Reports & Testimonies

  • GAO’s recommendations database contains report recommendations that still need to be addressed.

    GAO’s recommendations help congressional and agency leaders prepare for appropriations and oversight activities, as well as help improve government operations. Recommendations remain open until they are designated as Closed-implemented or Closed-not implemented. You can explore open recommendations by searching or browsing.

    GAO's priority recommendations are those that we believe warrant priority attention. We sent letters to the heads of key departments and agencies, urging them to continue focusing on these issues. These recommendations are labeled as such. You can find priority recommendations by searching or browsing our open recommendations below, or through our mobile app.

  • Browse Open Recommendations

    Explore priority recommendations by subject terms or browse by federal agency

    Search Open Recommendations

    Search for a specific priority recommendation by word or phrase



  • Governing on the go?

    Our Priorities for Policy Makers app makes it easier for leaders to search our recommendations on the go.

    See the November 10th Press Release


  • Have a Question about a Recommendation?

    • For questions about a specific recommendation, contact the person or office listed with the recommendation.
    • For general information about recommendations, contact GAO's Audit Policy and Quality Assurance office at (202) 512-6100 or apqa@gao.gov.
  • « Back to Results List Sort by   

    Results:

    Subject Term: Disabilities

    11 publications with a total of 29 open recommendations including 2 priority recommendations
    Director: Debra A. Draper
    Phone: (202) 512-7114

    4 open recommendations
    Recommendation: The Secretary of Veterans Affairs should direct the Acting Under Secretary for Health to develop and disseminate a system-wide standard operating procedure that clearly defines the roles and responsibilities of VAMCs in resolving pending enrollment applications.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Veterans Affairs should direct the Acting Under Secretary for Health to clearly define oversight roles and responsibilities for HEC, and for Veterans Integrated Service Networks as appropriate, to help ensure timely processing of applications and accurate enrollment determinations.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Veterans Affairs should direct the Acting Under Secretary for Health to develop procedures for collecting consistent and reliable data system-wide to track and evaluate timeliness of enrollment processes, and institute an oversight mechanism to ensure VAMC and HEC enrollment staff are appropriately following the procedures.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Veterans Affairs should direct the Acting Under Secretary for Health to clarify its 5-day timeliness standard for processing enrollment applications, including whether it covers the total time needed to make an enrollment determination and the time applications are pending, and ensure the clarification is communicated system-wide.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Seto Bagdoyan
    Phone: (202) 512-6722

    4 open recommendations
    Recommendation: The Commissioner (or Acting Commissioner) of SSA should direct the OAFP to lead a comprehensive fraud risk assessment that is consistent with leading practices, and develop a plan for regularly updating the assessment.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Commissioner (or Acting Commissioner) of SSA should direct the OAFP to develop, document, and implement an antifraud strategy that is aligned to its assessed fraud risks.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Commissioner (or Acting Commissioner) of SSA should direct the OAFP to work with components responsible for implementing antifraud initiatives to develop outcome-oriented metrics, including baselines and goals, where appropriate for antifraud activities.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Commissioner (or Acting Commissioner) of SSA should direct the OAFP to review progress toward meeting goals on a regular basis, and recommend that the NAFC make changes to control activities or take other corrective actions on any initiatives that are not meeting goals.

    Agency: Social Security Administration
    Status: Open

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

    1 open recommendations
    Recommendation: The Executive Director of NCD should assign responsibilities for conducting future campaign activities and develop an evaluation plan for its activities.

    Agency: National Council on Disability
    Status: Open

    Comments: As of July 2017, the National Council on Disability (NCD) had developed a plan for conducting campaign activities that had assigned responsibilities. However, as a result of recent changes in leadership and staff, several key activities do not have staff assigned and will need to be updated to ensure responsibility for completing the plan. Additionally, NCD said that they plan to conduct an internal audit in December 2017 to monitor the progress of their activities. While this audit is helpful in identifying progress to date, our recommendation suggests that NCD should also plan to evaluate the effectiveness of its activities.
    Director: Brenda S. Farrell
    Phone: (202) 512-3604

    1 open recommendations
    Recommendation: To help support DOD management of its FECA responsibilities, the Secretary of Defense should direct the Office of the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military departments and other defense agency leaders, to monitor timelines associated with significant FECA claims-management actions in order to identify the extent to which delays or inefficiencies may be occurring and at what points in the process; to identify any known reasons for the delays; and to communicate this information to DOL as appropriate for consideration and action.

    Agency: Department of Defense
    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

    6 open recommendations
    Recommendation: The Acting Commissioner of Social Security should direct the Deputy Commissioner of Operations to further consider cost savings as part of its prioritization of full medical reviews. Such options could include considering the feasibility of prioritizing different types of beneficiaries on the basis of their estimated average savings and, as appropriate, integrating case-specific indicators of potential cost savings, such as beneficiary age and benefit amount, into its modeling or prioritization process.

    Agency: Social Security Administration
    Status: Open

    Comments: In July 2017, SSA stated that there is no accepted way to accurately predict future benefit payments at the individual level and that any improvement from implementing this recommendation would be minimal - and would be reduced over time as the continuing disability review (CDR) backlog diminishes - because SSA already considers expected return on investment by cohort in its overall approach to releasing CDRs. It is unclear whether SSA will be able to achieve and sustain currency in its CDR workloads. Even if SSA were to eliminate the backlog of full medical reviews, refining its prioritization process would enable the agency to more efficiently use its resources with any future backlogs. SSA could use actuarial considerations to prioritize refined cohorts of beneficiaries (e.g., types of DI beneficiaries) on the basis of their estimated average savings. SSA Operations could collaborate with SSA's Office of the Actuary on this work as needed. SSA previously agreed that it could look for ways to improve its return on conducting CDRs, but also stated that its statistical models and prioritization process already do much of what we recommend. For example, SSA stated that age is already a strong variable in its statistical models. However, these models predict medical improvement and are not designed to take expected cost savings into account. We continue to believe that to maximize expected cost savings SSA could refine its prioritization process by factoring in additional actuarial considerations.
    Recommendation: The Acting Commissioner of Social Security should direct the Deputy Commissioner of Budget, Finance, Quality, and Management to complete a re-estimation of the statistical models that are used to prioritize CDRs and determine a plan for re-estimating these models on a regular basis to ensure that they reflect current conditions.

    Agency: Social Security Administration
    Status: Open

    Comments: In July 2016, SSA re-estimated the statistical models that it uses to prioritize CDRs. However, as of October 2017, SSA has not yet produced a plan for re-estimating the models on a regular basis to ensure that they continually reflect current conditions.
    Recommendation: The Acting Commissioner of Social Security should direct the Deputy Commissioner of Budget, Finance, Quality, and Management to monitor the characteristics of CDR errors to identify potential root causes and report results to the Disability Determination Services. For example, SSA could analyze CDRs with and without errors to identify trends by impairment, beneficiary type, or other characteristics.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA agreed with this recommendation and stated that it reports all errors to the relevant DDS for corrective action. SSA further stated that its identification of root causes is limited by the relatively few reviewed CDRs that have errors. However, in fiscal year 2014 as an example, SSA identified over 600 CDRs with errors. Although these CDRs make up a small percentage of the CDRs reviewed by SSA that year, the agency could analyze the characteristics of CDRs with errors by comparing relevant percentages without modeling. In addition, SSA could combine data from multiple years if it determined that considering more CDRs with errors would be helpful. There is no change in the status of this recommendation for 2017.
    Recommendation: The Acting Commissioner of Social Security should direct the Deputy Commissioner of Budget, Finance, Quality, and Management to regularly track the number and rate of date errors, which can affect benefit payments (e.g., incorrect cessation dates), and consider including those errors in its reported CDR accuracy rates.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA disagreed with this recommendation and stated that, per SSA regulation, the agency does not consider date errors when calculating accuracy rates because date errors do not affect the decision to cease or continue benefits. SSA also stated its stewardship reviews examine the non-medical quality of benefit payment decisions. However, these reviews are not focused on CDRs, and SSA does not report results from them for CDRs specifically. SSA also explained that it does not track the number and rate of date errors because they are infrequent. However, SSA's regulations do not prevent the agency from tracking date errors, and until it does, SSA cannot definitively determine the frequency of these errors. In addition, we found that considering date errors substantially reduced some states' estimated CDR accuracy rates. Without tracking these errors, SSA cannot assess their effect and consider whether including them in its reported CDR accuracy rates has merit. There is no change in the status of this recommendation for 2017.
    Recommendation: The Acting Commissioner of Social Security should direct the Deputy Commissioner of Budget, Finance, Quality, and Management to adjust its approach to sampling CDRs to efficiently produce reliable accuracy rate estimates for continuances and cessations separately in each state.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA disagreed with this recommendation and stated that some states do not generate enough CDR decisions, particularly cessations, to generate statistically valid samples. However, for states with CDR samples that are consistently too small to produce reliable results, SSA could, for example, pool decisions from more months than it currently does to generate statistically valid samples by state. Conversely, for states with CDR samples that are consistently larger than necessary to efficiently achieve reliable results, SSA could, for example, reduce sample sizes. Because CDR accuracy rates vary by state and cessations are consistently less accurate than continuances, we maintain that SSA should adjust its approach to sampling CDRs. There is no change in the status of this recommendation for 2017.
    Recommendation: The Acting Commissioner of Social Security should direct the Chief Actuary to better document the methods including data sources, assumptions, and limitations that factor into its estimates of CDR cost savings.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA agreed with this recommendation and stated that it will improve and expand its existing documentation as time and resources permit. As of July 2017, SSA had begun to improve documentation of its OASDI estimates and plans further enhancements including documenting the methods of its SSI estimates.
    Director: Jacqueline M. Nowicki
    Phone: (617) 788-0580

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

    Agency: Department of Education
    Status: Open

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

    Agency: Congress
    Status: Open

    Comments: Congress has not taken legislative action on this issue.
    Director: Valerie C. Melvin
    Phone: (202) 512-6304

    5 open recommendations
    including 1 priority recommendation
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to develop an updated plan for VBMS that includes (1) a schedule for when VBA intends to complete development and implementation of the system, including capabilities that fully support disability claims, pension claims, and appeals processing and (2) the estimated cost to complete development and implementation of the system.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: The Department of Veterans Affairs (VA) concurred with our recommendation calling for an updated plan for the Veterans Benefits Management System. However, as of June 2017, the department had not developed a plan that included a schedule for when the Veterans Benefits Administration intends to complete development and implementation of the system, as well as the estimated cost of doing so. We will continue to monitor VA's actions in response to this recommendation.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to establish goals for system response time and use the goals as a basis for periodically reporting actual system performance.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and reported that the Veterans Benefits Management System (VBMS) program office has developed draft metrics for performance of the system. Specifically, VA stated that the office has established key performance indicators as a basis for monitoring the response times of the most commonly executed user transactions (or work events) within VBMS. According to the department, these indicators have been incorporated into the application's continuous monitoring tools for all service level agreements and these agreements are enforced by the VA Service Level Management Board. Nevertheless, as of June 2017, VA had not identified its goals for VBMS response times, nor had the department reported actual system response times. We will continue to monitor VA's actions toward addressing this recommendation.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to reduce the incidence of high- and medium-priority level defects that are present at the time of future VBMS releases.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and, in June 2017, reiterated its plans and procedures for decreasing the incidences of defects in each system release. However, the incidences of high- and medium-priority level defects at the time of recent VBMS releases (i.e., releases 10.1 and 11.0) had increased relative to the number of defects present at the time of the earlier release (i.e., release 8.1) that we described in our report. We will continue to monitor VA's actions and progress in response to this recommendation.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to develop and administer a statistically valid survey of VBMS users to determine the effectiveness of steps taken to make improvements in users' satisfaction.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and in January 2017, conducted a survey of VBMS users that was sent to over 16,000 claims processors at each of its 56 regional offices. Although 52 percent of respondents indicated that they were very satisfied or satisfied with VBMS, the department received only about 2500 responses to the survey for a 15 percent response rate. This low response rate raises concern about whether the survey results are statistically valid. We have requested additional information from VA to determine any actions the department has taken to ensure the statistical validity of its survey results and will assess any information that is provided.
    Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to establish goals that define customer satisfaction with VBMS and report on actual performance toward achieving the goals based on the results of GAO's survey of VBMS users and any future surveys VA conducts.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and conducted a survey of VBMS users in January 2017. However, as of June 2017, the department had yet to develop customer satisfaction goals for VBMS that would provide users with an expectation of the system response times they should anticipate, and management with an indication of how well the system is performing relative to performance goals.
    Director: Mark Goldstein
    Phone: (202) 512-2834

    3 open recommendations
    Recommendation: To improve performance management of the Telecommunications Relay Service, the Chairman of the Federal Communications Commission should develop specific performance goals and measures for the TRS program. FCC should establish goals that would guide its efforts on major program dimensions--for example, consider goals and performance measures related to, but not limited to, service quality or competition among providers.

    Agency: Federal Communications Commission
    Status: Open

    Comments: On May 12, 2017, FCC's Liaison reported to us that FCC is working towards implementing these recommendations, but FCC does not have any specific achievements or documentation to report at this time. GAO will continue to monitor and update the status of this rec.
    Recommendation: To improve performance management of the Telecommunications Relay Service, following the establishment of TRS's performance goals, the Chairman of the Federal Communications Commission should conduct a robust risk assessment that can help FCC design a comprehensive internal-control system.

    Agency: Federal Communications Commission
    Status: Open

    Comments: On May 12, 2017, FCC's Liaison reported to us that FCC is working towards implementing these recommendations, but FCC does not have any specific achievements or documentation to report at this time. GAO will continue to monitor and update the status of this rec.
    Recommendation: To improve performance management of the Telecommunications Relay Service, the Chairman of the Federal Communications Commission should improve FCC's communication of TRS rules and procedures to the community of individuals who are deaf, hard of hearing, or have speech disabilities and the companies providing TRS services through the creation and dissemination of a handbook, program manual, or other consolidation of TRS rules and procedures.

    Agency: Federal Communications Commission
    Status: Open

    Comments: On May 12, 2017, FCC's Liaison reported to us that FCC is working towards implementing these recommendations, but FCC does not have any specific achievements or documentation to report at this time. GAO will continue to monitor and update the status of this rec.
    Director: Andrew Sherrill
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: Depending on the outcome of the litigation, the Secretary of Labor should take steps to ensure the agency will be positioned to conduct a meaningful retrospective review consistent with the Executive Order at an appropriate time. These steps should be taken in consultation with the Centers for Medicare & Medicaid Services, and could include, for example, identifying metrics that could be used to evaluate the rule, and implementing a plan to gather and analyze the necessary data.

    Agency: Department of Labor
    Status: Open

    Comments: The Department of Labor's Wage and Hour Division (WHD) agreed with this recommendation and reported that it is working to develop data collection plans and explore a potential evaluation that is focused on the Home Care Rule. As part of this effort, WHD noted that it will continue to work with HHS and other federal partners. In FY16, WHD reported that such an evaluation of how stakeholders and affected industries have responded to the rule would be beneficial. However, litigation has delayed implementation and enforcement of the rule significantly, and WHD believes an evaluation at this stage would be premature and would be unlikely to fully and accurately capture stakeholders' responses to the rule and the resulting impacts. Delaying the evaluation would allow WHD to monitor the results of its own investigations and the effects of ongoing compliance assistance, both of which would be extremely difficult to measure at this early stage. WHD will continue to monitor early implementation to determine the appropriate start for any evaluation.
    Director: Wise, David J
    Phone: (202)512-5731

    1 open recommendations
    Recommendation: To improve NTD data collection for ADA paratransit,the Secretary of Transportation should direct the FTA Administrator to provide guidance to transit agencies on how to accurately complete existing ADA paratransit fields.

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

    Comments: The Federal Register final notice on April 7, 2015, shows that FTA is eliminating the collection of certain ADA paratransit data (trips and expenses) from the NTD. This clarification instructs respondents on how to exclude data for demand-responsive services that are not ADA paratransit. We are reviewing the documentation and will make a decision regarding closing this recommendation as implemented at the conclusion of our review.
    Director: Cosgrove, James C
    Phone: (202) 512-7114

    1 open recommendations
    including 1 priority recommendation
    Recommendation: To help ensure appropriate payments to MA plans, the Administrator of CMS should take steps to improve the accuracy of the adjustment made for differences in diagnostic coding practices between MA and Medicare FFS. Such steps could include, for example, accounting for additional beneficiary characteristics, including the most current data available, identifying and accounting for all years of coding differences that could affect the payment year for which an adjustment is made, and incorporating the trend of the impact of coding differences on risk scores.

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

    Comments: CMS noted in the Medicaid Advantage Call Letter of April 2016 that it has extensively analyzed the MA data and determined that the optimal way to apply the adjustment is to do so using the statutory minimum adjustment level of 5.66 percent. However, as of October 2016, CMS had not provided any documentation of its analysis and the basis for its determination. CMS has requested a meeting with GAO to discuss the issues and GAO will meet with CMS. However, until we receive additional information about the actions CMS has taken, this recommendation remains open.