Federal Reports

The VA Office of Inspector General (OIG) conducted an inspection to evaluate novel coronavirus disease (COVID-19) screening processes at 237 VA facilities (medical centers, community-based outpatient clinics, and community living centers) and to collect data on pandemic preparations. Screening processes at 71 percent of visited medical centers were adequate, while 28 percent had opportunities for improvement. The vast majority of community-based outpatient clinics had screening procedures in place. Although VA announced a no visitors policy for community living centers on March 10, 2020, OIG staff had access to nine. Almost all medical facilities visited were collecting COVID-19 specimens, but none had the capability to process them on site. Facility leaders indicated that the VA Palo Alto Health Care System (a site not visited by OIG) was processing specimens. Facility leaders reported that the medication inventory used to (1) manage symptoms, (2) treat critically ill patients to support cardiovascular functions, and (3) sedate intubated patients may be insufficient. Some facility leaders expressed concerns with their inventory of COVID-19 testing kits and personal protective equipment supplies. Almost half of facility leaders reported a rise in absenteeism but were able to provide coverage or offer overtime pay to minimize impact. Some facilities reported low staffing levels for police and environmental management services. As of March 19, 2020, 43 percent of facility leaders reported plans to share intensive care beds, personal protective equipment supplies, or both, with community providers. Most leaders stated they would send patients to either another VA medical center, a private, community, university, or Department of Defense hospital if unable to meet patient care needs related to COVID-19. The OIG recognizes VA staff’s tremendous efforts and that challenges related to the pandemic may change rapidly. The OIG will continue to monitor VHA’s readiness efforts.

Williams Adley found that FEMA did not ensure that the Puerto Rico Department of Housing (PRDOH) established and implemented policies, procedures, and practices to account for and expend Public Assistance (PA) grant funds according to Federal regulations and FEMA guidance. Specifically, PRDOH did not have sufficient controls over its processes for claiming force account labor costs. This occurred because FEMA did not provide adequate oversight and ensure PRDOH correctly entered its employees’ timesheets into the payroll system, increasing the risk of fraud that might occur and not be detected. We made two recommendations to improve PRDOH’s management of FEMA PA funds, ensuring they are expended according to Federal regulations and FEMA guidance. FEMA concurred with the recommendations.

In New York, adult day care facilities provide functionally impaired adults with socialization, supervision and monitoring, and nutrition services in a protective setting. Beneficiaries enrolled in New York's Medicaid managed long-term-care program receive adult day care services from providers contracted with Medicaid managed care organizations (MCOs). New York's health and safety requirements for adult day care facilities are detailed in its MCO contract approved by the Centers for Medicare & Medicaid Services (CMS). Our audits of adult day care facilities in six States identified multiple health and safety issues that put vulnerable adults at risk; therefore, we decided to review similar facilities in New York.