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Submission For The Record of Military Officers Association of America

EXECUTIVE SUMMARY

Response to Recommendations of GAO Report on VA’s Federal Recovery Care Program (FRCP)

The Military Officers Association of America (MOAA) concurs with the findings and recommendations in the Government Accountability Office’s (GAO) report, GAO-11-250, issued March 2011, titled, “DoD and VA Health Care; Federal Recovery Coordination Program Continues to Expand but Faces Significant Challenges.”  Specifically, we agree that VA should:

  • Establish systematic oversight of enrollment decisions;
  • Complete development of a workload assessment tool;
  • Document staffing decisions; and,
  • Develop and document a rationale for Federal Recovery Coordinator (FRC) placement.

While we have seen great progress in VA’s development and expansion of the FRCP and just how effective these coordinators are based on feedback from those wounded warriors and family members receiving these services, MOAA believes, as GAO indicates in its report, that more needs to be done in the area of program management and accountability.

Our Association continues to hear from frustrated, and sometimes angry wounded warriors and their caregivers who are confused, overwhelmed or intimidated by the FRCP.  Some have been told they are ineligible for an FRC, some were not informed they were eligible, and others were constrained in accessing program services when and where needed because of improper timing of receipt or coordination of the information.

MOAA believes the absence of a way to systematically identify, track FRCP eligibles and administer case management for this population presents significant issues that need immediate attention.

Additional Recommendations

MOAA offers the following additional recommendations to improve the FRCP:

  • Establish a consistent and uniform system of care coordination in both VA and DoD that includes common terminology and definitions, and provides a simpler way for wounded warriors and their families to access and transition from DoD to VA programs.
  • Incorporate and integrate FRCP GAO recommendations and future program enhancements into the newly establish VA primary caregiver program mandated in the Caregivers and Veterans Omnibus Health Services Act of 2010 to ensure consistent and uniform enrollment criteria, terminology, and tracking procedures across the system.
  • Expand outreach and communication efforts in DoD and VA medical and benefit systems to help increase awareness of the FRCP and how to enroll eligible members and by conducting periodic needs assessment surveys to get feedback from wounded warriors and their families to improve the program and identify unmet needs.

MADAM CHAIRMAN BUERKLE, RANKING MEMBER MICHAUD AND DISTINGUISHED MEMBERS OF THE SUBCOMMITTEE, thank you for convening this important hearing and allowing the Military Officers Association of America (MOAA) to provide our observations concerning the GAO findings on the FRCP and offer our recommendations.

MOAA thanks the Subcommittee for its leadership in recent years to enhance programs in the VA for our wounded warriors and their families and to provide necessary oversight to ensure progress continues to made in the area of health care and benefits so these individuals will have the best quality of life possible over their lifetime. 

GAO Report Findings 

Many of the broad departmental issues plaguing both VA and DoD systems are also impacting and limiting FRCP, and likely a number of other wounded warrior programs, preventing them from effectively and efficiently meeting the needs of our most vulnerable servicemembers and disabled veterans who critically need these support services. 

Specifically, GAO cites limitations in:

  • information sharing;
  • multiple VA and DoD case management programs for the same wounded warriors;
  • Federal Recovery Coordinators (FRCs) relying on referrals to identify eligible enrollees;
  • role confusion on the part of FRCs and DoD-Service Recovery Care Coordinators and the numerous other case managers overseeing wounded warrior care; and
  • issues of compliance, accountability and oversight within the FRCP and across VA that inhibit uniformity and consistency of operations to achieve a state of seamless transition.

MOAA is deeply troubled at GAO’s finding that “VA does not know the number of severely wounded servicemembers in the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) conflicts because ‘severely wounded’ is not a categorical definition used by the DoD or VA medical and benefits programs.  Further, that estimates of the size of the severely wounded population vary depending on definitions and methodology.”

While much has improved in the last two years as the FRCP expanded to meet workload and improve seamless transition between the two programs, MOAA is very concerned that VA and DoD systems still struggle with basic terminology, policy, and management and technological system differences after more than a decade of war. 

The fact that the FRCP system was the first care coordination program jointly developed by the two agencies would lead one to believe that the program will be institutionalized and serve as a model for other VA-DoD collaboration.   But persistent problems with information sharing and other long standing issues, to include the proliferation of duplicative programs for recovering servicemembers and veterans, points to a greater systemic problem well above the control of the Executive Director of the FRCP.

The fact that VA must rely on referrals to identify eligible individuals for the program makes the program vulnerable to inconsistencies and inefficiencies, and those not identified are also more likely to fall through the administrative cracks, resulting in unintended medical consequences.

MOAA concurs with GAO’s assessment of the program and urges the Congress to require both VA and DoD to provide a report to this Subcommittee on their progress in addressing these issues and implementing the GAO recommendations.

Additional Recommendations for Consideration

MOAA believes that fixing the FRCP, in and of itself, will not address the challenges facing the program.  Multiple case management systems and case managers assigned to wounded warriors and the proliferation of programs and services in both the VA and DoD medical, personnel and benefits systems have greatly confused and overwhelmed wounded warriors and their families and have further stressed systems already unable to meet the demands and fallout of war.

Recommend establishing a consistent and uniform system of care coordination in both VA and DoD that includes common terminology, definitions, and provides a simpler way for wounded warriors and their families to access and transition from one system to the other.

With the lessons learned from establishing and implementing the FRCP and remaining issues that need to be addressed, VA has a unique opportunity to apply these experiences and knowledge as it rolls out the new primary caregiver program mandated in the Caregivers and Veterans Omnibus Health Services Act of 2010.  VA officials have stated on a number of occasions their difficulty in identifying the population that is eligible for the new caregiver services and benefits. If the two systems are focusing on the same population of severely wounded, then the transition process should be more streamlined and seamless.

We repeatedly hear from servicemembers and veterans who have an FRC how great the program is and how the FRCs are an important lifeline.  Our Association believes it is important for DoD and Service programs to learn from VA and wounded warriors’ experiences.

MOAA recommends VA incorporate FRCP GAO recommendations and future program enhancements into the newly established VA primary caregiver program to ensure consistent and uniform enrollment criteria, terminology, and tracking procedures across the system.

A recurring theme we hear from wounded warriors and family members is the overwhelming amount of information and program services pushed at them when they aren’t ready to receive it, or are not in a position to understand the information given to them, rather than making it accessible when and where they need it.  Disturbingly, others have never received information or have been given only limited information about programs like the FRCP or support services. 

Wounded warriors and families have become increasingly vocal in letting government program leaders know that they want to be consulted and included in developing and establishing new programs rather than having the administrators assume they know what is best for these individuals.  In other words, they want leaders to make greater efforts to ask about and understand their needs before programs are developed that don’t fit them.

MOAA recommends expansion of outreach and communication efforts in DoD and VA medical and benefit systems to help increase awareness of the FRCP and how to enroll and by conducting periodic needs assessment surveys to obtain and use feedback from wounded warriors and their families to improve the program and identify unmet needs.