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    Subject Term: Geography

    5 publications with a total of 19 open recommendations including 3 priority recommendations
    Director: Brian J. Lepore
    Phone: (202) 512-4523

    11 open recommendations
    Recommendation: To help determine the effectiveness of BRAC homeless assistance conveyances, the Secretaries of Housing and Urban Development and Defense should update the BRAC homeless assistance regulations to require that conveyance statuses be tracked. These regulatory updates could include requiring DOD to track and share disposal actions with HUD and requiring HUD to track the status following disposal, such as type of assistance received by providers and potential withdrawals by providers.

    Agency: Department of Defense
    Status: Open

    Comments: DOD partially concurred with the recommendation to update the BRAC homeless assistance regulations to require that conveyance statuses be tracked, which could include requiring DOD to track and share disposal actions with HUD and requiring HUD to track the status following disposal. In an April 2017 follow up, DOD stated that it plans to address our recommendations regarding the BRAC homeless assistance process when Congress provides BRAC authorizing legislation. DOD added that it will work closely with the military Departments and HUD staff in the process of revising the implementing regulation.
    Recommendation: To help determine the effectiveness of BRAC homeless assistance conveyances, the Secretaries of Housing and Urban Development and Defense should update the BRAC homeless assistance regulations to require that conveyance statuses be tracked. These regulatory updates could include requiring DOD to track and share disposal actions with HUD and requiring HUD to track the status following disposal, such as type of assistance received by providers and potential withdrawals by providers.

    Agency: Department of Housing and Urban Development
    Status: Open

    Comments: HUD generally concurred with the recommendation to update the BRAC homeless assistance regulations to require that conveyance statuses be tracked, which could include requiring DOD to track and share disposal actions with HUD and requiring HUD to track the status following disposal. HUD stated that it is willing to update the BRAC homeless assistance regulations to track the conveyances of property for homeless assistance, but noted that it will require DOD agreement to do so because the regulations are joint. In a March 2017 follow up, HUD stated it will address GAO recommendations regarding the BRAC homeless assistance process when Congress provides BRAC authorizing legislation. HUD added it would be premature to make any changes to current implementing policies or regulations which could be impacted by new BRAC authorizing legislation. HUD stated it will work closely with the military departments and DOD staff in the process of revising the implementing regulation.
    Recommendation: To assist homeless assistance providers and LRAs in completing the steps of the BRAC homeless assistance process within required time frames, to provide additional information to reduce unfulfilled expectations about the decisions made in executing the homeless assistance agreements, and to promote a greater dissemination of this information, the Secretaries of Housing and Urban Development and Defense, for each of the following four elements, should update the BRAC homeless assistance regulations; establish information-sharing mechanisms, such as a website or informational pamphlets; or develop templates to include specific guidance that clearly identifies the information that should be provided to homeless assistance providers during tours of on-base property, such as the condition of the property.

    Agency: Department of Defense
    Status: Open

    Comments: DOD partially concurred with the recommendation to update the BRAC homeless assistance regulations, establish information-sharing mechanisms, or develop templates to include specific guidance that clearly identifies the information that should be provided to homeless assistance providers during tours of on-base property, such as the condition of the property. DOD stated that while it already provides generic information about the property, the LRAs and interested homeless assistance providers can undertake facility assessments following the tours. However, DOD did not provide additional detail or explanation about how it would provide information about the condition of the property or access to it. In an April 2017 follow up, DOD stated that it plans to address our recommendations regarding the BRAC homeless assistance process when Congress provides BRAC authorizing legislation. DOD added that it will work closely with the military Departments and HUD staff in the process of revising the implementing regulation.
    Recommendation: To assist homeless assistance providers and LRAs in completing the steps of the BRAC homeless assistance process within required time frames, to provide additional information to reduce unfulfilled expectations about the decisions made in executing the homeless assistance agreements, and to promote a greater dissemination of this information, the Secretaries of Housing and Urban Development and Defense, for each of the following four elements, should update the BRAC homeless assistance regulations; establish information-sharing mechanisms, such as a website or informational pamphlets; or develop templates to include specific guidance that clearly identifies the information that should be provided to homeless assistance providers during tours of on-base property, such as the condition of the property.

    Agency: Department of Housing and Urban Development
    Status: Open

    Comments: HUD generally concurred with the recommendation to update the BRAC homeless assistance regulations, establish information-sharing mechanisms, or develop templates to include specific guidance that clearly identifies the information that should be provided to homeless assistance providers during tours of on-base property, such as the condition of the property. HUD stated that it will update its BRAC guidebook, website, and presentations to provide clarifying information for homeless assistance providers regarding what information should be included during tours of on-base property. HUD also noted in its response that this will require DOD and military department agreement to implement and that the provision of information about the condition of on-base property and access to that property is under the purview of the military department. In a March 2017 follow up, HUD stated it will address GAO recommendations regarding the BRAC homeless assistance process when Congress provides BRAC authorizing legislation. HUD added it would be premature to make any changes to current implementing policies or regulations which could be impacted by new BRAC authorizing legislation. HUD stated it will work closely with the military departments and DOD staff in the process of revising the implementing regulation.
    Recommendation: To assist homeless assistance providers and LRAs in completing the steps of the BRAC homeless assistance process within required time frames, to provide additional information to reduce unfulfilled expectations about the decisions made in executing the homeless assistance agreements, and to promote a greater dissemination of this information, the Secretaries of Housing and Urban Development and Defense, for each of the following four elements, should update the BRAC homeless assistance regulations; establish information-sharing mechanisms, such as a website or informational pamphlets; or develop templates to include information for homeless assistance providers to use for preparing their notices of interest.

    Agency: Department of Defense
    Status: Open

    Comments: DOD did not concur with the recommendation to update the BRAC homeless assistance regulations, establish information-sharing mechanisms, or develop templates to include information for homeless assistance providers to use in preparing their notices of interest. In its response, DOD stated that the existing regulatory guidance is adequate for providers' expressions of interest, given that these expressions evolve as the redevelopment planning effort proceeds and they learn more about the property. In an April 2017 follow up, DOD stated that it plans to address our recommendations regarding the BRAC homeless assistance process when Congress provides BRAC authorizing legislation. DOD added that it will work closely with the military Departments and HUD staff in the process of revising the implementing regulation.
    Recommendation: To assist homeless assistance providers and LRAs in completing the steps of the BRAC homeless assistance process within required time frames, to provide additional information to reduce unfulfilled expectations about the decisions made in executing the homeless assistance agreements, and to promote a greater dissemination of this information, the Secretaries of Housing and Urban Development and Defense, for each of the following four elements, should update the BRAC homeless assistance regulations; establish information-sharing mechanisms, such as a website or informational pamphlets; or develop templates to include information for homeless assistance providers to use for preparing their notices of interest.

    Agency: Department of Housing and Urban Development
    Status: Open

    Comments: HUD generally concurred with the recommendation to update the BRAC homeless assistance regulations, establish information-sharing mechanisms, or develop templates to include information for homeless assistance providers to use in preparing their notices of interest. HUD stated that it will update its BRAC guidebook, website, and presentations to provide clarifying information for homeless assistance providers to use in preparing their notices of interest. HUD also stated that it considered the current regulations and BRAC guidebook sufficient to inform providers as long as LRAs did not place additional requirements, which may create an undue burden for providers. In a March 2017 follow up, HUD stated it will address GAO recommendations regarding the BRAC homeless assistance process when Congress provides BRAC authorizing legislation. HUD added it would be premature to make any changes to current implementing policies or regulations which could be impacted by new BRAC authorizing legislation. HUD stated it will work closely with the military departments and DOD staff in the process of revising the implementing regulation.
    Recommendation: To assist homeless assistance providers and LRAs in completing the steps of the BRAC homeless assistance process within required time frames, to provide additional information to reduce unfulfilled expectations about the decisions made in executing the homeless assistance agreements, and to promote a greater dissemination of this information, the Secretaries of Housing and Urban Development and Defense, for each of the following four elements, should update the BRAC homeless assistance regulations; establish information-sharing mechanisms, such as a website or informational pamphlets; or develop templates to include guidance for legally binding agreements and clarification on the implications of unsigned agreements.

    Agency: Department of Defense
    Status: Open

    Comments: DOD partially concurred with the recommendation to update the BRAC homeless assistance regulations, establish information-sharing mechanisms, or develop templates to include guidance for legally binding agreements and clarification on the implications of unsigned agreements. DOD did not commit to taking any actions to provide this information and instead noted that any action should ensure that a legally binding agreement does not bind DOD to disposal actions it is unable to carry out. Nothing in the recommendation requires DOD to sign an agreement it cannot carry out. DOD further noted that the purpose of the legally binding agreement is to provide remedies and recourse for the LRA and provider in carrying out an accommodation following property disposal. In an April 2017 follow up, DOD stated that it plans to address our recommendations regarding the BRAC homeless assistance process when Congress provides BRAC authorizing legislation. DOD added that it will work closely with the military Departments and HUD staff in the process of revising the implementing regulation.
    Recommendation: To assist homeless assistance providers and LRAs in completing the steps of the BRAC homeless assistance process within required time frames, to provide additional information to reduce unfulfilled expectations about the decisions made in executing the homeless assistance agreements, and to promote a greater dissemination of this information, the Secretaries of Housing and Urban Development and Defense, for each of the following four elements, should update the BRAC homeless assistance regulations; establish information-sharing mechanisms, such as a website or informational pamphlets; or develop templates to include guidance for legally binding agreements and clarification on the implications of unsigned agreements.

    Agency: Department of Housing and Urban Development
    Status: Open

    Comments: HUD generally concurred with the recommendation to update the BRAC homeless assistance regulations, establish information-sharing mechanisms, or develop templates to include guidance for legally binding agreements and clarification on the implications of unsigned agreements. HUD stated that it will update its BRAC guidebook, website, and presentations to provide clarifying information for homeless assistance providers to use in preparing legally binding agreements and on the implications of unsigned agreements. In a March 2017 follow up, HUD stated it will address GAO recommendations regarding the BRAC homeless assistance process when Congress provides BRAC authorizing legislation. HUD added it would be premature to make any changes to current implementing policies or regulations which could be impacted by new BRAC authorizing legislation. HUD stated it will work closely with the military departments and DOD staff in the process of revising the implementing regulation.
    Recommendation: To assist homeless assistance providers and LRAs in completing the steps of the BRAC homeless assistance process within required time frames, to provide additional information to reduce unfulfilled expectations about the decisions made in executing the homeless assistance agreements, and to promote a greater dissemination of this information, the Secretaries of Housing and Urban Development and Defense, for each of the following four elements, should update the BRAC homeless assistance regulations; establish information-sharing mechanisms, such as a website or informational pamphlets; or develop templates to include specific information on legal alternatives to providing on-base property, including acceptable alternative options such as financial assistance or off-base property in lieu of on-base property, information about rules of sale for on-base property conveyed to homeless assistance providers, and under what circumstances it is permissible to sell property for affordable housing alongside the no-cost homeless assistance conveyance.

    Agency: Department of Defense
    Status: Open

    Comments: DOD did not concur with the recommendation to update the BRAC homeless assistance regulations, establish information-sharing mechanisms, or develop templates to include specific information on legal alternatives to providing on-base property, including acceptable alternative options such as financial assistance or off-base property in lieu of on-base property, information about rules of sale for on-base property conveyed to homeless assistance providers, and under what circumstances it is permissible to sell property for affordable housing alongside the no-cost homeless assistance conveyance. In its response, DOD stated that providers may only be considered through specific expressions of interest in surplus BRAC property, and these suggested alternatives may only be considered within the context of what is legally permissible given the specific circumstances at each installation. Further, DOD noted in its response that HUD may provide examples of alternatives to on-base property that have been approved to date as part of a local accommodation to offer examples for LRAs and providers. In an April 2017 follow up, DOD stated that it plans to address our recommendations regarding the BRAC homeless assistance process when Congress provides BRAC authorizing legislation. DOD added that it will work closely with the military Departments and HUD staff in the process of revising the implementing regulation.
    Recommendation: To assist homeless assistance providers and LRAs in completing the steps of the BRAC homeless assistance process within required time frames, to provide additional information to reduce unfulfilled expectations about the decisions made in executing the homeless assistance agreements, and to promote a greater dissemination of this information, the Secretaries of Housing and Urban Development and Defense, for each of the following four elements, should update the BRAC homeless assistance regulations; establish information-sharing mechanisms, such as a website or informational pamphlets; or develop templates to include specific information on legal alternatives to providing on-base property, including acceptable alternative options such as financial assistance or off-base property in lieu of on-base property, information about rules of sale for on-base property conveyed to homeless assistance providers, and under what circumstances it is permissible to sell property for affordable housing alongside the no-cost homeless assistance conveyance.

    Agency: Department of Housing and Urban Development
    Status: Open

    Comments: HUD generally concurred with the recommendation to update the BRAC homeless assistance regulations, establish information-sharing mechanisms, or develop templates to include specific information on legal alternatives to providing on-base property, including acceptable alternative options such as financial assistance or off-base property in lieu of on-base property, information about rules of sale for on-base property conveyed to homeless assistance providers, and under what circumstances it is permissible to sell property for affordable housing alongside the no-cost homeless assistance conveyance. HUD stated that it will update its BRAC guidebook, website, and presentations to clarify that the use of off-base property and financial assistance are acceptable alternate means of homeless assistance accommodation in base redevelopment plans and to include examples of alternatives to on-base property that have been approved to date. HUD also stated that this will require DOD and military department agreement to implement. In a March 2017 follow up, HUD stated it will address GAO recommendations regarding the BRAC homeless assistance process when Congress provides BRAC authorizing legislation. HUD added it would be premature to make any changes to current implementing policies or regulations which could be impacted by new BRAC authorizing legislation. HUD stated it will work closely with the military departments and DOD staff in the process of revising the implementing regulation.
    Recommendation: To help improve the timeliness of the HUD review process, the Secretary of Housing Urban Development should develop options to address the use of staff resources dedicated to the reviews of bases during a BRAC round, such as assigning temporary headquarters staff or utilizing current field HUD staff.

    Agency: Department of Housing and Urban Development
    Status: Open

    Comments: HUD generally concurred with the recommendation to develop options to address the use of staff resources dedicated to the reviews of bases during a BRAC round, such as assigning temporary headquarters staff or utilizing current field HUD staff. HUD stated that it temporarily assigned headquarters staff and utilized field office staff during the 2005 round of BRAC. HUD also stated that, in the event of another BRAC round the size of 2005, it would encourage Congress to allocate funding for appropriate temporary staff resources to assist the department in meeting important timelines. In a March 2017 follow up, HUD stated it will address GAO recommendations regarding the BRAC homeless assistance process when Congress provides BRAC authorizing legislation. HUD added it would be premature to make any changes to current implementing policies or regulations which could be impacted by new BRAC authorizing legislation. HUD stated it will work closely with the military departments and DOD staff in the process of revising the implementing regulation.
    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: Daniel Bertoni
    Phone: (202) 512-7215

    2 open recommendations
    Recommendation: To help improve the quality of VBA's disability compensation claim decisions, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to take steps to ensure that any future upgrades to local data systems allow QRTs to pause the claims process when errors are detected and enable QRTs to better track error trends.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of November 2017, VA had no further updates on this recommendation. VA previously reported that VBA had submitted business requirements to add new functionality in VA's electronic claims processing system, the Veterans Benefit Management System (VBMS), that would allow the agency to identify deficiencies during the claims process. If an error is detected, the claim would be paused to allow an in-process review (IPR), conducted by quality review teams, to occur. However, VA reported in August 2017 that these new business requirements would not be implemented due to limited VA Office of Information Technology (OIT) funding available for OIT updates in fiscal year 2018 and beyond. This recommendation will remain open until November 2018, in case circumstances or funding change.
    Recommendation: To help improve the quality of VBA's disability compensation claim decisions, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to take additional steps to evaluate the effectiveness of quality assurance activities to identify opportunities to improve or better target these activities.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of November 2017, VA reported that VBA's Compensation Service is beginning to gather and analyze quality assurance data to identify areas for improvements in VA processes, guidance, and training. This database, called Quality Management System (QMS), captures data from all types of quality reviews at various stages of the claims process, to include local regional office individual quality reviews, in-process reviews, national STAR reviews and consistency studies. According to VA, QMS has been functional since July 2017 and has captured over 130,000 quality reviews. VBA's Compensation Service is analyzing the first 90 days of data from QMS and once the data analysis is complete, it plans to implement the first set of changes or actions to improve accuracy. VA expects to implement these actions by January 2018. To close this recommendation, the agency will need to provide documentation of the comprehensive quality assurance data being captured, and how it is being used to either evaluate QA activities or make specific improvements with potential for improving accuracy.
    Director: Caldwell, Stephen L
    Phone: (202)512-9610

    1 open recommendations
    Recommendation: To better ensure consistent implementation of and accountability for DHS's resilience policy, the Secretary of Homeland Security should direct the Assistant Secretary for Policy to develop an implementation strategy for this new policy that identifies the following characteristics and others that may be deemed appropriate: (1) steps needed to achieve results, by developing priorities, milestones, and performance measures; (2) responsible entities, their roles compared with those of others, and mechanisms needed for successful coordination; and (3) sources and types of resources and investments associated with the strategy, and where those resources and investments should be targeted.

    Agency: Department of Homeland Security
    Status: Open

    Comments: In the 60-day letter provided in January 2013, DHS indicated that the Resilience Integration Team (RIT) was developing a draft implementation plan to be circulated among relevant stakeholders for review. On 10/30/13, we notified DHS that we would like to see a copy of the resilience policy implementation plan (if developed), or any other related documentation if the plan is still in development. We were informed later that day that a draft plan had been developed, and DHS needed to confirm its status. In May of 2015, we were told again that a draft plan had been developed but never finalized. As of August 2015, DHS's Policy Office is looking into the status of plan development. We await their response. DHS response still pending as of 10/4/16.
    Director: Cosgrove, James C
    Phone: (202)512-7029

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

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

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

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

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

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

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