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    Topic: Veterans

    70 publications with a total of 233 open recommendations including 24 priority recommendations
    Director: Williamson, Randall B
    Phone: (202) 512-7114

    4 open recommendations
    Recommendation: The Under Secretary for Health should specify in VHA policy that reviews of providers' clinical care after concerns have been raised should be documented, including retrospective and comprehensive reviews. (Recommendation 1)

    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 Under Secretary for Health should specify in VHA policy a timeliness requirement for initiating reviews of providers' clinical care after a concern has been raised. (Recommendation 2)

    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 Under Secretary for Health should require VISN officials to oversee VAMC reviews of providers' clinical care after concerns have been raised, including retrospective and comprehensive reviews, and ensure that VISN officials are conducting such oversight with the required standardized audit tool. This oversight should include reviewing documentation in order to ensure that these reviews are documented appropriately and conducted in a timely manner. (Recommendation 3)

    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 Under Secretary for Health should require VISN officials to establish a process for overseeing VAMCs to ensure that they are reporting providers to the NPDB and SLBs, and are reporting in a timely manner. (Recommendation 4)

    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: Shelby S. Oakley
    Phone: (202) 512-4841

    10 open recommendations
    Recommendation: The Director of the MSPV-NG program office should, with input from the Strategic Acquisition Center (SAC), develop, document, and communicate to stakeholders an overarching strategy for the program, including how the program office will prioritize categories of supplies for future phases of requirement development and contracting. (Recommendation 1)

    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 Veterans Health Administration (VHA) Chief Procurement and Logistics Officer should take steps to prioritize the hiring of the MSPV-NG program office's director position on a permanent basis. (Recommendation 2)

    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 assign the role of Chief Acquisition Officer to a non-career employee, in line with statute. (Recommendation 3)

    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 Director of the MSPV-NG program office should provide complete guidance to medical centers for matching equivalent supply items, which could include defining the roles of clinicians and local Clinical Product Review Committees. (Recommendation 4)

    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 Director of the MSPV-NG program office should, with input from SAC, communicate to medical centers the criteria and processes for adding or removing items from the formulary. (Recommendation 5)

    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 VHA Chief Procurement and Logistics Officer, in coordination with SAC, should calculate cost avoidance achieved by MSPV-NG on an ongoing basis. (Recommendation 6)

    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 MSPV-NG program office and SAC should establish a plan for how to mitigate the potential risk of gaps in contract coverage while SAC is still working to make competitive Phase 2 awards, which could include prioritizing supply categories that are most likely to yield cost avoidance. (Recommendation 7)

    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 VHA Chief Procurement and Logistics Officer should use input from national clinical program offices to prioritize its MSPV-NG requirements development and standardization efforts beyond Phase 2 to focus on supply categories that offer the best opportunity for standardization and cost avoidance. (Recommendation 8)

    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 VHA Chief Procurement and Logistics Officer should direct Veterans Integrated Service Network (VISN) Network Contracting Offices to work with medical centers to identify any opportunities to more strategically purchase goods and services frequently purchased on an emergency basis. For example, offices could do this by analyzing existing data. (Recommendation 9)

    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: VHA Chief Procurement and Logistics Officer should analyze data on items that are frequently purchased on an emergency basis, determine whether such items are suitable to be added to the MSPV-NG formulary, and work with SAC to make any suitable items available via MSPV-NG. (Recommendation 10)

    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: Brown Barnes, Cindy S
    Phone: (202) 512-7215

    6 open recommendations
    Recommendation: The Secretary of Defense should publicly report DOD's performance regarding participation and career readiness attainment for all TAP-eligible servicemembers and members of the National Guard and Reserve rather than exclude those for whom data are missing or clarify the extent of missing data. (Recommendation 1)

    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: The Secretary of Defense should monitor and report on the extent to which servicemembers participate in TAP within prescribed timeframes. (Recommendation 2)

    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: The Secretary of Defense should monitor and report on the extent to which servicemembers who elect to receive additional 2-day classes are able to receive the training. (Recommendation 3)

    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: The Secretary of Defense should monitor and report on the extent to which servicemembers attend TAP in a classroom setting unless allowed by regulation to participate online. (Recommendation 4)

    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: The Secretary of Defense should enable unit commanders and their higher-level commanders to access DOD reports on timeliness, 2-day classes, and the use of online TAP--after DOD begins monitoring and reporting this information--to help ensure the specific units they oversee are compliant with all TAP requirements. (Recommendation 5)

    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: The Secretary of Defense should seek ways to minimize the subjectivity involved in making career readiness determinations, particularly where judgments are involved, such as the quality of the individual transition plan and the resume. This could include developing guidance or training that provides quality standards for assessing career readiness materials. (Recommendation 6)

    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: 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: Randall Williamson
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: The Undersecretary for Health should take additional steps to ensure that VA's website reports health care quality measures that cover a broad range of health care services, highlights key differences in the clinical quality of care, and presents this information in an easily accessible and understandable way (Recommendation 1).

    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 Undersecretary for Health should direct VA Central Office to conduct a systematic assessment of the completeness and accuracy of patient clinical information across VAMCs that is used to calculate the health care quality measures VA reports and address any deficiencies that affect the accuracy of these measures (Recommendation 2).

    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: Debra A. Draper
    Phone: (202) 512-7114

    6 open recommendations
    Recommendation: The Under Secretary for Health should further clarify when and for what purposes each national policy and guidance document type should be used, including whether guidance documents, such as program office memos, should be vetted and recertified. (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 Under Secretary for Health should develop standard processes for consistently maintaining and disseminating guidance documents to each level of the organization. (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 Under Secretary for Health should systematically obtain information on potential implementation challenges from VISNs and VAMCs and take the appropriate actions to address challenges prior to policy issuance. (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 Under Secretary for Health should establish a mechanism by which program offices systematically obtain feedback from VISNs and VAMCs on national policy after implementation and take the appropriate actions. (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 Under Secretary for Health should establish a standard policy exemption waiver process and centrally track and monitor approved waivers. (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.
    Recommendation: The Under Secretary for Health should establish a standard process, including designated oversight roles, to periodically monitor that local policies established by VISNs and VAMCs align with national policies. (Recommendation 6)

    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: Jessica Lucas-Judy
    Phone: (202) 512-9110

    1 open recommendations
    Recommendation: The Secretary of Veterans Affairs should track data that can help VA determine whether AVO improves recruitment and retention.

    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: Debra A. Draper
    Phone: (202) 512-7114

    4 open recommendations
    Recommendation: The Secretary of Veterans Affairs should direct the Acting Under Secretary for Health to develop and disseminate a system-wide standard operating procedure that clearly defines the roles and responsibilities of VAMCs in resolving pending enrollment applications.

    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 Acting Under Secretary for Health to clearly define oversight roles and responsibilities for HEC, and for Veterans Integrated Service Networks as appropriate, to help ensure timely processing of applications and accurate enrollment determinations.

    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 Acting Under Secretary for Health to develop procedures for collecting consistent and reliable data system-wide to track and evaluate timeliness of enrollment processes, and institute an oversight mechanism to ensure VAMC and HEC enrollment staff are appropriately following the procedures.

    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 Acting Under Secretary for Health to clarify its 5-day timeliness standard for processing enrollment applications, including whether it covers the total time needed to make an enrollment determination and the time applications are pending, and ensure the clarification is communicated system-wide.

    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: 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: Valerie Melvin
    Phone: (202) 512-6304

    6 open recommendations
    Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to establish and implement a plan for updating the pharmacy system to address the inefficiencies with viewing patient medication data in the Outpatient Pharmacy application and between the pharmacy application and viewers.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and in August 2017 stated that it had identified $4 million in fiscal year 2018 to establish a pharmacy graphical user interface. According to the department, it plans to complete its action in response to this recommendation by June 2018.
    Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to complete a plan for the implementation of an approach to data standardization that will support the capability for clinicians and pharmacists to view complete DOD data and receive order checks that consistently include DOD data.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with our recommendation and in August 2017 stated that it plans to implement the electronic health record system that is being deployed by DOD, which will present VA clinicians with complete DOD data and the ability to perform order checks on DOD data. In parallel, the department is continuing and expanding the implementation of data standardization. According to the department, it plans to complete its action in response to this recommendation by October 2019.
    Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to conduct an assessment to determine to what extent interoperability of VA's pharmacy system with DOD's pharmacy system is impacting transitioning service members.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and in May 2017 stated that the health executive committee would complete an assessment to determine the extent interoperability with DOD's pharmacy system is impacting transitioning service members. According to the department, it planned to complete its actions in response to this recommendation by September 2017. We will update the status of this recommendation when VA provides documentation of its interoperability assessment to us.
    Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to develop and execute a plan for implementing the capability to send outbound e-prescriptions to non-VA pharmacies, in accordance with National Council for Prescription Drug Programs standards.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and in August 2017 stated that it will review its plan for e-prescribing functionality after it has signed a contract to adopt the electronic health record system that is being deployed by DOD. According to the department, it plans to complete its action in response to this recommendation by March 2018.
    Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to ensure that the department's evaluation of alternatives for electronic health records includes consideration for additional generation level 3 capability such as navigating from an alert to medication order in the electronic health record system.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and in August 2017 stated that it had entered into contract negotiations to acquire and deploy a level 3 electronic health record system that is expected to address pharmacy functions. The department plans to award this contract in December 2017. We will update the status of this recommendation when VA provides documentation of its evaluation of alternatives to us.
    Recommendation: To provide clinicians and pharmacists with improved tools to support pharmacy services to veterans and reduce risks to patient safety, the Secretary of Veterans Affairs should direct the Assistant Secretary for Information and Technology and the Under Secretary for Health to reassess the priority for establishing an inventory management capability to monitor and update medication levels and track when to reorder medications.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and in August 2017 stated that it will reassess the prioritization of medication inventory management after a contract for adoption of the electronic health record system is signed in December 2017. According to the department, it plans to complete its action in response to this recommendation by June 2018.
    Director: Randall B. Williamson
    Phone: (202) 512-7114

    4 open recommendations
    Recommendation: To improve the completeness and accuracy of VA's productivity metrics and efficiency models and strengthen the monitoring of clinical productivity and efficiency VA-wide, the Secretary of the Department of Veterans Affairs should direct the Undersecretary for Health to expand existing productivity metrics to track the productivity of all providers of care to veterans by, for example, including contract physicians who are not VA employees as well as advance practice providers acting as sole providers.

    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 improve the completeness and accuracy of VA's productivity metrics and efficiency models and strengthen the monitoring of clinical productivity and efficiency VA-wide, the Secretary of the Department of Veterans Affairs should direct the Undersecretary for Health to help ensure the accuracy of underlying staffing and workload data by, for example, developing training to all providers on coding clinical procedures.

    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 improve the completeness and accuracy of VA's productivity metrics and efficiency models and strengthen the monitoring of clinical productivity and efficiency VA-wide, the Secretary of the Department of Veterans Affairs should direct the Undersecretary for Health to develop a policy requiring VAMCs to monitor and improve clinical efficiency through a standard process, such as establishing performance standards based on VA's efficiency models and developing a remediation plan for addressing clinical inefficiency.

    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 improve the completeness and accuracy of VA's productivity metrics and efficiency models and strengthen the monitoring of clinical productivity and efficiency VA-wide, the Secretary of the Department of Veterans Affairs should direct the Undersecretary for Health to establish an ongoing process to systematically review VAMCs' remediation plans and ensure that VAMCs and Veterans Integrated Service Networks are successfully implementing remediation plans for addressing low clinical productivity and inefficiency.

    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: Randall B. Williamson
    Phone: (202) 512-7114

    5 open recommendations
    Recommendation: To increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should direct the Air Force and Navy to address inconsistencies with DOD policy in their policies related to screening certain servicemembers, including servicemembers separating in lieu of trial by court-martial, for PTSD and TBI and reviewing the results prior to separation for misconduct.

    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 increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should direct the Air Force and Navy to address inconsistencies with DOD policy in their policies related to training servicemembers, including officers, on how to identify mild TBI symptoms in the deployed setting.

    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 increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should ensure that the military services routinely monitor adherence to policies related to screening certain servicemembers for PTSD and TBI prior to separation for misconduct.

    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 increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should ensure that the military services routinely monitor adherence to policies related to training servicemembers, including officers, on how to identify mild TBI symptoms in the deployed setting.

    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 increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should ensure that the military services routinely monitor adherence to policies related to counseling about VA benefits and services during the process of separating certain servicemembers for misconduct.

    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: Wise, David J
    Phone: (202) 512-2834

    2 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.
    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: Randall B. Williamson
    Phone: (202) 512-7114

    6 open recommendations
    Recommendation: To help VHA achieve its objective of reducing the risk of diversion through effective implementation and oversight of the controlled substance inspection program, the Secretary of Veterans Affairs should direct the Under Secretary for Health to ensure that VA medical facilities have established an additional control procedure, such as an alternate controlled substance coordinator or additional inspectors, to help coordinators meet their responsibilities and prevent missed inspections.

    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 help VHA achieve its objective of reducing the risk of diversion through effective implementation and oversight of the controlled substance inspection program, the Secretary of Veterans Affairs should direct the Under Secretary for Health to ensure that VA medical facilities have established a process where coordinators, in conjunction with appropriate stakeholders (e.g., pharmacy officials), periodically compare facility inspection procedures to VHA's policy requirements and modify facility inspection procedures as appropriate.

    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 help VHA achieve its objective of reducing the risk of diversion through effective implementation and oversight of the controlled substance inspection program, the Secretary of Veterans Affairs should direct the Under Secretary for Health to improve the training of VA medical facility controlled substance coordinators by ensuring the training includes the inspection procedures that VHA requires.

    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 help VHA achieve its objective of reducing the risk of diversion through effective implementation and oversight of the controlled substance inspection program, the Secretary of Veterans Affairs should direct the Under Secretary for Health to ensure that medical facility directors have designed and implemented a process to address nonadherence with program requirements, including documenting the nonadherence and the corrective actions taken to remediate nonadherence or the actions that demonstrate why no remediation is necessary.

    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 help VHA achieve its objective of reducing the risk of diversion through effective implementation and oversight of the controlled substance inspection program, the Secretary of Veterans Affairs should direct the Under Secretary for Health to ensure that networks review their facilities' quarterly trend reports and ensure facilities take corrective actions when nonadherence is identified.

    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 help VHA achieve its objective of reducing the risk of diversion through effective implementation and oversight of the controlled substance inspection program, the Secretary of Veterans Affairs should direct the Under Secretary for Health to ensure that networks monitor their medical facilities' efforts to establish and implement a review process to periodically compare facility inspection procedures to VHA's policy requirements.

    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: 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: Robert Goldenkoff
    Phone: (202) 512-2757

    12 open recommendations
    including 5 priority recommendations
    Recommendation: To improve the capacity of HR functions at VA medical centers, the Secretary of Veterans Affairs should instruct the Under Secretary for Health to assign the following responsibility to the Assistant Deputy Under Secretary for Health for Workforce Service: develop a comprehensive competency assessment tool for HR staff that evaluates knowledge of all three personnel systems, (Title 5, Title 38 and Title 38-Hybrid).

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.
    Recommendation: To improve the capacity of HR functions at VA medical centers, the Secretary of Veterans Affairs should instruct the Under Secretary for Health to assign the following responsibility to the Assistant Deputy Under Secretary for Health for Workforce Service: ensure that all VHA HR staff complete the competency assessment tool and use this data to identify and address competency gaps within HR offices.

    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 improve the capacity of HR functions at VA medical centers, the Secretary of Veterans Affairs should instruct the Under Secretary for Health to assign the following responsibility to the Assistant Deputy Under Secretary for Health for Workforce Service: evaluate the extent to which training strategies are effective for improving the skills and competencies of HR staff.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.
    Recommendation: To improve the capacity of HR functions at VA medical centers, the Secretary of Veterans Affairs should instruct the Under Secretary for Health to establish clear lines of authority that provide the Assistant Deputy Under Secretary for Health for Workforce Service the ability to oversee and hold medical center HR offices accountable for implementing initiatives to improve HR processes within HR offices as well as monitoring and reporting on the results of these initiatives.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA agreed with our recommendation and stated that it plans to address this recommendation through an organizational realignment. As a first step, in March 2017, the Acting Under Secretary for Health issued a memo to VHA Deputy Under Secretaries, Network Directors, and Medical Center Directors stating that these officials are accountable for ensuring efficient and effective human capital service delivery. To fully implement the recommendation to hold medical center HR offices accountable, VA needs to establish procedures for monitoring and reporting on the results of its HR improvement initiatives.
    Recommendation: To improve the capacity of HR functions at VA medical centers, the Secretary of Veterans Affairs should instruct the Under Secretary for Health to establish clear lines of authority that provide the Assistant Deputy Under Secretary for Health for Workforce Service the ability to oversee and hold medical center HR offices accountable for requiring all HR staff to complete the competency assessment tool within HR offices.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA agreed with our recommendation and stated that it was taking steps to address it. As a first step, in March 2017, the Acting Under Secretary for Health issued a memo stating that the Assistant Deputy Under Secretary for Health for Workforce Services (ADUSHWFS) is authorized to establish HR competencies for VHA HR staff, and also require VHA HR staff to complete HR competency assessments and training. Further, the memo requires the ADUSHWFS to report quarterly to the DUSHOM on the status of HR competency assessments and training completion. In late April 2017, VA officials stated that they are establishing processes to collect and monitor data on completion rates for the HR staff competency assessment tool. To fully implement the recommendation, VA should implement these processes and provide quarterly data on competency tool completion rates to the DUSHOM.
    Recommendation: To ensure VA medical centers make needed improvements to HR functions, such as those identified by VA's Office of Oversight and Effectiveness and VHA's Consult, Assist, Review, Develop, and Sustain (CARDS) reviews, the Secretary of Veterans Affairs should provide the Assistant Secretary for Human Resources and Administration (HR&A) and the Under Secretary for Health with the oversight responsibility of effectively monitoring the status of corrective actions at medical center HR offices and ensuring that corrective actions are implemented.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.
    Recommendation: To ensure that positions across all VHA medical facilities are placed in the appropriate class and grade, the Secretary of Veterans Affairs should direct the Assistant Secretary for HR&A and the Under Secretary for Health to clarify their lines of authority and processes for overseeing and holding Veterans Integrated Service Network (VISNs) and VHA medical facilities accountable for the consistent application of federal classification policies.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.
    Recommendation: To accelerate efforts to develop a modern, credible, and effective performance management system the Assistant Secretary for HR&A should, with input from VHA stakeholders, ensure that meaningful distinctions are being made in employee performance ratings by (1) developing and implementing a standardized, comprehensive performance management training program for supervisors of Title 5, Title 38, and Title 38-Hybrid employees based on leading practices and ensuring procedures are in place to support effective performance conversations between supervisors and employees; (2) reviewing and revising Title 5 and Title 38 performance management policies consistent with leading practices (e.g., require definition of all performance levels); and (3) developing and implementing a process to standardize performance plan elements, standards, and metrics for common positions across VHA that are covered under VA's Title 5 performance management system.

    Agency: Department of Veterans Affairs: Assistant Secretary for Human Resources and Administration
    Status: Open
    Priority recommendation

    Comments: VA partially agreed with our recommendation and described the preliminary steps it is planning to take to identify and implement a modern, credible, and effective performance management system. In late April 2017, VA officials stated that they are in the early stages of identifying a way forward for a revised performance management system, and are considering different options. To implement our recommendation, VA must ensure that meaningful distinctions are being made in employee performance ratings. This includes reviewing and revising Title 5 and Title 38 performance management policies consistent with leading practices (e.g., requiring definition of all performance levels), and developing and implementing a process to standardize performance plan elements, standards, and metrics for all common Title 5 positions across VHA. We recognize that identifying and implementing a new performance management system will require significant effort on VA's part, and will continue to monitor its actions and progress in this area.
    Recommendation: To accelerate efforts to develop a modern, credible, and effective performance management system, the Assistant Secretary for HR&A should, with input from VHA stakeholders, ensure that ratings-based performance awards are administered in a manner that is consistent with leading practices and promotes improved employee performance.

    Agency: Department of Veterans Affairs: Assistant Secretary for Human Resources and Administration
    Status: Open
    Priority recommendation

    Comments: VA partially agreed with our recommendation and stated that it will explore how to create effective incentive and reward systems. VA also noted that due to constrained funding for such systems, it will pursue ways to maximize effective use of both monetary and non-monetary awards to promote employee performance. In late April 2017, VA officials stated that they are in the early stages of identifying a way forward for a revised performance management system (including ratings-based awards), and are considering different options. To implement our recommendation, VA must ensure that its award programs are administered in a valid, reliable, and transparent manner. We recognize that identifying and implementing a new performance management system will require significant effort on VA?s part, and will continue to monitor its actions and progress in this area.
    Recommendation: To accelerate efforts to develop a modern, credible, and effective performance management system, the Assistant Secretary for HR&A should, with input from VHA stakeholders, develop a plan for how and when it intends to implement a modern information technology (IT) system to support employee performance management processes.

    Agency: Department of Veterans Affairs: Assistant Secretary for Human Resources and Administration
    Status: Open
    Priority recommendation

    Comments: VA partially agreed with this recommendation and stated that it continues to pilot its performance appraisal IT system -- known as the ePerformance system -- but that broad implementation of new technology for performance management will require adequate IT funding. In late April 2017, VA officials stated that they are exploring other potential IT systems to support the performance management process. To implement our recommendation, VA must develop a plan for how and when it intends to implement a modern performance management IT system.
    Recommendation: To better monitor and improve employee engagement, the Under Secretary for Health should establish clear and effective lines of authority and accountability for developing, implementing, and monitoring strategies for improving employee engagement across VHA, such as by establishing an employee engagement office at the VHA headquarters level with appropriate oversight of VISNs and medical center initiatives.

    Agency: Department of Veterans Affairs: Office of the Under Secretary for Health
    Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.
    Recommendation: To better monitor and improve employee engagement, the Under Secretary for Health should ensure that VHA and VISN entities jointly develop (1) a system to facilitate sharing of employee engagement leading practices/lessons learned; and (2) a strategy to help address barriers to improving engagement, particularly for those medical centers with the lowest engagement scores.

    Agency: Department of Veterans Affairs: Office of the Under Secretary for Health
    Status: Open

    Comments: We will provide updated information once we confirm what actions the agency has taken in response to this recommendation.
    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: Brenda S. Farrell
    Phone: (202) 512-3604

    1 open recommendations
    Recommendation: To improve the management of DOD's credentialing program and better determine whether the program is achieving its desired results, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to develop and implement program performance measures that include key attributes, such as a baseline and goals, that can be used to assess performance.

    Agency: Department of Defense
    Status: Open

    Comments: DOD did not concur with our recommendation to develop and implement performance measures for its credentialing program. As of August 23, 2017, the department still has yet to develop performance measures for the program.
    Director: Debra Draper
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to conduct an evaluation of the implementation of the VISN realignment to determine whether deficiencies exist that need corrective actions, and apply lessons learned from the evaluation to future organizational structure changes, such as possible changes to VISN staffing models or actions to implement Commission on Care recommendations.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VHA concurred with this recommendation and has provided regular updates on its progress in implementing it. In July 2017, VHA told us that a Rapid Design and Implementation functional assessment of VHA Central Office and VISN organizations had been completed, which included a survey, interviews with central office and VISN officials, and other meetings. In November 2017, VHA reported that in October it awarded a contract to conduct an independent assessment of the VISN consolidation experience and to make recommendations for future actions. The independent assessment is expected to be completed in January 2018. VHA also reported in November 2017 that the Rapid Design and Implementation functional assessment process yielded a high-level organizational concept that is being used by teams to develop recommendations for consolidations within VHA, and that these recommendations will be submitted to VHA leadership in January 2018. In our recommendation, we stated that lessons learned from evaluating the VISN realignment need to be applied to future organizational structure changes. It is difficult to determine at this time how lessons learned from the VISN realignment's evaluation can be incorporated into new organizational structure changes if such changes are being drafted for VHA leadership approval at the same time that the evaluation is underway. As of December 2017, this recommendation remains open pending further updates from VHA.
    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to develop a process to ensure that organizational structure recommendations resulting from internal and external reviews of VHA are evaluated for implementation. This process should include the documentation of decisions and assigning officials or offices responsibility for ensuring that approved recommendations are implemented.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VHA concurred with this recommendation and has provided regular updates on its progress in implementing it. Earlier in 2017, VHA reported that its initial work on this recommendation was paused to allow the Agency to respond to President Trump's Executive Order dated March 13, 2017, on "Comprehensive Plan for Reorganizing the Executive Branch." VHA resumed work on this recommendation once the VA Modernization Initiative evaluated and approved the results of a VHA Rapid Design and Implementation that generated a revised VHA functional chart. In November 2017, VHA reported that the Acting Under Secretary for Health approved a new procedure for documenting and implementing organizational changes on July 12, 2017, and provided a copy. The standard operating procedure contains specific instructions and mechanisms for evaluating, recording, promulgating and implementing proposed organizational changes. VHA further reported that the procedure will be applied to implementing organizational structure changes proposed as part of operationalizing the revised VHA functional chart. VHA anticipated that the first proposal using the new organizational changes procedure will be submitted to senior VHA leadership for approval in January 2018. As of December 2017, this recommendation remains open pending further updates from VHA.
    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: 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: Farrell, Brenda S
    Phone: (202) 512-3604

    3 open recommendations
    Recommendation: To help ensure that the Gold Star Advocate Program achieves its mission and objectives and to enhance outreach for the program, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the service secretaries, to determine outreach goals and metrics by which to measure progress in attaining those goals.

    Agency: Department of Defense
    Status: Open

    Comments: As of December 2017, DOD had not yet taken action to implement this recommendation. We will continue to follow-up on DOD's progress.
    Recommendation: To help ensure that the Gold Star Advocate Program achieves its mission and objectives and to enhance outreach for the program, the Commandant of the Coast Guard should determine outreach goals and metrics by which to measure progress in attaining those goals.

    Agency: Department of Homeland Security: United States Coast Guard
    Status: Open

    Comments: The Coast Guard is planning to establish goals and metrics for the Coast Guard's Gold Star Advocate Program to include: identifying resources to support the program, creating a Gold Star Advocate Program website, updating the Coast Guard's "A Survivor's Guide to Benefits" and link it to the Gold Star Advocate Program website. The Coast Guard also plans to begin capturing addresses and other contact information for survivors of each active duty servicemember death and perform a one-time mass mailing to survivors to inform them of the program. They also plan to develop measures for outreach effectiveness and to partner with the Department of Defense to identify other ways to ensure that all survivors are contacted. As of September 18, 2017, the Coast Guard has not taken action to implement this recommendation, but expects to by December 2017. As of December 2017, we have not confirmed any action had been taken.
    Recommendation: To improve the efficacy of the training provided, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to develop indicators to help determine how casualty assistance officer training contributes to the quality of the casualty assistance program.

    Agency: Department of Defense
    Status: Open

    Comments: As of December 2017, DOD had not yet taken action to implement this recommendation. We will continue to follow-up on DOD's progress.
    Director: David A. Powner
    Phone: (202) 512-9286

    16 open recommendations
    including 4 priority recommendations
    Recommendation: The Director of OMB should identify and publish a specific goal associated with its non-provisioned O&M spending measure.

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

    Comments: The agency agreed with the recommendation. In April 2017, OMB indicated that it has been working with agencies on their Strategic Plans and associated performance goals and measures, but that it would be premature to say whether there would be a specific goal on its non-provisioned O&M spending measure. We will continue to monitor the implementation of this recommendation.
    Recommendation: The Director of OMB should commit to a firm date by which its draft guidance on legacy systems will be issued, and subsequently direct agencies to identify legacy systems and/or investments needing to be modernized or replaced.

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

    Comments: The agency agreed with the recommendation. In April 2017, OMB stated that it was updating the draft guidance on legacy systems and were unable to provide a date when they would be issuing it. We will continue to monitor the implementation of this recommendation.
    Recommendation: To monitor whether existing investments are meeting the needs of their agencies, the Secretaries of Commerce and the Treasury should direct the respective agency CIO to ensure that required analyses are performed on investments in the operations and maintenance phase.

    Agency: Department of Commerce
    Status: Open

    Comments: The agency agreed with the recommendation. In a May 2017 written update, the agency stated that it had updated its Capital Planning and Investment Control handbook with instructions on conducting operational analyses. However, the agency was unable to demonstrate that operational analyses were being completed on an annual basis, as required. We will continue to monitor the implementation of this recommendation.
    Recommendation: To monitor whether existing investments are meeting the needs of their agencies, the Secretaries of Commerce and the Treasury should direct the respective agency CIO to ensure that required analyses are performed on investments in the operations and maintenance phase.

    Agency: Department of the Treasury
    Status: Open

    Comments: The agency had no comment on the recommendation. In June 2017, Treasury provided an update on the IRS's efforts to ensure that operational analyses are performed on investments in the operations and maintenance phase. However, the recommendation is intended to address issues at the department level and not just at the IRS. Treasury declined to provide an update at the department level. We will continue to monitor the implementation of this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Department of Homeland Security
    Status: Open

    Comments: The agency agreed with the recommendation and in July 2017 stated that the department has drafted a Legacy Systems Modernization Framework. DHS is waiting for OMB?s draft guidance to be issued to ensure compliance. As a result, they now estimate this will be completed by December 2017. We will continue to monitor the implementation of this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Department of Agriculture
    Status: Open

    Comments: The agency agreed with the recommendation. As of May 2017, the agency stated that it had taken steps to improve its overall IT governance processes, and in particular, its oversight of legacy systems. These steps included, implementing its FITARA strategy, creating a Cloud Strategy and Policy Office, and two new executive oversight groups. In addition, the agency stated that it planned to complete an IT Modernization Plan in calendar year 2018. We will continue to monitor the implementation of this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Department of Commerce
    Status: Open

    Comments: The agency agreed with the recommendation. In May 2017, the agency stated that it was continuously assessing its current IT portfolio for opportunities to retire or modernize its mission critical legacy systems. Specifically, Commerce stated that it had identified two candidate systems for modernization--the National Weather Service Telecommunications Gateway and the USPTO Examiner Automated Search Tool. However, it is unclear how these plans will relate to OMB's guidance. We will continue to monitor the implementation of this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Department of Defense
    Status: Open

    Comments: The agency partially concurred with the recommendation, and stated that it would continue to identify, prioritize, and manage legacy systems that should be modernized or replaced, based on existing DOD policies, using existing department processes, consistent to the extent practicable with OMB's draft guidance. In June 2017, the department stated that its position has not changed; the department believes that no corrective actions are necessary or planned. We will continue to monitor the implementation of this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Department of Energy
    Status: Open
    Priority recommendation

    Comments: The department partially agreed with the recommendation and in a September 2017 update stated that the department had conducted a survey of the oldest hardware, software, and programming languages currently in use. They noted that the Office of the Chief Information Officer is in the process of gathering additional information regarding legacy systems and documenting a plan to modernize them. They further stated that such a plan will take considerable time to develop since the vast majority of systems are not within the direct control of the CIO. We will continue to monitor the implementation of this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: The agency agreed with the recommendation and in a September 2016 written update stated that the Office of the CIO is working to identify and plan to modernize or replace IT systems. As of July 2017, the agency had not responded to requests for updates on the implementation of this recommendation. We will continue to monitor this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Social Security Administration
    Status: Open

    Comments: The agency agreed with the recommendation and as of July 2017, the agency stated that it was working on finishing its Information Technology Modernization Plan that outlines 5 major applications that it plans to update. However, since OMB had not yet issued its legacy system guidance, it is unknown whether this plan is consistent with OMB's guidance. We will continue to monitor the implementation of this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Department of Justice
    Status: Open

    Comments: The agency had no comment on the recommendation and in a June 2017 update stated that the department has identified legacy systems to be modernized or replaced (the National Instant Background Check System (retired in 2016), SENTRY, and Uniform Crime Reporting System). The department stated that it is developing modernization plans. The department also plans to incorporate any forthcoming guidance from OMB on legacy systems. We will continue to monitor the implementation of this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Department of Transportation
    Status: Open

    Comments: The agency agreed with the recommendation and stated that work is underway to identify systems in need of modernization and upgrade. The department anticipated being able to close the recommendation 90 days after OMB issues guidance on legacy systems. Further, in a recent update, the agency stated that it had recently started a project to create an integrated inventory of Transportation's systems. According to the agency, through this project, it has been able to identify duplication and opportunities to create efficiencies. The next phase of this project is a future state diagram and a roadmap to show planned modernizations and possible divestments of legacy systems. We will continue to monitor the implementation of this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Department of the Treasury
    Status: Open
    Priority recommendation

    Comments: The agency had no comment on the recommendation. In a June 2017, Treasury provided an update on the IRS's efforts to modernize the IRS's legacy systems. However, the recommendation is intended to address issues at the department level and not just at the IRS. Treasury declined to provide an update at the department level. We will continue to monitor the implementation of this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: The agency agreed with the recommendation. As of May 2017, the agency stated that it was completing the initial phase of an assessment to provide a qualitative and definitive list of systems which meet criteria for retirement and/or decommission. This assessment will review the complexity of work per system, and provide a rough order of magnitude cost estimate on a system-by-system basis. Further, in an October 2017 updated, VA stated that it is in the process of decommissioning the BDN and PAID systems mentioned in our report. The decommissioning of BDN was estimated to cost $100 million and be completed by 2019. The agency stated that as of June 2016, PAID was no longer being used for human resources transactions. PAID is still being used as a data repository for human resources and payroll data to support financial and other business systems until VA's Time and Attendance system is fully deployed. The agency did not provide a time frame for PAID's total retirement. We will continue to monitor the implementation of this recommendation.
    Recommendation: To address obsolete IT investments in need of modernization or replacement, the Secretaries of Agriculture, Commerce, Defense, Energy, Health and Human Services, Homeland Security, State, the Treasury, Transportation, and Veterans Affairs; the Attorney General; and the Commissioner of Social Security should direct their respective agency CIOs to identify and plan to modernize or replace legacy systems as needed and consistent with OMB's draft guidance, including time frames, activities to be performed, and functions to be replaced or enhanced.

    Agency: Department of State
    Status: Open
    Priority recommendation

    Comments: The agency agreed with the recommendation and stated that it plans to work with OMB upon the publication of OMB's guidance to identify opportunities for modernization. In an April 2017 update, the agency stated that it had extended plans to replace the systems mentioned in the report by several years. As of August 2017, the agency stated that it had finalized a new capital planning guide which includes investment review policy to identify opportunities for modernization and away from legacy systems. However, it is too soon to tell if it is in line with OMB's forthcoming guidance. We will continue to monitor the implementation of this recommendation.
    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: 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: Debra A. Draper
    Phone: (202) 512-7114

    6 open recommendations
    Recommendation: The Secretaries of Veterans Affairs and Defense should collaborate to perform data-driven strategic workforce planning prior to implementing any future integration efforts.

    Agency: Department of Defense
    Status: Open

    Comments: We will update the status of this recommendation when we determine what steps the agency has taken to implement it.
    Recommendation: The Secretaries of Veterans Affairs and Defense should collaborate to perform data-driven strategic workforce planning prior to implementing any future integration efforts.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: We will update the status of this recommendation when we determine what steps the agency has taken to implement it.
    Recommendation: The Secretaries of Veterans Affairs and Defense should collaborate to determine how best to fill the FHCC's short-term staffing needs, including any additional statutory authorities that might be necessary to implement the desired approach.

    Agency: Department of Defense
    Status: Open

    Comments: We will update the status of this recommendation when we determine what steps the agency has taken to implement it.
    Recommendation: The Secretaries of Veterans Affairs and Defense should collaborate to determine how best to fill the FHCC's short-term staffing needs, including any additional statutory authorities that might be necessary to implement the desired approach.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: We will update the status of this recommendation when we determine what steps the agency has taken to implement it.
    Recommendation: The Secretaries of Veterans Affairs and Defense should collaborate to resolve differences in IT network security standards to the extent possible prior to implementing any future integration efforts.

    Agency: Department of Defense
    Status: Open

    Comments: We will update the status of this recommendation when we determine what steps the agency has taken to implement it.
    Recommendation: The Secretaries of Veterans Affairs and Defense should collaborate to resolve differences in IT network security standards to the extent possible prior to implementing any future integration efforts.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: We will update the status of this recommendation when we determine what steps the agency has taken to implement it.
    Director: Debra Draper
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: The Secretary of Defense should direct the Secretary of the Army to implement processes to review and monitor the Army military treatment facility prescribing practices for medications discouraged under the PTSD guideline and address identified deviations.

    Agency: Department of Defense
    Status: Open

    Comments: We requested an update on the status of this recommendation. As of June 21, 2016, we are waiting for a response from DOD.
    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: Melissa Emrey-Arras
    Phone: (617) 788-0534

    8 open recommendations
    Recommendation: To improve the administration of the Post-9/11 GI Bill, reduce the occurrence of overpayments, and increase debt collections, the Secretary of Veterans Affairs should improve program management by expanding monitoring of available information on overpayment debts and collections. This could include regularly tracking the number and amount of overpayments created and the effectiveness of collection efforts.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA reported in March 2017 that the Veterans Benefits Administration and the Debt Management Center had recently developed a plan to track, analyze, and report on new measures of overpayments. This will include the number and amount of new overpayments, average debt per student, and the amount of uncollected debts outstanding. VA plans to include this information in a bi-annual report and use the data to identify trends and determine root causes of student and school debts. We will consider closing this recommendation once VA has produced the new reports and we have had an opportunity to review them.
    Recommendation: To improve the administration of the Post-9/11 GI Bill, reduce the occurrence of overpayments, and increase debt collections, the Secretary of Veterans Affairs should address overpayments resulting from enrollment changes by providing guidance to educate student veterans about their benefits and consequences of changing their enrollment.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA officials reported in June 2017 that the agency has drafted revisions to the initial and subsequent award letters issued to students. The draft letters that we reviewed included more detailed information on education benefits and the consequences of changes in enrollment and a link to a website with additional helpful information about student overpayment debts. VA officials said these revisions are pending approval and the new award letters should be implemented by December 2017 once the necessary IT resources are available. We will close this recommendation when we receive confirmation that these changes have been incorporated into the letters that are sent to beneficiaries.
    Recommendation: To improve the administration of the Post-9/11 GI Bill, reduce the occurrence of overpayments, and increase debt collections, the Secretary of Veterans Affairs should address overpayments resulting from enrollment changes by providing guidance to schools about the benefits of using a dual certification process where schools wait to certify the actual tuition and fee amounts until after the school's deadline for adding and dropping classes.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA reported in March 2017 that the agency sent school administrators an official letter in March 2017 asking them to use the dual certification process and to wait to certify actual tuition and fee amounts until after the school's deadline for adding and dropping classes. In addition, VA reported that it had discussed the dual certification method during a webinar with school administrators in June 2016. While these communications are helpful, we believe that VA should also update its guidance, such as its School Certifying Official Handbook, to include this information so that specific guidance on how dual certification can reduce tuition and fee overpayments is available on a continuing basis for current and future school certifying officials.
    Recommendation: To improve the administration of the Post-9/11 GI Bill, reduce the occurrence of overpayments, and increase debt collections, the Secretary of Veterans Affairs should address overpayments resulting from enrollment changes by identifying and implementing a cost-effective way to allow Post-9/11 GI Bill beneficiaries to verify their enrollment status each month, and require monthly reporting.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA officials reported in March 2017 that the agency is developing a plan to add functionality for monthly verifications of student enrollment to its information technology systems, as GAO recommended in its 2015 report. Officials said they expect to complete these upgrades by December 2017once the necessary IT resources requested by the Veterans Benefits Administration are provided.
    Recommendation: To improve the administration of the Post-9/11 GI Bill, reduce the occurrence of overpayments, and increase debt collections, the Secretary of Veterans Affairs should improve efforts to notify veterans and schools about overpayment debts by identifying and implementing other methods of notifying veterans and schools about debts to supplement the agency's mailed notices (e.g., email, eBenefits).

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA officials reported in March 2017 that the agency is developing a plan to update its IT systems so veterans could be notified of overpayment debts through eBenefits or by email. VA plans to complete this action by December 2017 once the necessary IT resources are available.
    Recommendation: To improve the administration of the Post-9/11 GI Bill, reduce the occurrence of overpayments, and increase debt collections, the Secretary of Veterans Affairs should improve efforts to notify veterans and schools about overpayment debts by including information on both the cause of the debt and how to repay it in debt letters.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA agreed with our recommendation and reported in March 2017 that it is working on a plan to include school term dates on debt notification letters sent to schools. VA also plans to review and modify the initial debt letters sent to students and schools to include information on both the cause of the debt and how to repay the debt. VA plans to complete these actions by December 2017 once the necessary IT resources are available.
    Recommendation: To improve the administration of the Post-9/11 GI Bill, reduce the occurrence of overpayments, and increase debt collections, the Secretary of Veterans Affairs should revise policy for calculating overpayments to increase collections by prorating tuition overpayments when veterans reduce their enrollment during the term based on the actual date of the enrollment change rather than paying additional benefits through the end of the month during which the reduction occurred.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA officials reported in March 2017 that the agency is revising its tuition overpayment regulations, as GAO recommended in its 2015 report. VA officials said these proposed regulatory revisions are going through the internal approval process, which is expected to be completed by October 2017.
    Recommendation: To improve the administration of the Post-9/11 GI Bill, reduce the occurrence of overpayments, and increase debt collections, the Secretary of Veterans Affairs should ensure it is recovering the full amount of tuition and fee payments if a school does not charge a veteran for any tuition or fees after dropping a class or withdrawing from school. For example, VA could adjust its overpayment calculation to account for these situations or provide schools with guidance on how to account for school refund policies when reporting enrollment and tuition changes.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA officials reported in March 2017 that the agency plans to amend its procedures to account for school refund policies when calculating veterans' overpayment debts, as GAO recommended in its 2015 report. VA officials said they plan to publish this information in the School Certifying Official Handbook and notify schools and student veterans about the change. However, officials also reported that the agency needs to address several issues with its information technology systems before these changes can be made. Officials said they expect to complete these upgrades by December 2017 once the necessary IT resources requested by the Veterans Benefits Administration are provided.
    Director: Debra Draper
    Phone: (202) 512-7114

    2 open recommendations
    including 1 priority recommendation
    Recommendation: To help ensure the effective recruitment and retention of nurses across VA medical centers, the Secretary of Veterans Affairs should direct the Under Secretary for Health to develop a periodic reporting process to help monitor VA medical center compliance with the policies and procedures for each of its key recruitment and retention initiatives.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VHA convened a taskforce with accompanying charter to address all three of GAO's recommendations, including medical center compliance with policies and procedures for the key recruitment and retention initiatives. The taskforce consists of workgroups that are charged with reviewing current processes for reporting on compliance for the eight recruitment and retention initiatives we identified in our report, identifying opportunities for improvement, and developing recommendations to optimize medical centers' reporting on compliance. Based on the workgroup recommendations, VHA will generate and implement program-specific approaches for reporting on compliance of the initiatives. As of March 2017, the workgroups have reviewed, or are in the process of reviewing, compliance reporting processes for all eight initiatives. VHA anticipates implementing compliance reporting processes by October 2017.
    Recommendation: To help ensure the effective recruitment and retention of nurses across VA medical centers, the Secretary of Veterans Affairs should direct the Under Secretary for Health to conduct a system-wide evaluation of VHA's key nurse recruitment and retention initiatives, to determine the overall effectiveness of these initiatives, including any needed improvements, and communicate results and information in a timely manner to relevant stakeholders.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VHA convened a taskforce with accompanying charter to address all three of GAO's recommendations, including conducting a system-wide evaluation of VHA's key nurse recruitment and retention initiatives and identifying areas for improvement. The taskforce consists of workgroups that are charged with reviewing current processes for reporting on compliance for the eight recruitment and retention initiatives we identified in our report, identifying opportunities for improvement, and developing recommendations to optimize medical centers' reporting on compliance. Based on the workgroup recommendations, VHA will generate and implement program-specific approaches for reporting on compliance of the initiatives. As of March 2017, taskforce has evaluated, or is in the process of evaluating, the effectiveness of each of the eight initiatives. VHA anticipates completing these evaluations by October 2017. However, VHA did not provide any information on its efforts to evaluate the overall effectiveness of the key initiatives in meeting VHA's system-wide nurse recruitment and retention goals.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    2 open recommendations
    Recommendation: To help ensure the best use of the VA Adaptive Sports Grant program funds, the Secretary of Veterans Affairs should direct the Undersecretary for Public and Intergovernmental Affairs to systematically gather and disseminate, to all its grantees, techniques that can reduce the no-show rate at funded events.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation. In 2015, VA stated that it would have grantees report on their policies, tools and experience with veterans and service members who do not show up for events; and measures grantees have taken to reduce no-shows. VA stated that it will analyze this information and disseminate best techniques, tools, and recommended actions to current and future grantees. We will close this recommendation when we receive documentation showing that VA is systematically gathering and disseminating information on best practices for reducing no-shows.
    Recommendation: To help ensure the best use of the Department of Veterans Affairs (VA) Adaptive Sports Grant program funds, the Secretary of Veterans Affairs should direct the Undersecretary for Public and Intergovernmental Affairs to revise the draft monitoring plan to include guidance on the number and frequency of annual site visits and desk audits.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with this recommendation. In 2015, VA reported that its final monitoring plan calls for conduct of site visits or desk audits of at least 10 percent of grantees in a grant year. We will close this recommendation when we receive a copy of the final plan for FY16 documenting this commitment.
    Director: Valerie C. Melvin
    Phone: (202) 512-6304

    5 open recommendations
    including 1 priority recommendation
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to develop an updated plan for VBMS that includes (1) a schedule for when VBA intends to complete development and implementation of the system, including capabilities that fully support disability claims, pension claims, and appeals processing and (2) the estimated cost to complete development and implementation of the system.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: The Department of Veterans Affairs (VA) concurred with our recommendation calling for an updated plan for the Veterans Benefits Management System. However, as of June 2017, the department had not developed a plan that included a schedule for when the Veterans Benefits Administration intends to complete development and implementation of the system, as well as the estimated cost of doing so. We will continue to monitor VA's actions in response to this recommendation.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to establish goals for system response time and use the goals as a basis for periodically reporting actual system performance.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and reported that the Veterans Benefits Management System (VBMS) program office has developed draft metrics for performance of the system. Specifically, VA stated that the office has established key performance indicators as a basis for monitoring the response times of the most commonly executed user transactions (or work events) within VBMS. According to the department, these indicators have been incorporated into the application's continuous monitoring tools for all service level agreements and these agreements are enforced by the VA Service Level Management Board. Nevertheless, as of June 2017, VA had not identified its goals for VBMS response times, nor had the department reported actual system response times. We will continue to monitor VA's actions toward addressing this recommendation.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to reduce the incidence of high- and medium-priority level defects that are present at the time of future VBMS releases.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and, in June 2017, reiterated its plans and procedures for decreasing the incidences of defects in each system release. However, the incidences of high- and medium-priority level defects at the time of recent VBMS releases (i.e., releases 10.1 and 11.0) had increased relative to the number of defects present at the time of the earlier release (i.e., release 8.1) that we described in our report. We will continue to monitor VA's actions and progress in response to this recommendation.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to develop and administer a statistically valid survey of VBMS users to determine the effectiveness of steps taken to make improvements in users' satisfaction.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and in January 2017, conducted a survey of VBMS users that was sent to over 16,000 claims processors at each of its 56 regional offices. Although 52 percent of respondents indicated that they were very satisfied or satisfied with VBMS, the department received only about 2500 responses to the survey for a 15 percent response rate. This low response rate raises concern about whether the survey results are statistically valid. We have requested additional information from VA to determine any actions the department has taken to ensure the statistical validity of its survey results and will assess any information that is provided.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to establish goals that define customer satisfaction with VBMS and report on actual performance toward achieving the goals based on the results of GAO's survey of VBMS users and any future surveys VA conducts.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and conducted a survey of VBMS users in January 2017. However, as of June 2017, the department had yet to develop customer satisfaction goals for VBMS that would provide users with an expectation of the system response times they should anticipate, and management with an indication of how well the system is performing relative to performance goals.
    Director: Valerie C. Melvin
    Phone: (202) 512-6304

    4 open recommendations
    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should ensure related goals are defined to provide a basis for assessing and reporting on the status of interoperability-related activities and the extent to which interoperability is being achieved by the departments' modernized electronic health record systems.

    Agency: Department of Defense
    Status: Open

    Comments: The Department of Defense (DOD) and the Department of Veterans Affairs (VA) are working to define goals to provide a basis for assessing and reporting on the status of interoperability-related activities and the extent to which interoperability is being achieved by the departments' modernized electronic health record systems. Specifically, according to the DOD/VA Interagency Program Office (IPO), the office, in conjunction with the departments, has employed use cases in the Joint Interoperability Plan to define the interoperability-related goal areas, which are to be used as the basis for the development of outcome-oriented metrics, assessments, and reporting. The departments, the IPO, and workgroups within the Health Executive Committee's data sharing areas have focused on the feasibility and development of metrics aligned to six use cases as they relate to electronic health record interoperability between DOD and VA and outcomes to service members, veterans, and healthcare providers. The IPO reports that the work to establish these goals will be completed by December 2017. GAO will continue to review the results of these efforts.
    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should ensure related goals are defined to provide a basis for assessing and reporting on the status of interoperability-related activities and the extent to which interoperability is being achieved by the departments' modernized electronic health record systems.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) and the Department of Defense (DOD) are working to define goals to provide a basis for assessing and reporting on the status of interoperability-related activities and the extent to which interoperability is being achieved by the departments' modernized electronic health record systems. Specifically, according to the DOD/VA Interagency Program Office (IPO), the office, in conjunction with the departments, has employed use cases in the Joint Interoperability Plan to define the interoperability-related goal areas, which are to be used as the basis for the development of outcome-oriented metrics, assessments, and reporting. The departments, the IPO, and workgroups within the Health Executive Committee's data sharing areas have focused on the feasibility and development of metrics aligned to six use cases as they relate to electronic health record interoperability between VA and DOD and outcomes to service members, veterans, and healthcare providers. The IPO reports that the work to establish these goals will be completed by December 2017. GAO will continue to review the results of these efforts.
    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should update IPO guidance to reflect the metrics and goals identified.

    Agency: Department of Defense
    Status: Open

    Comments: According to the Department of Defense (DOD)/Department of Veterans Affairs (VA) Interagency Program Office (IPO), the office has issued an update to the Health Data Interoperability Management Plan that documents the IPO's role and outlines governance for supporting interoperability between the departments. The IPO is also in the process of updating additional guidance to describe the benefits of interoperability and reflect associated outcome-oriented metrics and goals. Specifically, IPO officials reported that the IPO's Joint Interoperability Plan is transitioning to the Joint Interoperability Strategic Plan and is expected to be finalized in November 2017. GAO will review this guidance once it is approved by DOD and VA.
    Recommendation: To facilitate oversight and inform decision making regarding their respective department's interoperability-related activities, the Secretaries of Defense and Veterans Affairs, working with the Interagency Program Office, should update IPO guidance to reflect the metrics and goals identified.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: According to the Department of Defense (DOD)/Department of Veterans Affairs (VA) Interagency Program Office (IPO), the office has issued an update to the Health Data Interoperability Management Plan that documents the IPO's role and outlines governance for supporting interoperability between the departments. The IPO is also in the process of updating additional guidance to describe the benefits of interoperability and reflect associated outcome-oriented metrics and goals. Specifically, IPO officials reported that the IPO's Joint Interoperability Plan is transitioning to the Joint Interoperability Strategic Plan and is expected to be finalized in November 2017. GAO will review this guidance once it is approved by VA and DOD.
    Director: Andrew Sherrill
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To inform decisions on any potential future iterations of the veterans' employment workshop, the Secretary of Labor should assess and report to Congress the extent to which further delivery of employment workshops to veterans and their spouses could fill a niche not fully served by existing federal programs. Such an assessment could involve collaboration with VA and other stakeholder organizations.

    Agency: Department of Labor
    Status: Open

    Comments: In May 2017, DOL repeated its assertion that the employment needs of veterans and spouses are best met through the services offered by their local American Job Centers. Additionally, DOL's Veterans' Employment and Training Service (VETS) has published its employment workshop TAP curriculum in eBook form, making it accessible to all veterans and spouses. VETS planned to report to Congress in 2017 on whether a need exists to provide an employment workshop to veterans and spouses. DOL has not provided an update to GAO on that assessment. Further, VETS is conducting a pilot to identify additional options to connect veterans and spouses to employment services available at American Job Centers, and plans to report its initial findings to Congress in 2018.
    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: 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: Linda Kohn
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To help determine if programs are effective at supporting those individuals with serious mental illness, the Secretaries of Defense, Health and Human Services, Veterans Affairs, and the Attorney General--which oversee programs targeting individuals with serious mental illness--should document which of their programs targeted for individuals with serious mental illness should be evaluated and how often such evaluations should be completed.

    Agency: Department of Defense
    Status: Open

    Comments: The Department of Defense's position is that it already engages in periodic program evaluation of its psychological health programs as required. It noted that on November 24, 2014, the Under Secretary of Defense for Personnel and Readiness directed the Military Departments and other Department of Defense components to assist in an initiative to evaluate Psychological Health and Traumatic Brain Injury programs across the Department of Defense. As of September 2017, we have not received a further update on the Department of Defense's actions. We will continue to monitor these efforts and seek to determine whether they result in documentation of which programs should be evaluated and how such evaluations should be completed.
    Recommendation: To help determine if programs are effective at supporting those individuals with serious mental illness, the Secretaries of Defense, Health and Human Services, Veterans Affairs, and the Attorney General--which oversee programs targeting individuals with serious mental illness--should document which of their programs targeted for individuals with serious mental illness should be evaluated and how often such evaluations should be completed.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS did not concur with this recommendation. The Helping Families in Mental Health Crisis Reform Act of 2016 enacted in December 2016 included a requirement for HHS to develop a strategy for conducting ongoing evaluations of programs related to mental illness--including serious mental illness--and substance use disorders. As of August 2017, HHS is in the process of preparing a report that identifies key programs and activities across the department, as well as summarizes data on those programs and develops criteria for use in prioritizing programs for evaluation. However, this report is not yet complete. We will continue to monitor HHS's efforts in this regard and look for documentation of HHS plans for future evaluations of programs for individuals with serious mental illness.
    Director: Yvonne D. Jones
    Phone: (202) 512-2717

    1 open recommendations
    Recommendation: Any federal agency designated to investigate future USERRA claims against federal executive agencies should undertake efforts to increase the response rate of the customer satisfaction survey if it continues to be administered, so more tenable conclusions can be drawn from its data. Such efforts may include follow-up phone calls to nonrespondents, additional email notifications requesting participation in the survey, or making the survey easier to complete and submit.

    Agency: Department of Labor
    Status: Open

    Comments: In February 2016, Department of Labor Veterans Employment and Training Service (DOL/VETS) reported their office is handling all USERRA complaints, Federal and non-Federal following conclusion of the demonstration project with OSC. DOL/VETS reported the agency deployed its customer satisfaction survey in May 2016 and will be monitoring and collecting responses on a quarterly basis. The agency plans to employ the same follow-up technique used during the demonstration project and will determine if additional follow-up emails are warranted.
    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 November 2017, VA had no further updates on this recommendation. VA previously reported that VBA had submitted business requirements to add new functionality in VA's electronic claims processing system, the Veterans Benefit Management System (VBMS), that would allow the agency to identify deficiencies during the claims process. If an error is detected, the claim would be paused to allow an in-process review (IPR), conducted by quality review teams, to occur. However, VA reported in August 2017 that these new business requirements would not be implemented due to limited VA Office of Information Technology (OIT) funding available for OIT updates in fiscal year 2018 and beyond. This recommendation will remain open until November 2018, in case circumstances or funding change.
    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 November 2017, VA reported that VBA's Compensation Service is beginning to gather and analyze quality assurance data to identify areas for improvements in VA processes, guidance, and training. This database, called Quality Management System (QMS), captures 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. According to VA, QMS has been functional since July 2017 and has captured over 130,000 quality reviews. VBA's Compensation Service is analyzing the first 90 days of data from QMS and once the data analysis is complete, it plans to implement the first set of changes or actions to improve accuracy. VA expects to implement these actions by January 2018. To close this recommendation, the agency will need to provide documentation of the comprehensive quality assurance data being captured, and how it is being used to either evaluate QA activities or make specific improvements with potential for improving accuracy.
    Director: Gregory C. Wilshusen
    Phone: (202) 512-6244

    1 open recommendations
    Recommendation: To address previously identified security vulnerabilities, the Secretary of Veterans Affairs should scan non-Windows network devices in authenticated mode.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs concurred with the recommendation but has not yet provided sufficient evidence that it has implemented the recommendation.
    Director: J. Christopher Mihm
    Phone: (202) 512-6806

    4 open recommendations
    Recommendation: Recognizing that moving toward a more customer-oriented culture within federal agencies is likely to be a continuous effort, the Secretary of Agriculture should direct the Under Secretary for Natural Resources and Environment, to improve Forest Service's customer service standards and feedback review, to: (1) ensure standards include performance targets or goals, (2) ensure standards include performance measures, (3) ensure standards are easily publicly available, (4) develop a feedback mechanism to collect comments agency-wide, which should include guidance or criteria to elevate customer feedback from local and regional offices to identify the need for and to make service improvements.

    Agency: Department of Agriculture
    Status: Open

    Comments: In August 2017, Forest Service provided an update for completing the tasks necessary to respond to our recommendations. In accordance with our recommendations, for each of its customer service standards, the Forest Service has developed goals, targets and measures and we consider this part of the recommendation closed. Forest Service stated the remaining part of the recommendation will be implemented by December 2018. Specifically, the Forest Service stated by December 2018 it will begin to make standards easily publicly available on its public-facing websites. The Forest Service provided the criteria for elevating customer comments and by December 2018 stated it will begin to deploy and collect feedback forms. We will close this recommendation as implemented when standards are publicly available and customer feedback forms are deployed.
    Recommendation: Recognizing that moving toward a more customer-oriented culture within federal agencies is likely to be a continuous effort, the Secretary of Education should direct Federal Student Aid's Chief Operating Officer, to improve Federal Student Aid's customer service standards and feedback review, to: (1) ensure standards are easily publicly available, (2) develop a feedback mechanism that includes guidance or criteria for service providers to elevate customer feedback to identify the need for and to make service improvements.

    Agency: Department of Education
    Status: Open

    Comments: We emailed Department of Education in June 2017 for an update on the status of this recommendation. Once a response is received we will update this recommendation.
    Recommendation: Recognizing that moving toward a more customer-oriented culture within federal agencies is likely to be a continuous effort, the Commissioner of U.S. Customs and Border Protection should, to improve CBP's customer service standards: (1) ensure standards include performance targets or goals, (2) ensure standards include performance measures.

    Agency: Department of Homeland Security: United States Customs and Border Protection
    Status: Open

    Comments: In January 2017, CBP sent an email stating that the agency has done all it can to fully implement the recommendation at this time. Because CBP does not have performance goals or targets for customer service standards this recommendation remains open. In April 2016, CBP provided us with customer service survey questions they use to collect data. Based on our review of that information, we were unable to confirm CBP had established performance targets and goals for the data being collected. As we stated in the report, performance goals should be in a quantifiable and measurable form to define the level of performance to be achieved for program activities each year. Although CBP is collecting new customer service data based on survey responses, without predetermined performance targets that align with a customer service standard it is not clear what or if internal targets or customer needs are being met. In June 2017, we emailed CBP for an update on the status of this recommendation. Once a response is received we will update this recommendation.
    Recommendation: Recognizing that moving toward a more customer-oriented culture within federal agencies is likely to be a continuous effort, the Secretary of the Interior should direct the Assistant Secretary of Fish, Wildlife and Parks, to improve the National Park Service's customer service standards and feedback review, to: (1) ensure standards include performance targets or goals, (2) ensure standards include performance measures, (3) ensure standards are easily publicly available, (4) develop a feedback mechanism that includes guidance or criteria to review and elevate customer feedback from local and regional offices to identify the need for and to make service improvements.

    Agency: Department of the Interior
    Status: Open

    Comments: According to NPS officials, NPS plans on defining a strategy that describes the intended customer experience for highest customer interactions such as Volunteer in Parks program and Teacher engagement program. NPS will align the strategy with overall organizational strategy, share the strategy with all employees (e.g., documentation, training), and update strategy plans to include performance targets and goals for customer service. NPS also plans on soliciting feedback from customers about their experiences with the VIP and Teacher Outreach Programs, collecting unsolicited feedback from customers about their experiences with the organization (e.g., by mining calls, emails, or social media posts), and gathering input from employees about their experiences with customers and their role in delivering the customer experience. NPS plans to share customer experience metrics and models with all employees (e.g., distribute reports and dashboards, conduct training sessions), publish customer service standards on website so that customers know what to expect, and publish customer service data to ensure actual service levels are transparent. Finally NPS plans on piloting the "Federal Feedback" Button and evaluate for expanded use in fiscal year 2018. In June 2017, we emailed NPS for an update on this recommendation. Once a response is received we will update this recommendation.
    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: Randall B. Williamson
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To ensure that the Family Caregiver Program is able to meet caregivers' demand for its services, the Secretary of the Department of Veterans Affairs should expedite the process for identifying and implementing an IT system that fully supports the program and will enable VHA program officials to comprehensively monitor the program's workload, including data on the status of applications, appeals, home visits, and the use of other support services, such as respite care.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with our recommendation and stated that its efforts to develop and implement a new IT system has two key steps. First, VA will enhance and stabilize the existing Caregiver Action Tracker IT system. Second, a replacement IT system with new features and capabilities will be implemented by the end of FY 2017. However, in January 2017, VA reported that the short-term stabilization effort for the current IT system continues to experience multiple challenges resulting in significant schedule delays. Furthermore, the replacement IT system--which is partially dependent on the success of the current stabilization effort--has experienced project barriers of its own, and lacks the funding needed for a contract extension to complete the work. According to VA, the successful implementation of the replacement IT system is at significant risk.
    Recommendation: The Secretary of the Department of Veterans Affairs should direct the Undersecretary for Health to use data from the IT system, once implemented, as well as other relevant data to formally reassess how key aspects of the program are structured and to identify and implement modifications as needed to ensure that the program is functioning as envisioned so that caregivers can receive the services they need in a timely manner.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with this recommendation; however, in January 2017, VA reported that barriers continue to place the replacement IT system at significant risk as stated in Recommendation 1. In advance of the electronic solution, VA has developed manual processes to obtain and monitor key data points, allowing it to reassess policies and procedures for the Program of Comprehensive Assistance for Family Caregivers. In its June 2015 update, VA stated that the Caregiver Support Program had started collaborating with VA's Health Services Research and Development to establish a Partnered Evaluation Center (PEC). The PEC is assessing the impact of all caregiver support services in order to evaluate their effectiveness and impact on the health and well-being of veterans and caregivers. In January 2017, VA reported that the PEC's initial work had concluded and key findings had been identified.
    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: St James, Lorelei
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: To improve the management of VA's leased outpatient-clinic projects, the Secretary of Veterans Affairs should update VHA's guidance for leasing outpatient clinics to better reflect the roles and responsibilities of all VA staff involved in leasing projects.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: On March 30, 2017, the Executive Director, Office of Construction and Facilities management told GAO that VA intends to issue an updated Leasing Manual by the end of fiscal year 2017. GAO plans to close this recommendation when the new manual is issued.
    Director: Randall Williamson
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: To improve VA's ability to address its strategic plan objective of educating and empowering veterans, the Secretary of Veterans Affairs should direct the Under Secretary for Health to take steps to better understand gaps in veterans' knowledge regarding eligibility for Millennium Act emergency care, such as by conducting veteran surveys of health care benefits knowledge, and using information from those surveys to more effectively tailor the agency's education efforts regarding the Millennium Act benefit. In conducting these surveys, consideration should be given to including a sample of veterans who have had denied Millennium Act claims in order to provide their views and specific details of their experiences.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of September 2016, 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: 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: 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 August 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: 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: Williamson, Randall B
    Phone: (206)287-4860

    3 open recommendations
    including 2 priority recommendations
    Recommendation: To ensure that servicemembers have equitable access to the military services' wounded warrior programs, including the RCP, and to establish central accountability for these programs, the Secretary of Defense should establish or designate an office to centrally oversee and monitor the activities of the military services' wounded warrior programs to include the following: (1) Develop consistent eligibility criteria to ensure that similarly situated recovering servicemembers from different military services have uniform access to these programs; (2) Direct the military services' wounded warrior programs to fully comply with the policies governing care coordination and case management programs and any future changes to these policies; (3) Develop a common mechanism to systematically monitor the performance of the wounded warrior programs--to include the establishment of common terms and definitions--and report this information on a biannual basis to the Armed Services Committees of the House of Representatives and the Senate.

    Agency: Department of Defense
    Status: Open
    Priority recommendation

    Comments: DOD did not concur with our part (1) of our recommendation to develop consistent eligibility criteria, explaining that the three military department secretaries should have the ability to control entrance criteria into their wounded warrior programs and that varying eligibility criteria have not resulted in noticeable differences in access to these programs by recovering servicemembers or their families. In attachments to a memo dated April 8, 2014, DOD provided an update on progress made to implement parts (2) and (3) of the DOD-specific recommendation made in GAO-13-5. Regarding part (2), DOD reported that budget constraints had delayed its plan to conduct oversight visits to 63 service sites over a 12-month period to ensure that military wounded warrior programs were operating in compliance with DOD Recovery Coordinator Program policy. DOD stated that the Warrior Care Policy office, in coordination with the military service branches, had intended to begin these oversight visits and interviews in September 2013; that as of March 2014, five sites had been reviewed; and that results of the compliance visits would be available upon completion. Regarding part (3) of the recommendation, DOD's memo stated that DOD and VA continue work on developing policies on clinical and non-clinical care coordination. It also noted that interagency metrics for monitoring complex care coordination performance were under development by the DOD/VA Interagency Care Coordination Committee. Further, DOD stated that because the Joint Executive Council publishes an annual report, that reporting the progress in developing common terms and definitions used by wounded warrior programs to congressional committees would be of limited value. As of October 2016, when we determine what additional steps the agency has taken to implement this recommendation, we will update this information.
    Recommendation: To ensure that persistent challenges with care coordination, disability evaluation, and the electronic sharing of health records are fully resolved, the Secretaries of Defense and Veterans Affairs should ensure that these issues receive sustained leadership attention and collaboration at the highest levels with a singular focus on what is best for the individual servicemember or veteran to ensure continuity of care and a seamless transition from DOD to VA. This should include holding the Joint Executive Council accountable for (1) ensuring that key issues affecting recovering servicemembers and veterans get sufficient consideration, including recommendations made by the Warrior Care and Coordination Task Force and the Recovering Warrior Task Force; (2) developing mechanisms for making joint policy decisions; (3) involving the appropriate decision-makers for timely implementation of policy; and; (4) establishing mechanisms to systematically oversee joint initiatives and ensure that outcomes and goals are identified and achieved.

    Agency: Department of Defense
    Status: Open
    Priority recommendation

    Comments: As of October 2016, under the joint DOD/VA Interagency Care Coordination Committee, the departments have made progress to improve nonclinical care coordination procedures, primarily through the development of two initiatives?the Lead Coordinator initiative (in which a single care coordinator serves as the primary point of contact for a recovering servicemember) and through the use of a single, interagency care plan (ICP) for each recovering servicemember. As of March 2016, the departments were continuing the national rollout of the Lead Coordinator initiative and had trained nearly 3,700 DOD and VA personnel on the new process. In addition, DOD and VA continued the development of the ICP initiative, which will depend upon their ability to electronically exchange the information needed to implement servicemembers' care plans. In December 2015, DOD awarded a contract to support the ICP and to create electronic interoperability with VA. The departments anticipate testing their ability to exchange information digitally in June 2016 and achieving full operational capability by September 2016. We will continue to monitor progress to implement the joint Lead Coordinator and the ICP care coordination initiatives.
    Recommendation: To ensure that persistent challenges with care coordination, disability evaluation, and the electronic sharing of health records are fully resolved, the Secretaries of Defense and Veterans Affairs should ensure that these issues receive sustained leadership attention and collaboration at the highest levels with a singular focus on what is best for the individual servicemember or veteran to ensure continuity of care and a seamless transition from DOD to VA. This should include holding the Joint Executive Council accountable for (1) ensuring that key issues affecting recovering servicemembers and veterans get sufficient consideration, including recommendations made by the Warrior Care and Coordination Task Force and the Recovering Warrior Task Force; (2) developing mechanisms for making joint policy decisions; (3) involving the appropriate decision-makers for timely implementation of policy; and; (4) establishing mechanisms to systematically oversee joint initiatives and ensure that outcomes and goals are identified and achieved.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of October 2016, under the joint DOD/VA Interagency Care Coordination Committee, the departments have made progress to improve nonclinical care coordination procedures, primarily through the development of two initiatives?the Lead Coordinator initiative (in which a single care coordinator serves as the primary point of contact for a recovering servicemember) and through the use of a single, interagency care plan (ICP) for each recovering servicemember. As of March 2016, the departments were continuing the national rollout of the Lead Coordinator initiative and had trained nearly 3,700 DOD and VA personnel on the new process. In addition, DOD and VA continued the development of the ICP initiative, which will depend upon their ability to electronically exchange the information needed to implement servicemembers' care plans. In December 2015, DOD awarded a contract to support the ICP and to create electronic interoperability with VA. The departments anticipate testing their ability to exchange information digitally in June 2016 and achieving full operational capability by September 2016. We will continue to monitor progress to implement the joint Lead Coordinator and the ICP care coordination initiatives.
    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: Garcia-diaz, Daniel
    Phone: (202) 512-4529

    4 open recommendations
    Recommendation: To build on task force and working group efforts already underway to coordinate, consolidate, or improve housing programs, and help inform Congress's decision-making process, the Secretaries or other designated officials of HUD, Treasury, USDA, and VA should evaluate and report on the specific opportunities for consolidating similar housing programs, including those that would require statutory changes.

    Agency: Department of Agriculture
    Status: Open

    Comments: Through their rental policy working group and single-family program task force, HUD, USDA, and Treasury have continued their efforts to improve operations and better coordinate and align certain requirements among the agencies' multifamily and single-family housing programs. For example, in 2014, the agencies implemented a pilot in 26 states and 808 multifamily housing properties to test the feasibility of conducting a single physical inspection that would satisfy all agencies' inspection requirements. Additionally, HUD, USDA, and Treasury signed a memorandum of understanding in November 2016 to formalize interagency efforts on federal rental housing policy. They are also developing a white paper to document the history and best practices of the rental policy working group. Further, USDA's Rural Housing Service (RHS) has entered into a shared service agreement with the Department of Veterans Affairs (VA) to manage real-estate owned (REO) preservation and disposition of single-family properties acquired through RHS's direct loan program. RHS stated that it also meets with FHA and VA to discuss single-family housing issues and opportunities for collaboration. According to the Office of Management and Budget (OMB), the current administration may reevaluate ongoing collaborative efforts across the different agencies, which could have implications for housing program consolidation. OMB has participated in interagency discussions on federal housing assistance, credit budgeting, and management of HUD, VA, and USDA housing programs. Nonetheless, the charters of both the rental policy working group and the single-family program task force limit their missions to issues that can be dealt with administratively. As of March 2017, neither group has reported on the areas where specific statutory changes are needed to help mitigate overlap and fragmentation and decrease costs.
    Recommendation: To build on task force and working group efforts already underway to coordinate, consolidate, or improve housing programs, and help inform Congress's decision-making process, the Secretaries or other designated officials of HUD, Treasury, USDA, and VA should evaluate and report on the specific opportunities for consolidating similar housing programs, including those that would require statutory changes.

    Agency: Department of Housing and Urban Development
    Status: Open

    Comments: Through their rental policy working group and single-family program task force, HUD, USDA, and Treasury have continued their efforts to improve operations and better coordinate and align certain requirements among the agencies' multifamily and single-family housing programs. For example, in 2014, the agencies implemented a pilot in 26 states and 808 multifamily housing properties to test the feasibility of conducting a single physical inspection that would satisfy all agencies' inspection requirements. Additionally, HUD, USDA, and Treasury signed a memorandum of understanding in November 2016 to formalize interagency efforts on federal rental housing policy. They are also developing a white paper to document the history and best practices of the rental policy working group. Further, USDA's Rural Housing Service (RHS) has entered into a shared service agreement with the Department of Veterans Affairs (VA) to manage real-estate owned (REO) preservation and disposition of single-family properties acquired through RHS's direct loan program. RHS stated that it also meets with FHA and VA to discuss single-family housing issues and opportunities for collaboration. According to the Office of Management and Budget (OMB), the current administration may reevaluate ongoing collaborative efforts across the different agencies, which could have implications for housing program consolidation. OMB has participated in interagency discussions on federal housing assistance, credit budgeting, and management of HUD, VA, and USDA housing programs. Nonetheless, the charters of both the rental policy working group and the single-family program task force limit their missions to issues that can be dealt with administratively. As of March 2017, neither group has reported on the areas where specific statutory changes are needed to help mitigate overlap and fragmentation and decrease costs.
    Recommendation: To build on task force and working group efforts already underway to coordinate, consolidate, or improve housing programs, and help inform Congress's decision-making process, the Secretaries or other designated officials of HUD, Treasury, USDA, and VA should evaluate and report on the specific opportunities for consolidating similar housing programs, including those that would require statutory changes.

    Agency: Department of the Treasury
    Status: Open

    Comments: Through their rental policy working group and single-family program task force, HUD, USDA, and Treasury have continued their efforts to improve operations and better coordinate and align certain requirements among the agencies' multifamily and single-family housing programs. For example, in 2014, the agencies implemented a pilot in 26 states and 808 multifamily housing properties to test the feasibility of conducting a single physical inspection that would satisfy all agencies' inspection requirements. Additionally, HUD, USDA, and Treasury signed a memorandum of understanding in November 2016 to formalize interagency efforts on federal rental housing policy. They are also developing a white paper to document the history and best practices of the rental policy working group. Further, USDA's Rural Housing Service (RHS) has entered into a shared service agreement with the Department of Veterans Affairs (VA) to manage real-estate owned (REO) preservation and disposition of single-family properties acquired through RHS's direct loan program. RHS stated that it also meets with FHA and VA to discuss single-family housing issues and opportunities for collaboration. According to the Office of Management and Budget (OMB), the current administration may reevaluate ongoing collaborative efforts across the different agencies, which could have implications for housing program consolidation. OMB has participated in interagency discussions on federal housing assistance, credit budgeting, and management of HUD, VA, and USDA housing programs. Nonetheless, the charters of both the rental policy working group and the single-family program task force limit their missions to issues that can be dealt with administratively. As of March 2017, neither group has reported on the areas where specific statutory changes are needed to help mitigate overlap and fragmentation and decrease costs.
    Recommendation: To build on task force and working group efforts already underway to coordinate, consolidate, or improve housing programs, and help inform Congress's decision-making process, the Secretaries or other designated officials of HUD, Treasury, USDA, and VA should evaluate and report on the specific opportunities for consolidating similar housing programs, including those that would require statutory changes.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: In responding to the draft report, VA concurred in principle with this recommendation but would not support unilateral reporting and evaluation in this area. VA maintains that the consolidation of the VA Home Guarantee Program with housing program of HUD or another agency is counter to statute that authorizes that its program be operated by VA. VA participates in the single-family interagency task force, along with HUD, USDA, and OMB. A tangible result from that task force is that VA has established an inter-agency agreement with USDA in an effort to increase efficiency and reduce costs by using VA processes for disposing of USDA real estate assets. However, the task force's charter limits its mission to issues that can be dealt with administratively and thus has not reported on areas where specific statutory changes are needed. The recommendation calls for the Secretaries or other designated officials to evaluate and report on opportunities to consolidate similar housing programs, including those that would require statutory changes. As such, the recommendation will stay open until the agencies provide sufficient evidence that they are working together to identify such opportunities. According to the VA, the agency will not take any action to identify opportunities that require statutory changes.
    Director: Draper, Debra A
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To systematically gauge the extent to which deficiencies identified by individual AIBs may be occurring throughout VHA; and to maximize opportunities for sharing information across VHA to improve its overall operations, the Secretary of Veterans Affairs should direct the Under Secretary for Health to establish a process to collect and analyze aggregate data from AIB investigations, including the number of investigations conducted, the types of matters investigated, whether the matters were substantiated, and systemic deficiencies identified.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with this recommendation and noted that it would explore any new processes for collecting and analyzing aggregate data from AIB investigations. In September 2015, VA reported that VHA had established a working group to review this recommendation and also had created a database to collect and analyze aggregate data from AIB investigations into senior executive service (SES) employees. Based on an informal survey of its working group as well as its analysis of AIB data for SES employees, VA stated that central office oversight of the AIB process is not needed and that several systems already in place capture data on system-wide risks (e.g., sexual assault reporting, Issue Briefs, and National Center for Patient Safety Patient Safety Information System Program). Ultimately, VA stated that it could not justify the resources needed to implement this recommendation.
    Recommendation: To systematically gauge the extent to which deficiencies identified by individual AIBs may be occurring throughout VHA; and to maximize opportunities for sharing information across VHA to improve its overall operations, the Secretary of Veterans Affairs should direct the Under Secretary for Health to establish a process for sharing information about systemic changes, including policies and procedures implemented in response to the results of AIB investigations, which may have broader applicability throughout VHA.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred with this recommendation and noted that it would explore any new processes for collecting and analyzing aggregate data from AIB investigations. In September 2015, VA reported that it had established a working group to review this recommendation. In addition, VA also had created a database to collect and analyze aggregate data from AIB investigations into senior executive service (SES) employees to identify trends and address deficiencies. Based on an informal survey of its working group and its analysis of AIB data for SES employees, VA stated that VISNs currently provide adequate oversight of the AIB process and notify VA central office when appropriate and that a comprehensive review of its AIB data for SES employees identified no system-wide issues. Ultimately, VA stated that it could not justify the resources needed to implement this recommendation.
    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: Williamson, Randall B
    Phone: (206)287-4860

    1 open recommendations
    Recommendation: To help identify risks and address vulnerabilities in physical security precautions at VA medical facilities, the Secretary of Veterans Affairs should direct the Under Secretary for Health to require relevant medical center stakeholders to coordinate and consult on (1) plans for new and renovated units, and (2) any changes to physical security features, such as closed-circuit television cameras.

    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: 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.