Veterans Health Administration (VHA) VA Community Care Program Department of Veterans Affairs (VA)

The VA Community Care Program helps ensure eligible Veterans receive timely and specialized healthcare. VA has authority under 38 U.S.C. 1703 and P.L. 113-146, as amended, to authorize Veteran care at non-VA healthcare facilities when the needed services are not available through the VA, when the Veteran is unable to travel to a VA facility, or when the Veteran is eligible for community care through the Veterans Choice Program. For purposes of this report, the VA Community Care Program does include care received through the Veterans Choice Program but does not include care received through sharing/reimbursement agreements with Indian Health Service (IHS) or Department of Defense (DOD).

Agency Accountable Official: Mr. John Rychalski, Assistant Secretary for Management and Chief Financial Officer

Program Accountable Official: Dr. Kameron Matthews, Acting Assistant Deputy Under Secretary for Health for Community Care

Total Payments
Improper Payments
Improper Payment Rate

Supplemental Measures

Current Measure: FY18 Q2: 65% FY18 Cumulative (Q1 – Q2): 64%

Target: 65 percent (maintain target from FY17)

Description: For the purposes of this measure, the VHA Office of Community Care tracks the payments associated with non-contract VA Community Care authorizations issued under 38 U.S.C. 1703 and the Veterans Choice Program. VA’s goal is to decrease the number of non-contract authorizations issued under 38 U.S.C. 1703 and increase the amount of non-VA health care services purchased through FAR-based contracts. Compliance with Federal Acquisition Regulations reduces improper payment designations. By September 30, 2018, the Office of Community Care will maintain the FY 2017 target of 65 percent. Payments associated with non-contract authorizations totaled $2,098,917,999.23 for the second quarter of FY 2018, accounting for approximately 65 percent of VA Community Care (as defined in the summary). At the end of second quarter FY 2018, payments associated with non-contract authorizations totaled $3,969,517,240.14 for the fiscal year. Overall, 64 percent of payments were associated with non-contract authorizations. The target rate for payments associated with non-contract authorizations is no more than 65 percent.

Update Frequency: Quarterly

Data Current as of: March 31, 2018

Current Measure: Zero percent of payments for Individual Authorizations under $10,000 are proper due to noncompliance with VAAR requirements for appropriate Delegation of Authority.

Target: 20 percent (VACC may make the target more aggressive as more is learned about the impact it may have to accessibility.)

Description: In order to build a quantitative measure, the following activities will be developed to define the process to purchase care consistent with VAAR requirements for delegations of authority. VHA Community Care will assess the current state and map process at various locations and will develop a high level process flow that captures appropriate process steps to support the front-end business process. From the process map, VHA Community Care in collaboration with VHA Office of Procurement and Logistics will draft Standard Operating Procedure(s) for national implementation. Once established, the SOPs will be reviewed to identify risk areas and corresponding internal controls. Once internal controls are identified, we will execute an implementation plan. Concurrently, we will design internal control testing to measure the effectiveness of the new process. Based on testing results, we will make necessary adjustments to the process and begin regular reporting on measurable results. The new delegation of authority process will be implemented by Quarter 2 of FY18; additional testing will take place in Quarter 3, with process improvements implemented based on the results of testing.

Update Frequency: Annually

Data Current as of: March 31, 2018

Program Comments

To determine payment accuracy, VHA samples its VA Community Care Program to make certain medical care payments to non-VA healthcare providers are correct. VHA uses a statistically valid sample to determine the program payment accuracy rates. In FY 2015, VA classified payments that did not follow all Federal Acquisition Regulations and where VA exceeded its regulatory authority as improper. This is a departure from how VA has traditionally reported improper payments related to the Community Care Program. Historically, VA only reported instances of community care as improper payments where the wrong party was paid, the wrong amount was paid, a duplicate payment was made, or services were not received. However, to ensure every effort to report in compliance with the statue and promote transparency, beginning in FY 2015, the Department included transactions that did not follow acquisition regulations as improper. As a result, this decision significantly increased both percentage and amount of improper payments made in the VA Community Care Program. VA is seeking a legislative change in order to become compliant with Federal Acquisition Regulations and has been actively pursuing the required changes since the issue was first raised during the Office of Inspector General’s 2015 review of VA’s compliance with the Improper Payments Elimination and Recovery Act. Until such time as proposed legislative and contractual remedies are implemented, VA will continue to utilize individual authorizations as required in order to support Veterans’ timely access to care. Additional information on the program and detail on the progress of corrective actions can be found in VA’s Agency Financial Report.