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    Results:

    Subject Term: "Community health services"

    4 publications with a total of 7 open recommendations including 1 priority recommendation
    Director: Katherine Iritani
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To achieve a better understanding of the effect of certain Personal care services (PCS) services on beneficiaries and a more consistent administration of policies and procedures across PCS programs, the Acting Administrator of CMS should collect and analyze states' required information on the impact of the Participant-Directed Option and Community First Choice programs on the health and welfare of beneficiaries as well as the state quality measures for the Participant-Directed Option and Community First Choice programs.

    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.
    Recommendation: To achieve a better understanding of the effect of certain PCS services on beneficiaries and a more consistent administration of policies and procedures across PCS programs, the Acting Administrator of CMS should take steps to harmonize requirements, as appropriate, across PCS programs in a way that accounts for common risks faced by beneficiaries and to better ensure that billed services are provided.

    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: King, Kathleen M
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: Should the Congress decide to cap payments for physician and other nonhospital services made through IHS's CHS program, the Secretary of Health and Human Services should direct the Director of IHS to monitor CHS program patient access to physician and other nonhospital care in order to assess how any new payment rates may benefit or impede the availability of care.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with GAO's recommendation and indicated that monitoring patient access to care in light of any payment changes is essential to providing high-quality health care to American Indians and Alaska Natives. Since there have not been any changes to the payment rates, IHS has not yet implemented this recommendation.
    Director: Trimble, David C
    Phone: (202)512-9338

    3 open recommendations
    including 1 priority recommendation
    Recommendation: To improve EPA's ability to oversee the states' implementation of the Safe Drinking Water Act and provide Congress and the public with more complete and accurate information on compliance, the Administrator of EPA should resume data verification audits to routinely evaluate the quality of selected drinking water data on health-based and monitoring violations that the states provide to EPA. These audits should also evaluate the quality of data on the enforcement actions that states and other primacy agencies have taken to correct violations.

    Agency: Environmental Protection Agency
    Status: Open
    Priority recommendation

    Comments: In October 2016, EPA reported that it had not resumed its data verification audits, but is continuing on-site file reviews, completing 5 in 2015, and planning to complete 8 in 2016. Further, EPA continues to focus on developing its SDWIS Prime, which will support electronic verification of data. It plans to have the system operational in March 2018. In the last year, EPA conducted two training events with the regional file review teams which the agency indicated helped (1) identify challenges in completing file reviews and potential solutions, and (2) share best practices to enhance the implementation of the protocol. EPA told us that as the regions build more capacity and experience in conducting these file reviews, EPA expects to gradually increase the number of file reviews completed in a year. According to OECA, who collaborates with the water office for file reviews in some regions, there were no systemic discrepancies between enforcement file contents and data reported to EPA in its test of the protocol for evaluating the quality of enforcement data in 3 states.
    Recommendation: To improve EPA's ability to oversee the states' implementation of the Safe Drinking Water Act and provide Congress and the public with more complete and accurate information on compliance, the Administrator of EPA should work with the states to establish a goal, or goals, for the completeness and accuracy of data on monitoring violations. In setting these goals, EPA may want to consider whether certain types of monitoring violations merit specific targets. For example, the agency may decide that a goal for the states to completely and accurately report when required monitoring was not done should differ from a goal for reporting when monitoring was done but not reported on time.

    Agency: Environmental Protection Agency
    Status: Open

    Comments: According to EPA, it has not worked with states to establish a national goal for the quality of monitoring violations. EPA stated that without the ability to conduct on-site data verifications using a statistically-based sample size, it is unable to derive a goal that would capture both completeness of state reporting to EPA and whether the states correctly assigned a violation for missed monitoring. EPA said that it intends to work with states to evaluate the establishment of a monitoring data quality goal once the new SDWIS NextGen data system has been developed and electronic data verification functions are incorporated into the system. In April 2015, EPA indicated that the agency intends to separate monitoring violations from reporting violations in the new SDWIS Primacy Agency data system. According to EPA, this will enable the primacy agencies and EPA to better understand the nature of system violations and with the violations delineated in this manner, will allow EPA to consider developing goals for monitoring and reporting violations. In September 2015, EPA reported to GAO that it anticipated that states will begin using SDWIS Prime in September 2017 and that it will consider GAO's recommendation once SDWIS Prime is fully operational and it is able to better establish such a goal.
    Recommendation: To improve EPA's ability to oversee the states' implementation of the Safe Drinking Water Act and provide Congress and the public with more complete and accurate information on compliance, the Administrator of EPA should consider whether EPA's performance measures for community water systems could be constructed to more clearly communicate the aggregate public health risk posed by these systems' noncompliance with SDWA and progress in having those systems return to compliance in a timely manner.

    Agency: Environmental Protection Agency
    Status: Open

    Comments: According to EPA, the agency has not made any adjustments to the performance measures for community water systems. EPA told us that, as part of its periodic review of the 5-year Strategic Plan, it will consult with the states, the Office of Management and Budget, GAO and the National Drinking Water Advisory Committee (NDWAC) on how it could construct a new measure to communicate better the aggregate public health risk posed by noncompliance as GAO suggests. EPA also said that it will continue to use a variety of tools and resources to convey to the public information on drinking water quality and potential health risks associated with exposure to contaminants. In April 2015, EPA wrote: OGWDW did not make any changes in Fiscal Year 2014 to the program's current community water system-based measure which communicates the results of efforts to return systems to compliance and maintain compliance. The "person month" measure provides insight into the duration of health based violations. For FY 15, we have developed a "person month" measure for tribal community water systems. Further efforts to evaluate the current measures and consideration of GAO suggestions will continue to be part of the Agency's periodic review of the five-year strategic plan. In September 2015, EPA told GAO that it was evaluating the effectiveness of the "person month" measure and is continuing to enhance and revise the measures taking GAO suggestions into consideration.
    Director: Dicken, John E
    Phone: (202)512-7043

    1 open recommendations
    Recommendation: To help states identify and address quality-of-care concerns among individuals with developmental disabilities receiving Medicaid HCBS waiver services, the Administrator of CMS should encourage states to (1) include death as a critical incident and conduct mortality reviews if they do not already do so and (2) broaden their mortality review processes if they already include death as a critical incident and conduct mortality reviews.

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

    Comments: In August 2009, CMS stated that it anticipated adding a question about mortality reviews to its next web-based version of the Home and Community-Based Services waiver application. CMS also indicated at that time that the next application version (i.e., Version 3.6) would be released in 2010. However, in July 2010, CMS indicated that this version would not be produced until 2011. In its 2011 update, CMS indicated that the version 3.6 online application had not yet been operationalized and therefore the recommendation should be left open until next year. In July 2013, CMS stated that version 3.6 remains on hold and that the agency is exploring other options for addressing this recommendation, with a target completion date of 12/31/2014.