GAO: VA Needs Better Contract Oversight in Community Care Program

In a report released on August 21, the Government Accountability Office (GAO) reviewed the Veteran's Community Care Program which is administered by the Department of Veterans Affairs. The program allows eligible veterans to access necessary medical care from community providers rather than VA Medical Centers and is administered over five geographic regions by two third party payers: Optum and TriWest which credential providers, enroll them in the Community Care Network, and pay for services delivered to veterans via approved service plans.

The GAO report outlines shortcomings in VA contract oversight of the third part administrator contracts and recommends the VA establish policies to better assess contract compliance, ensure all necessary contract compliance roles and responsibilities are covered, and establish best practices and lessons learned to inform contract amendments in upcoming cycles. These findings and recommendations are consistent with member struggles to become credentialed providers or obtain payment for approved services provided to veterans.

The VA's poor contract oversight compromises their ability to assess:

• Provider network adequacy in any provider category but particularly in specialist and long-term services and supports like adult day or home health
• If enrolled providers used to determine network adequacy are accepting new patients, submitting claims to the VA or even operational
• If veterans can access services from their preferred provider, as outlined in the regulations

The lack of internal controls in the VA puts veterans, their health, and the provider infrastructure serving them at risk. The report renders a history of the program and offers suggestions to re-establish health contract oversight within the program. Highlights from the report, along with the full report are available for review.

If you are experiencing struggles with the VA, please reach out to Georgia ([email protected]) to share your experience.