to events, such as changes in utility prices or market interest rates, or appropriations becoming available that could be used for modifications or terminations.

    Agency: General Services Administration
    Status: Open

    Comments: In comments on a draft of this report, GSA agreed with the recommendation. As of December 2016, we were working with GSA officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help agencies decide whether to use ESPCs to consolidate federal data centers, the Director of the Office of Management and Budget should document, for the purposes of scoring ESPCs, (1) what qualifies as energy-related savings and (2) the allowable proportion of energy and energy-related cost savings.

    Agency: Executive Office of the President: Office of Management and Budget
    Status: Open

    Comments: OMB did not comment on its plans to implement this recommendation in its review of a draft of the report and, as of December 2016, had not provided us with requested information on its actions to implement this recommendation. We will continue to follow-up on the status of this recommendation.
    Recommendation: To help agencies more consistently perform their oversight responsibilities and oversee contractors' measurement and verification activities, the Secretary of Energy should direct DOE's Federal Energy Management Program (FEMP) to evaluate existing training and determine whether additional training is needed on observing contractors' measurement and verification activities and reviewing and certifying measurement and verification reports.

    Agency: Department of Energy
    Status: Open

    Comments: As of December 2016, we were working with DOE officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on ESPC performance to oversee whether future and current contracts are achieving their expected savings, the Secretaries of Defense and Energy should specify in the scheduled revisions to their ESPC contract vehicles or in guidance to agencies that measurement and verification reports for future projects are to include estimates of cost and energy savings that were not achieved because of agency actions. Additionally, the Department of Energy (DOE) may wish to consider periodically analyzing data on other factors that may affect savings, such as utility prices, to provide information on how savings achieved by ESPCs awarded through its contract vehicle have been affected by changing utility prices since its prior study in 2007.

    Agency: Department of Defense
    Status: Open

    Comments: In comments on a draft of this report, DOD concurred with this recommendation. As of December 2016, we were working with DOD officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on ESPC performance to oversee whether future and current contracts are achieving their expected savings, the Secretaries of Defense and Energy should specify in the scheduled revisions to their ESPC contract vehicles or in guidance to agencies that measurement and verification reports for future projects are to include estimates of cost and energy savings that were not achieved because of agency actions. Additionally, the Department of Energy (DOE) may wish to consider periodically analyzing data on other factors that may affect savings, such as utility prices, to provide information on how savings achieved by ESPCs awarded through its contract vehicle have been affected by changing utility prices since its prior study in 2007.

    Agency: Department of Energy
    Status: Open

    Comments: As of December 2016, we were working with DOE officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on ESPC performance to oversee whether future and current contracts are achieving their expected savings, the Secretaries of Defense, Energy, and Veterans Affairs; the Attorney General; and the Administrator of the General Services Administration should work with contractors to determine the best way to obtain estimates of cost and energy savings that are not achieved because of agency actions in order to include these estimates in future measurement and verification reports for existing contracts, in accordance with DOE guidance, and where economically feasible.

    Agency: Department of Defense
    Status: Open

    Comments: In comments on a draft of this report, DOD concurred with this recommendation. As of December 2016, we were working with DOD officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on ESPC performance to oversee whether future and current contracts are achieving their expected savings, the Secretaries of Defense, Energy, and Veterans Affairs; the Attorney General; and the Administrator of the General Services Administration should work with contractors to determine the best way to obtain estimates of cost and energy savings that are not achieved because of agency actions in order to include these estimates in future measurement and verification reports for existing contracts, in accordance with DOE guidance, and where economically feasible.

    Agency: Department of Energy
    Status: Open

    Comments: As of December 2016, we were working with DOE officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on ESPC performance to oversee whether future and current contracts are achieving their expected savings, the Secretaries of Defense, Energy, and Veterans Affairs; the Attorney General; and the Administrator of the General Services Administration should work with contractors to determine the best way to obtain estimates of cost and energy savings that are not achieved because of agency actions in order to include these estimates in future measurement and verification reports for existing contracts, in accordance with DOE guidance, and where economically feasible.

    Agency: Department of Justice
    Status: Open

    Comments: In comments on a draft of this report, the Department of Justice agreed with the recommendation. As of December 2016, we were working with Department of Justice officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on ESPC performance to oversee whether future and current contracts are achieving their expected savings, the Secretaries of Defense, Energy, and Veterans Affairs; the Attorney General; and the Administrator of the General Services Administration should work with contractors to determine the best way to obtain estimates of cost and energy savings that are not achieved because of agency actions in order to include these estimates in future measurement and verification reports for existing contracts, in accordance with DOE guidance, and where economically feasible.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In comments on a draft of this report, the Department of Veterans Affairs did not agree with the recommendation, but suggested changes, which we incorporated. As of December 2016, we were working with Department of Veterans Affairs officials to confirm the status of their actions to implement the recommendation.
    Recommendation: To help ensure that agencies have sufficient information on ESPC performance to oversee whether future and current contracts are achieving their expected savings, the Secretaries of Defense, Energy, and Veterans Affairs; the Attorney General; and the Administrator of the General Services Administration should work with contractors to determine the best way to obtain estimates of cost and energy savings that are not achieved because of agency actions in order to include these estimates in future measurement and verification reports for existing contracts, in accordance with DOE guidance, and where economically feasible.

    Agency: General Services Administration
    Status: Open

    Comments: In comments on a draft of this report, GSA agreed with the recommendation. As of December 2016, we were working with GSA officials to confirm the status of their actions to implement the recommendation.
    Director: Bertoni, Daniel
    Phone: (202) 512-7215

    3 open recommendations
    including 1 priority recommendation
    Recommendation: To help ensure that Total Disability Individual Unemployability (TDIU) decisions are well supported and TDIU benefits are provided only to veterans whose service-connected disabilities prevent them from obtaining or retaining substantially gainful employment, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to update the TDIU guidance to clarify how rating specialists should determine unemployability when making TDIU benefit decisions. This updated guidance could clarify whether factors such as enrollment in school, education level, and prior work history should be used and if so, how to consider them; and whether or not to assign more weight to certain factors than others. Updating the guidance would also give VBA the opportunity to re-examine the applicability, if at all, of other factors it has identified as extraneous.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA reported in March 2017 that an internal workgroup is in the final stage of collecting and analyzing the data to determine if age should be a factor in deciding Total Disability Individual Unemployability (TDIU), and whether or not to use positive vocational assessments to disallow TDIU claims. VA reported that the workgroup is also in the process of completing an Inter-Rater Variability Assessment (IRVA) to examine the disparity in rating decisions involving entitlement to TDIU and service connection. After completion of the internal study on TDIU and the IRVA, targeted for September 30, 2017, the workgroup will submit its preliminary analysis and recommendations to VBA leadership for a decision on the next courses of action for future policy decisions and will then update any related guidance, as appropriate.
    Recommendation: To help ensure that TDIU decisions are well supported and TDIU benefits are provided only to veterans whose service-connected disabilities prevent them from obtaining or retaining substantially gainful employment, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to verify the self-reported income provided by veterans (a) applying for TDIU benefits and (b) undergoing the annual eligibility review process by comparing such information against IRS earnings data, which VBA currently has access to for this purpose. VA could also explore options to obtain more timely earnings data from other sources to ensure that claimants are working within allowable eligibility limits

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA is developing an upfront verification process by expanding the data sharing agreement with Social Security Administration (SSA), which enables VA to receive federal tax information via an encrypted electronic transmission through a secure portal. Once a Total Disability Individual Unemployability (TDIU) claim is received, VA will request the reported income through the secured SSA portal and receive a response within 10-16 days. VA reported that process will serve as a more efficient way to receive income data in a timely manner and maintain the integrity of the TDIU benefit while reducing improper payments. The development and implementation of the upfront verification process for TDIU claimants is anticipated to be completed by July 21, 2017. Meanwhile, VA has reinstituted the data match agreement with SSA through December 2017, which collects earned income (employment wages). The agreement allows VBA to compare reported income earnings of TDIU beneficiaries to earnings actually received. In addition, VA completed the upfront income verification manual guidance and is planning to pilot the guidance prior to implementation. VA also has drafted new manual guidance for the annual eligibility review process and the documents are currently under review. As of March 2017, VA reported delays and stated it planned to fully implement the annual eligibility review process by June 30, 2017.
    Recommendation: To help ensure that TDIU decisions are well supported and TDIU benefits are provided only to veterans whose service-connected disabilities prevent them from obtaining or retaining substantially gainful employment, in light of VA's agreement with the recommendations made by the Advisory Committee on Disability Compensation, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to develop a plan to study the complex TDIU policy questions on (1) whether age should be considered when deciding if veterans are unemployable and (2) whether it is possible to disallow TDIU benefits for veterans whose vocational assessment indicated they would be employable after rehabilitation.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of March 2017, a VA workgroup is in the final stages of collecting and analyzing the data to determine if age should be a factor in deciding TDIU, and whether or not the agency will use positive vocational assessments to disallow TDIU claims. Additionally, the workgroup is in the process of completing an Inter-Rather Variability Study (IRVA) to examine the disparity in rating decisions involving entitlement to TDIU and service connection. After completion of the internal study on TDIU and the IRVA, targeted for September 30, 2017, he workgroup will submit its preliminary analysis and recommendations and VA will then decide on the next courses of action for future policy decisions. Due to VA's earlier conclusions, in April 2015, that no immediate changes to its current guidance were necessary, and in the spirit of this recommendation, the status will remain open until the completion of these ongoing efforts.
    Director: Debra A. Draper
    Phone: (202) 512-7114

    3 open recommendations
    Recommendation: To eliminate the fragmentation and duplication in the storage of unclassified OEHS data, the Secretary of Defense should determine which IT system--DOEHRS or MESL--should be used to store specific types of unclassified OEHS data, clarify the department's policy accordingly, and require all other departmental and military-service-specific policies to be likewise amended and implemented to ensure consistency.

    Agency: Department of Defense
    Status: Open

    Comments: In November 2016, officials told us that draft versions of the revised DoDI 6490.03, Deployment Health, and the new Defense Health Agency Procedural Instruction (DHA PI) 6490.03, Deployment Health, are still under review with DOD components. These revised and updated documents will address the recommendation on OEHS data storage. Additionally, DoDI 6055.05, Occupational and Environmental Health (OEH), and Military Service and Combatant Command policy and guidance documents are still being revised to be consistent with DoDI 6490.03 and DHA PI 6490.03 after they are published. These revisions will ensure the consistency among policies. As of November 2016, the entire process is expected to be complete within 10 to 14 months.
    Recommendation: To ensure the reliability of OEHS data, the Secretary of Defense should establish clear policies and procedures for performing quality assurance reviews of the OEHS data collected during deployment, to include verifying the completeness and the reasonableness of these data, and require that all other related military-service-specific policies be amended and implemented to ensure consistency.

    Agency: Department of Defense
    Status: Open

    Comments: In August 2016, officials told us that draft versions of the revised DoDI 6490.03, Deployment Health, and the new Defense Health Agency Procedural Instruction (DHA PI) 6490.03, Deployment Health, are in review among the DOD Components. Further, DoDI 6055.05, Occupational and Environmental Health (OEH) and Military Service and Combatant Command policy and guidance documents will be revised to be consistent with DoDI 6490.03 and DHA PI 6490.03 after they are published. In addition, DOD is exploring improvement to the data quality assurance functionality within the Defense Occupational and Environmental Health Readiness System Industrial Hygiene (DOEHRS-IH). A new DOEHRS-IH version (2.0.18.1) was released on August 19, 2016 that contained several system enhancements and defect corrections to improve overall data quality in the system. DOD anticipates additional releases in FY 2017 that will further improve DOEHRS-IH data quality. The revised policies and the new DOEHRS-IH functionality will appropriately address the recommendation on quality assurance of OEHS data.
    Recommendation: To ensure that potential occupational and environmental health risks are mitigated for servicemembers deployed to Iraq and Afghanistan, the Secretary of Defense should require CENTCOM to revise its policy to ensure that base commanders' decisions on whether to implement risk mitigation recommendations identified in OEHSAs are adequately documented and consistently monitored by the appropriate command.

    Agency: Department of Defense
    Status: Open

    Comments: In August 2016, officials told us that the current DoDI 6055.01, DoD Safety and Occupational Health Program, requires DoD components to establish procedures that document, archive, and reevaluate risk management decisions on a recurring basis. Draft versions of the revised DoDI 6490.03, Deployment Health, and the new Defense Health Agency Procedural Instruction (DHA PI) 6490.03, Deployment Health, include language that is consistent with DoDI 6055.01. Additionally, U.S. Central Command Regulation 40-2 (CCR 40-2), which was updated as of March 8, 2016, references the requirement to establish procedures to assure risk management decisions are documented, archived, and reevaluated on a recurring basis. The DOD is also exploring a risk management decision and monitoring functionality in DOEHRS-IH. It has identified and approved the necessary system change requests required to improve risk management decisions and monitoring functionality. These functionalities are primarily focused around the Occupational & Environmental Health Site Assessment (OEHSA) and associated exposure pathways, sampling plans, and assessments. Subject to the availability of FY 2017 funding, DOD will implement the system change requests, and achieve the required enhancements to DOEHRS-IH. These policies once published and the new DOEHRS-IH functionality will appropriately address the recommendation on documenting and monitoring risk management decisions.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    2 open recommendations
    Recommendation: To help improve the quality of VBA's disability compensation claim decisions, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to take steps to ensure that any future upgrades to local data systems allow QRTs to pause the claims process when errors are detected and enable QRTs to better track error trends.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of March 2017, VA reported that VBA has submitted business requirements to add new functionality in VA's electronic claims processing system, the Veterans Benefit Management System (VBMS), that will allow the agency to identify deficiencies during the claims process. If an error is detected, the claim will be paused to allow an in-process review (IPR), conducted by quality review teams, to occur. These new business requirements are under review for inclusion in a future release of VBMS. VBA expects to deploy the new VBMS functionality to pause the claims process by July 2017. In addition, the agency has secured funding and is in the process of developing a new quality assurance database that will capture data from all types of quality reviews at various stages of the claims process, to include local regional office individual quality reviews, IPRs, national STAR and consistency studies. VBA stated that this new database will support increased data analysis capabilities and allow VBA to evaluate the effectiveness of quality assurance activities through improved and vigorous error trend analysis. VBA anticipates deploying the new quality assurance database by July 2017. We will close this recommendation when VA provides documentation of the systems change that allows the process to be paused.
    Recommendation: To help improve the quality of VBA's disability compensation claim decisions, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to take additional steps to evaluate the effectiveness of quality assurance activities to identify opportunities to improve or better target these activities.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of March 2017, VA reported that VBA is in the process of developing a new quality assurance database that will capture data from all types of quality reviews at various stages of the claims process, to include local regional office individual quality reviews in-process reviews, national STAR reviews and consistency studies. VBA stated that this new database will support increased data analysis capabilities and allow VBA to evaluate the effectiveness of quality assurance activities through improved and vigorous error trend analysis. VBA anticipates deploying the new quality assurance database by July 2017. To help close this recommendation, the agency will need to explain how this new approach will be used to evaluate the effectiveness of quality assurance activities and thus improve their rigor.
    Director: Debra A. Draper
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: To help ensure adequate and qualified nurse staffing at VAMCs, the Secretary of Veterans Affairs should direct the Interim Under Secretary for Health to enhance VHA's internal controls by completing evaluations of Phase I and Phase II and make any necessary changes to policies and procedures before national implementation of Phase II in all VAMCs.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA agreed with this recommendation and, according to an update received April 2017, VA is taking actions towards addressing this recommendation and expects to complete those actions Fall 2017. When additional information is received GAO will update the recommendation as appropriate.
    Director: Bertoni, Daniel
    Phone: (202) 512-7215

    1 open recommendations
    including 1 priority recommendation
    Recommendation: The Secretary of Veterans Affairs should take steps to better understand both the difficulties faced by readjusting veterans and the characteristics of those who may be more likely to face such difficulties, and use the results to determine how best to enhance its benefits and services to these veterans.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA has begun taking steps to better understand the difficulties faced by readjusting veterans but has not yet completed them. Since November 2014, VA reported that it has been working with DOD to develop the joint process for conducting Care Coordination Process Reviews (formerly known as Qualitative Case Reviews), which will focus on reviewing care coordination processes and effectiveness. VA's Interagency Care Coordination Committee (IC3) Policy and Oversight Work Group is revising the policies and procedures for these reviews and has begun a national roll out of the Lead Coordinator initiative, which, according to VA, will improve the level of complex care coordination within and between DOD and VA. After completing a tabletop exercise of case review presentations on October 3, 2016, VA identified areas which needed fine tuning, so it developed open forums for lead coordinators to discuss process and resources. In an effort to enhance its briefings under the Transition Assistance Program, now known as the Transition Goals, Plans, Success program, VA used participant satisfaction data and is developing a long-term survey instrument that will assist VA in identifying and tracking recommended process improvements. In January 2015, VA produced a report on veteran economic competitiveness that recommended that VA develop targeted strategies for vulnerable populations, such as veterans who separate from the military without a GED or high school diploma and veterans who are separating after their rehabilitation. The report also recommended that VA continue to research the educational and economic status of veterans and coordinate with other federal agencies to identify and address gaps in current programs and policies that may result in barriers to economic success among vulnerable segments of the veteran population. GAO will consider this recommendation closed when VA has completed the joint Care Coordination Process Reviews, developed the long-term survey instrument for the Transition Goals, Plans, and Success program, and used the results from these reviews and survey to determine how best to enhance its benefits and services to veterans.
    Director: Brian J. Lepore
    Phone: (202) 512-4523

    2 open recommendations
    Recommendation: To better enable NCA to meet its mission of providing reasonable access to burial options at veterans cemeteries, the Secretary of Veterans Affairs should direct the Under Secretary for Memorial Affairs to use the capability of NCA's existing software to estimate the served and unserved veteran populations using census tract data.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: On Nov 12, 2014, VA provided an update on the actions taken in response to the recommendation contained in "VETERANS AFFAIRS: Data Needed to Help Improve Decisions Concerning Veterans' Access to Burial Options" (GAO-14-537) released to the Department, September 9, 2014. In its letter, VA noted that it non-concurred with this recommendation, and identified no actions being taken.
    Recommendation: To better enable NCA to meet its mission of providing reasonable access to burial options at veterans cemeteries, the Secretary of Veterans Affairs should direct the Under Secretary for Memorial Affairs to develop and implement a plan to fully address all the elements required by the Consolidated and Further Continuing Appropriations Act, 2013, in VA's Rural Veteran Burial Access Strategy, including the estimated number and location of unserved veterans and a national map of cemeteries.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: On Nov 12, 2014, VA provided an update on the progress it has made in implementing this recommendation, contained in "VETERANS AFFAIRS: Data Needed to Help Improve Decisions Concerning Veterans' Access to Burial Options" (GAO-14-537) released to the Department, September 9, 2014. VA stated that, as previously reported in its response to VA's Office of Inspector General recommendations, the National Cemetery Administration (NCA) is developing a methodology to identify Veterans living in rural areas. VA also stated that NCA was in the process of establishing a new database intended to enable analysis of Veteran demographics at the county, state, regional, and national levels, including identifying each county in the country as either being served (within the 75-mile service area) or unserved by a VA national or VA-funded state Veterans cemetery and the specific cemeteries that provide service to each served county. In its November 2014 response to GAO, VA stated that NCA had completed the development of the new database and was able to produce a preliminary national map. VA stated that NCA management and staff were in the process of validating the accuracy of the information in the database, and that NCA expected to complete that process by the end of the second quarter of FY 2015. After that point, VA stated that it believed that NCA would then be able to publish the national map and address the other remaining elements required by the Consolidated and Further Continuing Appropriations Act, 2013.
    Director: Steve Lord
    Phone: (202) 512-6722

    1 open recommendations
    Recommendation: In order to improve the quality of the data collected on specific land-use agreements (i.e., sharing, outleases, licenses, and permits), enhance the monitoring of its revenue process and monitoring of agreements, and improve the accountability of the VA in this area, the Secretary of Veterans Affairs should develop mechanisms to monitor the billing and collection of revenues for land-use agreements to help ensure that transactions are promptly and accurately recorded at the three medical centers.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: Veterans Affairs-Veterans Health Administration officials are currently updating their policies on Sharing Use of Space. Veterans Affairs-Veterans Health Administration Office of Enterprise Management will provide support to the agency's office of Finance, as needed, on the process for recognition of revenue, billing, collections, and for financial reporting to ensure completeness of financial data for land use agreements. Agency officials began working on the Capital Asset Inventory validation report. Upon completion, the report will be provided to agency field staff for action on updating the database.
    Director: David A. Powner
    Phone: (202) 512-9286

    3 open recommendations
    Recommendation: The Director of the Office of Management and Budget should direct the Federal Chief Information Officer to update, and clearly and explicitly issue incremental development guidance that addresses the following three components: (1) requires projects associated with major IT investments to deliver incremental functionality at least every 12 months, with the exception of the three types of investments identified in this report; (2) specifies how agencies are to define the project functionality that is to be delivered; and (3) requires agencies to define a process for enforcing compliance with incremental functionality delivery, such as the use of TechStat sessions.

    Agency: Executive Office of the President: Office of Management and Budget
    Status: Open

    Comments: The Office of Management and Budget (OMB) agreed with our recommendation to update and issue incremental guidance, but disagreed that the time frame for incremental delivery should be changed to every 12 months. Subsequently, OMB began to take steps to address aspects of our recommendation. Specifically, in June 2014, OMB updated its information technology (IT) budget guidance to, among other things, define project functionality as any changes to an IT system that primarily provides new or improved capability to the end user. Additionally, in June 2015, OMB issued its guidance on how agencies are to implement December 2014 federal IT acquisition reform legislation. As part of that guidance, OMB required CIOs to ensure that all acquisition strategies and acquisition plans that include IT apply adequate incremental development principles. However, as of June 2017, OMB's annually updated IT budget capital planning guidance still requires that projects associated with major IT investments deliver functionality every 6 months, rather than every 12 months, as we recommended. In the absence of our recommended delivery time frame change, OMB is at risk of continuing to require functionality to be delivered in a time frame that we found to be unrealistic for many IT investments based on their current levels of performance. We will continue to evaluate OMB's progress in implementing the recently issued guidance and in considering a change in how often projects are to deliver functionality.
    Recommendation: The Secretaries of Defense, Health and Human Services, Homeland Security, and Transportation should modify, finalize, and implement their agencies' policies governing incremental development to ensure that those policies comply with OMB's guidance, once that guidance is made available.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: The Department of Health and Human Services (HHS) has begun to take steps to address this recommendation. Specifically, in January 2015, HHS established a working group on incremental development in order to define a methodology for more rapid development. Further, HHS officials reported in April 2017 that the department was working to finalize its new guidance on incremental development and CIO certification as required by OMB guidance but could not provide a time frame for when the policy would be finalized. Until HHS finalizes and implements its incremental development policy, its information technology expenditures are more likely to produce sub-optimal results. We will continue to evaluate HHS's progress in implementing this recommendation.
    Recommendation: When updating their policies, the Secretaries of Defense, Health and Human Services, Homeland Security, and Transportation should consider the factors identified in this report as enabling and inhibiting incremental development.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: The Department of Health and Human Services (HHS) has begun to take steps to address this recommendation. Specifically, in January 2015, HHS established a working group on incremental development in order to define a methodology for incremental development that would address the factors identified in the report. Further, HHS officials reported in April 2017 that the department was working to finalize its new guidance on incremental development and CIO certification as required by OMB guidance but could not provide a time frame for when the policy would be finalized. Until HHS updates and implements its incremental development policy, its information technology expenditures are more likely to produce sub-optimal results. We will continue to evaluate HHS's progress in implementing this recommendation.
    Director: Andrew Sherrill
    Phone: (202) 512-7215

    2 open recommendations
    Recommendation: To better ensure servicemember participation in and completion of TAP, the Secretary of Defense should direct the Under Secretary for Personnel and Readiness to require that all services provide unit commanders and their leaders information on TAP participation levels of servicemembers under their command, similar to that provided by the Army and Air Force. Such information could be used to help hold leaders accountable for ensuring TAP participation and completion.

    Agency: Department of Defense
    Status: Open

    Comments: DOD disagreed with this recommendation and, as of January 2016, has not taken action to address it. In its written comments published in GAO's 2014 report, DOD questioned GAO's concern that not having a mechanism to ensure a servicemember's completion of TAP by commander would result in commanders not supporting the release of servicemembers to attend TAP. DOD noted that GAO's concern is based on observations that preceded full implementation of the capstone event. In October 2013, DOD launched the capstone as a mandatory process by which commanders verify TAP participation and positively affirm that servicemembers have or have not met career readiness standards. In addition, DOD said that capstone event implementation was accompanied by a communications campaign to inform both commanders and the services. Finally, DOD said that capstone event completion is monitored departmentwide to ensure compliance. However, GAO believes that such monitoring does not provide routine information to commanders and their leaders and not all TAP locations will be monitored routinely. GAO's report noted that DOD reported that ensuring servicemember participation in capstone events was a challenge for most of the services possibly due, in part, to lack of commanders' support. Commander support for the program has been a long-standing challenge for the program. Therefore, we continue to believe that an accountability mechanism is needed for TAP that mirrors the level at which responsibility has been assigned. Since commanders are responsible for ensuring that eligible servicemembers have full access to and successfully complete required TAP components, providing them and their leaders information on TAP participation levels of servicemembers under their command could promote accountability and oversight. Servicemember participation in TAP is generally required by law and DOD policy, and also relates to a Cross-Agency Priority Goal, reinforcing the need for such a mechanism. For GAO to close this recommendation, DOD should require all services to provide unit commanders and their leaders information on TAP participation levels of servicemembers under their command.
    Recommendation: To provide information on the extent to which the revamped TAP is effective, the Secretary of Defense should direct the Under Secretary for Personnel and Readiness to work with the partner agencies to develop a written strategy for determining which components and tracks to evaluate and the most appropriate evaluation methods. This strategy should include a plan to use the results of evaluations to modify or redesign the program, as appropriate.

    Agency: Department of Defense
    Status: Open

    Comments: DOD has partially addressed GAO's recommendation on evaluating the effectiveness of the revamped TAP, information that is currently limited. DOD's May 2014 presentation to OMB on the status of TAP implementation and evaluation efforts lists specific TAP components and tracks in which VA, DOL, and SBA planned to assess TAP effectiveness or post-transition outcomes. Although the presentation to OMB indicated that VA planned a higher level evaluation, as of December 2015, VA officials said they are focusing on lower level evaluations, such as gauging participant reactions to training and monitoring. As of March 2016, DOL has been conducting a quasi-experimental evaluation of the Employment Workshop, which it expects to complete in 2017. Further, SBA officials said they are surveying Entrepreneurial track participants who agreed to a post-TAP, follow-up survey. However, DOD and the agencies have not fully demonstrated a strategic approach to planning higher level evaluations. Specifically, DOD and its partner agencies have not provided a rationale for why they chose to evaluate certain aspects of TAP and not others. A written rationale, along with how the agencies plan to use the results of the evaluations, is required for GAO to consider this recommendation closed.
    Director: Pendleton, John H
    Phone: 202-512-3489

    1 open recommendations
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to revise its guidance on imminent danger pay area designations to include specific time frames for completing periodic reviews of imminent danger pay area designations.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Bertoni, Daniel
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Benefits to develop new measures of long-term employment that go beyond the minimum 60 days of post-placement monitoring that is currently required. In developing measures, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to consider the feasibility of using results from planned post-closure surveys of veterans as a data source.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of March 2017, VA continues to develop its new Vocational Rehabilitation and Employment Case Management System (VRE-CMS). The expected date of implementation for this system is September 2018, and it will enable VA to track participants' status post-case closure. VA indicated that after this system has been operational for six months and initial data have been collected on participants' post-case closure outcomes, the agency will develop new performance metrics tied to these outcomes. VA also indicated that it is exploring the possibility of tracking VR&E participants post-closure earnings data through a data sharing agreement with the Social Security Administration. To close this recommendation as implemented, VA will need to demonstrate that it has developed and implemented performance metrics related to long-term employment outcomes.
    Director: Williamson, Randall B
    Phone: (202) 512-7114

    3 open recommendations
    including 1 priority recommendation
    Recommendation: To effectively manage fee basis care spending, the Secretary of Veterans Affairs should revise the beneficiary travel eligibility regulations to allow for the reimbursement of travel expenses for veterans to another VAMC to receive needed medical care when it is more cost-effective and appropriate for the veteran than seeking similar care from a fee basis provider.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of September 2015, VA has taken some actions to address this recommendation, but additional actions are needed to fully implement it. We will update the status of this recommendation when we receive additional information from VA.
    Recommendation: To effectively manage fee basis care wait times and spending, the Secretary of Veterans Affairs should direct the Under Secretary for Health to analyze the amount of time veterans wait to see fee basis providers and apply the same wait time goals to fee basis care that are used as VAMC-based wait time performance measures.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: In October 2014, VHA established a new wait-time goal, which is that veterans should be seen within 30 days of the date that an appointment is deemed clinically appropriate by a VA health care provider, or if no such clinical determination has been made, the date a veteran prefers to be seen for hospital care or medical services. While VHA has been monitoring the timeliness of VHA-based care according to this standard, it has not been applying the same standard to community-based care, including care delivered through the Veterans Choice Program. Therefore, VHA cannot determine whether veterans are receiving care in the community sooner or later than they otherwise would receive care at VA medical facilities. To fully implement this recommendation, VHA needs to take steps to ensure that its wait-time policies and procedures for both VHA-based care and community-based care (fee basis care) are aligned.
    Recommendation: To ensure that VA Central Office effectively monitors fee basis care, the Secretary of Veterans Affairs should direct the Under Secretary for Health to ensure that fee basis data include a claim number that will allow for VA Central Office to analyze the episode of care costs for fee basis care.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of September 2015, VA has taken some actions to address this recommendation, but additional actions are needed to fully implement it. We will update the status of this recommendation when we receive additional information from VA.
    Director: Mctigue Jr, James R
    Phone: (202) 512-7968

    3 open recommendations
    Recommendation: To improve the ability of the Army and local communities to manage future base closures, the Secretary of Defense should direct the Secretary of the Army to issue, consistent with DOD guidance, guidance on specific levels of maintenance to be followed in the event of a base closure based on the probable reuse of the facilities.

    Agency: Department of Defense
    Status: Open

    Comments: In DOD's comments on our report, it stated that it concurred with our recommendation and that the Army agrees to publish property maintenance guidance prior to closing installations in the event of future base closures. In June 2016, DOD stated that the Department is prohibited by Congressional/statutory language to plan for or implement future BRAC execution.
    Recommendation: To improve the ability of DOD and the local communities to respond to future growth actions, the Secretary of Defense should direct the Secretaries of the Army, the Navy, and the Air Force to consider developing a procedure for collecting service members' physical addresses while stationed at an installation, annually updating this information, and sharing aggregate information with community representatives relevant for local planning decisions, such as additional population per zip code, consistent with privacy and force protection concerns.

    Agency: Department of Defense
    Status: Open

    Comments: DOD partially concurred with this recommendation and stated that it agrees that information pertaining to the physical location of installation personnel helps affected communities plan for housing, schools, transportation and other off-post requirements in support of installations. It further stated that existing policy requires the military departments to provide planning information, including base personnel, to states and communities to support the establishment or expansion of a military base. In the event of future basing decisions affecting local communities, DOD stated that it will work with the military departments to assess and determine the best means to obtain, aggregate, and distribute this information to help ensure adequate planning information is made available. In June 2016, DOD stated that the Department is prohibited by Congressional/statutory language to plan for or implement future BRAC execution.
    Recommendation: The Secretary of Defense should direct the Secretaries of the Army and the Air Force to consider creating or designating a civilian position at the installation level to be the focal point and provide continuity for community interaction for future growth installations and to consider expanding this position to all installations. This position may be a collateral duty.

    Agency: Department of Defense
    Status: Open

    Comments: DOD partially agreed with this recommendation. It stated that it agrees with the need for a designated position at the installation level to work with the community and will ensure this requirement is being met through current practices and in accordance with each military department's personnel system. In many of the growth impacted communities, installation officials serve as ex-officio members of the community's growth management organization and relevant installation staff, including those engaged with public works, housing, education, and land use planning, and coordinate as needed with their civilian community counterparts. In July 2015, DOD stated that in the event the Department of Defense proceeds with future realignments that could result in a reduced footprint, there are provisions for Base Transition Coordinators (BTCs) to be designated as a liaison with the affected community. In the event these future realignments result in an expanded footprint or personnel growth, the Department would consider this recommendation at that time. In June 2016, DOD stated that the Department is prohibited by Congressional/statutory language to plan for or implement future BRAC execution.
    Director: Mihm, J Christopher
    Phone: (202) 512-6806

    2 open recommendations
    Recommendation: When such revisions are made, the Director of OMB should work with the Performance Improvement Council to test and implement these provisions.

    Agency: Executive Office of the President: Office of Management and Budget
    Status: Open

    Comments: According to information provided by Office of Management and Budget (OMB) and Performance Improvement Council (PIC) staff in June 2015, although OMB revised its guidance as we recommended, it did not work with the PIC to test implementation of these provisions. Instead, they told us that both PIC and OMB staff ensure agencies are implementing these provisions of their guidance when reviewing agencies' agency priority goals (APG) quarterly update submissions. However, our analysis of agencies' APG updates in October 2016 found implementation of these provisions continues to be mixed. We will continue to monitor progress.
    Recommendation: In addition, as OMB works with agencies to enhance Performance.gov to include additional information about APGs, the Director of OMB should ensure that agencies adhere to OMB's guidance for website updates by providing a description of how input from congressional consultations was incorporated into each APG.

    Agency: Executive Office of the President: Office of Management and Budget
    Status: Open

    Comments: In June 2015, OMB staff stated that they would focus agency attention on congressional consultations and publishing relevant input from those consultations during the development of the 2016-2017 agency priority goals (APG). OMB and agencies published information about the 2016-2017 APGs on Performance.gov in October 2015. However, our analysis of relevant sections of Performance.gov in October 2016 generally found that either agencies did not include information about congressional input or they had not updated Performance.gov to reflect the most recent round of stakeholder engagement. We will continue to monitor progress.
    Director: Mctigue, James R Jr
    Phone: (202)512-7968

    3 open recommendations
    including 1 priority recommendation
    Recommendation: To increase the overall reliability of the initial cost estimates that DOD submits with its recommendations to the BRAC Commission for any future BRAC round, the Under Secretary of Defense for Acquisition, Technology, and Logistics should direct the Deputy Under Secretary of Defense for Installations and Environment to take actions to enhance the department's ability to identify any potential costs associated with its alternatively financed projects in the event of a base closure. Specifically, the Under Secretary direct the Deputy Under Secretary should modify the procedures for collecting data in its BRAC data call to include questions that are consistent and comprehensive; directed to all three military departments; and specific to the potential types of costs associated with alternatively financed projects.

    Agency: Department of Defense: Office of the Secretary of Defense: Office of the Under Secretary of Defense for Acquisition, Technology, and Logistics
    Status: Open

    Comments: DOD comment - Non Concur. The Department does not believe that such costs should be collected as part of the BRAC data call, in that it would be impossible to determine those costs in advance. Those costs are similar to environmental remediation and program management costs, which also are not accounted for in the COBRA estimates. The reason environmental remediation and alternative financing costs are not included is that their inclusion could create a perverse incentive to retain bases with a lower military value. Moreover, the primary advantage of COBRA is to provide real time comparison of scenarios to aid analysis and decision maker review, not to develop budget quality estimates. This real time quality of COBRA is a critical component of both the Department's requirement to treat all bases equally and in the Commission's decision process. The team reviewed DOD IG Recommendation Summary Report of Currently Open GAO Cases (DMAIS). In the report's 05/12/16 update, DOD did not include recommendations from GAO-13-337. Also, in October 2016, an official of the Basing Directorate in OSD AT&L EI&E explained that DOD non-concurred with the report's recommendations, DOD has not taken action, and does not plan to take action on the recommendations. As of June 2017, DOD has not taken action.
    Recommendation: To increase the overall reliability of the initial cost estimates that DOD submits with its recommendations to the BRAC Commission for any future BRAC round, the Under Secretary of Defense for Acquisition, Technology, and Logistics should direct the Deputy Under Secretary of Defense for Installations and Environment to take actions to enhance the department's ability to identify any potential costs associated with its alternatively financed projects in the event of a base closure. Specifically, the Under Secretary direct the Deputy Under Secretary should modify the COBRA model to add a capability that allows users to indicate that a potential liability may exist, even if the amount of the liability cannot be estimated at the time of data entry. For example, a data field could be added that provides the user with a "Yes / No" option to indicate the possibility of such a cost. In addition, COBRA instructions could be modified to instruct the user to provide information on the likely costs, in footnotes. This would increase the information available to decision makers and signal that there are potential costs in the event that a precise estimate cannot be calculated at that time.

    Agency: Department of Defense: Office of the Secretary of Defense: Office of the Under Secretary of Defense for Acquisition, Technology, and Logistics
    Status: Open

    Comments: DOD comment -- Non-concur. In addition to the reasons stated above [see DOD response to first recommendation], noting a potential liability does not add value in the decision making process in which recommendations are developed on the basis of the selection criteria with military value having primary consideration. Accounting for these costs during BRAC implementation as part of the BRAC business plan and/or budget development process is a better approach because the data will be accurate. The team reviewed DOD IG Recommendation Summary Report of Currently Open GAO Cases (DAMIS). In the report's 05/12/16 update, DOD did not include recommendations from GAO-13-337. Also, in October 2016, an official of the Basing Directorate in OSD AT&L EI&E explained that DOD non-concurred with the report's recommendations, DOD has not taken action, and does not plan to take action on the recommendations. As of June 2017, DOD has not taken action.
    Recommendation: To increase the overall reliability of the initial cost estimates that DOD submits with its recommendations to the BRAC Commission for any future BRAC round, the Under Secretary of Defense for Acquisition, Technology, and Logistics should direct the Deputy Under Secretary of Defense for Installations and Environment to take actions to enhance the department's ability to identify any potential costs associated with its alternatively financed projects in the event of a base closure. Specifically, the Under Secretary direct the Deputy Under Secretary should modify COBRA instructions for entering information on costs associated with alternatively financed projects in the model to help ensure costs are consistently captured and complete. For example, illustrate the types of costs that should be included; specify whether costs should be entered as net costs or if costs and savings should be entered separately; indicate which data entry field is the appropriate field into which the user should enter such costs; and define key terms.

    Agency: Department of Defense: Office of the Secretary of Defense: Office of the Under Secretary of Defense for Acquisition, Technology, and Logistics
    Status: Open
    Priority recommendation

    Comments: DOD comment -- Non Concur. See reasons above. [See DOD response to 1st and 2nd recommendations] The team reviewed DOD IG Recommendation Summary Report of Currently Open GAO Cases (DAMIS). In the report's 05/12/16 update, DOD did not include recommendations from GAO-13-337. Also, in October 20016, an official of the Basing Directorate in OSD AT&L EI&E explained that DOD non-concurred with the report's recommendations, DOD has not taken action, and does not plan to take action on the recommendations. As of February 2017, DOD still does not plan to take action on the recommendation, as described in GAO-17-317, High Risk Update. As of June 2017, DOD has not taken action.
    Director: Draper, Debra A
    Phone: (202) 512-7114

    4 open recommendations
    including 2 priority recommendations
    Recommendation: To ensure reliable measurement of veterans' wait times for medical appointments, the Secretary of VA should direct the Under Secretary for Health to take actions to improve the reliability of wait time measures either by clarifying the scheduling policy to better define the desired date, or by identifying clearer wait time measures that are not subject to interpretation and prone to scheduler error.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA concurred with our recommendations to revise its scheduling policy to implement more reliable wait time measures and require all schedulers to complete standardized training on a revised scheduling policy. In July 2016, VA published VHA Directive 1230-Outpatient Scheduling Processes and Procedures, which updated and replaced the prior policy. Although the updated directive provides new instructions for scheduling appointments, the new instructions, which form the basis for measuring wait times, are still subject to scheduler interpretation, making training vital to consistent and accurate implementation of the policy. According to VHA, Directive 1230 was developed to correspond with a technical enhancement to the scheduling system, known as the Vista Scheduling Enhancement (VSE), which will also require training. As of November 2016, VHA reported that the majority of staff with scheduling access had been trained on the new directive and that separate training on VSE was scheduled to begin in February 2017. GAO cannot assess whether VHA scheduling staff are accurately implementing the new scheduling policy until the VSE roll-out is complete and all relevant staff are trained on the new system.
    Recommendation: To better facilitate timely medical appointment scheduling and improve the efficiency and oversight of the scheduling process,the Secretary of VA should direct the Under Secretary for Health to take actions to ensure that VAMCs consistently and accurately implement VHA's scheduling policy, including use of the electronic wait list, as well as ensuring that all staff with access to the VistA scheduling system complete the required training.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA concurred with our recommendations to revise its scheduling policy to implement more reliable wait time measures and require all schedulers to complete standardized training on a revised scheduling policy. In July 2016, VA published VHA Directive 1230-Outpatient Scheduling Processes and Procedures, which updated and replaced the prior policy. Although the updated directive provides new instructions for scheduling appointments, the new instructions, which form the basis for measuring wait times, are still subject to scheduler interpretation, making training vital to consistent and accurate implementation of the policy. According to VHA, Directive 1230 was developed to correspond with a technical enhancement to the scheduling system,known as the Vista Scheduling Enhancement (VSE), which will also require training. As of November 2016, VHA reported that the majority of staff with scheduling access had been trained on the new directive and that separate training on VSE was scheduled to begin in February 2017. GAO cannot assess whether VHA scheduling staff are accurately implementing the new scheduling policy until the VSE roll-out is complete and all relevant staff are trained on the new system.
    Recommendation: To improve timely medical appointment scheduling, the Secretary of VA should direct the Under Secretary for Health to develop a policy that requires VAMCs to routinely assess clinics' scheduling needs and resources to ensure that the allocation of staffing resources is responsive to the demand for scheduling medical appointments.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with this recommendation and noted that it would ask VA facilities to routinely assess clinics' availability and ensure staff are distributed to meet access standards for clinics, as well as revising and implementing improved clinic management tools. In February 2015, VHA noted that it had finalized a Scheduling Resource Assessment report to address this recommendation. In December 2016, VHA noted that the Scheduling Resource Assessment tool had been further enhanced and clarified that the training for this tool is not mandatory and use of the tool is optional. Although VHA has developed this and other tools, such as the Clinic Access Report, Wait Time List Report, Missed Opportunity report, it has not developed and implemented a policy that requires VAMCs to routinely assess clinics' scheduling needs and resources. Without such policy, we believe it is not clear how these tools should be used together or who is responsible for assessing scheduling needs and resources and for making operational decisions. To close this recommendation, VA needs to develop a policy that requires its medical centers to routinely assess clinics' scheduling needs and resources to ensure that the allocation of staffing resources is responsive to the demand for scheduling medical appointments.
    Recommendation: To improve timely medical appointments and to address patient and staff complaints about telephone access,the Secretary of VA should direct the Under Secretary for Health to ensure that all VAMCs provide oversight of telephone access and implement best practices outlined in its telephone systems improvement guide.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with this recommendation and stated that VISN and VA Medical Center leadership would use best practices to develop and implement improved telephone service plans. As of March 2015, VHA had developed a standardized telephone assessment tool and requested that facilities that care for 5,000 or more veterans complete the assessment and select actions for improvement based on its existing telephone systems improvement guide. Based on this request, VHA received telephone assessment and improvement plans from 286 facilities that care for 5,000 or more veterans. VHA is monitoring the facilities' telephone performance and is re-baselining call center infrastructure at each facility with a survey and new performance goals. In September 2015, VHA issued an updated Telephone Access and Contact Management Improvement Guide. VHA has also drafted an update to its directive on telephone access, but as of January 2017, it had not been published.
    Director: Draper, Debra A
    Phone: (202)512-3000

    6 open recommendations
    Recommendation: To facilitate the departments' current collaboration efforts, VA and DOD should systematically identify areas where department-level actions could help address significant barriers that hinder collaboration. Specifically, the Secretaries of Veterans Affairs and Defense should expedite and communicate a plan with time frames for when iEHR solutions will be made available to joint ventures and other collaboration sites.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information
    Recommendation: To facilitate the departments' current collaboration efforts, VA and DOD should systematically identify areas where department-level actions could help address significant barriers that hinder collaboration. Specifically, the Secretaries of Veterans Affairs and Defense should expedite and communicate a plan with time frames for when iEHR solutions will be made available to joint ventures and other collaboration sites.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information
    Recommendation: To facilitate the departments' current collaboration efforts, VA and DOD should systematically identify areas where department-level actions could help address significant barriers that hinder collaboration. Specifically, the Secretaries of Veterans Affairs and Defense should take steps to resolve problems with collaboration sites' incompatible business and administrative processes, including reimbursement for services, collection of workload information, dual credentialing, and computer security training.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information
    Recommendation: To facilitate the departments' current collaboration efforts, VA and DOD should systematically identify areas where department-level actions could help address significant barriers that hinder collaboration. Specifically, the Secretaries of Veterans Affairs and Defense should take steps to resolve problems with collaboration sites' incompatible business and administrative processes, including reimbursement for services, collection of workload information, dual credentialing, and computer security training.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information
    Recommendation: To facilitate the departments' current collaboration efforts, VA and DOD should systematically identify areas where department-level actions could help address significant barriers that hinder collaboration. Specifically, the Secretaries of Veterans Affairs and Defense should clarify, as part of the newly initiated joint efforts to address base access, departmental guidance regarding collaboration to include a discussion of base access issues that local officials should consider when discussing and planning collaboration efforts; this could include a discussion of successful approaches that current collaboration sites have adopted to facilitate base access for veterans and their escorts.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information
    Recommendation: To facilitate the departments' current collaboration efforts, VA and DOD should systematically identify areas where department-level actions could help address significant barriers that hinder collaboration. Specifically, the Secretaries of Veterans Affairs and Defense should clarify, as part of the newly initiated joint efforts to address base access, departmental guidance regarding collaboration to include a discussion of base access issues that local officials should consider when discussing and planning collaboration efforts; this could include a discussion of successful approaches that current collaboration sites have adopted to facilitate base access for veterans and their escorts.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information
    Director: Chaplain, Cristina T
    Phone: (202) 512-4841

    2 open recommendations
    including 2 priority recommendations
    Recommendation: To improve departmentwide strategic sourcing efforts at DOD, the Secretary of Defense should direct the Office of Acquisition, Technology, and Logistics to issue direction that (1) sets goals for spending managed through strategic sourcing vehicles, (2) establishes procedures for the identification and tracking of departmentwide and component strategic sourcing efforts through the PASS office, (3) implements the PASS office strategic sourcing guidance, (4) links strategic sourcing to its Better Buying Power memorandum, and (5) establishes metrics, such as utilization rates, to track progress toward these goals.

    Agency: Department of Defense
    Status: Open
    Priority recommendation

    Comments: DOD concurred with our recommendation. To fully implement this recommendation, DOD should improve department-wide strategic sourcing efforts to achieve significant cost savings. DOD has been working with the Office of Management and Budget's Category Management Leadership Council to determine appropriate strategic sourcing goals, but specific goals and corresponding metrics have not yet been established.
    Recommendation: To improve departmentwide strategic sourcing efforts at DOD, the Secretary of Defense should direct the Office of Acquisition, Technology, and Logistics to identify and evaluate the best way to strategically source DOD's highest spending categories of products and services (e.g., governmentwide vehicles, interagency collaboration, departmentwide vehicles).

    Agency: Department of Defense
    Status: Open
    Priority recommendation

    Comments: DOD concurred with our recommendation. To fully implement this recommendation, DOD should improve department-wide strategic sourcing efforts to achieve significant cost savings. DOD has been working with the Office of Management and Budget's Category Management Leadership Council to determine appropriate strategic sourcing goals, but specific goals and corresponding metrics have not yet been established.
    Director: Draper, Debra A
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To clarify IT requirements within the Executive Agreement, to enable VA and DOD to make an informed recommendation about whether the FHCC should continue after the end of the demonstration, and to provide useful information for other integrations that may be considered in the future, the Secretaries of Veterans Affairs and Defense should develop plans with clear definitions and specific deliverables, including time frames for two IT capabilities-documentation of patient care to support medical and dental operational readiness and outpatient appointment enhancements-and formalize these plans, for example, by incorporating them into the Executive Agreement.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of July 2017, VA and DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To clarify IT requirements within the Executive Agreement, to enable VA and DOD to make an informed recommendation about whether the FHCC should continue after the end of the demonstration, and to provide useful information for other integrations that may be considered in the future, the Secretaries of Veterans Affairs and Defense should develop plans with clear definitions and specific deliverables, including time frames for two IT capabilities-documentation of patient care to support medical and dental operational readiness and outpatient appointment enhancements-and formalize these plans, for example, by incorporating them into the Executive Agreement.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, VA and DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Director: Williamson, Randall B
    Phone: (202)512-3000

    2 open recommendations
    Recommendation: In order to better inform future budget requests, the Secretary of Veterans Affairs should develop a sound methodology for estimating savings from new operational improvements. This methodology should include: (1) an explanation of how savings from each operational improvement will be achieved; (2) an explanation for the basis of any assumptions included in the savings estimates; and (3) an implementation plan that includes a realistic timeline for implementation, to help ensure that savings can be achieved within the targeted time frame.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In February 2012, we recommended that the Department of Veterans Affairs (VA) develop a sound methodology for estimating savings from new operational improvements in future budget submissions. While VA concurred with this recommendation, in June 2016, VA reported that it intends to implement this recommendation when new operational improvements are proposed in the budget. However, recent budget submissions have not included operational improvements.
    Recommendation: The Secretary of Veterans Affairs should develop a detailed process for tracking VA's actual savings resulting from those operational improvements for which we identified concerns. This process should provide detailed written guidance for those responsible for tracking the savings, which outlines the methodology for calculating savings.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In February 2012, we recommended that the Department of Veterans Affairs (VA) develop a detailed process for tracking VA's actual savings resulting from those operational improvements for which we identified concerns. While VA partially concurred with this recommendation, in June 2016, VA reported that it has no future plans to fully implement this recommendation.
    Director: Melvin, Valerie C
    Phone: (202)512-6304

    3 open recommendations
    Recommendation: To enhance VA's effort to successfully fulfill its forthcoming plans for the outpatient scheduling system replacement project and the HealtheVet program, the Secretary of Veterans Affairs should direct the CIO to ensure implementation of a requirements management plan that reflects leading practices for requirements development and management. Specifically, implementation of the plan should include analyzing requirements to ensure they are complete, verifiable, and sufficiently detailed to guide development, and maintaining requirements traceability from high-level operational requirements through detailed low-level requirements to test cases.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In written comments on our report, VA concurred with this recommendation and in August 2014, identified initial actions the department had taken in response. Specifically, as part of its plans to issue a request for proposals to acquire a replacement scheduling system under its Medical Appointment Scheduling System (MASS) project, VA developed a Business Requirements Document that defines its specific business needs, capabilities, features, and constraints. Additionally, the department reported that it intends to manage and document requirements using processes supported by a Web-based tool called Rational Doors. In August 2015, VA's Office of Acquisition, Logistics, and Construction awarded a contract for the MASS project. However, in April 2016, the department paused MASS to evaluate an alternative project to enhance its legacy scheduling system. Subsequently, in early 2017, the department restarted the MASS project. Nevertheless, as of June 2017, the department had not developed a requirements management plan for MASS. Thus, the MASS project has not yet reached the point where the effectiveness of the requirements management activities we recommended can be assessed.
    Recommendation: To enhance VA's effort to successfully fulfill its forthcoming plans for the outpatient scheduling system replacement project and the HealtheVet program, the Secretary of Veterans Affairs should direct the CIO to adhere to the department's guidance for system testing including (1) performing testing incrementally and (2) resolving defects of average and above severity prior to proceeding to subsequent stages of testing.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In written comments on our report, VA concurred with this recommendation and stated that testing was managed using documented, repeatable processes that are included in the department's ProPath Web-based tool. According to the Acting Deputy Chief Information Officer for Product Development, the Medical Appointment Scheduling System (MASS) project is expected to incorporate Agile software development practices, including the use of incremental testing. In August 2015, the department awarded a contract for the MASS project that included task orders for the development of test plans. However, in April 2016, the department paused MASS to evaluate an alternative to enhance its legacy scheduling system. In early 2017, the department restarted the MASS project, but as of June 2017, had not developed a test plan for MASS. Thus, the project has not yet reached the point where adherence to the department's system testing guidance can be assessed.
    Recommendation: To enhance VA's effort to successfully fulfill its forthcoming plans for the outpatient scheduling system replacement project and the HealtheVet program, the Secretary of Veterans Affairs should direct the CIO to ensure that the policies and procedures VA is establishing to provide meaningful program oversight are effectively executed and that they include (1) robust collection methods for information on project costs, benefits, schedule, risk assessments, performance metrics, and system functionality to support executive decision making; (2) the establishment of reporting mechanisms to provide this information in a timely manner to department IT oversight control boards; and (3) defined criteria and documented policies on actions the department will take when development deficiencies for a project are identified.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs concurred with this recommendation and identified various actions it has taken in response. Specifically, the department awarded a contract for its Medical Appointment Scheduling System (MASS) project in August 2015. However, in April 2016, it paused MASS to evaluate an alternative to enhance its legacy scheduling system. In June 2017, VA reported that the MASS project had been resumed and indicated that it would adhere to the department's Veteran-focused Intake Process (VIP), which is intended to ensure oversight, accountability, and traceability of all program activity. Also, the department reported that MASS had met its first VIP milestone, Critical Decision 1, in January 2017. However, key future activities, including product development and testing, have not yet been demonstrated, while VIP milestones (e.g., Critical Decision 2), have not yet been met. Thus, MASS has not reached the point where the effectiveness of project oversight can be fully assessed.