Federal Reports

The Refugee Act of 1980 created the Refugee Resettlement Program (RRP) to provide for the effective resettlement of refugees and to assist them in achieving economic self-sufficiency after arriving in the United States. The Act provides Federal grants to States for cash and medical assistance, social services, and targeted assistance to help qualified refugees. Within HHS, the Administration for Children and Families, Office of Refugee Resettlement (ORR) runs the RRP program. In 2015 and 2016, ORR obligated $286 million and $417 million, respectively, to States for the RRP.

2019 Financial Statement Audit Opinion (November 20, 2019)

CPF Audit Opinion and Financial Statements FY 2019 (October 31, 2019)

The VA Office of Inspector General (OIG) conducted this audit to determine if the Veterans Health Administration (VHA) is efficiently managing positive airway pressure devices (sleep apnea devices) and supplies for veterans diagnosed with sleep apnea. The number of veterans diagnosed with sleep apnea who receive devices and supplies increased dramatically between fiscal years 2014 and 2018. This has significantly increased the financial risk to VA. If VHA does not change its practices and leverage opportunities to save money, the OIG estimates it risks spending about $261.3 million over the next five years on devices and supplies veterans will not use. VHA did not efficiently manage sleep apnea devices and associated supplies. The OIG found that almost half of the 250,000 veterans issued a device from October 2016 through May 2018 used it less than half the time. This can reduce therapy effectiveness. The mismanagement occurred in part because VHA did not identify and follow up with veterans who were not using their devices as recommended. The OIG also found that VHA did not have a sleep medicine staffing model to help ensure it conducted patient follow up. A model will determine staffing to help ensure follow up is conducted. VHA could save up to $39.9 million per year by loaning devices to veterans rather than issuing them for permanent use. A loan program would allow unused devices to be returned and reused. VHA could save up to an additional $12.4 million per year by not purchasing device supplies for veterans who do not use their devices. The OIG made three recommendations to the under secretary for health regarding sleep apnea device management. The recommendations include studying staffing levels, looking at using existing technologies to better monitor device use, and looking at alternatives to purchasing devices.

This Comprehensive Healthcare Inspection Program (CHIP) provides a focused evaluation of the quality of care delivered at the Richard L. Roudebush VA Medical Center, covering leadership and organizational risks and key processes associated with promoting quality care. For this inspection, areas of focus included Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Controlled Substances Inspections; Mental Health: Military Sexual Trauma Follow-Up and Staff Training; Geriatric Care: Antidepressant Use among the Elderly; Women’s Health: Abnormal Cervical Pathology Results Notification and Follow-Up; and High-Risk Processes: Emergency Department and Urgent Care Center Operations. The leadership team was relatively new, having worked together for about four months as of the week of the OIG’s visit. Selected survey scores related to employee satisfaction and patient experience were generally better than the VHA average but revealed some opportunities for improvement. The OIG reviewed accreditation agency findings, sentinel events, adverse patient event disclosures, patient safety indicator data, and identified organizational risk factors. Leaders were generally knowledgeable about selected Strategic Analytics for Improvement and Learning metrics but should continue to act to sustain and improve performance of measures contributing to the facility’s “3-star” quality rating. The OIG issued 13 recommendations for improvement: (1) Quality, Safety, and Value • Peer Review Committee summary reports • Interdisciplinary review of utilization management data • Review of relevant literature in root cause analyses • Resuscitative episode reviews • Implementation and monitoring of corrective actions (2) Medical Staff Privileging • Focused professional practice evaluation processes (3) Environment of Care • Wheelchair maintenance (4) Medication Management: Controlled Substances Inspections • Controlled substances inspection report reviews • Signatures for controlled substances waste • Override report reviews (5) Geriatric Care: Antidepressant Use among Elderly • Patient/caregiver education • Medication reconciliation (6) Women’s Health: Abnormal Cervical Pathology Results Notification and Follow-up • Women Veterans Health Committee membership composition

During prior reviews, we determined that New York claimed Medicaid reimbursement for home and community-based services (HCBS) under Medicaid waiver programs that did not comply with Federal requirements. New York's Bridges to Health (B2H) was an HCBS waiver program.