Reports & Testimonies

  • GAO’s recommendations database contains report recommendations that still need to be addressed.

    GAO’s recommendations help congressional and agency leaders prepare for appropriations and oversight activities, as well as help improve government operations. Recommendations remain open until they are designated as Closed-implemented or Closed-not implemented. You can explore open recommendations by searching or browsing.

    GAO's priority recommendations are those that we believe warrant priority attention. We sent letters to the heads of key departments and agencies, urging them to continue focusing on these issues. These recommendations are labeled as such. You can find priority recommendations by searching or browsing our open recommendations below, or through our mobile app.

  • Browse Open Recommendations

    Explore priority recommendations by subject terms or browse by federal agency

    Search Open Recommendations

    Search for a specific priority recommendation by word or phrase



  • Governing on the go?

    Our Priorities for Policy Makers app makes it easier for leaders to search our recommendations on the go.

    See the November 10th Press Release


  • Have a Question about a Recommendation?

    • For questions about a specific recommendation, contact the person or office listed with the recommendation.
    • For general information about recommendations, contact GAO's Audit Policy and Quality Assurance office at (202) 512-6100 or apqa@gao.gov.
  • « Back to Results List Sort by   

    Results:

    Subject Term: "Aid for the disabled"

    11 publications with a total of 39 open recommendations including 3 priority recommendations
    Director: Kathryn A. Larin
    Phone: (202) 512-7215

    8 open recommendations
    Recommendation: To ensure expedited processing of disability claims through CAL is consistent and accurate, the Acting Commissioner of Social Security should develop a formal and systematic approach to gathering information to identify potential conditions for the CAL list, including by sharing information through SSA's website on how to propose conditions for the list and by utilizing research that is directly applicable to identifying CAL conditions.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To ensure expedited processing of disability claims through CAL is consistent and accurate, the Acting Commissioner of Social Security should develop formal procedures for consistently notifying those who propose conditions for the CAL list of the status of their proposals.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To ensure expedited processing of disability claims through CAL is consistent and accurate, the Acting Commissioner of Social Security should develop and communicate internally and externally criteria for selecting conditions for the CAL list.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To ensure expedited processing of disability claims through CAL is consistent and accurate, the Acting Commissioner of Social Security should take steps to obtain information that can help refine the selection software for CAL claims, for example by using management data, research, or DDS office feedback.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To ensure expedited processing of disability claims through CAL is consistent and accurate, the Acting Commissioner of Social Security should clarify written policies and procedures regarding when manual addition and removal of CAL flags should occur on individual claims.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To ensure expedited processing of disability claims through CAL is consistent and accurate, the Acting Commissioner of Social Security should assess the reasons why the uses of manual actions vary across DDS offices to ensure that they are being used appropriately.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To ensure expedited processing of disability claims through CAL is consistent and accurate, the Acting Commissioner of Social Security should develop a schedule and a plan for updates to the CAL impairment summaries to ensure that information is medically up to date.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To ensure expedited processing of disability claims through CAL is consistent and accurate, the Acting Commissioner of Social Security should develop a plan to regularly review and use available data to assess the accuracy and consistency of CAL decision-making.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    4 open recommendations
    Recommendation: The Acting Commissioner of the Social Security Administration should analyze the SEIE data to determine why a large proportion of transition-age youth on SSI with reported earnings did not benefit from the SEIE and, if warranted, take actions to ensure that those eligible for the incentive benefit from it.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA agreed with this recommendation. The agency stated that it would also explore various options for increasing connections to Vocational Rehabilitation (VR), stating that in addition to assessing options for referring youth to VR and/or changing the Ticket to Work program, the agency will continue to research other options for supporting transitioning youth.
    Recommendation: The Acting Commissioner of the Social Security Administration should analyze options to improve communication about SSA-administered work incentives and the implications of work on SSI benefits, with a goal of increasing understanding of SSI program rules and work incentives among transition-age youth and their families. This should include, but not necessarily be limited to, updating SSAs procedures for staff meeting with SSI applicants, recipients, and their families to regularly and consistently discuss - when applicable--how work incentives can prevent reductions in benefit levels and how work history is considered during eligibility redeterminations.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA disagreed with this recommendation, noting that it already analyzed, and continuously monitors and solicits feedback on, options to improve communications. SSA also said it requires staff to meet with SSI recipients regularly and instructs staff to discuss relevant work incentives, and that there is no indication that staff are not providing youth with appropriate work incentive information. However, SSA did not explain how it knows or ensures that staff are providing this information and SSA policies do not instruct staff to consistently convey information to youth and families on how work may or may not affect age 18 redetermination. While SSA's new brochure provides information on age-18 redeterminations, work incentives and other resources, we believe it could also contain additional relevant information, for example, on Medicaid eligibility. We also noted that written information may not be sufficient for conveying complex information. In addition, while we recognize the important role that WIPA projects play in providing work incentives counseling to SSI youth, WIPA projects have limited capacity for serving youth along with other SSI recipients and disability insurance beneficiaries. Therefore, we continue to believe that there are opportunities for SSA to improve its communication with transition-age youth and their families, including through in-person or telephone interactions.
    Recommendation: The Acting Commissioner of the Social Security Administration should work with the Secretary of Education to determine the extent to which youth on SSI are not receiving transition services through schools that can connect them to VR agencies and services.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA partially agreed with this recommendation. SSA noted its ongoing collaboration with Education and other agencies through the Promoting Readiness of Minors in SSI (PROMISE) project, stating the initiative is testing the provision of VR services to youth receiving SSI and will provide some evidence related to the role of schools and VR services for this population. SSA also stated it will continue to pursue research in this area. While we recognize the value of this initiative, a final PROMISE evaluation is not expected until winter 2022. In addition, the PROMISE initiative was not designed to determine the extent to which youth on SSI are receiving transition services through schools or are otherwise connected to VR services. SSA also noted that it works with Education and other agencies through the Federal Partners in Transition (FPT) Workgroup to improve the provision of transition services to students with disabilities, and that the FPT has issued a blueprint of agencies' efforts. While the FPT can be a promising vehicle to help connect youth on SSI to key transition services, the FPT had not set timelines or milestones to achieve its broad goal to support positive outcomes for youth with disabilities, nor does it have a list or specific activities and tasks it will undertake. Therefore, we continue to believe additional collaboration by SSA with Education would be beneficial. SSA also noted several concerns related to complying with this recommendation, such as legal (privacy) concerns with data sharing, the capacity of state VR agencies to serve more individuals, and the receptivity of youth on SSI to receiving services. While we acknowledge these challenges, we believe that SSA can take steps to explore actions it could take after considering such legal issues. While low state VR capacity or individual motivation can obstruct receipt of VR services, they should not prevent SSA from working with Education to determine the extent to which SSI youth are sufficiently informed of VR resources that are potentially available to them.
    Recommendation: The Acting Commissioner of the Social Security Administration should explore various options for increasing connections to VR agencies and services, including their potential costs and benefits. One option, among others, could be to expand the Ticket to Work program to include youth.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA agreed with this recommendation. The agency stated that, in addition to assessing legal and statutory options for referring youth to VR and/or changing the Ticket to Work program, it would also continue its research supporting youth.
    Director: Kay Brown
    Phone: (202) 512-7215

    3 open recommendations
    Recommendation: To better ensure FEMA's regional activities effectively support individuals with disabilities, the Secretary of Homeland Security should direct the FEMA Administrator to take steps to establish written procedures for how regions should involve the Office of Disability Integration and Coordination in clarifying disability integration staff's roles, evaluating staff performance, and setting expectations for how staff communicate with headquarters and the regions.

    Agency: Department of Homeland Security
    Status: Open

    Comments: FEMA agreed with this recommendation and FEMA's Office of Disability Integration and Coordination is in the process of establishing a working group that will clarify and codify the roles, responsibilities, and expectations among the various agency offices and personnel involved in carrying out the agency's disability integration mission. GAO will monitor the progress of these efforts. FEMA expects to complete these efforts by December 31, 2017. At that time, GAO will await documentation of the agency's procedures for carrying out its disability integration mission.
    Recommendation: To better position FEMA to expand access to key training on incorporating access and functional needs into emergency planning for state, local, and voluntary organization emergency management officials, the Secretary of Homeland Security should direct the FEMA Administrator to evaluate alternative cost-effective methods for delivering its course on access and functional needs, such as via virtual classes.

    Agency: Department of Homeland Security
    Status: Open

    Comments: FEMA agreed with this recommendation and reported that it will explore options for updating one of its existing online courses--IS-368 "Including People with Disabilities and Other with Access and Functional Needs in Disaster Operations"--to tailor the content for a broader audience, including members of the public. The agency also reported that it will evaluate the need for alternative cost-effective methods for delivering other courses on inclusive emergency management it currently offers, such as its classroom course, "Integrating Access and Functional Need into Emergency Planning." The agency anticipates completing these efforts by December 31, 2017. When these efforts are complete, GAO will await documentation that the agency has evaluated its delivery of key training on incorporating access and functional needs into emergency planning.
    Recommendation: To help ensure its key training on incorporating access and functional needs into emergency planning reaches a sufficiently wide audience, the Secretary should direct the FEMA Administrator to collect information about the potential pool of participants, set general goals for the number of state and local emergency managers that will take this course, and implement the delivery methods needed to meet these goals.

    Agency: Department of Homeland Security
    Status: Open

    Comments: FEMA agreed with this recommendation and reported that it will work with its regional staff to map potential training participants in each state and set goals for delivery of the course to state and local emergency managers. The agency also reported that it may be able to use data in the State Preparedness Report and states' self-reporting on the need for training on integrating the needs of people with access and functional needs into emergency management. GAO will monitor the progress of these efforts. The agency anticipates completing these efforts by December 31, 2017.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    4 open recommendations
    Recommendation: To ensure that it provides all eligible populations access to its services and that its eligibility requirements are consistent with currently accepted practices, the Library of Congress should re-examine and potentially revise its requirement that medical doctors must certify eligibility for the NLS program for those with a reading disability caused by organic dysfunction.

    Agency: Library of Congress
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has contracted for a study of how eligibility based on reading disability should be certified. This study will look at medical advances in the diagnosis of reading disabilities, the NLS authorizing statute, and the potential impact of a regulatory change on the program. The expected completion date is December 2017. To close this recommendation, the Library of Congress must demonstrate that this study has been completed and that NLS has determined whether a change in its requirements is warranted.
    Recommendation: To ensure funds are directed to the most cost-effective outreach efforts, NLS should evaluate the effectiveness of its outreach efforts, including the extent to which different outreach efforts have resulted in new users.

    Agency: Library of Congress: National Library Service for the Blind and Physically Handicapped
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has begun revising the program application form so that it captures information on how applicants were referred to the program. NLS expects to have all libraries nationwide using this revised application by sometime in 2018. In addition, the Library of Congress indicated that NLS has contracted for a multi-year, multi-media advertising campaign. This effort will assess the effectiveness of different approaches by connecting direct responses to ads with verified program enrollment. The campaign is expected to be fully underway by January 2018. To close this recommendation, the Library of Congress will need to demonstrate that NLS has fully implemented one or more of its planned new approaches for evaluating outreach.
    Recommendation: To help it determine the most cost-effective approach for its next audio player, NLS should comprehensively assess the alternatives of designing its own specialized audio player versus providing commercially available players to its users.

    Agency: Library of Congress: National Library Service for the Blind and Physically Handicapped
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has contracted for a study of the different commercially available audio players for their usability, life-cycle costs, maintenance needs, and durability. The study is expected to be completed by December 2017, and will guide NLS in its decision about how to develop its next generation of audio players. To close this recommendation as implemented, the Library of Congress will have to demonstrate that this study has been conducted and that NLS has considered its findings in making a decision about its next generation audio player.
    Recommendation: To help it determine whether to supplement its collection of human-narrated audio materials with text-to-speech materials, NLS should thoroughly assess the text-to-speech option versus continuing to provide only human-narrated materials.

    Agency: Library of Congress: National Library Service for the Blind and Physically Handicapped
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has developed a library of 100 text-to-speech (synthetic speech) talking books. In September 2017, NLS will begin a 3-month pilot in which a group of NLS users try out these talking books and provide input to NLS. Also, NLS will require that its next generation of audio players have the capacity to play synthetic speech talking books, and the study it has contracted of commercially available players will consider this requirement among other factors. To close this recommendation as implemented, NLS needs to demonstrate that it has completed its text-to-speech pilot and has decided on an approach going forward with regards to expanding this program.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    6 open recommendations
    Recommendation: The Acting Commissioner of Social Security should direct the Deputy Commissioner of Operations to further consider cost savings as part of its prioritization of full medical reviews. Such options could include considering the feasibility of prioritizing different types of beneficiaries on the basis of their estimated average savings and, as appropriate, integrating case-specific indicators of potential cost savings, such as beneficiary age and benefit amount, into its modeling or prioritization process.

    Agency: Social Security Administration
    Status: Open

    Comments: In July 2017, SSA stated that there is no accepted way to accurately predict future benefit payments at the individual level and that any improvement from implementing this recommendation would be minimal - and would be reduced over time as the continuing disability review (CDR) backlog diminishes - because SSA already considers expected return on investment by cohort in its overall approach to releasing CDRs. It is unclear whether SSA will be able to achieve and sustain currency in its CDR workloads. Even if SSA were to eliminate the backlog of full medical reviews, refining its prioritization process would enable the agency to more efficiently use its resources with any future backlogs. SSA could use actuarial considerations to prioritize refined cohorts of beneficiaries (e.g., types of DI beneficiaries) on the basis of their estimated average savings. SSA Operations could collaborate with SSA's Office of the Actuary on this work as needed. SSA previously agreed that it could look for ways to improve its return on conducting CDRs, but also stated that its statistical models and prioritization process already do much of what we recommend. For example, SSA stated that age is already a strong variable in its statistical models. However, these models predict medical improvement and are not designed to take expected cost savings into account. We continue to believe that to maximize expected cost savings SSA could refine its prioritization process by factoring in additional actuarial considerations.
    Recommendation: The Acting Commissioner of Social Security should direct the Deputy Commissioner of Budget, Finance, Quality, and Management to complete a re-estimation of the statistical models that are used to prioritize CDRs and determine a plan for re-estimating these models on a regular basis to ensure that they reflect current conditions.

    Agency: Social Security Administration
    Status: Open

    Comments: In July 2016, SSA re-estimated the statistical models that it uses to prioritize CDRs. However, as of October 2017, SSA has not yet produced a plan for re-estimating the models on a regular basis to ensure that they continually reflect current conditions.
    Recommendation: The Acting Commissioner of Social Security should direct the Deputy Commissioner of Budget, Finance, Quality, and Management to monitor the characteristics of CDR errors to identify potential root causes and report results to the Disability Determination Services. For example, SSA could analyze CDRs with and without errors to identify trends by impairment, beneficiary type, or other characteristics.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA agreed with this recommendation and stated that it reports all errors to the relevant DDS for corrective action. SSA further stated that its identification of root causes is limited by the relatively few reviewed CDRs that have errors. However, in fiscal year 2014 as an example, SSA identified over 600 CDRs with errors. Although these CDRs make up a small percentage of the CDRs reviewed by SSA that year, the agency could analyze the characteristics of CDRs with errors by comparing relevant percentages without modeling. In addition, SSA could combine data from multiple years if it determined that considering more CDRs with errors would be helpful. There is no change in the status of this recommendation for 2017.
    Recommendation: The Acting Commissioner of Social Security should direct the Deputy Commissioner of Budget, Finance, Quality, and Management to regularly track the number and rate of date errors, which can affect benefit payments (e.g., incorrect cessation dates), and consider including those errors in its reported CDR accuracy rates.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA disagreed with this recommendation and stated that, per SSA regulation, the agency does not consider date errors when calculating accuracy rates because date errors do not affect the decision to cease or continue benefits. SSA also stated its stewardship reviews examine the non-medical quality of benefit payment decisions. However, these reviews are not focused on CDRs, and SSA does not report results from them for CDRs specifically. SSA also explained that it does not track the number and rate of date errors because they are infrequent. However, SSA's regulations do not prevent the agency from tracking date errors, and until it does, SSA cannot definitively determine the frequency of these errors. In addition, we found that considering date errors substantially reduced some states' estimated CDR accuracy rates. Without tracking these errors, SSA cannot assess their effect and consider whether including them in its reported CDR accuracy rates has merit. There is no change in the status of this recommendation for 2017.
    Recommendation: The Acting Commissioner of Social Security should direct the Deputy Commissioner of Budget, Finance, Quality, and Management to adjust its approach to sampling CDRs to efficiently produce reliable accuracy rate estimates for continuances and cessations separately in each state.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA disagreed with this recommendation and stated that some states do not generate enough CDR decisions, particularly cessations, to generate statistically valid samples. However, for states with CDR samples that are consistently too small to produce reliable results, SSA could, for example, pool decisions from more months than it currently does to generate statistically valid samples by state. Conversely, for states with CDR samples that are consistently larger than necessary to efficiently achieve reliable results, SSA could, for example, reduce sample sizes. Because CDR accuracy rates vary by state and cessations are consistently less accurate than continuances, we maintain that SSA should adjust its approach to sampling CDRs. There is no change in the status of this recommendation for 2017.
    Recommendation: The Acting Commissioner of Social Security should direct the Chief Actuary to better document the methods including data sources, assumptions, and limitations that factor into its estimates of CDR cost savings.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA agreed with this recommendation and stated that it will improve and expand its existing documentation as time and resources permit. As of July 2017, SSA had begun to improve documentation of its OASDI estimates and plans further enhancements including documenting the methods of its SSI estimates.
    Director: Mark L. Goldstein
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: The Chairman of FCC should evaluate the effectiveness of FCC's accessibility-related public outreach efforts and ensure those efforts incorporate key practices identified in this report, such as defining objectives and establishing process and outcome metrics.

    Agency: Federal Communications Commission
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Bertoni, Daniel
    Phone: (202) 512-7215

    3 open recommendations
    including 1 priority recommendation
    Recommendation: To help ensure that Total Disability Individual Unemployability (TDIU) decisions are well supported and TDIU benefits are provided only to veterans whose service-connected disabilities prevent them from obtaining or retaining substantially gainful employment, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to update the TDIU guidance to clarify how rating specialists should determine unemployability when making TDIU benefit decisions. This updated guidance could clarify whether factors such as enrollment in school, education level, and prior work history should be used and if so, how to consider them; and whether or not to assign more weight to certain factors than others. Updating the guidance would also give VBA the opportunity to re-examine the applicability, if at all, of other factors it has identified as extraneous.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA reported in March 2017 that an internal workgroup is in the final stage of collecting and analyzing the data to determine if age should be a factor in deciding Total Disability Individual Unemployability (TDIU), and whether or not to use positive vocational assessments to disallow TDIU claims. VA reported that the workgroup is also in the process of completing an Inter-Rater Variability Assessment (IRVA) to examine the disparity in rating decisions involving entitlement to TDIU and service connection. After completion of the internal study on TDIU and the IRVA, targeted for September 30, 2017, the workgroup will submit its preliminary analysis and recommendations to VBA leadership for a decision on the next courses of action for future policy decisions and will then update any related guidance, as appropriate.
    Recommendation: To help ensure that TDIU decisions are well supported and TDIU benefits are provided only to veterans whose service-connected disabilities prevent them from obtaining or retaining substantially gainful employment, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to verify the self-reported income provided by veterans (a) applying for TDIU benefits and (b) undergoing the annual eligibility review process by comparing such information against IRS earnings data, which VBA currently has access to for this purpose. VA could also explore options to obtain more timely earnings data from other sources to ensure that claimants are working within allowable eligibility limits

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA is developing an upfront verification process by expanding the data sharing agreement with Social Security Administration (SSA), which enables VA to receive federal tax information via an encrypted electronic transmission through a secure portal. Once a Total Disability Individual Unemployability (TDIU) claim is received, VA will request the reported income through the secured SSA portal and receive a response within 10-16 days. VA reported that process will serve as a more efficient way to receive income data in a timely manner and maintain the integrity of the TDIU benefit while reducing improper payments. The development and implementation of the upfront verification process for TDIU claimants is anticipated to be completed by July 21, 2017. Meanwhile, VA has reinstituted the data match agreement with SSA through December 2017, which collects earned income (employment wages). The agreement allows VBA to compare reported income earnings of TDIU beneficiaries to earnings actually received. In addition, VA completed the upfront income verification manual guidance and is planning to pilot the guidance prior to implementation. VA also has drafted new manual guidance for the annual eligibility review process and the documents are currently under review. As of March 2017, VA reported delays and stated it planned to fully implement the annual eligibility review process by June 30, 2017.
    Recommendation: To help ensure that TDIU decisions are well supported and TDIU benefits are provided only to veterans whose service-connected disabilities prevent them from obtaining or retaining substantially gainful employment, in light of VA's agreement with the recommendations made by the Advisory Committee on Disability Compensation, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to develop a plan to study the complex TDIU policy questions on (1) whether age should be considered when deciding if veterans are unemployable and (2) whether it is possible to disallow TDIU benefits for veterans whose vocational assessment indicated they would be employable after rehabilitation.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of March 2017, a VA workgroup is in the final stages of collecting and analyzing the data to determine if age should be a factor in deciding TDIU, and whether or not the agency will use positive vocational assessments to disallow TDIU claims. Additionally, the workgroup is in the process of completing an Inter-Rather Variability Study (IRVA) to examine the disparity in rating decisions involving entitlement to TDIU and service connection. After completion of the internal study on TDIU and the IRVA, targeted for September 30, 2017, he workgroup will submit its preliminary analysis and recommendations and VA will then decide on the next courses of action for future policy decisions. Due to VA's earlier conclusions, in April 2015, that no immediate changes to its current guidance were necessary, and in the spirit of this recommendation, the status will remain open until the completion of these ongoing efforts.
    Director: Mark Goldstein
    Phone: (202) 512-2834

    3 open recommendations
    Recommendation: To improve performance management of the Telecommunications Relay Service, the Chairman of the Federal Communications Commission should develop specific performance goals and measures for the TRS program. FCC should establish goals that would guide its efforts on major program dimensions--for example, consider goals and performance measures related to, but not limited to, service quality or competition among providers.

    Agency: Federal Communications Commission
    Status: Open

    Comments: On May 12, 2017, FCC's Liaison reported to us that FCC is working towards implementing these recommendations, but FCC does not have any specific achievements or documentation to report at this time. GAO will continue to monitor and update the status of this rec.
    Recommendation: To improve performance management of the Telecommunications Relay Service, following the establishment of TRS's performance goals, the Chairman of the Federal Communications Commission should conduct a robust risk assessment that can help FCC design a comprehensive internal-control system.

    Agency: Federal Communications Commission
    Status: Open

    Comments: On May 12, 2017, FCC's Liaison reported to us that FCC is working towards implementing these recommendations, but FCC does not have any specific achievements or documentation to report at this time. GAO will continue to monitor and update the status of this rec.
    Recommendation: To improve performance management of the Telecommunications Relay Service, the Chairman of the Federal Communications Commission should improve FCC's communication of TRS rules and procedures to the community of individuals who are deaf, hard of hearing, or have speech disabilities and the companies providing TRS services through the creation and dissemination of a handbook, program manual, or other consolidation of TRS rules and procedures.

    Agency: Federal Communications Commission
    Status: Open

    Comments: On May 12, 2017, FCC's Liaison reported to us that FCC is working towards implementing these recommendations, but FCC does not have any specific achievements or documentation to report at this time. GAO will continue to monitor and update the status of this rec.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    2 open recommendations
    Recommendation: As part of initiatives currently under way to improve agency information on claims with appointed representatives and detect potential fraud associated with representatives, the Commissioner of the Social Security Administration should consider actions to provide more timely access to data on representatives and enhance mechanisms for identifying and monitoring trends and patterns related to representation, particularly trends that may present risks to program integrity. Specifically, SSA could (1) Identify additional data elements, or amendments to current data collection efforts, to improve information on all appointed representatives, including those under contract with states and other third parties; (2) Implement necessary policy changes to ensure these data are collected. This could include enhancing technical systems needed to finalize SSA's 2008 proposed rules that would recognize organizations as representatives; and (3) Establish mechanisms for routine data extracts and reports on claims with representatives.

    Agency: Social Security Administration
    Status: Open

    Comments: In July 2017, SSA reported that it is approaching the conclusion of the first phase of a new initiative, called Registration, Appointment and Services for Representatives (RASR). This initiative aims to register all appointed representatives and improve relevant business processes and data collection. SSA reported that it had to postpone the first release of RASR, originally targeted for December 2016, due to some systems issues. SSA stated that it has not yet set a new target date for the first release. SSA stated that this new application will enhance data collection and management of representatives' information and that it will help make strides toward better oversight and improved data analysis and reporting. We will consider closing this recommendation when these efforts are completed.
    Recommendation: To address risks associated with potential overpayments to representatives and protect claimant benefits, the Commissioner of the Social Security Administration should take steps to enhance coordination with states, counties, and other third parties with the goal of improving oversight and preventing and identifying potential overpayments. This coordination could be conducted in a cost-effective manner, such as issuing guidance to states and other third parties on vulnerabilities for overpayment; sharing best practices on how to prevent overpayments; or considering the costs and benefits, including any privacy and security concerns, of providing third parties controlled access to portions of the eFolder to facilitate the detection of potential overpayments.

    Agency: Social Security Administration
    Status: Open

    Comments: In July 2017, SSA stated that it added a section to a new form--Form SSA-1698, Fee Agreement for Representation before the Social Security Administration--that claimants and representatives can use to enter into fee agreements. According to SSA, this form requires the disclosure of fees that the representative will receive from a third party and the amount of those fees. SSA expects this form to be in use upon OMB approval. Similar language already exists in another form--Form SSA-1560-U4, Petition to Obtain Approval of a Fee for Representing a Claimant before the Social Security Administration--that claimants and representatives can use for fee petitions. SSA stated that these forms are (and will be) included in the folder of evidence that adjudicators may review before determining whether and how much to authorize in fees. According to SSA, disclosure and approval of any third party fees, with potential adjustment of the fee, by both the claimant and SSA should help prevent excessive fees. While the proposed change to the form may help improve transparency of fee arrangements, the potential for a representative to receive a payment from SSA and also receive a payment from a state or other third party still exists. Unless SSA and the state or other third party share information on their payments or have policies and procedures in place to prevent such cases, representatives could still receive both SSA and state payments that total more than the SSA-authorized fee. In order to address this vulnerability, we continue to believe that SSA should enhance coordination or issue guidance to states and other third parties about this vulnerability, which could include SSA sharing best practices for preventing these types of overpayments. For example, one state requires contracted organizations to submit copies of their signed form 1696 (Appointment of Representative) so the state could verify the representative checked the appropriate box for payment.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    3 open recommendations
    including 1 priority recommendation
    Recommendation: To improve the ability of the agency to detect and prevent potential physician-assisted fraud, and to address potential disincentives for staff to detect and prevent physician-assisted fraud, SSA should review the standards used to assess DDS performance; and develop and distribute promising practices to incentivize staff to better balance the goal of processing claims promptly with the equally important goal of identifying and reporting evidence of potential fraud.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA partially agreed with this recommendation, citing that their employees take their stewardship responsibilities seriously and that field office and disability determination services (DDS) employees are the agency's first and best line of defense against fraud. In 2016, the agency reported that it was working with experts in its OIG and Office of Anti-Fraud Programs to develop and disseminate promising practices on identifying and reporting fraud. We will close this recommendation once SSA takes steps to review its standards for assessing DDS performance and disseminates the best practices it is developing.
    Recommendation: To improve the ability of the agency to detect and prevent potential physician-assisted fraud, and to address the potential risks associated with medical evidence submitted by sanctioned physicians, SSA should evaluate the threat posed by this information and, if warranted, consider changes to its policies and procedures.

    Agency: Social Security Administration
    Status: Open

    Comments: As of 2016, SSA reported that it was pursuing several options to address the potential risks of medical evidence submitted by sanctioned physicians. This included determining how it could use licensure information from the List of Excluded Individuals and Entities. SSA stated that it believes the best opportunity to further evaluate the possible review of the license statuses of medical evidence providers is in conjunction with the implementation of the National Vendor File, part of the national Disability Case Processing System, which is under development. In addition, SSA reported it had drafted two Social Security Rulings to define fraud and to provide processes for disregarding evidence and making redeterminations in disability claims when there is reason to believe that fraudulent evidence was provided. We will close this recommendation once SSA articulates a strategy for using license status information in the vendor file and it finalizes its rulings.
    Recommendation: To improve the ability of the agency to detect and prevent potential physician-assisted fraud, and to help ensure new initiatives that use analytics to identify potential fraud schemes are successful, SSA should develop an implementation plan that identifies both short- and long-term actions, including: (1) timeframes for implementation; (2) resources and staffing needs; (3) data requirements, e.g., the collection of unique medical provider information; (4) how technology improvement will be integrated into existing technology improvements such as the Disability Case Processing System and National Vendor File; and (5) how different initiatives will interact and support each other.

    Agency: Social Security Administration
    Status: Open
    Priority recommendation

    Comments: Since fiscal year 2015, SSA has taken several steps that will help the agency to combat fraud, waste, and abuse. SSA established the Office of Anti-Fraud Programs to provide centralized oversight and accountability for the agency's initiatives, which, in consultation with the Office of the Inspector General and other SSA components, will lead the development of SSA's anti-fraud initiatives and activities. This includes efforts to mitigate fraud through data analytics that utilize SSA's existing data systems. SSA developed a strategic plan for fiscal years 2016-2018 to guide its anti-fraud efforts that includes the use of data analytics. However, this plan does not specifically address actions to combat potential physician-assisted fraud. As of April 2017, SSA stated that it continued to develop a fraud management strategy that is consistent with the leading practices identified in GAO's report. Once the strategy is complete, SSA plans to conduct a fraud risk assessment on its major lines of business, beginning with the disability program in fiscal year 2017. We will continue to monitor SSA's progress to identify and prevent fraud schemes that include physicians.
    Director: Iritani, Katherine M
    Phone: (202) 512-7114

    2 open recommendations
    including 1 priority recommendation
    Recommendation: To improve the transparency of the process for reviewing and approving spending limits for comprehensive section 1115 demonstrations, the Secretary of Health and Human Services should update the agency's written budget neutrality policy to reflect actual criteria and processes used to develop and approve demonstration spending limits, and ensure the policy is readily available to state Medicaid directors and others.

    Agency: Department of Health and Human Services
    Status: Open
    Priority recommendation

    Comments: HHS does not agree with this recommendation. However, we continue to believe that HHS should have a formal written budget neutrality policy in place that reflects the Department's actual criteria and processes. HHS's written budget neutrality policy was last issued in 2001 and is not publicly available, and staff have acknowledged that aspects of the policy as written do not reflect their current criteria or processes.
    Recommendation: To improve the transparency of the process for reviewing and approving spending limits for comprehensive section 1115 demonstrations, the Secretary of Health and Human Services should reconsider adjustments and costs used in setting the spending limits for the Arizona and Texas demonstrations, and make appropriate adjustments to spending limits for the remaining years of each demonstration.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: As of September 2016, HHS officials reported that they have not implemented this recommendation. GAO considers it to be open. We will update this information when we receive additional information