Recommendation: The Assistant Secretary for the Administration for Children and Families (ACF) should establish an ongoing process to proactively share information and best practices with states about programs it administers that are available to serve kin caregivers, especially in states with a relatively large share of grandparent caregivers. This could be achieved, for example, by leveraging regional office staff to provide additional assistance and information sharing, particularly related to kinship navigator programs. (Recommendation 1)

Agency: Department of Health and Human Services: Administration for Children and Families
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 for the Administration for Community Living (ACL) should establish an ongoing process to proactively share information and best practices with states about using National Family Caregiver Support Program (NFCSP) funds to serve older relative caregivers of children, especially in states with a relatively large share of grandparent caregivers. This could be achieved, for example, by leveraging regional office staff to share information from states and area agencies on aging that have successfully used this program to serve older relative caregivers. (Recommendation 2)

Agency: Department of Health and Human Services: Administration for Community Living
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 FTA should develop a communication plan that will effectively share information with state transportation agencies and rural and tribal transit providers on coordination opportunities and leading coordination practices in an accessible and informative way. (Recommendation 1)

Agency: Department of Transportation: Federal Transit Administration
Status: Open

Comments: As of June 2020, FTA partially concurred with this recommendation. FTA noted that they will direct the National Rural Transit Assistance Program (NRTAP) to create a centralized, searchable library database cataloging all available resources that cover transportation coordination. This library database will include resources developed by FTA, other Coordinating Council on Access and Mobility (CCAM) members, and their technical assistance centers and initiatives, such as the Rural Opportunities to Use Transportation for Economic Success (ROUTES). FTA will complete these actions by August 31, 2021. We will review the database and other resources when they become available.

Recommendation: The Administrator of ACL should work with other relevant HHS officials to document the department's plan to focus on the specific nutritional needs of older adults in the 2025-2030 update of the Dietary Guidelines for Americans, which would include, in part, plans to identify existing information gaps on older adults' specific nutritional needs. (Recommendation 1)

Agency: Department of Health and Human Services: Administration for Community Living
Status: Open

Comments: HHS agreed with this recommendation, stating that ACL plans to work with the Office of Disease Prevention and Health Promotion and other relevant HHS officials and agencies to document HHS's plans to emphasize the specific and varying nutritional needs of older adults in the 2025-2030 update. HHS also stated that ACL plans to acquire the services of a registered dietician with specialized expertise in older adults' nutritional needs. We will consider closing this recommendation when these efforts are completed.

Recommendation: The Administrator of ACL should direct regional offices to take steps to ensure states are monitoring providers to ensure meal consistency with federal nutrition requirements for meals served in the congregate and home-delivered meal programs. (Recommendation 2)

Agency: Department of Health and Human Services: Administration for Community Living
Status: Open

Comments: HHS agreed with this recommendation. HHS stated that ACL's program and evaluation offices will collaborate on the development of plans to ensure state compliance with federal requirements.

Recommendation: The Administrator of FNS should take steps to improve its oversight of CACFP meals provided in adult day care centers. For example, FNS could amend its approach for determining federal onsite reviews of CACFP meal providers to more consistently include adult day care centers. (Recommendation 3)

Agency: Department of Agriculture: Office of the Secretary: Food, Nutrition and Consumer Services: Food and Nutrition Service
Status: Open

Comments: In May 2020, the Department of Agriculture's Food and Nutrition Service told us that, in an effort to improve oversight of the CACFP meals provided in adult day care centers, it will place a special interest on lessons learned from onsite local reviews that are conducted by states where the adult portion of the CACFP is administered separately by the state department of aging and thus, adult day care institutions are always selected for local onsite reviews as part of their management evaluation. Further, Food and Nutrition Service told us it will commit to sharing this information with other state agencies that administer the CACFP. Food and Nutrition Service estimates completing this action by the end of calendar year 2020. We will review the status of this recommendation upon receipt of Food and Nutrition Service updates at the end of 2020.

Recommendation: The Administrator of ACL should centralize information on promising approaches for making meal accommodations to meet the nutritional needs of older adult participants in the congregate and home-delivered meal programs, for example in one location on its National Resource Center on Nutrition and Aging website, to assist providers' efforts. (Recommendation 4)

Agency: Department of Health and Human Services: Administration for Community Living
Status: Open

Comments: HHS agreed with this recommendation. The agency stated that ACL will award a contract in fiscal year 2020 for a new National Resource Center on Nutrition and Aging to, among other things, centralize information on promising approaches so nutrition services providers can access it easily. We will consider closing this recommendation when this effort is complete.

Recommendation: The Administrator of FNS should take steps to better disseminate existing information that could help state and local entities involved in providing CACFP meals meet the varying nutritional needs of older adult participants, as well as continue to identify additional promising practices or other information on meal accommodations to share with CACFP entities. (Recommendation 5)

Agency: Department of Agriculture: Office of the Secretary: Food, Nutrition and Consumer Services: Food and Nutrition Service
Status: Open

Comments: In May 2020, the Department of Agriculture's Food and Nutrition Service told us that it will take several actions over the next 12 months to address our recommendation. Food and Nutrition Service actions will include holding listening sessions specifically focused on the adult day care side of the program at two national CACFP conferences this year to understand the specific information providers are looking for the address the needs of older adults and identify promising strategies for accommodating those needs; review existing guidance for training opportunities and areas that could benefit from further clarifications; and updating the Adult Day Care Handbook to include promising practice examples to address specific information and concerns gathered from the listening sessions, GAO's report findings, and further clarifications from existing guidance. Food and Nutrition Service also told us it will use multiple channels to ensure the handbook is widely disseminated to state agencies and adult day care program operators. We will review the status of this recommendation upon receipt of additional updates from Food and Nutrition Service regarding the aforementioned actions to be taken over the next 12 months.

Recommendation: The Under Secretary for Benefits should systematically solicit and collect information on potential financial exploitation from VA's Pension Management Centers and other relevant VA components, including VA's Office of General Counsel, and assess this information to inform plans to address the potential exploitation of veterans receiving pension benefits. Such plans could also address the broader population of veterans with disabilities. (Recommendation 1)

Agency: Department of Veterans Affairs
Status: Open

Comments: As of July 2020, VA reported taking steps to share data on potential financial exploitation threats, but further opportunities to collect information exist. In February 2020, VA updated its policy manual, instructing Pension Management Centers to send copies of any OIG fraud referrals to VA's Fraud, Waste, and Abuse Incident Team. This team plans to use the information to identify trends in potential fraud, and recommend changes to VA laws, policies, or procedures, as needed. VA also plans to use this data to coordinate with other Government agencies and offices to help prevent financial exploitation. However, VA has not reported taking steps to collect information from its Office of General Counsel, Pension Management Centers, and other components on threats to veterans that do not result in fraud referrals to OIG. VA asserts that collecting additional information on suspicious activities that do not meet the level of fraud that can be referred to OIG would be inappropriate because VA lacks investigative authority. As GAO noted in its report, not all suspicious activity or complaints rise to the level of fraud. Collecting additional information could improve VA's ability to understand threats to veterans and develop responses, such as outreach, and could build on VA efforts already underway with its Fraud, Waste, and Abuse Incident Team.

Recommendation: The Under Secretary for Benefits should place additional warnings on paper and electronic documents, including on benefit applications, regarding fees which veterans cannot be charged. (Recommendation 2)

Agency: Department of Veterans Affairs
Status: Open

Comments: As of July 2020, VA reports that it plans to include warnings on its pension applications to clarify which fees attorneys and others may charge veterans for representing them when applying for pension benefits. According to VA, information collection requests were published in the Federal Register in June 2020, and VA expects its application forms to be revised by the end of calendar year 2020. GAO will close this recommendation once VA's applications are revised.

Recommendation: The Under Secretary for Benefits should explore the costs and benefits of additional steps claims processors could take to verify that the direct deposit information provided by claimants on their applications is for the appropriate party. (Recommendation 4)

Agency: Department of Veterans Affairs
Status: Open

Comments: In August 2020 VA reported that it is in the process of updating its application forms to require claimants to submit documentation, such as a voided check or deposit slip, when applying for pension benefits. GAO will close this recommendation once changes to these applications are complete.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Recommendation: The CFPB Director should work with FHA to complete an agreement for sharing the results of CFPB examinations of HECM servicers with FHA. (Recommendation 7)

Agency: Consumer Financial Protection Bureau
Status: Open

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

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

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

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

Recommendation: The administrator of CMS should require that abuse and perpetrator type be submitted by state survey agencies in CMS's databases for deficiency, complaint, and facility-reported incident data, and that CMS systematically assess trends in these data. (Recommendation 1)

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

Comments: HHS concurred with this recommendation. In February 2020, HHS said CMS is developing the ability to review survey trends related to alleged perpetrator and alleged abuse types and aims to implement this recommendation by December 2020.

Recommendation: The administrator of CMS should develop and disseminate guidance—including a standardized form—to all state survey agencies on the information nursing homes and covered individuals should include on facility-reported incidents. (Recommendation 2)

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

Comments: HHS concurred with this recommendation. In February 2020, HHS said CMS will list the elements that all nursing homes should report to state agencies and aims to implement this recommendation by December 2020.

Recommendation: The administrator of CMS should require state survey agencies to immediately refer complaints and surveys to law enforcement (and, when applicable, to Medicaid Fraud Control Units (MFCU)) if they have a reasonable suspicion that a crime against a resident has occurred when the complaint is received. (Recommendation 3)

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

Comments: HHS concurred with this recommendation. In February 2020, HHS said CMS will require state survey agencies to immediately refer complaints upon receipt and surveys to law enforcement (and, when applicable, to Medicaid Fraud Control Units) if they have a reasonable suspicion that a crime against a resident has occurred and aims to implement this requirement by December 2020.

Recommendation: The administrator of CMS should conduct oversight of state survey agencies to ensure referrals of complaints, surveys, and substantiated incidents with reasonable suspicion of a crime are referred to law enforcement (and, when applicable, to MFCUs) in a timely fashion. (Recommendation 4)

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

Comments: HHS concurred with this recommendation. In February 2020, HHS said CMS will revise guidance to ensure state survey agencies will investigate and track incidents of abuse and neglect and report substantiated findings to local law enforcement. CMS aims to implement this recommendation by December 2020.

Recommendation: The administrator of CMS should develop guidance for state survey agencies clarifying that allegations verified by evidence should be substantiated and reported to law enforcement and state registries in cases where citing a federal deficiency may not be appropriate. (Recommendation 5)

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

Comments: HHS concurred with this recommendation. In February 2020, HHS said CMS will provide clarification to the state survey agencies regarding the definition of substantiated and when cases need to be referred to law enforcement. CMS aims to implement this recommendation by December 2020.

Recommendation: The administrator of CMS should provide guidance on what information should be contained in the referral of abuse allegations to law enforcement. (Recommendation 6)

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

Comments: HHS concurred with this recommendation. In February 2020, HHS said it will provide guidance to state agencies and nursing homes on identifying and reporting potential abuse and neglect of residents and will develop a list of standardized elements that should be included when reporting an abuse allegation to law enforcement. HHS aims to implement this recommendation by July 2020.

Recommendation: The Attorney General should develop and document goals that explain the common outcomes DOJ seeks to achieve through its elder justice efforts. (Recommendation 1)

Agency: Department of Justice
Status: Open

Comments: In its comments on a draft of our report in May 2019, DOJ did not explicitly state whether or not it concurred with the two recommendations we directed to the department, but stated that it is taking our recommendations under serious review. Specifically, DOJ stated that it planned to form a subcommittee within its Elder Justice Working Group to consider the development or clarification of goals and the development of outcome measures. In a follow-up response dated December 17, 2019, DOJ noted that the subcommittee had been formed, and had met to explore the development of additional---or clarification of present---goals, including those referenced in our report. We will continue to monitor DOJ's efforts towards implementing this recommendation.

Recommendation: The Attorney General should develop and document outcome measures to track the progress the agency is making toward achieving its elder justice goals. (Recommendation 2)

Agency: Department of Justice
Status: Open

Comments: In its comments on a draft of our report in May 2019, DOJ did not explicitly state whether or not it concurred with the two recommendations we directed to the department, but stated that it is taking our recommendations under serious review. Specifically, DOJ stated that it planned to form a subcommittee within its Elder Justice Working Group to consider the development or clarification of goals and the development of outcome measures. In a follow-up response dated December 17, 2019, DOJ noted that the subcommittee had been formed, and had met to begin developing and documenting appropriate outcome measures that can better track the Department's progress on its overall elder justice efforts. This will include consideration of the specific suggestions cited in our report, as well exploring opportunities for additional data collection to enhance the Department's efforts and better measure outcomes. We will continue to monitor DOJ's efforts towards implementing this recommendation.

Recommendation: The Administrator of ACL should take steps to better centralize access to and promote awareness of information on promising practices or other useful information pertinent to serving rural older adults.

Agency: Department of Health and Human Services: Administration for Community Living
Status: Open

Comments: HHS agreed with this recommendation, stating that it would encourage its resource centers to identify promising practices and other information specific to rural communities so that these resources would be searchable. In December 2019, ACL stated that it would continue to list all resource centers on its website so that anyone can find resources specific to any topic funded by ACL. The agency also noted that it would begin implementation of this action with new resource centers funded with FY 2020 appropriations. GAO continues to encourage ACL to centralize access to information pertinent to rural older adults by making it easily searchable across these websites or compiling it in other ways and promoting awareness of this information.

Recommendation: The FEMA Administrator should develop and publicize guidance for partners working to assist individuals who are older or have disabilities for requesting data and working with FEMA staff throughout the data sharing process to obtain Individual Assistance data, as appropriate. (Recommendation 1)

Agency: Department of Homeland Security: Directorate of Emergency Preparedness and Response: Federal Emergency Management Agency
Status: Open

Comments: DHS agreed with this recommendation and has plans to address it. Specifically, FEMA is developing new, enhanced templates, policies and guidance for field staff to facilitate data sharing with states and other partners. The agency also reported that it is expanding its Open FEMA datasets to provide more autonomous, self-service sharing of aggregated data to fulfill partner data needs when personally identifiable information data is not required. FEMA plans to publish data sharing guidelines on its web site by March 31, 2020 on how to obtain FEMA data to best service individuals who are older or have disabilities.

Recommendation: The FEMA Administrator should improve communication of registrants' disability-related information across FEMA programs, such as by developing an alert within survivor files that indicates an accommodation request. (Recommendation 3)

Agency: Department of Homeland Security: Directorate of Emergency Preparedness and Response: Federal Emergency Management Agency
Status: Open

Comments: FEMA disagreed with this recommendation, noting that it lacks specific funding to augment the legacy data systems that capture and communicate registration information. Also, FEMA began a long-term initiative in April 2017 to improve data management and exchange, and improve overall data quality and standardization. The agency expects the initiative to include the development of a modern, cloud-based data storage system with a data analytics platform that will allow analysts, decision makers, and stakeholders more ready access to FEMA data. After the completion of this initiative, FEMA expects that efforts to share and flag specific disability-related data will be much easier. Our recommendation, however, is not solely focused on system changes: other cost-effective ways may improve communication of registrants' disability-related information prior to implementing the system upgrades. For example, as noted in the report, FEMA officials handling different stages of the disaster assistance process may overlook disability-related needs recorded in the case file notes. FEMA could revise its guidance to remind program officials to review the notes to identify whether there is a record of any such needs. As FEMA moves ahead with its data improvement initiatives, we encourage it to consider and ultimately implement technology changes, such as developing an alert within files that indicates an accommodation request. Such improvements would be consistent with the recommendation and help improve communication across FEMA programs.

Recommendation: The FEMA Administrator should communicate to Regional Administrators and Regional Disability Integration Specialists a written plan for implementing its new disability integration staffing approach, consistent with the objectives established for disability integration. Such a plan should include an implementation timeline and details on staff responsibilities, which regions could use to evaluate staff performance. (Recommendation 5)

Agency: Department of Homeland Security: Directorate of Emergency Preparedness and Response: Federal Emergency Management Agency
Status: Open

Comments: DHS agreed with this recommendation, reporting that it is developing a project plan to implement the proposed staffing approach in the Regions. The plan will include implementation timelines, detailed roles and responsibilities for the proposed Disability Integration Advisor positions, a force structure for each Region, and recommendations to the Regional Administrator to establish performance metrics for the new positions that support the overall approach to disability integration. The plan will be presented to the Administrator for review and concurrence in 2019.

Recommendation: The FEMA Administrator should develop a plan for delivering training to FEMA staff that promotes competency in disability awareness. The plan should include milestones and performance measures, and outline how performance will be monitored. (Recommendation 6)

Agency: Department of Homeland Security: Directorate of Emergency Preparedness and Response: Federal Emergency Management Agency
Status: Open

Comments: FEMA agreed with this recommendation and has plans to improve disability competencies among FEMA staff, but it does not include training. Specifically, FEMA is developing a plan to include a disability integration competency in the position task books for all deployable staff, rather than through training. Position task books outline the required activities, tasks, and behaviors for each job, and serve as a record for task completion. The plan will also include a communications and outreach plan; milestones for measuring the effectiveness of the integration of this competency across the agency; and a monitoring plan and milestones to measure the overall integration of this competency across the deployable workforce. However, the plan doesn't cover how it will deliver training to promote competency in disability awareness among its staff, including milestones, performance measures, and how performance will be monitored.

Recommendation: To preserve the balance between the importance of repaying federal student loan debt and protecting a minimum level of Social Security benefits put in place by the Debt Collection Improvement Act of 1996, Congress should consider modifying Social Security administrative offset provisions, such as by authorizing the Department of the Treasury to annually index the amount of Social Security benefits exempted from administrative offset to reflect changes in the cost of living over time.

Agency: Congress
Status: Open

Comments: As of December 2018, Congress has not yet taken action on this matter.

Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should inform affected borrowers of the suspension of offset and potential consequences if the borrower does not take action to apply for a TPD discharge. Such information could include notification that interest continues to accrue and that offsets may resume once their disability benefits are converted to retirement benefits.

Agency: Department of Education
Status: Open

Comments: The Department of Education does not currently notify borrowers of the suspension of offset, but plans to implement a process to do so in the future using a new mailing sent to affected borrowers by their default servicer. The current budget situation does not allow for this type of enhancement, and it is not clear when that will change. In the interim, the agency is exploring alternative notification approaches that could be put in place prior to the implementation of an automated solution. Although Education reported in December 2018 that it has implemented this recommendation, we will consider closing it when we receive documentation that this effort has been completed. As of October 2020, Education's website includes information about the suspension of offset. However, affected borrowers may not know to check the website and the agency has not provided documentation that it has directly alerted affected borrowers.

Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should revise forms sent to borrowers already approved for a TPD discharge to clearly and prominently state that failure to provide annual income verification documentation during the 3-year monitoring period will result in loan reinstatement.

Agency: Department of Education
Status: Open

Comments: The FUTURE Act (H.R. 5363), signed into law on Dec. 19, 2019, requires the Department of Education (Education) to automate the income monitoring process for borrowers whose loans are discharged for total and permanent disability. As a result of automating the process, borrowers will no longer need to receive Education's forms requesting the borrower to individually provide their income verification documentation during the 3-year monitoring period.

Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should inform borrowers about the financial hardship exemption option and application process on the agency's website, as well as the notice of offset sent to borrowers.

Agency: Department of Education
Status: Open

Comments: The Department of Education agrees with the recommendation and said that they will include this change in upcoming revisions to the agency's web content. The agency reported that the Notice of Offset to borrowers is sent by Treasury and that they will share this recommendation with Treasury and discuss possible changes to the notice. As of October 2020, Education's website notes that borrowers can request a review of their offset , but it does not specifically note that they may do so because of a financial hardship. Although Education reported in December 2018 that it has implemented this recommendation, we will consider closing it when we receive documentation that the agency has notified borrowers about the financial hardship exemption process on its website and the notice of offset sent to borrowers.

Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should implement an annual review process to ensure that only eligible borrowers are exempted from offset for financial hardship on an ongoing basis.

Agency: Department of Education
Status: Open

Comments: The Department of Education reported that it plans to fully automate their process for tracking hardships and other exceptions from offset. However, due to competing priorities and funding limitations, full implementation of these improvements have not been scheduled. As they fully implement this process, they will review complementary strategies to assist borrowers in complying with annual reporting requirements. As of December 2018, Education reported that it is in the process of re-designing the student loan financial services environment, which will lead to major improvements such as offset exceptions. They are conducting market research on the new environment, then plan to develop requirements and timelines in support of a procurement with a projected completion in September 2020. We will consider closing this recommendation when we receive documentation that the agency has implemented an annual review process.

Recommendation: To better inform Congress and improve what is known about the extent to which elderly residents of Section 202 properties are assisted by service coordinators, the Assistant Secretary for Housing should develop and implement written guidance that describes how HUD staff should assess Section 202 properties' compliance with the program's supportive services requirement. Such guidance should include information on the roles and responsibilities of HUD staff for (1) identifying stand-alone Section 202 properties and (2) monitoring the supportive services requirement for Section 202 properties with grant- and budget-based service coordinators, Section 202 properties that do not have service coordinators, and stand-alone Section 202 properties.

Agency: Department of Housing and Urban Development
Status: Open

Comments: In February 2018, HUD noted that it is in the process of finalizing written guidance which will document the agency's expectations regarding the supportive services requirement for Section 202 properties. HUD plans to finalize the guidance and post it on its website by May 2018. In July 2019, HUD noted that it posted guidance related to service coordinators on its website in 2018. The guidance describes the roles and responsibilities of service coordinators as well is reporting policies related to budget-based service coordinators. As of October 2019, HUD noted that it is drafting guidance that includes information on identifying and monitoring stand-alone Section 202 properties. This recommendation will remain open until HUD can demonstrate providing guidance to HUD staff on (1) identifying stand-alone Section 202 properties, and (2) monitoring the supportive services requirement for various types of Section 202 properties, including properties without service coordinators and stand-alone Section 202 properties. In December 2019, we requested further information from HUD and will continue to follow up on the agency's progress toward implementing this recommendation.

Recommendation: To better inform Congress and improve what is known about the extent to which elderly residents of Section 202 properties are assisted by service coordinators, the Assistant Secretary for Housing should develop and implement policies and procedures for (1) verifying the accuracy of a sample of the performance information that Section 202 properties submit through semiannual performance reports and (2) analyzing the performance information collected.

Agency: Department of Housing and Urban Development
Status: Open

Comments: In February 2018, HUD noted that it had implemented a pilot program in 2017 which connected the information systems that some Section 202 properties use to record information on their service coordinator programs to a "grant reporting framework." In February 2018, HUD staff told us that all Section 202 properties with Service Coordinators would be required to use the new grant reporting framework in 2018, and that the new framework included edit checks and other mechanisms designed to improve the reliability of the data reported. In July 2019, HUD noted that they are continuing work on the pilot program and have not analyzed the data yet. They also stated that the pilot includes processes to help ensure the reliability of the data. In October 2019, HUD stated that the pilot ended in FY 2018 and the new grant reporting framework became a national reporting requirement for all Multifamily service coordinator programs (grant-funded and budget-based) in FY 2019. This recommendation will remain open until HUD develops and implements policies and procedures for (1) verifying the accuracy of a sample of performance information, and (2) analyzing the performance information collected. In December 2019, we requested further information from HUD and will continue to follow up on the agency's progress toward implementing this recommendation.

Recommendation: Depending on the outcome of the litigation, the Secretary of Labor should take steps to ensure the agency will be positioned to conduct a meaningful retrospective review consistent with the Executive Order at an appropriate time. These steps should be taken in consultation with the Centers for Medicare & Medicaid Services, and could include, for example, identifying metrics that could be used to evaluate the rule, and implementing a plan to gather and analyze the necessary data.

Agency: Department of Labor
Status: Open

Comments: The Department of Labor's Wage and Hour Division (WHD) agreed with this recommendation and reported that it is working to develop data collection plans and explore a potential evaluation that is focused on the Home Care Rule. As part of this effort, WHD noted that it will continue to work with HHS and other federal partners. In FY16, WHD reported that such an evaluation of how stakeholders and affected industries have responded to the rule would be beneficial. However, litigation has delayed implementation and enforcement of the rule significantly, and WHD believes an evaluation at this stage would be premature and would be unlikely to fully and accurately capture stakeholders' responses to the rule and the resulting impacts. Delaying the evaluation would allow WHD to monitor the results of its own investigations and the effects of ongoing compliance assistance, both of which would be extremely difficult to measure at this early stage. In 2017, WHD reported that it will continue to monitor early implementation to determine the appropriate start for any evaluation and lay the groundwork for future assessment, including a plan for how to identify data that would inform such as an assessment. In 2018, WHD reported that it is too early in the implementation phase of the rule to conduct an evaluation of the rule's impact. The Department and WHD continue to engage with HHS to understand stakeholders' responses to the rule. WHD also continues to lay the groundwork for any future assessment by working to identify data sources that would inform such as an assessment.

Recommendation: To promote and enhance federal, state, and local NEMT coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and complete and publish a new or updated strategic plan that, among other things, clearly outlines a strategy for addressing NEMT and how it can be coordinated across federal agencies that fund NEMT service.

Agency: Department of Transportation
Status: Open

Comments: The Federal Transit Administration (FTA) concurred with this recommendation. The Department of Transportation (DOT), which chairs the Coordinating Council on Access and Mobility (Coordinating Council) and provides administrative support and staff, has made some progress to enhance coordination of NEMT programs through the development of a new or updated strategic plan, as GAO recommended in December 2014, but coordination at the federal level remains limited. In October 2019, the Coordinating Council adopted a new strategic plan as recommended by GAO. However, DOT indicated that strategies for coordinating NEMT across federal agencies would not be fully articulated until November 2020 when it plans to issue a report to the President and Congress. Until the report is finalized, the Coordinating Council may be missing an opportunity to identify and align goals and strategies for increased NEMT coordination with the benefits of coordination, such as increased program efficiency or reduced costs.

Recommendation: To promote and enhance federal, state, and local NEMT coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and finalize and issue a cost-sharing policy and clearly identify how it can be applied to programs under the purview of member agencies of the Coordinating Council that provide funding for NEMT.

Agency: Department of Transportation
Status: Open

Comments: FTA concurred with this recommendation. The Department of Transportation (DOT), which chairs the Coordinating Council and provides administrative support and staff, has made minimal progress to develop and issue a cost-sharing policy, as GAO recommended in December 2014, which would allow agencies to identify and allocate costs among programs. In October 2019, the Coordinating Council adopted a new strategic plan. DOT plans to include a cost sharing policy as part of a report to the President and Congress in September 2020. According to DOT officials, they have begun the process of soliciting and including input from Coordinating Council agencies to develop the elements of the report, including the cost sharing policy, as of December 2019. The development of a cost sharing policy would provide federal guidance on how to address cost sharing issues across agencies and help facilitate ride and vehicle sharing. Until the Coordinating Council develops federal cost allocation principles for transportation providers, federal agencies may be unable to address cost-sharing issues across agencies such as ride and vehicle sharing.

Recommendation: To promote and enhance federal, state, and local NEMT coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and using the on-going work of the Health, Wellness, and Transportation working group and other appropriate resources, (1) identify the challenges associated with coordinating Medicaid and VA NEMT programs with other federal programs that fund NEMT, (2) develop recommendations for how these challenges can be addressed while still maintaining program integrity and fraud prevention, and (3) report these recommendations to appropriate committees of Congress. To the extent feasible, the Coordinating Council should implement those recommendations that are within its legal authority.

Agency: Department of Transportation
Status: Open

Comments: FTA said they concurred in part with this recommendation. The Fixing America's Surface Transportation (FAST) Act requires the Coordinating Council on Access and Mobility (Coordinating Council) to develop and publish a strategic plan. The Department of Transportation (DOT), which chairs the Coordinating Council and provides administrative support and staff, has made some but minimal progress to address the challenges associated with coordinating Medicaid and VA NEMT programs and other federal programs, as GAO recommended in December 2014. In October 2019, the Coordinating Council adopted a new strategic plan. According to DOT, it has made progress identifying challenges associated with coordinating Medicaid and VA NEMT programs, in part through the use of focus groups and a survey conducted by the National Center for Mobility Management. DOT expects it will include recommendations for addressing the challenges identified in a November 2020 report to the President and Congress. As of December 2019, DOT had begun the process of soliciting input from Coordinating Council agencies into these recommendations. Until DOT's assessment to identify and address coordination challenges is completed, agencies will be limited in coordinating Medicaid and VA NEMT programs with other federal programs that fund NEMT.

Recommendation: To promote and enhance federal, state, and local coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and define and report on desired outcomes and collect related data to track and measure progress in achieving results, including the extent of coordination efforts that are under way, such as improved services for older adults. This effort could be conducted as a part of the Coordinating Council's process to update its strategic plan, which we have also recommended in a concurrent report.

Agency: Department of Transportation
Status: Open

Comments: The Federal Transit Administration (FTA) has taken steps to enhance older adult mobility. As of September 2020, FTA stated they continued to make progress toward implementing the recommendation by November, 2020. The Coordinating Council for Access and Mobility plans to issue its report to Congress and the President on September 30, 2020, and we will continue monitor FTA's progress on its efforts when the report is released.