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Closure of OIG Recommendations

Health Eligibility Center

• All 13 of 13 OIG recommendations closed effective October 25, 2016


• Report No. 14-01792-510, Issued September 2, 2015: Review of Alleged
Mismanagement at the Health Eligibility Center
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1. Guidance for Pending Applications
2. Assign Accountable Senior Official
3. Develop and Execute Project Management Plan
4. Implement Controls
5. Date of Death Process
6. WRAP data Controls
7. WRAP Access Controls
8. Administrative Actions
9. OIT Workload Report/Product Controls
10. OIT Collection & Retention Controls
11. OIT Dev Monthly Backup Testing
12. OIT Administrative Actions
13. Monthly Performance Reporting

1
Process to Close Incomplete Applications
Health Eligibility Center

• Executed statutory authority (38 USC 5102) to close incomplete applications


after 365 days.
• Initial distribution of 365-day letters deployed beginning March 07, 2016,
followed by monthly distribution, as required.
• Beginning March 2017, Veterans who received 365-day letters, and do not
respond with required information, will be moved to a closed application status.
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• Beginning March 2016, Veterans began receiving letters (per 38 USC 5102)
requesting missing military service information or missing financial information
needed to complete their health care application. If Veteran does not submit
the required information within 365 days from date of letter, their application is
closed. The Veteran will need to re-submit an application to receive VA
healthcare services.

2
Combat Veteran Enrollment
Health Eligibility Center

• One-time Auto-Enrollment of 75,850 Combat Veterans (Completed 01/13/17)


• Enrolled 9,708 Still-Eligible Combat Veterans Pending; Means Test Required
• Enrolled 66,142 Previously Enrolled Combat Veterans Pending; Means Test Required
• Interim Solution for New Applications: Manual enrollment within 48 hours,
followed by outbound telephone call confirming enrollment on all new Combat
Veterans Pending Means Test.
• Long-Term Solution for New Applications: OI&T will make a change to the ES to
eliminate the need for a Means Test for Combat Veterans, allowing eligibility
determination to be made automatically. Estimated Implementation Date:
Summer 2017
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• Enrollment System (ES) places Combat Veterans in a Pending; Means Test
Required status until Means Test (financial assessment) is submitted. Combat
Veterans are not required to provide a Means Test to receive VA health care.
3
Online Application Processing Defects
Health Eligibility Center

• Service defects were discovered following Vets.gov Health Care Application


(HCA) launch on June 30, 2016.
• 8,441 records required manual processing due to service defects. All records
were reviewed and provided determination by September 2016.
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• Following the launch of Vets.gov Health Care Application (HCA) on June 30,
2016, service defects were discovered which caused some records not to
transmit or be received correctly. These records required manual processing.
Subsequent submissions were redirected until service fixes were completed in
November 2016. Submissions were not being transmitted correctly to the
Enrollment System (ES).
• 8,441 submissions were affected by the service defect. These records were
reviewed and manually processed.

4
Vista 1010EZ Holding File Backlog
Health Eligibility Center

• In September 2016, 17,728 applications were discovered in the 1010EZ Holding


File requiring final processing. In October 2016, Health Eligibility Center (HEC)
disseminated instruction to field sites to process the pending applications in the
VistA 1010EZ Holding File. As of December 31, 2016, 17,665 applications were
processed.
• In November 2016, OI&T released a transmission fix to eliminate the need for
files to go to the 1010EZ Holding File but to transmit directly to ES for
processing.
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• 1010EZ Holding File is the term for field site’s databases where 1010EZ
applications were routed for processing by onsite staff.
• Due to processing failures between the online Health Care Application (HCA)
web service and the Enrollment System (ES), applications were routed to the
field sites for processing beginning August 20, 2016. The Office of Information
and Technology (OI&T) completed a web service fix in November 2016. 5
Concierge for Care (C4C)
Health Eligibility Center

• Proactive health care enrollment model for Transitioning Service Members


(TSMs) and Veterans.
• Collaborative effort with DoD and Social Behavioral Sciences Team.
• Health Executive Committee (HEC) briefing occurred October 2016.
• Benefits Executive Committee (BEC) briefing occurred December 2016.
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• C4C is an effort to actively engage Transitioning Service Members and Veterans
regarding their VA health care options. Focus to improve ease of use of VHA
enrollment services and the customer experience for Transitioning Service
Members (TSMs).
• Operational October 2017.

6
Hot Springs Call Center
Health Eligibility Center

• Recruitment efforts to hire 120 employees to fill positions for the Member
Services Hot Springs Call Center began November 2016.
• The goal is to have 120 staff hired by April 16, 2017.
• There are a multiple positions from GS-5 to GS-12, in which over hundreds of
applications were received.
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• VHA Member Services sought out the VA Black Hills Health Care System, Hot
Springs campus for space to accommodate VA employees who will provide
services to Veterans and their beneficiaries through call center support for
eligibility, enrollment, and pharmacy-related inquiries. Currently, Member
Services operates out of facilities in Atlanta, GA.; Canandaigua, NY; Topeka, KS.;
Waco, TX; Fort Riley, KS.; with various staff working virtually throughout the
continental United States.