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As of May 16, 2024, there are 5143 open recommendations that still need to be addressed. 413 of these are priority recommendations, those that we believe warrant priority attention. Learn more about our priority designation on our Recommendations page.

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401 - 413 of 413 Recommendations

Climate Change: Future Federal Adaptation Efforts Could Better Support Local Infrastructure Decision Makers

GAO-13-242
David Trimble
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1 Open Recommendations
1 Priority
Agency Recommendation Status
U.S. Global Change Research Program
Priority Rec.
To improve the resilience of the nation's infrastructure to climate change, the Executive Director of the United States Global Change Research Program or other federal entity designated by the Executive Office of the President should work with relevant agencies to clarify sources of local assistance for incorporating climate-related information and analysis into infrastructure planning, and communicate how such assistance will be provided over time.
Open – Partially Addressed

In January 2023, officials from the Office of Science and Technology Policy (OSTP) noted that regional science organizations, such as the National Oceanic and Atmospheric Administration's Climate Action Partnerships, work to provide climate information to regional and local agencies. These officials also said that the United States Global Change Research Program (USGCRP) continues work on the development of the Climate Resilience Information System (CRIS), which will allow for more efficient development of regionally- and locally-tailored resources. They further stated that the evolving

End-Stage Renal Disease: CMS Should Improve Design and Strengthen Monitoring of Low-Volume Adjustment

GAO-13-287
James Cosgrove
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Centers for Medicare & Medicaid Services
Priority Rec.
To reduce the incentive for facilities to restrict their service provision to avoid reaching the LVPA treatment threshold, the Administrator of CMS should consider revisions such as changing the LVPA to a tiered adjustment.
Open – Partially Addressed

CMS concurred with this recommendation and has taken some steps to implement it. For example, CMS obtained input on the LVPA from sources such as Technical Expert Panels that the agency convened as well as responses to a Request for Information as part of the CY 2022 rulemaking process. CMS stated that the agency planned to use this input to inform potential proposals for refining the LVPA through the rulemaking process. CMS also stated that, as of February 2024, the agency's plan was to issue a proposed and final rule in CY 2024 to revise the LVPA. Once CMS has issued the final rule to revise

Export Promotion: Small Business Administration Needs to Improve Collaboration to Implement Its Expanded Role

GAO-13-217
Loren Yager
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Small Business Administration
Priority Rec.
To more effectively implement SBA's expansion of OIT field staff as required by the SBJA, the Administrator of the SBA should update SBA's plan for additional OIT staff to include funding sources and time frames, as well as possible efficiencies from clearly defining roles and responsibilities and leveraging other entities' export assistance resources.
Open

SBA agreed with this recommendation. In December 2023, SBA officials said the Office of International Trade had filled 23 of the 30 Export Finance Manager positions required under the Small Business Jobs Act of 2010. According to SBA officials, its current staffing level adequately fills the export finance needs of small businesses due to SBA's use of technology to provide training and counseling to more exporters in the past 2 years and consolidation of the industry. In March 2024 SBA submitted a legislative proposal to Congress to reduce the Act's requirement of 30 export finance specialists

VA Health Care: Reliability of Reported Outpatient Medical Appointment Wait Times and Scheduling Oversight Need Improvement

GAO-13-130
Debra A. Draper
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Veterans Affairs
Priority Rec.
To ensure reliable measurement of veterans' wait times for medical appointments, the Secretary of VA should direct the Under Secretary for Health to take actions to improve the reliability of wait time measures either by clarifying the scheduling policy to better define the desired date, or by identifying clearer wait time measures that are not subject to interpretation and prone to scheduler error.
Open – Partially Addressed

VA agreed with our recommendation. Since 2013, VA has taken actions intended to address the reliability of appointment wait times through improvements in appointment scheduling, including issuing a revised scheduling policy, providing and documenting scheduler training, and improving oversight through scheduler audits. While the revised scheduling policy and subsequent guidance changed the terminology of wait-time measures, they did not substantively clarify or define the wait time measurement. In February 2024, VA provided evidence to GAO that the department established "Third Next Available

Federal Disaster Assistance: Improved Criteria Needed to Assess a Jurisdiction's Capability to Respond and Recover on Its Own

GAO-12-838
William O. Jenkins, Jr.
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Federal Emergency Management Agency
Priority Rec.
To increase the efficiency and effectiveness of the process for disaster declarations, the FEMA Administrator should develop and implement a methodology that provides a more comprehensive assessment of a jurisdiction's capability to respond to and recover from a disaster without federal assistance. This should include one or more measures of a jurisdiction's fiscal capacity, such as TTR, and consideration of the jurisdiction's response and recovery capabilities. If FEMA continues to use the PA per capita indicator to assist in identifying a jurisdiction's capabilities to respond to and recover from a disaster, it should adjust the indicator to accurately reflect the annual changes in the U.S. economy since 1986, when the current indicator was first adopted for use. In addition, implementing the adjustment by raising the indicator in steps over several years would give jurisdictions more time to plan for and adjust to the change.
Open – Partially Addressed

FEMA has taken actions to update its methodology to provide a more comprehensive assessment of a jurisdiction's capability to respond to and recover from a disaster without federal assistance . In particular, FEMA has taken steps to update the factors considered when evaluating a request for a major disaster declaration for Public Assistance, specifically the estimated cost of assistance (i.e. the per capita indicator), via the federal rulemaking process three times--in 2016, 2017, and 2020. However, as of February 2024, the agency has not issued a final rule updating the estimated cost of

2012 Annual Report: Opportunities to Reduce Duplication, Overlap and Fragmentation, Achieve Savings, and Enhance Revenue

GAO-12-342SP
Janet St. Laurent, Zina Merritt
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Office of Management and Budget
Priority Rec.
To improve performance through greater coordination among the many federal programs that support employment for people with disabilities, the Office of Management and Budget (OMB) should consider establishing measurable, government-wide goals for employment of people with disabilities. Given the number of federal agencies and approaches involved in supporting employment for people with disabilities, government-wide goals could help spur greater coordination and more efficient and economical service delivery in overlapping program areas. To determine whether these goals are being met, agencies should establish related measures and indicators and collect additional data to inform these measures.
Open

OMB neither agreed nor disagreed with this recommendation, but reported in March 2024 that it does not plan to establish government-wide goals for the employment of people with disabilities. OMB cited the difficulty of setting goals for more than 40 programs with different designs and target populations. Instead, to enhance federal coordination, OMB staff previously noted that the Department of Labor's (DOL) Office of Disability Employment Policy led an interagency subcommittee on employment of people with disabilities. However, in April 2024, OMB officials said that the subcommittee had

Medicare Advantage: CMS Should Improve the Accuracy of Risk Score Adjustments for Diagnostic Coding Practices

GAO-12-51
James Cosgrove
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Centers for Medicare & Medicaid Services
Priority Rec.
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.
Open – Partially Addressed

CMS indicated in March 2021 that, given the complexity of measuring coding changes attributable to plan behavior and the difficulty of measuring countervailing factors, there is not a single correct factor within the viable range of adjustment factors. In addition, the agency noted that there is policy discretion with respect to the appropriate adjustment factor for the payment year. CMS applied the statutory minimum adjustment of 5.90 for calendar year 2023. As of February 2024, CMS had not provided any documentation of its analysis and the basis for its determination. Although the

Preventing Sexual Harassment: DOD Needs Greater Leadership Commitment and an Oversight Framework

GAO-11-809
Brenda S. Farrell
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Defense
Priority Rec.
To enhance oversight of the department's program to help prevent and to address incidents of sexual harassment involving servicemembers, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to ensure that the Office of Diversity Management and Equal Opportunity develops and aggressively implements an oversight framework to help guide the department's efforts. At a minimum, such a framework should contain long-term goals, objectives, and milestones; strategies to accomplish goals; criteria for measuring progress; and results-oriented performance measures to assess the effectiveness of the department's sexual harassment policies and programs. Such a framework should also identify and include a plan for ensuring that adequate resources are available to carry out the office's oversight responsibilities.
Open

DOD concurred with our recommendation and stated that as part of its revised guidance it proposed to strengthen and institutionalize the responsibilities and authorities needed for successful implementation of the department's sexual harassment policies. In February 2018, DOD took action toward addressing this recommendation and issued an update to DOD Instruction 1020.03, Harassment Prevention and Response in the Armed Forces, that directs DOD's Office of Diversity, Equity, and Inclusion to ensure that DOD components' harassment prevention and response programs incorporate , at a minimum, (1)

Drinking Water: Unreliable State Data Limit EPA's Ability to Target Enforcement Priorities and Communicate Water Systems' Performance

GAO-11-381
David Trimble
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Environmental Protection Agency
Priority Rec.
To improve EPA's ability to oversee the states' implementation of the Safe Drinking Water Act and provide Congress and the public with more complete and accurate information on compliance, the Administrator of EPA should resume data verification audits to routinely evaluate the quality of selected drinking water data on health-based and monitoring violations that the states provide to EPA. These audits should also evaluate the quality of data on the enforcement actions that states and other primacy agencies have taken to correct violations.
Open

EPA partially agreed with our recommendation. As of March 2023, EPA indicated that it continues to work on modernizing its Safe Drinking Water Information System (SDWIS) and expects to start transitioning states to the system by the end of 2024. In addition, EPA plans to engage with states as it develops data quality goals for monitoring violations and other information. However, our recommendation was that EPA should resume data verification audits. In March 2022, EPA told us it was not planning to resume the audits due to budgetary constraints. Instead, EPA said it was taking other actions

2010 Census: Key Efforts to Include Hard-to-Count Populations Went Generally as Planned; Improvements Could Make the Efforts More Effective for Next Census

GAO-11-45
Robert N. Goldenkoff
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Commerce
Priority Rec.
To help improve the effectiveness of the Bureau's outreach and enumeration efforts, especially for HTC populations, should they be used again in the 2020 Census, and to improve some of the Bureau's key efforts to enumerate HTC populations, the Secretary of Commerce should require the Under Secretary for Economic Affairs as well as the Director of the U.S. Census Bureau to evaluate the extent to which each special enumeration activity improved the count of traditionally hard-to-enumerate groups and use the results to help inform decision making on spending for these programs in 2020.
Open

The Department generally agreed with this recommendation. In 2012, the Bureau reported on assessments of many 2010 special enumeration activities such as the Service-Based Enumeration and the Be Counted/Questionnaire Assistance Center Programs. These assessments revealed the number of persons counted and spending for the special enumeration activities. Separately, the Bureau issued results of the 2010 Census Coverage Measurement Program that described census coverage of various traditionally undercounted populations generally, although these did not attribute coverage to specific enumeration

Government Performance and Accountability: Tax Expenditures Represent a Substantial Federal Commitment and Need to Be Reexamined

GAO-05-690
James (Jay) R. McTigue, Jr
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2 Open Recommendations
2 Priority
Agency Recommendation Status
Department of the Treasury
Priority Rec.
To ensure that policymakers and the public have the necessary information to make informed decisions and to improve the progress toward exercising greater scrutiny of tax expenditures, the Director of OMB, in consultation with the Secretary of the Treasury, should develop and implement a framework for conducting performance reviews of tax expenditures. In developing the framework, the Director should (1) determine which agencies will have leadership responsibilities to review tax expenditures, how reviews will be coordinated among agencies with related responsibilities, and how to address the lack of credible performance information on tax expenditures; (2) set a schedule for conducting tax expenditure evaluations; (3) re-establish appropriate methods to test the overall evaluation framework and make improvements as experience is gained; and (4) to identify any additional resources that may be needed for tax expenditure reviews.
Open

Treasury did not submit comments on this report and deferred to OMB. OMB agreed that this recommendation had promise and also said that tax expenditure evaluations were the responsibility of Treasury, which had access to the necessary data. As of March 2024, the Director of OMB had not taken action to develop a framework for reviewing tax expenditure performance, as GAO recommended in June 1994 and again in September 2005. Since their initial efforts in 1997 and 1999 to outline a framework for evaluating tax expenditures and preliminary performance measures, OMB and the Department of the
Office of Management and Budget
Priority Rec.
To ensure that policymakers and the public have the necessary information to make informed decisions and to improve the progress toward exercising greater scrutiny of tax expenditures, the Director of OMB, in consultation with the Secretary of the Treasury, should develop and implement a framework for conducting performance reviews of tax expenditures. In developing the framework, the Director should (1) determine which agencies will have leadership responsibilities to review tax expenditures, how reviews will be coordinated among agencies with related responsibilities, and how to address the lack of credible performance information on tax expenditures; (2) set a schedule for conducting tax expenditure evaluations; (3) re-establish appropriate methods to test the overall evaluation framework and make improvements as experience is gained; and (4) to identify any additional resources that may be needed for tax expenditure reviews.
Open

As of March 2024, the Director of OMB had not taken action to develop a framework for reviewing tax expenditure performance, as GAO recommended in June 1994 and again in September 2005. Since their initial efforts in 1997 and 1999 to outline a framework for evaluating tax expenditures and preliminary performance measures, OMB and the Department of the Treasury have ceased to make progress and retreated from setting a schedule for evaluating tax expenditures. The President's fiscal year 2012 budget stated that developing an evaluation framework is a significant challenge due to limited data

Medicaid and SCHIP: Recent HHS Approvals of Demonstration Waiver Projects Raise Concerns

GAO-02-817
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1 Open Recommendations
1 Priority
Agency Recommendation Status
Department of Health and Human Services
Priority Rec.
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.
Open – Partially Addressed

As of February 2024, the Department of Health and Human Services (HHS) had taken some action to address GAO's 2002 recommendation. In August 2018, HHS issued written guidance through a State Medicaid Directors Letter documenting four key changes it made in 2016 to its budget neutrality policy. These changes addressed some, but not all of the questionable methods GAO identified in its reports. To fully address this recommendation, HHS should also address these other questionable methods, such as setting demonstration spending limits based on hypothetical costs--what the state could have paid-
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