Recommendation: The Assistant General Counsel should provide additional information on the process OACP uses to investigate potential consumer protection violations, to assess risk, and to pursue enforcement actions and establish a timeframe for doing so. Such transparency could be provided through the handbook that OACP is currently drafting or through other public means such as providing additional information on its website. (Recommendation 1)

Agency: Department of Transportation: Office of Aviation Consumer Protection
Status: Open

Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Recommendation: The Assistant General Counsel should take steps to provide transparency and clarity into the results of OACP's enforcement of consume including investigations that do not result in a consent order. Such information could be aggregated data about cases, investigations, or warning letters. (Recommendation 2)

Agency: Department of Transportation: Office of Aviation Consumer Protection
Status: Open

Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Recommendation: The Administrator of CMS should take steps to obtain quality information on the experiences of dual-eligible beneficiaries who have been default enrolled into D-SNPs, such as by obtaining information about the extent to which and reasons that beneficiaries disenroll from a D-SNP after being default enrolled. (Recommendation 1)

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: The Assistant Secretary of Labor for the Employee Benefits Security Administration should evaluate whether targeted oversight in response to information received is effective for ensuring compliance with MH/SU parity requirements. If this evaluation determines the current targeted oversight approach results in significant program risks, the Employee Benefits Security Administration should develop a plan to more effectively enforce MH/SU parity requirements and if necessary seek additional oversight authority, as warranted. (Recommendation 1)

Agency: Department of Labor: Employee Benefits Security Administration
Status: Open

Comments: DOL agreed with this recommendation. In February 2020, DOL reported that its Employee Benefits Security Administration plans to evaluate its targeted approach to MH/SU parity enforcement. When we confirm what actions DOL has taken in response to this recommendation, we will provide updated information.

Recommendation: The Administrator of CMS should evaluate whether targeted oversight in response to information received is effective for ensuring compliance with MH/SU parity requirements for non-federal governmental plans. If this evaluation determines the current targeted oversight approach results in significant program risks, CMS should develop a plan to more effectively enforce MH/SU parity requirements and if necessary seek additional oversight authority, as warranted. (Recommendation 2)

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

Comments: HHS agreed with this recommendation. In August 2020, HHS reported that CMS has developed a two-part evaluation to determine whether targeted oversight of non-federal governmental plans is effective for enforcing MH/SU parity requirements. According to HHS, this evaluation will include (1) a review of non-federal governmental plan documents for compliance with MH/SU parity requirements and (2) a survey of state enforcement authority and regulatory best practices for ensuring MH/SU parity compliance. As of August 2020, HHS reported that the first part of the CMS evaluation is underway.

Recommendation: The FHA Commissioner should take steps to improve the quality and accuracy of HECM termination data. These steps may include updating the termination reasons in the HERMIT system or updating the HERMIT User Guide to more clearly instruct servicers how to record termination reasons. (Recommendation 1)

Agency: Department of Housing and Urban Development: Federal Housing 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 FHA Commissioner should establish, periodically review, and report on performance indicators for the HECM program—such as the percentage of terminations due to borrower defaults, the proportion of active HECMs with delinquent property charges, the amount of servicer advances, and the percentage of distressed borrowers who have received foreclosure prevention options—and examine the impact of foreclosure prevention options in the forthcoming HECM program evaluation. (Recommendation 2)

Agency: Department of Housing and Urban Development: Federal Housing 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 FHA Commissioner should develop analytic tools, such as dashboards or watch lists, to better monitor outcomes for the HECM portfolio, such as reasons for HECM terminations, defaults, use of foreclosure prevention options, or advances paid by servicers on behalf of HECM borrowers. (Recommendation 3)

Agency: Department of Housing and Urban Development: Federal Housing 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 FHA Commissioner should evaluate FHA's foreclosure prioritization process for FHA-assigned loans. Such an analysis should include the implications that the process may have for HECM borrowers, neighborhoods, and FHA's insurance fund. (Recommendation 4)

Agency: Department of Housing and Urban Development: Federal Housing 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 FHA Commissioner should develop and implement procedures for conducting on-site reviews of HECM servicers, including a risk-rating system for prioritizing and determining the frequency of reviews. (Recommendation 5)

Agency: Department of Housing and Urban Development: Federal Housing Administration
Status: Open

Comments: As of February 2020, FHA had taken steps to implement this recommendation--including developing a HECM Servicing Review Guide and scheduling reviews of the three largest HECM servicers--but had not finalized a risk-rating system for prioritizing and determining the frequency of additional HECM servicing reviews. We will update the status of the recommendation when FHA provides documentation of a risk-rating system for prioritizing and determining the frequency of reviews and has completed the three reviews scheduled for fiscal year 2020.

Recommendation: The FHA Commissioner should work with CFPB to complete an agreement for sharing the results of CFPB examinations of HECM servicers with FHA. (Recommendation 6)

Agency: Department of Housing and Urban Development: Federal Housing 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 CFPB Director should work with FHA to complete an agreement for sharing the results of CFPB examinations of HECM servicers with FHA. (Recommendation 7)

Agency: Consumer Financial Protection Bureau
Status: Open

Comments: As of April 2020, CFPB has begun to take steps to complete an information sharing agreement to facilitate the process of sharing confidential information with FHA, including the results of HECM examinations. However, work on the agreement remains ongoing and CFPB noted it looks forward to finalizing the agreement as soon as practicable.

Recommendation: The FHA Commissioner should periodically analyze available internal and external consumer complaint data about reverse mortgages to help inform management and oversight of the HECM program. (Recommendation 9)

Agency: Department of Housing and Urban Development: Federal Housing Administration
Status: Open

Comments: As of March 2020, FHA had taken steps to implement this recommendation, including using a different system to collect and record consumer complaints about HECMs and generating monthly reports on the information for FHA senior management. We will update the status of the recommendation when FHA provides documentation showing that it also periodically analyzes external consumer complaint data on HECMs.

Recommendation: The Chief Operating Officer of the Office of Federal Student Aid should integrate the TEPSLF request into the PSLF application, for example, by including a checkbox on the PSLF application, to provide borrowers a more seamless way to request TEPSLF consideration. (Recommendation 1)

Agency: Department of Education: Office of Federal Student Aid
Status: Open

Comments: Education agreed with this recommendation. To make the TEPSLF loan forgiveness process easier for borrowers, Education stated that it will integrate the TEPSLF request into the PSLF application as part of the improvements planned for the PSLF application under its new online interface for student borrowers. On April 15, 2020, Education published a notice in the Federal Register, seeking comments on its plans to consolidate the forms that borrowers must complete if they want to request either PSLF or TEPSLF loan forgiveness, so that borrowers would only need to submit a single form to obtain public service loan forgiveness. In June 2020, Education reported that its consolidated form to request PSLF or TESPLF loan forgiveness is in the final stages of the Office of Management and Budget clearance process, and they expect it to be finalized by October 2021. This consolidated form should provide borrowers a more seamless way to request public service loan forgiveness for whichever program they are eligible for. We will update the status of this recommendation once this consolidated loan forgiveness form is in place and borrowers are able to use it.

Recommendation: The Chief Operating Officer of the Office of Federal Student Aid should provide certain borrowers, for example, those who are denied TEPSLF for not having 120 qualifying payments, with more information about options available to contest TEPSLF decisions on the TEPSLF website and in their denial letters. (Recommendation 2)

Agency: Department of Education: Office of Federal Student Aid
Status: Open

Comments: Education agreed with this recommendation. In March 2020, Education reported that it will add language to the TEPSLF website to provide borrowers with information on available options for contesting TEPSLF decisions. With respect to including this information in denial letters, Education noted that it is creating a new student loan infrastructure (Next Gen) and that it is not worth the time and resources to update the denial letters in the old system. However, Education reported that it will incorporate this information in denial letters created in the new Next Gen infrastructure, which is expected to be in place in October 2021. We will consider closing this recommendation when Education provides documentation that it has included information about options available to contest TEPSLF decisions on the TEPSLF website and in denial letters, as recommended.

Recommendation: The Chief Operating Officer of the Office of Federal Student Aid should include TEPSLF information in its PSLF Online Help Tool. (Recommendation 4)

Agency: Department of Education: Office of Federal Student Aid
Status: Open

Comments: Education agreed with this recommendation and stated that it will include TEPSLF information in the PSLF Help Tool. In March 2020, Education noted that it is creating a new student loan infrastructure (Next Gen) and that it is not worth the time and resources to update the PLSF Online Help tool with TEPSLF information under the old system. However, Education reported that it will respond to this recommendation when the new Next Gen infrastructure is in place, which is expected to be in place in October 2021. We will consider closing this recommendation when Education provides documentation that it has included TEPSLF information in its PSLF Online Help Tool.

Recommendation: The Director of CFPB should communicate to CRAs its expectations regarding reasonable procedures for assuring maximum possible accuracy of consumer report information. (Recommendation 1)

Agency: Consumer Financial Protection Bureau
Status: Open

Comments: In a January 2020 update, CFPB reemphasized statements made in its comment letter, including its expectation for CRAs to fully comply with applicable federal consumer financial laws and the role of case law in providing guidance to CRAs. CFPB additionally noted that its publicly available examination procedures discuss factors that CFPB will consider in evaluating compliance with the reasonableness standard under the Fair Credit Reporting Act (FCRA). CFPB stated that since publication of the report, it has taken actions to convey expectations to CRAs, including holding a joint workshop with FTC in December 2019 on consumer reporting accuracy and publishing a Supervisory Highlights special edition focused on consumer reporting. More direct communication of CFPB's expectations can provide CRAs with clearer information on what actions might constitute a FCRA violation and how CRAs should comply with the reasonableness standard. We maintain that providing additional information to CRAs about its expectations for key FCRA requirements could help CFPB to promote consistency and transparency in its supervisory approach and that the recommendation should be addressed.

Recommendation: The Director of CFPB should communicate to CRAs its expectations regarding reasonable investigations of consumer disputes. (Recommendation 2)

Agency: Consumer Financial Protection Bureau
Status: Open

Comments: In a January 2020 update, CFPB restated the requirements for a reasonable investigation under the Fair Credit Reporting Act (FCRA) and noted that court cases have articulated what qualifies as a reasonable investigation. CFPB also noted that a 2011 FTC report summarizes how the courts and FTC have interpreted these obligations, and that CFPB issued a bulletin on reasonable investigations in September 2013. CFPB stated that it has and will continue to communicate its expectations to CRAs regarding applicable provisions of FCRA. We maintain that providing additional information to CRAs about its expectations for key FCRA requirements could help CFPB to promote consistency and transparency in its supervisory approach and that the recommendation should be addressed.

Recommendation: CMS should evaluate state survey agency processes in all states to ensure all state survey agencies are meeting federal requirements that state survey agencies are responsible for investigating complaints and facility-reported incidents alleging abuse in nursing homes, and that the results of those investigations are being shared with CMS. (Recommendation 1)

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

Comments: HHS concurred with this recommendation. As of November 2019, HHS officials have not informed us of actions taken to complete implementation of this recommendation. We will update the status of this recommendation when we receive additional information.

Recommendation: CMS should identify options for capturing information from Oregon's APS investigations of complaints and facility-reported incidents of abuse and incorporate this information into oversight of Oregon nursing homes. (Recommendation 2)

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

Comments: HHS concurred with this recommendation. As of November 2019, HHS officials have not informed us of actions taken to complete implementation of this recommendation. We will update the status of this recommendation when we receive additional information.

Recommendation: The Director of CFPB should identify additional sources of information, such as through registering CRAs or leveraging state information, that would help ensure the agency is tracking all CRAs that meet the larger participant threshold. (Recommendation 1)

Agency: Consumer Financial Protection Bureau
Status: Open

Comments: In July 2020, CFPB staff noted that they have reviewed state CRA registration information available to them, are working to obtain additional state registration information, and are exploring additional ways to leverage the information. GAO will continue to monitor CFPB's progress in leveraging additional sources of information that would help identify larger participant CRAs.

Recommendation: The Director of CFPB should assess whether its process for prioritizing CRA examinations sufficiently incorporates the data security risks CRAs pose to consumers, and take any needed steps identified by the assessment to more sufficiently incorporate these risks. (Recommendation 2)

Agency: Consumer Financial Protection Bureau
Status: Open

Comments: In July 2020, CFPB staff noted that they were assessing whether, and if so, how and when, to incorporate data security risks into their supervisory prioritization. As part of that evaluation, CFPB is assessing whether those processes should incorporate data security risks CRAs pose to consumers in light of the agency's statutory authorities, supervisory responsibilities, and resources. GAO will continue monitoring CFPB's assessment of prioritization of CRA data security risks.

Recommendation: Congress should consider providing the Federal Trade Commission with civil penalty authority for the privacy and safeguarding provisions of the Gramm-Leach-Bliley Act to help ensure that the agency has the tools it needs to most effectively act against data privacy and security violations. (Matter for Consideration 1)

Agency: Congress
Status: Open

Comments: As of July 2020, Congress has not passed legislation to provide FTC with civil penalty authority for the privacy and safeguarding provisions of the Gramm-Leach-Bliley Act.

Recommendation: The Director of CFPB should implement a systematic process for prioritizing risks to consumers and considering how to use the bureau's available policy tools—such as rulemaking, supervision, enforcement, and consumer education—to address these risks. Such a process could incorporate principles from the prior One Bureau process, such as an assessment of the extent of potential harm to consumers in financial markets, to prioritize the most significant risks. (Recommendation 1)

Agency: Consumer Financial Protection Bureau
Status: Open

Comments: In October 2019, CFPB staff told us that the CFPB Director approved a proposal to implement a short-term policy prioritization exercise. According to a memorandum describing this exercise, CFPB anticipates that it will involve CFPB's Strategy Office engaging members of cross-bureau working groups to review and update priorities related to addressing risks to consumers. According to CFPB staff, the working groups will need up to a few months to complete this work, and the results should be available in the second quarter of 2020. To fully address this recommendation, CFPB needs to make further progress in implementing this planned prioritization exercise, including by demonstrating steps taken to prioritize risks to consumers and considering how to use CFPB's various policy tools to address these risks.

Recommendation: The Office of the Secretary should assess the feasibility and cost of updating its airline case management system to address data and reporting limitations, and to undertake those updates that are cost effective and feasible. (Recommendation 2)

Agency: Department of Transportation
Status: Open

Comments: DOT concurred with this recommendation and said it would take steps to update its case management tracking system. As of June, 2020, DOT has not provided an update regarding the status of its efforts to implement this recommendation. DOT indicated the agency would provide a response in the coming months, citing delays with workloads due to COVID-19. Once DOT provides a response to this recommendation, we will provide updated information.

Recommendation: The Office of the Secretary should establish performance measures for each of its objectives for its five key airline-compliance activities. (Recommendation 3)

Agency: Department of Transportation
Status: Open

Comments: DOT concurred with this recommendation and said it would take steps to establish appropriate performance measures. As of June, 2020, DOT has not provided an update regarding the status of its efforts to implement this recommendation. DOT indicated the agency would provide a response in the coming months, citing delays with workloads due to COVID-19. Once DOT provides a response to this recommendation, we will provide updated information.

Recommendation: The Office of the Secretary should capture feedback directly from airline passengers or identify other mechanisms to capture passengers' perspectives to inform DOT's education efforts. (Recommendation 4)

Agency: Department of Transportation
Status: Open

Comments: DOT concurred with this recommendation and said it would take steps to capture feedback directly from consumers. As of June, 2020, DOT has not provided an update regarding the status of its efforts to implement this recommendation. DOT indicated the agency would provide a response in the coming months, citing delays with workloads due to COVID-19. Once DOT provides a response to this recommendation, we will provide updated information.

Recommendation: The Office of the Secretary should develop performance measures for DOT's efforts to educate airline passengers. (Recommendation 6)

Agency: Department of Transportation
Status: Open

Comments: DOT concurred with this recommendation and said it would take steps to develop appropriate performance measures for DOT's efforts to educate airline passengers. As of June, 2020, DOT has not provided an update regarding the status of its efforts to implement this recommendation. DOT indicated the agency would provide a response in the coming months, citing delays with workloads due to COVID-19. Once DOT provides a response to this recommendation, we will provide updated information.

Recommendation: The Chief Operating Officer of the Office of Federal Student Aid should develop a timeline for issuing a comprehensive guidance and instructions document for PSLF servicing. This could involve developing a new servicing manual or expanding upon the PSLF servicer's existing processing handbook. (Recommendation 1)

Agency: Department of Education: Office of Federal Student Aid
Status: Open

Comments: Education agreed with this recommendation and reported in September 2019 that it was continuing its efforts to improve and streamline guidance for the PSLF servicer. While Education said it is working on developing its comprehensive PSLF servicing manual, it does not yet have a timeline for how it will complete this manual and has indicated that it intends to deliver completed chapters on an iterative basis based on servicing priorities. To implement this recommendation, Education needs to develop a timeline for completing the PSLF servicing manual and demonstrate that it will provide comprehensive guidance and instructions for PSLF servicing.

Recommendation: The Chief Operating Officer of the Office of Federal Student Aid should provide additional information to the PSLF servicer and borrowers to enhance their ability to determine which employers qualify for PSLF. This could involve Education developing an authoritative list of qualifying employers or improving the PSLF servicer's existing database, and making this information available to borrowers. (Recommendation 2)

Agency: Department of Education: Office of Federal Student Aid
Status: Open
Priority recommendation

Comments: Education agreed with this recommendation, and in December 2018, the agency released a new online tool to help borrowers better understand the PSLF eligibility requirements. Education has indicated that this tool could eventually be expanded to incorporate additional qualifying employer information. Education has also indicated that implementation of the recommendation is tied to the rollout of a new loan servicing system, which it expects to be fully operational in October 2021. To implement this recommendation, Education needs to demonstrate that it is providing information that will help the PSLF servicer and borrowers determine whether employment with specific employers will qualify borrowers for the program.

Recommendation: The Chief Operating Officer of the Office of Federal Student Aid should ensure that borrowers receive sufficiently detailed information from the PSLF servicer to be able to identify any errors in the servicer's counts of qualifying payments, including information on whether or not each payment qualified toward forgiveness. (Recommendation 4)

Agency: Department of Education: Office of Federal Student Aid
Status: Open

Comments: Education agreed with this recommendation, and in June 2020, reported that it is reviewing communications from the PSLF servicer to ensure that borrowers receive sufficiently detailed information regarding payment counts and payment history. Education also indicated that implementation of the recommendation is tied to the rollout of a new loan servicing system, which it expects to be fully operational in October 2021. We will close the recommendation once Education provides documentation of the changes in communications from the PSLF servicer that demonstrate borrowers are receiving sufficiently detailed information regarding payment counts and payment history.

Recommendation: The VHA Undersecretary for Health should provide updated guidance to VAMCs on the governance of the patient advocacy program, including clear definitions of reporting lines. (Recommendation 1)

Agency: Department of Veterans Affairs: Veterans Health Administration
Status: Open

Comments: VHA concurred with this recommendation and has provided regular updates on its progress in implementing it. As of April 2019, VHA's Office of Patient Advocacy (OPA) partnered with VA's Center for Healthcare Organization and Implementation Research (CHOIR) to better understand the current state of patient advocacy services in VHA, focusing on position descriptions, grade levels, and reporting structures. VA medical center staff completed questionnaires about the patient advocacy program in January 2019 and VHA analyzed the results. CHOIR officials are conducting site visits to interview key staff directly to identify the benefits and opportunities for improvements with patient advocacy services, including reporting structure. Upon completion of site visits to validate questionnaire findings, CHOIR will present their final recommendations to OPA. OPA will develop reporting structure guidance and work with workforce management and VHA senior leaders to communicate and implement the guidance. VHA's target completion for these efforts is December 2019.

Recommendation: The VHA Undersecretary for Health should assess and provide guidance to VAMCs on appropriately staffing the patient advocacy program, including guidance on how to determine the appropriate number and type of staff. (Recommendation 2)

Agency: Department of Veterans Affairs: Veterans Health Administration
Status: Open

Comments: VHA concurred with this recommendation and has provided regular updates on its progress in implementing it. As of April 2019, VHA's Office of Patient Advocacy (OPA) partnered with VA's Center for Healthcare Organization and Implementation Research (CHOIR) and VHA's Workforce Management to develop an evidence-based patient advocacy staffing model that accounts for facility size, complexity and geographic region. A set of questions was distributed to all VAMCs in December 2018. Responses to these questions have been analyzed by CHOIR, and on-site interviews at select facilities are in progress to validate the report findings. VHA's Workforce Management is working with CHOIR and OPA to use the results to develop a recommended and validated staffing model. This guidance will also be incorporated in the future revision of the VHA directive. The target completion of these efforts is December 2019.

Recommendation: The VHA Undersecretary for Health should monitor PATS data-entry practices to ensure all complaints are entered into PATS and that veterans' feedback is coded consistently. (Recommendation 5)

Agency: Department of Veterans Affairs: Veterans Health Administration
Status: Open

Comments: VHA concurred with this recommendation and has provided regular updates on its progress in implementing it. As of April 2019, VHA's Office of Patient Advocacy (OPA) receives a weekly report from both the Patient Advocate Tracking System (PATS) and PATS-Replacement (PATS-R) Systems reporting on the number of new cases entered at every VA medical center (VAMC). With development of the PATS-R web-based tool, OPA, the Veterans Experience Office and the PATS-R developers have conducted a review of existing codes and are currently working with various VHA program offices to standardize codes across various data systems. VA plans to develop an auditing toolkit to ensure standardized, timely documentation of complaints, including accurate coding within PATS. The target completion date for these efforts is December 2019.

Recommendation: To improve its oversight of network adequacy in MA, the Administrator of CMS should augment MA network adequacy criteria to address provider availability.

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

Comments: HHS concurred with this recommendation, and noted in a February 2018 update that CMS requires MAOs to identify provider availability in certain circumstances, such as in granting exceptions to the agency's network adequacy criteria. CMS also stated that it would consider augmenting MA network adequacy criteria to address provider availability in future years. However, CMS's 2018 MA network adequacy guidance stated that the agency does not currently consider provider availability when reviewing an organization's network adequacy, and this guidance was not updated in 2019. As a result, as of September 2019, agency officials have not implemented this recommendation.

Recommendation: To improve its oversight of network adequacy in MA, the Administrator of CMS should verify provider information submitted by MAOs to ensure validity of the Health Services Delivery data.

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

Comments: HHS concurred with this recommendation, and noted in a February 2018 update that the agency has standardized existing protocols to ensure the validity of the Health Services Delivery data submitted by MAOs with regards to exceptions requests and partial county justifications. However, CMS's 2018 MA network adequacy guidance stated that MAOs remain responsible for conducting validation of Health Services Delivery data. Unless CMS verifies provider information submitted by MAOs, the agency cannot be confident that MAOs are meeting network adequacy criteria. As of September 2019, agency officials have not implemented this recommendation.

Recommendation: To improve its oversight of network adequacy in MA, the Administrator of CMS should set minimum requirements for MAO letters notifying enrollees of provider terminations and require MAOs to submit sample letters to CMS for review.

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

Comments: HHS concurred with this recommendation. In a September 2017 update, the agency stated that it had met the spirit of our recommendation by adding its best practice suggestions of what should be included in the written termination notice to the Medicare Managed Care Manual. However, as we noted in our report, those practices are not required, nor are the letters regularly reviewed. As of September 2019, agency officials have not yet implemented this recommendation.