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    Subject Term: "Federal and state relations"

    47 publications with a total of 90 open recommendations including 15 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: Elizabeth H. Curda
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To help ensure that HHS agencies and offices fully understand the requirements and processes for the temporary reassignment authority, their responsibilities under the authority, and that ASPR is adequately and comprehensively assessing the effect of the authority on public health emergency response and medical surge, the Secretary of HHS should direct ASPR to conduct outreach to HHS agencies and offices that administer programs eligible for the reassignment authority to inform them of their responsibilities and ASPR's expected time frames for reviewing and approving states' and tribes' requests for personnel reassignments, and inform them of their responsibilities and ASPR's expectations for reviewing states' and tribes' after-action reports.

    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 help ensure that HHS agencies and offices fully understand the requirements and processes for the temporary reassignment authority, their responsibilities under the authority, and that ASPR is adequately and comprehensively assessing the effect of the authority on public health emergency response and medical surge, the Secretary of HHS should direct ASPR to develop a plan to evaluate states' and tribes' after-action reports to assess the impact of the reassignment authority on states' public health emergency response and medical surge and to provide technical assistance as necessary.

    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: Fennell, Anne-marie Lasowski
    Phone: (202) 512-3841

    2 open recommendations
    Recommendation: To help ensure that the Corps and FEMA carry out the national leveesafety- related activities required in the Water Resources Reform and Development Act of 2014, the Secretary of Defense should direct the Secretary of the Army to direct the Chief of Engineers and Commanding General of the U.S. Army Corps of Engineers and that the Secretary of Homeland Security direct the FEMA Administrator to develop a plan, with milestones, for implementing these activities, using existing resources or requesting additional resources as needed. This plan could be posted on the Corps' website and monitored for progress.

    Agency: Department of Homeland Security
    Status: Open

    Comments: As of December 2016, GAO is awaiting action by the agency to implement this recommendation.
    Recommendation: To help ensure that the Corps and FEMA carry out the national leveesafety- related activities required in the Water Resources Reform and Development Act of 2014, the Secretary of Defense should direct the Secretary of the Army to direct the Chief of Engineers and Commanding General of the U.S. Army Corps of Engineers and that the Secretary of Homeland Security direct the FEMA Administrator to develop a plan, with milestones, for implementing these activities, using existing resources or requesting additional resources as needed. This plan could be posted on the Corps' website and monitored for progress.

    Agency: Department of Defense
    Status: Open

    Comments: As of December 2016, GAO is awaiting action by the agency to implement this recommendation.
    Director: J. Alfredo Gómez
    Phone: (202) 512-3841

    6 open recommendations
    Recommendation: The EPA Administrator should direct the Office of Grants and Debarment (OGD) and program and regional offices, as appropriate, as part of EPA's ongoing streamlining initiatives and the development of a grantee portal, to incorporate expanded search capability features, such as keyword searches, into its proposed web-based portal for collecting and accessing performance reports to improve their accessibility.

    Agency: Environmental Protection Agency
    Status: Open

    Comments: In correspondence to GAO, EPA reiterated its agreement with this recommendation. EPA also stated that its vision for grants management includes having grant recipients submit performance reports and other information to the agency through a web-based portal. The portal would incorporate capabilities such as key word searches to allow for easier access to performance report information. However, the portal is a long-term initiative, subject to the agency's budget process, and dependent on the completion of the Next Generation Grants System, which EPA expects to fully deploy in fiscal year 2018. During fiscal year 2017, EPA officials stated that the agency has not started any work for the centralized grantee portal project, which is subject to available funds.
    Recommendation: The EPA Administrator should direct OGD and program and regional offices, as appropriate, as part of EPA's ongoing streamlining initiatives and the development of a grantee portal, to identify grant programs where existing program-specific data reporting can meet EPA's performance reporting requirements for grants management purposes to reduce duplicative reporting by grantees.

    Agency: Environmental Protection Agency
    Status: Open

    Comments: In correspondence to GAO, EPA reiterated its general agreement with this recommendation and stated it will work with recipient partners to identify where duplicative reporting can be reduced. However, EPA also noted that program-specific data cannot be relied upon to meet all grants management requirements, and performance reports often contain other information that allows project officers to monitor a recipient's progress. Further, EPA will need to consider the feasibility of expanding project officer access to certain program databases to enhance grant performance monitoring. During fiscal year 2017, EPA officials said that the agency is on track to complete the process for identifying where duplicative reporting can be reduced.
    Recommendation: The EPA Administrator should direct OGD and program and regional offices, as appropriate, as part of EPA's ongoing streamlining initiatives and the development of a grantee portal, once EPA's new performance system is in place, to ensure that the Office of Water adopts software tools, as appropriate, to electronically transfer relevant data on program results from program-specific databases to EPA's national performance system.

    Agency: Environmental Protection Agency
    Status: Open

    Comments: In correspondence to GAO, EPA reiterated its general agreement with this recommendation and stated that it will apply it, where appropriate and cost effective, to program-specific databases, not only the Office of Water databases. EPA noted that not all data from program-specific databases may be appropriate for direct electronic transfer to the national performance system; some individual grant data may need to be analyzed before being rolled up into national data. Additionally, implementation of this recommendation will depend upon the agency's program offices modifying their databases to interface with the new performance system. Further, implementation of this recommendation is dependent upon completion of EPA's new performance system, currently under development. During fiscal year 2017, EPA officials said that continued work on this effort was subject to the availability of funds.
    Recommendation: The EPA Administrator should direct OGD and program and regional offices, as appropriate, as part of EPA's ongoing streamlining initiatives and the development of a grantee portal, to clarify the factors project officers should consider when determining whether performance reports are consistent with EPA's environmental results directive.

    Agency: Environmental Protection Agency
    Status: Open

    Comments: In correspondence to GAO, EPA reiterated its agreement with this recommendation and stated that it will make conforming changes to the implementation guidance for the Environmental Results Order (directive). During fiscal year 2017, EPA officials said that they agency is on track to make the necessary changes.
    Recommendation: The EPA Administrator should direct OGD and program and regional offices, as appropriate, as part of EPA's ongoing streamlining initiatives and the development of a grantee portal, to expand aspects of EPA's policy for certain categorical grants, specifically, the call for an explicit reference to the planned results in grantees' work plans and their projected time frames for completion, to all grants.

    Agency: Environmental Protection Agency
    Status: Open

    Comments: In correspondence to GAO, EPA reiterated its agreement with this recommendation and stated that it will make conforming changes to existing policy. During fiscal year 2017, EPA officials said that this effort will be completed in fiscal year 2018.
    Recommendation: The EPA Administrator should direct OGD and program and regional offices, as appropriate, as part of EPA's ongoing streamlining initiatives and the development of a grantee portal, to incorporate built-in data quality controls for performance reports into the planned web-based portal based on EPA's environmental results directive.

    Agency: Environmental Protection Agency
    Status: Open

    Comments: In correspondence to GAO, EPA reiterated its general agreement with this recommendation. However, EPA emphasized that identifying and deploying appropriate data quality controls is a long-term effort subject to budgetary considerations, completion of the Next Generation Grants System, and extensive collaboration with internal and external stakeholders. Specifically, the report's vision for built-in data quality controls involves the use of electronic templates and reduced reliance on manual data entry--which would require standardized work plan and performance report formats subject to clearance by the Office of Management and Budget. Further, EPA noted that both grant recipients and EPA program offices generally have not supported standardizing the format of work plan and progress reports in the past. Accordingly, as a first step, EPA will seek feedback from the recipient and program office community. During fiscal year 2017, EPA officials said that it plans to complete the first phase of its work within the year.
    Director: Susan Fleming
    Phone: (202) 512-2834

    5 open recommendations
    Recommendation: To promote the transition to improved crash test standards, to strengthen FHWA's oversight of the roadside safety hardware's crash-testing process, and to make more information available to states and industry on how roadside safety hardware performs in actual conditions, the Secretary of Transportation should direct the Administrator of FHWA to direct FHWA's division offices to help ensure, through their oversight of states' standards and design specifications, that states have written policies in place to require the installation of appropriately crash-tested roadside safety hardware on the National Highway System to address inconsistent practices across states.

    Agency: Department of Transportation
    Status: Open

    Comments: DOT concurred with this recommendation and stated that FHWA will review existing state policies and procedures regarding the installation of appropriately crash-tested roadside safety hardware on the National Highway System and complete this review by July 2017. Based on these findings, DOT stated that FHWA will, by December 2017, direct its division offices to work with state Departments of Transportation to modify or improve state DOT written policies as appropriate.
    Recommendation: To promote the transition to improved crash test standards, to strengthen FHWA's oversight of the roadside safety hardware's crash-testing process, and to make more information available to states and industry on how roadside safety hardware performs in actual conditions, the Secretary of Transportation should direct the Administrator of FHWA to monitor and periodically report to Congress (or report through the agency's publicly available website) progress states and the industry are making in transitioning to the MASH crash-testing standards for roadside safety hardware.

    Agency: Department of Transportation
    Status: Open

    Comments: DOT concurred with this recommendation and stated FHWA will collect information on states' progress in implementing a policy to use MASH-tested hardware and post this information on FHWA's website. DOT also stated that FHWA will coordinate with the American Association of State Highway and Transportation Officials to monitor the progress of the MASH transition and to have this monitoring process in place by July 2017.
    Recommendation: To promote the transition to improved crash test standards, to strengthen FHWA's oversight of the roadside safety hardware's crash-testing process, and to make more information available to states and industry on how roadside safety hardware performs in actual conditions, the Secretary of Transportation should direct the Administrator of FHWA to provide additional guidance to crash test labs and accreditation bodies to ensure that labs have a clear separation between device development and testing in cases where lab employees test devices that were developed within their parent organization.

    Agency: Department of Transportation
    Status: Open

    Comments: DOT concurred with this recommendation and stated that FHWA will conduct outreach to determine how conflicts of interest are viewed and addressed by labs and by the accrediting bodies. FHWA will also determine how to most effectively provide any additional guidance on mitigating potential these conflicts within its current legal authority. DOT stated FHWA will complete this outreach by June 2017 and issue additional guidance communicating FHWA's expectations by December 2017.
    Recommendation: To promote the transition to improved crash test standards, to strengthen FHWA's oversight of the roadside safety hardware's crash-testing process, and to make more information available to states and industry on how roadside safety hardware performs in actual conditions, the Secretary of Transportation should direct the Administrator of FHWA to develop a process for third-party verification of results from crash-test labs.

    Agency: Department of Transportation
    Status: Open

    Comments: DOT concurred with this recommendation and stated that FHWA will conduct outreach to identify potential processes for third party review of results from crash labs. DOT stated FHWA will complete this outreach by July 2017.
    Recommendation: To promote the transition to improved crash test standards, to strengthen FHWA's oversight of the roadside safety hardware's crash-testing process, and to make more information available to states and industry on how roadside safety hardware performs in actual conditions, the Secretary of Transportation should direct the Administrator of FHWA to support additional research and disseminate results on roadside safety hardware's in-service performance, either as part of future phases of FHWA's current pilot study on guardrail end terminals' performance or as part of FHWA's broader research portfolio.

    Agency: Department of Transportation
    Status: Open

    Comments: DOT concurred with this recommendation and stated that FHWA is conducting a pilot effort to establish a protocol for the collection of data from crashes involving guardrail terminals, and that this pilot will be completed by November 2018. In addition, DOT stated that FHWA continues to support additional research through the National Research Council and the National Cooperative Highway Research Program.
    Director: Maurer, Diana C
    Phone: (202) 512-8777

    2 open recommendations
    Recommendation: To ensure that costs savings estimates are reliable, the Director of the USMS should direct its Prisoner Operations Division to develop reliable methods for estimating cost savings and validating reported savings achieved.

    Agency: Department of Justice: United States Marshals Service
    Status: Open

    Comments: In May 2016, we reported on United States Marshals Service's (USMS) actions to reduce prisoner-related costs from fiscal years 2010 through 2015. During the course of our review, we found that while USMS implemented actions that it reports have continued to save prisoner-related costs, USMS's methods to determine savings for certain actions were not reliable. For example, USMS identified $375 million in savings from the alternatives to pre-trial detention program for fiscal years 2010 through 2015, but did not verify the data or methodology used to develop the estimate or provide documentation supporting its reported savings for fiscal years 2012 onward. Consequently, we recommended that USMS direct its prisoner operations division to develop reliable methods for estimating cost savings and validating reports savings achieved. USMS concurred with our recommendation. In July 2016, USMS provided more information about how it would address the recommendation by confirming that its future cost savings estimates would be consistent with OMB guidelines for conducting benefit-cost analyses and GAO-identified practices for assessing the reliability of computer-processed data. Aligning USMS estimates with these identified practices would better position the agency to assess the effectiveness of its cost savings efforts. As USMS develops such mechanisms, we will request and consider documentation and other evidence to determine that USMS has implemented this recommendation.
    Recommendation: To enable USMS to more consistently identify deficiencies and monitor corrective actions, the Director of the USMS should establish a mechanism to aggregate and analyze the results of annual district self-assessments.

    Agency: Department of Justice: United States Marshals Service
    Status: Open

    Comments: In May 2016, we reported on United States Marshals Service's (USMS) actions to design systems to help identify cost savings opportunities. During the course of our review, we found that USMS has designed several systems for identifying cost savings, including, for example, developing a strategic plan and guidance for district officials that reinforce policies to provide for the safe, secure, and cost-effective containment of its prisoners. In addition, USMS requires districts to conduct annual self-assessments of their procedures to identify any deficiencies which could lead to cost savings. However, USMS cannot aggregate and analyze the results of the assessments across districts. As a result, we recommended that USMS establish a mechanism to aggregate and analyze the results of annual district self-assessments. USMS concurred with our recommendation. In July 2016, USMS informed us that the agency will develop a method to aggregate and analyze the results of the annual district self-assessments. However, it has not provided information on its plans or timelines to implement the recommendation. As USMS develops such mechanisms, we will consider documentation and other evidence to determine that USMS has implemented this recommendation.
    Director: Diana Maurer
    Phone: (202) 512-9627

    6 open recommendations
    including 6 priority recommendations
    Recommendation: To improve transparency and better ensure that face recognition capabilities are being used in accordance with privacy protection laws and policy requirements, the Attorney General should assess the PIA development process to determine why PIAs were not published prior to using or updating face recognition capabilities, and implement corrective actions to ensure the timely development, updating, and publishing of PIAs before using or making changes to a system.

    Agency: Department of Justice
    Status: Open
    Priority recommendation

    Comments: DOJ officials did not concur with this recommendation, and stated that the FBI has established practices that protect privacy and civil liberties beyond the requirements of the law. DOJ officials stated that it will internally evaluate the PIA process as part of the Department's overall commitment to improving its processes, not in response to our recommendation. In March 2017, we followed up with DOJ to obtain its current position on our recommendation. DOJ continues to believe that its approach in designing the NGI system was sufficient to meet legal privacy requirements and that our recommendation represents a "checkbox approach" to privacy. We disagree with DOJ's characterization of our recommendation. We continue to believe that the timely development and publishing of future PIAs would increase transparency of the department's systems. We recognize the steps the agency took to consider privacy protection during the development of the NGI system. We also stand by our position that notifying the public of these actions is important and provides the public with greater assurance that DOJ components are evaluating risks to privacy when implementing systems. As a result, the recommendation remains open and unimplemented.
    Recommendation: To improve transparency and better ensure that face recognition capabilities are being used in accordance with privacy protection laws and policy requirements, the Attorney General should assess the SORN development process to determine why a SORN was not published that addressed the collection and maintenance of photos accessed and used through NGI for the FBI's face recognition capabilities prior to using NGI-IPS, and implement corrective actions to ensure SORNs are published before systems become operational.

    Agency: Department of Justice
    Status: Open
    Priority recommendation

    Comments: DOJ agreed, in part, with our recommendation and submitted the SORN for publication to the Federal Register on April 21, 2016, and it was published on May 5, 2016. DOJ did not agree that the publication of a SORN is required by law. We disagree with DOJ's interpretation regarding the legal requirements of a SORN. The Privacy Act of 1974 requires that when agencies establish or make changes to a system of records, they must notify the public through a SORN published in the Federal Register. DOJ's comments on our draft report acknowledge that the automated nature of face recognition technology and the sheer number of photos now available for searching raise important privacy and civil liberties considerations. DOJ officials also stated that the FBI's face recognition capabilities do not represent new collection, use, or sharing of personal information. We disagree. We believe that the ability to perform automated searches of millions of photos is fundamentally different in nature and scope than manual review of individual photos, and the potential impact on privacy is equally fundamentally different. By assessing the SORN development process and taking corrective actions to ensure timely development of future SORNs, the public would have a better understanding of how personal information is being used and protected by DOJ components. As a result, the recommendation remains open and unimplemented.
    Recommendation: To better ensure that face recognition capabilities are being used in accordance with privacy protection laws and policy requirements, the Director of the Federal Bureau of Investigation should conduct audits to determine the extent to which users of NGI-IPS and biometric images specialists in FACE Services are conducting face image searches in accordance with Criminal Justice Information Services Division policy requirements.

    Agency: Department of Justice: Federal Bureau of Investigation
    Status: Open
    Priority recommendation

    Comments: In March 2017, DOJ provided us with the audit plan the CJIS Audit Unit developed in June 2016 for NGI-IPS users. In addition, DOJ reported that the CJIS Audit Unit began assessing NGI-IPS requirements at participating states in conjunction with its triennial National Identity Services audit and that, as of February 2017, the unit had conducted NGI-IPS audits of four states. Further, DOJ officials said CJIS developed an audit plan of the FACE Services Unit to coincide with the existing triennial FBI internal audit for 2018. However, DOJ did not provide the audit plan for the FACE Services Unit. DOJ officials said the methodology would be the same as the audit plan for NGI-IPS, but that methodology does not describe oversight on use of information obtained from external systems accessed by FACE Services employees. Therefore, we believe DOJ is making progress towards meeting the recommendation, but has not fully implemented our recommendation.
    Recommendation: To better ensure that face recognition systems are sufficiently accurate, the Director of the Federal Bureau of Investigation should conduct tests of NGI-IPS to verify that the system is sufficiently accurate for all allowable candidate list sizes, and ensure that the detection and false positive rate used in the tests are identified.

    Agency: Department of Justice: Federal Bureau of Investigation
    Status: Open
    Priority recommendation

    Comments: In comments on our draft report in 2016, and reiterated during recommendation follow-up, as of March 2017, DOJ did not concur with this recommendation. DOJ officials stated that the FBI has performed accuracy testing to validate that the system meets the requirements for the detection rate, which fully satisfies requirements for the investigative lead service provided by NGI-IPS. We disagree with DOJ. A key focus of our recommendation is the need to ensure that NGI-IPS is sufficiently accurate for all allowable candidate list sizes. Although the FBI has tested the detection rate for a candidate list of 50 photos, NGI-IPS users are able to request smaller candidate lists (between 2 and 50 photos). FBI officials stated that they do not know, and have not tested, the detection rate for other candidate list sizes. According to these officials, a smaller candidate list would likely lower the detection rate because a smaller candidate list may not contain a likely match that would be present in a larger candidate list. However, according to the FBI Information Technology Life Cycle Management Directive, testing needs to confirm the system meets all user requirements. Because the accuracy of NGI-IPS's face recognition searches when returning fewer than 50 photos in a candidate list is unknown, the FBI is limited in understanding whether the results are accurate enough to meet NGI-IPS users' needs. DOJ officials also stated that searches of NGI-IPS produce a gallery of likely candidates to be used as investigative leads, not for positive identification. As a result, according to DOJ officials, NGI-IPS cannot produce false positives and there is no false positive rate for the system. We disagree with DOJ. The detection rate and the false positive rate are both necessary to assess the accuracy of a face recognition system. Generally, face recognition systems can be configured to allow for a greater or lesser number of matches. A greater number of matches would generally increase the detection rate, but would also increase the false positive rate. Similarly, a lesser number of matches would decrease the false positive rate, but would also decrease the detection rate. Reporting a detection rate of 86 percent without reporting the accompanying false positive rate presents an incomplete view of the system's accuracy. As a result, the recommendation remains open and unimplemented.
    Recommendation: To better ensure that face recognition systems are sufficiently accurate, the Director of the Federal Bureau of Investigation should conduct an operational review of NGI-IPS at least annually that includes an assessment of the accuracy of face recognition searches to determine if it is meeting federal, state, and local law enforcement needs and take actions, as necessary, to improve the system.

    Agency: Department of Justice: Federal Bureau of Investigation
    Status: Open
    Priority recommendation

    Comments: As of March 2017, FBI officials stated they implemented the recommendation by submitting a paper to solicit feedback from users through the Fall 2016 Advisory Policy Board Process. Specifically, officials said the paper requested feedback on whether the face recognition searches of the NGI-IPS are meeting their needs, and input regarding search accuracy. According to FBI officials, no users expressed concern with any aspect of the NGI-IPS meeting their needs, including accuracy. Although FBI's action of providing working groups with a paper presenting GAO's recommendation is a step, the FBI's actions do not fully meet the recommendation. The FBI's paper was presented as informational, and did not result in any formal responses from users. We disagree with the FBI's conclusion that receiving no responses on the informational paper fulfills the operational review recommendation, which includes determining that NGI-IPS is meeting user's needs. As such, we continue to recommend the FBI conduct an operational review of NGI-IPS at least annually.
    Recommendation: To better ensure that face recognition systems are sufficiently accurate, the Director of the Federal Bureau of Investigation should take steps to determine whether each external face recognition system used by FACE Services is sufficiently accurate for the FBI's use and whether results from those systems should be used to support FBI investigations.

    Agency: Department of Justice: Federal Bureau of Investigation
    Status: Open
    Priority recommendation

    Comments: In comments on our draft report in 2016, and reiterated during recommendation follow-up in 2017, DOJ officials did not concur with this recommendation and had no plans to implement it. DOJ officials stated that the FBI has no authority to set or enforce accuracy standards of face recognition technology operated by external agencies. In addition, DOJ officials stated that the FBI has implemented multiple layers of manual review that mitigate risks associated with the use of automated face recognition technology. Further, DOJ officials stated there is value in searching all available external databases, regardless of their level of accuracy. We disagree with the DOJ position. We continue to believe that the FBI should assess the quality of the data it is using from state and federal partners. We acknowledge that the FBI cannot and should not set accuracy standards for the face recognition systems used by external partners. We also do not dispute that the use of external face recognition systems by the FACE Services Unit could add value to FBI investigations. However, we disagree with FBI's assertion that no assessment of the quality of the data from state and federal partners is necessary. We also disagree with the DOJ assertion that manual review of automated search results is sufficient. Even with a manual review process, the FBI could miss investigative leads if a partner does not have a sufficiently accurate system. By relying on its external partners' face recognition systems, the FBI is using these systems as a component of its routine operations and is therefore responsible for ensuring the systems will help meet FBI's mission, goals and objectives. The recommendation remains open and unimplemented.
    Director: Carolyn L. Yocom
    Phone: (202) 512-7114

    3 open recommendations
    including 2 priority recommendations
    Recommendation: To improve the effectiveness of states' and plans' Medicaid managed care (MMC) plan provider screening efforts, the Acting Administrator of CMS should consider which additional databases that states and MMC plans use to screen providers could be helpful in improving the effectiveness of these efforts and determine whether any of these databases should be added to the list of databases identified by CMS for screening purposes.

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

    Comments: HHS concurred with this recommendation. CMS analyzed 22 databases that were reported to GAO as being used by Medicaid managed care plans to screen providers. It determined that several were already in use by CMS and mentioned in its guidance, several required more study by CMS, and others were not reliable. In April 2017, we reviewed CMS's analysis. For 8 of the databases, CMS noted that more information is needed, including the availability of the data and whether CMS would need an identifier to link providers to the data. CMS has requested additional information for these databases and has not yet concluded whether the databases should be added to the list of databases it has identified for screening purposes. To close the recommendation, CMS will need to determine whether the remaining databases it has studied should be added to the CMS list of databases to be used for provider screening and take the appropriate action.
    Recommendation: To improve the effectiveness of states' and plans' MMC plan provider screening efforts, the Acting Administrator of CMS should collaborate with SSA to facilitate sharing CMS's Death Master File subscription with state Medicaid programs.

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

    Comments: HHS concurred with this recommendation. CMS has signed an Interagency Agreement that provides for the states' ability to access the SSA Death Master File. CMS said that it will provide Death Master File information to specific individuals within each state in the near future. To close the recommendation, CMS will need to begin to provide the states with access to Death Master File data and provide us with documentation that it has done so.
    Recommendation: To improve the effectiveness of states' and plans' MMC plan provider screening efforts, the Acting Administrator of CMS should coordinate with other federal agencies, as necessary, to explore the use of an identifier that is relevant for the screening of MMC plan providers and common across databases used to screen MMC plan providers.

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

    Comments: HHS concurred with the recommendation. We will update the status of this recommendation when we receive additional information.
    Director: Lawrance L. Evans Jr.,
    Phone: (202) 512-8678

    1 open recommendations
    Recommendation: To ensure that FHFA has adequate authority to ensure the safety and soundness of the enterprises and to clarify its supervisory role, Congress should consider granting FHFA explicit authority to examine third parties that do business with and play a critical role in the operations of the enterprises.

    Agency: Congress
    Status: Open

    Comments: As of April 2017, Congress has not taken any action on this matter.
    Director: Chris P. Currie
    Phone: (404) 679-1875

    2 open recommendations
    Recommendation: To promote more effective grant management coordination, the Secretary of Homeland Security should direct the FEMA Administrator to develop a plan with time frames, goals, metrics and milestones detailing how Grant Programs Directorate intends to resolve longstanding challenges associated with its existing hybrid grants management model, which divides responsibilities between regional and headquarters staff.

    Agency: Department of Homeland Security
    Status: Open

    Comments: As of March 2017, FEMA did not believe a plan was warranted to address long-standing coordination issues associated with its existing hybrid grants management model, as recommended in GAO's February 2016 report. According to the Department of Homeland Security, FEMA believes strongly in the importance of close and collaborative relationships between headquarters and regional grants staff. Further, FEMA stated the Grant Programs Directorate at headquarters already has in place numerous steps to ensure coordination and collaboration with regional grants staff. However, these steps by FEMA were already in place when GAO conducted its review in 2015 and early 2016, yet GAO identified continuing challenges related to coordination between headquarters and regions in conducting monitoring visits and providing consistent guidance to state grantees. As a result, GAO continues to believe that without a plan with time frames, goals, metrics, and milestones detailing how officials intend to resolve long-standing challenges associated with FEMA's existing hybrid grants management model, these challenges will continue to hamper the effectiveness of interactions between FEMA and state and local stakeholders in implementing the grant programs.
    Recommendation: To enable more sophisticated and comprehensive awareness of states' NIMS implementation, the Secretary of Homeland Security should direct the FEMA Administrator to develop policies and procedures for regional staff to review after-action reports from preparedness exercises within their region, and headquarters staff to review these evaluations in order to have a better understanding of NIMS implementation.

    Agency: Department of Homeland Security
    Status: Open

    Comments: In March 2017, FEMA officials provided an update on the status of actions taken in response to our report. In the update, FEMA officials said the National Integration Center (NIC) is holding consultative sessions with state and local emergency managers to ensure the revised National Incident Management System (NIMS) doctrine and implementation objectives is operationally sound from the perspective of FEMA's stakeholders. They expect to complete this effort by September 30, 2017. Pending completion of this effort, the recommendation will remain open.
    Director: Carolyn L. Yocom
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: To ensure states have appropriate and current guidance to assist them in designing and administering Medicaid NEMT, the Secretary of HHS should direct CMS to assess current Medicaid NEMT guidance and update that guidance as needed.

    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: J. Alfredo Gómez
    Phone: (202) 512-3841

    2 open recommendations
    Recommendation: To help federal, state, local, and private sector decision makers access and use the best available climate information, the Executive Office of the President should designate a federal entity to develop and periodically update a set of authoritative climate change observations and projections for use in federal decision making, which state, local, and private sector decision makers could also access to obtain the best available climate information.

    Agency: Executive Office of the President
    Status: Open

    Comments: As of 6/7/17, the Executive Office of the President has yet to take action in response to this recommendation.
    Recommendation: To help federal, state, local, and private sector decision makers access and use the best available climate information, the Executive Office of the President should designate a federal entity to create a national climate information system with defined roles for federal agencies and nonfederal entities with existing statutory authority.

    Agency: Executive Office of the President
    Status: Open

    Comments: As of 6/7/17, the Executive Office of the President has yet to take action in response to this recommendation.
    Director: Jacqueline M. Nowicki
    Phone: (617) 788-0580

    2 open recommendations
    Recommendation: To strengthen states' monitoring and facilitate local MOE compliance, the Secretary of Education should prioritize technical assistance and information sharing across states on ways to facilitate local MOE compliance with respect to the use of the four calculation methods and the exceptions.

    Agency: Department of Education
    Status: Open

    Comments: In August 2016, Education officials reported that the Office of Special Education Programs (OSEP) has been working on guidance on local educational agency maintenance of effort (LEA MOE) and intends to issue an expanded question and answer document by the end of 2016. In addition, the officials reported that the OSEP-funded Center for Idea Fiscal Reporting (CIFR) has taken additions steps, including creating an LEA MOE calculator projected for publication in fall 2016. GAO anticipates closing this recommendation when these activities have been implemented.
    Recommendation: To help districts address key challenges in meeting MOE and mitigate unintended consequences that may affect services for students with disabilities, while preserving the safeguard for funding for students with disabilities, Congress should consider options for a more flexible MOE requirement. This could include adopting a less stringent MOE requirement to align with the MOE requirements in other education programs or adding to or modifying exceptions. For example, current exceptions could be changed to allow one-time increases in spending without changing a district's MOE baseline in order to encourage pilot innovations or to allow certain spending decreases (e.g., state caps on teacher benefits), as long as a district can demonstrate the decrease does not negatively affect services.

    Agency: Congress
    Status: Open

    Comments: Congress has not taken legislative action on this issue.
    Director: Carolyn L. Yocom
    Phone: (202) 512-7114

    2 open recommendations
    including 2 priority recommendations
    Recommendation: To improve the effectiveness of its oversight of eligibility determinations, the Administrator of CMS should conduct reviews of federal Medicaid eligibility determinations to ascertain the accuracy of these determinations and institute corrective action plans where necessary.

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

    Comments: The Department of Health and Human Services (HHS) has taken some steps to improve the accuracy of Medicaid eligibility determinations, as GAO recommended in October 2015, but has not conducted a systematic review of federal eligibility determinations. In March 2017, HHS reported that it is reviewing federal determinations of Medicaid eligibility in two of the nine states that have delegated eligibility determination authority to the federal marketplace and HHS is planning to include reviews of federal determinations as part of its future Payment Error Rate Measurement (PERM) reviews, which will resume in 2018 pending final publication of the proposed PERM rule (81 FR 40596). In October 2016, HHS officials provided information indicating that the Department is relying upon operational controls within federally marketplaces to ensure accurate eligibility determinations as well as new processes that would identify duplicate coverage. These actions have value, however, they are not sufficient to identify other types of erroneous eligibility determinations. Without a systematic review of federal eligibility determinations, HHS lacks a mechanism to identify and correct errors and associated payments.
    Recommendation: To increase assurances that states receive an appropriate amount of federal matching funds, the Administrator of CMS should use the information obtained from state and federal eligibility reviews to inform the agency's review of expenditures for different eligibility groups in order to ensure that expenditures are reported correctly and matched appropriately.

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

    Comments: As of April 2017, HHS is establishing a process to make the eligibilty and expenditure reviews interact with one another. GAO will work with the agency to determine if these actions address the recommendation.
    Director: Carolyn L. Yocom
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: To better minimize the risk of coverage gaps and duplicate coverage for individuals transitioning between Medicaid and the exchange in FFE states, the Administrator of CMS should routinely monitor the timeliness of account transfers from state Medicaid programs to CMS and identify alternative procedures if near real time transfers are not feasible in a state.

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

    Comments: As of June 2017, CMS had taken a number of steps to improve the timeliness of account transfers. In June 2016, CMS conducted a webinar for states setting forth that best practices for account transfers was that they happen real time or, at a minimum, in daily batches. In July 2016, CMS issued guidance to states reiterating the requirement that states transfer accounts to CMS promptly and providing examples of ways for states to streamline that process. In June 2017, CMS reported that they have developed standard reports for reviewing errors in account transfers and those reports are being reviewed on a weekly basis. However, CMS reported that it does not have access to data on how promptly states are transferring accounts outside of limited survey data from 8 states that indicate that some transfers are occurring real-time while others are being transferred daily or weekly. We will continue to monitor CMS's progress and will close the recommendation when CMS has a greater understanding of how many states are transferring data in accordance with CMS guidance on the timeliness of transfers.
    Director: Valerie C. Melvin
    Phone: (202) 512-6304

    2 open recommendations
    Recommendation: To improve the oversight of states' marketplace IT projects, the Secretary of Health and Human Services should direct the Administrator of the Centers for Medicare & Medicaid Services to ensure that all CMS senior executives from IT and business units who are involved in the establishment of state marketplace IT projects review and approve funding decisions for these projects.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In 2015, Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) concurred with the recommendation. The department, in its agency comments, stated that it already included senior executives in its funding decisions for these projects. However, as noted in our report, CMS did not provide evidence that key senior executives from CCIIO, CMCS, and OTS were involved in various funding decisions associated with the states' IT projects. For example, CMS did not demonstrate that senior-level executives from all relevant business and IT units were involved in the initial approval of grant awards or the release of restricted IT funds from marketplace grants as states progressed with their projects. In addition, CMS did not provide evidence of senior executive involvement in the approval of Medicaid funds for marketplace IT projects. Furthermore, as of March 10, 2017, CMS still had not provided evidence that it had taken such actions to support the implementation of this recommendation. By ensuring such executive involvement, CMS would increase accountability for decisions to fund states' IT projects and ensure that these decisions are well informed in order to make efficient use of federal funds.
    Recommendation: To improve the oversight of states' marketplace IT projects, the Secretary of Health and Human Services should direct the Administrator of the Centers for Medicare & Medicaid Services to ensure that states have completed all testing of marketplace system functions prior to releasing them into operation.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In 2015, Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) concurred with the recommendation. The department noted that it would continue to follow its guidelines to determine if state marketplace system functions are ready for release. The department added that it would work closely with state-based marketplaces to improve their systems and verify that system requirements are met and fully tested before approving them for release into production. While CMS drafted guidance to update its process in June 2016, which required states to submit certain testing reports and supporting documentation, as of March 10, 2017, the agency had not provided evidence that it had determined that state systems had been sufficiently tested for release into operations.
    Director: Anne-Marie Fennell
    Phone: (202) 512-3841

    2 open recommendations
    Recommendation: To better ensure that the agencies have sufficient information to understand the effectiveness of their approach to wildland fires, and to better position them to develop appropriate and effective strategies for wildland fire management, the Secretaries of Agriculture and the Interior should direct the Chief of the Forest Service and the Director of the Office of Wildland Fire to develop specific criteria for selecting wildland fires for review and for conducting the reviews as part of their efforts to improve their approach to reviewing fires.

    Agency: Department of Agriculture
    Status: Open

    Comments: In August 2017, the Forest Service amended its policy to reflect criteria it developed for selecting wildland fires for review. In addition, in August 2017, Forest Service officials told us the agency will host a "Risk Learning Summit" in November 2017 during which they plan to begin developing criteria for conducting fire reviews. They told us that once criteria are agreed upon, they will be reflected in Forest Service policy (through the Forest Service Manual) within a year or so of the summit (around November 2018).
    Recommendation: To better ensure that the agencies have sufficient information to understand the effectiveness of their approach to wildland fires, and to better position them to develop appropriate and effective strategies for wildland fire management, the Secretaries of Agriculture and the Interior should direct the Chief of the Forest Service and the Director of the Office of Wildland Fire to, once such criteria are established, revise agency policies to align with the specific criteria developed by the agencies.

    Agency: Department of Agriculture
    Status: Open

    Comments: In August 2017, the Forest Service amended its policy to reflect criteria it developed for selecting wildland fires for review. In addition, in August 2017, Forest Service officials told us the agency will host a "Risk Learning Summit" in November 2017 during which they plan to begin developing criteria for conducting fire reviews. They told us that once criteria are agreed upon, they will be reflected in Forest Service policy (through the Forest Service Manual) within a year or so of the summit (around November 2018).
    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: Seto J. Bagdoyan
    Phone: (202) 512-6722

    1 open recommendations
    Recommendation: To further improve efforts to limit improper payments, including fraud, in the Medicaid program, the Acting Administrator of CMS should provide guidance to states on the availability of automated information through Medicare's enrollment database--the Provider Enrollment, Chain and Ownership System (PECOS)--and full access to all pertinent PECOS information, such as ownership information, to help screen Medicaid providers more efficiently and effectively.

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

    Comments: HHS considers this recommendation closed because they provide states with training and direct access to PECOS on an ongoing basis. Additionally, CMS also makes Medicare Enrollment data available to states through custom data extracts. We do not consider this action sufficient to close the recommendation, to provide states information on the availability of automated information through PECOS. For example, custom extracts do not constitute automated information containing all information in PECOS states need to screen providers in Medicaid. Additionally, the states the we interviewed for our study were not aware that custom extracts were available. CMS should provide guidance to state Medicaid programs that this information is available until fully automated access to PECOS is available. We reached out to CMS about the status of this recommendation. As of May 2017, we have not received a response. We will continue to monitor progress on this recommendation.
    Director: Mark L. Goldstein
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: To improve the accountability and transparency of FirstNet's operations, and ensure that FirstNet is gaining as much knowledge from the early builder projects as possible, FirstNet should strengthen FirstNet's internal control system by fully assessing risks, developing standards of conduct, and evaluating performance against these standards.

    Agency: Department of Commerce: National Telecommunications and Information Administration: First Responder Network Authority
    Status: Open

    Comments: When we confirm what actions the First Responder Network Authority (FirstNet) has taken in response to this recommendation, we will provide updated information.
    Director: Jacqueline M. Nowicki
    Phone: (617) 788-0580

    1 open recommendations
    Recommendation: To help ensure that states are better able to sustain RTT reforms and that Education can effectively support other grant programs managed by the Office of State Support, the Secretary of Education should direct the Office of State Support to fully implement and incorporate into its coordinated technical assistance policies and procedures the types of support that would be useful in sustaining RTT reforms and providing effective support to grantees in other programs supporting education reform that the Office of State Support oversees. These could include: (1) providing individualized technical assistance to states, such as that currently provided by Education program officers; (2) facilitating communities of practice to promote opportunities for collaboration across states; (3) providing professional development (or training) throughout the grant period, as opposed to only during the early stages of the grant; (4) making training more easily accessible by conducting training locally in their respective states, when possible; and (5) to the extent permissible in the context of federal and state requirements and restrictions, exploring the possibility of assisting states in identifying skilled contractors to help implement reform efforts.

    Agency: Department of Education
    Status: Open

    Comments: In 2015, Education stated that the Office of State Support drafted a technical assistance plan that is being revised based on stakeholder input. Officials stated that the technical assistance plan addresses all of the suggestions included in our recommendation. In September 2017, Education provided a "Draft Conceptual Framework for OSS Technical Assistance Plan" dated March 2016, which the agency confirmed to be a final version. However, this document is a plan that does not show the activities were actually implemented. We will consider closing this recommendation when the agency provides documentation that the activities have been completed.
    Director: Katherine M. Iritani
    Phone: (202) 512-7114

    3 open recommendations
    including 2 priority recommendations
    Recommendation: To improve CMS's oversight of Medicaid payments, the Administrator of CMS should take steps to ensure that states report accurate provider-specific payment data that include accurate unique national provider identifiers (NPI).

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

    Comments: HHS concurred with GAO's recommendation. As of September 2016, CMS has not provided additional information showing that the recommendation has been implemented. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To improve CMS's oversight of Medicaid payments, the Administrator of CMS should develop a policy establishing criteria for when such payments at the provider level are economical and efficient.

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

    Comments: HHS concurred with GAO's recommendation and as of October 2016 was evaluating ways to improve its oversight, including gathering information from states to better inform future policies. In November 2016, CMS plans to publish a proposed rule for public comment to improve the oversight of supplemental payments made to individual providers. Supplemental payments are large lump sum payments that most states make to certain providers and are not based on claims for services provided. According to CMS, the proposed rule will establish criteria for determining the economy and efficiency of Medicaid payments made to individual providers.
    Recommendation: To improve CMS's oversight of Medicaid payments, the Administrator of CMS should, once criteria are developed, develop a process for identifying and reviewing payments to individual providers in order to determine whether they are economical and efficient.

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

    Comments: HHS concurred with GAO's recommendation and as of October 2016 was evaluating ways to improve its oversight, including gathering information from states to better inform future policies. In November 2016, CMS plans to publish a proposed rule for public comment to improve the oversight of supplemental payments made to individual providers. According to CMS, the proposed rule will establish a process for identifying and reviewing payments to individual providers to determine if these payments meet the criteria of economy and efficiency established by the rule.
    Director: Kay Brown
    Phone: (202) 512-7215

    2 open recommendations
    Recommendation: To improve the consistency of assistance provided to tribes, the Secretary of Health and Human Services should take steps to provide consistent title IV-E guidance to tribes across its regional offices.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In May 2015, HHS hired a tribal coordinator who will work in the Office of the Associate Commissioner of the Children's Bureau. The tribal coordinator's primary functions will include facilitating communication across the regions and with tribes to share experiences and information, so as to ensure greater consistency and clarity. While this hire represents an initial step towards improving communication with tribal title IV-E agencies, more time is needed for the tribal coordinator to implement policies and procedures that will ensure consistent title IV-E guidance to tribes across HHS regional offices. In May 2017, the agency reported that tribal coordinator position was ultimately elevated to the Office of the ACYF Commissioner and became the Commissioner's representative to the Tribes. We await documentation on any guidance provided to the regional offices that would help with consistency.
    Recommendation: To improve the timeliness of assistance provided to tribes, the Secretary of Health and Human Services should establish procedures to ensure reviews of draft title IV-E plans are conducted by regional office staff in a timely manner.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: As of May 2017, HHS stated that it does not anticipate taking action in response to this recommendation because of its existing protocols for communicating with and responding to tribal title IV-E grantees. We maintain that establishing procedures, including but not limited to timeframes for responses, would help ensure that tribes receive timely feedback from regional offices regarding their draft title IV-E plans.
    Director: Susan Fleming,
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: The Secretary of Transportation should direct the Administrator of NHTSA to identify actions--in addition to the agency's currently planned efforts--to support state efforts to increase public awareness of the dangers of drug-impaired driving. This effort should be undertaken in consultation with ONDCP, HHS, state highway-safety offices, and other interested parties as needed.

    Agency: Department of Transportation
    Status: Open

    Comments: NHTSA met with ONDCP, HHS, and GHSA in March 2016 and discussed what consumer research has been done and education materials have been used in raising awareness for the drug-impaired driving issue. NHTSA completed marijuana creative concept focus group market research in the Fall of 2016; however, the findings from this research were inconclusive. NHTSA plans to determine next steps and develop a new strategy in communicating on this challenging topic by Spring 2017. NHTSA anticipates conducting additional market research that will provide the direction for the development of creative materials by Fall 2017.
    Director: Susan Fleming
    Phone: (202) 512-4431

    2 open recommendations
    including 1 priority recommendation
    Recommendation: In order to clarify the federal role related to freight-related local traffic congestion, in implementing MAP-21 and any subsequent reauthorization, in its final guidance on state freight plans, Secretary of Transportation should incorporate additional information to help states define and prioritize local community impacts of national freight movements, including traffic-congestion impacts, and to establish what data could be consistently collected and analyzed in order to prioritize impacts of freight on local traffic congestion.

    Agency: Department of Transportation
    Status: Open

    Comments: On October 14, 2016, DOT finalized guidance on state freight plans and state freight advisory committees. Among other things, the guidance incorporates information to help states define and prioritize local community impacts of national freight movements and identifies data sources to assist in collecting and analyzing data to prioritize impacts of freight on local traffic congestion. Including this information in the final guidance to states, will assist in better defining the extent of freight-related congestion, prioritizing projects to mitigate such impacts at both the state and national level and in DOT establishing a clear federal role for addressing these issues.
    Recommendation: In order to clarify the federal role related to freight-related local traffic congestion, in implementing MAP-21 and any subsequent reauthorization, the Secretary of Transportation should include in the National Freight Strategic Plan a written statement articulating the federal role in freight-related local congestion impacts, by clearly identifying potential objectives and goals (under the general area DOT has established for the Freight Transportation Conditions and Performance Report of reducing adverse environmental and community impacts) for mitigating local congestion caused by national freight movements and the type of role federal and state stakeholders could play in achieving each objective and goal, and including a written strategy for improving the availability of national data needed to quantify, assess, and establish measures on freight trends and impacts on local traffic congestion.

    Agency: Department of Transportation
    Status: Open
    Priority recommendation

    Comments: DOT concurred with this recommendation, and has developed a draft National Freight Strategic Plan, for which the public comment period ended in April 2016. In December 2016, DOT noted that it is continuing to review public comments received and beginning work on a final draft plan that will address the federal role in freight-related local congestion, as well as the other elements of GAO's recommendation. DOT stated that it plans to release a final National Freight Strategic Plan by its statutory due date of December 4, 2017. A number of our recommendations to DOT to address national freight issues are tied to the issuance of DOT's National Freight Strategic Plan.Implementing our recommendation in connection with development of the freight strategic plan expeditiously would help maximize the efficient movement of freight and ensure accountability around identified national interests and goals.
    Director: Cackley, Alicia P
    Phone: (202) 512-7022

    1 open recommendations
    Recommendation: To reduce the varying interpretations of LRRA, which have led to uncertainty and disagreements among RRGs and state insurance regulators, and at the same time continue to facilitate the formation and efficient operation of RRGs, Congress may wish to consider clarifying certain LRRA provisions. For example, clarifying whether (1) RRG registration requirements beyond those currently specified in LRRA are permitted in nondomiciliary states and (2) fees in addition to premium and other taxes could be charged to RRGs by nondomiciliary states in which they operate. Congress may also wish to consider providing a more specific definition of the types of insurance coverage permitted under LRRA.

    Agency: Congress
    Status: Open

    Comments: As of August 2017, Congress had not taken actions to clarify the provisions we had noted within the Liability Risk Retention Act as causing some uncertainty among risk retention groups and state insurance regulators.
    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: Currie, Christopher
    Phone: (404)679-3000

    1 open recommendations
    Recommendation: In order to help build and maintain a national biosurveillance capability in a manner that accounts for the particular challenges and opportunities of reliance on state and local partnerships, we recommend the Homeland Security Council direct the National Security Staff to take the following action as part of its implementation of our previous recommendation for a national biosurveillance strategy: Ensure that the national biosurveillance strategy (1) incorporates a means to leverage existing efforts that support nonfederal biosurveillance capabilities, (2) considers challenges that nonfederal jurisdictions face in building and maintaining biosurveillance capabilities, and (3) includes a framework to develop a baseline and gap assessment of nonfederal jurisdictions' biosurveillance capabilities.

    Agency: Executive Office of the President: Homeland Security Council
    Status: Open

    Comments: In June 2010, GAO recommended a national biosurveillance strategy to provide a framework for building and maintaining a national biosurveillance capability. In October 2011, building on that recommendation, we called for such a strategy to address key challenges we identified in state and local biosurveillance by accounting for the need to leverage nonfederal resources. In July 2012, the White House released the National Strategy for Biosurveillance. A strategic implementation plan was to be published within 120 days of strategy issuance. The July 2012 strategy did not adequately address the issues we raised related to state and local biosurveillance and acknowledged but did not meaningfully address the need to leverage nonfederal resources. As of March 14, 2013 the implementation plan has not been released.
    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: 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: As of May 2017, EPA reported that it had not resumed its data verification audits due to budgetary constraints, but was continuing on-site file reviews to support efficient and effective state programs. EPA completed 5 file reviews in 2015, 7 in 2016, and was planning to complete 10 in 2017. According to EPA, budgetary constraints may affect its ability to reach this goal. According to the agency, EPA continues to focus on developing its Safe Drinking Water Information System (SDWIS) Prime database, which it claims will reduce state burden, support effective management and prioritization of resources, and will enhance data quality and support the possibility of building an electronic data verification protocol. EPA said it plans to have the system operational in 2018. In addition, EPA said that it continues to provide training sessions as well as identify best practices that file reviewers can use to enhance file review implementation. For 2017-2018, EPA plans to continue quarterly national training events. A July 2017 report by EPA's Office of the Inspector General concluded that limitations to EPA's oversight tools impede the agency's ability to conduct consistent oversight of the national drinking water program and reduce the reliability of its monitoring and reporting data. The Inspector General did not make any recommendations because it concluded the agency is taking steps to address the shortcomings. For example, according to the Inspector General's report, EPA released the Compliance Monitoring Data Portal in September 2016. EPA water officials said the portal will enable public water systems and laboratories to report drinking water data electronically to primacy agencies. Utah became the first state to use the portal in March 2017 and EPA staff anticipate that five additional states will begin using the portal by the end of 2017. EPA anticipates this system will lead to fewer reporting errors, improved data quality, and reduced time needed to report state data to EPA.
    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: As of May 2017, EPA 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 Safe Drinking Water Information System (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 (Prime) 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, EPA will be able to consider developing goals for monitoring and reporting violations. As of May 2017, EPA is scheduled to have SDWIS Prime available for testing in September 2017 and available for state users at the end of March 2018. EPA 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: In August 2017, EPA told GAO that it continues to use a variety of tools and resources to identify strategies that will enhance how the agency conveys to the public information on drinking water quality and potential health risks associated with exposure to contaminants. With regard to GAO's recommendation, EPA told us it had previously collaborated with the EPA Regional managers to identify language that would enhance the communication of aggregate public health risk to consumers in regards to community water system measures. EPA developed the "person month" measure because it describes the percentage of people served by community water system that receive drinking water that meets all health-based drinking water standards, accounting for the duration of violations that occurred. EPA piloted this measure in Fiscal Year 2007 as an indicator measure. In Fiscal Year 2008, the measure was elevated to a strategic plan measure with established targets. After receiving positive response regarding this measure, in Fiscal Year 2015, the agency developed a "person month" measure for tribal community water systems. According to the agency, EPA will continue to take comments on existing and future measures during its 5 year strategic plan reviews.
    Director: Dicken, John E
    Phone: (202)512-7043

    6 open recommendations
    Recommendation: To ensure that information entered into CMS's complaints database is reliable and consistent, the Administrator of CMS should identify issues with data quality and clarify guidance to states about how particular fields in the database should be interpreted, such as what it means to substantiate a complaint.

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

    Comments: HHS concurred with this recommendation. In November 2014, CMS officials reported that the agency's Survey and Certification Group was in the early stages of a planned multi-year review of all of its business processes, including those related to nursing home complaint investigations. Officials stated that, as part of that review, agency staff would seek to provide clarification on all aspects of the complaint process, including what it means to substantiate a complaint. As of September 2016, CMS officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To strengthen CMS's assessment of state survey agencies' performance in the management of nursing home complaints, the Administrator of CMS should conduct additional monitoring of state performance using information from CMS's complaints database, such as additional timeliness measures.

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

    Comments: In November 2014, CMS officials reported that the fiscal year 2014 protocol for assessment of state agency performance includes a new measure that tracks how soon after the completion of a complaint investigation a state agency uploads data from that investigation to CMS's complaint tracking system. However, the protocol does not call for assessment of the number of days by which state survey agencies miss the deadlines for some complaint investigations--a measure that we suggested could provide a more comprehensive picture of state agency performance. As of September 2016, CMS officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To strengthen CMS's assessment of state survey agencies' performance in the management of nursing home complaints, the Administrator of CMS should assure greater consistency in assessments by identifying differences in interpretation of the performance standards and clarifying guidance to state survey agencies and CMS regional offices.

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

    Comments: HHS agreed that CMS needed to strengthen its assessment of state survey agencies' performance in the management of nursing home complaints. In November 2014, CMS officials reported that the agency's fiscal year 2014 protocol for assessment of state agencies' performance requires CMS regional offices to review the extent to which the states' policies are consistent with CMS policies. CMS officials acknowledged that there was some variation among states and noted that the agency's Survey and Certification Group is in the early stages of a multi-year review of all of its business processes. Officials expected this review would identify additional opportunities to improve consistency among states in the application of the performance standards. As of September 2016, CMS officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To strengthen and increase accountability of state survey agencies' management of the nursing home complaints process, the Administrator of CMS should clarify guidance to the state survey agencies about the minimum information that should be conveyed to complainants at the close of an investigation.

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

    Comments: HHS agreed that CMS needed to take steps to strengthen and increase accountability of state survey agencies' management of nursing home complaints. In November 2014, CMS officials reported that while they believed the CMS State Operations Manual, which specifies procedures for addressing complaints, provides significant guidance regarding the information that state agencies should convey to complainants at the close of an investigation, they would review the guidance to identify any needed changes. As of September 2016, CMS officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To strengthen and increase accountability of state survey agencies' management of the nursing home complaints process, the Administrator of CMS should provide guidance encouraging state survey agencies to prioritize complaints at the level that is warranted, not above that level.

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

    Comments: HHS agreed that CMS needed to take steps to strengthen and increase accountability of state survey agencies' management of the nursing home complaints process and stated that CMS would provide clarification and guidance to states to ensure complaints were prioritized at the appropriate level. However, in CMS's fiscal year 2014 protocol for assessment of state agency performance, the prioritization standard still required only that complaints be assigned a priority level at or above the level assigned by CMS reviewers. We remain concerned that defining the standard this way may create an incentive for survey agencies to prioritize some complaints at a higher level than is warranted--which could increase workload and potentially jeopardize the timeliness of investigations that warrant the higher priority level. As of September 2016, CMS officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To strengthen and increase accountability of state survey agencies' management of the nursing home complaints process, the Administrator of CMS should implement CMS's proposed plans to publish state survey agencies' scores but limit publication to those performance standards that CMS considers the most reliable and clear.

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

    Comments: HHS agreed that CMS needed to take steps to strengthen and increase accountability of state survey agencies' management of the nursing home complaints process and said that CMS would work with state officials and others to identify key performance information that would be of public value. In November 2014, CMS officials reported that the agency had not yet outlined a method or timetable for publishing states' performance scores. As of September 2016, CMS officials 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: Iritani, Katherine M
    Phone: (206)287-4820

    2 open recommendations
    Recommendation: In light of the need for accurate and complete information on children's access to health services under Medicaid and CHIP, the requirement that states report information to CMS on certain aspects of their Medicaid and CHIP programs, and problems with accuracy and completeness in this state reporting, the Administrator of CMS should establish a plan, with goals and time frames, to review the accuracy and completeness of information reported on the CMS 416 and CHIP annual reports and ensure that identified problems are corrected.

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

    Comments: In September 2016, CMS said that it was taking new steps to review data on children's access and quality of care by reviewing required reports that evaluate states' Medicaid managed care plans; however, these reports do not represent a consistent set of measures used by all states that CMS can use for oversight purposes. Accurate, complete, and reliable data for both Medicaid and CHIP are necessary for CMS's oversight of children's access to services. GAO considers this recommendation open.
    Recommendation: In light of the need for accurate and complete information on children's access to health services under Medicaid and CHIP, the requirement that states report information to CMS on certain aspects of their Medicaid and CHIP programs, and problems with accuracy and completeness in this state reporting, the Administrator of CMS should work with states to identify additional improvements that could be made to the CMS 416 and CHIP annual reports, including options for reporting on the receipt of services separately for children in managed care and fee-for-service delivery models, while minimizing reporting burden, and for capturing information on the CMS 416 relating to children's receipt of treatment services for which they are referred.

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

    Comments: In September 2016, CMS said that it had changed the instructions for completing the CMS 416 to provide more detailed guidance for states on capturing required information on the total number of children who were referred for treatment services. However, CMS is not planning to require states to submit information on whether children received the treatment services for which they were referred. We maintain that having ability to monitor receipt of treatment services, receipt of services in managed care separate from fee-for-service, and having data from all states is important to CMS oversight. GAO considers this recommendation open.
    Director: Wise, David J
    Phone: (202)512-5731

    1 open recommendations
    Recommendation: To ensure that FTA targets its resources effectively as it increases its safety efforts and is able to track the results of these efforts, the Secretary of Transportation should direct the FTA Administrator to use leading practices as FTA develops its plans for fiscal year 2011 and in the future. In particular, the Administrator should create a set of clear and specific performance goals and measures that (1) are aligned with the department's strategic safety goals and identify the intended results of FTA's various safety efforts and (2) address important dimensions of program performance.

    Agency: Department of Transportation
    Status: Open

    Comments: The Moving Ahead for Progress in the 21st Century Act (MAP-21), enacted in 2012, gave the Federal Transit Administration (FTA) authority to establish and enforce a new comprehensive framework for overseeing the safety of public transportation in the U.S. FTA is developing a new National Public Transportation Safety Program, including new safety regulations and a National Safety Plan, to implement this authority. FTA has proposed a National Safety Plan that identifies a potential set of performance measures for FTA, but does not identify related goals or targets. FTA officials said that they would address our recommendation within the next 6-12 months by establishing, within an internal performance plan, a set of clear and specific performance goals and measures for FTA that align with the leading practices we identify. We will follow up in Spring 2017 to check on FTA's progress in implementing this recommendation.
    Director: Gambler, Rebecca
    Phone: (202) 512-6912

    2 open recommendations
    Recommendation: To help ensure DHS is maximizing the benefits of its coordination efforts with northern border partners through interagency forums, documented agreements, and its resource planning process, the Secretary of Homeland Security should provide DHS-level guidance and oversight for interagency forums established or sponsored by its components to ensure that the missions and locations are not duplicative and to consider the downstream burden on northern border partners.

    Agency: Department of Homeland Security
    Status: Open

    Comments: In fiscal year 2011, we reviewed and reported the extent to which the Department of Homeland Security (DHS) had improved federal coordination of border security intelligence and enforcement operations with state, local, and Canadian law enforcement partners. We found, among other things, that DHS improved northern border security coordination through interagency forums and joint operations; however, partners raised concerns about the resources needed for the increasing number of interagency forums and that some efforts may be overlapping. In May 2011 and June 2012, DHS reported that it took action to coordinate law enforcement initiatives and advance communications interoperability and information sharing, while reducing duplicative activities. DHS also reported that the DHS Northern Border Strategy, released in June 2012, is intended to align internal DHS operations and provide a unified direction that will also help the department reduce duplicative activities. However, DHS's efforts to coordinate law enforcement initiatives and its Northern Border Strategy do not specifically address possible duplication of efforts and resource constraints that may be imposed by interagency forums. Further, DHS leadership has not yet determined how the strategy will be implemented. In October 2015, DHS officials stated that a statement of cooperation for a Cross-Border Law Enforcement Advisory Committee was signed by all five core members. The intent of the committee is to provide executive-level strategic guidance to cross-border law enforcement initiatives involving partnerships between U.S. and Canadian law enforcement agencies on the northern border. However, DHS officials stated that it will take at least a year to show how this committee will increase coordination and prevent duplication among interagency forums, including the IBET and BEST. Development of this committee is a positive step; however, it is too soon to assess the extent to which this committee helps prevent duplication of effort and strengthen coordination efforts along the northern border. As of August 31, 2017, DHS had not provided updated information to show how the committee increased coordination and prevented duplication among interagency forums. To fully address this recommendation, DHS needs to provide guidance specific to interagency forums established or sponsored by its components and conduct DHS-level oversight for those forums to ensure they are not duplicative and do not burden northern border partners.
    Recommendation: To help ensure DHS is maximizing the benefits of its coordination efforts with northern border partners through interagency forums, documented agreements, and its resource planning process, the Secretary of Homeland Security should provide regular DHS-level oversight of Border Patrol and ICE compliance with the provisions of the interagency memorandum of understanding (MOU), including evaluation of outstanding challenges and planned corrective actions.

    Agency: Department of Homeland Security
    Status: Open

    Comments: In fiscal year 2011, we reviewed and reported on the extent to which the Department of Homeland Security (DHS) had made progress in addressing past coordination challenges between U.S. Border Patrol, an office within U.S. Customs and Border Protection (CBP), and Immigration and Customs Enforcement (ICE), and across the Drug Enforcement Administration and Forest Service, according to northern border security partners. We found, among other things, that federal agency coordination to secure the northern border was improved, but partners cited ongoing challenges sharing information and resources for daily border security related to operations and investigations despite the efforts made to establish and update interagency agreements. In June 2012, DHS reported that the DHS Northern Border Strategy emphasizes the importance of partnerships and coordination and discusses the benefits that can be garnered through collaboration and information sharing. DHS also reported that a National Special Agent in Charge/Chief Patrol Agent Advisory Council was established to enhance collaboration between Border Patrol and ICE, which includes addressing historical points of contention between the two components. While the strategy emphasizes and encourages coordination between Border Patrol and ICE, it does not specifically address compliance with the interagency memoranda of agreement, evaluation of longstanding challenges, or any planned corrective actions. In addition, the advisory council established does not provide DHS-level oversight as it is composed of ICE and Border Patrol officials. In October 2015, DHS officials stated that the Cross-Border Law Enforcement Advisory Committee may provide DHS-level oversight because both CBP and ICE officials are members of the committee. However, as of August 31, 2017, DHS has not yet indicated how the committee may provide guidance and oversight to ensure Border Patrol and ICE compliance with the provisions of the interagency memorandum of understanding, and DHS could not provide timeframes for addressing this recommendation. To fully address this recommendation, DHS needs to take action to specifically address long-standing coordination challenges and enforce DHS-level oversight of Border Patrol and ICE compliance with the interagency memoranda of agreement.
    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: Dicken, John E
    Phone: (202)512-7043

    2 open recommendations
    Recommendation: To address state agency practices and external pressure that may compromise survey accuracy, the Administrator of CMS should reestablish expectations through guidance to state survey agencies that noncitation practices--official or unofficial--are inappropriate, and systematically monitor trends in states' citations.

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

    Comments: September 2017: HHS reported CMS is working to address this recommendation. We will update the status of this recommendation when we receive further information. September 2016: CMS has not yet provided additional information. GAO will update the recommendation, as appropriate, when information is received. July 2015: CMS indicated it will provide GAO with updated actions in early 2016. May 2014: Though the best method to address external pressures on State Agencies was not identified, CMS is continuing to address the consistency, effectiveness, and integrity of the survey process through the following activities: reviewing citation patterns for the nursing home surveys; systematically identifying and testing opportunities to make the survey process more efficient and effective; and holding monthly CO and RO calls to address consistencies in the survey and enforcement process. CMS Regional Offices also routinely hold conference calls (e.g., monthly) with the State Survey Agencies in their region to address survey, enforcement and certification issues and conduct the federal validation survey of the state's findings. CMS is looking to review specific regulatory deficiencies for trends and areas where additional guidance is needed. Anticipated completion date of October 31, 2014. June 2013: Though the best method to address external pressures on State Agencies was not identified. CMS is continuing to address the consistency, effectiveness, and integrity of the survey process through the following activities: reviewing citation patterns for the nursing home surveys; systematically identifying and testing opportunities to make the survey process more efficient and effective; and holding monthly CO and RO calls to address consistencies in the survey and enforcement process. CMS Regional Offices also routinely hold conference calls (e.g., monthly) with the State Survey Agencies in their region to address survey, enforcement and certification issues and conduct the federal validation survey of the state's findings. September 2010: CMS held a State/Federal meeting in April 2010. The discussion with the State/Federal meeting did not shed light on best method to address possible external pressures on State Agencies. Some expressed that poor documentation/inadequate investigation may cause deficiencies to be dropped and not necessarily external pressure. They will continue to work on developing next steps.
    Recommendation: To address state agency practices and external pressure that may compromise survey accuracy, the Administrator of CMS should establish expectations through guidance to state survey agencies to communicate and collaborate with their CMS regional offices when they experience significant pressure from legislators or the nursing home industry that may affect the survey process or surveyors' perceptions.

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

    Comments: September 2017: HHS reported CMS is working to address this recommendation. We will update the status of this recommendation when we receive further information. September 2016: CMS has not yet provided additional information. GAO will update the recommendation, as appropriate, when information is received. July 2015: CMS indicated it will provide GAO with updated actions in early 2016. May 2014: CMS has undertaken a broader review of both the QIS and traditional survey processes, and the extent to which the methodology and guidance result in an effective and efficient survey process. In August 2012, CMS convened a broad group of surveyors to address these issues and make recommendations which have resulted in continuing work to develop and test alternative guidance and processes. CMS is looking to review specific regulatory deficiencies for trends and areas where additional guidance is needed. Anticipated Completion date of December 31, 2014. June 2013: Though the best method to address external pressures on State Agencies was not identified. CMS is continuing to address the consistency, effectiveness, and integrity of the survey process through the following activities: reviewing citation patterns for the nursing home surveys; systematically identifying and testing opportunities to make the survey process more efficient and effective; and holding monthly CO and RO calls to address consistencies in the survey and enforcement process. CMS Regional Offices also routinely hold conference calls (e.g., monthly) with the State Survey Agencies in their region to address survey, enforcement and certification issues and conduct the federal validation survey of the state's findings. September 2010: CMS held a State/Federal meeting in April 2010. The discussion with the State/Federal meeting did not shed light on best method to address possible external pressures on State Agencies. CMS will continue to work on developing next steps.
    Director: Wise, David J
    Phone: (202) 512-3000

    2 open recommendations
    Recommendation: To strengthen formal collaboration efforts, the Secretary of Transportation should direct the Administrator of the Federal Transit Administration, and the Secretary of Housing and Urban Development should direct the appropriate program offices, to develop a plan to ensure that data collected on the various programs of the agencies related to affordable housing and transit are sufficient to measure the agencies' performance toward goals and outcomes established in the HUD-FTA action plan and the Partnership for Sustainable Communities.

    Agency: Department of Housing and Urban Development
    Status: Open

    Comments: On November 30, 2009, we received a response from HUD stating that actions were planned or underway to address this and the other recommendation in this report. As of June 2011, we have received no response from DOT. However, we are following up with DOT on the actions it has taken and will follow up with HUD about the status of the actions it planned.
    Recommendation: To strengthen formal collaboration efforts, the Secretary of Transportation should direct the Administrator of the Federal Transit Administration, and the Secretary of Housing and Urban Development should direct the appropriate program offices, to develop a plan to ensure that data collected on the various programs of the agencies related to affordable housing and transit are sufficient to measure the agencies' performance toward goals and outcomes established in the HUD-FTA action plan and the Partnership for Sustainable Communities.

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

    Comments: On November 30, 2009, we received a response from HUD stating that actions were planned or underway to address this and the other recommendation in this report. As of June 2011, we have received no response from DOT. However, we are following up with DOT on the actions it has taken and will follow up with HUD about the status of the actions it planned.
    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)512-3000

    1 open recommendations
    Recommendation: Taking action to address the challenges FMCSA faces to ensure that its drug testing program detects drivers who are using illegal drugs, and to keep drivers who have tested positive off the road until they have completed the return-to-duty process, provides an opportunity to improve safety on the roads. In order to assist the Department of Transportation (DOT) and FMCSA in addressing these challenges, and thereby improving road safety, Congress may wish to consider adopting legislation to ban subversion products.

    Agency: Congress
    Status: Open

    Comments: On February 4, 2009, Representative Engel introduced the Drug Testing Integrity Act of 2009 in the House of Representatives. The Act would ban products designed to defraud drug tests. On February 15, 2011 Representative Engel re-introduced the bill, which was referred to the House Committee on Energy and Commerce and then to the Subcommittee on Commerce, Manufacturing, and Trade. Representative Engel re-introduced the bill in the 113th Congress in May of 2013. However, the bill has not been reintroduced since.
    Director: Herr, Phillip R
    Phone: (202)512-8984

    2 open recommendations
    Recommendation: To improve the effectiveness of the federal investment in surface transportation, meet the nation's transportation needs, and ensure a sustainable commitment to transportation infrastructure, Congress may wish to consider reexamining and refocusing surface transportation programs to be responsive to these principles so that they institute tools and approaches to that emphasize the return on the federal investment.

    Agency: Congress
    Status: Open

    Comments: As of December 2017, Congress has not yet acted on this recommendation. The Fixing America's Surface Transportation Act (FAST Act; P.L. 114-94), signed into law in December 2015, is due to be reauthorized in fiscal year 2021.
    Recommendation: To improve the effectiveness of the federal investment in surface transportation, meet the nation's transportation needs, and ensure a sustainable commitment to transportation infrastructure, Congress may wish to consider reexamining and refocusing surface transportation programs to be responsive to these principles so that they address the current imbalance between federal surface transportation revenues and spending.

    Agency: Congress
    Status: Open

    Comments: As of December 2017, Congress has not yet acted on this recommendation. The Fixing America's Surface Transportation Act (FAST Act; P.L. 114-94), signed into law in December 2015, did not address the current imbalance between federal surface transportation revenues and spending. The Act is due to be reauthorized in fiscal year 2021.
    Director: Iritani, Katherine
    Phone: (212) 512-3000

    2 open recommendations
    Recommendation: Congress may wish to consider requiring increased attention to fiscal responsibility in the approval of section 1115 Medicaid demonstrations by requiring the Secretary of HHS to improve the demonstration review process through steps such as (1) clarifying criteria for reviewing and approving states' proposed spending limits, (2) better ensuring that valid methods are used to demonstrate budget neutrality, and (3) documenting and making public material explaining the basis for any approvals.

    Agency: Congress
    Status: Open

    Comments: As of July 2015, no legislation on this topic had been passed, although at least one bill had been introduced in Congress that would make budget neutrality a statutory requirement for Medicaid demonstrations.The House Energy and Commerce Committee held a hearing in June 2015 examining HHS's approval of spending under Medicaid demonstrations. In addition, the House Oversight and Government Reform and House Energy and Commerce Committees had sent letters to the Administration inquiring as to how HHS was responding to GAO findings and recommendations to improve the process and methods used to set demonstration spending limits.
    Recommendation: Congress may wish to consider addressing whether demonstrations that allow states to operate public managed care organizations and retain excess revenue to support programs previously funded by the state--including the Vermont demonstration--are within the scope of the Secretary of HHS's authority under section 1115 of the Social Security Act.

    Agency: Congress
    Status: Open

    Comments: As of July 2015, Congress had not passed legislation in response to our matter for congressional consideration.
    Director: Iritani, Katherine M
    Phone: (202)512-3000

    1 open recommendations
    Recommendation: To enhance the transparency of CMS oversight and clarify and communicate the types of allowable state financing arrangements, the Administrator of CMS should provide each state CMS reviews under its initiative with specific and written explanations regarding agency determinations on the allowability of various arrangements for financing the nonfederal share of Medicaid payments and make these determinations available to all states and interested parties.

    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.
    Director: Daly, Kay L
    Phone: 2025166906

    1 open recommendations
    Recommendation: To help further the progress toward meeting the goals of IPIA and determining states' role in assisting federal agencies to report a national improper payment estimate on federal programs, the Director, Office of Management and Budget, should expand IPIA guidance to provide criteria that federal agencies should consider when developing a plan or methodology for estimating a national improper payment estimate for state-administered programs, such as criteria that address the nature and extent of data and documentation needed from the states to calculate a national improper payment estimate.

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

    Comments: On August 10, 2006, OMB issued its revised guidance to implement the Improper Payments Information Act of 2002 (IPIA)--OMB Circular No. A-123, Appendix C "Requirements for Effective Measurement and Remediation of Improper Payments." OMB expanded its guidance to define federally funded state-administered programs and provided that federal agencies, upon the approval of OMB, could implement alternative methodologies for generating a national improper payment estimate for state-administered programs such as a systematic selection of States each year. The IPIA guidance provides that as part of the justification for using an alternative methodology, the federal agency must include a description of the States selected each year, the methodology for generating annual national estimates, and basis for using an alternative approach rather than the required methodology to calculate the national estimate based on a random statistical sample. While this revision, if fully and effectively implemented, may improve OMB's ability to carry out its oversight responsibilities with respect to determining appropriate methodologies to be employed in generating a program's improper payment estimate, these revisions did not include criteria that agencies should consider in developing plans or methodologies for estimating a national improper payment estimate for state-administered programs--the essence of our recommendation. In fiscal year 2017, we sent a follow inquiry to the OMB to get an update of actions it has taken to address this recommendation. As of August 24, 2017, no updated information has been provided by the OMB. We will continue to monitor the status of this recommendation.
    Director: Goldstein, Mark L
    Phone: (202)512-6670

    1 open recommendations
    Recommendation: In order to provide the Congress and federal and state officials with an accurate assessment of the progress being made toward the goal of full deployment of wireless E911, the Department of Transportation should work with state-level E911 officials, the National Emergency Number Association, and other public safety groups to determine which public safety answering points will need to have their equipment upgraded. This information should then be reflected in the PSAP database managed by NENA under contract with DOT. This will provide the baseline needed to measure progress toward the goal of full nationwide deployment of wireless E911 service.

    Agency: Department of Transportation
    Status: Open

    Comments: GAO has made several attempts to contact DOT to update the status of this recommendation and are awaiting a reply.
    Director: Iritani, Katherine M
    Phone: (202)512-7059

    1 open recommendations
    including 1 priority recommendation
    Recommendation: To meet its fiduciary responsibility of ensuring that section 1115 waivers are budget neutral, the Secretary of Health and Human services should better ensure that valid methods are used to demonstrate budget neutrality, by developing and implementing consistent criteria for consideration of section 1115 demonstration waiver proposals.

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

    Comments: HHS has generally disagreed with this recommendation. However, we have reiterated the need for increased attention to the fiscal responsibility in the approval of the section 1115 Medicaid demonstrations in subsequent 2008 and 2013 reports (GAO-08-87 and GAO-13-384). Although HHS has not issued a written budget neutrality policy as of October 2016, it has taken steps to change some aspects of methods states can use to determine budget neutrality and demonstration spending limits. The new methods are intended to result in more appropriate demonstration spending limits. For example, according to CMS officials, starting in May 2016, the agency began reducing the amount of accumulated savings that states can carryover when demonstrations are renewed, which was previously unlimited. We are continuing to monitor the effect of the recent changes. The recent changes did not address all of the questionable methods we have identifed in our reports.