Recommendation: The Secretary of the U.S. Department of Agriculture should direct the Agricultural Marketing Service to conduct an evaluation of the Farmers to Families Food Box Program after the third round of the program. (Recommendation 1)

Agency: Department of Agriculture
Status: Open

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

Recommendation: The Commissioner of the FDA should ensure that PAC renews its charter. (Recommendation 1)

Agency: Department of Health and Human Services: Food and Drug Administration
Status: Open

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

Recommendation: The Commissioner of Internal Revenue should require ETAAC and IRSAC to make decisions on proposed recommendations to IRS during open meetings. (Recommendation 2)

Agency: Department of the Treasury: Internal Revenue Service
Status: Open

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

Recommendation: The Commissioner of Internal Revenue should require ETAAC and IRSAC to compile meeting minutes and make them publicly available. (Recommendation 3)

Agency: Department of the Treasury: Internal Revenue Service
Status: Open

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

Recommendation: The Director of the Census Bureau should require CSAC to compile meeting minutes and make them publicly available. (Recommendation 4)

Agency: Department of Commerce: Bureau of the Census
Status: Open

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

Recommendation: The Secretary of the Treasury should require FACA committees under Treasury's purview to provide access to meeting agendas and supporting documents on the committees' websites. (Recommendation 5)

Agency: Department of the Treasury
Status: Open

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

Recommendation: The Director of NIH should establish and implement a policy requiring all FACA committees under NIH's jurisdiction to post meeting minutes online. (Recommendation 6)

Agency: Department of Health and Human Services: Public Health Service: National Institutes of Health
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 GSA should encourage FACA committees to make information on agencies' responses to and implementation of specific recommendations publicly available online, unless exempted from public disclosure under the Freedom of Information Act. (Recommendation 7)

Agency: General Services 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 Administrator of GSA should require agencies to develop and implement written policies or procedures to identify, calculate, and fully document FACA committee costs, and ensure agency staff enter accurate and complete cost data into the FACA database. (Recommendation 8)

Agency: General Services 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 Administrator of GSA should direct the Committee Management Secretariat to require FACA committees to specify the exact date when they last updated cost data in the FACA database. This could be completed in a field in the database under the "Committee Cost" section or in another relevant data field. (Recommendation 9)

Agency: General Services Administration
Status: Open

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

Recommendation: Congress should consider amending FACA to require agencies and advisory committees to make available online documents FACA already requires to be made available for public inspection and copying. (Matter for Consideration 1)

Agency: Congress
Status: Open

Comments: When we determine what steps the Congress has taken, we will provide updated information.

Recommendation: The Commandant of the Coast Guard should ensure that the Deputy Commandant for Mission Support assesses and addresses the causes of data errors and inconsistent entries in MISLE as identified by program offices and MISLE users, including reviewing MISLE training and data validation processes. (Recommendation 1)

Agency: Department of Homeland Security: United States Coast Guard
Status: Open

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

Recommendation: The Commandant of the Coast Guard should ensure that the Deputy Commandant for Mission Support uses the results of its 2019 Standardization Team assessment of command centers to develop a plan for improving the consistency and accuracy of MISLE data identified in its report. (Recommendation 2)

Agency: Department of Homeland Security: United States Coast Guard
Status: Open

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

Recommendation: The Commandant of the Coast Guard should ensure that the Deputy Commandant for Mission Support and the Deputy Commandant for Operations use the processes outlined in the SELC to identify needed enhancements across the MISLE system by developing an updated mission needs statement. (Recommendation 3)

Agency: Department of Homeland Security: United States Coast Guard
Status: Open

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

Recommendation: The Commandant of the Coast Guard should ensure that the Deputy Commandant for Mission Support and the Deputy Commandant for Operations use the processes outlined in the SELC to identify and analyze alternatives, and objectively select the preferred solution for MISLE to meet approved mission needs. (Recommendation 4)

Agency: Department of Homeland Security: United States Coast Guard
Status: Open

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

Recommendation: GSA should assess and address the reliability of the information used to calculate reported cost savings for the broker program. (Recommendation 1)

Agency: General Services Administration
Status: Open
Priority recommendation

Comments: In June 2020, GSA said the agency would validate system data through regional and broker outreach and fully utilize validated system data to manage the broker program. The agency also said it will develop a quality control plan and follow-up on outcomes. We will continue to monitor GSA's progress with implementing this recommendation.

Recommendation: GSA should develop outcome-based metrics to evaluate the effectiveness of using brokers to supplement the GSA's leasing workforce. (Recommendation 2)

Agency: General Services Administration
Status: Open

Comments: Although GSA initially did not concur with this recommendation, the agency stated in June 2020 that it agrees with the recommendation and will take steps to implement it. Specifically, GSA plans to revise the broker performance standards and document broker effectiveness through lease cost avoidance, timely lease replacement, and earned commission credits. We will continue to monitor GSA's progress with implementing this recommendation.

Recommendation: The Secretary of Defense should ensure the Under Secretary of Defense for Acquisition and Sustainment, in consultation with the F-35 Program Executive Officer, develops a program-wide process for measuring, collecting, and tracking information on how ALIS is affecting the performance of the F-35 fleet to include, but not be limited to, its effects on mission capability rates. (Recommendation 1)

Agency: Department of Defense: Office of the Secretary of Defense
Status: Open

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

Recommendation: The Secretary of Defense should ensure the Under Secretary of Defense for Acquisition and Sustainment, in consultation with the F-35 Program Executive Officer, develops and implements a strategy for the re-design of ALIS. The strategy should be detailed enough to clearly identify and assess the goals, key risks or uncertainties, and costs of re-designing the system. (Recommendation 2)

Agency: Department of Defense: Office of the Secretary of Defense
Status: Open

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

Recommendation: The Secretary of VA should direct the Under Secretary for Health and the Assistant Secretary for Information and Technology/Chief Information Officer to develop and implement a methodology for reliably identifying and reporting the total costs of VistA. The methodology should include steps to identify the definition of VistA and what is to be included in its sustainment activities, as well as ensure that comprehensive costs are corroborated by reliable data. (Recommendation 1)

Agency: Department of Veterans Affairs
Status: Open

Comments: The Department of Veterans Affairs (VA) generally agreed with our conclusions and concurred with our recommendation. In a January 2020 update, the department described steps it planned to take to address the recommendation including establishing a team of experts to formulate a comprehensive taxonomy for VistA and all of its components, identifying authoritative and reliable data sources to assign costs to those components, and developing a methodology for ongoing cost tracking and reporting. The department expects these steps to be implemented by September 30, 2020. We will continue to monitor the department's progress to address this recommendation.

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: The Secretary of the Army should require monitoring of its processes used for recording all required real property information--to include evaluating on an ongoing basis whether or to what extent these activities are being carried out--and remediating any identified deficiencies. (Recommendation 1)

Agency: Department of Defense: Department of the Army
Status: Open
Priority recommendation

Comments: The Army concurred with this recommendation. As of February 2020, DOD officials told us that the Army has required monitoring of its processes used for recording all real property information. Specifically, the Army developed a 5-year plan to address the recommendations to improve data quality and accountability in conjunction with the ongoing DOD financial statement audit. The plan reportedly requires measuring results through directed physical inspections and record updates, using a single, standardized Accountable Property System of Record (APSR) for all assets. DOD officials also told us that the Army developed an automated validation and second-person verification to comply with the requirements and business rules of the DOD Real Property Information Model (RPIM), and that it continue to use OSD's validation and verification tool when providing annual data inputs to OSD's Real Property Assets Database, with any feedback to be addressed at senior Army levels. However, DOD officials did not provide any documentation that these requirements have been established. Once we receive that documentation, we will review it to assess the extent to which it meets the intent of our recommendation.

Recommendation: The Secretary of the Navy should require monitoring of Navy and Marine Corps processes used for recording all required real property information--to include evaluating on an ongoing basis whether or to what extent these activities are being carried out--and remediating any identified deficiencies. (Recommendation 2)

Agency: Department of Defense: Department of the Navy
Status: Open
Priority recommendation

Comments: The Navy concurred with this recommendation. As of February 2020, DOD officials stated that the Navy required monitoring of its processes used for recording real property information. Specifically, the Navy established a requirement for a 100% inventory check to ensure existence and completeness of its real property information. As part of DOD larger effort to improve its financial management through the Financial Improvement and Audit Readiness (FIAR) guidance, DOD officials also told us that the Navy plans to implement the existence and completeness results provided by an independent Public Accounting Firm. Further, it will continue to use OSD's validation and verification tool when providing annual data inputs to OSD's Real Property Assets Database, with any feedback to be addressed at senior Navy levels. However, DOD officials did not provide any documentation that these requirements had been put in place. Once we receive that documentation, we will review it to assess the extent to which it meets the intent of our recommendation.

Recommendation: The Secretary of the Air Force should require monitoring of its processes used for recording all required real property information--to include evaluating on an ongoing basis whether or to what extent these activities are being carried out--and remediating any identified deficiencies. (Recommendation 3)

Agency: Department of Defense: Department of the Air Force
Status: Open
Priority recommendation

Comments: The Air Force concurred with this recommendation. As of February 2020, DOD officials told us that the Air Force has required monitoring of its processes for recording all required real property information. For example, the Air Force plans to establish a Data Quality Program (DQP) within the Air Force Civil Engineer Center Information Technology Functional Management Office to incorporate requirements for improving accuracy of its asset information in its Accountable Property System of Record (APSR). The Air Force also plans to revise its instruction AFI 32-9005 to define responsibility for the accuracy of data at the lowest level. Further, it plans to require use of OSD's validation and verification tool to identify and correct inaccuracies when providing annual data inputs to OSD's Real Property Assets Database, with any feedback to be addressed at senior Air Force levels. However, DOD officials did not provide any documentation that these requirements had yet been put in place. We await documentation of these requirements and will review them, once received, to assess the extent to which they meet the intent of our recommendation.

Recommendation: The Secretary of Defense should ensure that the Undersecretary of Defense for Acquisition and Sustainment, in collaboration with the military services, defines and documents which data elements within the RPAD submissions are most significant for decision-making. (Recommendation 4)

Agency: Department of Defense
Status: Open
Priority recommendation

Comments: DOD concurred with this recommendation to define and document which data elements within its Real Property Assets Database (RPAD) submissions are most significant for decision-making. As of February 2020, DOD officials told us they will conduct a review of all data elements in its Real Property Assets Database, including compiling list of all data elements actively being used by data consumers. DOD also plans to divide required data elements into blocks to begin strenuous monitoring for accuracy. DOD's estimated completion date for these actions is September 2023. We will continue to monitor the completion of DOD's planned actions.

Recommendation: The Secretary of Defense should ensure that the Undersecretary of Defense for Acquisition and Sustainment, in collaboration with the military services, coordinates on corrective action plans to remediate discrepancies in significant data elements in its real property data system that are identified by OSD's verification and validation tool. (Recommendation 5)

Agency: Department of Defense
Status: Open
Priority recommendation

Comments: DOD concurred with this recommendation to coordinate on corrective action plans to remediate discrepancies in significant data elements in its real property data system that are identified by OSD's verification and validation tool. As of February 2020, DOD officials told us they plan to establish a senior leader Functional Governance Board to monitor accuracy compliance. DOD also plans to establish quarterly progress reports to be posted on the Data Analytics Integration Support (DAIS) application for constant monitoring by all users. DOD's estimated completion date for these actions is September 2022. We will continue to monitor the completion of DOD's planned actions.

Recommendation: The Secretary of Defense should ensure that the Undersecretary of Defense for Acquisition and Sustainment, in collaboration with the military services, develops a strategy that identifies and addresses risks to data quality and information accessibility. At a minimum, this strategy should establish time frames and performance metrics for addressing risks related to (1) unfilled real property positions, (2) a lack of a department-wide approach to improving its data, and (3) implementation of OSD's expanded data platform. (Recommendation 6)

Agency: Department of Defense
Status: Open
Priority recommendation

Comments: DOD partially concurred with this recommendation and stated that it plans to collaborate with the military services on separate service strategies that reflect each military service's operating environment. As of February 2020, DOD officials told us they plan to stabilize their Data Analytics Integration Support (DAIS) platform to improve data inventory by ensuring successful network connectivity for all military service users. DOD will update policy guidance to formalize the use of the DAIS platform for inventory submission by the military services. DOD also will develop and formalize in policy benchmarks and metrics to monitor data accuracy. DOD's estimated completion date for these actions is September 2023. We will continue to monitor the completion of DOD's planned actions.

Recommendation: The Administrator of CMS should provide states with more information on how to fulfill the requirement for independent encounter data audits, including information on the required audit scope and methodology, and what should be described in the resulting report. (Recommendation 1)

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

Comments: HHS agreed with our recommendation, noting that CMS would provide states with additional information on how to fulfill the requirement for independent encounter data audits. HHS also noted in January 2019 that CMS was developing voluntary guidance that will include information on best practices for validating encounter data. To implement this recommendation, the Administrator of CMS should inform states of the required audit scope and methodology as well as the resulting report. As of January 2020, HHS officials have not informed us of any additional actions taken to implement this recommendation. We will update the status of this recommendation when we receive additional information.

Recommendation: The Administrator of CMS should provide states information on the required content of the annual assessment of encounter data reporting. (Recommendation 2)

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

Comments: HHS agreed with our recommendation, noting that CMS would provide states further information on the required content of the annual assessment. In January 2019, HHS noted that CMS continues to develop guidance to states on how to fulfill the annual assessment requirement. As of January 2020, HHS officials have not informed us of any additional actions taken to implement this recommendation. We will update the status of this recommendation when we receive additional information.

Recommendation: The Administrator of CMS should provide states with information on the circumstances under which CMS would defer or disallow matching funds in response to noncompliant encounter data submissions. (Recommendation 3)

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

Comments: HHS neither agreed nor disagreed with our recommendation and noted steps it has already taken to remind states of their obligation to submit timely, quality encounter data, and prioritize data quality. In January 2019, HHS identified a possible step CMS could take in the event it finds deficiencies in states' encounter data reporting that cannot be resolved through informal monitoring and discussions with state Medicaid agencies. In particular, HHS noted that CMS would issue guidance on the parameters by which the agency would impose financial penalties on states for noncompliant encounter data submissions, if necessary. In February 2020, CMS officials told us that they continue to monitor state encounter data submissions and would issue guidance to states if they identify deficiencies in the data that cannot be resolved through informal monitoring and disccussions with state Medicaid agencies. To implement this recommendation, the Administrator of CMS should provide states with this information. We will update the status of this recommendation when we receive additional information.

Recommendation: The Department of Veterans Affairs (VA) Inspector General should revise its policy to include a requirement to verify whether evidence produced in senior-official case referrals demonstrates that the six elements required in VA Directive 0701 have been addressed. (Recommendation 6)

Agency: Department of Veterans Affairs
Status: Open

Comments: The VA Office of the Inspector General updated VA Directive 0701 to require a written or electronic signature from the person preparing the response that the specific requirements of the directive were met. The updated version of the directive was submitted to the Department, the concurrence was signed on November 16, 2018. As of January 2019, the VA OIG was working with the VA to finalize and publish the directive. On February 15, 2019, the VA OIG contacted GAO with revised language for VA Directive 0701. The language clarified the requirement to include a signature and attestation by the person preparing the response. As of June 2020, the VA OIG is in the process of working with the VA administration to finalize and publish the directive. In September 2020, GAO requested an update from the VA OIG on the status of publishing the directive.

Recommendation: The Director of BLM should systematically and comprehensively track the actual costs BLM incurs when reclaiming orphaned wells and the information, including the number of orphaned wells and inactive wells over time, necessary to determine the agency's potential liabilities. (Recommendation 1)

Agency: Department of the Interior: Bureau of Land Management
Status: Open

Comments: BLM concurred with this recommendation and, in July 2019, the agency developed a new funding code to track the costs incurred when reclaiming orphaned wells and issued written guidance to state and field offices in order to implement the bureau-wide use of the code. Also in July 2019, BLM officials stated that the agency will expand existing reporting capabilities to provide the ability to track orphaned and inactive well records over time. As of September 2020, we are working to confirm what actions BLM has taken to track the number of orphaned and inactive wells over time, and we will provide updated information when we obtain it.

Recommendation: The Director of BLM should develop a resource management plan addressing resources needed for conducting well and bond adequacy reviews and reclaiming orphaned wells. (Recommendation 6)

Agency: Department of the Interior: Bureau of Land Management
Status: Open

Comments: BLM officials stated that the agency conducts annual work planning processes which facilitates the decisions regarding the allocation of agency resources. In July 2019, BLM included additional language in its annual work plan that underscores the importance and relevance of well and bond adequacy reviews. The agency also developed a new fund code to track the actual reclamation costs incurred from reclaiming orphaned wells. The annual work plan also lists identifying and cataloging orphaned wells as a performance goal and the plan states that BLM is working with state regulatory agencies to plug wells within funding levels and state agreements. However, as of September 2020, absent identification of funds needed to reclaim orphaned wells and where those funds will come from, BLM does not have a plan to reclaim wells that are currently orphaned.

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: The Director of OMB should continue to provide ongoing technical assistance that significantly contributes to agencies making their own determinations about their DATA Act reporting requirements and monitor agency submissions. (Recommendation 1)

Agency: Executive Office of the President: Office of Management and Budget
Status: Open
Priority recommendation

Comments: OMB stated in January 2020 that it believes that the assistance it has previously provided to help agencies make their own reporting determinations fulfills the recommendation's intent. However, because we continue to identify instances where agencies had not submitted these data, we continue to believe that OMB needs to follow up with agencies that are not submitting quarterly data to find out why they are not reporting. It also needs to update its list of agencies required to report.

Recommendation: The Director of OMB should clarify and align existing guidance regarding the appropriate definitions agencies should use to collect and report on Primary Place of Performance and establish monitoring mechanisms to foster consistent application and compliance. (Recommendation 2)

Agency: Executive Office of the President: Office of Management and Budget
Status: Open
Priority recommendation

Comments: OMB has issued or contributed to guidance documents that are intended to help agencies collect and report on "Primary Place of Performance." We believe that providing specific examples of how agencies should approach challenging situations when reporting on this data element for grants would provide further clarity.

Recommendation: The Secretary of the Treasury should reasonably assure that ongoing monitoring controls to help ensure the completeness and accuracy of agency submissions are designed, implemented, and operating as designed. (Recommendation 4)

Agency: Department of the Treasury
Status: Open
Priority recommendation

Comments: In September 2019, Treasury officials stated that they are working to formalize a process for monitoring agency submissions. This process will include (1) emailing agencies prior to submission deadlines to remind them of the approaching submission deadlines; (2) following up with agencies that do not submit required data by the submission deadline and offering technical assistance as needed; and (3) forwarding a list of non-compliant agencies to OMB. GAO will continue to monitor Treasury's efforts to establish monitoring controls to help ensure the completeness and accuracy of the data.

Recommendation: The Secretary of the Treasury should disclose known data quality issues and limitations on the new USAspending.gov. (Recommendation 5)

Agency: Department of the Treasury
Status: Open
Priority recommendation

Comments: As of January 2020, Treasury has made progress by disclosing limitations related to unreported spending, among other things. Treasury is planning a major update to the USAspending.gov website to include more information about known data quality issues. Treasury plans to make this update to the website in the coming months and has an internal target date of June 2020 for completion. When completed, this action will help users make more informed decisions about how to interpret and use the data provided on the website.

Recommendation: The Commandant of the Coast Guard should either develop new performance goals to address mission activity gaps, or explain in the Coast Guard's Annual Performance Report (APR) why certain aspects of mission performance are measured while others are not. (Recommendation 1)

Agency: Department of Homeland Security: United States Coast Guard
Status: Open

Comments: In October 2017, the Coast Guard concurred with our recommendation and stated that it would add new measures in future Annual Performance Reports (APRs) and explain what is measured and what is not, as appropriate. In May 2020, the Coast Guard provided GAO with its updated fiscal year 2019 APR. After reviewing the fiscal year 2019 APR, we found that the Coast Guard made revisions to the goals for the Ports, Waterways, and Coastal Security (PWCS) and Marine Environmental Protection-prevention activities (MEP) missions and added a goal for the Search and Rescue mission. However, the APR did not include additional goals or an explanation why certain aspects of mission performance are measured while others are not for the other performance goals we previously identified as not fully addressing all related mission activities. In its July 2020 update to this recommendation, the Coast Guard reported that the metrics published in the APR are measures of Coast Guard performance and not performance goals. The Coast Guard also noted that it continually evaluates the utility of its performance measures, and makes changes to individual measures, as well as its suite of measures, when doing so provides meaningful improvement. In its July 2020 update, the Coast Guard added that targets established for performance measures are intended to be realistic expectations of future performance and targets are continually evaluated and changed when current performance modify expectations. However, we continue to believe that in the absence of documentation explaining how existing performance goals address each mission, the extent to which the Coast Guard's performance goals encompass all of its mission activities is unclear. Either developing new goals to address mission activity gaps, or describing in the APR how existing goals sufficiently assess the performance of each mission could provide more meaningful information on progress in achieving Coast Guard's missions to executive branch decision makers, Congress, and the public. In order to fully implement the recommendation as intended, in instances in which performance goals do not fully address all of the respective mission activities, the Coast Guard's APR should include an explanation of the Coast Guard's rationale for why certain aspects of mission performance are measured while others are not. We will continue to follow-up on the Coast Guard's efforts to address this recommendation.

Recommendation: The Secretary of the Army should direct the Chief of Engineers and the Commanding General of the U.S. Army Corps of Engineers to systematically review data on municipal and industrial water storage agreements stored within the OMBIL system and correct errors, as appropriate, to ensure that the data are accurate and complete.

Agency: Department of Defense: Department of the Army
Status: Open

Comments: As of September 2020, based on information provided by the Corps, the agency has reviewed approximately half of the data and hopes to review the rest of the data by the end of June 2021.

Recommendation: The Secretary of the Army should direct the Chief of Engineers and the Commanding General of the U.S. Army Corps of Engineers to collect and analyze data on the length of time it takes to complete the reallocation process.

Agency: Department of Defense: Department of the Army
Status: Open

Comments: As of September 2020, the Corps is studying how data are captured in the OMBIL system to ensure the agency has a sustainable approach that can be used to collect and analyze data into the future. The Corps hopes to complete its actions on this recommendation by the end of December 2021.

Recommendation: Early in the next decennial cycle, the Secretary of Commerce should direct the Under Secretary of the Economics and Statistics Administration and the Director of the U.S. Census Bureau to plan and execute more flexible, and perhaps smaller, address canvassing test and evaluation activity needed to support key design decisions having significant effect on the cost and quality of the census.

Agency: Department of Commerce
Status: Open

Comments: As of September 2020, the Bureau had not yet begun its 2030 testing and evaluation planning. When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Recommendation: To improve annual reporting on PTC improper payments, control activities related to eligibility determinations, and calculations of advance PTC, the Secretary of Health and Human Services should direct the Administrator of CMS to annually report improper payment estimates and error rates for the advance PTC program.

Agency: Department of Health and Human Services
Status: Open
Priority recommendation

Comments: The Department of Health and Human Services (HHS) concurred with this recommendation. On May 23, 2018, HHS's Centers for Medicare and Medicaid Services (CMS) stated that it is currently in the process of developing an improper payment measurement for the advance premium tax credit (PTC). The development of the measurement methodologies will be a multi-year process which consists of the development of measurement policies, procedures, and tools. It also includes extensive pilot testing to ensure an accurate and efficient improper payment estimate, as well as, acquisition activities for procurement of improper payment measurement contractors. In January 2020, CMS stated that it is still in the process of developing an improper payment measurement for the advance PTC. Further, CMS stated that it provided progress updates in the fiscal year 2019 HHS agency financial report (AFR), and will continue to do so in future AFRs until an improper payment rate is estimated. We will continue to monitor the agency's actions to address this recommendation.

Recommendation: To improve annual reporting on PTC improper payments, control activities related to eligibility determinations, and calculations of advance PTC, and until annual reporting of improper payment estimates and error rates for the advance PTC program is performed, the Secretary of Health and Human Services should direct the Administrator of CMS to disclose significant matters relating to the Improper Payments Information Act (IPIA) estimation, compliance, and reporting objectives for the advance PTC program in the agency financial report, including CMS's progress and timeline for expediting the achievement of those objectives and the basis for any delays in meeting IPIA requirements.

Agency: Department of Health and Human Services
Status: Open

Comments: HHS concurred with this recommendation. On February 28, 2018, the Department of Health and Human Services's (HHS) Centers for Medicare and Medicaid Services (CMS) stated that updates on the advance premium tax credit (PTC) program improper payment measurement development were provided in the fiscal year (FY) 2017 Agency Financial Report (AFR), which was published in November 2017. In FY 2018, we reviewed the FY 2017 AFR that HHS's CMS cited in support for closing this recommendation. Based on our review, the FY 2017 AFR does not address our recommendation as it does not provide a timeline for reporting an improper payment estimate. In FY 2019, we reviewed HHS's FY 2018 AFR published in November 2018, which includes a statement that HHS will continue to update its annual AFRs on the status of the measurement program development until the improper payment estimate is reported. However, this latest AFR also does not provide a timeline for reporting an improper payment estimate for HHS's PTC program. In January 2020, CMS stated that it is in the process of procuring federal contractors to perform the improper payment measurement. However, CMS further stated that due to uncertainties surrounding the timing of the procurement, CMS does not anticipate publishing a reporting timeline until the contracts have been awarded. We will continue to monitor the agency's actions to address this recommendation.

Recommendation: To improve annual reporting on PTC improper payments, control activities related to eligibility determinations, and calculations of advance PTC, the Secretary of Health and Human Services should direct the Administrator of CMS to design and implement procedures for verifying the identities of phone and mail applicants to reasonably assure that ineligible individuals are not enrolled in qualified health plans in the marketplaces or provided advance PTC.

Agency: Department of Health and Human Services
Status: Open

Comments: The Department of Health and Human Services (HHS) neither agreed nor disagreed with this recommendation. Regarding verification of filer identity, HHS stated, in response to the draft report, that for individuals starting an application via phone, the call center representatives use verbal attestations for verifications from individuals. HHS stated that for paper applications, individuals must provide names and complete addresses as well as other information. In addition, HHS stated that individuals must attest that the information they provide on all applications is accurate by signing under penalty of perjury. However, these steps do not involve the verification of an applicant's identity to a third-party source. In August 2018, HHS officials stated that they are exploring alternatives for assessing risk and ensuring integrity of applicant information that is provided to the program and ways to ensure personal information provided by an individual is accurate through a variety of means. After this analysis phase, they will assess resource requirements, cost, and operational implications for potential implementation approaches with a target date for completion of 2019. As of December 2018, HHS had not designed and implemented procedures for verifying the identities of phone and mail applicants, as GAO recommended. As of January 2020, HHS indicated that it is developing new policy and guidance which could significantly change potential solutions or requirements. However, HHS did not provide us a time frame for when it plans to finalize the new policy and guidance. We will continue to monitor agency's actions to address the recommendation.

Recommendation: To comply with improper payments reporting requirements and improve procedures related to processing PTC information on tax returns, the Commissioner of Internal Revenue should direct the appropriate officials to assess the program against applicable IPIA-defined thresholds and conclude on its susceptibility to significant improper payments, and revise the scope of its improper payments susceptibility assessment for the PTC program to include instances in which advance PTC is greater than or equal to the amount of PTC claimed on the tax return. If the program meets the IPIA definition for being susceptible to significant improper payments based on this assessment, estimate and report improper payments associated with the PTC program consistent with IPIA requirements.

Agency: Department of the Treasury: Internal Revenue Service
Status: Open
Priority recommendation

Comments: The Internal Revenue Service (IRS) partially agreed with this recommendation. On December 13, 2019, IRS provided us a status update and stated that its Research, Applied Analytics and Statistics division completed an analysis of net premium tax credit (PTC) using National Research Program (NRP) tax years 2015 and 2014 data during the 4th quarter of fiscal year 2019 and developed improper payment estimates using two different methodological approaches. However, IRS indicated that it did not publish these improper payment estimates in Treasury's Agency Financial Report for two reasons: (1) there is as yet insufficient NRP data to develop an estimate that is within the confidence interval and margin of error prescribed by the Office of Management and Budget for improper payments sampling, and (2) the Department of the Treasury (Treasury) wishes to engage with Health and Human Services' Centers for Medicare & Medicaid Services on the potential for developing a joint rate estimate for advance PTC and PTC. In addition, IRS noted that it had not yet determined whether this is even possible from a data compatibility standpoint. Further, IRS stated that while the estimates do not meet the statistical precision requirement, they do suggest that Net PTC would meet the criteria to be considered susceptible to significant improper payments. IRS indicated that when it last discussed this recommendation with GAO, it was suggested this recommendation would be closed once improper payment rates are published. However, IRS would now like GAO to consider closing this recommendation at this time given (1) the IRS's efforts to analyze potential improper payments, (2) Treasury's new approach to reporting, and (3) the need for additional years of data before a statistically valid estimate can be developed. We do not believe the recommendation should be closed at this time based on the three reasons IRS has listed above. However, we credit IRS for exploring ways to meet the intent of the recommendation. We will continue to monitor the agency's actions to address this recommendation.

Recommendation: To comply with improper payments reporting requirements and improve procedures related to processing PTC information on tax returns, the Commissioner of Internal Revenue should direct the appropriate officials to assess and document the feasibility of approaches for incorporating information from the marketplaces on individuals who did not demonstrate that they met the eligibility requirements for citizenship or lawful presence in the tax compliance process. If determined feasible, IRS should work with Treasury to require marketplaces to periodically provide such information on individuals and use such information to recover advance PTC made for those individuals.

Agency: Department of the Treasury: Internal Revenue Service
Status: Open

Comments: The Internal Revenue Service (IRS) agreed with this recommendation. In December 2018, an IRS official indicated that IRS conducted a detailed review of the recommendation. IRS informed GAO that it is internally discussing an alternative way to address the recommendation to prevent premium tax credit to noncitizens. The IRS official indicated that IRS is reviewing this alternative with the Department of the Treasury and the Department of Health and Human Services' Centers for Medicare & Medicaid Services. IRS did not provide GAO with a time frame for its implementation. On December 13, 2019, IRS provided us a status update and stated that it had no new information for this recommendation. We will continue to monitor the agency's actions to address this recommendation.

Recommendation: To help ensure that NTTFI is able to provide quality information to support management and program oversight efforts, the Secretary of the Interior should direct the Assistant Secretary-Indian Affairs to coordinate with the Federal Highway Administration and tribal stakeholders and reexamine the need for road-description and condition data currently collected in the NTTFI and eliminate fields that do not serve an identified purpose.

Agency: Department of the Interior
Status: Open

Comments: In June 2019, Interior reported that the Bureau of Indian Affairs' (BIA) and Federal Highway Administration's (FHWA) efforts to coordinate with tribes and the Tribal Transportation Program Coordinating Committee (TTPCC) to address this recommendation were progressing. Established by federal regulations, TTPCC is the committee comprised of 24 tribal representatives that provides input and makes recommendations to the BIA and FHWA. According to Interior, TTPCC has identified data elements--14 of 54 data fields--to be considered for removal from NTTFI, and BIA and FHWA have held discussions with tribes concerning a draft plan to remove these identified data elements from NTTFI. Interior reported that tribal groups have posed no objections to the plan and that they anticipate the plan being implemented later in the year. We will continue to monitor actions to address this recommendation.

Recommendation: To help ensure that NTTFI is able to provide quality information to support management and program oversight efforts, the Secretary of the Interior should direct the Assistant Secretary-Indian Affairs to for fields determined to have continued relevance for management and program oversight take steps to improve the quality of these data by clarifying guidance in the NTTFI coding guide that tribes use to collect data and by providing additional guidance on steps needed to ensure that data are consistently reported.

Agency: Department of the Interior
Status: Open

Comments: In June 2019, Interior reported that a group of tribal users organized by the Bureau of Indian Affairs (BIA) and the Federal Highway Administration (FHWA) to review the NTTFI and the coding guide was progressing in its efforts to recommend updates to the coding guide. According to Interior, the group has made recommendations to the Tribal Transportation Program Coordinating Committee (TTPCC) on which data elements to remove from the NTTFI and for clarifying guidance in the coding guide, relevant to the data elements proposed to remain in the NTTFI. Interior anticipates that updates to the coding guide based on the group's recommendations will be completed in 2019. We will continue to monitor actions to address this recommendation.

Recommendation: To help ensure that NTTFI is able to provide quality information to support management and program oversight efforts, the Secretary of the Interior should direct the Assistant Secretary-Indian Affairs to establish a process to monitor data to facilitate timely and targeted corrections to missing or erroneous data.

Agency: Department of the Interior
Status: Open

Comments: Interior told us that, along with the Bureau of Indian Affairs (BIA) and Federal Highway Administration (FHWA), it has held several meetings with tribal users to identify missing or erroneous data in the NTTFI. For example, the meeting participants identified that data which were formerly but are no longer used in formulas to allocate federal funding to tribes are likely outdated and not useful. Further, recognizing that approximately 70 percent of NTTFI data reflects inventory and condition information of roads owned by non-BIA and non-tribal entities, such as state and local governments, the meeting participants determined that opportunities exist to work with these external entities to monitor data obtained from them to ensure that it is current and accurate for use and display in the NTTFI. As of June 2019, Interior said that, in anticipation of changes to the NTTFI format, its main actions to address this recommendation will be to coordinate with these external entities to monitor the data they provide to NTTFI to ensure it conforms to NTTFI's new format. We will continue to monitor actions to address this recommendation.

Recommendation: To improve the DMR, the Secretary of the Interior should direct the Assistant Secretary-Indian Affairs to develop a means to document when the level of service for each road section was last evaluated.

Agency: Department of the Interior
Status: Open

Comments: In June 2019 Interior reported that BIA had developed a data reporting process that incorporates use of a "time-stamp" to indicate when the level of service for a road section is evaluated. Interior said that it anticipates providing guidance on this process to BIA staff, tribes, and others that perform level of service road maintenance assessments so that they can implement the process in 2020. We will continue to monitor efforts to implement this recommendation.

Recommendation: To improve the DMR, the Secretary of the Interior should direct the Assistant Secretary-Indian Affairs to develop and maintain documentation supporting the unit costs of maintenance used to estimate maintenance needs.

Agency: Department of the Interior
Status: Open

Comments: In June 2019 Interior reported that the Bureau of Indian Affairs (BIA) had surveyed tribes to determine their capabilities for managing data related to road maintenance costs. Interior further reported that BIA was investigating the use of computer software for tracking road maintenance costs and developing estimates of maintenance needs. Interior said that it expects to complete actions to implement this recommendation in 2020. We will continue to monitor actions to address this recommendation.

Recommendation: To improve the DMR, the Secretary of the Interior should direct the Assistant Secretary-Indian Affairs to develop a process for more complete and accurate reporting occurring under existing authority of Road Maintenance Program funds expended for performed maintenance on BIA roads.

Agency: Department of the Interior
Status: Open

Comments: In its official comments on our report, Interior said that that it cannot reasonably accomplish this recommendation because, in reference to the tribes which have agreements with the Bureau of Indian Affairs (BIA) to maintain BIA roads in their area, it conflicts with the intent of federal law and the minimum-reporting requirements when a tribal entity takes over the day-to-day actions and tasks of a program. However, following our report's issuance, Interior told us that its actions to address other recommendations will assist the tribes in developing data on Road Maintenance Program (RMP) funds expended for performed maintenance on BIA roads. In addition, Interior said that tribes have expressed interest in gathering this data. Further, in June 2019, Interior reported that the Tribal-Interior Budget Council had approved a plan for a pilot project in the BIA Great Plains Region to gather data relevant to addressing this recommendation. Even though tribal reporting of this data is voluntary, we continue to believe that by coordinating with affected tribes on developing a process for their self-reporting of RMP funds expended for maintenance, and by implementing such a process for tribes that BIA serves directly, Interior could improve the reporting of maintenance performed on BIA roads and be better positioned to provide Congress with more accurate and complete information on RMP funding decisions. We will continue to monitor actions to address this recommendation.

Recommendation: To best align resources allocation decisions to needs, the Secretary of the Interior should direct the Assistant Secretary-Indian Affairs to review the formula to fund transportation at BIE schools and determine, with BIA and tribal stakeholders, what adjustments, such as distinguishing between gravel and paved roads, are needed to better reflect transportation costs for schools.

Agency: Department of the Interior
Status: Open

Comments: At the time of our report, Interior said that it concurred with this recommendation; however, it subsequently changed its position. Interior noted that its tribal and school partners have not requested changes to this formula and that it was therefore not compelled to undertake the rigorous consultation and negotiated rulemaking actions that would be needed to change the formula. As of June 2019, Interior has not acted to address this recommendation.

Recommendation: To improve management and oversight of the SAVE program, the director of USCIS should develop and implement a mechanism to oversee agencies' completion of training on additional verification in accordance with SAVE MOA provisions and program policies.

Agency: Department of Homeland Security: United States Citizenship and Immigration Services
Status: Open

Comments: In March 2017, we found that USCIS does not track or monitor whether SAVE users have completed training and therefore does not have reasonable assurance that users have mastered SAVE policies and procedures prior to accessing the system. We recommended that USCIS develop and implement a mechanism to oversee agencies' completion of training on additional verification in accordance with SAVE provisions and program policies. The USCIS Verification Division reported that it planned to address providing additional training for SAVE users developed by December 31, 2017. The SAVE Program would then offer training events for agencies on the new material reflecting the agency user requirements for additional verification as well as system enhancements. In September 2017, the Verification Division implemented part one of this recommendation, a monthly webinar training session on user agency responsibilities and additional verification. This training can also be delivered to user agencies upon request. For part two of this recommendation, the SAVE program also developed training features to oversee agencies' completion of training. These training features are a system enhancement that will be incorporated into SAVE's overall modernization effort and was expected to be completed by September 30, 2019. In the interim, SAVE is implementing several other enhancements that will reduce the number of cases sent to additional verification, including the completion of modernized matching logic and initial verification screens and retiring less efficient access methods. In September 2019, SAVE officials told us that SAVE has reduced the number of cases sent to additional verification by retiring inefficient access methods and completing modernization of SAVE matching logic and initial verification screens. However, SAVE officials said they also determined that they must update the SAVE tutorial platform and content to account for these and other changes. Officials said that while SAVE is updated, the program continues to provide training, resources, and other support to user agencies to help ensure they are performing additional verification in accordance with SAVE MOA provisions and program policies. The new estimated completion date is February 28, 2021.

Recommendation: To improve oversight of states' payment structures for MLTSS, the Administrator of CMS should require all states to collect and report on progress toward achieving MLTSS program goals, such as whether the program enhances the provision of community-based care.

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

Comments: As of June 2020, CMS has not informed us of any additional actions taken to implement this recommendation. CMS previously reported that it is working to develop guidance on how states report on progress towards achieving MLTSS program goals, such as the extent to which the program enhances the provision of community-based care. CMS has contracted with a vendor to produce recommendations for what would be included in the state reporting. We will update the status of this recommendation when we receive additional information.

Recommendation: To improve oversight of states' payment structures for MLTSS, the Administrator of CMS should establish criteria for what situations would warrant exceptions to the federal standards that the data used to set rates be no older than the three most recent and complete years.

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

Comments: As of June 2020, CMS has not informed us of any additional actions taken to implement this recommendation. CMS previously reported that it has monitored rate certifications and the data used for rating periods starting on or after July 1, 2017. CMS said that it has not had any states set rates that do not meet the federal standards for the data being no older than the three most recent and complete years and, therefore, does not believe that it should publish guidance on what situations would warrant exceptions. In order to better determine whether there is a need for such guidance, we believe that CMS should continue to monitor rate certifications and assess the data being used, particularly as additional states are developing or considering implementation of MLTSS programs. We will update the status of this recommendation as CMS conducts reviews of other states' payment structures and data used to establish them.

Recommendation: To improve oversight of states' payment structures for MLTSS, the Administrator of CMS should provide states with guidance that includes minimum standards for encounter data validation procedures.

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

Comments: As of June 2020, CMS has not informed us of any additional actions taken to implement this recommendation. CMS previously reported to GAO that it has convened a workgroup to develop an Encounter Data Toolkit, which will provide best practices for encounter data submissions and validation procedures. The workgroup is also discussing minimum standards for states to determine if the encounter data are complete and accurate for purposes of rate setting. The workgroup met in June and July 2018, and two additional workgroup meeting are planned prior to the drafting of the toolkit. We will update the status of this recommendation when we receive additional information.

Recommendation: To improve the transparency and clarity of the Trafficking in Persons Report and improve its usefulness as a diplomatic tool to encourage countries to address trafficking, the Secretary of State should improve explanations in narratives for Tier 1 rankings, including using consistent language, as feasible, in the Trafficking in Persons Report.

Agency: Department of State
Status: Open

Comments: In comments on the draft report, State concurred with this recommendation and said that it seeks to make the Trafficking in Persons Report as useful as possible to a broad array of stakeholders and will continue its commitment to ensure each narrative better serves this purpose. GAO analyzed State's 2017, 2018, and 2019 Trafficking in Persons Report and found improvements in the explanations in narratives for Tier 1 countries. However, narratives for some Tier 1 countries did not clearly explain their placement, including language that seemed contradictory to certain standards and criteria and ambiguous language that meant we were unable to determine how State had determined whether certain standards and criteria were met. As of December 2019, GAO is continuing to monitor State's efforts to fully implement the recommendation. GAO will review State's upcoming 2020 Trafficking in Persons Report.

Recommendation: To improve the accessibility and reliability of SNF expenditure data, the Acting Administrator of CMS should take steps to improve the accessibility of SNF expenditure data, making it easier for public stakeholders to locate and use the data.

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

Comments: In September 2016, GAO recommended that CMS improve the accessibility and reliability of SNF expenditure data, thereby making it easier for public stakeholders to locate and use the data. The agency concurred with this recommendation in 2016 and stated that it would review the feasibility of increasing the accessibility of this data. However, in August 2017, HHS told GAO that it now believes that the cost of implementing this recommendation would outweigh its benefits. HHS confirmed in July 2019 that its position on this recommendation has not changed. GAO continues to hold that data on SNFs' relative expenditures should be readily accessible to the public to ensure transparency in SNF expenditures.

Recommendation: To improve the accessibility and reliability of SNF expenditure data, the Acting Administrator of CMS should take steps to ensure the accuracy and completeness of SNF expenditure data.

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

Comments: In September 2016, GAO recommended that CMS take steps to ensure the accuracy and completeness of SNF expenditure data. However, the agency did not concur with this recommendation. HHS reported in 2016 that the amount of time and resources to verify the accuracy and completeness of SNF expenditure data could be substantial, without assurance of benefit to the agency and the public. However, during the course of our work, GAO found that CMS uses this expenditure data to update overall SNF payment rates, in addition to more general purposes. GAO continues to believe that CMS should take steps to ensure reliable expenditure data are accurate and complete. As of July 2019, the agency continues to non-concur with this recommendation.

Recommendation: To improve the quality of the data published on ForeignAssistance.gov and help ensure consistency in published information, the Secretary of State should, in consultation with the Director of OMB and the USAID Administrator, develop additional guidance that takes into consideration current challenges to updating ForeignAssistance.gov with verified data.

Agency: Department of State
Status: Open
Priority recommendation

Comments: As of May 2020, State had taken some steps to coordinate with OMB and USAID to improve the quality of data reported for ForeignAssistance.gov. Notably, in May 2020, State and USAID submitted a joint report to Congress outlining a plan to consolidate the two federal websites reporting foreign assistance spending--ForeignAssistance.gov (managed by State) and explorer.usaid.gov (managed by USAID). As part of the plan, State and USAID will establish a joint data governance structure to reduce discrepancies in data, bolster the capacity of agencies to submit data, and ensure the accuracy and quality of data. Once the governance structure is finalized, they will send a copy to GAO. GAO will then review this information to assess if it sufficiently addresses GAO's recommendation.

Recommendation: To enhance FAA's risk-based approach for oversight of repair stations, the Secretary of Transportation should direct the Administrator of the Federal Aviation Administration to develop and implement a process in Flight Standards for incorporating into SAS the volume of critical maintenance that each U.S. airline contracts to repair stations.

Agency: Department of Transportation
Status: Open

Comments: FAA did not concur with this recommendation. In July 2019, GAO confirmed that FAA does not plan to implement the recommendation because the agency continues to believe the subjective nature of volume of work makes it an ineffective risk indicator. However, the agency monitors many factors as primary risk indicators at repair stations. Many of these risk indicators are associated with important aspects of work volume such as high workforce turnover; changes in management; rapid growth or downsizing; changes in aircraft complexity/programs; financial conditions; age of fleet and increases in aircraft discrepancies. FAA considers these factors and the criticality of a specific maintenance action on an aircraft to be the most important risk indicators.

Recommendation: To enhance FAA's risk-based approach for oversight of repair stations, the Secretary of Transportation should direct the Administrator of the Federal Aviation Administration to develop and implement an evaluative process with measurable performance goals and measures to determine the effectiveness of SAS as the SMS safety assurance component.

Agency: Department of Transportation
Status: Open

Comments: In July 2019, GAO confirmed that FAA plans to develop overall program goals and metrics as part of the next implementation phase of its new Safety Assurance System. These metrics are expected to be fully developed based on the final design of the new system and the program requirements identified. Final system testing and deployment into production for the Safety Assurance System is expected to be completed by February 2021, with final implementation scheduled to be completed by May 2022. Additionally, prior to deploying the system, FAA plans to provide training courses to the aviation safety workforce who will be using the new system, and plans to issue new policy documentation in June 2020 that will be used to provide additional guidance to that workforce on properly using the system.

Recommendation: To help the Department of Health and Human Services ensure accuracy in Part B drug payment rates, Congress should consider requiring all manufacturers of Part B drugs paid at ASP, not only those with Medicaid drug rebate agreements, to submit sales price data to CMS, and ensure that CMS has authority to request source documentation to periodically validate all such data.

Agency: Congress
Status: Open

Comments: As of June 2020, no action has been taken on this Matter for Congressional Consideration.

Recommendation: CMS should periodically verify the sales price data submitted by a sample of drug manufacturers by requesting source documentation from manufacturers to corroborate the reported data, either directly or by working with the HHS Office of Inspector General as necessary.

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

Comments: In September 2018, HHS officials reiterated that they believe the agency has addressed our recommendation because CMS works with HHS's Office of Inspector General (OIG) as appropriate to collect source documentation from drug manufacturers and takes action as warranted. HHS stated that CMS has continued to provide information regarding problematic ASP submissions to OIG for evaluation of misreporting and continues to use AMP and other benchmarks as comparisons for pricing determinations. They further stated that they do not believe that additional collection of detailed sales information about ASP, such as invoices, is authorized under Part B drug payment provisions in section 1847A or under section 1927(b). As of June 2020, CMS did not provide any additional updates. While we recognize that CMS conducts routine checks to assess the completeness of ASP data submitted by drug manufacturers, we do not believe these activities are enough to close the recommendation. Specifically, CMS only collects source documentation from manufacturers under very limited circumstances (e.g., when there are obvious inconsistencies in the data submitted by manufacturers). CMS does not periodically verify the accuracy of ASP data for a sample of manufacturers by tracing the data to and from drug manufacturers' source documents, such as sales invoices. Because CMS does not routinely verify the accuracy of the underlying data used to determine Medicare payment rates, the resulting payment rates may be inaccurate if drug manufacturers do not report accurate data. With regards to CMS's authority to collect additional information, such as invoices, we believe the agency could work through OIG to collect such information.

Recommendation: To strengthen the transparency of the complaints process, the Secretary of Homeland Security should direct CBP and ICE to develop and issue guidance on how and which complaint mechanisms should be communicated to individuals in custody at holding facilities.

Agency: Department of Homeland Security
Status: Open

Comments: In May 2016, we reported on the Department of Homeland Security's management and oversight of short-term holding facilities. We found, for example, that only 4 of 17 Border Patrol holding facilities posted information on how individuals can contact the DHS OIG to file general complaints, and the remaining facilities did not have information posted on any complaint mechanisms, such as the Joint Intake Center or CBP INFO Center. In December 2016, ICE Enforcement and Removal Operations (ERO) sent a broadcast to ICE field offices stating that posters should be visible at all of ICE ERO temporary holding facilities. This broadcast directed ICE ERO Field Office staff to immediately post copies of the Detention Reporting and Information Line poster, both in English and in Spanish, in temporary confinement areas or other areas so that it is visible to individuals in custody at ICE ERO temporary holding facilities. With regard to CBP, in October 2019, officials informed us there is no current CBP guidance requiring signage in CBP holding facilities to communicate complaint mechanisms other than the Prison Rape Elimination Act poster, which relates to reporting mechanisms for any potential incidents of sexual abuse and assault. In September 2020, CBP told us it planned to implement the necessary corrective actions to close this recommendation by March 31, 2021. In order to be able to close the recommendation as implemented, we will need to see updated guidance to the field about the posters that should be displayed in CBP facilities.

Recommendation: To strengthen DOL's efforts to ensure employers protect the safety and health of workers at meat and poultry plants, the Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health, working together with the Commissioner of Labor Statistics as appropriate, to develop and implement a cost-effective method for gathering more complete data on musculoskeletal disorders.

Agency: Department of Labor
Status: Open

Comments: DOL generally agreed with this recommendation and stated that its implementation would make a difference in working conditions in the meat and poultry industry. The agency also noted that resource constraints may make it difficult to implement. DOL reported in 2018 that it is reviewing its options for moving forward and is exploring accurate coding and recordkeeping of MSDs and drivers for underreporting in poultry processing and elsewhere. As of March 2020, OSHA stated that it continues to examine ways to work with BLS to address the recommendation. We will monitor the agency's actions to address this recommendation.

Recommendation: To develop a better understanding of meat and poultry sanitation workers' injuries and illnesses, the Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health and the Commissioner of Labor Statistics to study how they could regularly gather data on injury and illness rates among sanitation workers in the meat and poultry industry.

Agency: Department of Labor
Status: Open

Comments: DOL generally agreed with this recommendation and stated that its implementation would make a difference in working conditions in the meat and poultry industry. The agency noted that resource constraints may make it difficult to implement, particularly due to privacy concerns related to using form 301 (injury and illness incident report) and form 300 (log of work-related illnesses and injuries. DOL also noted that form 300A (Summary of Work-Related Injuries and Illnesses) does not have the specificity necessary to develop an understanding of worker injuries and illnesses in specific occupations. Our report explained that plants may use various job titles in their OSHA logs for sanitation workers they employ directly. However, those workers who are employed by contracted sanitation companies may be included in the sanitation companies' OSHA logs, and there may be nothing to indicate that their workplace is a meat or poultry plant. Thus, the problem is not the data source, but rather how to identify these particular workers by occupation and by industry in order to collect information about the full extent of injuries and illnesses in meat and poultry plants. We reiterate our recommendation that OSHA should work together with BLS to study how to regularly gather data on injury and illness rates among sanitation workers in the meat and poultry industry.

Recommendation: To develop a better understanding of meat and poultry sanitation workers' injuries and illnesses, the Secretary of Health and Human Services should direct the Director of the Centers for Disease Control and Prevention to have the National Institute for Occupational Safety and Health (NIOSH) conduct a study of the injuries and illnesses these workers experience, including their causes and how they are reported. Given the challenges to gaining access to this population, NIOSH may want to coordinate with the Occupational Safety and Health Administration to develop ways to initiate this study.

Agency: Department of Health and Human Services
Status: Open

Comments: HHS concurred with this recommendation and noted the previous difficulties NIOSH has had gaining access to these workplaces and the potential resource commitment involved in conducting such a study. We acknowledge this access challenge and noted in our report that OSHA has negotiated access for NIOSH in other industries, hence the rationale for recommending that NIOSH may want to coordinate with OSHA. In February 2020, NIOSH reported it met with industry associations to discuss areas of mutual interest for research on worker safety in poultry plants. However, according to NIOSH, the advent of COVID-19 and its challenges have limited plans for field studies for FY20. During the COVID-19 epidemic NIOSH informed us its representatives have: (1) created COVID-19 safety guidelines with OSHA and (2) performed more than 30 meat and poultry worksite evaluations focusing on the prevention of COVID-19. NIOSH notes that it continues to have an interest in learning more about and providing assistance to minimize various types of illnesses and injuries that may affect meat and poultry sanitation workers, and at some point in the future they hope to "re-initiate" their interactions with stakeholders such as the National Chicken Council and US Egg & Poultry Association on the study of peracetic acid exposure in the poultry processing industry. Our recommendation was aimed at increasing the understanding of the various types of illnesses and injuries that are common among meat and poultry sanitation workers, including their causes and how they are reported. We look forward to hearing about future studies that address this topic.

Recommendation: As CMS continues to implement and refine the contract-level RADV audit process to improve the efficiency and effectiveness of reducing and recovering improper payments and to improve the accuracy of CMS's calculation of coding intensity, the Administrator should modify that calculation by taking actions such as the following: (1) including only the three most recent pair-years of risk score data for all contracts; (2) standardizing the changes in disease risk scores to account for the expected increase in risk scores for all MA contracts; (3) developing a method of accounting for diagnostic errors not coded by providers, such as requiring that diagnoses added by MA organizations be flagged as supplemental diagnoses in the agency's Encounter Data System to separately calculate coding intensity scores related only to diagnoses that were added through MA organizations' supplemental record review (that is, were not coded by providers); and (4) including MA beneficiaries enrolled in contracts that were renewed from a different contract under the same MA organization during the pair-year period.

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

Comments: CMS is working to improve the accuracy of its calculation of coding intensity, as GAO recommended in April 2016. In October 2017, CMS officials told GAO that the agency is reevaluating the design of the risk adjustment data validation audits to ensure their rigor in the context of all the payment error data acquired since the original design of the audits. As part of this work, CMS officials told GAO that the agency will examine whether coding intensity is the best criterion to use to select contracts for audit. As a result, in October 2018, CMS told GAO that rather than coding intensity, it plans to implement a new methodology using payment error as the key sampling driver beginning with audits for payment year 2014. Additionally, CMS was taking steps to modernize its audit system to improve reliability. For example, it initiated a project to explore how to directly receive electronic medical record documentation. As of January 2020, the agency is continuing to reevaluate the design of these audits. Unless CMS takes this and other actions to improve the risk adjustment data validation contract-level audit process, it will fail to recover improper payments of hundreds of millions of dollars annually.

Recommendation: As CMS continues to implement and refine the contract-level RADV audit process to improve the efficiency and effectiveness of reducing and recovering improper payments. The Administrator should modify CMS's selection of contracts for contract-level RADV audits to focus on those contracts most likely to have high rates of improper payments by taking actions such as the following: (1) selecting more contracts with the highest coding intensity scores; (2) excluding contracts with low coding intensity scores; (3) selecting contracts with high rates of unsupported diagnoses in prior contract-level RADV audits; (4) if a contract with a high rate of unsupported diagnoses is no longer in operation, selecting a contract under the same MA organization that includes the service area of the prior contract; and (5) selecting some contracts with high enrollment that also have either high rates of unsupported diagnoses in prior contract-level RADV audits or high coding intensity scores.

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

Comments: CMS is working to modify the selection of MA contracts for audit, as GAO recommended in April 2016. In October 2017, CMS officials told GAO that the initial RADV audit design was based on a limited set of payment error data available at the time. As part of efforts to improve the audits, CMS officials told GAO that the agency will examine whether coding intensity is the best criterion to select contracts for audit. In October 2018, CMS told GAO that it plans to implement a new methodology using payment error as the key sampling driver-rather than coding intensity-beginning with audits for payment year 2014. As of January 2020, the agency is using the revised methodology on the 2014 and 2015 payment year audits. They expect to conclude this process in late fiscal year 2020 and 2021, respectively. Unless CMS completes actions to improve the RADV contract-level audit process, it will fail to recover improper payments of hundreds of millions of dollars annually.

Recommendation: As CMS continues to implement and refine the contract-level RADV audit process to improve the efficiency and effectiveness of reducing and recovering improper payments. The Administrator should enhance the timeliness of CMS's contract-level RADV process by taking actions such as the following: (1) closely aligning the time frames in CMS's contract-level RADV audits with those of the national RADV audits the agency uses to estimate the MA improper payment rate; (2) reducing the time between notifying MA organizations of contract audit selection and notifying them about the beneficiaries and diagnoses that will be audited; (3) improving the reliability and performance of the agency's process for transferring medical records from MA organizations, including assessing the feasibility of updating Electronic Submission of Medical Documentation for use in transferring medical records in contract-level RADV audits; and (4) requiring that CMS contract-level RADV auditors complete their medical record reviews within a specific number of days comparable to other medical record review time frames in the Medicare program.

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

Comments: HHS concurred with this recommendation in its fiscal year 2021 budget justification. HHS reaffirmed its commitment to identifying and correcting improper payments in the MA program. It has begun taking steps to improve the timeliness of the contract-level RADV audit process, such as aligning the time frames in CMS's contract-level RADV audits with those of the national RADV audits. Once completed, CMS needs to provide evidence that the actions taken by the agency have enhanced the timeliness of CMS's contract-level RADV process.

Recommendation: As CMS continues to implement and refine the contract-level RADV audit process to improve the efficiency and effectiveness of reducing and recovering improper payments. The Administrator should improve the timeliness of CMS's contract-level RADV appeal process by requiring that reconsideration decisions be rendered within a specified number of days comparable to other medical record review and first-level appeal time frames in the Medicare program.

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

Comments: CMS is working to improve the timeliness of the agency's contract-level risk adjustment data validation appeals process, as GAO recommended in April 2016. In October 2017, CMS officials told GAO that the agency is actively considering options for expediting the appeals process. For example, CMS is considering the appropriate number of days for rendering reconsideration decisions while allowing for a complete and thorough adjudication. In December 2019, CMS officials told GAO they expect to issue a final rule in January 2021 that will establish uniform timelines to expedite the appeals process. Specifically, they plan to require that a findings determination be made within 60-90 days of an arbiter's receipt of each party's arguments at each stage of an appeal. Unless CMS takes such actions to improve the risk adjustment data validation contract-level audit process, it will fail to recover improper payments of hundreds of millions of dollars annually.

Recommendation: As CMS continues to implement and refine the contract-level RADV audit process to improve the efficiency and effectiveness of reducing and recovering improper payments. The Administrator should ensure that CMS develops specific plans and a timetable for incorporating a RAC in the MA program as mandated by the Patient Protection and Affordable Care Act.

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

Comments: CMS has attempted to incorporate a recovery audit contractor in the Medicare Advantage program, as GAO recommended in April 2016. After failing to receive any proposals when CMS first issued a request for proposals (RFP) in 2014, CMS issued a request for information to industry in December 2015, which included a draft Statement of Work to solicit feedback, gauge interest, and conduct market research regarding CMS entering into a contract with a recovery audit contractor to identify underpayments and overpayments associated with diagnosis data submitted to CMS by Medicare Advantage Organizations. CMS reported that it subsequently issued another RFP in 2016 and did not receive any proposals for a second time. In December 2019, CMS officials told GAO that the functions of the Part C recovery Audit programs are being performed through other program integrity mechanisms. CMS subsequently reported in its fiscal year 2021 budget justification that CMS believes the proposed scope of the Part C RAC has been subsumed by RADV and CMS will demonstrate that the RADV program satisfies this recommendation. Until CMS completes efforts to improve the risk adjustment data validation contract-level audit process and demonstrates that it has satisfied the requirement to incorporate a recovery audit contractor in the MA program, CMS will fail to recover improper payments of hundreds of millions of dollars annually.

Recommendation: In addition to implementing our previous recommendations, to more effectively implement security-related policies and plans, the Commissioner of Internal Revenue should update system and application audit plans based on the current version of referenced policies and guidelines and when significant changes are made to a system or application.

Agency: Department of the Treasury: Internal Revenue Service
Status: Open

Comments: During GAO's audit of IRS' FY 2019 financial statements, IRS indicated that it had not yet implemented this recommendation. When the agency indicates that it has implemented this recommendation, we will review its actions.

Recommendation: To improve DOD's ability to oversee its inventory of leased real property, aimed at improving the accuracy and completeness of data in RPAD, the Secretary of Defense should direct the Secretary of the Army to enforce DOD's Real Property Inventory (RPI) Reporting Guidance, which states that for multiple assets associated with a single lease, the military departments and WHS must provide a breakout of the annual rent plus other costs for each asset on the same lease, to avoid overstating costs associated with such leases.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with GAO's March 2016 recommendation to enforce DOD's Real Property Inventory (RPI) Reporting Guidance to break out the annual rent plus other costs for each asset on the same lease to avoid overstating the costs associated with such leases. In July 2019, DOD provided GAO a copy of its annual guidance for end of year submission of its real property inventory, including notes and timeline for submission. DOD stated in its Corrective Action Plan that this annual guidance provided the requirements for proper submission of data to meet the issues identified in this recommendation. However, the documentation provided is generic language and does not provide any detailed information to support closure of this recommendation. In August 2020, we requested documentation that shows that the DOD has reiterated its RPI Reporting Guidance and that military departments and WHS have made the needed adjustments in the reporting of their leased facilities to show a breakout of the annual rent plus other costs for each asset on the same lease. We will continue to monitor this area and update this if DOD provides information showing that DOD has reiterated its RPI Reporting Guidance and that military departments and WHS have adjusted the reporting of their leased facilities to show a breakout of the annual rent plus other costs for each asset on the same lease. .

Recommendation: To improve DOD's ability to ensure that its leased facilities are secure, the Secretary of Defense should direct the Under Secretary of Defense (Intelligence) to request reports from the Federal Protective Service for all leased facilities on a periodic basis as determined necessary for oversight. At a minimum, the Under Secretary should request (1) the results of the assessments, (2) the date on which the last assessment was completed for each facility and the date for which the next scheduled assessment is planned, and (3) information on whether these dates meet the time frames established by Interagency Security Committee standards.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with GAO's March 2016 recommendation. In its July 2019 Corrective Action Plan, DOD stated that it had coordinated with the Federal Protective Service (FPS) to obtain data pertaining to the 677 DOD facilities across 539 total locations (i.e., some locations have multiple tenants, hence more facilities than locations) for which FPS provides physical security. DOD stated that the data provided to them by FPS shows that, as of July 2018, 98 percent of DOD leased facilities met the established time frame for completing assessments and remaining 2 percent (15 of the 677 facilities) had out-of-date assessments. In January 2020, DOD provided GAO with the raw data it received from the Federal Protective Service that DOD said supported these assertions. While this data included the last and next facility assessment dates for each facility, along with several other variables, it did not include sufficient information for us to replicate DOD's analysis that 98 percent of assessments were completed in the 3 to 5 year period. We will continue to monitor this area and will update if DOD provides information that more fully explains DOD's analysis.

Recommendation: To improve DOD's ability to oversee its inventory of leased real property, aimed at improving the accuracy and completeness of data in RPAD, the Secretary of Defense should direct the Assistant Secretary of Defense (Energy, Installations and Environment) to modify the office's Real Property Information Model to include a data element to capture the square footage for each lease of space in a single building and also make a corresponding change to its Real Property Inventory (RPI) Reporting Guidance to require that the square footage for each individual lease be reported when multiple leases exist for a single building, to avoid overstating the total square footage assigned to each lease in RPAD.

Agency: Department of Defense
Status: Open

Comments: DOD did not concur with GAO's March 2016 recommendation to capture the total square footage assigned to each individual lease when multiple leases exist for a single building and make a corresponding change to its guidance to avoid overstating the total square footage assigned to each lease in RPAD. In its comments, DOD stated that it agreed that the issue we identified existed regarding multiple leases that are assigned the same building (leases managed by WHS in the National Capital Region), but that DOD did not agree with GAO's recommended solution to this issue. DOD stated that it believed that the underlying cause for overstating the total square footage for these records in RPAD was a data aggregation issue. DOD stated that its Data Analytics and Integration Support (DAIS) platform that was in the process of being developed would include the capability to capture square footage for multiple leases in a single asset. GAO is not wedded to a particular solution, only that the issue be resolved to improve the accuracy and completeness of the data. As of August 2020, DAIS is fully operational. We will continue to monitor this area and will update if DOD provides information to support that DIAS includes the total square footage assigned to individual leases when multiple leases are assigned to the same building.

Recommendation: To better oversee the efficacy of PPACA's enrollment control process; to better monitor costs, risk, and program performance; to assist with tax compliance; to strengthen the eligibility determination process; to provide applicants with improved customer service and up-to-date information about submission of eligibility documentation; and to better document agency activities, the Secretary of Health and Human Services should direct the Acting Administrator of CMS to track the value of advance premium tax credit and cost-sharing reduction (CSR) subsidies that are terminated or adjusted for failure to resolve application inconsistencies, and use this information to inform assessments of program risk and performance. (See related recommendation 7.)

Agency: Department of Health and Human Services
Status: Open
Priority recommendation

Comments: In April 2016, HHS reported it considers this recommendation closed because it expanded the use of analytics to analyze the value of premium tax credit and CSR subsidies that are eliminated or adjusted for 2015 actions at the policy level, and that CMS continues to analyze the data to develop future operations changes. In May 2016, we requested documentation of these actions, including (1) information produced using the capability described; (2) ways in which this information is being used for analysis for purposes such as program operations, monitoring, risk assessment, or fraud cleaning; and (3) a description of the future operational changes contemplated based on the analyses done. However, as of December 2018, HHS officials had not provided GAO with evidence that the agency had implemented this recommendation. GAO said it would continue to monitor the agency's progress in this area. In March 2019, CMS reversed its initial concurrence with the recommendation, citing inability to obtain necessary data from another agency and a legal opinion on CSR subsidies. GAO kept the recommendation open, saying the developments HHS cited were irrelevant. In December 2019, after HHS reiterated its non-concurrence, GAO continued to maintain the recommendation as open.

Recommendation: To better oversee the efficacy of PPACA's enrollment control process; to better monitor costs, risk, and program performance; to assist with tax compliance; to strengthen the eligibility determination process; to provide applicants with improved customer service and up-to-date information about submission of eligibility documentation; and to better document agency activities, the Secretary of Health and Human Services should direct the Acting Administrator of CMS to, in the case of CSR subsidies that are terminated or adjusted for failure to resolve application inconsistencies, consider and document, in conjunction with other agencies as relevant, whether it would be feasible to create a mechanism to recapture those costs, including whether additional statutory authority would be required to do so; and for actions determined to be feasible and reasonable, create a written plan and schedule for implementing them.

Agency: Department of Health and Human Services
Status: Open

Comments: As of December 2018, CMS officials said the Department of Health and Human Services (HHS) had received a legal opinion from the U.S. Attorney General regarding validity of CSR payments, which prompted the agency to halt the payments as of October 2017. CMS officials said that if the recommendation were to be implemented, it would amount to creating new rules and a process for a program feature that no longer exists. However, in January 2019, HHS indicated that the administration supports a legislative solution that would appropriate CSR payments, and GAO continues to monitor for relevant legislative action. If funding becomes available to restore CSR payments, then implementing this recommendation would aid CMS in reducing improper payments. In December 2019, CMS reversed its initial concurrence with the recommendation, citing the legal opinion. GAO, however, continued to maintain the recommendation as open.

Recommendation: To better oversee the efficacy of PPACA's enrollment control process; to better monitor costs, risk, and program performance; to assist with tax compliance; to strengthen the eligibility determination process; to provide applicants with improved customer service and up-to-date information about submission of eligibility documentation; and to better document agency activities, the Secretary of Health and Human Services should direct the Acting Administrator of CMS to identify and implement procedures to resolve Social Security number inconsistencies where the Marketplace is unable to verify Social Security numbers or applicants do not provide them.

Agency: Department of Health and Human Services
Status: Open
Priority recommendation

Comments: In April 2016, HHS reported that it considered this recommendation open and was working on implementing functionality for updating consumers' Social Security numbers (SSN) and their eligibility based on the correct SSN. HHS reported that is it targeting deployment of the SSN update functionality in 2017. However, as of December 2018, HHS officials had not provided GAO with evidence that the agency had implemented this recommendation. In December 2019, HHS told GAO it continues to evaluate steps necessary to implement the recommendation, and expects close-out by October 2020. We will continue to monitor the agency's progress in this area.

Recommendation: To better oversee the efficacy of PPACA's enrollment control process; to better monitor costs, risk, and program performance; to assist with tax compliance; to strengthen the eligibility determination process; to provide applicants with improved customer service and up-to-date information about submission of eligibility documentation; and to better document agency activities, the Secretary of Health and Human Services should direct the Acting Administrator of CMS to reevaluate CMS's use of Prisoner Update Processing System (PUPS) incarceration data and make a determination to either (a) use the PUPS data, among other things, as an indicator of further research required in individual cases, and to develop an effective process to clear incarceration inconsistencies or terminate coverage, or (b) if no suitable process can be identified to verify incarceration status, accept applicant attestation on status in all cases, unless the attestation is not reasonably compatible with other information that may indicate incarceration, and forego the inconsistency process.

Agency: Department of Health and Human Services
Status: Open
Priority recommendation

Comments: In April 2016, HHS reported it considers this recommendation closed because in 2015, it made the determination to no longer require application filers to submit documentation regarding incarceration status. We were aware of that determination, but the recommendation was to reevaluate use of PUPS from the specific standpoint of using the data as it was intended to be used as in indicator of further research and then draw a conclusion on the use of the data. In May 2016, we requested documentation demonstrating that in the period since we made this recommendation, CMS has undertaken the reevaluation in the fashion that we indicated. As of December 2018, HHS officials had not provided GAO with evidence that the agency had implemented this recommendation. In December 2019, HHS told GAO it continues to evaluate steps necessary to implement the recommendation, and expects close-out by October 2021. We will continue to monitor the agency's progress in this area.

Recommendation: To better oversee the efficacy of PPACA's enrollment control process; to better monitor costs, risk, and program performance; to assist with tax compliance; to strengthen the eligibility determination process; to provide applicants with improved customer service and up-to-date information about submission of eligibility documentation; and to better document agency activities, the Secretary of Health and Human Services should direct the Acting Administrator of CMS to create a written plan and schedule for providing Marketplace call center representatives with access to information on the current status of eligibility documents submitted to CMS's documents processing contractor.

Agency: Department of Health and Human Services
Status: Open
Priority recommendation

Comments: In April 2016, HHS reported that since May 2015, call center representatives have received daily updates on the status of eligibility documentation. HHS reported that it is working to provide call center representatives with real-time data. HHS reported it considers this February 2016 recommendation to be closed. In May 2016, GAO noted that its February 2016 recommendation was focused on providing such real-time capability and requested (1) confirmation that call center representatives currently have on-demand, real-time access to up-to-date, application-level document status; and documentation showing development and implementation of this capability; or (2) a written plan and schedule for providing this capability as recommended. However, as of December 2018, HHS officials had not provided GAO with evidence that the agency has implemented this recommendation. In December 2019, the agency provided new evidence in support of closure, for which GAO requested supporting information. We will continue to monitor the agency's progress in this area.

Recommendation: To better oversee the efficacy of PPACA's enrollment control process; to better monitor costs, risk, and program performance; to assist with tax compliance; to strengthen the eligibility determination process; to provide applicants with improved customer service and up-to-date information about submission of eligibility documentation; and to better document agency activities, the Secretary of Health and Human Services should direct the Acting Administrator of CMS to fully document prior to implementation, and have readily available for inspection thereafter, any significant decision on qualified health plan enrollment and eligibility matters, with such documentation to include details such as policy objectives, supporting analysis, scope, and expected costs and effects.

Agency: Department of Health and Human Services
Status: Open
Priority recommendation

Comments: In April 2016, HHS reported it considers this recommendation closed because CMS prepares an annual Marketplace and Related Programs Cycle Memo to fulfill reporting requirements for internal control. The Memo describes all significant eligibility and enrollment policy and process changes, including new internal key controls associated with these changes, and the 2015 Memo was released in September 2015. In May 2016, we notified HHS that its actions do not close the recommendation. Information contained in the Memos is after-the-fact and while useful, does not meet the full range of documentation contemplated by our recommendation, especially development and analysis of changes prior to implementation. As of December 2018, HHS officials had not provided GAO with evidence that the agency has implemented this recommendation. In December 2019, HHS reversed its initial concurrence with the recommendation and said it would provide additional information on that decision. We will continue to monitor the agency's progress in this area.

Recommendation: To better ensure agencies fulfill their requirements, including implementing IQA guidelines and helping to promote easier public access to IQA information on agency websites, the Director of OMB should consolidate and centralize on OMB's IQA guidance website a government-wide summary of requests for correction submitted under the IQA.

Agency: Executive Office of the President: Office of Management and Budget
Status: Open

Comments: According to OMB, during the last two years OIRA has significantly improved the ease of access to and findability of documents on OMB's information quality website. OMB says it has a number of additional improvements in progress. We have requested information on those additional improvements. We will continue to monitor OMB's efforts related to this recommendation.

Recommendation: To better ensure agencies fulfill their requirements, including implementing IQA guidelines and helping to promote easier public access to IQA information on agency websites, the Director of OMB should work with the Department of Defense and the Federal Housing Finance Agency to help ensure that they post their IQA administrative mechanisms and IQA guidance online.

Agency: Executive Office of the President: Office of Management and Budget
Status: Open

Comments: According to OMB, it worked with the Federal Housing Finance Agency (FHFA) to improve the accessibility of their Information Quality Act guidance. In addition, OMB stated that FHFA took it upon themselves to update their guidelines. OMB has not provided any information regarding its work with DOD in this area. We will continue to monitor OMB's efforts related to this recommendation.

Recommendation: To better ensure agencies fulfill their requirements, including implementing IQA guidelines and helping to promote easier public access to IQA information on agency websites, the Director of OMB should provide additional guidance for agencies to help improve the transparency and usability of their IQA websites to help ensure the public can easily find and access online information about agency IQA implementation. Such guidance should include (1) specific time frames for agencies to post information on the IQA correction requests they have received, including making it clear when agencies have not received IQA requests; (2) instructions for agencies to include a statement on their IQA websites that the agencies may address correction requests through other administrative processes; (3) instructions for agencies to include, when responding to correction requests, whether those agencies plan to address the request through another administrative processes, and if so, which process they will use; and (4) suggestions for improving usability of agencies' websites including fixing broken links.

Agency: Executive Office of the President: Office of Management and Budget
Status: Open

Comments: According to OMB, in conjunction with its annual data call, the agency has and will continue to provide guidance to agencies about improving the transparency and usability of their websites, including the need to update broken links. In addition OMB issued M-19-15, designed to address a number of related and additional implementation concerns, including transparency and procedural improvements. OMB's guidance to date has not included specific items as specified in the recommendation. We will continue to monitor OMB's efforts related to this recommendation.

Recommendation: To improve the data on tracked safety issues and postmarket studies that are needed for required reporting and for systematic oversight of postmarket drug safety, the Secretary of HHS should direct the Commissioner of FDA to work with stakeholders within FDA to identify additional improvements that could be made to FDA's current database or future information technology investments to capture information in a form that can be easily and systematically used by staff for oversight purposes.

Agency: Department of Health and Human Services
Status: Open

Comments: FDA has made changes intended to improve its process for overseeing tracked safety issues, but as of August 2020, FDA was still working on changes to its process for postmarket study data. For tracked safety issues, FDA held a one-day workshop to solicit input from staff on changes to its tracked safety issue process and collect user requirements for a new IT system to support tracking safety issues. In April 2020, FDA finalized new policies and procedures and implemented a new IT system for tracking safety issues. The new IT system allows anyone within FDA's Center for Drug Evaluation and Research to enter new safety signals and has integrated product and adverse event dictionaries. FDA stated that integrating standardized data will support consistent regulatory decisions and improve the quality of analysis. For postmarket studies, FDA has indicated that it intends to formally assess the IT needs of users as part of the planned transfer of postmarket data to its new informatics platform. As of August 2020, FDA anticipated creating a project team to address specific concerns related to postmarket study data by the end of calendar year 2020 or the beginning of calendar year 2021. GAO is keeping this recommendation open until FDA has completed its planned improvements to its process for tracking postmarket study data.

Recommendation: To improve the public reporting about how agencies are ensuring the quality of performance information used to measure progress towards their priority goals, the Secretaries of Agriculture, Defense, Homeland Security, Interior, and Labor, and the Administrator of NASA should more fully address GPRAMA requirements and OMB guidance by working with OMB to describe on Performance.gov how they are ensuring the quality of performance information used to measure progress towards their APGs.

Agency: Department of Agriculture
Status: Open

Comments: The Department of Agriculture (USDA) has identified five priority goals (APGs) for fiscal years 2020 and 2021. USDA states that action plans and progress updates for these goals are "coming soon". In a November 2018 letter to the Comptroller General, USDA's Inspector General acknowledged that additional efforts are needed to better describe the quality of the data supporting the APGs and said that the Department will increase the amount of information provided in the quarterly APG updates. In April 2020, we followed up and once more requested updated information from USDA officials. As of May 6, 2020, we have not received the requested information. We will continue to monitor USDA's efforts to address our recommendation.

Recommendation: To improve the public reporting about how agencies are ensuring the quality of performance information used to measure progress towards their priority goals, the Secretaries of Agriculture, Defense, Homeland Security, Interior, and Labor, and the Administrator of NASA should more fully address GPRAMA requirements and OMB guidance by working with OMB to describe on Performance.gov how they are ensuring the quality of performance information used to measure progress towards their APGs.

Agency: Department of Defense
Status: Open

Comments: The Department of Defense (DOD) has identified three priority goals (APGs) for fiscal years 2020 and 2021. DOD states action plans and progress updates are "coming soon" for Performance.gov. In March 2020, DOD officials reported that they continue to work to address our recommendation. We will continue to monitor DOD's efforts to address our recommendation.

Recommendation: To improve the public reporting about how agencies are ensuring the quality of performance information used to measure progress towards their priority goals, the Secretaries of Agriculture, Defense, Homeland Security, Interior, and Labor, and the Administrator of NASA should more fully address GPRAMA requirements and OMB guidance by working with OMB to describe on Performance.gov how they are ensuring the quality of performance information used to measure progress towards their APGs.

Agency: Department of the Interior
Status: Open

Comments: The Department of the Interior (Interior) has identified six priority goals (APGs) for fiscal years 2020 and 2021. Interior states on Performance.gov that action plans and progress updates are "coming soon". We will continue to monitor Interior's efforts to address our recommendation.

Recommendation: To improve the public reporting about how agencies are ensuring the quality of performance information used to measure progress towards their priority goals, the Secretaries of Agriculture, Defense, Interior, and Labor, and the Administrator of NASA should more fully address GPRAMA requirements and OMB guidance by describing in their agencies' annual performance plans and reports how they are ensuring the quality of performance information used to measure progress towards their APGs.

Agency: Department of Agriculture
Status: Open

Comments: The Department of Agriculture's (USDA) Fiscal Year 2021 Annual Performance Plan and Fiscal Year 2019 Annual Performance Report provides a general statement on how the agency uses a standardized methodology to measure its performance and that agency officials attest to the quality of the performance information. USDA also identifies its priority goals for fiscal years 2020 and 2021, but specific data quality explanation is not provided for these APGs. In a November 2018 letter to the Comptroller General, USDA's Inspector General stated that the Department agrees with the recommendation and will begin providing data quality explanation for the APGs in its next annual performance plan and report to be published in February 2019, but our review in 2019 found no such explanation. Further, as noted above the most recent plan and report do not provide the required explanation. In April 2020, we once more requested updated information from USDA officials and as of May 6, 2020 have not received the requested information. We will continue to monitor USDA's efforts to address our recommendation.

Recommendation: To improve the public reporting about how agencies are ensuring the quality of performance information used to measure progress towards their priority goals, the Secretaries of Agriculture, Defense, Interior, and Labor, and the Administrator of NASA should more fully address GPRAMA requirements and OMB guidance by describing in their agencies' annual performance plans and reports how they are ensuring the quality of performance information used to measure progress towards their APGs.

Agency: Department of Defense
Status: Open

Comments: The Department of Defense's (DOD) Fiscal Year (FY) 2021 Annual Performance Plan and FY2019 Annual Performance Report states that, "each goal owner has attested the performance results and narrative information included in this report is complete, accurate, and reliable; and that data validation and verification procedures are documented and available upon request," and DOD refers readers to Performance.gov for more information about its priority goals (APGs). However, the GPRA Modernization Act of 2010 requires agencies to publish more specific data quality explanation for each APG in performance plans and reports and on Performance.gov. DOD's performance plan and report does not contain the more specific explanation required. Nor did our review of Performance.gov find the required explanation. In March 2020, DOD officials reported that they continue to work to address our recommendation. We will continue to monitor DOD's efforts to address our recommendation.

Recommendation: To improve the public reporting about how agencies are ensuring the quality of performance information used to measure progress towards their priority goals, the Secretaries of Agriculture, Defense, Interior, and Labor, and the Administrator of NASA should more fully address GPRAMA requirements and OMB guidance by describing in their agencies' annual performance plans and reports how they are ensuring the quality of performance information used to measure progress towards their APGs.

Agency: Department of the Interior
Status: Open

Comments: The Department of the Interior's (Interior) 2021/2020 Annual Performance Plan & 2019 Report (APP&R) includes a section concerning data accuracy and reliability and describes in general terms how Interior ensures the accuracy and reliability of performance information and how it addresses the five data quality requirements in the GPRA Modernization Act of 2010. Interior states in this section that measurement procedures for agency performance goals are described on Performance.gov. As of May 2020, our review found that Interior has not provided specific data quality explanation for its APGs on Performance.gov. We will continue to monitor Interior's efforts to address our recommendation.

Recommendation: To strengthen oversight of the individual shared responsibility and premium tax credit provisions, the Commissioner of Internal Revenue should assess whether or not the data received from the health insurance marketplaces are sufficiently complete and accurate to enable effective correction of tax returns at-filing based on matching with the marketplace data and, if the assessment determines that such corrections would be effective, seek legislative authority to correct tax returns at-filing based on the marketplace data.

Agency: Department of the Treasury: Internal Revenue Service
Status: Open

Comments: The Internal Revenue Service (IRS) agreed with GAO's recommendation. IRS reports that the quality of data submitted by health insurance marketplaces has improved since the 2015 return filing season, and it continues to use its correspondence process for resolving discrepancies between marketplace data and that reported by the taxpayer after the return has been filed. IRS has not considered requesting legislative authority to correct tax returns at the time of filing based specifically on discrepancies between the data submitted by the health insurance marketplace and reported by the taxpayer. Agency officials believe that would be premature at this time. They noted that a broader legislative initiative has already been proposed that would grant IRS with correctable error authority in cases where the information provided by the taxpayer does not match the information contained in government databases. Should this broad authority be granted in the future, IRS will then consider how to approach correction of tax returns at the time of filing based on discrepancies with health insurance marketplace data. Such authority was also included in the Administration's 2021 budget.

Recommendation: To strengthen oversight of the individual shared responsibility and premium tax credit provisions, the Commissioner of Internal Revenue should evaluate IRS efforts to collaborate and communicate with key external stakeholders to inform efforts related to implementation of the new 2015 PPACA requirements.

Agency: Department of the Treasury: Internal Revenue Service
Status: Open

Comments: The Internal Revenue Service (IRS) agreed with GAO's recommendation but has not yet initiated an evaluation of collaboration and communication efforts with external stakeholders. IRS currently utilizes informal feedback processes to share information and identify opportunities for improvement with external stakeholders in implementing the shared responsibility payment and premium tax credit provisions. We continue to encourage IRS to evaluate its collaboration and communication efforts, but such an evaluation has not yet happened. We will continue to monitor IRS efforts.

Recommendation: To help improve CMS's process for establishing relative values for Medicare physicians' services, the Administrator of CMS should better document the process for establishing relative values for Medicare physicians' services, including the methods used to review RUC recommendations and the rationale for final relative value decisions.

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

Comments: To help improve the Centers for Medicare & Medicaid Service's (CMS) process for establishing relative values for Medicare physicians' services, in May 2015 we recommended that the Administrator of CMS better document the process, including the methods used to review recommendations from the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) and the rationale for final relative value decisions. CMS concurred with this recommendation, stating that CMS establishes relative values for new, revised, and potentially misvalued physicians' services based on its review of a variety of sources of information, including the RUC. At that time, CMS officials told us the agency was working to improve the transparency of its process by proposing and finalizing changes to the process in the annual rule for the Physician Fee Schedule. Officials estimated that this process would take several years to complete. In order to close this recommendation as implemented, CMS will need to demonstrate that it has improved its internal and external documentation of its process for establishing relative values. As of June 2020, GAO was still waiting on confirmation from CMS that it had completed its enhancement process for establishing relative values for Medicare physicians' services in a way that would allow for greater transparency and documentation. CMS will need to demonstrate that it has improved its internal and external documentation for establishing relative values in order for GAO to close the recommendation. CMS officials agreed the recommendation should remain open as progress continues.

Recommendation: To help improve CMS's process for establishing relative values for Medicare physicians' services, the Administrator of CMS should develop a process for informing the public of potentially misvalued services identified by the RUC, as CMS already does for potentially misvalued services identified by CMS or other stakeholders.

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

Comments: To help improve the Centers for Medicare & Medicaid Service's (CMS) process for establishing relative values for Medicare physicians' services, in May 2015 we recommended that the Administrator of CMS develop a process for informing the public of potentially misvalued services identified by the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC), as CMS already does for potentially misvalued services identified by CMS or other stakeholders. CMS did not concur with this recommendation, asserting that the RUC is completely independent of CMS, and as such CMS has no authority to set the RUC's agenda for which services are reviewed. As of June 2020, CMS had not changed its position on the recommendation. We continue to believe that CMS needs to inform the public of potentially misvalued services identified by the RUC, as it does for potentially misvalued services identified by other stakeholders. We acknowledge that in 2017 CMS changed its process for establishing relative values by including proposed values for almost all services in the annual proposed rulemaking for the Physician Fee Schedule, which means that the changes in values for potentially misvalued services identified by the RUC are open for public comment before they become effective. However, we continue to believe CMS should inform stakeholders of these potentially misvalued services before CMS receives RUC recommendations for them and subsequently publishes the values in the proposed rule. Doing so would give stakeholders the same amount of time they have to provide input on potentially misvalued services identified by other stakeholders.

Recommendation: To help improve CMS's process for establishing relative values for Medicare physicians' services, the Administrator of CMS should incorporate data and expertise from physicians and other relevant stakeholders into the process as well as develop a timeline and plan for using the funds appropriated by the Protecting Access to Medicare Act of 2014.

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

Comments: To help improve the Centers for Medicare & Medicaid Service's (CMS) process for establishing relative values for Medicare physicians' services, in May 2015 we recommended that the Administrator of CMS incorporate data and expertise from physicians and other relevant stakeholders into the process, as well as develop a timeline and plan for using the funds appropriated by the Protecting Access to Medicare Act of 2014 (PAMA). CMS concurred with this recommendation, stating that stakeholders have the opportunity each year to nominate potentially misvalued services for review through a public nomination process. In August 2017, CMS officials reported that the final rulemaking for the 2017 Physician Fee Schedule included a data collection effort using PAMA funds and other authorities that will help furnish data to help in valuations for more than half of physician services. However, this effort pertains to global services, which are a specific type of service under the Physician Fee Schedule that include global, professional, and technical components, and does not apply to non-global services, which encompass almost half of physician services. Officials also reported that they had awarded a contract to explore data collection on practice expense and methodologies for using such data when valuing services in the Physician Fee Schedule. However, CMS did not indicate a specific timeline and plan for using the PAMA funds, just that the agency would continue to use these funds to explore more ways to gain improved data. In March 2018, CMS reported that it now incorporates data and expertise from relevant stakeholders-apart from the RUC-into its process for establishing relative values by including any new, revised, or potentially misvalued values in the annual proposed rulemaking, instead of establishing them on an interim final basis in the final rule. This means that the changes in values for services will be open for public comment prior to the implementation of changes to payment. We acknowledge that CMS has made progress towards meeting our recommendation by changing its process to allow for public comments on proposed changes to relative values before they go into effect. CMS has also made progress by beginning to use PAMA funds to assist with valuing global services and exploring avenues for collecting practice expense data. To close this recommendation, we need documentation that CMS has started to incorporate data more broadly into its process for establishing relative values and that it has a documented timeline and plan for how it will use the funds appropriated by the Protecting Access to Medicare Act of 2014. As of June 2020, we had not received this documentation.

Recommendation: To improve the military whistleblower reprisal investigation process and oversight of such investigations, the Secretary of Defense should work in coordination with the Department of Defense Inspector General (DODIG) to direct the services to follow standardized investigation stages and issue guidance clarifying how the stages are defined.

Agency: Department of Defense
Status: Open

Comments: DOD officials concurred with this recommendation and provided an update in May 2019, in which they stated that the office was preparing an issuance for coordination that will direct the services to follow standardized investigation stages and guidance clarifying how the stages are defined. DOD officials estimated that the issuance would be completed by December 31, 2019.

Recommendation: To further improve its production verification efforts and to provide greater assurance that BLM staff are consistently applying the new guidance to commingling agreement requests and determine whether the guidance corrected deficiencies and produced improvements, the Secretary should direct BLM to schedule and complete the internal review as expeditiously as possible.

Agency: Department of the Interior
Status: Open

Comments: In July 2019, Interior officials stated BLM will not be conducting a separate internal review of the guidance for commingling agreement requests issued in July 2013. However, officials stated they are committed to performing the internal review as part of the internal review on its inspection and enforcement program and believed their pending actions related to implementing the recommendations in the GAO report "Oil and Gas Development: Actions Needed to Improve Oversight of the Inspection and Enforcement Program" (GAO-19-7) would also address this recommendation. Interior officials stated the target date for implementing this recommendation is June 30, 2021.

Recommendation: In addition to implementing our previous recommendations, to effectively implement key elements of the IRS information security program, the Commissioner of Internal Revenue should ensure that control testing methodology and results fully meet the intent of the control objectives being tested.

Agency: Department of the Treasury: Internal Revenue Service
Status: Open
Priority recommendation

Comments: During our audit of IRS's FY 2019 financial statements, , the agency submitted this recommendation for closure, but our testing determined it should remain open. Subsequently, IRS updated its anticipated closure date for the recommendation to July 2020. As part of our FY 2020 audit, we will continue to monitor IRS's progress in ensuring that its control testing methodology and results fully meet the intent of the control objectives being tested.

Recommendation: In addition to implementing our previous recommendations, to effectively implement key elements of the IRS information security program, the Commissioner of Internal Revenue should update the remedial action verification process to ensure actions are fully implemented.

Agency: Department of the Treasury: Internal Revenue Service
Status: Open
Priority recommendation

Comments: During the audit of IRS's FY 2019 financial statements, the agency submitted this recommendation for closure, but our testing determined that it should remain open. While IRS continued to make positive steps to address our recommendation, the agency's implementation of corrective actions did not fully address it. As part of our FY 2020 audit, we will continue to monitor IRS's progress in strengthening its remedial action verification process and ensuring its corrective actions are fully implemented.

Recommendation: To improve DOD's ability to collect and maintain reliable data on its acquisitions, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology, and Logistics, in consultation with DOD components, to establish guidelines on what constitutes a "current" ACAT II or III program for reporting purposes; the types of programs, if any, that do not require ACAT designations; and whether the rules for identifying current MDAPs would be appropriate for ACAT II and III programs.

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with our recommendation and stated that it planned to review existing policy to see if revisions were needed. Since that time, DOD has taken some steps to implement this recommendation, but has not established department-wide guidelines as we recommended. Starting in September 2018, DOD began providing the military departments with a capability to identify ACAT II and III programs using the Defense Acquisition Visibility Environment (DAVE) system. The DAVE system is now considered to be a trusted source for ACAT II and III program data. DOD, in consultation with the military departments, established standard data elements for collection across ACAT II and III programs for inclusion in DAVE, but the military departments determine individually what constitutes a "current" program and the types of programs that do not require ACAT designations. As of August 2019, the Army and Navy have established guidance regarding what constitutes an active ACAT II or III program for reporting purposes. We have requested an update on DOD's recent actions to address this recommendation, but have not received information as of September 2020. We will continue to monitor DOD's progress in implementing this recommendation.

Recommendation: To improve DOD's ability to collect and maintain reliable data on its acquisitions, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology, and Logistics, in consultation with DOD components, to determine what metrics should be used and what data should be collected on ACAT II and III programs to measure cost and schedule performance; and whether the use of DAMIR and the MDAP selected acquisition report format may be appropriate for collecting data on ACAT II and III programs.

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with our recommendation and stated that it planned to review existing policy to see if revisions were needed. DOD has taken steps to implement this recommendation, but has yet to determine at the department level what metrics should be collected on ACAT II and III cost and schedule performance as we recommended. DOD determined that the use of the Defense Acquisition Visibility Environment (DAVE) system, which is closely related to DAMIR, was appropriate to collect information on ACAT II and III programs and has made that system available to the military departments. Specifically, DOD provided the military departments with the capability to identify ACAT II and III programs in DAVE/DAMIR in September 2018 and made the DAVE/DAMIR Acquisition Program Baseline (APB) workflow tool for cost and schedule data collection available for components' use in April 2019. However, according to officials from the Office of the Under Secretary of Defense for Acquisition and Sustainment, the military departments are responsible for individually determining what cost and schedule metrics to collect and monitor for ACAT II and III programs. According to December 2018 Army guidance, the Army will require all ACAT II and III programs use DOD's APB tool by the end of fiscal year 2019 to capture baseline cost, schedule, and performance parameters for ACAT II and III programs. According to Navy officials, the Navy is developing an APB tool in its for a future update of its acquisition information system that will collect APB cost and schedule information for ACAT II and III programs. We have requested an update on DOD's recent actions to address this recommendation, but have not received information as of September 2020. We will continue to monitor DOD's progress in implementing this recommendation.

Recommendation: To improve DOD's ability to collect and maintain reliable data on its acquisitions, the Secretary of Defense should direct the Secretaries of the Air Force, Army, and Navy and the Commander of SOCOM to assess the reliability of data collected on ACAT II and III programs and work with PEOs to develop a strategy to improve procedures for the entry and maintenance of data.

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with our recommendation and stated that it would direct DOD components to evaluate data on ACAT II and III programs and report back on the reliability of the data and plans to improve it. In September 2015, the Assistant Secretary of Defense directed the military departments and DOD components to assess the reliability of ACAT II and III data, but in July 2018, the Office of the Under Secretary of Defense for Acquisition & Sustainment confirmed that based on the results of the assessments reported by the components, it does not plan to take any additional action to implement this recommendation. Since that time, as of September 2018, DOD began providing standard data elements and definitions of those elements that it collects for ACAT II and III program identification in order to improve the consistency of data. However, officials from the Office of the Under Secretary of Defense for Acquisition and Sustainment stated that it is still up to the military departments to ensure the accuracy of data entered. We have requested an update on DOD's recent actions to address this recommendation, but have not received information as of September 2020. We will continue to monitor DOD's progress in implementing this recommendation.

Recommendation: To improve DOD's ability to collect and maintain reliable data on its acquisitions, the Secretary of Defense should direct the Secretaries of the Air Force, Army, and Navy and the Commander of SOCOM to develop implementation plans to coordinate and execute component initiatives to improve data on ACAT II and III programs.

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with our recommendation and stated that it would direct DOD components to evaluate data on ACAT II and III programs and report back plans to improve it. In September 2015, the Office of the Assistant Secretary of Defense for Acquisition requested that DOD components provide an update on their plans to improve the availability and quality of ACAT II and III data. In July 2018, the Office of the Under Secretary of Defense for Acquisition & Sustainment confirmed that based on an assessment of the information reported by the components, it does not plan to take any additional action to implement this recommendation. Officials from the Office of the Under Secretary of Defense for Acquisition & Sustainment reiterated in August 2019 that while DOD now provides a department-wide system to be used for collecting basic program data for ACAT II and III programs, it remains the responsibility of the military departments to enter complete and accurate data. We have requested an update on DOD's recent actions to address this recommendation, but have not received information as of September 2020. We will continue to monitor DOD's progress in implementing this recommendation.

Recommendation: To help ensure compliance with relevant provisions of DOD acquisition policy with the purpose of improving DOD's ability to provide oversight for ACAT II and III programs, including those programs that may become MDAPs, the Secretary of Defense should direct the Secretary of the Air Force and Commander of SOCOM to establish a mechanism to ensure compliance with APB requirements in DOD policy.

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with our recommendation and stated that the Office of the Under Secretary of Defense for Acquisition, Technology, and Logistics would issue guidance to DOD components related to APB requirements for ACAT II and III programs. DOD has taken some steps related to this recommendation. In September 2015, the Office of the Assistant Secretary of Defense for Acquisition requested that DOD components review their mechanisms for establishing and enforcing the APB requirements for all ACAT II and III programs. In July 2018, the Office of the Under Secretary of Defense for Acquisition & Sustainment confirmed that, based on the results of these reviews, it does not plans to take any action to implement this recommendation. However, in 2019, DOD made its DAVE/DAMIR APB workflow tool available for military department use, and the Air Force elected to use the tool to create and track APBs for ACAT II and III programs. We have requested an update on DOD's recent actions to address this recommendation, but have not received information as of September 2020. We will continue to monitor DOD's progress in implementing this recommendation.

Recommendation: To help ensure compliance with relevant provisions of DOD acquisition policy with the purpose of improving DOD's ability to provide oversight for ACAT II and III programs, including those programs that may become MDAPs, the Secretary of Defense should direct the Secretaries of the Air Force, Army, and Navy to improve component procedures for notifying the Defense Acquisition Executive of programs with a cost estimate within 10 percent of ACAT I cost thresholds.

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with our recommendation and stated that the Office of the Under Secretary of Defense for Acquisition, Technology, and Logistics would issue guidance to DOD components related to notification requirements for programs approaching ACAT I cost thresholds. The Army and Navy have reiterated existing guidance and the Air Force is evaluating additional actions it might take to improve its notification procedures. The Office of the Under Secretary of Defense for Acquisition & Sustainment confirmed in July 2018 that it does not plan to take additional actions to implement this recommendation, and as of August 2019, that office has not directed DOD components to improve their processes as we recommended .We have requested an update on DOD's recent actions to address this recommendation, but have not received information as of September 2020. We will continue to monitor DOD's progress in implementing this recommendation.

Recommendation: To address the limitations of existing distribution performance metrics, the Secretary of Defense should direct the Under Secretary of Defense for Acquisition, Technology and Logistics, in conjunction with TRANSCOM, to revise guidance to ensure that a customer wait time standard is established and used for the Marine Corps.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation. In September 2016, the Marine Corps established a Customer Wait Time (CWT) standard and developed CWT metrics that are in alignment with DOD policy. These changes were to be incorporated into Marine Corps policy through their normal Service procedures. As of August 2020, the Marine Corps has the CWT standard included in its new policy document, but the policy is going through internal coordination and is still in draft at this time. Current timeframe for publication is January 2021. Once we confirm the CWT standard is in the issued policy, we will close the recommendation.

Recommendation: To ensure that MA encounter data are of sufficient quality for their intended purposes, the Administrator of CMS should establish specific plans and time frames for using the data for all intended purposes in addition to risk adjusting payments to MAOs.

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

Comments: HHS generally agreed with this recommendation. Although CMS reports using MA encounter data for purposes other than risk adjustment, as of February 2020, it has not fully developed specific plans and time frames with dates for all uses. CMS reports that it has begun testing the use of MA encounter data for public health purposes, such as identifying beneficiaries with a history of opioid-related overdose and with other conditions, such as cancer and sickle cell. Further, CMS uses MA encounter data to help identify beneficiaries at risk in areas affected by public health emergencies. CMS reports that its Office of the Actuary (OACT) has used MA encounter data to analyze MA beneficiary utilization of certain Part B drugs. Further, OACT reports that it intends to assess other areas where it could use MA encounter data, such as analyses comparing Medicare fee-for-service and MA. As of February 2020, the agency has not developed specific plans and time frames for this and other intended purposes. For example, although CMS intends to use MA encounter data for program integrity purposes, it has not yet developed specific plans and time frames to do so. We will continue to monitor CMS's progress in developing specific plans and time frames with dates for all intended purposes of MA encounter data.

Recommendation: To ensure that MA encounter data are of sufficient quality for their intended purposes, the Administrator of CMS should complete all the steps necessary to validate the data, including performing statistical analyses, reviewing medical records, and providing MAOs with summary reports on CMS's findings, before using the data to risk adjust payments or for other intended purposes.

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

Comments: HHS generally agreed with this recommendation, however, HHS did not commit to completing data validation before using MA encounter data for risk adjustment. As of February 2020, CMS has continued to make progress in examining the completeness and accuracy of MA encounter data, but more work remains to fully validate these data. CMS has developed and is implementing an MA Encounter Data Integrity and Monitoring plan, which includes data analysis, guidance, and monitoring. As part of this plan, CMS has established preliminary performance metrics for MA encounter data completeness and accuracy. CMS is also conducting analyses related to accuracy and completeness, but has not established performance benchmarks for these analyses. While the agency plans to communicate findings from the analyses to Medicare Advantage organizations, it has not yet done so. Finally, CMS has not verified MA Encounter data by reviewing medical records. While these steps are encouraging, without fully validating the completeness and accuracy of MA encounter data, CMS would be unable to confidently use these data for risk adjustment or other program management or policy purposes.

Recommendation: To improve the completeness and accuracy of data submissions to the USASpending.gov website, the Director of the Office of Management and Budget, in collaboration with Treasury's Fiscal Service, should clarify guidance on (1) agency responsibilities for reporting awards funded by non-annual appropriations; (2) the applicability of USASpending.gov reporting requirements to non-classified awards associated with intelligence operations; (3) the requirement that award titles describe the award's purpose (consistent with our prior recommendation); and (4) agency maintenance of authoritative records adequate to verify the accuracy of required data reported for use by USASpending.gov.

Agency: Executive Office of the President: Office of Management and Budget
Status: Open
Priority recommendation

Comments: OMB has taken several steps related to this recommendation as of December 2019, but have not fully addressed it. Specifically, working with the Department of the Treasury to implement the DATA Act, OMB took partial action on two aspects of the recommendation and are still considering actions on two others. 1) OMB staff said they continue to deliberate on agency responsibilities for reporting awards funded by non-annual appropriations. 2) OMB staff provided a Frequently Asked Question (FAQ) addressing the applicability of USASpending.gov reporting requirements for recipient information related to classified or sensitive information. GAO reviewed the FAQ and determined that additional guidance is still needed to ensure complete reporting of unclassified awards as required by FFATA. 3) OMB staff have agreed that it will be important to clarify guidance on how agencies can report on award titles that appropriately describes the awards' purposes and noted that they are working on providing additional guidance to agencies as part of their larger DATA Act implementation efforts. 4) OMB released policy guidance in May 2016 (MPM 2016-03) that identifies the authoritative sources for reporting procurement and award data. However, GAO's review of this policy guidance determined that it does not address the underlying source that can be used to verify the accuracy of non-financial procurement data or any source for data on assistance awards.

Recommendation: While IRS works to improve the quality of its Schedule K-1 data, the Commissioner of Internal Revenue should develop a plan for conducting testing or other analysis to determine whether the improved Schedule K-1 data, perhaps combined with other IRS information about businesses and taxpayers, could be used more effectively to ensure compliance with the reporting of flow-through income.

Agency: Department of the Treasury: Internal Revenue Service
Status: Open

Comments: IRS stated that it understands the objective of this recommendation and, at such time that resources are available to enhance capabilities, it would consider the proposed methodology of advanced testing. However, based on current and anticipated budget constraints, it does not expect its plans to change in the near future. As of September 2020, there has been no change. As such we will continue to monitor progress.

Recommendation: To enhance its oversight of drug shortages, particularly as the agency fine-tunes the manner in which it gathers data on shortages and transitions from its database to a more robust system, the Commissioner of FDA should conduct periodic analyses using the existing drug shortages database (and, eventually, the new drug shortages information system) to routinely and systematically assess drug shortage information, and use this information proactively to identify risk factors for potential drug shortages early, thereby potentially helping FDA to recognize trends, clarify causes, and resolve problems before drugs go into short supply.

Agency: Department of Health and Human Services: Food and Drug Administration
Status: Open

Comments: In September 2018, FDA told us that it was using its drug shortage data system, the "Shortage Tracker," to summarize information reported by manufacturers as the reasons for existing shortages. The agency indicated that it was developing a model that would factor in drug shortage data, warning signs identified through social media, and other factors to help identify early indicators that may predict future shortages. In July 2019, the agency indicated it could conduct periodic analyses of the causes of drug shortages. However, FDA had not yet proactively conducted any rigorous analyses of predictors of drug shortages to help recognize trends, clarify causes, and resolve problems before drugs go into short supply. In an August 2020 written response, FDA reported that it was undertaking modeling efforts to explore the feasibility of predicting future drug shortages using machine learning approaches. FDA planned to complete the initial modeling by fall 2020, at which time it would identify next steps. The agency indicated that the recommendation should remain open, and GAO will continue to monitor the implementation of this recommendation.

Recommendation: To take advantage of opportunities to collect UCMR data on additional unregulated contaminants, Congress should consider amending SDWA to give EPA the flexibility to select more than 30 contaminants for monitoring under the UCMR program if high-priority contaminants, such as those on the Contaminant Candidate List (CCL) or contaminants of emerging concern, can be included at minimal cost, with minimal additional burden on public water systems, and while using analytical methods that EPA is already employing.

Agency: Congress
Status: Open

Comments: As of July 2020, Congress has not taken action to address this matter; we will continue to monitor actions and provide updated information when it becomes available.

Recommendation: To optimize the ability of the UCMR data to support regulatory determinations, Congress should consider adjusting the statutory time frames for the UCMR and regulatory determinations cycles so that EPA can use the UCMR data to support regulatory determinations in the same cycle.

Agency: Congress
Status: Open

Comments: As of July 2020, Congress has not taken action to address this matter; we will continue to monitor actions and provide updated information when it becomes available.

Recommendation: To help ensure that qualified CDRs promote improved quality and efficiency of physician care for Medicare beneficiaries, the Secretary of Health and Human Services should direct CMS to establish a requirement for qualified CDRs to demonstrate improvement on key measures of quality and efficiency for their target populations.

Agency: Department of Health and Human Services
Status: Open

Comments: As of April 2019, HHS officials reported that they were implementing new requirements for qualified CDRs, but these requirements were not related to demonstrating improvement on the measures of quality and efficiency, as GAO recommended. We will update the status of this recommendation when we receive additional information.

Recommendation: To help ensure that qualified CDRs promote improved quality and efficiency of physician care for Medicare beneficiaries, the Secretary of Health and Human Services should direct CMS to establish a process for monitoring compliance with requirements for qualified CDRs that draws on relevant expert judgment. This process should assess CDR performance on each requirement in a way that takes into account the varying circumstances of CDRs and their available opportunities to promote quality and efficiency improvement for their target populations.

Agency: Department of Health and Human Services
Status: Open

Comments: As of April 2019, HHS officials have not informed us of any actions taken to implement this recommendation. We will update the status of this recommendation when we receive additional information.

Recommendation: To help ensure that qualified CDRs promote improved quality and efficiency of physician care for Medicare beneficiaries, the Secretary of Health and Human Services should determine and implement actions to reduce barriers to the development of qualified CDRs, such as (1) developing guidance that clarifies Health Insurance Portability and Accountability Act requirements to promote participation in qualified CDRs; (2) working with private sector entities to make relevant multipayer cost data available to qualified CDRs; (3) testing one or more models of shared savings between Medicare and qualified CDRs that achieve reduced Medicare expenditures with improved quality of care, and (4) providing technical assistance to qualified CDRs.

Agency: Department of Health and Human Services
Status: Open

Comments: As of April 2019, HHS officials have not informed us of any actions taken to implement this recommendation beyond providing limited technical assistance to qualified CDRs through monthly support calls and an annual kick-off meeting. We will update the status of this recommendation when we receive additional information.

Recommendation: To help ensure that qualified CDRs promote improved quality and efficiency of physician care for Medicare beneficiaries, the Secretary of Health and Human Services should determine key data elements needed by qualified CDRs--such as those relevant for a required core set of measures--and direct Office of the National Coordinator for Health Information Technology and CMS to include these data elements, if feasible, in the requirements for certification of EHRs under the EHR incentive programs.

Agency: Department of Health and Human Services
Status: Open

Comments: As of April 2019, HHS officials have not informed us of any actions taken to implement this recommendation. We will update the status of this recommendation when we receive additional information.

Recommendation: To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's methodology for estimating and comparing the full cost of its various workforces, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation to further develop guidance for cost elements that users have identified as challenging to calculate, such as general and administrative, overhead, advertising and recruiting, and training.

Agency: Department of Defense
Status: Open

Comments: According to DOD's April 2017 report on Comparing the Cost of Civilians and Contractors, DOD's Cost Assessment and Program Evaluation (CAPE) office is updating fiscal year 2017 estimates in its Full Cost of Manpower (FCoM) system to reflect separate officer and enlisted training costs. If more specific cost estimates are required, users of FCoM are directed to cost estimating tools operated by the military departments.

Recommendation: To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's methodology for estimating and comparing the full cost of its various workforces, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation to develop business rules for estimating the full cost of National Guard and Reserve personnel.

Agency: Department of Defense
Status: Open

Comments: According to DOD's April 2017 report in Comparing the Cost of Civilians and Contractors, a cost estimating function for Reserve Component personnel far exceeds the combination of variables for developing active component and DOD civilian cost estimates. Due to the scope of the Full Cost of Manpower (FCoM) contract, OSD(CAPE) has not adopted this recommendation in terms of a web-based application. However, OSD(CAPE) intends to address general business rules for Reserve Component cost estimates in the next DoDI revision.

Recommendation: To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's methodology for estimating and comparing the full cost of its various workforces, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation, in coordination with the department's Office of the Actuary and appropriate federal actuarial offices, to reevaluate the inclusion and quantification of pension, retiree health care costs, and other relevant costs of an actuarial nature and make revisions as appropriate.

Agency: Department of Defense
Status: Open

Comments: According to DOD's April 2017 report on Comparing the Cost of Civilians and Contractors, OSD(CAPE) has reviewed the inclusion of payments that the government makes to retirement and health benefits. All identified costs that are attributable to current retirees and past service of active civilian and military personnel, such as unfunded liabilities, are being revised in the cost estimating guidelines. OSD(CAPE) intends to incorporate these changes in the next DoDI revision and coordinate a review with the Office of the DoD Actuaty.

Recommendation: To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's ability to estimate contractor support costs, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation, consistent with established practices for developing credible cost estimates, to research the data sources it is currently using and reassess its contractor support data sources for use when determining contractor support costs.

Agency: Department of Defense
Status: Open

Comments: According to DOD's April 2017 report on Comparing the Cost of Civilian and Contractors, the department's efforts to improve data sources are ongoing.

Recommendation: To improve EPA's management of the conditional registration process, the Administrator of EPA should direct the Director of the Office of Pesticide Programs to complete plans to automate data related to conditional registrations to more readily track the status of these registrations and related registrant and agency actions and identify potential problems requiring management attention.

Agency: Environmental Protection Agency
Status: Open

Comments: As of August 2020, EPA's Office of Pesticide Programs is providing status information on conditional registrations issued from 2000 through 2020 on the web at https://www.epa.gov/pesticide-registration/conditional-pesticide-registration. However, because plans are not yet complete for automating data related to conditional registrations to more readily track their status and related information, this recommendation remains open. According to EPA, due to the government shutdown and delays in the award of its mission support IT contract, IT modernization efforts enabling the Office of Pesticide Programs to track conditionally registered products electronically are now targeted for completion in 2021 rather than 2020.

Recommendation: To improve NASA management and oversight of its spaceflight projects, and to improve the reliability of project EVM data, the NASA Administrator should direct the appropriate offices to modify the NASA Procedural Requirements (NPR) 7120.5 to require projects to implement a formal surveillance program that: (1) Ensures anomalies in contractor-delivered and in-house monthly earned value management reports are identified and explained, and report periodically to the center and mission directorate's leadership on relevant trends in the number of unexplained anomalies. (2) Ensures consistent use of work breakdown structures (WBS) for both the EVM report and the schedule. (3) Ensures that lower level EVM data reconcile to project level EVM data using the same WBS structure. (4) Improves underlying schedules so that they are properly sequenced using predecessor and successor dependencies and are free of constraints to the extent practicable so that the EVM baseline is reliable.

Agency: National Aeronautics and Space Administration
Status: Open
Priority recommendation

Comments: NASA partially agreed with this recommendation, stating that the reliability and utility of the EVM data needed to be improved but that it did not plan to implement a formal surveillance plan due to resource constraints. Since initially commenting on the report, however, in December 2018, NASA included an initiative in its Corrective Action Plan-a plan put in place in response to recent programmatic performance and NASA's designation on GAO's High-Risk List-to enhance EVM implementation. In June 2019, NASA issued EVM guidance that covered several items, including enhancing in-house and contracted earned value management surveillance and requiring EVM reporting at Baseline Performance Review. NASA officials reported that its near-term plans are well-defined to address the reliability of project EVM data, but they have expressed concerns about funding challenges and cultural resistance. To fully implement this recommendation, NASA will need to take action and provide documentary support for several of its identified planned next steps to enhance EVM surveillance. Without implementing proper surveillance, NASA may be utilizing unreliable EVM data in its analyses to inform its cost and schedule decision making.

Recommendation: To enhance FAA's efforts to improve general aviation safety, the Secretary of Transportation should direct the FAA Administrator to improve measures of general aviation activity by requiring the collection of the number of hours that general aviation aircraft fly over a period of time (flight hours). FAA should explore ways to do this that minimize the impact on the general aviation community, such as by collecting the data at regular events (e.g., during registration renewals or at annual maintenance inspections) that are already required.

Agency: Department of Transportation
Status: Open

Comments: In July 2019, GAO confirmed that FAA still does not plan to collect General Aviation (GA) flight hour data during registration renewals or annual maintenance inspections because this would require rulemaking and could have a significant economic and paperwork impact on the GA industry. While FAA has made changes to the GA Activity Survey to improve the accuracy of the flight hour data collected for a sample of GA populations, FAA still does not plan to collect all GA flight hour data as part of its GA Activity Survey. GAO maintains that without comprehensive GA flight hour data, estimates from the GA Activity Survey may not be sufficient for drawing conclusions about changes in crash rates over time and that more precise flight hour data could allow FAA to better target its safety efforts within the GA industry.

Recommendation: To enhance FAA's efforts to improve general aviation safety, and to ensure that ongoing safety issues are addressed, the Secretary of Transportation should direct the FAA Administrator to set specific general aviation safety improvement goals--such as targets for fatal accident reductions--for individual industry segments using a datadriven, risk management approach.

Agency: Department of Transportation
Status: Open

Comments: In July 2019, GAO confirmed that FAA still does not plan to develop safety targets for different segments of the General Aviation (GA) industry. While FAA's General Aviation Joint Steering Committee was exploring metrics for monitoring different GA industry segments, it was determined that developing credible metrics was not feasible using the GA Activity Survey. GAO maintains that FAA needs to develop specific general aviation safety improvement targets for individual industry segments to support a data-driven, risk management approach.

Recommendation: To enhance FAA's efforts to improve general aviation safety, and to determine whether the programs and activities underlying the 5-year strategy are successful and if additional actions are needed, the Secretary of Transportation should direct the FAA Administrator to develop performance measures for each significant program and activity underlying the 5-year strategy.

Agency: Department of Transportation
Status: Open

Comments: FAA reported it established performance measures for significant programs and activities underlying its 5-year strategy. However, as of July 2019 FAA has still not provided GAO with documentation of these performance measures. Without this documentation, GAO cannot confirm that the agency has developed performance measures for each significant program and activity underlying its 5-year strategy.

Recommendation: To improve DOD's ability to identify how many headquarters personnel it has, including military, civilian and contractor personnel, and improve the information Congress and DOD need to ensure that headquarters organizations are appropriately sized and overhead positions are reduced to the extent possible, the Secretary of Defense should direct the Director of Administration and Management, in consultation with the Under Secretary of Defense for Personnel and Readiness, to revise DOD Instruction 5100.73, Major DOD Headquarters Activities, to (1) include all major DOD headquarters activity organizations, (2) specify how contractors performing major DOD headquarters activity functions will be identified and included in headquarters reporting, (3) clarify how components are to compile the major DOD headquarters activities information needed to respond to the reporting requirements in section 1109 of the fiscal year 2010 National Defense Authorization Act, and (4) establish time frames for implementing the actions above to improve tracking and reporting headquarters resources.

Agency: Department of Defense
Status: Open

Comments: The department partially concurred with this recommendation, stating that while it supports the refinement and update of DOD Instruction 5100.73, it uses the major headquarters activity designation to identify and manage the size of organizations in order to comply with statutory limits on headquarters personnel, not as tool to manage the organizational efficiency of the department or its components. With regard to the element of the recommendation concerning contractors, the department stated that in November of 2011 it had submitted a plan to the congressional defense committees for its Inventory of Contracts for Services that establishes both near and long term actions to improve visibility over all contracted services. This plan, and subsequent guidance issued in December 2011, describes the steps being taken to account for the level of effort of contracted support, based on the activity requiring the service. With regard to the element of the recommendation to meet reporting requirements for major headquarters activities, the department stated it had incorporated this requirement into the Defense Manpower Requirements Report in fiscal year 2012 and 2013. However, as of March 2020, DOD has not completed actions to address three of the four parts of this recommendation. In September 2017, DOD completed a revised framework for major DOD headquarters activities tied to funding, but as of March 2020 has not yet updated DOD Instruction 5100.73 to reflect all major DOD headquarters activity organizations included in the revised framework. DOD has also not identified an approach to include contractor personnel as part of its headquarters reporting. For fiscal year 2020 reporting, DOD intends to rely on the Federal Procurement Data System-Next Generation (FPDS-NG) as the basis for collecting information on contracted services. GAO has previously reported that FPDS-NG has certain limitations, including not being able to (a) identify and record more than one type of service purchased for each contracting action entered into the system, (b) identify the requiring activity specifically, and (c) determine the number of contractor full-time equivalents used to perform each service. Consequently, it is unclear the extent to which using FPDS-NG will enable DOD to determine the number of contractors and the functions they are performing in support of headquarters activities. DOD did clarify how it would respond to section 1109 of the fiscal year 2010 National Defense Authorization Act to satisfy this part of the recommendation. Lastly, DOD has also not yet established time frames for updating DOD Instruction 5100.73 or for determining how contractor personnel are to be included in major DOD headquarters activity reporting.

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 July 2020 there has been no change in the status of this recommendation. EPA, as of September 2019, had not resumed data verification audits to routinely evaluate the quality of the data states provide to the agency. The Safe Drinking Water Information System (SDWIS) Prime and the Compliance Monitoring Data Portal (CMDP) will replace the data verification audits in the future. EPA has made SDWIS Prime available through incremental interim releases to state drinking water agencies for exploring and testing but does not expect to fully release it until mid-2020. However, as of August 2019, SDWIS Prime was unavailable while EPA awaited progress on the SDWIS Modernization Project plan. According to EPA, the CMDP will enable utilities and laboratories to report data electronically to primacy agencies with fewer errors and in a more efficient manner; but it is not clear when it will be fully operational. According to data provided by EPA in September 2019, 10 states were using CMDP to varying degrees. EPA information identified another 6 states that plan to transition to CMDP between September and December 2019, 2 states that plan to transition in 2020, and 12 others that may transition in the future. In the meantime, EPA indicated that the agency will complete nine file reviews in 2019 to verify data in agencies that do not currently use CMDP. EPA's actions may improve its ability to oversee states' implementation of the act and provide more complete and accurate information on compliance, but because EPA's systems to replace data verification audits are not yet fully in place, we are keeping this recommendation open.

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 July 2020 there has been no change in the status of this recommendation. EPA is developing the Safe Drinking Water Information System (SDWIS) Prime, with several efforts underway as of September 2019 as we noted under recommendation 1, but until it is fully operational, EPA will not be able to work with states to establish a national goal for the quality of monitoring violations. EPA noted in 2017 that it expected SDWIS Prime to enable the agency and primacy agencies to better understand the nature of system violations and consider developing goals for monitoring and reporting violations. However, according to EPA, SDWIS Prime will not be released until mid-2020. EPA indicated plans to modify the Annual Public Water System Supervision (PWSS) Program Review requirements but the agency states that it is dependent on approval by the Office of the Inspector General. Despite the ongoing delays to address the call in the recommendation for establishing new goals, we are keeping this recommendation open while EPA continues its efforts to implement SDWIS Prime.

Recommendation: To ensure that information entered into CMS's complaints database is reliable and consistent, the Administrator of CMS should identify issues with data quality and clarify guidance to states about how particular fields in the database should be interpreted, such as what it means to substantiate a complaint.

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

Comments: HHS concurred with this recommendation. In November 2014, CMS officials reported that the agency's Survey and Certification Group was in the early stages of a planned multi-year review of all of its business processes, including those related to nursing home complaint investigations. Officials stated that, as part of that review, agency staff would seek to provide clarification on all aspects of the complaint process, including what it means to substantiate a complaint. In July 2019 CMS officials said some actions have been taken and that they would forward us information. We will update the status of this recommendation when we receive additional information.

Recommendation: To strengthen CMS's assessment of state survey agencies' performance in the management of nursing home complaints, the Administrator of CMS should conduct additional monitoring of state performance using information from CMS's complaints database, such as additional timeliness measures.

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

Comments: In November 2014, CMS officials reported that the fiscal year 2014 protocol for assessment of state agency performance includes a new measure that tracks how soon after the completion of a complaint investigation a state agency uploads data from that investigation to CMS's complaint tracking system. However, the protocol does not call for assessment of the number of days by which state survey agencies miss the deadlines for some complaint investigations--a measure that we suggested could provide a more comprehensive picture of state agency performance. In July 2019 CMS officials said some actions have been taken and that they would forward us information. We will update the status of this recommendation when we receive additional information.

Recommendation: To strengthen and increase accountability of state survey agencies' management of the nursing home complaints process, the Administrator of CMS should clarify guidance to the state survey agencies about the minimum information that should be conveyed to complainants at the close of an investigation.

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

Comments: HHS agreed that CMS needed to take steps to strengthen and increase accountability of state survey agencies' management of nursing home complaints. In November 2014, CMS officials reported that while they believed the CMS State Operations Manual, which specifies procedures for addressing complaints, provides significant guidance regarding the information that state agencies should convey to complainants at the close of an investigation, they would review the guidance to identify any needed changes. In July 2019 CMS officials said some actions have been taken and that they would forward us information. We will update the status of this recommendation when we receive additional information.

Recommendation: To strengthen and increase accountability of state survey agencies' management of the nursing home complaints process, the Administrator of CMS should provide guidance encouraging state survey agencies to prioritize complaints at the level that is warranted, not above that level.

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

Comments: HHS agreed that CMS needed to take steps to strengthen and increase accountability of state survey agencies' management of the nursing home complaints process and stated that CMS would provide clarification and guidance to states to ensure complaints were prioritized at the appropriate level. However, in CMS's fiscal year 2014 protocol for assessment of state agency performance, the prioritization standard still required only that complaints be assigned a priority level at or above the level assigned by CMS reviewers. We remain concerned that defining the standard this way may create an incentive for survey agencies to prioritize some complaints at a higher level than is warranted--which could increase workload and potentially jeopardize the timeliness of investigations that warrant the higher priority level. In July 2019 CMS officials said some actions have been taken and that they would forward us information. We will update the status of this recommendation when we receive additional information.

Recommendation: 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 improve the Bureau's marketing/outreach efforts, the Secretary of Commerce should require the Under Secretary for Economic Affairs as well as the Director of the U.S. Census Bureau to develop mechanisms to increase coordination and communication between the partnership and local census office staff. Possible actions include offering more opportunities for joint training, establishing protocols for coordination, and more effectively leveraging the partnership contact database to better align partnership outreach activities with local needs.

Agency: Department of Commerce
Status: Open
Priority recommendation

Comments: The Department generally agreed with this recommendation. In 2011, the Bureau reported on the agency's assessment of the partnership program. In September 2014, the Bureau's Path to the 2020 Census, identified the Partnership Program as one of the best methods for communicating the importance of response and states its intent to map out details about the Partnership Program in early 2016. As of March 2018, Bureau officials said they were developing coordination mechanisms between partnership and Area Census Office staff for the 2020 Census. For example, the Bureau updated a form it had used during the 2010 Census to track partnership outreach activities to help facilitate information sharing within the Bureau and said it plans to make additional updates. In March 2019, the Bureau informed us that it is assigning at least one partnership specialist to each census office manager to help address this recommendation. As we reported in May 2020, the Bureau had not put in place expectations for how Partnership staff should support area census office staff. We also reported that pluralities of area census office managers we surveyed in March 2020 were dissatsified with the level of clarity of roles and responsibilities of Partnership staff, as well as the level of communication and coordination between Partnership and office staff. To fully implement this recommendation, the Bureau will need to take such steps as documenting for partnership specialists and their area census office manager how they are expected to work together and other significant mechanisms that would increase effectiveness of coordination and communication between partnership and local field office staff.

Recommendation: 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 determine the factors that led to the staffing issues observed during SBE and take corrective actions to ensure more efficient SBE staffing levels in 2020.

Agency: Department of Commerce
Status: Open

Comments: The Department generally agreed with this recommendation. In September 2012, the Bureau issued its assessment of the Service Based Enumeration Program. The assessment reported on the number of individuals counted and the complexities of this special enumeration activity. The assessment did not address the Bureau's approach to staffing this special enumeration activity. In its 2020 Census Operational Plan, issued in October 2017, the Bureau provided a high level overview of reengineered field operations plans but did not provide details on special enumeration efforts. In April 2018, the Bureau provided us with its planned staffing ratios for its Service-Based Enumeration activity for the 2020 Census in comparison to those used in the 2010 Census, as well as results of its 2016 Census Test of SBE activity. As of August 2020 we have ongoing work that will be examining implementation of peak field operations and providing updates to this recommendation. In order to fully implement this recommendation, the Bureau needs to demonstrate that its planning for how it will determine staffing levels for SBE takes into account the factors that led to inefficient staffing allocation previously.

Recommendation: 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.

Agency: Department of Commerce
Status: Open
Priority recommendation

Comments: 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 the level of coverage of various hard-to-enumerate populations generally without attributing coverage to specific enumeration activities. Since 2015, the Bureau has issued annual updates of its 2020 Census Operational Plans, which have not provided details of plans for various special enumeration activities. In April 2017 Bureau officials provided us with evaluation results of its 2010 communication efforts and other documents related to ongoing efforts to reduce errors in the census. As of August 2020, we are in communication with Bureau officials about steps they are taking to implement this recommendation. To fully implement this recommendation, the Bureau needs to demonstrate how it is relying on data about how various special enumeration activities of historically hard-to-enumerate groups contributed to census coverage in 2010 to inform its design for the 2020 Census.

Recommendation: To help ensure that Congress is fully apprised of efforts to resolve a case, Congress may wish to consider amending USERRA to require DOJ and OSC to report on additional time taken to resolve a matter after they decline representation.

Agency: Congress
Status: Open

Comments: As of February 4, 2020, this matter has not yet been considered by Congress.

Recommendation: To help ensure that that servicemembers who file complaints are adequately being informed of their USERRA complaint process rights in accordance with VBIA 2008, Congress may wish to consider amending USERRA to require DOL to report on the extent to which it is notifying complainants of their USERRA complaint process rights within 5 days of filing a complaint.

Agency: Congress
Status: Open

Comments: As of February 4, 2020, this matter has not yet been considered by Congress.

Recommendation: To help ensure that DOJ handles state cases as expediently as private employer cases, Congress may wish to consider amending USERRA to specifically require DOJ to adhere to the same 60-day deadline for state employer matters that they must adhere to for matters against private employers.

Agency: Congress
Status: Open

Comments: As of February 4, 2020, this matter has not yet been considered by Congress.

Recommendation: To help ensure that servicemembers in state employer cases are kept apprised of the status of DOJ's decision making without potentially compromising DOJ's ability to successfully bring suit against state employers, Congress may wish to consider amending USERRA to require DOJ to notify these servicemembers of the status of DOJ's efforts.

Agency: Congress
Status: Open

Comments: As of February 4, 2020, this matter has not yet been considered by Congress.

Recommendation: To simplify the burden that the corporate exemption places on payers to distinguish payees' business status and also provide greater information reporting, Congress may wish to consider requiring payers to report payments to corporations on the form 1099 MISC, as we previously suggested and as proposed in the Bush Administration's budget.

Agency: Congress
Status: Open

Comments: No legislative action has been taken, as of March 2020, to require payers engaged in a trade or business to report on payments to corporations for services, thereby reducing these payers' burden to determine which payments require reporting, as GAO recommended in January 2009. Reporting of third-party information is a powerful compliance tool, and eliminating the reporting exemption for payments to corporations would be a cost-effective way to improve voluntary compliance.

Recommendation: To gauge the extent of 1099-MISC payer noncompliance and its contribution to the tax gap, the Commissioner of Internal Revenue should, as part of future research studies, develop an estimate of 1099-MISC payer noncompliance.

Agency: Department of the Treasury: Internal Revenue Service
Status: Open

Comments: According to IRS, developing such an estimate requires a multi-pronged approach and a large amount of coordinated effort. One prong is to determine the extent of filing compliance among employers. A second prong would determine the extent to which 1099-MISC payers properly report their payments. Starting with the Tax Year 2001 individual income tax reporting compliance study, the National Research Program (NRP) office has been collecting some data related to Form 1099-MISC compliance, from both the payer and payee perspectives. Additional data were generated by the NRP reporting compliance study for employment tax. As part of the NRP employment tax research, IRS examiners were to review taxpayers' Form 1099 filing compliance. Data collected from these studies should shed some light on whether employers are appropriately reporting required payments on Form 1099-MISC. As of March 2020, IRS had completed its preliminary analysis and expected to complete more comprehensive analysis of the NRP employment tax data by May 2020. GAO will continue to monitor IRS's progress.

Recommendation: To gauge the extent of 1099-MISC payer noncompliance and its contribution to the tax gap, the Commissioner of Internal Revenue should, as part of future research studies, determine the nature and characteristics of those payers that do not comply with 1099-MISC reporting requirements so that this information can be factored into an IRS-wide strategy for increasing 1099-MISC payer compliance.

Agency: Department of the Treasury: Internal Revenue Service
Status: Open

Comments: IRS researchers collected data on 1099-MISC reporting as part of its National Research Program (NRP) study on employment taxes, a program that involved examinations of a sample of tax returns for tax years 2008 through 2010. As part of the NRP employment tax research, IRS examiners were to review taxpayers' Form 1099 filing compliance. Collecting data on this issue will enable IRS to study the nature and characteristics of payers that do not comply with 1099-MISC reporting requirements. As of March 2020, IRS had completed its preliminary analysis and expected to complete more comprehensive analysis of the NRP employment tax data by May 2020. GAO will continue to monitor IRS's progress.

Recommendation: The Secretary of the Department of Homeland Security should direct FEMA to take steps to ensure that its rate-setting methods and the data it uses to set rates result in full-risk premiums rates that accurately reflect the risk of losses from flooding. These steps should include, for example, verifying the accuracy of flood probabilities, damage estimates, and flood maps; ensuring that the effects of long-term planned and ongoing development, as well as climate change, are reflected in the flood probabilities used; and reevaluating the practice of aggregating risks across zones.

Agency: Department of Homeland Security
Status: Open
Priority recommendation

Comments: In April 2018, FEMA officials told us they had begun to redesign NFIP's risk rating system to help ensure policy rates better reflect the risk of flooding. The redesign, known as Risk Rating 2.0, includes efforts to use catastrophe models, stochastic approaches, and updated map information to better reflect the variation in flood risk. These reforms are also intended to improve how FEMA's rating process accounts for general and specific factors that affect flood probabilities and damage. While FEMA initially announced that new rates for all single-family homes would go into effect nationwide on October 1, 2020, it announced in November 2019 that it would defer implementation to October 1, 2021. FEMA said this would allow it to conduct a comprehensive analysis of the proposed rating structure so as to protect policyholders and minimize any unintentional negative effects of the transition, and that the new implementation date would cover all NFIP policies.

Recommendation: The Secretary of the Department of Homeland Security should direct FEMA to ensure that information is collected on the location, number, and losses associated with existing and newly created grandfathered properties in NFIP and to analyze the financial impact of these properties on the flood insurance program.

Agency: Department of Homeland Security
Status: Open

Comments: As of February 2020, FEMA officials said they had finished identifying properties with grandfathered premium rates and that they planned to analyze their economic implications as part of their efforts to update their premium rate setting approach, known as Risk Rating 2.0. FEMA plans to implement this redesign on October 1, 2021.

Recommendation: Given the lack of information on IRD users and where property claimed under IRD is placed in service, Congress may wish to consider requiring IRS to collect information identifying which taxpayers use IRD and the reservation and/or address where they have placed the property into service. In deliberating additional requirements, Congress should weigh the need for more IRD information with the associated costs of collecting and analyzing the information as well as the effects on IRS's other priorities.

Agency: Congress
Status: Open

Comments: As of February 2020, we continue to monitor the issue.

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: As of August 2020, CMS had taken some steps to address this recommendation but additional actions are needed to fully implement it. In June 2018 CMS issued a Medicaid update to states explaining that CMS strongly encourages them to include unexpected deaths in their definition of reportable critical incidents. CMS also stated in the update that states should conduct a preliminary review of all beneficiary deaths and investigations should focus on those deaths determined to be unexpected. Further, CMS has shared with states best practices for state mortality reviews that include, for example, the use of an interdisciplinary review committee and taking actions to address identified quality of care problems. CMS also developed a webinar training (Incident Management 101) to help states improve their incident management systems for the Medicaid HCBS waiver. The webinar outlines the key elements of building a comprehensive incident management system (e.g., establishing a process for conducting investigations of incidents, tracking and trending incidents to help prevent and mitigate incidents from occurring) and reiterates CMS's expectation that states identify and address unexplained deaths on an ongoing basis in order to meet the waiver's health and welfare assurance. In late 2018, CMS planned to include in its revised waiver application questions to determine practices regarding states' review and evaluation of unexpected deaths. In September 2019, CMS officials notified us that it will provide an updated status report on this recommendation in November 2019. As of August 2020, CMS officials have not provided us information regarding its revised waiver application and technical guide. We will update the status of this recommendation when we receive this information.

Recommendation: To develop timely chemical risk information that EPA needs to effectively conduct its mission, the Administrator, EPA, should require the Office of Research and Development to re-evaluate its draft proposed changes to the IRIS assessment process in light of the issues raised in this report and ensure that any revised process periodically assesses the level of resources that should be dedicated to this significant program to meet user needs and maintain a viable IRIS database.

Agency: Environmental Protection Agency
Status: Open
Priority recommendation

Comments: As of February 2020, EPA officials indicated that the IRIS Program had almost completed internal review of a "Handbook for Developing IRIS Assessments," intended to guide staff through the sequential stages of the IRIS assessment process and ensure consistency across assessments. The Handbook, when finalized and used by staff, codifies the agency's effort to reevaluate their assessment process, but doesn't address the resources that should be dedicated to the IRIS Program. A workforce plan that includes both staff and budget resources consistent with user needs is necessary. As we reported in March 2019, the program has made strides utilizing project management software and project management techniques that enable the IRIS Program to better plan assessment schedules and utilize staff. However, we also reported in March 2019 that the President's budget requests since fiscal year 2018 have repeatedly cut the budget by as much as 40 percent for the Health and Environmental Risk Assessment (HERA) area, of which IRIS is a part. While these cuts were not enacted by Congress, the President's fiscal year 2021 budget request again cuts the HERA program by 34 percent, or approximately $12.7 million dollars. These cuts could have an impact on the IRIS program's ability to meet EPA program and regional office needs, if enacted by Congress.

Recommendation: To better account for physicians practicing in underserved areas through the use of J-1 visa waivers, the Secretary of Health and Human Services should collect and maintain data on waiver physicians--including information on their numbers, practice locations, and practice specialties--and use this information when identifying areas experiencing physician shortages and placing physicians in these areas.

Agency: Department of Health and Human Services
Status: Open

Comments: HHS concurred with our recommendation, commenting that the department's goal was to assure that the limited resources of the J-1 visa waiver program and other programs addressing areas and populations with limited access to health care professionals are targeted most effectively. In 2013, HHS indicated that it was considering the best approach to collect information to identify J-1 visa physicians practicing in underserved areas. As of February 2018, however, HHS reported that it does not have the capacity to track physicians practicing in underserved areas through the use of J-1 visa waivers, citing reasons such as the number of federal entities and states involved in the process. While we recognize that collecting and maintaining these data requires coordination with other agencies, we continue to believe that without data on waiver physicians, HHS--the federal agency with primary responsibility for addressing physician shortages--will lack the information needed to consider waiver physicians working in underserved areas when placing providers in these areas under other programs. As of August 2019, HHS officials have not informed us of actions taken to implement this recommendation. We are leaving this recommendation open until the department collects and maintains data on waiver physicians and considers those physicians in its efforts to address physician shortages.

Recommendation: The Administrator, EPA, should take a number of steps to further protect the American public from elevated lead levels in drinking water. Specifically, to improve EPA's ability to oversee implementation of the lead rule and assess compliance and enforcement activities, EPA should ensure that data on water systems' test results, corrective action milestones, and violations are current, accurate, and complete.

Agency: Environmental Protection Agency
Status: Open

Comments: As of July 2020 there has been no change on the status of this recommendation. In June 2019, EPA reported to GAO that its tools for improving data about water systems compliance are not complete, though some states and laboratories have been exploring and testing incremental versions of them. EPA reported in a previous update that the agency had been working with states through face-to-face trainings and webinars on the reporting of milestone data. GAO will continue to monitor these efforts and reevaluate whether water systems' test results, corrective action milestones and violations are current, accurate and complete subsequent to the completion of the Compliance Monitoring Data Portal and the Safe Drinking Water Information System (SDWIS) Prime, described briefly below. However, until these new tools are complete, the status of this recommendation remains open. According to EPA, as of June 2018, SDWIS Prime has been available for exploring and testing, following incremental interim releases, since early 2018. In addition, EPA stated that SDWIS Prime will continue to be available for exploring and testing until the first production release anticipated for mid-2020.The agency has also focused on promoting electronic reporting of drinking water data through the development of the Compliance Monitoring Data Portal (CMDP). In June 2019, EPA stated that as of May 31, 2019, 10 states and more than 200 laboratories were using CMDP. According to EPA, as a result of using CMDP, these states reported a 30-70 percent reduction in staff time for data processing and a 90-99 percent reduction in errors for data.