August 20, 2010

Expansion of Enrollment in the VA Health Care System

Proposed Rule
Summary

Score: 17 / 60

Key materials
Additional details
Agency
Department of Veterans Affairs
Regulatory Identification Number
2900-AN23
Agency Name
Department of Veterans Affairs
Rule Publication Date
01/21/2009
Comment Closing Date
02/20/2009

RULE SUMMARY

The Department of Veterans Affairs (VA) proposes to amend its regulations regarding enrollment in the VA health care system. In particular, it proposes to establish additional subpriorities within enrollment priority category 8 and provide that beginning on the effective date of the rule, VA would enroll priority category 8 veterans whose income exceeds the current means test and geographic means test income thresholds by 10 percent or less.

METHODOLOGY

There are twelve criteria within our evaluation within three broad categories: Openness, Analysis and Use. For each criterion, the evaluators assign a score ranging from 0 (no useful content) to 5 (comprehensive analysis with potential best practices). Thus, each analysis has the opportunity to earn between 0 and 60 points.

Criterion Score

Openness

1. How easily were the RIA , the proposed rule, and any supplementary materials found online?
2900-AN23 can be found from regulations.gov using RIN and using a keyword search, as well as on the Department of Veteran Affair's website. On their website, search the RIN and the regulation link appears in the first few results. Then, scroll through the regulations and find 2900-AN23. The regulation can be found this way. However, note that the Regulatory Impact Analysis is very brief within the document.
5/5
2. How verifiable are the data used in the analysis?
Data used to estimate changes in enrollment are apparently VA data. There is no explanation of how to get these data.
1/5
3. How verifiable are the models and assumptions used in the analysis?
VA asserts that it projected enrollment using the "Enrollee Health Care Projection Model," but it provides just a brief qualitative explanation of the model and no source documentation. Some assumptions are justified simply as "based on our experience."
2/5
4. Was the analysis comprehensible to an informed layperson?
It was an easy read, mainly because it is extremely brief and merely presents enrollment predictions. VA explains how it did the enrollment projections, but because the model is opaque, it's not clear whether the results follow from the inputs. The bigger problem is that so little analysis was actually done.
3/5

Analysis

5. How well does the analysis identify the desired outcomes and demonstrate that the regulation will achieve them?
1/5
Does the analysis clearly identify ultimate outcomes that affect citizens’ quality of life?
The goal is apparently to let more veterans enroll in the VE health system. Presumably the ultimate outcome is either better health or cost savings for veterans or both, but this is not articulated.
1/5
Does the analysis identify how these outcomes are to be measured?
The analysis merely projects how many more veterans will enroll; no measurement of outcomes.
1/5
Does the analysis provide a coherent and testable theory showing how the regulation will produce the desired outcomes?
No theory is presented; veterans are merely assumed to enroll "based on past experience."
0/5
Does the analysis present credible empirical support for the theory?
VA asserts that the projected enrollment figures are justified based on past experience.
1/5
Does the analysis adequately assess uncertainty about the outcomes?
No relevant discussion.
0/5
6. How well does the analysis identify and demonstrate the existence of a market failure or other systemic problem the regulation is supposed to solve?
0/5
Does the analysis identify a market failure or other systemic problem?
No. The analysis and preamble say that the purpose of the regulation is to implement the law, with no discussion of what problem Congress thought it was solving.
0/5
Does the analysis outline a coherent and testable theory that explains why the problem (associated with the outcome above) is systemic rather than anecdotal?
No relevant discussion.
0/5
Does the analysis present credible empirical support for the theory?
No relevant discussion.
0/5
Does the analysis adequately assess uncertainty about the existence or size of the problem?
No relevant discussion.
0/5
7. How well does the analysis assess the effectiveness of alternative approaches?
1/5
Does the analysis enumerate other alternatives to address the problem?
VA does not consider alternatives because it asserts that no alternatives would implement the law. The proposed regulation is simply compared to current policy.
1/5
Is the range of alternatives considered narrow (e.g., some exemptions to a regulation) or broad (e.g., performance-based regulation vs. command and control, market mechanisms, nonbinding guidance, information disclosure, addressing any government failures that caused the original problem)?
No alternatives are considered.
0/5
Does the analysis evaluate how alternative approaches would affect the amount of the outcome achieved?
No alternatives are considered.
0/5
Does the analysis adequately address the baseline? That is, what the state of the world is likely to be in the absence of federal intervention not just now but in the future?
A table shows projected enrollment and expenditures under current policy but does not explain how the numbers were calculated.VA projects enrollment based on past priority category 8 enrollment rates.
1/5
8. How well does the analysis assess costs and benefits?
1/5
Does the analysis identify and quantify incremental costs of all alternatives considered?
VA calculates increased federal costs due to increased enrollment for the next five years. The regulation's earlier analysis has accounted for many of the incremental costs projected out to 2019. However, it seems that much is missing considering this depends on enrollment, and there are many variables to consider. Also, since only one option is considered, only some discussion and relevant analysis is present.
2/5
Does the analysis identify all expenditures likely to arise as a result of the regulation?
Tha analysis only considers federal expenditures, though apparently some of these expenditures will be funded by fees paid by enrollees. "The projected expenditures represent the cost to provide the projected health care services to these new enrollees."
3/5
Does the analysis identify how the regulation would likely affect the prices of goods and services?
No relevant discussion.
0/5
Does the analysis examine costs that stem from changes in human behavior as consumers and producers respond to the regulation?
The analysis presumes more veterans will enroll but does not explain why.
1/5
If costs are uncertain, does the analysis present a range of estimates and/or perform a sensitivity analysis?
No relevant discussion.
0/5
Does the analysis identify the alternative that maximizes net benefits?
No relevant discussion.
0/5
Does the analysis identify the cost-effectiveness of each alternative considered?
No relevant discussion.
0/5
Does the analysis identify all parties who would bear costs and assess the incidence of costs?
The analysis mentions that some of the costs will be paid via copays or third-party reimbursements.
1/5
Does the analysis identify all parties who would receive benefits and assess the incidence of benefits?
No relevant discussion.
0/5

Use

9. Does the proposed rule or the RIA present evidence that the agency used the analysis?
It is clear that VA issued this regulation extending eligibility because that is what Congress told the agency to do. There is no evidence that VA would have made any decsion differently as a result fo the small amount of analysis done.
1/5
10. Did the agency maximize net benefits or explain why it chose another alternative?
The analysis is not nearly thorough enough to make it possible to consider net benefits.
0/5
11. Does the proposed rule establish measures and goals that can be used to track the regulation's results in the future?
It contains analysis or results that could readily be used to establish goals and measures or indicators assessing the results of the regulation in the future. VA could track future changes in enrollment to see if they match projections. This would tell us nothing about outcomes, though.
1/5
12. Did the agency indicate what data it will use to assess the regulation's performance in the future and establish provisions for doing so?
The preamble to the rule demonstrates that the agency has access to data that could be used to assess some aspects of the regulation’s performance in the future.
1/5
 
Total 17 / 60