Federal Reports

The VA Office of Inspector General (OIG) conducted a healthcare inspection to assess Veterans Health Administration (VHA) facilities’ utilization of clinical pharmacists who work under a scope of practice in a mental health outpatient care setting. After reviewing relevant policies and conducting interviews, the OIG found that mental health clinical pharmacists’ (MHCPs’) independence levels were not clearly identified by staff or facilities’ bylaws. Guidance provided conflicting instructions regarding requirements for collaborating agreements and lacked provision for oversight by a specific physician. Facilities’ scopes of practice were inconsistent in describing delegated duties that were specific to mental health. VHA policy was insufficient to ensure the chief of mental health reviews and endorses MHCPs’ scopes of practice. Referral processes were not clear or standardized regarding how diagnoses were conveyed to MHCPs or whether involvement of a licensed independent practitioner with prescriptive authority was considered to determine appropriateness for patients’ referrals. VHA policy does not require a defined process to consider patient’s clinical complexity and policies lacked guidance instructing MHCPs on when or how to refer patients to a higher level of care. The OIG made nine recommendations to the VHA Under Secretary for Health related to autonomy, collaborating agreements, collaborating with licensed independent practitioners with prescribing authority, scopes of practice, and referrals.

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements

We reviewed whether RUS rural infrastructure programs ensured that Native American communities were informed of and appropriately received communityspecific benefits.