VA lacks contingency budget modeling to prepare for health crises like COVID, GAO says

VA lacks contingency budget modeling to prepare for health crises like COVID, GAO says

If another major health crisis like the COVID-19 pandemic occurs, the Department of Veterans Affairs may not have a way to calculate the additional costs needed to address it, a Government Accountability Office report said Thursday.

The report — which examined how the VA allocated $36.7 billion in additional funding received during the pandemic — found that the department strengthened a host of health care delivery functions, as well as information technology capabilities to expand telehealth services, during the crisis. health and factored the costs of continuing those few services into his fiscal 2024 budget.

However, the GAO said that with COVID funds expiring in September 2023, the VA lacks the ability to model for future disasters and how much it will need to meet them.

“This type of modeling has been used by other federal agencies to prepare for catastrophic events,” the report states. “For example, the Federal Emergency Management Agency uses advanced analytical modeling to inform its flood insurance program and statistical modeling to determine workforce baselines for future emergencies.”

GAO officials said that when the COVID pandemic emerged in 2020, the VA was not prepared to provide additional funding estimates than it would need to address the crisis because it lacked historical knowledge and analytical modeling capabilities.

Instead, it informs its funding requests with information “such as reported cases of COVID-19

in China and the Cruise Industry’s Early Experiences with COVID-19,” alongside the department’s own response data and levels of COVID-19 transmission for funding bills such as the CARES Act, the Families First Response Act, and The American Rescue Plan Act.

According to the report, VHA officials lack the analytical modeling needed to predict the costs of a catastrophe because it is not within the scope of even its actuarial model used to develop the estimates, known as the Enrolled Health Care Design Model. , or the contract of the actuarial consultant used. to help inform it.

“Partly as a result of lacking the modeling capacity to prepare estimates for catastrophic events, VHA needed to make multiple transfers of CARES Act funds to accommodate the changing needs of the pandemic and was more general in identifying needs when requesting funds ARPA,” report. said.

The GAO also said that while VHA officials also adjusted the EHCPM to account for pandemic impacts when they drafted the department’s 2024 budget request, they did not detail key decisions that VHA and its actuarial consultant made in developing this year’s model.

The EHCPM accounts for 84% of VHA’s health care budget estimate, including outpatient and inpatient health care services provided at VA facilities and community providers, over two fiscal years — with some budget projections made three to four years.

But the report said that VHA has not shared key details of the decision by EHCPM with either VHA’s Office of Registration and Forecasting or VHA Finance.

“VHA does not document or share all key EHCPM decisions because there is no requirement to do so,” the report said, noting that a September 2023 standard operating procedure provides “guidance on processes and deliverables” but does not requires key documentation. decisions that informed EHCPM scenarios with other stakeholders.

GAO offered two recommendations, including a compilation requirement to document and share the rationale for key EHCPM decisions with internal VHA stakeholders and enhancing VA’s analytical modeling capacity to account for catastrophic events.

VA officials agreed with the recommendations and planned to create a task force to evaluate appropriate models. However, GAO officials said “it is unclear from VA’s response how this task force will enhance VA’s modeling capacity” and added that they will continue to monitor the department’s work on the issue.

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