According to the 2008 VistA / HealtheVet Monograph, the Fee Basis package…“supports VHA’s Non-VA Medical Care Program (NVC) (Fee for Service) program, which is care authorized for Veterans who are eligible and are in need of care that cannot feasibly be provided by a VA facility. A VA facility unable to meet the patient care requirements of a Veteran may authorize Non-VA Medical Care for short-term care, ongoing outpatient care, or home health care from Non-VA Health Care facilities. Bills for service are then submitted to the authorizing VA facility. The bill is reviewed by the facility and certified for payment through VA’s payment center in Austin, Texas.”
The issue of Separation of Duties in the Fee Basis VistA application and the need to incorporate the enhancements requested were brought about by a tasking from the Government Accountability Office (GAO) regarding Access Controls and Separation of Duties.
The Department of Veterans Affairs was tasked in early 2008 to develop an Access and Separation of Duties Review plan that will be used VA-wide as one of the primary preventative controls to stop fraud, theft, collusion, or unauthorized release of sensitive data. This included the creation of subordinate plans for VHA, VBA and the NCS. The plan for VHA was authored and delivered in January of 2009. An important set of recommendations within the document calls for enhancements in the VistA system to incorporate the separation of duties.
The Continuous Readiness in Information Security Program (CRISP) was enacted in March of 2012 by the Department of Veterans Affairs, toensure that suitable internal controls and responsibilities are in place, and to have documentary evidence that higher level official reviews are accomplished.
This proposed enhancement seeks modification to the Fee Basis module of VA’s VistA software application.
Fee Basis Claims System, a COTS product, which sits on top of VistA Fee, will require corresponding updates to support full compliance of the GAO Separation of Duties requirement. The updates to this product will be addressed as a separate project, independent of these VistA changes.