VA Health Care: Preliminary Information on Resources Allocated	 
for Mental Health Strategic Plan Initiatives (28-SEP-06,	 
GAO-06-1119T).							 
                                                                 
The Department of Veterans Affairs (VA) provides mental health	 
services to veterans with conditions such as post-traumatic	 
stress disorder (PTSD) and substance abuse disorders. To address 
gaps in services needed by veterans, VA approved a mental health 
strategic plan in 2004. VA planned to increase its fiscal year	 
2005 allocations for plan initiatives by $100 million above	 
fiscal year 2004 levels. VA also planned to increase its fiscal  
year 2006 allocations for plan initiatives by $200 million above 
fiscal year 2004 levels--composed of $100 million for		 
continuation of fiscal year 2005 initiatives and an additional	 
$100 million identified in the President's fiscal year 2006	 
budget request. GAO was asked to provide preliminary information 
on VA's allocation and use of funding for mental health strategic
plan initiatives in fiscal years 2005 and 2006. A report on this 
work will be issued later in the fall of 2006. GAO reviewed VA	 
reports and documents on mental health strategic plan initiatives
and conducted interviews with VA officials from headquarters, 4  
of 21 health care networks, and 7 medical centers. VA delegates  
decision making to its health care networks for most budget and  
management responsibilities regarding medical center operations, 
and medical centers receive most of their resources from the	 
networks.							 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-06-1119T					        
    ACCNO:   A61546						        
  TITLE:     VA Health Care: Preliminary Information on Resources     
Allocated for Mental Health Strategic Plan Initiatives		 
     DATE:   09/28/2006 
  SUBJECT:   Alcohol or drug abuse problems			 
	     Federal funds					 
	     Funds management					 
	     Health care services				 
	     Mental health					 
	     Mental health care services			 
	     Mental illnesses					 
	     Post-traumatic stress disorders			 
	     Strategic planning 				 
	     Veterans						 
	     Allocation (Government accounting) 		 

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GAO-06-1119T

     

     * Background
     * VA Allocated $88 of the $100 Million Planned for Mental Heal
          * VA Allocated Approximately $53 Million Directly to Medical C
          * VA Allocated $35 Million through Its General Resource Alloca
          * VA Did Not Allocate About $12 Million Planned for Mental Hea
          * Medical Center Officials Reported Using Allocations for Ment
     * As of September 20, 2006, VA Had Allocated $158 Million of t
          * VA Allocated about $158 Million Directly to Medical Centers
          * VA Did Not Allocate about $42 Million for Mental Health Stra
          * Medical Center Officials Reported Using Allocations for Ment
     * Concluding Observations
     * GAO Contact and Staff Acknowledgments
     * GAO's Mission
     * Obtaining Copies of GAO Reports and Testimony
          * Order by Mail or Phone
     * To Report Fraud, Waste, and Abuse in Federal Programs
     * Congressional Relations
     * Public Affairs

Testimony

Before the Subcommittee on Health, Committee on Veterans' Affairs, House
of Representatives

United States Government Accountability Office

GAO

For Release on Delivery Expected at 10:00 a.m. EDT

Thursday, September 28, 2006

VA HEALTH CARE

Preliminary Information on Resources Allocated for Mental Health Strategic
Plan Initiatives

Statement for the Record by Laurie E. Ekstrand

Director, Health Care

GAO-06-1119T

Mr. Chairman and Members of the Subcommittee:

We are pleased to have the opportunity to provide preliminary information
from our work on the Department of Veterans Affairs (VA) resource
allocation for mental health strategic plan initiatives for fiscal years
2005 and 2006 and how those funds were used by selected medical centers in
those 2 fiscal years. VA provides a range of inpatient and outpatient
mental health services to veterans with conditions such as depression,
post-traumatic stress disorder (PTSD), and substance abuse disorders. In
November 2004, the Secretary of VA approved a mental health strategic plan
that identified additional services that VA planned to add to the baseline
of mental health services that it already offered to meet veterans' mental
health needs.1 This mental health strategic plan was intended to help VA's
leadership identify the actions and resources needed to begin eliminating
the gaps between mental health services VA provided at the time of the
plan's formulation and those additional services VA anticipated it would
need in the future.

VA indicated at a 2005 congressional hearing2 that it would provide $100
million above fiscal year 2004 levels for mental health strategic plan
initiatives in fiscal year 2005 from available resources. In addition, in
a 2005 executive decision memo VA indicated its intent to increase its
fiscal year 2006 funding levels to $200 million above fiscal year 2004
levels for mental health strategic plan initiatives. This $200 million in
funds for fiscal year 2006 was to be composed of $100 million for a
continuation of fiscal year 2005 initiatives plus an additional $100
million included in the President's budget request for fiscal year 2006,
according to the executive decision memo. However, these additional funds
represented only a portion of the overall funds available to support VA
mental health services in those 2 fiscal years. VA's appropriation for
fiscal year 2006, for example, included more than $31.5 billion for its
medical programs,3 of which VA expected to spend more than $2 billion on
mental health services. VA headquarters allocates most of these resources
to VA's 21 regional health care networks4 through a general resource
allocation system and the networks in turn allocate resources to their
medical centers.

1The plan is known formally as A Comprehensive Veterans Health
Administration Strategic Plan for Mental Health Services. In this
statement, we will refer to it as the mental health strategic plan.

2Full Committee Hearing on the Continuum of Care for Post Traumatic Stress
Disorder Before the House Comm. on Veterans' Affairs, 109th Cong. (July
27, 2005).

3Total includes medical care collections, but does not include certain
other amounts, such as appropriations for construction.

VA officials have stated that funds for mental health strategic plan
initiatives are to be used to address priorities such as the expansion of
PTSD services, postdeployment mental health services for veterans
returning from combat in Iraq and Afghanistan and other areas-Operation
Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), respectively,
and expansion of programs for the treatment of substance abuse disorders.
Concerns have been expressed by members of Congress and others regarding
the adequacy of resources that VA is devoting to provide mental health
care for OIF and OEF veterans while also continuing to provide services
for veterans who are currently receiving mental health care.

In this statement we are providing preliminary information on VA's
spending for mental health strategic plan initiatives in fiscal years 2005
and 2006. We are currently examining the allocation and use of these
additional funds targeted to mental health strategic plan initiatives.
Therefore, we focus on the increase from fiscal year 2004 targeted on
these initiatives--$100 million in fiscal year 2005 and $200 million in
fiscal year 2006. In this statement we provide (1) information on how much
of the $100 million for mental health strategic plan initiatives in fiscal
year 2005 was allocated and how those funds were used by selected medical
centers, and (2) information on how much of the $200 million for mental
health strategic plan initiatives in fiscal year 2006 was allocated and
how those funds were used by selected medical centers. A more detailed
report concerning these issues and how VA tracked the use of the funds
allocated will be issued later in the fall of 2006.

To provide information on how much of the $100 million for fiscal year
2005 and $200 million for fiscal year 2006 for mental health strategic
plan initiatives was allocated to networks, medical centers, and certain
offices, we reviewed the plan itself as well as reports and other
documents related to the development, implementation, and funding of the
mental health strategic plan. We also conducted interviews with VA
headquarters officials with responsibilities related to mental health
services, budgeting, and the allocation of financial resources. We used a
September 20, 2006, cut off date for reviewing VA's allocation of the $200
million for implementing the mental health strategic plan in fiscal year
2006. We took steps to ensure that the data VA provided to us on the
funding allocated in fiscal years 2005 and 2006 were sufficiently reliable
for our purposes. We reviewed the data for internal consistency and
compared the data to other VA information as well as information we
obtained through interviews with VA officials. We did not independently
verify the accuracy of the data. To describe how funds were used by
selected medical centers, in May and June 2006, we conducted site visits
to 2 of VA's 21 health care networks and 3 medical centers located in
those networks, and we also conducted phone interviews with officials in 2
other networks and 4 medical centers located in those networks.5 We
selected these 4 networks because VA had identified them as having gaps in
substance abuse and/or mental health services prior to the implementation
of the mental health strategic plan, and because they received varying
levels of funding-from relatively high to relatively low-in fiscal year
2005 for mental health strategic plan initiatives. We interviewed clinical
and administrative officials at these networks and medical centers, and at
3 community based outpatient clinics (CBOC)6 associated with these medical
centers and 5 Vet Centers.7 The findings from our site visits and phone
interviews with network and medical center officials cannot be generalized
to other medical centers or networks. We discussed the information in this
statement with VA officials who have responsibilities related to mental
health services, budgeting, and the allocation of financial resources.
These officials agreed that the data are accurate and they also provided
updated data which we incorporated as appropriate. We performed our work
from January 2006 through September 2006 in accordance with generally
accepted government auditing standards.

4VA headquarters delegates decision making regarding financing and service
delivery for health care services to its 21 health care networks,
including most budget and management responsibilities concerning medical
center operations. Medical centers typically include one or more hospitals
as well as other types of health care facilities such as outpatient
clinics and nursing homes.

5Throughout this report, the phrase "how funds were used by medical
centers" refers to information provided by medical center officials
regarding the hiring of staff, purchase of certain equipment, and other
purposes. These activities would be expected to result in obligations and
expenditures of funds either immediately or in the future.

6CBOCs provide medical services, which may include mental health services,
on an outpatient basis in local communities. VA has about 800 CBOCs
nationwide.

7Vet Centers provide mental health services, including readjustment
counseling and outreach services, to all veterans who served in any combat
zone. There are 207 such centers that operate in all 50 states, the
District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.

In summary, VA headquarters allocated $88 million of the $100 million VA
officials said would be used for mental health strategic plan initiatives
in fiscal year 2005 by using several approaches. VA allocated about $53
million directly to medical centers and certain offices based on proposals
submitted for funding and other approaches targeted to specific
initiatives. VA solicited submissions from networks for specific
initiatives to be carried out at their individual medical centers through
requests for proposals (RFPs). In addition, VA headquarters officials said
that they allocated $35 million for mental health strategic plan
initiatives through VA's general resource allocation system to its 21
health care networks, which, in turn, could allocate these resources to
individual medical centers. VA's decision that $35 million of the funds
allocated through its general resource allocation system was for plan
initiatives was a retroactive decision. VA made this decision several
months after resources had been provided to the networks through the
general allocation system. Moreover, VA did not notify networks and
medical centers that these funds were to be used for plan initiatives.
Network and medical center officials we interviewed in 4 networks told us
that they were unaware that any portion of their general allocation was to
be specifically used for mental health strategic plan initiatives. The
approximately $12 million remaining of the $100 million was not allocated
by any approach because, according to headquarters officials, there was
not enough time during the fiscal year to allocate the funds. Officials we
interviewed at 7 medical centers in 4 networks reported using resources
allocated directly to their medical centers for plan initiatives that
included new mental health services and more of the services they were
already providing. Some medical center officials told us that they had not
been able to spend all of the funds provided for mental health strategic
plan initiatives during the fiscal year in part because of the length of
time it takes to hire new staff.

As of September 20, 2006, VA headquarters had allocated $158 million of
the $200 million VA planned for mental health strategic plan initiatives
in fiscal year 2006 by using several approaches. VA allocated about $92
million of these funds directly to medical centers and certain offices to
support new mental health strategic plan initiatives, using RFPs and other
approaches targeted to specific initiatives. VA also allocated about $66
million to support the recurring costs of continuing mental health
strategic plan initiatives that were funded in fiscal year 2005 through
RFPs and other targeted approaches. About $42 million of the $200 million
for fiscal year 2006 had not been allocated as of September 20. According
to VA officials, a portion of the $42 million not allocated is a result of
partial-year allocations made for projects that were funded later in the
fiscal year and that are expected to receive 12-month allocations for
fiscal year 2007. Officials we interviewed at 7 medical centers said they
had used funds to implement plan initiatives such as a new mental health
intensive case management program. However, officials at some medical
centers told us that they were uncertain that they would be able to use
all the funds for plan initiatives by the end of the fiscal year.

                                   Background

VA provides health care services to more than 5 million patients annually.
This care includes mental health services to veterans in inpatient and
outpatient settings in a variety of VA health care facilities including
medical centers, CBOCs, and Vet Centers. Mental health services are
provided for a range of conditions such as depression, PTSD, and substance
abuse disorders. Resources for these and other health care services are
allocated by VA headquarters through a general resource allocation
system-the Veterans Equitable Resource Allocation (VERA) system-to its 21
health care networks. Although the VERA system is used to allocate funds,
it does not designate funds for specific purposes or prescribe how those
funds are to be used.

In November 2004, the Secretary of VA approved the mental health strategic
plan. This mental health strategic plan contained recommended initiatives
for improving VA mental health services by addressing a range of issues,
including, for example, improving awareness about mental illness and
filling gaps in access to mental health services. Some of the service gaps
identified were in treating veterans with serious mental illness,8 female
veterans, and veterans returning from combat in Iraq and Afghanistan.
Within VA, the Office of Mental Health Services (OMHS) is responsible for
coordinating with the networks and medical centers on the overall
implementation of the mental health strategic plan. This includes
formulating strategies for allocating funds to medical centers and certain
offices for plan initiatives. Such strategies include, for example, the
use of RFPs to decide how the mental health strategic plan funds are to be
allocated to medical centers.

8For the purposes of the mental health strategic plan, VA defined veterans
with serious mental illness to be "those who currently or at any time
during the past year: (1) have a diagnosed mental, behavioral or emotional
disorder of sufficient duration to meet the Diagnostic and Statistical
Manual of Mental Disorders (Fourth Edition) criteria, that (2) results in
a disability (i.e. functional impairment that substantially interferes
with or limits one or more major life activities)." This definition
included adults who would meet these criteria during the year without the
benefit of treatment or support services.

 VA Allocated $88 of the $100 Million Planned for Mental Health Strategic Plan
 Initiatives in Fiscal Year 2005, but Officials Reported That Not All Allocated
                      Funds Were Used for Plan Initiatives

VA headquarters allocated $88 million of the $100 million that VA
officials said would be used for mental health strategic plan initiatives
in fiscal year 2005 by using several approaches. About $53 million was
allocated directly to medical centers and certain offices and $35 million
was allocated through its general resource allocation system to its health
care networks, according to VA officials. The remaining $12 million of the
$100 million was not allocated by any approach, headquarters officials
said, because there was not enough time during the fiscal year to allocate
the funds. Officials we interviewed at 7 medical centers in 4 networks
reported using allocated funds to provide new mental health services and
to provide more of existing services. However, some medical center
officials reported that they did not use all allocated funds for plan
initiatives by the end of the fiscal year, due in part to the length of
time it took to hire new staff.

VA Allocated Approximately $53 Million Directly to Medical Centers and Certain
Offices

VA headquarters allocated about $53 million directly to medical centers
and certain offices based on proposals submitted for funding and other
approaches targeted to specific initiatives related to the mental health
strategic plan in fiscal year 2005. VA headquarters developed and
solicited submissions from networks for specific initiatives to be carried
out at their individual medical centers through requests for proposals
(RFPs). VA made resources available through these RFPs and other targeted
approaches to medical centers for plan initiatives to support a range of
specific mental health services based, in part, on the priorities of VA
leadership and legislation for programs related to PTSD, substance abuse,
and other mental health areas, according to VA headquarters officials.
Nearly $20 million of the $53 million allocated by using RFPs and other
targeted approaches was for mental health services related to legislation,
according to VA officials.9

9The Veterans Health Care, Capital Asset, and Business Improvement Act of
2003, Pub. L. No. 108-170, S:108, 117 Stat. 2042, 2046-47, required VA to
allocate a minimum of $25 million in each of fiscal years 2004, 2005, and
2006 to carry out a program to expand and improve the provision of
specialty mental health services for veterans, including PTSD and
substance abuse services. Congress also required VA to ensure that after
these allocations, total expenditures related to treatment of substance
abuse and PTSD were not less than $25 million above the total expenditures
on such programs in fiscal year 2003, adjusted for increases in the costs
of delivering those services. The Homeless Veterans Comprehensive
Assistance Act of 2001, Pub. L. No. 107-95, S:2043, 115 Stat. 903, 913,
authorized VA to establish up to 10 new domiciliary programs for homeless
veterans.

Most of the approximately $53 million allocated-about $48 million-went to
VA medical centers. PTSD services and OEF/OIF veterans' mental health care
received an allocation of about $18 million, with Compensated Work Therapy
(CWT) receiving the second highest total-nearly $10 million. Other
initiatives receiving funding included substance abuse services, mental
health services in nursing homes, domiciliary expansion, and psychosocial
rehabilitation for veterans with serious mental illness.

VA headquarters issued five RFPs from October 2004 to January 2005 that
described the specific types of services for which mental health strategic
plan funding was available. Review panels headed by mental health experts
within VA reviewed the proposals, ranked them, and provided their rankings
to VA's leadership. Once funding decisions were made, VA allocated funding
directly to the medical centers for the mental health strategic plan
initiatives. VA also used other funding approaches targeted to specific
initiatives. For example, headquarters officials allocated funding to
medical centers to expand mental health services at CBOCs that had fewer
mental health visits than a standard VA identified for this purpose. VA
also used other targeted funding approaches to determine which medical
centers would receive some of the funds for PTSD, OIF and OEF veterans',
and substance abuse services. In addition, VA targeted funds to mental
health initiatives in Polytrauma Centers-centers within certain VA medical
centers that provide specialized treatment for veterans of OIF and OEF who
have complex rehabilitation needs.

VA headquarters officials said that allocations made for initiatives in
fiscal year 2005 through RFPs and other approaches targeted to specific
initiatives would be made for a total of 2 to 3 fiscal years. These
officials said they anticipated that medical centers would hire permanent
staff whose positions would need to be funded for more than 1 year. The
expectation of VA leadership was that after funds allocated through these
approaches were no longer available, medical centers would continue to
support these programs using their general operating funds received
through VA's general resource allocation system.

VA Allocated $35 Million through Its General Resource Allocation System to Its
Health Care Networks on a Retrospective Basis

VA allocated $35 million for mental health strategic plan initiatives in
fiscal year 2005 through its general resources allocation system to its
health care networks, according to VA headquarters officials. The decision
to allocate these resources to VA's networks for mental health strategic
plan initiatives was retrospective and VA did not notify networks and
medical centers of this decision. Although VA headquarters made fiscal
year 2005 general resource allocations to the networks in December 2004,
the decision that $35 million of the funds allocated at that time were for
mental health strategic plan initiatives was not finalized until April
2005, several months after the general allocation had been made. VA
headquarters officials said that they made the decision to allocate $35
million from the general resource allocation system because these
resources would be more rapidly allocated than if they had been allocated
through RFPs. However, other VA headquarters officials told us that the
decision was also made, in part, because VA did not have sufficient
unallocated funds remaining after the December 2004 general allocation to
fund $100 million for mental health strategic plan initiatives through
RFPs and other targeted approaches.

VA headquarters officials, as well as network and medical center
officials, indicated that there was no guidance to the networks and
medical centers instructing them to use specific amounts from their
general fiscal year allocation for mental health strategic plan
initiatives. Network and medical center officials we spoke with were
unaware that any specific portion of their general allocation was to be
used for mental health strategic plan initiatives. Several VA medical
center officials noted, however, that some of the funds in their general
allocation were used to support their mental health programs generally, as
part of their routine operations. However, because network and medical
center officials we interviewed did not know that funds had been allocated
for mental health strategic plan initiatives through VA's general resource
allocation system, nor did VA headquarters notify networks and medical
centers throughout VA of this retroactive allocation, it is likely that
some of these funds were not used for plan initiatives.

VA Did Not Allocate About $12 Million Planned for Mental Health Strategic Plan
Initiatives

VA did not allocate the approximately $12 million remaining of the $100
million planned for mental health strategic plan initiatives in fiscal
year 2005 because, according to VA headquarters officials, there was not
enough time during the fiscal year to allocate the funds through the RFP
process or other approaches targeted to specific initiatives. Officials
said that when resources were allocated later in the fiscal year through
an RFP rather than at the beginning, the amount allocated was only a
portion of the annualized cost. The full annualized cost could be
supported in the next fiscal year. For example, if a project with an
annual cost of $4 million was allocated mid way through the fiscal year,
only half the annual cost was allocated at that time--$2 million. The
expectation was that the full $4 million would be available for the
project over 12 months in the next fiscal year. The $12 million that VA
did not allocate for fiscal year 2005 was intended for certain mental
health strategic plan initiatives based on an allocation plan developed by
VA for the $65 million it planned to allocate through RFPs and other
approaches. VA headquarters officials said that funds not allocated for
mental health strategic plan initiatives were allocated for other health
care purposes.

Medical Center Officials Reported Using Allocations for Mental Health Strategic
Plan Initiatives, but Not Using All Funds Allocated for Plan Initiatives

Officials we interviewed from seven medical centers in four networks
reported using funds allocated to them for mental health strategic plan
initiatives through RFPs and other targeted approaches, but they said that
some of these funds were not used for plan initiatives in fiscal year
2005. Officials said they used funds allocated to provide new mental
health services and to provide more of existing services included in plan
initiatives. For example, two medical centers used funds to increase the
number of mental health providers available at CBOCs. One of those medical
centers also implemented a new 6-week PTSD day treatment program in which
veterans live in the community but come to the medical center daily for
counseling, group therapy, and other services.

Officials at some medical centers reported that they were not able to use
all of their fiscal year 2005 funding for plan initiatives by the end of
the year as planned and cited several reasons that contributed to this
situation. The length of time it takes to recruit new staff in general and
the special problems of hiring specialized staff, such as psychiatrists,
were cited. In some cases the need to locate or renovate space for
programs contributed to delays in using mental health strategic plan
funds, according to medical center officials.

Medical centers varied in how they treated fiscal year 2005 funds that
were allocated by VA for mental health strategic plan initiatives but not
used for those initiatives. Some reported that they carried over the funds
for use in the next fiscal year.10 Officials at some medical centers
reported that they used these funds for other health care purposes. For
example, officials at one medical center said they used funds that they
did not spend on mental health strategic plan initiatives to support other
mental health programs. VA headquarters officials advised participants
from networks and medical centers in a weekly conference call in August
2005 that if they were unable to hire staff for initiatives in fiscal year
2005, they should use the funds allocated only for mental health services.

10VA may carry over from one fiscal year to the next unobligated balances
of funds made available without fiscal year limitation and other funds
appropriated for multiple fiscal years.

  As of September 20, 2006, VA Had Allocated $158 Million of the $200 Million
 Planned for Mental Health Strategic Plan Initiatives in Fiscal Year 2006, but
 Some Officials Were Uncertain If All Funds Would Be Used for Plan Initiatives

As of September 20, 2006, VA headquarters had allocated $158 million of
the $200 million to be used for VA mental health strategic plan
initiatives in fiscal year 2006 by using several approaches. About $92
million of these funds was allocated directly to medical centers and
certain offices to support new mental health strategic plan initiatives
for fiscal year 2006. VA also allocated about $66 million to support the
recurring costs of the continuing mental health initiatives that were
funded in fiscal year 2005. The remaining $42 million had not been
allocated as of September 20. Officials at some medical centers expected
to spend all of the allocations they received during fiscal year 2006.
However, officials at some medical centers were uncertain that they would
spend all their allocations for plan initiatives during the fiscal year.

VA Allocated about $158 Million Directly to Medical Centers and Certain Offices

VA headquarters had allocated about $158 million directly to medical
centers and certain offices by September 20, 2006, through RFPs and other
approaches targeted to specific initiatives related to the mental health
strategic plan in fiscal year 2006. About $92 million was for new mental
health strategic plan activities, and about $66 million was to support the
recurring costs of continuing mental health strategic plan initiatives
that were first funded in fiscal year 2005. As in fiscal year 2005, the
new resources went to support a range of mental health services in line
with priorities of VA's leadership and legislation, according to VA
officials. Funding for services for PTSD, OIF and OEF veterans, substance
abuse, and CBOC mental health services accounted for nearly three-fifths
of the funds allocated for new initiatives. As of September 18, 2006, VA
had not allocated resources for mental health strategic plan initiatives
through its general resource allocation system and VA headquarters
officials said VA was not planning to do so.

VA Did Not Allocate about $42 Million for Mental Health Strategic Plan
Initiatives

As of September 20, 2006, VA did not allocate about $42 million of the
$200 million planned for mental health strategic plan initiatives in
fiscal year 2006 by any approach. VA officials said that a portion of
these unallocated funds are related to the timing of allocations that were
made for plan initiatives through RFPs and other funds targeted to medical
centers. Specifically, some of the allocations through RFPs were made well
into the fiscal year. VA allocated only the amount of funds through these
approaches for fiscal year 2006 that would fund the projects through the
end of the fiscal year, and not the full 12-month cost which VA expects to
fund in fiscal year 2007. Because some of these allocations were made in
the later part of fiscal year 2006, these allocations were smaller than
they would be on a 12-month basis and accounted for part of the $42
million not allocated. VA officials said they anticipated that these funds
would be available in fiscal year 2007.

Medical Center Officials Reported Using Allocations for Mental Health Strategic
Plan Initiatives, but Were Uncertain Whether All Funds Allocated Would Be Used
for Plan Initiatives

Officials from seven medical centers we interviewed in May and June of
2006 reported using funds allocated to them through RFPs and other
approaches to support new 2006 mental health initiatives and to continue
to support the initiatives first funded in fiscal year 2005. For example,
one medical center used funding for a new mental health intensive case
management program. Officials at some medical centers reported that they
did not anticipate problems using all of the funds they had received in
fiscal year 2006. However, others were less certain they would be able to
use all of the funds. Officials at several medical centers were not sure
they would be able to hire all of the new staff related to mental health
strategic plan initiatives by the end of the fiscal year. In May 2006,
officials at two medical centers that we interviewed said that they did
not know whether they would receive additional funds through RFPs to spend
in fiscal year 2006, and as a result they were uncertain whether they
would be able to use all of their fiscal year 2006 funds for plan
initiatives by the end of the fiscal year.

                            Concluding Observations

Our preliminary findings show that VA allocated additional resources for
mental health strategic plan initiatives in fiscal years 2005 and 2006 to
help address identified gaps in VA's mental health services for veterans.
VA intended to allocate $100 million for plan initiatives in fiscal year
2005. The allocations that were made resulted in some new and expanded
mental health services to address gaps, according to officials at selected
medical centers. However, approximately $12 million of the $100 million
was not allocated by any method and $35 million was allocated through VA's
general resource allocation system on a retrospective basis and without
notifying networks and medical centers that resources for plan initiatives
had been allocated in the general allocation that networks received
several months earlier. Finally, some portion of the approximately $53
million that was allocated directly to medical centers was not used for
plan initiatives in part because the timing of the allocation of the funds
did not leave time to hire needed staff by the end of the fiscal year. As
a result, it is likely that a substantial portion of the $100 million
intended for mental health strategic plan funds in fiscal year 2005 was
not used for plan initiatives. A larger amount of the planned mental
health strategic plan funds was allocated in fiscal year 2006, although as
of September 20, 2006, about a fifth of the $200 million planned for these
initiatives was not allocated. However, it is unclear whether medical
centers will be able to spend all of the fiscal year 2006 mental health
strategic plan funds for plan initiatives by the end of the year, in part
because of how late in the year the funds were allocated.

                     GAO Contact and Staff Acknowledgments

For further information about this statement, please contact Laurie E.
Ekstrand at (202) 512-7101 or [email protected] . Contact points for our
Offices of Congressional Relations and Public Affairs may be found on the
last page of this statement. James Musselwhite, Assistant Director, and
Robin Burke made key contributions to this statement.

(290573)

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www.gao.gov/cgi-bin/getrpt? GAO-06-1119T .

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Highlights of GAO-06-1119T , a statement for the record for the
Subcommittee on Health, Committee on Veterans' Affairs, House of
Representatives

September 28, 2006

VA HEALTH CARE

Preliminary Information on Resources Allocated for Mental Health Strategic
Plan Initiatives

The Department of Veterans Affairs (VA) provides mental health services to
veterans with conditions such as post-traumatic stress disorder (PTSD) and
substance abuse disorders. To address gaps in services needed by veterans,
VA approved a mental health strategic plan in 2004. VA planned to increase
its fiscal year 2005 allocations for plan initiatives by $100 million
above fiscal year 2004 levels. VA also planned to increase its fiscal year
2006 allocations for plan initiatives by $200 million above fiscal year
2004 levels---composed of $100 million for continuation of fiscal year
2005 initiatives and an additional $100 million identified in the
President's fiscal year 2006 budget request.

GAO was asked to provide preliminary information on VA's allocation and
use of funding for mental health strategic plan initiatives in fiscal
years 2005 and 2006. A report on this work will be issued later in the
fall of 2006.

GAO reviewed VA reports and documents on mental health strategic plan
initiatives and conducted interviews with VA officials from headquarters,
4 of 21 health care networks, and 7 medical centers. VA delegates decision
making to its health care networks for most budget and management
responsibilities regarding medical center operations, and medical centers
receive most of their resources from the networks.

In fiscal year 2005, VA headquarters allocated $88 million of the $100
million VA officials intended for mental health strategic plan
initiatives. VA allocated about $53 million directly to medical centers
and certain offices based on proposals submitted for funding and other
approaches targeted to specific initiatives. VA solicited submissions from
networks for specific initiatives to be carried out at their individual
medical centers through requests for proposals (RFPs). In addition, VA
headquarters officials said that VA allocated $35 million for this purpose
through VA's general resource allocation system to its 21 health care
networks on a retrospective basis. VA made this decision several months
after resources had been provided to the networks through the general
allocation system. Moreover, VA did not notify network and medical center
officials that these funds were to be used for plan initiatives.Health
care network and medical center officials interviewed told GAO that they
were not aware these allocations had been made. As a result, it is likely
that some of these funds were not used for plan initiatives. Moreover, VA
did not allocate the approximately $12 million remaining of the $100
million for fiscal year 2005 because, according to VA officials, there was
not enough time during the fiscal year to do so. Medical center officials
said they used the funds allocated directly to their medical centers for
plan initiatives that included new mental health services and more of the
services they already provided. For example, two medical centers used
funds allocated to them through RFPs or other targeted approaches to
increase the number of mental health providers at community based
outpatient clinics. One of those medical centers also started a new 6-week
PTSD day treatment program. However, some medical center officials
reported that they did not use all funds allocated for plan initiatives by
the end of fiscal year 2005, due in part to the length of time it took to
hire new staff.

In fiscal year 2006, as of September 20, 2006, VA headquarters had
allocated $158 million of the $200 million planned for mental health
strategic plan initiatives. VA allocated about $92 million of these funds
directly to medical centers and certain offices to support new
initiatives, using RFPs and other targeted funding approaches. VA also
allocated about $66 million to support recurring costs of the continuing
initiatives from the prior fiscal year. As of September 20, 2006, about
$42 million of the $200 million for fiscal year 2006 had not been
allocated. Officials from seven medical centers we interviewed reported
that they had used funds for plan initiatives, such as the creation of a
new intensive mental health case management program. Officials at some
medical centers reported that they did not anticipate problems using all
of the funds allocated to them through RFPs and other targeted approaches
in fiscal year 2006. However, officials at other medical centers were less
certain that they would use all of these funds for plan initiatives by the
end of fiscal year 2006.

GAO discussed the information in this statement with VA officials who
agreed that the data are accurate, and provided updated data which are
incorporated as appropriate.
*** End of document. ***