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    Subject Term: "Appeals process"

    7 publications with a total of 27 open recommendations including 2 priority recommendations
    Director: Katherine Iritani
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: To improve CMS's oversight of states' MLTSS programs, the Administrator of CMS should take steps to identify and obtain key information needed to oversee states' efforts to monitor beneficiary access to quality services, including, at a minimum, obtaining information specific to network adequacy, critical incidents, and appeals and grievances.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Chris Currie
    Phone: (404) 679-1875

    6 open recommendations
    Recommendation: In order to improve employee misconduct policies and procedures, the Secretary of Homeland Security should direct the FEMA Administrator to document policies and procedures to address potential Surge Capacity Force misconduct.

    Agency: Department of Homeland Security
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: In order to improve employee misconduct policies and procedures, the Secretary of Homeland Security should direct the FEMA Administrator to document Reservist disciplinary options and appeals policies and procedures that are currently in practice at the agency.

    Agency: Department of Homeland Security
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: In order to improve employee misconduct policies and procedures, the Secretary of Homeland Security should direct the FEMA Administrator to communicate the range of penalties for specific misconduct offenses to all employees and supervisors.

    Agency: Department of Homeland Security
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: In order to better identify and address trends in employee misconduct, the Secretary of Homeland Security should direct the FEMA Administrator to improve the quality and usefulness of the misconduct data it collects by implementing quality control measures, such as adding additional drop-down fields with standardized entries, adding unique case identifier fields, developing documented guidance for data entry, or considering the adoption of database software.

    Agency: Department of Homeland Security
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: In order to better identify and address trends in employee misconduct, the Secretary of Homeland Security should direct the FEMA Administrator to, once the quality of the data is improved, conduct routine reporting on employee misconduct trends.

    Agency: Department of Homeland Security
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: In order to ensure that all allegations of employee misconduct referred by DHS OIG are reviewed and addressed, the Secretary of Homeland Security should direct the FEMA Administrator to develop reconciliation procedures to consistently track referred cases.

    Agency: Department of Homeland Security
    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

    5 open recommendations
    including 1 priority recommendation
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to ensure development of a timely, detailed workforce plan for recruiting, hiring and training new hires. In particular, this plan should: (1) include detailed steps and timetables for updating training curriculum (such as preparing decisions in a virtual environment) and ensuring office space (such as telework guidance); and (2) incorporate risk mitigation strategies that consider how the timing of recruitment and training dovetails with uncertain time frames for implementing a new appeals process.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA took additional steps to recruit, hire, manage space and train additional FTEs to address appeals workloads. However, detailed workforce plans would help ensure timely hiring and proper supports and training. We will close this recommendation when VA provides documentation of its actions and related guidance in several areas: agency telework plan; case adjudication in an virtual environment; status of hiring for FY17; hiring goals for FY18; space management plan indicating how FY17 and FY18 hiring will be accommodated; and plans for ongoing training for remote teleworkers.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to develop a schedule for IT updates that explicitly addresses when and how any process reform will be integrated into new systems and when Caseflow will be ready to support a potential streamlined appeals process at its onset.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation. In July 2017, VA reported its latest actions to address this recommendation, including documentation of the 6-month road map. However, we continue to believe that while the agile process can help mitigate risks and avoid cost overruns and delays, VA should define schedules beyond 6 months. Such planning allows VA to take additional steps to consider the scope of potential changes required by a new appeals process and have a broad plan in place to ensure that all aspects of the new process are adequately supported by Caseflow.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to conduct additional sensitivity analyses based on the assumptions used in projection models to more accurately estimate future appeals inventories and timeliness. In doing so, consider running additional analyses on how these factors, in conjunction with one another, may affect the timeliness and cost of deciding pending appeals.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation, noting that it plans to refine the model on a regular basis. However, we continue to believe that additional analyses of potential hiring options and of the compounded effect of assumptions that VA identified is consistent with sound practices and will help the agency anticipate and plan for different contingencies. In addition, as VA goes forward with appeals process reform and begins to collect real-time data, these data could improve modeling accuracy and serve as a valuable management tool. VA also noted plans to analyze, update and refine the model. We will consider closing this recommendation when VA completes these efforts and provides documentation of plans for modeling inventories and resource needs.
    Recommendation: To further align efforts to address appeals workload and improve timeliness of decisions, and reduce the risk that efforts will not go as planned, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate, to develop a more robust plan for closely monitoring implementation of process reform that includes metrics and interim goals to help track progress, evaluate efficiency and effectiveness, and identify trouble spots.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA agreed in principle with this recommendation. However, to fully implement it, VA needs to develop a monitoring plan with metrics and interim goals for implementing appeal process reform. Although VA agreed that developing such a plan is valuable for monitoring the implementation of process reform, VA also stated that it considered this recommendation complete and noted that preparing such a detailed plan depends on appeals reform legislation being enacted. While we recognize that VA cannot assume to know the exact provisions that may be included in future enacted legislation, we consider having a more robust monitoring plan - for example, that includes metrics and interim goals to help track implementation progress, evaluate efficiency and effectiveness of the reformed process, and identify trouble spots - to be essential to the successful implementation of a new appeals process.
    Recommendation: To better understand whether appeals process reform, in conjunction with other efforts, has improved timeliness, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits; the Chairman, Board of Veterans' Appeals; and the Chief Information Officer, as appropriate to develop a strategy for assessing process reform--relative to the current process--that ensures transparency in reporting to Congress and the public on the extent to which VA is improving veterans' experiences with its disability appeals process.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: VA concurred in principle with this recommendation and reported on its plans to measure veteran wait times as well as use customer satisfaction surveys to measure the success of the new appeals process. However, while we agree that metrics based on the different options could be valuable for VA, the Congress, and the public, we disagree that VA's focus on measuring timeliness by option is in the best interest of the veteran. Because veterans may pursue more than one option under VBA, the Board or both, we believe that VA's approach does not take into account the veteran's perspective of how long it took for them to receive a final appeal decision. Metrics from the veterans' overall perspective would complement, not replace, metrics for VBA, the Board, and each option. The absence of such metrics raises questions as to how the agency will ensure appropriate resources are devoted to managing appeals under the new versus old process, or intended results are achieved as the new process is implemented. Further, while the legislation requires VA to report a number of metrics, the agency still needs to implement the legislation. We will consider closing this recommendation when VA develops a plan for collecting metrics consistent with this recommendation.
    Director: Valerie Melvin
    Phone: (202) 512-6304

    2 open recommendations
    Recommendation: To provide greater transparency in the reporting of FOIA litigation costs, Congress could consider requiring Justice to provide a cost estimate for collecting and reporting information on costs incurred when defending lawsuits in which the plaintiffs prevailed.

    Agency: Congress
    Status: Open

    Comments: Congress has not yet considered if it plans to amend FOIA regarding the reporting of costs for defending lawsuits in which the plaintiffs prevailed.
    Recommendation: Congress could consider amending the act to require Justice to reflect in its Litigation and Compliance reports, changes in the award of attorneys' fees and costs resulting from the appeals process and settlement agreements between agencies and plaintiffs, if deemed to be cost-effective.

    Agency: Congress
    Status: Open

    Comments: Congress has not yet considered if it plans to amend FOIA to require Justice to make changes to its Litigation and Compliance reports.
    Director: David C. Trimble
    Phone: (202) 512-3841

    6 open recommendations
    including 1 priority recommendation
    Recommendation: To improve DOE's ability to evaluate and monitor the effectiveness of policies that call for all organizations, including contractors, to embrace a strong safety culture and create a work environment that encourages a questioning attitude by all employees, the Secretary of Energy should develop and implement an independent evaluation process for routinely and accurately measuring contractor employees' willingness to raise safety and other concerns without fear of retaliation. This process should ensure that an independent third party develops, conducts, and consistently applies the evaluation methodology--which should include safeguards that protect anonymity. The process should also enable DOE to oversee and ensure that appropriate corrective actions are taken in response to evaluation results.

    Agency: Department of Energy
    Status: Open

    Comments: DOE concurred with the recommendation. In December 2016, the Office of Enterprise Assessments formed a working group to address our recommendations. According to DOE, as of March 2017 the working group developed a strategy and plan to independently analyze data associated with willingness to raise concerns within contractor organizations at DOE sites with high hazard nuclear facilities. We will continue to monitor DOE's efforts to implement this recommendation.
    Recommendation: To help ensure that the organizational placement and practices of DOE- and contractor- provided Employee Concerns Programs (ECP) do not inhibit contractor employees from raising safety and other concerns, the Secretary of Energy should revise DOE's ECP order and guidance to (1) require that the organizational placement and practices of contractor ECP's do not compromise or impair their independence, (2) clarify the circumstances under which DOE's ECP is permitted to transfer and refer concerns to contractors, and notify or require approval of the contractor employee raising the concern, and (3) provide criteria for overseeing and evaluating the effectiveness and independence of contractor-provided ECPs.

    Agency: Department of Energy
    Status: Open

    Comments: DOE concurred with the recommendation. To address this recommendation, DOE planned to update DOE Order 442.1A, Department of Energy Employee Concerns Program, to (1) address the potential for conflicts of interest that could affect the independence of contractor ECPs, (2) clarify the circumstances under which an employee concern can be referred or transferred from a DOE ECP to a contractor ECP, and (3) specify that the processes already identified in DOE Order 226.1B, Implementation of Department of Energy Oversight Policy, be used as part of the oversight processes for contractor-provided ECPs, to include evaluation of their effectiveness and independence. According to DOE, the draft order was affected by a Presidential Memorandum issued in January 2017, which put a temporary stop to the DOE directives process. We will continue to monitor the status of DOE's implementation of this recommendation.
    Recommendation: To help ensure that Congress has the information it needs as it considers whether or not to make permanent the enhanced whistleblower pilot program and that DOE has assurance that contractor employees have an effective mechanism to seek remedy for unlawful retaliation, the Secretary of Energy should fully evaluate the extent to which the pilot program has been implemented and whether its provisions will mitigate challenges associated with DOE's 708 program. This evaluation should include, at a minimum, an assessment of (1) contractors that have adopted the pilot program and the date they did so; (2) contractors that have not adopted the pilot program and an explanation of why not; (3) cases filed under the pilot program, if any; and (4) the pilot program's potential for mitigating challenges associated with the 708 program.

    Agency: Department of Energy
    Status: Open

    Comments: DOE concurred in principle with the recommendation. In response to this recommendation, the Office of Hearings and Appeals conducted a review of the Part 708 program that, according to DOE, evaluated each of the areas of concern and compared current part 708 regulations with the pilot program. We will update the status of this recommendation after we review the resulting report.
    Recommendation: To help improve DOE's ability to take enforcement action against unlawful retaliation when appropriate and take action against contractors that create a chilled work environment, the Secretary of Energy should expedite the department's time frames for codifying in regulatory language its policy that retaliation for nuclear safety-related disclosures is a nuclear safety violation and develop a specific schedule for issuing the proposed and final rules.

    Agency: Department of Energy
    Status: Open

    Comments: DOE concurred with the recommendation and planned to amend its regulations to clarify which DOE regulations constitute DOE Nuclear Safety Requirements. DOD planned to expedite the schedule for this rulemaking. We will update the status of this recommendation after we confirm DOE's actions
    Recommendation: To help improve DOE's ability to take enforcement action against unlawful retaliation when appropriate and take action against contractors that create a chilled work environment, the Secretary of Energy should direct DOE's Office of Enforcement to routinely collect information from the Department of Labor and other sources regarding substantiated cases of retaliation and take appropriate enforcement action.

    Agency: Department of Energy
    Status: Open

    Comments: According to DOE, the Office of Enforcement has revised its internal implementing procedure to require that a review of DOE Office of Hearings and Appeals whistleblower cases, Department of Labor complaints submitted under the Energy Reorganization Act, and an online legal research service (for court decisions) be conducted each quarter to identify cases wherein a DOE contractor may have retaliated against an employee for reporting a safety concern and evaluate the information for potential enforcement action. We will update the status of this recommendation after we review the updated procedure.
    Recommendation: To help improve DOE's ability to take enforcement action against unlawful retaliation when appropriate and take action against contractors that create a chilled work environment, the Secretary of Energy should revise DOE's Integrated Safety Management policy and guidance to clarify what constitutes evidence of a chilled work environment and define the appropriate steps DOE should take to hold contractors accountable for creating a chilled work environment.

    Agency: Department of Energy
    Status: Open
    Priority recommendation

    Comments: DOE concurred with the recommendation. DOE officials said that the department was revising the Integrated Safety Management policy but the revisions are currently on hold indefinitely along with all other actions to publish new, or update existing departmental directives in response to two Presidential Executive Orders issued in January and February 2017 that directed federal agencies to, among other things, reduce and reform agency regulations.
    Director: Kathleen King
    Phone: (202) 512-7114

    3 open recommendations
    Recommendation: To reduce the number of Medicare appeals and to strengthen oversight of the Medicare FFS appeals process, the Secretary of Health and Human Services should direct CMS, Office of Medicare Hearings and Appeals (OMHA), or Departmental Appeals Board (DAB) to modify the various Medicare appeals data systems to collect information on the reasons for appeal decisions at Level 3.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: According to HHS as of August 2016, OMHA and DAB were considering the cost and technical feasibility of collecting this information within their appeals data systems. As of September 2017, HHS officials have not implemented this recommendation. We will update the status of this recommendation when we receive additional information.
    Recommendation: To reduce the number of Medicare appeals and to strengthen oversight of the Medicare FFS appeals process, the Secretary of Health and Human Services should direct CMS, OMHA, or DAB to modify the various Medicare appeals data systems to capture the amount, or an estimate, of Medicare allowed charges at stake in appeals in Medicare Appeals System (MAS) and Medicare Operations Division Automated Case Tracking System (MODACTS).

    Agency: Department of Health and Human Services
    Status: Open

    Comments: According to HHS as of August 2016, this information was not captured in any CMS system, including MAS. HHS reported that if MAS is modified to capture the amount of Medicare allowed charges at stake, OMHA will consider modifying its Electronic Case Adjudication and Processing Environment (ECAPE) to include this information as well, and DAB can capture it in a new case management system currently being developed by the agency. As of September 2017, HHS officials have not implemented this recommendation. We will update the status of this recommendation when we receive additional information.
    Recommendation: To reduce the number of Medicare appeals and to strengthen oversight of the Medicare FFS appeals process, the Secretary of Health and Human Services should direct CMS, OMHA, or DAB to modify the various Medicare appeals data systems to collect consistent data across systems, including appeal categories and appeal decisions across MAS and MODACTS.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: According to HHS as of August 2016, HHS reported taking several initial steps to standardize data across Medicare appeals systems. Specifically, HHS stated that, in November 2016, CMS will modify MAS to standardize appeal categories between Levels 1 through 3 and that OMHA will incorporate the standardized MAS appeal categories for Levels 1 and 2 into ECAPE in its next release. DAB will also work to incorporate these standardized categories into its new appeals data system. In addition, HHS reported that CMS is working to modify MAS to collect additional information related to appeal decisions. As of September 2017, HHS officials have not implemented this recommendation. We will update the status of this recommendation when we receive additional information.
    Director: Jeszeck, Charles A
    Phone: (202) 512-7215

    4 open recommendations
    Recommendation: To enhance understanding and better inform debate on the possible effects of moving to a more risk-based premium structure, during consideration of various redesign options and after a redesign may be authorized, the Director of PBGC should continue to develop PBGC's hypothetical model, analyzing various premium redesign options and their impacts on sponsors, and report the results to Congress. As part of these analyses, PBGC should evaluate the potential effects on sponsors of incorporating additional risk factors, such as company financial health and plan investment mix, and include an assessment to identify any potentially disproportional hardships on smaller companies that may result from the redistribution of higher rates to riskier sponsors.

    Agency: Pension Benefit Guaranty Corporation
    Status: Open

    Comments: PBGC agreed with this recommendation. The agency is committed to continued development of the databases, models, and analyses of various premium redesign options and their impacts on sponsors, and to report the results of these analyses to Congress. In April 2014, PBGC noted that its efforts are still in process. As of August 2015, PBGC had provided no additional updates on actions taken on this recommendation.
    Recommendation: To help strengthen the PBGC insurance program, Congress should authorize redesign of PBGC's premium structure to more fully reflect the risk posed by plans and sponsors to the agency, such as by providing for the incorporation of additional risk factors.

    Agency: Congress
    Status: Open

    Comments: In July 2012 and December 2013, Congress passed premium increases (P.L. No. 112-141 and P.L. 113-67, respectively) to better reflect the risk posed to the Pension Benefit Guaranty Corporation by certain defined benefit pension plans and plan sponsors. Nevertheless, As of September 2015, Congress had yet to authorize a redesign of PBGC's premium structure.
    Recommendation: In addition, to improve PBGC's ability to collect key information that may be necessary to help the agency estimate its risk exposure to future claims and strengthen implementation of any changes to the premium structure, Congress should provide PBGC with access to additional information needed to assess risk and assist in setting premiums, such as by expanding the criteria requiring plan sponsors to report under section 4010 of ERISA.

    Agency: Congress
    Status: Open

    Comments: As of September 2015, Congress has taken no action related to this matter.
    Recommendation: Moreover, to better understand the mechanics of how best to incorporate additional risk factors, improve transparency, and help inform the evaluation of the various redesign options, Congress should establish an independent premiums advisory committee reflecting a range of perspectives--including, for example, representatives from federal agencies, sponsors, actuaries, private insurers, and labor groups--to assist with such activities as developing the mechanics for incorporating additional risk factors and implementing new rates, as well as delineating a variety of alternative methods to address PBGC's deficit.

    Agency: Congress
    Status: Open

    Comments: As of September 2015, Congress has taken no action related to this matter.