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    Results:

    Subject Term: Adults

    12 publications with a total of 30 open recommendations including 3 priority recommendations
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    4 open recommendations
    Recommendation: The Acting Commissioner of the Social Security Administration should analyze the SEIE data to determine why a large proportion of transition-age youth on SSI with reported earnings did not benefit from the SEIE and, if warranted, take actions to ensure that those eligible for the incentive benefit from it.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA agreed with this recommendation. The agency stated that it would also explore various options for increasing connections to Vocational Rehabilitation (VR), stating that in addition to assessing options for referring youth to VR and/or changing the Ticket to Work program, the agency will continue to research other options for supporting transitioning youth.
    Recommendation: The Acting Commissioner of the Social Security Administration should analyze options to improve communication about SSA-administered work incentives and the implications of work on SSI benefits, with a goal of increasing understanding of SSI program rules and work incentives among transition-age youth and their families. This should include, but not necessarily be limited to, updating SSAs procedures for staff meeting with SSI applicants, recipients, and their families to regularly and consistently discuss - when applicable--how work incentives can prevent reductions in benefit levels and how work history is considered during eligibility redeterminations.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA disagreed with this recommendation, noting that it already analyzed, and continuously monitors and solicits feedback on, options to improve communications. SSA also said it requires staff to meet with SSI recipients regularly and instructs staff to discuss relevant work incentives, and that there is no indication that staff are not providing youth with appropriate work incentive information. However, SSA did not explain how it knows or ensures that staff are providing this information and SSA policies do not instruct staff to consistently convey information to youth and families on how work may or may not affect age 18 redetermination. While SSA's new brochure provides information on age-18 redeterminations, work incentives and other resources, we believe it could also contain additional relevant information, for example, on Medicaid eligibility. We also noted that written information may not be sufficient for conveying complex information. In addition, while we recognize the important role that WIPA projects play in providing work incentives counseling to SSI youth, WIPA projects have limited capacity for serving youth along with other SSI recipients and disability insurance beneficiaries. Therefore, we continue to believe that there are opportunities for SSA to improve its communication with transition-age youth and their families, including through in-person or telephone interactions.
    Recommendation: The Acting Commissioner of the Social Security Administration should work with the Secretary of Education to determine the extent to which youth on SSI are not receiving transition services through schools that can connect them to VR agencies and services.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA partially agreed with this recommendation. SSA noted its ongoing collaboration with Education and other agencies through the Promoting Readiness of Minors in SSI (PROMISE) project, stating the initiative is testing the provision of VR services to youth receiving SSI and will provide some evidence related to the role of schools and VR services for this population. SSA also stated it will continue to pursue research in this area. While we recognize the value of this initiative, a final PROMISE evaluation is not expected until winter 2022. In addition, the PROMISE initiative was not designed to determine the extent to which youth on SSI are receiving transition services through schools or are otherwise connected to VR services. SSA also noted that it works with Education and other agencies through the Federal Partners in Transition (FPT) Workgroup to improve the provision of transition services to students with disabilities, and that the FPT has issued a blueprint of agencies' efforts. While the FPT can be a promising vehicle to help connect youth on SSI to key transition services, the FPT had not set timelines or milestones to achieve its broad goal to support positive outcomes for youth with disabilities, nor does it have a list or specific activities and tasks it will undertake. Therefore, we continue to believe additional collaboration by SSA with Education would be beneficial. SSA also noted several concerns related to complying with this recommendation, such as legal (privacy) concerns with data sharing, the capacity of state VR agencies to serve more individuals, and the receptivity of youth on SSI to receiving services. While we acknowledge these challenges, we believe that SSA can take steps to explore actions it could take after considering such legal issues. While low state VR capacity or individual motivation can obstruct receipt of VR services, they should not prevent SSA from working with Education to determine the extent to which SSI youth are sufficiently informed of VR resources that are potentially available to them.
    Recommendation: The Acting Commissioner of the Social Security Administration should explore various options for increasing connections to VR agencies and services, including their potential costs and benefits. One option, among others, could be to expand the Ticket to Work program to include youth.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA agreed with this recommendation. The agency stated that, in addition to assessing legal and statutory options for referring youth to VR and/or changing the Ticket to Work program, it would also continue its research supporting youth.
    Director: Jacqueline M. Nowicki
    Phone: (617) 788-0580

    6 open recommendations
    Recommendation: To determine whether IDEA's current transition age requirement allows youth with disabilities, including those with ASD, the time needed to plan and prepare for the transition to adult life, the Secretary of Education should examine outcomes for students when transition services begin at age 16 and the merits and implications of amending IDEA to lower the age at which school districts are to begin providing transition services to students with disabilities, such as 14.

    Agency: Department of Education
    Status: Open

    Comments: Education neither agreed nor disagreed with this recommendation and has not taken steps to implement it.
    Recommendation: To improve collaboration and leverage the knowledge of key federal agencies serving youth with ASD, the Secretary of HHS should regularly engage key non-member federal agencies that serve or provide supports to young adults with autism in IACC activities. This could include, for example, directly engaging and soliciting input from federal agencies on the IACC strategic plan, or inviting other federal agencies that serve or provide supports to young adults with autism to become IACC members.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In 2017, HHS stated that it has engaged with federal agencies as part of an interagency working group on the needs of youth and young adults with Autism Spectrum Disorder. Our report stated that the IACC missed opportunities to collaborate with non-member federal agencies to report on and monitor services and supports activities for individuals with ASD, which Congress has called for IACC to include in its annual strategic plan and monitoring activities. In response, HHS stated that it has engaged several nonmember federal agencies at various points. However, we continue to believe it should develop strategies to regularly engage key non-member federal agencies in IACC activities, such as by soliciting input on its annual strategic plan.
    Recommendation: To implement the goals and policy priorities of the 2020 Federal Youth Transition Plan, the Federal Partners in Transition (FPT) workgroup--the Secretaries of HHS, Education, Department of Labor, and the Commissioner of the Social Security Administration--should develop a long-term implementation plan that includes milestones and specific agency roles and assignments.

    Agency: Department of Education
    Status: Open

    Comments: Education agreed with this recommendation but has not yet taken action to implement it.
    Recommendation: To implement the goals and policy priorities of the 2020 Federal Youth Transition Plan, the Federal Partners in Transition (FPT) workgroup--the Secretaries of HHS, Education, Department of Labor, and the Commissioner of the Social Security Administration--should develop a long-term implementation plan that includes milestones and specific agency roles and assignments.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with this recommendation but stated that the voluntary nature of the FPT precludes definitive implementation plans. We maintain, however, that being a voluntary initiative does not preclude the FPT from establishing long-term milestones and clarifying roles and responsibilities. Without a long-term implementation plan that includes milestones and specific agency roles and assignments, it is less likely that the priorities outlined in the Federal Youth Transition Plan will be achieved.
    Recommendation: To implement the goals and policy priorities of the 2020 Federal Youth Transition Plan, the Federal Partners in Transition (FPT) workgroup--the Secretaries of HHS, Education, Department of Labor, and the Commissioner of the Social Security Administration--should develop a long-term implementation plan that includes milestones and specific agency roles and assignments.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA stated that the voluntary nature of the FPT precludes definitive implementation plans. However, we maintain that being a voluntary initiative does not preclude the FPT from establishing long-term milestones and clarifying roles and responsibilities. Without a long-term implementation plan that includes milestones and specific agency roles and assignments, it is less likely that the priorities outlined in the Federal Youth Transition Plan will be achieved.
    Recommendation: To implement the goals and policy priorities of the 2020 Federal Youth Transition Plan, the Federal Partners in Transition (FPT) workgroup--the Secretaries of HHS, Education, Department of Labor, and the Commissioner of the Social Security Administration--should develop a long-term implementation plan that includes milestones and specific agency roles and assignments.

    Agency: Department of Labor
    Status: Open

    Comments: DOL agreed with this recommendation but has not yet taken action to implement it.
    Director: Dan Bertoni
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To ensure the agency has sufficient information about risks to SSI program integrity when making decisions about efforts to address them, the Commissioner of the Social Security Administration should conduct a risk assessment of the current manual process for connecting and adjusting claim records of SSI recipients who live in households with other SSI recipients, and, as appropriate, take steps to make cost-effective improvements to SSA's claims management system to address identified risks.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA disagreed with this recommendation stating that current SSI program rules do not support connecting records of unrelated individuals living in multiple recipient households. SSA also noted that it does not have evidence from its fiscal year 2014 payment accuracy reviews that manual processing of married couple multiple recipient household claims led to payment errors. As such, the agency stated that it could not commit resources to address this recommendation at this time, but noted if a legislative proposal is put forth that affects unrelated multiple SSI recipient households, SSA will assess program policy and systems risks as part of its evaluation and planning. However, we continue to believe that the manual processing currently used to connect and adjust claim records of SSI recipients who live in households with other SSI recipients leaves the agency at risk. SSA has acknowledged that it has not assessed the extent to which manual processing leads to payment errors, and the data they provided us on fiscal year 2014 improper payments to married couple recipients does not address the full scope of the issues we identified. Specifically, field office staff reported several instances in which manual processing is used to connect and adjust claims records for multiple recipient households due to system limitations, and indicated that these manual adjustments increase the likelihood of erroneous payments. These manually processed claims are for households with multiple related recipients whose SSI benefits are currently inter-related under program rules, such as multiple child recipients who are siblings or individual recipients who marry another recipient. Without an assessment of the risks associated with the manual processing of these claims, SSA is unable to determine if additional adjustments to its system would be a cost-effective use of its resources.
    Director: Melissa Emrey-Arras
    Phone: (617) 788-0534

    7 open recommendations
    Recommendation: To help foster and unaccompanied homeless youth better navigate the college admissions and federal student aid processes, the Secretaries of Education and HHS should jointly study potential options for encouraging and enabling child welfare caseworkers, McKinney-Vento homeless youth liaisons, and other adults who work with these youth to more actively assist them with college planning.

    Agency: Department of Education
    Status: Open

    Comments: Education, working with the Department of Health and Human Services, issued a Foster Youth Transition Toolkit in May 2016 which addresses both financial aid and college admissions processes. The toolkit was written for youth in or formerly in foster care rather than for professionals who serve these youth. Education noted that it had also posted a Homeless Youth Fact sheet for teachers and other professionals on its website in July. Education said that it will continue to work with HHS and the National Association for the Education of Homeless Children and Youth about college admissions and federal student aid processes for foster and unaccompanied homeless youth. Education also plans to conduct a technical assistance webinar for McKinney-Vento homeless youth liaisons and to provide technical assistance for other programs. Making such information available on Education's website is an encouraging step, as are plans to conduct webinars for professionals who work with homeless youth. We look forward to the implementation of these plans. However, we continue to believe that HHS and Education should consider ways to encourage more active college planning efforts among professionals who work with homeless and foster youth that consider professional staff's competing goals and priorities and multiple responsibilities.
    Recommendation: To help foster and unaccompanied homeless youth better navigate the college admissions and federal student aid processes, the Secretaries of Education and HHS should jointly study potential options for encouraging and enabling child welfare caseworkers, McKinney-Vento homeless youth liaisons, and other adults who work with these youth to more actively assist them with college planning.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS, working with the Department of Education, issued a Foster Youth Transition Toolkit in May 2016 which encourages current and former foster youth to pursue college and addresses both financial aid and college admissions processes. The toolkit was written for youth in or formerly in foster care, and HHS considers it a resource for unaccompanied homeless youth as well as for the adults who serve these youth. Making such information available through this joint publication is an encouraging step. However, child welfare caseworkers, school homelessness liaisons, and other professionals who work with homeless and foster youth have competing goals and priorities and multiple responsibilities. To encourage and facilitate college planning and admissions efforts, Education and HHS would need to carefully consider professional staff's workloads, responsibilities, and training needs, among other issues, and develop some options for encouraging college planning efforts among professionals in these programs who work with homeless and foster youth.
    Recommendation: To help foster and unaccompanied homeless youth, as well as adults who assist these youth, better navigate the federal student aid process and obtain information about college resources, the Secretary of Education, in consultation with the Secretary of HHS, should create webpages directed to homeless and foster youth so they can more easily find tailored and centralized information about available federal and other resources, such as Pell Grants, Chafee Education and Training Voucher Program (Chafee ETV Vouchers), and waivers for college admission tests.

    Agency: Department of Education
    Status: Open

    Comments: In addition to having a webpage about foster youth, Education noted that in April 2016 it had created a new webpage with resources for homeless children and youth. In July 2016, Education developed and posted online a Foster Care Transition Toolkit and a Fact Sheet on federal student aid for homeless youth that is available through its resources webpage. The development and posting of these materials on the agency's website offers helpful resources to foster and homeless youth; however, Education should also make it easier for these youth, who often lack adult support, to find these documents easily--such as by referring to them on the page that says who is eligible for federal student aid--without lengthy searching of the Website.
    Recommendation: To help college financial aid administrators more effectively implement eligibility rules for unaccompanied homeless youth, the Secretary of Education should make available an optional worksheet or form that college financial aid administrators can voluntarily use to document unaccompanied homeless youth status or encourage the use of existing forms that are available.

    Agency: Department of Education
    Status: Open

    Comments: Education agreed that it would be helpful to make forms developed by outside organizations knowledgeable about homelessness issues available for financial aid administrators to use for documenting the status of unaccompanied homeless youth. Education also said that it plans to highlight the availability of these forms and provide guidance at its annual conference and in updates to the Federal Student Aid Handbook. Education noted that it will not endorse the use of a specific form but that it will highlight forms that already exist that may be useful to financial aid administrators. We look forward to Education making such forms available for college financial aid administrators so that they can more effectively implement eligibility rules for unaccompanied homeless youth.
    Recommendation: To help homeless youth more easily access federal student aid, the Secretary of Education should clarify its guidance to financial aid administrators and students about whether financial aid administrators should accept any unaccompanied homeless youth determination provided by McKinney-Vento homeless liaisons or other authorized officials even if a student is not in high school or receiving program services.

    Agency: Department of Education
    Status: Open

    Comments: In June 2016, Education posted questions and answers about federal student for homeless youth on its website and in July, the agency posted a fact sheet about Homeless Youth on its webpage for teachers and other professional staff. However, neither document states whether financial aid administrators should accept any unaccompanied homeless youth determination provided by McKinney-Vento liaisons or authorized officials even if a student is not in high school or receiving program services. In July 2016, Education issued guidance for the McKinney-Vento program specifying that a local liaison may continue to provide verification of a youth's homelessness status for federal student aid purposes for as long as the liaison has access to the information necessary to make such a determination for a particular youth. The guidance also stated that local homelessness liaisons should ensure that all homeless high school students receive information and counseling on college-related issues. Education said that it will also hold a technical assistance webinar for McKinney-Vento Education for Homeless Children and Youths Program liaisons. In July 2016, Education said that it will issue the most-up-to-date guidance clarifying that financial aid administrators should accept any unaccompanied homeless youth determination provided by McKinney-Vento liaisons or authorized officials even if a student is not in high school or receiving program services. In addition to updating its guidance for financial aid administrators, the agency should also update the question and answer factsheet on federal student aid for homeless students and the factsheet for professionals so that the information on unaccompanied homeless youth determinations is presented consistently in these key documents.
    Recommendation: To enhance access to federal student aid for unaccompanied homeless youth, the Secretary of Education should consider developing a legislative proposal for congressional action to simplify the application process so that once a student has received an initial determination as an unaccompanied homeless youth, the student will not be required to have that status re-verified in subsequent years but attest to their current status on the Free Application for Federal Student Aid, unless a financial aid administrator has conflicting information.

    Agency: Department of Education
    Status: Open

    Comments: In July 2016, Education said that the department had proposed further simplification of the FAFSA in its fiscal year 2017 budget proposal. Education stated that it will also consider the feasibility of a legislative proposal to not require re-verification of homelessness after a student has received an initial determination. Such a legislative proposal would enhance access to federal student aid for unaccompanied homeless youth.
    Recommendation: To simplify program rules for Chafee ETV vouchers and improve access to these vouchers for former foster youth ages 21 and 22, the Secretary of HHS should consider developing a legislative proposal for congressional action to allow foster youth to be eligible for the Chafee ETV voucher until age 23 without also requiring that they start using the voucher before they turn 21.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS's budget request for fiscal year 2018 does not contain a legislative proposal to improve access to Chafee vouchers for former foster youth ages 21 and 22. In July 2016, HHS noted that it had made a proposal for mandatory programs to improve foster youth's access to vouchers for title IV-E Chafee programs in the Administration for Children and Families' fiscal year 2017 budget request. However, the agency explained that the proposal's purpose is to extend eligibility for Chafee Foster Care Independence Program (CFCIP) services to youth up to age 23 in jurisdictions that have extended foster care to age 21. According to HHS, the budgetary proposal does not affect the Chafee Vouchers. A legislative proposal to simplify program rules for Chafee ETV vouchers would support improving access to these vouchers for former foster youth ages 21 and 22.
    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 October 2016, 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: 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: Michael Courts
    Phone: (202) 512-8980

    3 open recommendations
    Recommendation: To enhance State's efforts to protect SWT participants from abuse and the SWT program from misuse, the Secretary of State should direct the Bureau of Education and Cultural Affairs to establish a mechanism to ensure that sponsors provide complete and consistent lists of fees that participants must pay.

    Agency: Department of State
    Status: Open

    Comments: In response to our recommendation that the State Department (State) establish a mechanism to ensure that sponsor provide complete and consistent lists of fees that exchange visitors on the Summer Work Travel program must pay, State acknowledged it collected such fee information in 2016. As of August 3, 2017, we are awaiting State's review and analysis of this information to ensure the price lists are consistent and comprehensive.
    Recommendation: To enhance State's efforts to protect SWT participants from abuse and the SWT program from misuse, the Secretary of State should direct the Bureau of Education and Cultural Affairs to establish a mechanism to establish a mechanism to ensure that information about these participant fees is made publicly available.

    Agency: Department of State
    Status: Open

    Comments: In response to our recommendation that the State Department (State) establish a mechanism to ensure that information about Summer Work Travel participant fees is made publically available, State noted that it had published a notice for proposed rulemaking on January 12, 2017. When finalized, this would require would require each sponsor to include in its recruiting material, and post on its main Web site (e.g., with a visible link to such a page on the sponsor?s homepage), examples of the typical monthly budgets of exchange visitors placed in various regions of the United States to illustrate wages (based on the required weekly minimum of 32-hours of work at a typical host placement) balanced against itemized fees and estimated costs. Until State finalizes this rule, they cannot enforce this requirement. As of July 27, 2017, this information was not available to the public on the six sponsor websites we checked.
    Recommendation: To enhance State's efforts to protect SWT participants from abuse and the SWT program from misuse, the Secretary of State should direct the Bureau of Education and Cultural Affairs to establish detailed criteria that will allow State to assess the sufficiency and appropriateness of opportunities for cultural activities outside the workplace that sponsors provide to SWT participants.

    Agency: Department of State
    Status: Open

    Comments: In response to our recommendation that the State Department (State) establish detailed criteria that will allow it to assess the sufficiency and appropriateness of opportunities for cultural activities outside the workplace that sponsors provide to Summer Work Travel participants, State published a notice for proposed rulemaking on January 12, 2017. When finalized, this would require sponsors and their host entities to create cultural opportunities at least once per month. The proposed rule also notes that State will issue guidance outlining best practices for cross-cultural programming. As of July 27, 2017 this is not finalized.
    Director: David J. Wise
    Phone: (202) 512-2834

    1 open recommendations
    Recommendation: To promote and enhance federal, state, and local coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and define and report on desired outcomes and collect related data to track and measure progress in achieving results, including the extent of coordination efforts that are under way, such as improved services for older adults. This effort could be conducted as a part of the Coordinating Council's process to update its strategic plan, which we have also recommended in a concurrent report.

    Agency: Department of Transportation
    Status: Open

    Comments: The Federal Transit Administration (FTA) has taken steps to enhance older adult mobility. For example, the agency and the Coordinating Council on Access and Mobility (CCAM) developed a draft strategic plan, which is being reevaluated in light of requirements in the Fixing America's Surface Transportation Act of 2015. FTA officials will provide GAO with an update on the status of those efforts after the July 2016 CCAM meeting.
    Director: Moran, Revae E
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To improve the consistency and completeness of national data on participants in the WIA Adult and Dislocated Worker Programs, the Secretary of Labor should take additional steps to improve the uniformity of participant data reported by states. The Secretary of Labor should promote a formal, continuous process for improving the quality of data on participants in the WIA Adult and Dislocated Worker Programs through such measures as the following: (a) consistently sharing the results of all oversight activities with states and local areas, including findings from validation of participant data; (b) reviewing the methods used for data validation, such as its scope and error rate threshold, to identify opportunities to increase efficiencies and accountability in the process. This could include implementing, if appropriate, recommendations from the Regions' review of data validation procedures; (c) evaluating data validation efforts to determine their effects on data quality, particularly on systemic errors, and providing targeted guidance and assistance to states and local areas to address such errors; (d) regularly monitoring Social Policy Research Associates' corrections and analyses of state WIA participant data, sharing this information with states, and coordinating with states to ensure that any corrections are appropriate and accurate; and (e) collecting and disseminating promising practices to states and local areas on data collection and reporting on a regular basis.

    Agency: Department of Labor
    Status: Open

    Comments: States began using a Participant Individual Record Layout (PIRL)--which includes common reporting definitions across WIOA core programs--as of July 1, 2016, and DOL anticipates receiving the first State Annual Performance Reports based on these data by October 16, 2017. As part of this effort, DOL has held in-person training sessions with state and local officials and also provided them with technical assistance, including guidance related to implementing required data collection and reporting efforts under WIOA. In addition, DOL outlined several ongoing data validation efforts, such as adding additional edit checks and identifying and addressing technical issues as they occur. We will close this recommendation when DOL receives and processes the first state performance reports under the PIRL and furnishes documentation of its data validation efforts.
    Director: Brown, Kay E
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To provide the basis for greater consistency across states in assessing elder justice service delivery, the Secretary of HHS, as chairman of the Elder Justice Coordinating Council, should direct the Council to make it a priority to identify common objectives for the federal elder justice effort and define common outcomes.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with this recommendation and noted the formation of the Elder Justice Coordinating Council (EJCC) as an effort to develop common objectives and plans for action to address elder justice issues. As of June 2014, the EJCC had developed eight recommendations for increased federal leadership in combating elder abuse based on input from elder justice experts in financial exploitation, public policy and awareness, enhancing response, and advancing research. Staff compiled information on best and promising practices for primary, secondary, and tertiary prevention; empirical evidence from peer-reviewed research; approaches used in related disciplines; and information about where gaps exist in the collective knowledge about elder abuse, neglect and exploitation. Staff then turned the suggestions into proposals with accompanying steps for federal action. Those proposals were subsequently presented at two public EJCC meetings (May and September 2013) and were made available for public review and comment. The Secretary of HHS formally accepted the recommendations in May 2014, and they were posted to the EJCC page of the Administration on Aging's website. In May 2015, HHS reported that the EJCC had published these recommendations in a document entitled "Eight (8)Recommendations for Increased Federal Involvement in Addressing Elder Abuse, Neglect, and Exploitation" and stated that the recommendations addressed the issues identified in GAO's recommendation. While we recognized that these 8 recommendations corresponded to the common objectives included in our recommendation, we also sought from HHS information on the status of common outcomes for the objectives. HHS reported that outcomes for the eight common objectives that the EJCC has approved were being discussed, but have not yet been approved. In March 2016,HHS reported that the EJCC's Elder Justice Working Group continued to gather and discuss action steps and outcomes for the eight recommendations. We will monitor the EJCC's progress in agreeing upon outcomes and close the recommendation when agreement on outcomes is reported.
    Director: Gomez, Jose A
    Phone: (202) 512-3841

    2 open recommendations
    Recommendation: To enhance FDA's ability to use AERs and to oversee dietary supplement products, the Secretary of the Department of Health and Human Services should direct the Commissioner of FDA to incorporate a mechanism to collect information on when AERs are used to support and inform consumer protection actions (i.e., surveillance, advisory, and regulatory actions).

    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 update this information.
    Recommendation: To enhance FDA's ability to use AERs and to oversee dietary supplement products, the Secretary of the Department of Health and Human Services should direct the Commissioner of FDA to establish a time frame for issuing final guidance for the draft (1) New Dietary Ingredient (NDI) guidance and (2) guidance clarifying whether a liquid product may be labeled and marketed as a dietary supplement or as a conventional food with added ingredients.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: Although FDA issued final guidance for distinguishing liquid dietary supplements from beverages in January 2014, it has not yet issued final guidance on new dietary ingredients (NDI). Once FDA completes the NDI guidance, we can close the recommendation.
    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.