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    Subject Term: "Federal aid to states"

    18 publications with a total of 32 open recommendations including 2 priority recommendations
    Director: David A. Powner
    Phone: (202) 512-9286

    6 open recommendations
    Recommendation: The Secretary of Health and Human Services should direct the Administrator of the Centers for Medicare & Medicaid Services to take steps to ensure that state-based marketplace annual sustainability plans, to the extent possible, have complete 5-year budget forecasts. (Recommendation 1)

    Agency: Department of Health and Human Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Health and Human Services should direct the Administrator of the Centers for Medicare & Medicaid Services to take steps to ensure that all state-based marketplaces provide required annual financial audit reports which are in accordance with generally accepted government auditing standards. (Recommendation 2)

    Agency: Department of Health and Human Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Health and Human Services should direct the Administrator of the Centers for Medicare & Medicaid Services to take steps to ensure that marketplace IT self-sustainability risk assessments are based on fully defined measurable terms, a clear categorization process, and a defined response to high risks. (Recommendation 3)

    Agency: Department of Health and Human Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Health and Human Services should direct the Administrator of the Centers for Medicare & Medicaid Services to take steps to ensure that states develop, update, and follow performance measurement plans that allow the states to continuously identify and assess the most important IT metrics for their state marketplaces. (Recommendation 4)

    Agency: Department of Health and Human Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Health and Human Services should direct the Administrator of the Centers for Medicare & Medicaid Services to take steps to conduct operational analysis reviews and systematically monitor the performance of states' marketplace IT systems using key performance indicators. (Recommendation 5)

    Agency: Department of Health and Human Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Health and Human Services should direct the Administrator of the Centers for Medicare & Medicaid Services to take steps to ensure that metrics collected from states to monitor marketplaces' operational performance link to performance goals and include baselines and targets to monitor progress. (Recommendation 6)

    Agency: Department of Health and Human Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Susan Fleming
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: To better position DOT and FHWA to effectively guide the transformation of federal surface transportation programs to a more performance-oriented approach, and to help states and MPOs overcome anticipated challenges, the Secretary of Transportation should direct the Administrator of FHWA to take the following two actions: 1. Develop a formal TPM implementation plan to include overarching implementation goals, specific actions FHWA plans to take to help states and MPOs successfully implement TPM, and corresponding timelines. 2. Publicly communicate this plan and approach to build a shared understanding of the goals and purpose of the transformation with its grantees.

    Agency: Department of Transportation
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Allison B. Bawden
    Phone: (202) 512-6806

    2 open recommendations
    Recommendation: To help ensure that the pilot programs for disconnected youth can be effectively implemented over the lifetime of the initiative, the Director of OMB should coordinate with relevant federal agencies to identify and estimate expected annual financial and staff resource contributions from each agency, including during the implementation and evaluation phases of the pilots.

    Agency: Executive Office of the President: Office of Management and Budget
    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 that federal agencies involved in the disconnected youth pilots are able to evaluate pilot outcomes and ultimately communicate to Congress whether and to what extent the flexibilities tested by the pilots should be integrated into broader efforts, the Director of OMB should coordinate with relevant federal agencies to identify criteria or standards for assessing scalability, and collect data needed to address those criteria or standards.

    Agency: Executive Office of the President: Office of Management and Budget
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Katherine Iritani
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To improve consistency in CMS oversight of federal spending under section 1115 demonstrations, the Secretary of Health and Human Services should require the Administrator of CMS to develop and document standard operating procedures for monitoring spending under demonstrations that (1) require setting reporting requirements for states that provide CMS the data elements needed for CMS to assess compliance with demonstration spending limits; (2) require consistent enforcement of states' compliance with financial reporting requirements; and (3) require consistent tracking of the amount of unspent funds under demonstration spending limits.

    Agency: Department of Health and Human 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 improve consistency in CMS oversight of federal spending under section 1115 demonstrations, the Secretary of Health and Human Services should require the Administrator of CMS to issue formal guidance on the revised budget neutrality policy, including information on how the policy will be applied.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Allison B. Bawden
    Phone: (202) 512-6806

    3 open recommendations
    Recommendation: To improve transparency in the grant merit-review process, the Secretary of the Department of the Interior should direct the Fish and Wildlife Service to issue written guidance to require all competitive grant programs to clarify in the public notice of funding opportunity all review criteria, including cost sharing factors as relevant, and their related scores to be used to make final award decisions.

    Agency: Department of the Interior
    Status: Open

    Comments: As of August 2017, Interior had updated its notice of funding opportunity template for competitive grant programs to clarify that the review process must ensure that applications are scored and selected based on announced criteria. In addition, competitive grant programs must establish a written merit review plan that details the merit review factors and sub-factors and the rating system and evaluation standards which explain the scoring basis. Furthermore, the Fish and Wildlife Service is developing new guidance to ensure discretionary grant programs include all required elements to be completed in December of 2017.
    Recommendation: To reduce the risk of duplicative and overlapping funding at the grant award level, the Secretary of the Department of the Interior should direct the National Park Service and the Fish and Wildlife Service to issue written guidance that ensures their grant management staff review grant applications for potential duplication and overlap before awarding their competitive grants and cooperative agreements.

    Agency: Department of the Interior
    Status: Open

    Comments: The Fish and Wildlife Service issued guidance to ensure grant applications are reviewed for potential overlap and duplication, as GAO recommended in January 2017, but as of August 2017 the National Park Service had yet to issue such guidance. In August 2017, the Department of Interior (Interior) provided documentation showing that the Fish and Wildlife Service now requires discretionary grant applicants to provide a statement that addresses whether there is any overlap or duplication of proposed projects or activities to be funded by the grant. Fish and Wildlife also updated its guidance to grant awarding offices instructing them to perform a potential overlap and duplication review of all selected applicants prior to award. Interior said the National Park Service had yet to issue guidance on duplication and overlap review, but it would provide the guidance to GAO when it is finalized and implemented. Completing these improvements will help the Fish and Wildlife Service and the National Park Service reduce the risk of unnecessary or inadvertent overlap or duplication in grant funding.
    Recommendation: To reduce the risk of duplicative and overlapping funding at the grant award level, the Secretary of Agriculture should direct the Food and Nutrition Service to issue written guidance that ensures its grant management staff review grant applications for potential duplication and overlap before awarding competitive grants and cooperative agreements.

    Agency: Department of Agriculture
    Status: Open

    Comments: In August 2017, the Department of Agriculture (Agriculture) said the Food and Nutrition Service was developing written guidance that will ensure its grants management staff identify grant programs for potential duplication and overlap with other federal agencies before awarding competitive grants and cooperative agreements, as GAO recommended in January 2017. Agriculture officials said the guidance would be based on input from grants management staff, relevant Food and Nutrition program officials, and reviews of similar guidance already in place at other Agriculture sub-agencies. The Food and Nutrition Service plans to issue this guidance by the end of federal fiscal year 2017 for use beginning in fiscal year 2018. Issuing and implementing this guidance will reduce the risk of unnecessary or inadvertent overlap or duplication in grant funding.
    Director: Mark Goldstein
    Phone: (202) 512-2834

    3 open recommendations
    Recommendation: To improve the effectiveness, transparency, and accountability of the ECPC's efforts, the Secretary of Homeland Security, as the administrative leader of the ECPC, should clearly document the ECPC's strategic goals.

    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: To improve the effectiveness, transparency, and accountability of the ECPC's efforts, the Secretary of Homeland Security, as the administrative leader of the ECPC, should establish a mechanism to track progress by the ECPC's member agencies in implementing the ECPC's recommendations.

    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: To improve the effectiveness, transparency, and accountability of the ECPC's efforts, the Secretary of Homeland Security, as the administrative leader of the ECPC, should clearly define the roles and responsibilities of the ECPC's member agencies.

    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: Mark Goldstein
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: To further build on the efforts to improve emergency communications interoperability in the NCR, as part of its efforts to restructure the JFC, the Federal Emergency Management Agency Administrator should direct the Director of ONCRC to clearly articulate in a written agreement the roles and responsibilities of the participating agencies and specify how these agencies are to work together across agency boundaries.

    Agency: Department of Homeland Security: Directorate of Emergency Preparedness and Response: Federal Emergency Management Agency
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Katherine Iritani
    Phone: (202) 512-7114

    2 open recommendations
    including 2 priority recommendations
    Recommendation: To promote consistency in the distribution of supplemental payments among states and with CMS policy, the Administrator of CMS should issue written guidance clarifying its policy that requires a link between the distribution of supplemental payments and the provision of Medicaid-covered services.

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

    Comments: CMS plans to publish a proposed rule for public comment in the summer of 2017 to improve the oversight of supplemental payments, including a proposal to require that supplemental payments be distributed proportional to the volume or cost of services delivered or be tied to meeting performance benchmarks. To the extent the agency issues a final rule that results in states distributing supplemental payments in a manner that aligns their distribution with individual facilities' Medicaid workloads, CMS's ability to ensure that state Medicaid payments are not excessive and are used for Medicaid purposes will improve.
    Recommendation: To promote consistency in the distribution of supplemental payments among states and with CMS policy, the Administrator of CMS should issue written guidance clarifying its policy that payments should not be made contingent on the availability of local funding.

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

    Comments: CMS plans to publish a proposed rule for public comment in the summer of 2017 to improve the oversight of supplemental payments, including a proposal to require that supplemental payments be distributed proportional to the volume or cost of services delivered or be tied to meeting performance benchmarksTo the extent the agency issues a final rule that results in states distributing supplemental payments in a manner that aligns their distribution with individual facilities' Medicaid workloads, CMS's ability to ensure that state Medicaid payments are not excessive and are used for Medicaid purposes will improve.
    Director: John Pendleton
    Phone: (202) 512-3489

    1 open recommendations
    Recommendation: To ensure that resources are being efficiently applied to meet the National Guard counterdrug program's objectives, the Secretary of Defense should direct the National Guard Bureau in consultation with the Deputy Assistant Secretary of Defense for Counternarcotics and Global Threats to subsequently collect and use performance information to help inform funding distribution decisions to state programs and to conduct oversight of the training offered by the counterdrug schools.

    Agency: Department of Defense
    Status: Open

    Comments: The National Guard counterdrug program has plans to implement performance information into its fiscal year 2017 annual assessments of the state programs and counterdrug schools. The fiscal year 2017 annual assessments are scheduled to be complete by December 2017. The recommendation will remain open until performance information has been included in the annual assessments.
    Director: David J. Wise
    Phone: (202) 512-2834

    2 open recommendations
    Recommendation: To ensure that transit agencies have appropriate and current guidance to assist them when procuring transit buses, the Administrator of FTA should update its Best Practices Procurement Manual and assess its other related guidance identified in this report and update that guidance as needed.

    Agency: Department of Transportation: Federal Transit 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 provide a more efficient and cost-effective way for transit agencies to procure transit buses while complying with federal procurement requirements, the Administrator of FTA, in conjunction with the Administrator of the General Services Administration, should submit a legislative proposal to Congress that would authorize transit agencies that are recipients of FTA grants to access GSA sources of supply for the purchase of transit buses.

    Agency: Department of Transportation: Federal Transit Administration
    Status: Open

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

    1 open recommendations
    Recommendation: The Secretary of the Department of Health and Human Services should facilitate development of a cross-agency federal strategy to help ensure that federal resources from Administration for Community Living, CMS, USDA, HUD, and DOT are effectively and efficiently used to support a comprehensive system of HCBS and related supports for older adults. Through such a strategy the agencies could, for example, define common outcomes for affordable housing with supportive services, non-medical transportation, and nutrition assistance at the federal level; develop lessons learned for the local networks that area agencies on aging and community-based organizations are forming; and develop strategies for leveraging limited resources.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with this recommendation, noting that it continually strives to improve its strategic coordination and described ways that it facilitates cross agency strategic efforts, including a community-living initiative with HUD and an interagency workgroup on Olmstead requirements. HHS also described collaboration by HHS and HUD on policy research projects concerning housing and supportive services for older adults, including a comparison of health service utilization by older adults who live in assisted housing with those who do not and an evaluation of a demonstration in Vermont that provides services and supports to residents of HUD-assisted housing. We continue to encourage HHS to engage all five agencies to develop a cross agency federal strategy for administering home and community-based services for older adults. Using the eight practices to enhance and sustain interagency collaboration that we identified in prior work could help the five agencies address some of the challenges. In May 2016, HHS reported that it believes it addressed the recommendation and plans no additional action.
    Director: Yocom, Carolyn L
    Phone: (202)512-4931

    1 open recommendations
    Recommendation: To ensure that federal funding efficiently and effectively responds to the countercyclical nature of the Medicaid program, Congress may wish to consider enacting an FMAP formula that is targeted for variable state Medicaid needs and provides automatic, timely, and temporary increased FMAP assistance in response to national economic downturns.

    Agency: Congress
    Status: Open

    Comments: On February 10, 2016, GAO testified on considerations related to the Medicaid funding formula. See Medicaid: Changes to Funding Formula Could Improve Allocation of Funds to States GAO-16-377T January 26, 2016. We also cited this report in our discussion on Medicaid funding during economic downturns in Medicaid: Key Policy and Data Considerations for Designing a Per Capita Cap on Federal Funding(GAO-16-726).
    Director: St James, Lorelei
    Phone: (214)777-5719

    1 open recommendations
    Recommendation: To know whether its data on committed spending can be relied on to determine state DOTs' progress in meeting goals, to enhance FHWA's ability to know whether state DOTs meet their DBE goals, and to help increase transparency in the reporting of spending on DBEs, the Secretary of Transportation should direct the FHWA Administrator, in the information it provides to decision makers, including Congress, to include statements about potential limitations of the data it uses to determine state DOTs' progress towards goals.

    Agency: Department of Transportation
    Status: Open

    Comments: An official from the Department of Transportation said that the agency expects the recommendation to be met with a final rule regarding disadvantaged business enterprises, which will be signed by the Secretary of the Department of Transportation by the end of the calendar year.
    Director: Wise, David J
    Phone: (202)512-3000

    1 open recommendations
    Recommendation: To establish accountability for meeting the programs' goal of increasing the participation of traditionally underrepresented groups in the highway construction workforce, the Secretary of Transportation should direct the FHWA Administrator to create and implement an oversight mechanism that (1) holds states accountable for meeting federal training criteria and (2) clearly stipulates how FHWA will assess state program effectiveness, including what type of program achievement data states are to submit and how such data will be used. This oversight mechanism should include assessing the effectiveness of its division offices in overseeing state activities.

    Agency: Department of Transportation
    Status: Open

    Comments: FHWA has taken steps to implement an oversight mechanism that may address this recommendation. FHWA officials anticipate completing their work in response to this recommendation in mid- to late 2017.
    Director: Dagostino, Davi M
    Phone: (202) 512-3000

    1 open recommendations
    Recommendation: To improve DOD's ability to conduct its civil support missions, the Secretary of Defense should direct the Assistant Secretary of Defense for Homeland Defense and Americas' Security Affairs, in coordination with the Chairman of the Joint Chiefs of Staff, to conduct a review of staffing requirements for the Defense Coordinating Officers, Defense Coordinating Elements, and Emergency Preparedness Liaison Officers in both the NORTHCOM and PACOM areas of responsibility that includes but is not limited to an assessment of staff size, subject-matter expertise, and military service composition by FEMA region.

    Agency: Department of Defense
    Status: Open

    Comments: DOD concurred with the recommendation. DOD indicated several past and ongoing efforts will help address the recommendation. DOD highlighted, in particular, DOD Instruction 3025.16, "Defense Emergency Preparedness Liaison Officer (EPLO) Programs," published on September 8, 2011; and a draft instruction on "Defense Planning and Coordination in Support of Civil Authorities," which is undergoing substantial revision due to recent updates in the DOD initiative for DOD Support to Complex Catastrophes. DOD stated that is plans to issue the instruction in September 2014. In July 2013, U.S. Northern Command (NORTHCOM) stated that as part of the Secretary of Defense's initiative to Improve DOD support in Complex Catastrophes, the Under Secretary of Defense for Personnel and Readiness, in coordination with the Under Secretary of Defense for Policy, and the Chairman of the Joint Chiefs of Staff, based upon the requirements of NORTHCOM and U.S. Pacific Command, are to identify requirements and make recommendations to the Secretary of Defense to support effective DOD coordination and liaison with DOD's Federal, Regional, and State partners on complex catastrophe preparedness and response. As part of this effort, the Under Secretary of Defense for Personnel and Readiness will consider the feasibility of joint billets for DCOs, DCEs, EPLOs, JRMPOs, and Joint Force Headquarters (JFHQ)-States. As of September 2014, NORTHCOM's IG office stated that despite positive initiatives taken to date, a review of DCO/EPLO staffing requirements has not been completed. DOD, the Combatant Commands, and the Services would benefit from such an analysis. They added that despite positive actions taken to date to improve DCO/EPLO operations, multiple efforts are still ongoing that support this action item. DODD 3025.jj remains in development with OSD, the Services, and USNORTHCOM. A USNORTHCOM operational planning team is in the process of coordinating command and control relationships for DCOs and their Defense Coordinating Elements (DCE). Another effort is underway to revive the annual DSCA/IDR Preparedness Workshop, which provided a vehicle for coordination among all DOD DSCA participants to institutionalize these processes. USNORTHCOM and components are still evaluating requirements and potential solutions for providing additional staff support to the DCOs/DCEs.
    Director: Scire, Mathew J
    Phone: (202)512-6794

    1 open recommendations
    Recommendation: To the extent that the CDBG program continues to be the primary vehicle used to provide post-disaster assistance for permanent housing, Congress may wish to consider providing more specific direction regarding the distribution of disaster-related CDBG assistance that states are to provide for homeowners and renters. If Congress wishes to change the proportion of assistance directed to homeowners and rental property owners in future recovery efforts, Congress could, for example, require states to demonstrate to HUD that they are adequately addressing the needs of both homeowners and renters with their CDBG allocation and other resources as a condition for receiving funds. Alternatively, Congress could direct HUD to develop a formula that accounts for the housing needs of both homeowners and renters. Such a formula could be used by states to determine the proportions of their disaster CDBG funds that should be used for housing, specifically rental housing. Further, the formula could also reflect the anticipated production levels of other programs that provide permanent housing assistance, such as the Low-Income Housing Tax Credit program.

    Agency: Congress
    Status: Open

    Comments: Since the Gulf Coast hurricanes, Congress appropriated CDBG Disaster Funding for subsequent disasters, including $16 billion to assist recovery in areas affected by Hurricane Sandy and other eligible events in calendar years 2011, 2012, and 2013. According to Pub. L. No. 113-2, Congress did not require states to demonstrate to HUD that they were adequately addressing the needs of both homeowners and renters. Moreover, Congress does not appear to have directed HUD to develop a formula that accounts for the housing needs of both homeowners and renters. As of January 2017, no CDBG appropriations for disaster relief have addressed this issue.
    Director: Iritani, Katherine M
    Phone: (202)512-3000

    1 open recommendations
    Recommendation: To improve the oversight of states' Medicaid supplemental payments, the Administrator of CMS should develop a strategy to identify all of the supplemental payment programs established in states' Medicaid plans and to review those programs that have not been subject to review under CMS's August 2003 initiative.

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

    Comments: As of July 2016, HHS officials reported that they have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Director: Siggerud, Katherine A
    Phone: (202)512-6570

    2 open recommendations
    Recommendation: In order to put the Emergency Relief program on a sound financial footing, Congress may wish to consider the expected future demands on the program and reexamine the appropriate level and sources of funding--including whether to increase the $100 million annual authorized funding and whether the Highway Trust Fund, the General Fund, or some combination would allow the program to accomplish its purpose in a fiscally sustainable manner.

    Agency: Congress
    Status: Open

    Comments: As of October 2017, Congress has not yet taken action on this recommendation. The Emergency Relief Program is due to be reauthorized in fiscal year 2021.
    Recommendation: Congress may also wish to consider tightening the eligibility criteria for Emergency Relief funding, either through amending the purpose of the Emergency Relief program, or by directing FHWA to revise its program regulations. Revised criteria could include limitations on the use of Emergency Relief funds to fully finance projects with scope and costs that have grown as a result of environmental and community concerns.

    Agency: Congress
    Status: Open

    Comments: As of October 2017, Congress has not yet taken action on this recommendation. The Emergency Relief Program is due to be reauthorized in fiscal year 2021.