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Open Recommendations

Medicaid: Managed Care Plans’ Prior Authorization Decisions for Children Need Additional Oversight
GAO-24-106532
May 29, 2024
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2 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services The Administrator of CMS should communicate in writing expectations for how states are to monitor the appropriateness of managed care plans' prior authorization decisions and take steps to confirm whether states are meeting those expectations. Such communication should include expectations related to monitoring prior authorization decisions of EPSDT services for children. (Recommendation 1)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Centers for Medicare & Medicaid Services The Administrator of CMS should clearly define whether managed care plans can require prior authorization for EPSDT services when the state does not have such requirements. This should include defining the term "non-quantitative treatment limits" as it relates to managed care plans providing medically necessary services to children in a manner no more restrictive than that used in the state Medicaid program. (Recommendation 2)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

VA Health Care: Additional Assessments of Mileage Reimbursement Data and Veterans' Travel Costs Needed
GAO-24-106816
May 28, 2024
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4 Open Recommendations
Agency Affected Recommendation Status
Department of Veterans Affairs The Under Secretary for Health should collect and assess information on subpopulations of veterans' use of the mileage reimbursement benefit and identify options, as appropriate, to help improve access to care for underserved veterans. (Recommendation 1)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs The Under Secretary for Health should collect additional information on veterans' travel costs and assess costs by demographic, geographic, or other subpopulations to inform evidence-based decisions about transportation programs' resources. This additional information could include fuel costs and the cost of vehicle maintenance, accessories, parts, and tires. (Recommendation 2)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs The Under Secretary for Health should finalize and implement an outreach plan for improving veterans' awareness of aspects of the mileage reimbursement benefit. The plan should include outcome-oriented performance measures and appropriate communication methods, based on factors such as the intended audience. (Recommendation 3)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs The Under Secretary for Health should evaluate the effectiveness of the outreach plan for improving veterans' awareness of the benefit, and revise communication methods as appropriate. (Recommendation 4)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Veterans Affairs: Actions Needed to Improve Access to Care in the U.S. Territories and Freely Associated States
GAO-24-106364
May 23, 2024
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6 Open Recommendations
Agency Affected Recommendation Status
Department of Veterans Affairs The Secretary of VA should assess the underlying data sources of its VetPop model to identify the extent to which known data limitations impact the accuracy of population estimates for veterans living in the U.S. territories and FAS. In doing so, VA should consult with local government officials and stakeholders to identify and validate available veteran data sources, and make changes as appropriate to VetPop's data sources. (Recommendation 1)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs The VA Under Secretary for Health should clearly communicate in writing appropriate uses for the new capabilities within its VHA Support Service Center databases to generate utilization and timeliness of care data by veteran location. (Recommendation 2)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs The Secretary of VA should assess whether it is feasible and advisable to expand travel reimbursement eligibility for any condition among service-connected disabled veterans in the U.S. territories, and as appropriate or consistent with that analysis, amend its regulations to do so. (Recommendation 3)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs The Secretary of VA should ensure that the Director of VAPIHCS, in collaboration with DOD, identify and implement additional opportunities to share resources and solutions to address shared challenges affecting the implementation of their resource sharing agreements in the Pacific. (Recommendation 4)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs The VA Under Secretary for Health, in coordination with the Executive Directors of the VA Office of Procurement, Acquisition, and Logistics, and the VHA Procurement and Logistics Office, should clarify in writing the appropriate processes, in line with VHA's Supply Chain Management Operations Directive, for VA Caribbean Healthcare System officials to communicate challenges receiving medical services or devices. (Recommendation 5)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense The Secretary of DOD should ensure that the Directors of the Defense Health Networks Indo-Pacific and Pacific Rim, in collaboration with VA, identify and implement additional opportunities to share resources and solutions to address shared challenges affecting the implementation of their resource sharing agreements in the Pacific. (Recommendation 6)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Military Health Care: DOD and VA Could Benefit from More Information on Staff Use of Military Toxic Exposure Records
GAO-24-106423
May 23, 2024
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4 Open Recommendations
Agency Affected Recommendation Status
Department of Defense The Assistant Secretary of Defense for Health Affairs should ensure that the Deployment Health Work Group establishes goals with performance measures on the extent of ILER use by types of staff and purpose within DOD and VA (Recommendation 1).
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense The Assistant Secretary of Defense for Health Affairs should ensure that the Deployment Health Work Group or other relevant entities, such as the ILER Steering Group, use the data collected for the goals' performance measures to inform management decisions, including outreach, training, or other efforts that support the appropriate use of ILER (Recommendation 2).
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs The VA Under Secretary for Health should ensure that the Deployment Health Work Group establishes goals with performance measures on the extent of ILER use by types of staff and purpose within DOD and VA (Recommendation 3).
Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs The VA Under Secretary for Health should ensure that the Deployment Health Work Group or other relevant entities, such as the ILER Steering Group, use the data collected for the goals' performance measures to inform management decisions, including outreach, training, or other efforts that support the appropriate use of ILER (Recommendation 4).
Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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