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    Subject Term: Children

    26 publications with a total of 61 open recommendations including 4 priority recommendations
    Director: Larin, Kathryn A
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: GAO recommends that the Director of OMB consider developing a goal that addresses a coordinated federal approach to child well-being among its next set of cross-agency priority (CAP) goals, including working with relevant agencies to ensure their strategic plans include goals and objectives related to the CAP goal. (Recommendation 1)

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

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

    3 open recommendations
    Recommendation: To better ensure FEMA's regional activities effectively support individuals with disabilities, the Secretary of Homeland Security should direct the FEMA Administrator to take steps to establish written procedures for how regions should involve the Office of Disability Integration and Coordination in clarifying disability integration staff's roles, evaluating staff performance, and setting expectations for how staff communicate with headquarters and the regions.

    Agency: Department of Homeland Security
    Status: Open

    Comments: FEMA agreed with this recommendation and FEMA's Office of Disability Integration and Coordination is in the process of establishing a working group that will clarify and codify the roles, responsibilities, and expectations among the various agency offices and personnel involved in carrying out the agency's disability integration mission. GAO will monitor the progress of these efforts. FEMA expects to complete these efforts by December 31, 2017. At that time, GAO will await documentation of the agency's procedures for carrying out its disability integration mission.
    Recommendation: To better position FEMA to expand access to key training on incorporating access and functional needs into emergency planning for state, local, and voluntary organization emergency management officials, the Secretary of Homeland Security should direct the FEMA Administrator to evaluate alternative cost-effective methods for delivering its course on access and functional needs, such as via virtual classes.

    Agency: Department of Homeland Security
    Status: Open

    Comments: FEMA agreed with this recommendation and reported that it will explore options for updating one of its existing online courses--IS-368 "Including People with Disabilities and Other with Access and Functional Needs in Disaster Operations"--to tailor the content for a broader audience, including members of the public. The agency also reported that it will evaluate the need for alternative cost-effective methods for delivering other courses on inclusive emergency management it currently offers, such as its classroom course, "Integrating Access and Functional Need into Emergency Planning." The agency anticipates completing these efforts by December 31, 2017. When these efforts are complete, GAO will await documentation that the agency has evaluated its delivery of key training on incorporating access and functional needs into emergency planning.
    Recommendation: To help ensure its key training on incorporating access and functional needs into emergency planning reaches a sufficiently wide audience, the Secretary should direct the FEMA Administrator to collect information about the potential pool of participants, set general goals for the number of state and local emergency managers that will take this course, and implement the delivery methods needed to meet these goals.

    Agency: Department of Homeland Security
    Status: Open

    Comments: FEMA agreed with this recommendation and reported that it will work with its regional staff to map potential training participants in each state and set goals for delivery of the course to state and local emergency managers. The agency also reported that it may be able to use data in the State Preparedness Report and states' self-reporting on the need for training on integrating the needs of people with access and functional needs into emergency management. GAO will monitor the progress of these efforts. The agency anticipates completing these efforts by December 31, 2017.
    Director: Kay E. Brown
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To help states effectively address ongoing challenges related to ensuring the appropriate use of psychotropic medications for children in foster care, the Secretary of HHS should consider cost-effective ways to convene state child welfare, Medicaid, and other stakeholders to promote collaboration and information sharing within and across states on psychotropic medication oversight.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with this recommendation and provided examples of the virtual convening of contingency groups they employed to provide technical assistance and peer to peer networking in child welfare. The agency plans to offer additional technical assistance that is specifically related to the topic of mental health and psychotropic medication. GAO will consider closing the recommendation when the agency completes these efforts.
    Director: Rebecca Gambler
    Phone: (202) 512-8777

    1 open recommendations
    Recommendation: To better assess whether the LOP and LOPC are having a measurable impact in meeting their program objectives, the Director of EOIR should develop and implement a system of performance measures, including establishing a baseline, to regularly evaluate the effectiveness of LOP and LOPC and assess whether the programs are achieving their stated goals.

    Agency: Department of Justice: Executive Office for Immigration Review
    Status: Open

    Comments: In January 2017, EOIR reported that the agency is working with a contractor to redesign EOIR's performance management system consistent with the principles outlined in the Government Performance and Results Modernization Act of 2010. In addition, EOIR reported that staff from its Office of Legal Access Programs (OLAP) plan to participate in strategic planning training, which will include how to establish performance measurements. To fully address the recommendation, EOIR should develop and implement a system of performance measures for LOP and LOPC, including establishing a baseline, and assess program performance against such measures.
    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: Kay Brown
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To help improve tribes' ability to maintain safe, stable, and permanent care for children, the Secretary of Health and Human Services should direct the Children's Bureau to explore the reasons for low tribal participation and identify actions to increase this participation in the title IV-E Guardianship Assistance Program.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with this recommendation. The agency noted that some tribal-state agreements might predate 2008, when GAP was established. HHS also said that regional office staff participate annually in joint planning for the title IV-B and IV-E programs with their respective states and tribes and that participation in GAP is a topic covered in joint planning activities. In addition, HHS said that regional office staff are available to assist states and tribes with discussions about GAP participation when tribal-state agreements are renegotiated and that technical assistance is available to tribes, if needed. According to HHS, the agency plans to add information to the Children's Bureau website about direct federal funding for tribal title IV-E agencies and about tribal-state partnership agreements and plans to distribute issue briefs on GAP and best practices for tribal-state agreements. We agree that HHS has the planning process, technical assistance resources, and regional staff in place to discuss GAP participation with title IV-E state and tribal agency officials. However, our review found that tribal participation in GAP remains low, which suggests that HHS needs to identify actions to increase participation in this program. We believe that the additional actions HHS plans to take - providing information on the Children's Bureau website about direct funding and distributing issue briefs on GAP and best practices for tribal - state partnerships and agreements - could support tribes' participation in GAP either by helping tribes to directly operate a title IV-E program or to negotiate a tribal-state agreement that includes a provision for GAP participation. Because some tribes reported challenges at the state level to participating in GAP and several tribes reported that the state where they are located does not participate in the program, we encourage HHS to engage title IV-E state agency officials in discussions about tribal participation in GAP during the annual review of the their title IV-E state plan. HHS could identify ways that regional office staff might help state agencies resolve any challenges to GAP participation that tribes experience at the state level. HHS has taken several steps over the past few years to help tribes with their title IV-E programs, including hiring a tribal coordinator to facilitate communication between regional offices and tribal title IV-E agencies. Taking additional steps to ensure that tribes have the opportunity to participate in GAP could go a long way toward helping tribes gain more resources for children under their care and better support tribes' efforts to care for children exiting foster care to permanent homes.
    Director: Brenda S. Farrell
    Phone: (202) 512-3604

    2 open recommendations
    Recommendation: To more fully understand the food assistance needs that exist for active-duty servicemembers and their families, and to help ensure that DOD effectively targets its support to those in need of assistance, the Secretary of Defense should direct the Office of the Under Secretary of Defense for Personnel and Readiness to revise, as appropriate, any existing data-collection mechanisms, such as periodic surveys, to collect and analyze more complete data on the use of food assistance programs by servicemembers and their families and use the data to determine if any further actions are needed, such as assigning responsibilities at the department-level for monitoring the use of food assistance programs by active-duty servicemembers.

    Agency: Department of Defense
    Status: Open

    Comments: As of August 2017, The Department of Defense (DOD) revised the questions on the September 2016 Status of Force Survey of Active Duty Members to include questions on whether servicemembers and their families had in the past 12 months run out of food, skipped meals, or were unable to eat balanced meals due to a lack of money. The survey also included questions on whether the servicemembers or their families had used food pantries in the past twelve months and asked the servicemembers to identify the factors that had contributed to their food concerns and/or need to use a food pantry. Finally, the survey included questions on the extent servicemember had ever applied for Supplemental Nutrition Assistance Program (SNAP) benefits (formerly known as the Food Stamp Program), whether they were currently receiving SNAP benefits, their paygrade at the time they first started receiving SNAP benefits, the total number of people in the household when they first started receiving SNAP benefits, and how long they have received SNAP benefits. DOD official stated that the results of the survey were not published until July 31, 2017 so they have not had the opportunity to review the results of the survey to determine what further actions, if any, are needed.
    Recommendation: To more fully understand the food assistance needs that exist for active-duty servicemembers and their families, and to help ensure that DOD effectively targets its support to those in need of assistance, the Secretary of Defense should direct the Office of the Under Secretary of Defense for Personnel and Readiness to coordinate with USDA to leverage its access to data on active-duty servicemembers and their families who use its programs and services and consider outreaching to other organizations that have data on servicemembers' use of food assistance.

    Agency: Department of Defense
    Status: Open

    Comments: As of August 2017, DOD has not provided information on steps it has taken to address this recommendation. When more information becomes available, we will update the recommendation?s status accordingly.
    Director: Marcia Crosse
    Phone: (202) 512-7114

    10 open recommendations
    Recommendation: To increase awareness of the health and legal consequences of FGM/C among visa recipients, the Secretary of State should update the Foreign Affairs Manual to require posts located in countries where FGM/C is commonly practiced to directly provide information about FGM/C to nonimmigrant visa recipients in the same manner as is done for immigrant visa recipients.

    Agency: Department of State
    Status: Open

    Comments: The Department of State (State) concurred with this recommendation, and noted in a September 2016 update that it will expand the pool of visa applicants who will receive information on FGM/C. Specifically, once its transition to providing paperwork electronically during the visa application process is complete, State will directly distribute the fact sheet on FGM/C to both immigrant and nonimmigrant visa recipients. According to State, both immigrant and nonimmigrant visa recipients will have to certify that they have read and understood the fact sheet on FGM/C before signing and submitting their respective visa applications. As of August 2017, State has not yet completed these actions.
    Recommendation: To increase awareness of the health and legal consequences of FGM/C among visa recipients, the Secretary of State should update the Foreign Affairs Manual to require posts located outside of the countries where FGM/C is commonly practiced to directly provide information on FGM/C to immigrant and nonimmigrant visa recipients who are nationals of countries where FGM/C is commonly practiced.

    Agency: Department of State
    Status: Open

    Comments: The Department of State (State) concurred with this recommendation, and noted in a September 2016 update that it will expand the pool of visa applicants who will receive information on FGM/C. Specifically, once its transition to providing paperwork electronically during the visa application process is complete, State will directly distribute the fact sheet on FGM/C to both immigrant and nonimmigrant visa recipients who are from or were nationals of a country where FGM/C is commonly practiced. State noted that this change will ensure the widest distribution possible by providing all individuals from countries where FGM/C is commonly practiced with access to the fact sheet on FGM/C regardless of place of application or visa recipient type. As of August 2017, State has not yet completed these actions.
    Recommendation: To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each develop a written plan that describes the agency's approach for conducting education and outreach to key stakeholders in the United States regarding FGM/C.

    Agency: Department of Education
    Status: Open

    Comments: The Department of Education (Education) concurred with this recommendation, and noted in a September 2016 update that it will develop a written plan for disseminating relevant FGM/C resources to the agency?s key stakeholder groups. As of August 2017, Education reported that action is still pending.
    Recommendation: To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each develop a written plan that describes the agency's approach for conducting education and outreach to key stakeholders in the United States regarding FGM/C.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: The Department of Health and Human Services (HHS) concurred with this recommendation, and noted in a September 2016 update that various HHS offices and agencies are working together to develop a written plan for its approaches to addressing FGM/C. In August 2017, HHS reported that once a key leadership position has been filled, it will provide more information on developing a written plan.
    Recommendation: To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each develop a written plan that describes the agency's approach for conducting education and outreach to key stakeholders in the United States regarding FGM/C.

    Agency: Department of Justice
    Status: Open

    Comments: The Department of Justice (DOJ) concurred with this recommendation, and noted in a September 2016 update that the Human Rights and Special Prosecutions Section of its Criminal Division is taking the lead on developing a written plan on its FGM/C outreach and awareness efforts. As of August 2017, DOJ has not yet developed a written plan.
    Recommendation: To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each develop a written plan that describes the agency's approach for conducting education and outreach to key stakeholders in the United States regarding FGM/C.

    Agency: Department of State
    Status: Open

    Comments: The Department of State (State) did not concur with our recommendation, and, as of August 2017, has not indicated that it would implement this recommendation.
    Recommendation: To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each communicate the plan with other relevant federal agencies and stakeholder groups, as appropriate.

    Agency: Department of Education
    Status: Open

    Comments: The Department of Education (Education) concurred with this recommendation, and noted in a September 2016 update that it will develop a written plan for disseminating relevant FGM/C resources to the agency?s key stakeholder groups and will explore how to best communicate and coordinate efforts at the federal level. As of August 2017, Education reported that action is still pending.
    Recommendation: To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each communicate the plan with other relevant federal agencies and stakeholder groups, as appropriate.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: The Department of Health and Human Services (HHS) concurred with this recommendation, and noted in a September 2016 update that various HHS offices and agencies are working together to develop a written plan for its approaches to addressing FGM/C. HHS also noted that it would share this plan with other federal partners and key stakeholders. In August 2017, HHS reported that once a key leadership position has been filled, it will provide more information on disseminating a written plan.
    Recommendation: To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each communicate the plan with other relevant federal agencies and stakeholder groups, as appropriate.

    Agency: Department of Justice
    Status: Open

    Comments: The Department of Justice (DOJ) concurred with this recommendation, and noted in a September 2016 update that the Human Rights and Special Prosecutions Section of its Criminal Division is taking the lead on developing a written plan on its FGM/C outreach and awareness efforts. DOJ also noted that it would communicate its written plan with other relevant federal agencies and stakeholder groups, as appropriate. As of August 2017, DOJ has not yet disseminated a written plan.
    Recommendation: To make the best use of federal resources directed toward combating FGM/C in the United States, the Attorney General and the Secretaries of Education, Health and Human Services, Homeland Security, and State should each communicate the plan with other relevant federal agencies and stakeholder groups, as appropriate.

    Agency: Department of State
    Status: Open

    Comments: The Department of State (State) did not concur with our recommendation, and, as of August 2017, has not indicated that it would implement this recommendation.
    Director: James R. McTigue, Jr.
    Phone: (202) 512-9110

    4 open recommendations
    Recommendation: To strengthen efforts to identify and address noncompliance with the EITC, ACTC, and AOTC, the Commissioner of Internal Revenue should direct Refundable Credits Policy and Program Management (RCPPM) to, building on current efforts, develop a comprehensive operational strategy that includes all the RTCs for which RCPPM is responsible. The strategy could include use of error rates and amounts, evaluation and guidance on the proper use of indicators like no-change and default rates, and guidance on how to weigh trade-offs between equity and return on investment in resource allocations.

    Agency: Department of the Treasury: Internal Revenue Service
    Status: Open

    Comments: As of February 2017, IRS is taking steps toward developing a comprehensive compliance strategy that includes the three refundable tax credits GAO reviewed, as well as the PTC. These steps include initial planning meetings with Lean Six Sigma consultants and refundable credit policy and program managers and soliciting volunteers for the teams needed to develop the strategy. GAO will continue to monitor the progress of this effort.
    Recommendation: To strengthen efforts to identify and address noncompliance with the EITC, ACTC, and AOTC, the Commissioner of Internal Revenue should direct Refundable Credits Policy and Program Management (RCPPM) to assess whether the data received from the Department of Education's Postsecondary Education Participants System (PEPS) database (a) are sufficiently complete and accurate to reliably correct tax returns at filing and (b) provide additional information that could be used to identify returns for examination; if warranted by this research, IRS should use this information to seek legislative authority to correct tax returns at filing based on PEPS data.

    Agency: Department of the Treasury: Internal Revenue Service
    Status: Open

    Comments: In February 2016, Refundable Credits Policy and Program Management asked Wage & Investment Strategy & Solutions (WISS) to test the Department of Education's Postsecondary Education Participants System database (PEPS) to match and validate the EINS reported on Form 8863, Education Credits. According to IRS, preliminary assessment of the PEPS database indicates that it is not a sufficiently complete database to confirm AOTC eligibility during return processing or post processing. GAO reviewed the study results and submitted several follow-up questions to IRS in May 2017. GAO followed-up with IRS on the status of that information request in June 2017.
    Recommendation: To strengthen efforts to identify and address noncompliance with the EITC, ACTC, and AOTC, the Commissioner of Internal Revenue should direct Refundable Credits Policy and Program Management (RCPPM) to take necessary steps to ensure the reliability of collections data and periodically review that data to (a) compute a collections rate for post-refund enforcement activities and (b) determine what additional analyses would provide useful information about compliance results and costs of post-refund audits and document-matching reviews.

    Agency: Department of the Treasury: Internal Revenue Service
    Status: Open

    Comments: IRS raised concerns about the cost of studying collections data for post-refund enforcement activities. GAO recognizes that gathering collections data has costs. However, a significant amount of enforcement activity is occurring after refunds have been paid, and use of these data could better inform resource allocation decisions and improve the overall efficiency of enforcement efforts.
    Recommendation: To strengthen efforts to identify and address noncompliance with the EITC, ACTC, and AOTC, the Commissioner of Internal Revenue should direct Refundable Credits Policy and Program Management (RCPPM) to, as RCPPM begins efforts to track the number of erroneous returns claiming the ACTC or AOTC identified through pre-refund enforcement activities, such as screening filters and use of math error authority, it should develop and implement a plan to collect and analyze these data that includes such characteristics as identifying timing goals, resource requirements, and the appropriate methodologies for analyzing and applying the data to compliance issues.

    Agency: Department of the Treasury: Internal Revenue Service
    Status: Open

    Comments: As of February 2017, IRS is taking steps toward developing a comprehensive compliance strategy that includes the three refundable tax credits GAO reviewed, as well as the PTC. These steps include initial planning meetings with Lean Six Sigma consultants and refundable credit policy and program managers and soliciting volunteers for the teams needed to develop the strategy. GAO will continue to monitor the progress of this effort.
    Director: Kay E. Brown
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To help ensure vulnerable unaccompanied children receive child advocate services, the Secretary of the Department of Health and Human Services should direct ORR to develop a monitoring process that includes: (1) regularly reviewing referrals to the program contractor, including identifying which care providers in locations with a child advocate program do not make referrals; and (2) reviewing information on the children the program contractor determines it is unable to serve.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In June 2016, the Office of Refugee Resettlement (ORR) reported that it is working with the child advocate contractor to develop standard operating procedures (SOP) to assign child advocates for children as well as address issues identified in the report and monitor the referral and selection process. ORR also reported that its field staff are working with care providers to ensure that care providers are making referrals for child advocates where a local program exists. In July 2017, ORR reported that new SOPs are under development and the program continues to deny cases when child advocates are unavailable due to the limited number of child advocates. Finalizing standard operating procedures for program referrals and developing a process to review information on the children the program contractor determines it is unable to serve would be positive steps towards addressing the recommendation.
    Director: Kay E. Brown
    Phone: (202) 512-7215

    3 open recommendations
    including 1 priority recommendation
    Recommendation: The Secretary of the Department of Health and Human Services should direct the Office of Refugee Resettlement to develop a process to update its bed capacity framework on an annual basis to include the most recent data related to numbers of unaccompanied children who may be referred to its care and adjust its planning scenarios that guide its bed capacity as appropriate.

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

    Comments: The Office of Refugee Resettlement (ORR) developed a bed capacity framework for fiscal year 2016, and produced a FY 2017 bed capacity framework in June 2017. The frameworks include a discussion of the indicators, referrals and triggers ACF uses to monitor bed capacity, as well as the agency's framework for ensuring that it has sufficient capacity to meet its need for shelter beds and services.
    Recommendation: The Secretary of the Department of Health and Human Services should direct the Office of Refugee Resettlement to review its monitoring program to ensure that onsite visits are conducted in a timely manner, case files are systematically reviewed as part of or separate from onsite visits, and that grantees properly document the services they provide to children.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with our recommendation. According to HHS, in the beginning of FY 2016, the Office of Refugee Resettlement (ORR) conducted a review of its monitoring procedures to develop uniform protocols for all ORR monitoring activities. In addition, ORR reported that it completed its scheduled monitoring visits for FY 2016. HHS reported that for FY 2017 and FY 2018 the UAC Program Monitoring Team will biannually monitor all of its ORR UAC care providers.
    Recommendation: The Secretary of the Department of Health and Human Services should direct the Office of Refugee Resettlement to develop a process to ensure all information collected through its existing post-release efforts are reliable and systematically collected so that they can be compiled in summary form and provide useful information to other entities internally and externally.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: The Office of Refugee Resettlement (ORR) created a new section in its unaccompanied children's policy guide that, among other things, includes case reporting, records management, retention, and information sharing requirements for post-release service providers. However, as of August 2017, case management functionality has not been built into ORR's UAC Portal, a web-based database that contains, among other things, intake, placement, and sponsor information, as well as individual service plans for the children. Also, the post-release service program does not yet have OMB-approved forms that ORR can require grantees use for reporting purposes. Nevertheless, ORR has collected and released data on Safety and Well-Being (SWB) follow-up calls that were made to children and their sponsors. In addition, ORR has developed a plan for collecting and analyzing National Call Center data.
    Director: Robert Goldenkoff
    Phone: (202) 512-2757

    1 open recommendations
    including 1 priority recommendation
    Recommendation: To help ensure the Bureau focuses its resources on those activities that show promise for substantially reducing enumeration cost, in advance of the 2016 Census Test and later tests, the Secretary of Commerce should direct the Under Secretary of the Economics and Statistics Administration and the Director of the U.S. Census Bureau to, ensure systematic capture of information about fieldwork cases that experience problems by including information in enumerator training about where to record the issues, who to contact, what details to include, and the importance of doing so.

    Agency: Department of Commerce
    Status: Open
    Priority recommendation

    Comments: Commerce concurred with this recommendation. The Census Bureau informed us in December 2015 that no later than the end of December 2015, it would document how these matters have been addressed in the enumerator training (or in help screens on their mobile device) planned for the 2016 Census Test, and that it would use results and observations from that test to further refine such information for future tests and for the 2020 Census. The Bureau provided us with related training materials for the 2016 Test, yet we made similar observations during the test. To fully implement this recommendation, the Bureau needs to identify what information from tests on a case-by-case basis it finds valuable to have from its enumerators, such as the incidence of specific technical problems with the survey instrument or mobile device and ensure that during tests enumerators and their first-line supervisors are made aware of the importance of recording such information and how to do so. As of July 2017, the Bureau is working to provide documentation that shows it has implemented this recommendation.
    Director: Kimberly Gianopoulos
    Phone: (202)512-8612

    1 open recommendations
    Recommendation: To strengthen agency performance measurement related to deterring child smuggling, the Secretary of Homeland Security should instruct DHS's U.S. Immigration and Customs Enforcement to establish annual performance targets associated with the performance measures it has established for its Transnational Criminal Investigative Units.

    Agency: Department of Homeland Security
    Status: Open

    Comments: In its comments on the report in July 2015, the Department of Homeland Security stated that it concurred with this recommendation, and that it would work with host nation partners to establish goals to measure these units' investigative activities and capacity development. In September 2015, DHS noted that it planned to use law enforcement data to measure TCIU success rates and inform efforts going forward. GAO has followed up with DHS--most recently in June 2017--on the status of its efforts to establish performance targets, but has not yet received a response.
    Director: Rebecca Gambler
    Phone: (202) 512-8777

    9 open recommendations
    Recommendation: To better ensure that DHS complies with TVPRA requirements for training, screening, and transferring UAC to HHS, the Secretary of Homeland Security should direct the Commissioner of U.S. Customs and Border Protection to develop and implement TVPRA training for OFO officers at airports who have substantive contact with UAC.

    Agency: Department of Homeland Security
    Status: Open

    Comments: The Office of Field Operations (OFO) within U.S. Customs and Border Protection (CBP), in collaboration with U.S. Immigration and Customs Enforcement, conducted a "Train-the-Trainer" conference in August 2015 that focused on juvenile and unaccompanied alien children (UAC). The conference, among other things, addressed screening requirements for UAC consistent with Trafficking Victims Protection Reauthorization Act of 2008 (TVPRA). CBP officers who received this additional training were then responsible for training other officers who process UAC at the ports of entry. According to CBP, while the conference was comprehensive, it did not fully encompass CBP's needs. In June 2016, CBP reported that OFO, Office of Chief Counsel, and a headquarters-level working group on UAC issues are finalizing a revised Form CBP-93 and with that are developing a detailed, relevant Train-the-Trainer course for officers responsible for TVPRA at all CBP ports of entry. In December 2016, CBP notified GAO that OFO, in coordination with CBP's Office of Training and Development, was concluding the design and embarking on the development phase of a distance learning course, tentatively entitled "Processing, Holding, and Transfer of Unaccompanied Alien Children by CBP." This course will be an annual requirement for all OFO officers. In April 2017, CBP reported that OFO was no longer pursuing a separate Train-the-Trainer course for CBP officers at air ports of entry. However, CBP continues to develop a new UAC training course. The new course is a collaborative effort between OFO and USBP, in consultation with CBP's Office of Chief Counsel, and in partnership with CBP's Office of Training and Development (OTD) to develop, deconflict, and revise training consistent with requirements under TVPRA, specifically outlining rules to identify and screen UAC, among other things. As of September 2017, CBP estimates that they will finalize the training module by June 2018. To fully address this recommendation, CBP needs to ensure that OFO officers at airports who have substantive contact with UAC complete this training.
    Recommendation: To better ensure that DHS complies with TVPRA requirements for training, screening, and transferring UAC to HHS, the Secretary of Homeland Security should direct the Commissioner of U.S. Customs and Border Protection to revise the Form 93 to include indicators or questions that agents and officers should ask UAC to better assess (1) a child's ability to make an independent decision to withdraw his or her application for admission to the United States and (2) credible evidence of the child's risk of being trafficked if returned to his or her country of nationality or last habitual residence.

    Agency: Department of Homeland Security
    Status: Open

    Comments: In September 2015, CBP officials stated that CBP formed a working group in headquarters with representatives from the department's Office of Policy and Office for Civil Rights and Civil Liberties to examine the screening process for UAC. In addition, CBP officials noted that CBP is in the process of convening a similar group in the field. According to CBP officials, the working group meets weekly and is coordinating with nongovernmental organizations and the United Nations High Commissioner for Refugees, among others. As of June 30, 2016, CBP reported that CBP's Office of Field Operations (OFO) and U.S. Border Patrol (BP) have finalized and routed the Form CBP-93 to the OFO Executive Assistant Commissioner and United States Border Patrol Chief for final approval. As of June 2017, the revised CBP Form 93 is still under review and CBP officials estimate that the review process will be completed by December 31, 2017. To fully address this recommendation, CBP should revise the Form 93 to include indicators or questions that CBP officers and Border Patrol agents should ask UAC relative to their ability to make an independent decision and regarding the potential risk of the UAC being trafficked if returned to their country of nationality or last habitual residence.
    Recommendation: To better ensure that DHS complies with TVPRA requirements for training, screening, and transferring UAC to HHS, the Secretary of Homeland Security should direct the Commissioner of U.S. Customs and Border Protection to provide guidance to Border Patrol agents and OFO officers that clarifies how they are to implement the TVPRA requirement to transfer to HHS all Mexican UAC who have fear of returning to Mexico owing to a credible fear of persecution.

    Agency: Department of Homeland Security
    Status: Open

    Comments: In commenting on a draft of our report, DHS indicated that CBP's U.S. Border Patrol (USBP) and Office of Field Operations (OFO) would issue further guidance to agents and officers emphasizing TVPRA transfer procedures for UAC who are nationals or habitual residents of Canada or Mexico and who are victims of a severe form of trafficking in persons. In September 2015, CBP reported that USBP and OFO estimated implementing this additional guidance by the end of calendar year 2015. In January 2016, CBP reported to GAO that, since June 2015, a headquarters level working group had been reviewing CBP's screening process for UAC. According to CBP officials, the activities of this working group will influence the guidance that will be deployed to Border Patrol agents and OFO officers and that USBP and OFO will be working together to develop additional guidance to the field by September 2016. In December 2016, CBP notified GAO that Border Patrol and OFO have partnered with CBP's Office of Training and Development, as well as the Office of Chief Counsel, to develop a distance learning course, tentatively entitled "Processing, Holding, and Transfer of Unaccompanied Alien Children by CBP." According to CBP, this course will be an annual requirement for all CBP agents and officers. As of September 2017, CBP estimates that they will finalize the training module by June 2018. To fully address this recommendation, CBP should ensure that this distance learning training module on how to implement the Trafficking Victims Protection Reauthorization Act of 2008 (TVPRA) criteria is developed and implemented, as required by CBP policy, to all Border Patrol agents and OFO officers.
    Recommendation: To better ensure that DHS complies with TVPRA requirements for training, screening, and transferring UAC to HHS, the Secretary of Homeland Security should direct the Commissioner of U.S. Customs and Border Protection to develop and implement guidance on how Border Patrol agents and OFO officers are to implement the TVPRA requirement to transfer to HHS all Canadian and Mexican UAC who are victims of a severe form of trafficking in persons.

    Agency: Department of Homeland Security
    Status: Open

    Comments: In commenting on a draft of our report, DHS indicated that CBP's U.S. Border Patrol (USBP) and Office of Field Operations (OFO) would issue further guidance to agents and officers emphasizing TVPRA transfer procedures for UAC who are nationals or habitual residents of Canada or Mexico and who are victims of a severe form of trafficking in persons. In September 2015, CBP reported that USBP and OFO estimated implementing this additional guidance by the end of calendar year 2015. In January 2016, CBP reported to GAO that, since June 2015, a headquarters level working group has been reviewing CBP's screening process for UAC. According to CBP officials, the activities of this working group will influence the guidance that will be deployed to Border Patrol agents and OFO officers and that USBP and OFO will be working together to develop additional guidance to the field by September 2016. In December 2016, CBP notified GAO that Border Patrol and OFO have partnered with CBP's Office of Training and Development as well as the Office of Chief Counsel to develop a distance learning course, tentatively entitled "Processing, Holding, and Transfer of Unaccompanied Alien Children by CBP." According to CBP, this course will be an annual requirement for all CBP agents and officers. As of September 2017, CBP estimates that they will finalize the training module by June 2018. To fully address this recommendation, CBP should ensure that this distance learning training module on how to implement the Trafficking Victims Protection Reauthorization Act of 2008 (TVPRA) criteria is developed and implemented, as required by CBP policy, to all Border Patrol agents and OFO officers.
    Recommendation: To better ensure that DHS complies with TVPRA requirements for training, screening, and transferring UAC to HHS, the Secretary of Homeland Security should direct the Commissioner of U.S. Customs and Border Protection to ensure that Border Patrol agents document the basis for their decisions when assessing screening criteria related to (1) an unaccompanied alien child's ability to make an independent decision to withdraw his or her application for admission to the United States, and (2) whether UAC are victims of a severe form of trafficking in persons.

    Agency: Department of Homeland Security
    Status: Open

    Comments: As of December 2015, CBP officials reported that an internal working group charged with assessing UAC screening procedures was considering issues related to independent decision-making and appropriate documentation as it develops a revised screening tool. As of June 30, 2016, CBP reported that CBP's Office of Field Operations (OFO) and U.S. Border Patrol (BP) had finalized and routed a revised CBP Form 93 to the OFO Executive Assistant Commissioner and United States Border Patrol Chief for final approval. As of August 31, 2016, the revised CBP Form 93 was still under review and CBP officials estimated that the review process would be completed by December 31, 2016. In January 2017, CBP notified GAO that the expected completion date for the revised form is April 2017, and that direction to Border Patrol agents on the new form would be delivered by June 2017. In June 2017, CBP told GAO that Border Patrol and other CBP partners were continuing to determine which changes are necessary to the CBP Form 93 and estimated that these efforts would not be completed until December 31, 2017. As of September 2017, CBP reported that these efforts would not be completed until June 2018. To fully address this recommendation, CBP should ensure that Border Patrol agents document the basis for their decisions when assessing screening criteria related to (1) an unaccompanied alien child's ability to make an independent decision to withdraw his or her application for admission to the United States, and (2) whether UAC are victims of a severe form of trafficking in persons.
    Recommendation: To better ensure that DHS complies with TVPRA requirements for training, screening, and transferring UAC to HHS, the Secretary of Homeland Security should direct the Commissioner of U.S. Customs and Border Protection to determine which agents and officers who have substantive contact with UAC, complete the annual UAC training, and ensure that they do so, as required.

    Agency: Department of Homeland Security
    Status: Open

    Comments: On July 1, 2015, the Assistant Commissioner for Field Operations (OFO) disseminated a memorandum to all OFO Field Office Directors regarding the mandatory annual UAC training requirement. The Assistant Commissioner directed all Field Offices to ensure that officers completed the required training by December 31, 2015 (the memo also specified which officers are required to complete the training). On July 31, 2015, the Chief of the U.S. Border Patrol disseminated a memorandum to all Chief Patrol Agents and Directorate Chiefs for dissemination to all uniformed personnel, including supervisors, regarding the mandatory annual UAC training requirement. CBP documentation indicates that CBP implemented a new learning management system mandated by DHS on July 13, 2015, through which online training courses are offered to all CBP employees. Further, in 2016 DHS added a feature to this system that provided the capability to produce reports on courses completed by CBP employees. In April 2017, CBP provided 2016 data on the OFO officers and Border Patrol agents that had completed the required UAC training course. According to the data, 23 percent of OFO officers and 7 percent of Border Patrol agents required to complete the training had not done so. CBP officials stated that they plan to take steps to increase the percent of agents and officers who complete the required training in 2017 and will provide new data to GAO in early 2018. To fully address this recommendation, Border Patrol and OFO should ensure that all required personnel have completed the annual training, as required.
    Recommendation: To help ensure that DHS has complete and reliable data needed to ensure compliance with the UAC time-in-custody requirement under TVPRA and for required reports on UAC time in custody under the Flores Agreement, the Secretary of Homeland Security should require ICE officers to record accurate and reliable data in their automated system when UAC leave ICE custody in order to track the length of time UAC are in ICE custody.

    Agency: Department of Homeland Security
    Status: Open

    Comments: In a July 23, 2015 memo, ICE's Assistant Director for Custody Management, with concurrence from the Acting Assistant Director for Field Operations, provided instructions to all ICE Field Office Directors, Deputy Field Office Directors, and Field Office Juvenile Coordinators (FOJCs) with instructions for processing juveniles, including unaccompanied alien children (UAC). The memo stated that FOJCs or assigned officers must immediately book UAC into ICE's automated system upon the UAC's transfer into ICE's custody (including ICE transportation contractors). The instructions state that no more than 4 hours may elapse without recording the UAC's time in ICE custody. Further, the instructions stated that when ICE transfers UAC to a new location, that FOJCs, or other assigned officers, must also ensure that ICE's automated system is updated to reflect the exact location of the transfer. According to ICE, these instructions are to be included in a juvenile processing handbook that will provide detailed instructions for officers in processing and managing juvenile cases. ICE expects to complete this handbook by June 30, 2016. As of October 2016, the handbook was still being cleared within ICE. To fully implement our recommendation, ICE should require that officers record accurate and reliable data (date and time) in their automated system when UAC leave ICE custody.
    Recommendation: To increase the efficiency and improve the accuracy of the interagency UAC referral and placement process, the Secretaries of Homeland Security and Health and Human Services should jointly develop and implement a documented interagency process with clearly defined roles and responsibilities, as well as procedures to disseminate placement decisions, for all agencies involved in the referral and placement of UAC in HHS shelters.

    Agency: Department of Homeland Security
    Status: Open

    Comments: In September 2015, DHS stated that the department was collaborating with HHS on finalizing a Memorandum of Agreement (MOA) regarding UAC procedures. According to DHS, the MOA is meant to provide a framework for interagency coordination on the responsibilities of the parties in coordinating and establishing procedures, shared goals, and interagency cooperation with respect to UAC. In February 2016, DHS and HHS finalized the MOA. The MOA states that DHS and HHS agree to establish a Joint Concept of Operations (JCO) that should be completed no later than one year following the signing of the MOA. According to the MOA, the JCO should include, among other things, standard protocols for consistent interagency cooperation on the care, processing, and transport of UAC during both steady state operations, as well as in the event the number of UAC exceeds the standard capabilities of the departments to process, transport, and/or shelter with existing resources. As of February 2017, HHS told GAO that HHS and DHS are still in the process of drafting the JCO. To fully address the recommendation, DHS and HHS will need to ensure that the JCO, once finalized and implemented, includes a documented interagency process with clearly defined roles and responsibilities, as well as procedures to disseminate placement decisions, for all agencies involved in the referral and placement of UAC in HHS shelters.
    Recommendation: To increase the efficiency and improve the accuracy of the interagency UAC referral and placement process, the Secretaries of Homeland Security and Health and Human Services should jointly develop and implement a documented interagency process with clearly defined roles and responsibilities, as well as procedures to disseminate placement decisions, for all agencies involved in the referral and placement of UAC in HHS shelters.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In September 2015, DHS stated that the department was collaborating with HHS on finalizing a Memorandum of Agreement (MOA) regarding UAC procedures. According to DHS, the MOA is meant to provide a framework for interagency coordination on the responsibilities of the parties in coordinating and establishing procedures, shared goals, and interagency cooperation with respect to UAC. In February 2016, DHS and HHS finalized the MOA. The MOA states that DHS and HHS agree to establish a Joint Concept of Operations (JCO) that should be completed no later than one year following the signing of the MOA. According to the MOA, the JCO should include, among other things, standard protocols for consistent interagency cooperation on the care, processing, and transport of UAC during both steady state operations, as well as in the event the number of UAC exceeds the standard capabilities of the departments to process, transport, and/or shelter with existing resources. As of August 2017, HHS told GAO that HHS and DHS are still in the process of drafting the JCO. To fully address the recommendation, DHS and HHS will need to ensure that the JCO, once finalized and implemented, includes a documented interagency process with clearly defined roles and responsibilities, as well as procedures to disseminate placement decisions, for all agencies involved in the referral and placement of UAC in HHS shelters.
    Director: David Gootnick
    Phone: (202) 512-3149

    1 open recommendations
    Recommendation: To improve USAID's ability to measure progress in achieving a quantitative reading goal in any future education strategy, the Acting USAID Administrator should ensure that the future strategy includes targets that will allow USAID to monitor interim progress toward its goal in comparison with planned performance.

    Agency: United States Agency for International Development
    Status: Open

    Comments: In written comments on the report, USAID agreed to implement GAO's recommendation. USAID told GAO in August 2015 that a new Education Strategy will continue to focus on primary grade reading through 2020. The current strategy was scheduled to end in December 2015. USAID noted that as it expands its body of knowledge surrounding achievements of current reading projects, it will be better able to set achievable project and country level targets and report interim progress toward the new strategy's aggregate primary grade reading goal. USAID announced on August 28, 2017 that it has extended the 2011-2015 Education Strategy until December 2017, to allow adequate time for development of a new strategy with "the full backing and ownership of the new Administration." This recommendation will be applicable once USAID establishes a new strategy with new targets. According to a USAID official, as of September 14, 2017, the current strategy remains extended through December 2017. We will continue to monitor this recommendation.
    Director: Maurer, Diana C
    Phone: (202) 512-9627

    2 open recommendations
    Recommendation: To ensure the timely expenditure of VOCA grant funds and thereby limit the carryover of unexpended grant balances, minimize the need for multiple grant extensions, and strengthen OJJDP's capacity to collect and assess grantee performance information, the Assistant Attorney General for OJP should work with the Administrator of OJJDP to conduct a study to examine whether any of its administrative processes contribute to unnecessary delays in grantees' ability to expend VOCA funds within the established 12-month project period and make modifications to these processes as appropriate.

    Agency: Department of Justice: Office of Justice Programs: Office of the Assistant Attorney General
    Status: Open

    Comments: In April 2015, we found that OJJDP had several administrative review and approval processes in place that had contributed to delays in grantees' ability to begin spending their award funds. For instance, grantees could not access their funds until OJJDP had completed its internal review of grantees' budgets--a step that had taken more than 2 months, on average, after the grantees' project period had begun. We recommended that OJP examine its processes and, if appropriate, make modifications to prevent unnecessary delays in grantees' ability to expend VOCA funds within the established project period. In March 2017, OJP reported that its Office of Audit, Assessment and Management (OAAM), worked with OJJDP to complete an assessment to determine the impact of administrative processes on VOCA awards. Focusing on VOCA grants awarded in fiscal years 2010 through 2015, OAAM assessed a number of factors, including (1) the average timeframe for approval of budget reviews; (2) the average timeframe for approval of conference cost requests, and (3) the number of no-cost extensions granted. OJP reported that OAAM continues to work with OJJDP to review documentation to support implementation of process improvements to address the issues the assessment identified. In December 2017, OJP reported that DOJ anticipates issuing a report by the end of January 2018 that summarizes the results of OAAM's assessment and provide updates on the process improvements OJJDP has begun to implement. Examining the delays associated with its administrative review processes and making modifications as necessary will help OJP ensure the effective administration and timely use of grant funds.
    Recommendation: To ensure the timely expenditure of VOCA grant funds and thereby limit the carryover of unexpended grant balances, minimize the need for multiple grant extensions, and strengthen OJJDP's capacity to collect and assess grantee performance information, the Assistant Attorney General for OJP should work with the Administrator of OJJDP to, considering the results of this study, examine whether the current 12-month project period is realistic in light of any administrative processes that cause delay but cannot be modified and extend the project period if necessary.

    Agency: Department of Justice: Office of Justice Programs: Office of the Assistant Attorney General
    Status: Open

    Comments: In April 2015, we found that VOCA grant activities were not being completed within the time parameters OJJDP established for the grant program, and that this may affect the ability of grantees to complete their grant goals and objectives. Specifically, we found that for the 28 VOCA grants that OJJDP awarded from fiscal years 2010 through 2013, grantees had expended less than 20 percent, on average, of each grant they received during the original 12-month project period. In particular, we found that OJJDP's processes for reviewing grantees' budgets and conference planning requests were contributing to delays in grantees' ability to begin spending their funds. We recommended that OJP examine whether 12 months is an appropriate project period length to ensure that VOCA grantees are well positioned to fully expend their grant funds. In March 2017, OJP reported that its Office of Audit, Assessment and Management (OAAM), worked with OJJDP to complete an assessment to determine the impact of administrative processes on VOCA awards. Focusing on VOCA grants awarded in fiscal years 2010 through 2015, OAAM assessed a number of factors, including (1) the average timeframe for approval of budget reviews; (2) the average timeframe for approval of conference cost requests, and (3) the number of no-cost extensions granted. OJP reported that OAAM continues to work with OJJDP to review documentation to support implementation of process improvements to address the issues the assessment identified. In December 2017, OJP reported that DOJ anticipates issuing a report by the end of January 2018 that summarizes the results of OAAM's assessment and provide updates on the process improvements OJJDP has begun to implement. Once OJJDP examines its administrative delays, makes any necessary changes, and reviews the original project period length, OJP will be better positioned to ensure that grantees have an appropriate period in which to expend VOCA grant awards.
    Director: Kay E. Brown
    Phone: (202) 512-7215

    2 open recommendations
    Recommendation: To better ensure that WIC participants are aware of the prohibition against selling WIC formula, and to assist states' efforts to prevent and address online formula sales, the Secretary of Agriculture should direct the Administrator of FNS to require state agencies to articulate their procedures for identifying attempted sales of WIC food benefits in their WIC state plans and analyze the information to ascertain the national extent of state efforts.

    Agency: Department of Agriculture
    Status: Open

    Comments: USDA agreed with this recommendation and reported that in April 2015 the agency revised the guidance for WIC state plans to include policies on informing participants that the sale of WIC benefits is a program violation. As part of that document, state agencies were required to report/articulate their policies and procedures for identifying and monitoring online sales of WIC benefits. In October 2015, USDA contracted a study to determine 1) the national extent of WIC state agency policies and procedures intended to prevent, monitor, and take administrative action related to online sales of WIC infant formula; and 2) effective preventative, monitoring, and investigative approaches to address the online sale of WIC infant formula. USDA reported that a narrative state plan report, based on the contractor's review of 2016 and 2017 state plans, is expected to be completed by the end of FY 2017. GAO will close this recommendation once USDA has issued its report.
    Recommendation: To better ensure that WIC participants are aware of the prohibition against selling WIC formula, and to assist states' efforts to prevent and address online formula sales, the Secretary of Agriculture should direct the Administrator of FNS to collect information to help assess the national extent of attempted online sales of WIC formula benefits and determine cost-effective techniques states can use to monitor online classified advertisements.

    Agency: Department of Agriculture
    Status: Open

    Comments: USDA agreed with this recommendation and reported that it would explore options for using available resources to assess the extent of online sales of WIC formula and to identify and share best practices, cost-effective techniques, or new approaches with state agencies to use in monitoring online advertisements. In October 2015, USDA contracted a case study analysis of two state agencies in order to provide examples of prevention, monitoring, investigation, and sanctioning practices related to the online sale of WIC infant formula. As part of this study, the contractor sought to identify cost-effective techniques State agencies can use to monitor sales of WIC infant formula. USDA reported that the Case Study Analysis Report is expected to be completed by the end of FY 2017, and after it is completed, USDA will work to disseminate the study results to state agencies. GAO supports these efforts and will close this recommendation when the study is completed, providing the study identifies cost-effective techniques states can use to monitor online sales of infant formula.
    Director: Stephen M. Lord
    Phone: (202) 512-6722

    1 open recommendations
    Recommendation: To assist states that rely on or are planning to contract with an MCO to administer Medicaid prescription benefits, and to help provide effective oversight of psychotropic medications prescribed to children in foster care, the Secretary of Health and Human Services should issue guidance to state Medicaid, child-welfare, and mental-health officials regarding prescription-drug monitoring and oversight for children in foster care receiving psychotropic medications through MCOs.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In a July 2016 written response, Health and Human Services (HHS) stated that the Centers for Medicare & Medicaid Services (CMS) in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA), issued an informational bulletin in August 2012 and in July 2013, that addressed this recommendation. However, in the report, we acknowledged that CMS issued this bulletin along with other guidance. Further, as we stated in our report, the HHS guidance did not address third-party MCOs administering medications. We continue to believe that additional HHS guidance that helps states implement oversight strategies within the context of a managed-care environment is needed to help ensure appropriate monitoring of psychotropic medications prescribed to children in foster care.
    Director: Crosse, Marcia G
    Phone: (202) 512-7114

    3 open recommendations
    Recommendation: To improve the usefulness of IACC data and enhance its efforts to coordinate HHS autism activities and monitor all federally funded autism activities, the Secretary of Health and Human Services should direct the IACC and NIH, in support of the IACC, to provide consistent guidance to federal agencies when collecting data for the portfolio analysis and web tool so that information can be more easily and accurately compared over multiple years.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS continues to disagree with this recommendation. In the spring of 2016 NIH released fiscal years 2011 and 2012 data, and in the spring of 2017, it released fiscal year 2013 data and made these data available through the IACC Web Tool. GAO continues to believe that the issuance of consistent guidance could enhance coordination and monitoring and that implementing this recommendation would be beneficial.
    Recommendation: To improve the usefulness of IACC data and enhance its efforts to coordinate HHS autism activities and monitor all federally funded autism activities, the Secretary of Health and Human Services should direct the IACC and NIH, in support of the IACC, to create a document or database that provides information on non-research autism-related activities funded by the federal government and make this document or database publicly available.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS continues to disagree with this recommendation. However, GAO believes that having a document or database that contains current information on these non-research activities is an important aspect of fulfilling the IACC's responsibility to monitor all federal autism activities, not just research. In May 2016, we issued another report on federal autism activities (GAO-16-446). During our work for this engagement, we found that HHS and the IACC have recently taken actions required by the Autism CARES Act that could help coordinate federal non-research autism activities and implement our November 2013 recommendation. First, as directed by the act, in April 2016, the Secretary of Health and Human Services designated an official to serve as the Autism Coordinator to oversee national autism research, services, and support activities and ensure that autism activities funded by HHS and other federal agencies are not unnecessarily duplicative. Secondly, the Act required the development of a strategic plan for autism research, including for services and supports as practicable, for individuals with autism and the families of such individuals. The plan is to include recommendations to ensure that autism research, and services and support activities to the extent practicable, of HHS and other federal departments and agencies are not unnecessarily duplicative. During IACC meetings in 2016, NIH staff and IACC members discussed updating the strategic plan to include services and supports. This plan is expected to be published in calendar year 2017. We acknowledge the steps taken by HHS and the IACC in response to the Autism CARES Act; however, we believe continued action is needed to develop these initial steps into methods for identifying and monitoring non-research autism-related activities funded by the federal government. We believe that continued fulfillment of provisions in the Autism CARES Act could help the department implement GAO's 2013 recommendation.
    Recommendation: To improve the usefulness of IACC data and enhance its efforts to coordinate HHS autism activities and monitor all federally funded autism activities, the Secretary of Health and Human Services should direct the IACC and NIH, in support of the IACC, to identify projects through its monitoring of federal autism activities--including Office of Autism Research Coordination's annual collection of data for the portfolio analysis and the IACC's annual process to update the strategic plan--that may result in unnecessary duplication and thus may be candidates for consolidation or elimination, and identify potential coordination opportunities among agencies.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS continues to disagree with this recommendation. However, GAO questions the purpose and value of devoting federal resources to collecting these data, if they are not then used to ensure federal funds are used appropriately. In May 2016, we issued another report on federal autism activities (GAO-16-446), which among other topics, examined the steps HHS and other federal agencies have taken to improve coordination and help avoid unnecessary duplication in autism research. We reported that HHS has recently taken actions required by the Autism CARES Act that could help coordinate federal autism research and implement our November 2013 recommendation. First, as directed by the act, in April 2016 the Secretary of Health and Human Services designated an official to serve as the Autism Coordinator to oversee national autism research, services, and support activities and ensure that autism activities funded by HHS and other federal agencies are not unnecessarily duplicative. Second, the Autism Cares Act requires that the IACC's strategic plan include recommendations to ensure that autism research funded by HHS and other federal agencies is not unnecessarily duplicative. During IACC meetings in 2016, NIH staff and IACC members discussed updating the strategic plan, including the aforementioned requirement. This plan is expected to be published in calendar year 2017. We acknowledge the steps taken by HHS and the IACC in response to the Autism CARES Act; however, until the designated Autism Coordinator takes steps to meet the act's requirements and the forthcoming strategic plan is published, there is a risk that opportunities to coordinate and create efficiencies and avoid unnecessary duplication in federal autism research will not be seized. We believe that continued fulfillment of provisions in the Autism CARES Act could help the department implement GAO's 2013 recommendation.
    Director: Iritani, Katherine M
    Phone: (202) 512-7114

    2 open recommendations
    including 1 priority recommendation
    Recommendation: To improve the transparency of the process for reviewing and approving spending limits for comprehensive section 1115 demonstrations, the Secretary of Health and Human Services should update the agency's written budget neutrality policy to reflect actual criteria and processes used to develop and approve demonstration spending limits, and ensure the policy is readily available to state Medicaid directors and others.

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

    Comments: HHS does not agree with this recommendation. However, we continue to believe that HHS should have a formal written budget neutrality policy in place that reflects the Department's actual criteria and processes. HHS's written budget neutrality policy was last issued in 2001 and is not publicly available, and staff have acknowledged that aspects of the policy as written do not reflect their current criteria or processes.
    Recommendation: To improve the transparency of the process for reviewing and approving spending limits for comprehensive section 1115 demonstrations, the Secretary of Health and Human Services should reconsider adjustments and costs used in setting the spending limits for the Arizona and Texas demonstrations, and make appropriate adjustments to spending limits for the remaining years of each demonstration.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: As of September 2016, HHS officials reported that they have not implemented this recommendation. GAO considers it to be open. We will update this information 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: Iritani, Katherine M
    Phone: (206)287-4820

    2 open recommendations
    Recommendation: To enhance the provision of dental care to children covered by Medicaid and CHIP, and to help ensure that HHS's Insure Kids Now Web site is a useful tool to help connect children covered by Medicaid and CHIP with participating dentists who will treat them, the Secretary of HHS should establish a process to periodically verify that the dentist lists posted by states on the Insure Kids Now Web site are complete, usable, and accurate, and ensure that states and participating dentists have a common understanding of what it means for a dentist to indicate he or she can treat children with special needs.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS has reported taking steps to improve the data on the Insure Kids Now website, including establishing an ongoing system to check that data are in the correct format and conducting validation surveys. HHS has also reported that CMS will provide technical assistance to low performing States and develop mechanisms to better identify providers that serve children with special health care needs. As of September 2017, CMS has not indicated that it has communicated with states and providers on what it means for a dentist to indicate he or she can treat children with special needs. We will leave this recommendation open until the agency takes steps to ensure that states and participating dentists have a common understanding of what it means for a dentist to indicate he or she can treat children with special needs.
    Recommendation: To enhance the provision of dental care to children covered by Medicaid and CHIP, and to help ensure that HHS's Insure Kids Now Web site is a useful tool to help connect children covered by Medicaid and CHIP with participating dentists who will treat them, the Secretary of HHS should require states to verify that dentists listed on the Insure Kids Now Web site have not been excluded from Medicaid and CHIP by the HHS-OIG, and periodically verify that excluded providers are not included on the lists posted by the states.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: As of September 2017, CMS has not indicated the agency has required states to ensure that excluded providers are not listed on the Insure Kids Now website and has not indicated that the agency has taken steps to periodically verify that excluded providers are not listed. CMS has said that it relies on states to provide accurate lists of eligible dentists and that data issues prevent the agency from independently verifying that excluded providers are not included on the Insure Kids Now website. We continue to believe that CMS should require states to ensure that excluded providers are not listed on the website and periodically verify that excluded providers are not included on the lists posted by the states, so that the website does not present inaccurate information about providers available to serve Medicaid-covered children.
    Director: Stephenson, John B
    Phone: (202)512-6225

    1 open recommendations
    Recommendation: Because EPA alone cannot address the complexities of the nation's challenges in addressing environmental health risks for children, Congress may wish to consider re-establishing a government-wide task force on children's environmental health risks, similar to the one previously established by Executive Order 13045 and co-chaired by the Administrator of EPA and the Secretary of Health and Human Services. Congress may wish to consider charging it with identifying the principal environmental health threats to children and developing national strategies for addressing them. Congress may also wish to consider establishing in law the Executive Order's requirement for periodic reports about federal research findings and research needs regarding children's environmental health.

    Agency: Congress
    Status: Open

    Comments: As of December 2016, we have not identified actions by the Congress to establish in law requirements such as those in EO 13025.
    Director: White, James R
    Phone: (202) 512-5594

    1 open recommendations
    Recommendation: Given the potential for improving compliance now and in the future, Congress may wish to provide IRS with the authority to use math error checks to identify and correct returns with ineligible (1) IRA "catch-up" contributions, and (2) contributions to traditional IRAs from taxpayers over age 70-1/2.

    Agency: Congress
    Status: Open

    Comments: As of April 2017, the Congress has not provided IRS with the math error authority to ensure that taxpayers comply with certain catch-up and contributions requirements.
    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.