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    Subject Term: "Test facilities"

    4 publications with a total of 11 open recommendations including 3 priority recommendations
    Director: Joseph Kirschbaum
    Phone: (202) 512-9971

    3 open recommendations
    Recommendation: To improve the identification, alignment, and management of DOD's chemical and biological defense infrastructure and to fully institutionalize the use of risk assessments to support future investment decisions, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology and Logistics to update the roles and responsibilities guidance in DOD Directive 5160.05E to identify which organizations are responsible for conducting and participating in CBDP Enterprise risk assessments.

    Agency: Department of Defense
    Status: Open

    Comments: DOD concurred with this recommendation but has not yet completed actions to implement it. As of August 2017, DOD was still waiting to release the final version of DOO Directive 5160.05E.
    Recommendation: To improve the identification, alignment, and management of DOD's chemical and biological defense infrastructure and to fully institutionalize the use of risk assessments to support future investment decisions, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology and Logistics to update the CBDP Enterprise's portfolio planning process, to include when risk assessments will be conducted.

    Agency: Department of Defense
    Status: Open

    Comments: DOD concurred with this recommendation but has not yet completed actions to implement it. On 6/8/16, DOD reported that the risk assessment process was initially piloted in 2014 to determine its utility for informing CBDP Enterprise portfolio planning and guidance. Moving forward, the CBDP Enterprise plans to conduct risk assessments annually to support portfolio planning and guidance. As of August 2017, DOD reported that the department was beginning an approximately 12-month process to revise the CBDP Business Plan, which would likely be published as a DOD Instruction. This plan should address the risk assessment recommendation.
    Recommendation: To improve the identification, alignment, and management of DOD's chemical and biological defense infrastructure and to enhance PAIO's ongoing analysis of potential infrastructure duplication in the CBDP Enterprise and gain potential efficiencies, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology and Logistics to identify, request, and consider any information from existing infrastructure studies from other federal agencies with chemical and biological research and development and test and evaluation infrastructure.

    Agency: Department of Defense
    Status: Open

    Comments: DOD concurred with this recommendation but has not yet completed actions to implement it. As of July 2017, DOD has requested, but not received, such studies from other federal agencies. However, DOD is currently engaged in phase two of a three-phase effort regarding its chemical and biological defense infrastructure program (CBDP), which includes a review of the department's interagency roles and responsibilities for its chemical and biological defense Infrastructure Manager. Targeted completion for this phase is December 2017, at which time, DOD may have obtained relevant information from other federal agencies.
    Director: Cosgrove, James C
    Phone: (202)512-7029

    3 open recommendations
    including 3 priority recommendations
    Recommendation: In order to improve CMS's ability to identify self-referred advanced imaging services and help CMS address the increases in these services, the Administrator of CMS should insert a self-referral flag on its Medicare Part B claims form and require providers to indicate whether the advanced imaging services for which a provider bills Medicare are self-referred or not.

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

    Comments: HHS did not concur with this recommendation, noting that CMS did not think this recommendation would be effective in addressing overutilization resulting from self-referral and that it would be complex to administer. We continue to believe that such a flag on Part B claims would likely be the easiest and most cost-effective way for CMS to identify self-referred advanced imaging services and monitor the behavior of those providers who self-refer these services even though the agency has no plans to take further action. As of October 2016, CMS has not provided any additional information about actions to address this recommendation.
    Recommendation: In order to improve CMS's ability to identify self-referred advanced imaging services and help CMS address the increases in these services, the Administrator of CMS should determine and implement a payment reduction for self-referred advanced imaging services to recognize efficiencies when the same provider refers and performs a service.

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

    Comments: HHS did not concur with this recommendation, noting that CMS did not believe that a payment reduction would address overutilization that occurs as a result of self-referral and that the agency's multiple procedure payment reduction policy for advanced imaging already captures efficiencies inhering in providing multiple advanced imaging services by the same physician. Further, CMS officials stated that providers in self-referring arrangements could avoid this reduction by having one provider refer an advanced imaging service while having another perform the service. Finally, CMS questioned whether implementing our recommendation would violate the Medicare statute prohibiting paying a differential by physician specialty for the same service. Our recommendation, however, refers to specific self-referral arrangements in which the same provider refers and performs an imaging service, and therefore would not be addressed by CMS's multiple procedure payment reduction policy. As noted in our report, this payment reduction would affect about 10 percent of advanced imaging services referred by self-referring providers. In addition, while CMS raised questions about whether implementing our recommendation would violate Medicare's prohibition on paying a differential by physician specialty for the same service, the agency did not indicate how it would do so as of October 2016. We continue to believe that CMS should determine and implement a payment reduction to recognize efficiencies for advanced imaging services referred and performed by the same provider even though, as of October 2016, the agency has no plans to take further action.
    Recommendation: In order to improve CMS's ability to identify self-referred advanced imaging services and help CMS address the increases in these services, the Administrator of CMS should determine and implement an approach to ensure the appropriateness of advanced imaging services referred by self-referring providers.

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

    Comments: HHS noted that it would consider this recommendation. The Secretary of HHS has the authority to establish a program to promote the use of appropriate use criteria - criteria that are evidenced-based (to the extent feasible) and that assist professionals to make the most appropriate treatment decisions for a specified clinical condition - for advanced imaging services under the Protecting Access to Medicare Act of 2014. CMS has begun developing its appropriate use criteria program (e.g., in November 2015, CMS established criteria to identify Qualified Provider Led Entities that are responsible for developing appropriate use criteria and has since selected Qualified Provider Led Entities), but full implementation of the program will not occur until at least January 1, 2018. If it - and the subsequent prior authorization program that incorporates appropriate use criteria - are implemented broadly enough (i.e., they ensure the appropriateness of advanced imaging services by all physicians, including those who self-refer), we could close the recommendation.
    Director: Aloise, Eugene E
    Phone: (202)512-6870

    2 open recommendations
    Recommendation: To strengthen NNSA's oversight practices and current and future facility modernization efforts, and to improve the transparency and usefulness of cost analyses prepared for future NNSA nuclear facilities modernization projects, the Secretary of Energy should direct the Administrator of NNSA to ensure that life cycle cost analyses include a thorough and balanced evaluation of short- and long-term construction and financing alternatives. Such analyses should consider the full useful life of the facility rather than the 20-year requirement for GSA leases or any predetermined length of time that might produce results that favor one option over another.

    Agency: Department of Energy
    Status: Open

    Comments: NNSA provided evidence that it requires life cycle cost analyses for projects greater than $20 million. However, this is not fully responsive to GAO's recommendation. For example, the recommendation stated that each life cycle cost analysis performed includes short- and long-term construction and financing alternatives and that these analyses should consider the full life of the facility rather than the 20-year requirements for GSA leases or any predetermined length of time. NNSA's actions do not address this aspect of the life cycle cost analysis. Our work found that facility's life cycle cost analysis only covered 20 years and it failed to reflect cost savings over a longer useful life (possibly over 50 years) that could have been realized if the facility were purchased instead of leased. Nothing in the draft Order addresses how the life cycle cost period to be analyzed should be established (e.g., 20 years or 50 plus years). Our review of NNSA's additional responses have not provided sufficient evidence to close the recommendation.
    Recommendation: To strengthen NNSA's oversight practices and current and future facility modernization efforts, and because of the importance of mitigating the risks of outsourcing nuclear weapons components and other information that if exported, might allow potential adversaries to develop or advance their nuclear capabilities, the Secretary of Energy should direct the Administrator of NNSA to take immediate action to assess the effectiveness of NNSA's oversight of KCP's current export control and nonproliferation practices and, if appropriate, initiate corrective actions to strengthen that oversight.

    Agency: Department of Energy
    Status: Open

    Comments: While NNSA/contractor actions are commendable and appear to be beneficial, such as adding performance-based incentives, training 950 employees, and including new contract clauses in its supplier purchase orders, these actions do not fully satisfy the recommendation. GAO's recommendation was specifically directed at the effectiveness of NNSA's oversight of the KCP contractor's export control and nonproliferation practices and to initiate corrective actions to strengthen that NNSA oversight. While the Kansas City Site Office's addition of a performance based incentive seems to be a good improvement, NNSA has not demonstrated its own oversight effectiveness. Our review of NNSA's response provided in March 2014 was not persuasive. In addition, GAO-16-710 found that as of May 2016, the Secretary of Energy had not used the enhanced procurement authority to ensure supply chain integrity, and the Department of Energy (DOE) had not developed processes for using the authority, as it had not fully assessed the circumstances under which the authority might be useful.
    Director: Trimble, David
    Phone: (202) 512-3000

    3 open recommendations
    Recommendation: To improve the management of the stockpile life extension program, the Administrator of NNSA should direct the Deputy Administrator for Defense Programs to develop a realistic schedule for the W76 warhead and future life extension programs that allows NNSA to (1) address technical challenges while meeting all military requirements and (2) build in time for unexpected technical challenges that may delay the program.

    Agency: Department of Energy: National Nuclear Security Administration
    Status: Open

    Comments: In past and ongoing work, GAO has identified areas where NNSA's modernization plans may not align with planned funding requests over the Future Years Nuclear Security Plan (FYNSP) and post-FYNSP periods. Based on the FY 2014 Stockpile Stewardship and Management Plan (SSMP), (GAO-14-45) NNSA plans to work on five LEPs or major alterations through 2038. The FY 2014 SSMP states that the LEP workload represents a resource and production throughput challenge that requires improvements in LEP planning and execution. GAO's analysis indicates there is limited contingency time built into the LEP schedules, all of which are technically ambitious. Any delays in schedules could lead to an increase in program costs or a reduction in the number built for any of the LEPs, both of which have occurred in prior and ongoing LEPs. While NNSA has acknowledged issues and identified some steps to improve the LEP process, this recommendation will remain open and unimplemented until NNSA demonstrates successful LEP and refurbishment execution. We recently reconfirmed this finding in GAO-17-341 where we found the following: In some cases, NNSA's fiscal year 2017 nuclear security budget materials do not align with the agency's modernization plans, both within the 5-year Future-Years Nuclear Security Program (FYNSP)for fiscal years 2017 through 2021 and beyond, raising concerns about the affordability of NNSA's planned portfolio of modernization programs.
    Recommendation: To improve the management of the stockpile life extension program, the Administrator of NNSA should direct the Deputy Administrator for Defense Programs to ensure that the program managers responsible for overseeing the construction of new facilities directly related to future life extension programs coordinate with the program managers of such future programs to avoid the types of delays and problems faced with the construction and operation of the Fogbank manufacturing facility for the W76 program.

    Agency: Department of Energy: National Nuclear Security Administration
    Status: Open

    Comments: A number of Stockpile Stewardship and Management Plans (SSMP) states that the life extension program (LEP) workload represents a resource and production throughput challenge that requires improvements in LEP planning and execution. The officials elaborated that the main area that will be strained is pit production. The alternate plutonium strategy needs to be resourced fully to support the W78/88-1 LEP. Additionally, the officials said that the UPF transition needs to go as planned or there will be challenges in completing all of the planned LEPs. As such, this recommendation will remain open.
    Recommendation: To improve the management of the stockpile life extension program, the Administrator of NNSA should direct the Deputy Administrator for Defense Programs to ensure that program managers for the construction of new facilities for future life extensions base their schedule for the construction and start-up of a facility on the life extension program managers' needs identified in their risk mitigation strategies.

    Agency: Department of Energy: National Nuclear Security Administration
    Status: Open

    Comments: NNSA has generally improved its management of construction projects, to include requirements setting, Analysis of Alternatives, independent cost estimates, etc. However, it is too soon to tell if these positive developments will help-or hinder-LEPs that are underway or are being conducted. Key uranium activities, to include construction and operating funds will not be complete until 2025; key plutonium activities are underway as well, but will not be complete until the late 2020s. As a result, this recommendation will need to remain open.