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    Subject Term: "Community health services"

    3 publications with a total of 6 open recommendations including 1 priority recommendation
    Director: Katherine Iritani
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To achieve a better understanding of the effect of certain Personal care services (PCS) services on beneficiaries and a more consistent administration of policies and procedures across PCS programs, the Acting Administrator of CMS should collect and analyze states' required information on the impact of the Participant-Directed Option and Community First Choice programs on the health and welfare of beneficiaries as well as the state quality measures for the Participant-Directed Option and Community First Choice programs.

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

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To achieve a better understanding of the effect of certain PCS services on beneficiaries and a more consistent administration of policies and procedures across PCS programs, the Acting Administrator of CMS should take steps to harmonize requirements, as appropriate, across PCS programs in a way that accounts for common risks faced by beneficiaries and to better ensure that billed services are provided.

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

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Trimble, David C
    Phone: (202)512-9338

    3 open recommendations
    including 1 priority recommendation
    Recommendation: 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.

    Agency: Environmental Protection Agency
    Status: Open
    Priority recommendation

    Comments: As of May 2017, EPA reported that it had not resumed its data verification audits due to budgetary constraints, but was continuing on-site file reviews to support efficient and effective state programs. EPA completed 5 file reviews in 2015, 7 in 2016, and was planning to complete 10 in 2017. According to EPA, budgetary constraints may affect its ability to reach this goal. According to the agency, EPA continues to focus on developing its Safe Drinking Water Information System (SDWIS) Prime database, which it claims will reduce state burden, support effective management and prioritization of resources, and will enhance data quality and support the possibility of building an electronic data verification protocol. EPA said it plans to have the system operational in 2018. In addition, EPA said that it continues to provide training sessions as well as identify best practices that file reviewers can use to enhance file review implementation. For 2017-2018, EPA plans to continue quarterly national training events. A July 2017 report by EPA's Office of the Inspector General concluded that limitations to EPA's oversight tools impede the agency's ability to conduct consistent oversight of the national drinking water program and reduce the reliability of its monitoring and reporting data. The Inspector General did not make any recommendations because it concluded the agency is taking steps to address the shortcomings. For example, according to the Inspector General's report, EPA released the Compliance Monitoring Data Portal in September 2016. EPA water officials said the portal will enable public water systems and laboratories to report drinking water data electronically to primacy agencies. Utah became the first state to use the portal in March 2017 and EPA staff anticipate that five additional states will begin using the portal by the end of 2017. EPA anticipates this system will lead to fewer reporting errors, improved data quality, and reduced time needed to report state data to EPA.
    Recommendation: 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 work with the states to establish a goal, or goals, for the completeness and accuracy of data on monitoring violations. In setting these goals, EPA may want to consider whether certain types of monitoring violations merit specific targets. For example, the agency may decide that a goal for the states to completely and accurately report when required monitoring was not done should differ from a goal for reporting when monitoring was done but not reported on time.

    Agency: Environmental Protection Agency
    Status: Open

    Comments: As of May 2017, EPA has not worked with states to establish a national goal for the quality of monitoring violations. EPA stated that, without the ability to conduct on-site data verifications using a statistically-based sample size, it is unable to derive a goal that would capture both completeness of state reporting to EPA and whether the states correctly assigned a violation for missed monitoring. EPA said that it intends to work with states to evaluate the establishment of a monitoring data quality goal once the new Safe Drinking Water Information System (SDWIS) NextGen data system has been developed and electronic data verification functions are incorporated into the system. In April 2015, EPA indicated that the agency intends to separate monitoring violations from reporting violations in the new SDWIS Primacy Agency (Prime) data system. According to EPA, this will enable the primacy agencies and EPA to better understand the nature of system violations and with the violations delineated in this manner, EPA will be able to consider developing goals for monitoring and reporting violations. As of May 2017, EPA is scheduled to have SDWIS Prime available for testing in September 2017 and available for state users at the end of March 2018. EPA will consider GAO's recommendation once SDWIS Prime is fully operational and it is able to better establish such a goal.
    Recommendation: 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 consider whether EPA's performance measures for community water systems could be constructed to more clearly communicate the aggregate public health risk posed by these systems' noncompliance with SDWA and progress in having those systems return to compliance in a timely manner.

    Agency: Environmental Protection Agency
    Status: Open

    Comments: In August 2017, EPA told GAO that it continues to use a variety of tools and resources to identify strategies that will enhance how the agency conveys to the public information on drinking water quality and potential health risks associated with exposure to contaminants. With regard to GAO's recommendation, EPA told us it had previously collaborated with the EPA Regional managers to identify language that would enhance the communication of aggregate public health risk to consumers in regards to community water system measures. EPA developed the "person month" measure because it describes the percentage of people served by community water system that receive drinking water that meets all health-based drinking water standards, accounting for the duration of violations that occurred. EPA piloted this measure in Fiscal Year 2007 as an indicator measure. In Fiscal Year 2008, the measure was elevated to a strategic plan measure with established targets. After receiving positive response regarding this measure, in Fiscal Year 2015, the agency developed a "person month" measure for tribal community water systems. According to the agency, EPA will continue to take comments on existing and future measures during its 5 year strategic plan reviews.
    Director: Dicken, John E
    Phone: (202)512-7043

    1 open recommendations
    Recommendation: To help states identify and address quality-of-care concerns among individuals with developmental disabilities receiving Medicaid HCBS waiver services, the Administrator of CMS should encourage states to (1) include death as a critical incident and conduct mortality reviews if they do not already do so and (2) broaden their mortality review processes if they already include death as a critical incident and conduct mortality reviews.

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

    Comments: In August 2009, CMS stated that it anticipated adding a question about mortality reviews to its next web-based version of the Home and Community-Based Services waiver application. CMS also indicated at that time that the next application version (i.e., Version 3.6) would be released in 2010. However, in July 2010, CMS indicated that this version would not be produced until 2011. In its 2011 update, CMS indicated that the version 3.6 online application had not yet been operationalized and therefore the recommendation should be left open until next year. In July 2013, CMS stated that version 3.6 remains on hold and that the agency is exploring other options for addressing this recommendation, with a target completion date of 12/31/2014.