Federal Reports

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of Veterans Health Administration (VHA) facilities’ selected requirements and guidelines for care coordination. This evaluation focused on compliance with program requirements related to life-sustaining treatment decisions for hospice patients.This report describes care coordination findings from healthcare inspections initiated at 36 VHA medical facilities from November 4, 2019, through September 21, 2020, and electronic health record review at five additional randomly selected facilities. Each inspection involved interviews with facility leaders and staff and reviews of clinical and administrative processes. The results in this report are a snapshot of VHA performance at the time of the fiscal year 2020 OIG reviews.During the time frame of this retrospective review, VHA policy required certain elements of goals of care conversations to be documented in patients’ electronic health records. However, in March 2020, VHA revised its policy to require fewer elements. The OIG observed general compliance with the selected requirements after these rules were updated during the review period. However, under the original VHA requirements in place when patients received their care, the OIG estimated that providers did not consistently• identify a surrogate should the patient lose decision-making capacity;• address previous advance directives, state-authorized portable orders, and/or life-sustaining treatment plans; or• address the patient or surrogate’s understanding of the patient’s condition.The OIG did not issue recommendations but developed this summary report for leaders to consider when improving operations and clinical care at VHA facilities.

The objectives of the audit were to determine whether the State of Missouri (Missouri) designed and implemented awarding processes that ensured that the Governor's Emergency Education Relief Fund (GEER grant) was used to support local educational agencies (LEAs) and institutions of higher education (IHEs) that were most significantly impacted by the coronavirus or LEAs, IHEs, or other education-related entities within the State that were deemed essential for carrying out emergency educational services; and monitoring processes to ensure that subgrantees used GEER grant funds in accordance with the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and other applicable Federal requirements.We found that for two of the initiatives Missouri funded with its GEER grant (LEA Transportation Supplement Initiative and IHE Initiative), Missouri’s DESE and DHEWD designed and implemented awarding processes that ensured the GEER grant was used to support LEAs and IHEs that were most significantly impacted by the coronavirus, as determined by the State. However, for the third initiative (LEA Connectivity Initiative), while DESE created a methodology designed to ensure the GEER grant funds were used to support LEAs that were most significantly impacted by the coronavirus, it did not correctly implement the process it designed. We found that for all three initiatives, Missouri ensured that the LEAs and IHEs that received a GEER grant allocation submitted the required applications and assurances. We also found that Missouri followed cash management requirements. We found that Missouri’s DHEWD designed and implemented a comprehensive reimbursement process as its monitoring strategy to ensure that subgrantees of its IHE Initiative used GEER grant funds in accordance with the CARES Act and other applicable Federal requirements. However, we found that DESE’s plan for monitoring subgrantees of its LEA Connectivity and LEA Transportation Supplement initiatives could be strengthened.