THE SECRETARY OF VETERANS AFFAIRS WASHINGTON March 4, 2019 The Honorable Debbie Wasserman Schultz Madam Chair Subcommittee on Military Construction, Veterans Affairs, and Related Agencies Committee on Appropriations US. House of Representatives Washington, DC 20515 Dear Madam Chairwoman: In accordance with Section 218 of Division of the Energy and Water, Legislative Branch, and Military Construction and Veterans Affairs Appropriations Act, 2019 (Public Law (PL) 115?244), this letter provides notification of the Department of Veterans Affairs? (VA) intent to transfer $95.94 million of Fiscal Year (FY) 2019 funds, $68.78 million from the Medical Community Care appropriation and $27.16 million from the Medical Services appropriation, to the Information Technology (IT) Systems account. The purpose of this transfer is to fund the IT projects that are required to support implementation of the John S. McCain Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 (PL. 115-182). The successful implementation of the MISSION Act is VA's highest priority. This critical funding will provide multiple IT projects that will allow VA to implement various sections of the MISSION Act. VA does not expect any adverse impact to Veterans? health care due to the transfer of funds from the Medical Community Care and Medical Services accounts. Enclosed is a summary description of each project, the funding, and the category of requested IT funding. Without timely approval of this request, VA implementation of critical sections of the MISSION Act could be in jeopardy. VA has already identified $33.5 million in IT Systems account carryover sustainment funds to be applied against MISSION Act implementation requirements. Similar letters have been sent to the leadership of the House and Senate Committees on Appropriations. Thank you for your continued support of our mission to provide services and benefits to our honored Veterans. SincerelyRobert L. Wilkie Enclosures Enclosure 1 Department of Veterans Affairs Information Technology Systems 2019 Transfer Request The Department of Veterans Affairs (VA) is requesting approval to transfer $95.94 million from Medical Care programs to the Information Technology (IT) Systems account in support of 2019 MISSION Act lT requirements. The requested funding will support 11 Office of Information and Technology (OIT) Congressional Projects across 6 OIT Congressional Programs. This transfer will provide funding for critical IT systems development and modernization needed in Fiscal Year (FY) 2019, consisting of $51.75 million in DeveIOpment and $44.19 million in Operation and Maintenance. The request funds critical projects and ensures that VA has the resources to support its highest priority MISSION Act programs for FY 2019. The requested transfer totals $95.94 million, $68.78 million from the Medical Community Care appropriation and $27.16 million from the Medical Services appropriation: A. $51.75 Million Transfer to FY 2019 IT Systems Development Subaccount 1. Health Management Platform - $45.87 million Funding will support MISSION Act (Sections 101, 102, 105, 108, 111, 113, 114, and 134x - $12.44 million (Sections 101, 105, and 108) will allow VA to integrate and deploy the Referral Manager (HSRM) to include integration to be in alignment with Community Care Network (CCN) and MISSION Act requirements. HSRM is VA's future state referral system that will be used to create all referrals for Community Care. This system will integrate with CCN vendor systems, VA claims payment systems, and vendor reimbursement systems to ensure Community Care medical claims are apprOpriately adjudicated based on the approved care. In addition, this system will provide a portal to Community Care providers that will allow them to access Veterans? applicable referrals and medical documentation associated with individual episodes of care as well as support receiving Veterans? medical documentation after the care has been received in the community. Funding will be used to continue automation and integration with VA systems, continue integration and rollout with VA payment systems, integrate walk-in care and urgent care requirements, develop new requirements to support the CCN contract requirements, and to fully replace legacy referral systems. 0 $5.62 million (Section 101) will fund continued development of the Decision Support Tool (DST) for automation and integration of a long term sustainable CC tool. DST will implement new functionality that will aid clinical staff in determining whether a Veteran should be seen in a VA clinic and, if not, which non-VA program authority should be used to refer the Veteran into the community. Funding will be used to integrate DST with VA Enclosure 1 scheduling systems, as well as continue automation and integration of data to support the decision-making process. $4.8 million (Section 101 and 102) will fund the Enterprise Program Reporting System (EPRS) to monitor operations of the Community Care Program (CC) and CCN contract. EPRS is a reporting tool that will provide Office of Community Care leadership and the CCN Contracting Officer Representative data on Community Care metrics for CCN oversight and executive reporting. Funding will be used to integrate new data and reports associated with Veterans' Community Care experience data, Access Standards implementation, and additional metrics for monitoring the quality of care provided and furnished through CCN. $2.15 million (Sections 101 and 102) will fund the Integrated Billing and Accounts Receivable to assist in tracking visits and to bill the appropriate type of copay to prevent loss of revenue and mitigate a potentially large backlog of first party billing. $1.24 million (Sections 101, 102, 105, 111, 113, and 114) will provide funding for the Community Care Reimbursement System (CCRS) and Computerized Patient Record System (CPRS) to continue to enhance both systems in support of the MISSION Act, remove Choice program options, and add apprOpriate MISSION Act eligibility requirements. CCRS is a new system that will be implemented to reimburse CCN contractors for medical claims paid to Community Care Providers. Funding will be used to support new MISSION Act requirements associated with walk?in care and urgent care. Enhancements to CPRS include removing references to the Choice program and adding MISSION Act eligibility options. $18.54 million (Section 134) will provide for drug monitoring pharmacy management allowing VA to participate in the national network of state-based Prescription Drug Monitoring Program (PDMP). The goal is to establish an automated Veterans Health Administration (VHA)-wide solution to query state Prescription Monitoring Program databases. VHA, when providing patient care or performing administrative functions, using a third?party service, will link or be interconnected to State PDMP data resources to provide interstate PDMP data sharing to health care institutions for integration into VA's electronic health systems Veterans Health Information Systems and Technology Architecture (VistA), Computerized Patient Record System (CPRS), and Electronic Health Record Modernization). $1.08 million to fully integrate the Provider Profile Management System (PPMS) with Integrated Access Management and VistA. PPMS manages all Community Care Providers? contact information, locations, eligibility, and VA contract or agreement association. This system provides provider data to many systems to ensure Veterans and VA staff have a single location to identify available external providers. Funding will be used to enhance PPMS to include managing walk-in care providers, integrating Veteran Community Care experience data, updating existing functionality to automatically and manually deactivate providers that are excluded from 2 Enclosure 1 providing services, and providing the ability to track provider training requirements. 2. Clinical Applications - $4.08 million Funding will support MISSION Act Section 162(a) to fund development of Caregiver Application Tracker (CAT) database. The new Caregivers solution will provide a system that allows qualified families of severely disabled Veterans to receive stipends from VA for providing caregiver services. 3. Other IT Systems - $1.80 million Funding will support MISSION Act Section 152 to fund development of the Customer Relationship Management (CRM) Platform to create a CRM database back-end platform to support an internal and external stakeholder engagement website to facilitate innovation sourcing and engagement at scale by leveraging appropriate technology with minimal FTE support to drive sustainable Operations at scale. B. $44.19 Million Transfer to FY 2019 IT Systems Operations and Maintenance Subaccount 1. Benefits Operations and Maintenance - $2.2 million Funding will support MISSION Act (Sections 101, 105, and 143) to ensure that the Veterans Customer Experience project complies with MISSION Act direction to enhance the enrollment system to meet grandfather status eligibility requirements. 2. Enterprise Operations and Maintenance $6.77 million Funding will support MISSION Act (Sections 101, 104, 106, 131, and 203): $3.0 million (Section 104) will fund continued sustainment and enhancements of the Business Information Services Library (BISL) Electronic Quality Measurement infrastructure. Funding will be used to continue maintenance and enhancements for Community Care data management in the Corporate Data Warehouse, which is used to provide a consolidated view of decentralized Veteran data for reporting and managing standards for quality. a $3.0 million (Sections 101 and 131) will support Data Access Service (DAS) to ensure continued sustainment support to include bug fixes and maintenance support. DAS is gateway to receiving and sending external data and this funding will provide the ability to continue to communicate with CCN vendors as well as integrate new CCN vendors while ensuring compliance with the CCN contracts. 0 $0.77 million (Sections 106 and 203) will provide enhance abilities within the Geographic Information Systems (GIS) Healthcare Enterprise Support and Services Infrastructure. GIS technology will be used for strategic planning, patient drive time analysis, population health management, emergency management, bio-surveillance, and tools and analysis to support the MISSION Act requirements, as well as future Office of Community Care 3 Enclosure 1 transformation initiatives. The Community Care Program (CCP) relies on this ability to provide GIS data when determining geographic eligibility for its approximately 9 million eligible members. The GIS data are critical to supporting GOP and are legislatively mandated to do so. 3. Health Operations and Maintenance - $35.22 million Funding will support MISSION Act (Sections 101, 102, 105, 106, 108, 111, 112, 114,122,131,132,143,and 203): $21.80 million will support community care initiatives related to: additional enhancements for Data Access Service support for the Get the Data Back MISSION Act requirements, streamlining the external medical data collection process; and a program integrity tool to support a more robust infrastructure to aid in increased claims volume in support of MISSION Act. It will also support PPMS modifications to existing PPMS CRM functionalities, Data Web Services, and Integration Web Services that support full Community Care integration requirements. VA will continue to work with onboarding CCN Regions to ensure VA receives external provider data required by Community Care. This funding will also support the provider locator functionality on the VA.gov Web site allowing Veterans the ability to search for Community Care providers. $0.12 million (Sections 106 and 203) will fund Data Access, Archiving, and Disposition for Veterans Health Administration Strategic Analysis Service Planners to analyze Veterans? geographic locations. $5.13 million will fund Connected Health and Mobile Apps to support and sustain Mobile application infrastructure in VA Enterprise Cloud and to support cloud capacity and tier 2 and tier 3 support and sustainment of developed mobile apps. $3.5 million will fund the sunsetting of legacy medical claims payment system, Fee Basis Claims System (FBCS), and the management of data migration to a centralized location for historical management and reporting. Additionally, this will allow for migration of open claims at the time of FBCS sunset to the new payment and authorization systems to ensure that all medical claims are appropriately adjudicated. $3.9 million will be used to create the ability to monitor opioid prescriptions from Community Providers. $0.77 million (Sections 101 and 102) to support Cloud credits to support EPRS to successfully monitor operations of GOP and CCN. Department of Veterans Affairs March 2019 Enclosure 2 Department of Veterans Affairs Fiscal Year 2019 OffiCe of Information and Technology Systems VHA Mission Act Transfer to OIT (Dollars in Thousands) Revised FY FY 2019/2020 VHA 2019/2020 Plan Transfer In Plan Development by Program Clinical Applications 32,479 4,080 36,559 Health Management Platform 70,391 45,870 116,261 Benefits Systems 129,615 - 129,615 Memorial Affairs 18,800 18,300 Other IT Systems 78,571 1,800 80,371 Cyber Security 17,000 - 17,000 lnformation/lnfrastructu re Management 33,715 - 33,715 I Subtotal, Development 380,571 51,750 432,321 Sustainme nt/O&M by Portfolio Health Operations and Maintenance 816,659 35,220 851,879 Benefits Operations and Maintenance 258,682 2,200 260,882 Corporate Operations and Maintenance 251,857 - 251,857 Enterprise Operations and Maintenance 1,192,730 6,770 1,199,500 Memorial Operations and Maintenance 3,281 - 3,281 I Subtotal,Sustainment 2,523,209 44,190 2,557,399 Development 380,571 51,750 432,321 Sustainment/O&M 2,523,209 44,190 2,567,399 Staffing and Ad ministration 1,199,220 - 1,199,220 Total 4, 103, 000 95,940 4, 198,940 Development Details by Program 8: Project Clinical Applications 32,479 4,080 36,559 Access and Billing 5,891 - 5,891 My HealtheVet 10,300 10,300 Health Data Interoperability 13,000 - 13,000 Registries 3,288 - 3,288 Healthcare Administrative Systems - 4,080 4,080 Health Management Platform 70,391 45,870 116,261 Digital Health Platform 15,682 - 15,682 Community Care 25,303 26,950 52,253 Patient Records System (CPRS) 14,300 380 14,680 Purchased Care 9,076 9,076 Telehealth Services 6,030 - 6,030 Pharmacy - 18,540 18,540 Benefits Systems 129,615 - 129,615 Benefits Appeals 2,500 - 2,500 Education Benefits 37,830 37,830 Veterans Customer Experience VCE 47,564 - 47,564 Veterans Benefits Management 10,000 5 10,000 Be nefits Systems 31,721 31,721 Memorial Affairs 18,800 - 18,800 [Memorials Automation 18,800 18,800 Other IT Systems 78,571 1,800 80,371 Human Resources 12,600 12,600 Financial and Acquisition Management Modernization 65,971 65,971 Data Access, Archiving and Disposition 1,800 1,800 Cyber Security 17,000 - 17,000 JCyber Security 17,000 17,000 Information/lnfrastructure Management 33,715 - 33,715 lData Integration and Management 33,715 33,715 Grand Total 380,571 51,750 432,321