Open Recommendations

Reassess the amount and condition of leased storage space needed to support current program operations and reduce waste.

Work with states to ensure appropriate job classifications for disability determination services (DDS) employees, particularly disability examiners.

Resume the retention and recruitment workgroup, or a similar endeavor, to develop initiatives that provide support to DDSs.

Consider technologies, such as artificial intelligence, that could accelerate the Transferability of Skills Assessment or other processes without compromising the accuracy of DDS' disability determinations.

Work with DDSs to identify an ideal staffing level at each DDS and estimate the costs to achieve those staffing levels to support congressional budget requests.

Create procedures that give DDSs the flexibility to replace staffing losses as needed throughout the year based on annual budget estimates.

The District 5 Director conducts a full review of care provided to the client by the Everett Vet Center Director and counselor, consults with Human Resources and General Counsel Offices, and takes action as needed.

The District 5 Director ensures vet center leaders and staff are knowledgeable about applicable state laws pertaining to duty to warn.

The District 5 Director makes certain that the Everett Vet Center Director and staff adhere to requirements for consultation with support facility external consultants and suicide prevention coordinators when indicated, and monitors compliance.

The Chief Officer, Readjustment Counseling Service provides written guidance to clarify crisis reporting criteria and monitoring responsibilities.

The Chief Officer, Readjustment Counseling Service establishes written policy that clarifies clinical record documentation requirements regarding entry dates; non-visit progress note completion time frames; and progress note deletion and addition, and monitors compliance.

The Chief Officer, Readjustment Counseling Service establishes written guidance regarding time requirements for the completion of risk assessment documentation in clients’ clinical records.

The District 5 Director ensures readjustment counselors’ compliance with updating and reviewing safety plans as required by Readjustment Counseling Service policy.

The Chief Officer, Readjustment Counseling Service ensures that vet center directors are issued the correct position description and are performing duties within the identified scope of work.

The District 5 Director conducts a review of the care provided to complex clients by the Everett Vet Center Director since March 2021 and addresses identified clinical needs.

We recommend that the Grantee develop and implement written policies and procedures surrounding the management of Federal awards, in accordance with the Uniform Guidance and the ARC grant manual.

We recommend that the Grantee establish a proper accounting system to accurately maintain and track grant records of funds related to Federally-funded activities, in accordance with Federal requirements.

The Under Secretary for Health assesses the feasibility of the 7-day appointment scheduling requirement for Care in the Community consults and considers stratifying the time frame requirement according to risk.

The VA Maryland Health Care System Director develops and implements an education plan to address incomplete Care in the Community consult submissions and monitors efficacy of the plan.

The VA Maryland Health Care System Director implements Care in the Community consult management process improvements, focusing on consult completion.

The Veterans Integrated Service Network Director assists system leaders with completing corrective actions to improve Care in the Community performance.

The VA Maryland Health Care System Director ensures system Care in the Community staff create and use care coordination plan notes for documenting all care coordination activities for consults with an assigned level of care other than basic and monitors for compliance.

The VA Maryland Health Care System Director ensures full implementation of Veterans Health Administration’s enhanced Referral Coordination Initiative as required and monitors for compliance.

The VA Maryland Health Care System Director ensures Care in the Community Patient Advocate Tracking System data is analyzed for use in service-level quality and process improvement and monitors for compliance.

We recommend that USAID/Kenya and East Africa determine the allowability of $171,432 in ineligible questioned costs identified on page 18 of the audit report and recover any amount that is unallowable.