Recommendation: The Secretary of Health and Human Services in coordination with the Administrator of the Federal Emergency Management Agency—who head agencies leading the COVID-19 response through the Unified Coordination Group—should immediately document roles and responsibilities for supply chain management functions transitioning to the Department of Health and Human Services, including continued support from other federal partners, to ensure sufficient resources exist to sustain and make the necessary progress in stabilizing the supply chain, and address emergent supply issues for the duration of the COVID-19 pandemic. (Recommendation 1)

Agency: Department of Health and Human Services
Status: Open

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

Recommendation: The Secretary of Health and Human Services in coordination with the Administrator of the Federal Emergency Management Agency—who head agencies leading the COVID-19 response through the Unified Coordination Group—should further develop and communicate to stakeholders plans outlining specific actions the federal government will take to help mitigate remaining medical supply gaps necessary to respond to the remainder of the pandemic, including through the use of Defense Production Act authorities. (Recommendation 2)

Agency: Department of Health and Human Services
Status: Open

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

Recommendation: The Secretary of Health and Human Services—who heads one of the agencies leading the COVID-19 response through the Unified Coordination Group—consistent with their roles and responsibilities, should work with relevant federal, state, territorial, and tribal stakeholders to devise interim solutions, such as systems and guidance and dissemination of best practices, to help states enhance their ability to track the status of supply requests and plan for supply needs for the remainder of the COVID-19 pandemic response. (Recommendation 3)

Agency: Department of Health and Human Services
Status: Open

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

Recommendation: The Administrator of the Federal Emergency Management Agency—who heads one of the agencies leading the COVID-19 response through the Unified Coordination Group—consistent with their roles and responsibilities, should work with relevant federal, state, territorial, and tribal stakeholders to devise interim solutions, such as systems and guidance and dissemination of best practices, to help states enhance their ability to track the status of supply requests and plan for supply needs for the remainder of the COVID-19 pandemic response. (Recommendation 4)

Agency: Department of Homeland Security: Directorate of Emergency Preparedness and Response: Federal Emergency Management Agency
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 Health and Human Services, with support from the Secretary of Defense, should establish a time frame for documenting and sharing a national plan for distributing and administering COVID-19 vaccine, and in developing such a plan ensure that it is consistent with best practices for project planning and scheduling and outlines an approach for how efforts will be coordinated across federal agencies and nonfederal entities. (Recommendation 5)

Agency: Department of Health and Human Services
Status: Open

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

Recommendation: As the Centers for Disease Control and Prevention (CDC) implements its COVID-19 Response Health Equity Strategy, the Director of the Centers for Disease Control and Prevention should determine whether having the authority to require states and jurisdictions to report race and ethnicity information for COVID-19 cases, hospitalizations, and deaths is necessary for ensuring more complete data, and if so, seek such authority from Congress. (Recommendation 6)

Agency: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention
Status: Open

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

Recommendation: As CDC implements its COVID-19 Response Health Equity Strategy, the Director of the Centers for Disease Control and Prevention should involve key stakeholders to help ensure the complete and consistent collection of demographic data. (Recommendation 7)

Agency: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention
Status: Open

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

Recommendation: As CDC implements its COVID-19 Response Health Equity Strategy, the Director of the Centers for Disease Control and Prevention should take steps to help ensure CDC's ability to comprehensively assess the long-term health outcomes of persons with COVID-19, including by race and ethnicity. (Recommendation 8)

Agency: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention
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, in coordination with the Commissioner of Internal Revenue, should update and refine the estimate of eligible recipients who have yet to file for an economic impact payment to help target outreach and communications efforts. (Recommendation 9)

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 Secretary of the Treasury, in coordination with the Commissioner of Internal Revenue, should make estimates of eligible recipients who have yet to file for an economic impact payment, and other relevant information, available to outreach partners to raise awareness about how and when to file for economic impact payments. (Recommendation 10)

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 the Office of Management and Budget, in consultation with the Department of the Treasury, should issue the addendum to the 2020 Compliance Supplement as soon as possible to provide the necessary audit guidance. (Recommendation 11)

Agency: Executive Office of the President: Office of Management and Budget
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 Centers for Disease Control and Prevention should ensure that, as it makes updates to its federal guidance related to reassessing schools' operating status, the guidance is cogent, clear, and internally consistent. (Recommendation 12)

Agency: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention
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 Homeland Security, in coordination with the Secretary of Defense, should (1) revise the criteria in the 2019 National Interest Action code memorandum of agreement to clearly identify steps they will take to obtain input from key federal agencies prior to extending or closing a National Interest Action code, (2) establish timelines for evaluating the need to extend a National Interest Action code, and (3) define what constitutes a consistent decrease in contract actions and routine contract activity to ensure the criteria for extending or closing the National Interest Action code reflect government-wide needs for tracking contract actions in longer term emergencies, such as a pandemic. (Recommendation 13)

Agency: Department of Homeland Security
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, in coordination with the Secretary of Homeland Security, should (1) revise the criteria in the 2019 National Interest Action code memorandum of agreement to clearly identify steps they will take to obtain input from key federal agencies prior to extending or closing a National Interest Action code, (2) establish timelines for evaluating the need to extend a National Interest Action code, and (3) define what constitutes a consistent decrease in contract actions and routine contract activity to ensure the criteria for extending or closing the National Interest Action code reflect government-wide needs for tracking contract actions in longer term emergencies, such as a pandemic. (Recommendation 14)

Agency: Department 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 Health and Human Services, in consultation with the Centers for Medicare & Medicaid Services and CDC, should develop a strategy to capture more complete data on confirmed COVID-19 cases and deaths in nursing homes retroactively back to January 1, 2020, and to clarify the extent to which nursing homes have reported data before May 8, 2020. To the extent feasible, this strategy to capture more complete data should incorporate information nursing homes previously reported to CDC or to state or local public health offices. (Recommendation 15)

Agency: Department of Health and Human Services
Status: Open

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

Recommendation: Based on the imminent cybersecurity threats, the Secretary of Health and Human Services should expedite implementation of our prior recommendations regarding cybersecurity weaknesses at its component agencies. (Recommendation 16)

Agency: Department of Health and Human Services
Status: Open

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

Recommendation: The Archivist of the United States should require small and micro agencies that were determined to be at high risk of not complying with statutory and regulatory records management requirements to develop plans and timelines to address their records management weaknesses (Recommendation 1)

Agency: National Archives and Records Administration: Office of the Archivist
Status: Open

Comments: The National Archives and Records Administration concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Archivist of the United States should monitor the agencies' progress towards these efforts on a regular basis. (Recommendation 2)

Agency: National Archives and Records Administration: Office of the Archivist
Status: Open

Comments: The National Archives and Records Administration concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Chief Executive Officer of the Armed Forces Retirement Home should establish a time frame to develop an inventory of electronic information systems used to store agency records that includes all of the required elements. (Recommendation 3)

Agency: Armed Forces Retirement Home
Status: Open

Comments: The Armed Forces Retirement Home did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Chief Executive Officer of the Armed Forces Retirement Home establish a time frame to update its policies and procedures to include all of the required electronic information system functionalities for recordkeeping systems. (Recommendation 4)

Agency: Armed Forces Retirement Home
Status: Open

Comments: The Armed Forces Retirement Home did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Chief Executive Officer of the Armed Forces Retirement Home should establish a time frame to update the agency's policies and procedures to include the (1) following records management controls required for electronic information systems: usability, content, context, and structure and (2) required preservation mechanisms to ensure that records in its electronic recordkeeping system will be retrievable and useable. (Recommendation 5)

Agency: Armed Forces Retirement Home
Status: Open

Comments: The Armed Forces Retirement Home did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Chief Executive Officer of the Armed Forces Retirement Home should ensure existing policies and procedures describe the rules for using personal email accounts when conducting official agency business to include instructing the employee to (1) copy an official electronic messaging account of the employee in the original creation or transmission of the records and (2) forward a complete copy of the record to an official electronic messaging account of the employee no later than 20 days after the original creation or transmission of the record. (Recommendation 6)

Agency: Armed Forces Retirement Home
Status: Open

Comments: The Armed Forces Retirement Home did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Secretary of Commerce should establish a time frame to ensure all records schedules are up-to-date and submitted to NARA. The schedules should include all required information, including when eligible temporary records must be destroyed or deleted and when permanent records are to be transferred to NARA. (Recommendation 7)

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

Comments: The Department of Commerce concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the department states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Secretary of Commerce should ensure the electronic system that manages email provides the capabilities to manage permanent and temporary email records and to identify, retrieve, and retain records. (Recommendation 8)

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

Comments: The Department of Commerce concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the department states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Consumer Financial Protection Bureau should establish a time frame to develop an inventory of electronic information systems used to store agency records that includes all of the required elements. (Recommendation 9)

Agency: Consumer Financial Protection Bureau
Status: Open

Comments: The Consumer Financial Protection Bureau concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the bureau states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Executive Director of the Election Assistance Commission should establish a time frame to develop an inventory of electronic information systems used to store agency records that includes all of the required elements. (Recommendation 10)

Agency: Election Assistance Commission
Status: Open

Comments: The U.S. Election Assistance Commission did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the commission states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Executive Director of the Election Assistance Commission should establish a time frame to develop a plan on how the agency intends to manage permanent electronic records. (Recommendation 11)

Agency: Election Assistance Commission
Status: Open

Comments: The U.S. Election Assistance Commission did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the commission states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Executive Director of the Election Assistance Commission should establish a time frame to update its policies and procedures to include all of the required electronic information system functionalities for recordkeeping systems. (Recommendation 12)

Agency: Election Assistance Commission
Status: Open

Comments: The U.S. Election Assistance Commission did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the commission states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Executive Director of the Election Assistance Commission should establish a time frame to update its policies and procedures to include the (1) following records management controls required for electronic information systems: content, context, and structure and (2) required preservation mechanisms to ensure that records in its electronic recordkeeping system will be retrievable and useable. (Recommendation 13)

Agency: Election Assistance Commission
Status: Open

Comments: The U.S. Election Assistance Commission did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the commission states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Executive Director of the Election Assistance Commission should develop a written policy that describes the rules for using personal email accounts when conducting official agency business to include instructing the employee to (1) copy an official electronic messaging account of the employee in the original creation or transmission of the records and (2) forward a complete copy of the record to an official electronic messaging account of the employee no later than 20 days after the original creation or transmission of the record. (Recommendation 14)

Agency: Election Assistance Commission
Status: Open

Comments: The U.S. Election Assistance Commission did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the commission states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Chairman of the Federal Trade Commission should establish a time frame to update the agency's electronic information system inventory to include the following characteristics: reading and processing the records contained in the system, inputs and outputs, contents of the files and records, and cycle updates. (Recommendation 15)

Agency: Federal Trade Commission
Status: Open

Comments: The Federal Trade Commission did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the commission states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Chairman of the Marine Mammal Commission should use recently developed policies and procedures to implement and maintain an active, continuing agency records management program that includes policies and procedures to provide for effective controls over the creation, maintenance, and use of records in the conduct of current business. (Recommendation 16)

Agency: Marine Mammal Commission
Status: Open

Comments: The Marine Mammal Commission did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the commission states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Administrator of the National Aeronautics and Space Administration should establish a time frame to develop an inventory of electronic information systems used to store agency records that includes all of the required elements. (Recommendation 17)

Agency: National Aeronautics and Space Administration
Status: Open

Comments: The National Aeronautics and Space Administration concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the National Science Foundation should establish a time frame to ensure all records schedules are up-to-date and submitted to NARA. The schedules should include all required information, including when eligible temporary records must be destroyed or deleted and when permanent records are to be transferred to NARA. (Recommendation 18)

Agency: National Science Foundation
Status: Open

Comments: The National Science Foundation concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the foundation states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the National Science Foundation should establish a time frame to update the agency's electronic information system inventory to include the following characteristics: technical characteristics of the systems, identify inputs and outputs, and describe update cycles. (Recommendation 19)

Agency: National Science Foundation
Status: Open

Comments: The National Science Foundation concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the foundation states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the National Science Foundation should establish a time frame to update the agency's policies and procedures to include all of the records management controls required for electronic information systems and the required preservation mechanisms to ensure that records in its electronic recordkeeping system will be retrievable and useable. (Recommendation 20)

Agency: National Science Foundation
Status: Open

Comments: The National Science Foundation concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the foundation states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the National Science Foundation should develop policies and procedures for the required retention and management requirements for email, including instructions to staff to ensure that the names and addresses of the sender, date of message, attachments, calendars, and draft documents will be retained. (Recommendation 21)

Agency: National Science Foundation
Status: Open

Comments: The National Science Foundation concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the foundation states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of Management and Budget should ensure, in conjunction with the Executive Office of the President's Office of Administration, that existing policies and procedures incorporate the management of electronic records into its overall records management program. (Recommendation 22)

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

Comments: The Office of Management and Budget did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the office states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of Management and Budget should establish a time frame to develop an inventory of electronic information systems used to store agency records that includes all of the required elements. (Recommendation 23)

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

Comments: The Office of Management and Budget did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the office states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of Management and Budget should establish a time frame to update its policies and procedures to include all of the required electronic information system functionalities for recordkeeping systems. (Recommendation 24)

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

Comments: The Office of Management and Budget did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the office states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of Management and Budget should establish a time frame to ensure, in conjunction with the Office of Administration, that policies and procedures include the (1) following records management controls required for electronic information systems: reliability, context, and structure and (2) required preservation mechanisms to ensure that records in its electronic recordkeeping system will be retrievable and useable. (Recommendation 25)

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

Comments: The Office of Management and Budget did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the office states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of Management and Budget should ensure, in conjunction with the Office of Administration, that existing policies and procedures include the required retention and management requirements for email. (Recommendation 26)

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

Comments: The Office of Management and Budget did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the office states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of National Drug Control Policy should establish a time frame to develop an inventory of electronic information systems used to store agency records that includes all of the required elements. (Recommendation 27)

Agency: Executive Office of the President: Office of National Drug Control Policy
Status: Open

Comments: The Office of the National Drug Control Policy did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the office states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of National Drug Control Policy should establish a time frame to ensure, in conjunction with the Office of Administration, that policies and procedures include the (1) following records management controls required for electronic information systems: reliability, context, and structure; and (2) required preservation mechanisms to ensure that records in its electronic recordkeeping system will be retrievable and useable. (Recommendation 28)

Agency: Executive Office of the President: Office of National Drug Control Policy
Status: Open

Comments: The Office of the National Drug Control Policy did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the office states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of National Drug Control Policy should ensure, in conjunction with the Office of Administration, that existing policies and procedures include the required retention and management requirements for email. (Recommendation 29)

Agency: Executive Office of the President: Office of National Drug Control Policy
Status: Open

Comments: The Office of the National Drug Control Policy did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the office states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of Personnel Management should establish a time frame to ensure that all records schedules are up-to-date and submitted to NARA. The schedules should include all required information, including when eligible temporary records must be destroyed or deleted and when permanent records are to be transferred to NARA. (Recommendation 30)

Agency: Office of Personnel Management: Office of the Director
Status: Open

Comments: The Office of Personnel Management concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of Personnel Management should establish a time frame to develop an inventory of electronic information systems used to store agency records that includes all of the required elements. (Recommendation 31)

Agency: Office of Personnel Management: Office of the Director
Status: Open

Comments: The Office of Personnel Management concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of Personnel Management should establish a time frame to develop a plan to manage permanent electronic records. (Recommendation 32)

Agency: Office of Personnel Management: Office of the Director
Status: Open

Comments: The Office of Personnel Management concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of Personnel Management should establish a time frame to update its policies and procedures to include all of the required electronic information system functionalities for recordkeeping systems. (Recommendation 33)

Agency: Office of Personnel Management: Office of the Director
Status: Open

Comments: The Office of Personnel Management concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Office of Personnel Management should establish a time frame to update the agency's policies and procedures on retention and management for email to include retaining electronic calendars and draft documents. (Recommendation 34)

Agency: Office of Personnel Management: Office of the Director
Status: Open

Comments: The Office of Personnel Management concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Chief Executive Officer of the Overseas Private Investment Corporation should establish a time frame to develop an inventory of electronic information systems used to store agency records that includes all of the required elements. (Recommendation 35)

Agency: Overseas Private Investment Corporation (OPIC)
Status: Open

Comments: The Overseas Private Investment Corporation did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Chief Executive Officer of the Overseas Private Investment Corporation should establish a time frame to develop policies and procedures that define required electronic information system functionalities for recordkeeping systems including declaring records and assigning unique identifiers, capturing records, maintaining security, and preserving records. (Recommendation 36)

Agency: Overseas Private Investment Corporation (OPIC)
Status: Open

Comments: The Overseas Private Investment Corporation did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Chief Executive Officer of the Overseas Private Investment Corporation should establish a time frame to update the agency's policies and procedures to include the (1) following records management controls required for electronic information systems: reliability, content, context, and structure; and (2) required preservation mechanisms to ensure that records in its electronic recordkeeping system will be retrievable and useable. (Recommendation 37)

Agency: Overseas Private Investment Corporation (OPIC)
Status: Open

Comments: The Overseas Private Investment Corporation did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Chief Executive Officer of the Overseas Private Investment Corporation should establish a time frame to update the agency's policies and procedures on retention and management for email to include policies for retaining electronic calendars. (Recommendation 38)

Agency: Overseas Private Investment Corporation (OPIC)
Status: Open

Comments: The Overseas Private Investment Corporation did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Peace Corps should establish a time frame to update the agency's electronic information systems inventory to (1) specify technical characteristics necessary for reading and processing the records contained in the system, (2) identify system inputs and outputs, (3) define the contents of the files and records, (4) determine restrictions on access and use, and (5) specify how the agency ensures the timely disposition of records. (Recommendation 39)

Agency: Peace Corps
Status: Open

Comments: The Peace Corps did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Peace Corps should establish a time frame to update its policies and procedures to include all of the required electronic information system functionalities for recordkeeping systems. (Recommendation 40)

Agency: Peace Corps
Status: Open

Comments: The Peace Corps did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Director of the Peace Corps should establish a time frame to update the agency's policies and procedures to include (1) following records management controls required for electronic information systems: usability, context, and structure and (2) required preservation mechanisms to ensure that records in its electronic recordkeeping system will be retrievable and useable. (Recommendation 41)

Agency: Peace Corps
Status: Open

Comments: The Peace Corps did not state whether or not it concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the agency states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Executive Director of Udall Foundation should establish a time frame to develop and maintain an active, continuing agency records management program that includes policies and procedures to provide for effective controls over the creation, maintenance, and use of records in the conduct of current business. (Recommendation 42)

Agency: Morris K. Udall and Stewart L. Udall Foundation
Status: Open

Comments: The Udall Foundation concurred with this recommendation. As of June 2020, we had not received information pertaining to planned actions for this recommendation. Once the foundation states that it has taken action, we plan to verify whether implementation has occurred.

Recommendation: The Secretary of VA should direct GEC leadership to develop measurable goals for its efforts to address key long-term care challenges: workforce shortages, geographic alignment of care, and difficulty meeting veterans' needs for specialty care. (Recommendation 1)

Agency: Department of Veterans Affairs: Office of the Secretary
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 GEC leadership to set time frames for and implement a consistent GEC structure at the VAMC level. (Recommendation 2)

Agency: Department of Veterans Affairs: Office of the Secretary
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 GEC leadership to set time frames for and implement a VAMC-wide standardization of the tool for assessing the noninstitutional program needs of veterans. (Recommendation 3)

Agency: Department of Veterans Affairs: Office of the Secretary
Status: Open

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

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 Commissioner of the Social Security Administration should ensure that (a) the agency's policies and guidance are specific enough so field office staff know how to apply complex suitability criteria for assessing payee suitability, such as by providing a minimum set of specific questions; and (b) additional regional guidance that is made available to staff is centrally reviewed for compliance and completeness. (Recommendation 1)

Agency: Social Security Administration
Status: Open

Comments: SSA agreed with this recommendation but did not specify plans to address it.

Recommendation: The Commissioner of the Social Security Administration should create safeguards in the Electronic Representative Payee System (eRPS) to ensure that field office staff fully document all required information, such as the rationale for their decision, before approving an application. (Recommendation 2)

Agency: Social Security Administration
Status: Open

Comments: SSA agreed with this recommendation and identified actions to address it. Specifically, SSA reported that, as part of implementing the Strengthening Protections for Social Security Beneficiaries Act of 2018, planned changes to eRPS will improve documentation of selection decisions. SSA also reported it will also consider additional enhancements to eRPS in the future. We will consider closing this recommendation when this effort is complete.

Recommendation: The Commissioner of the Social Security Administration should complete a plan, including timeframes, for comprehensively evaluating if and how to leverage external sources of information on organizations' suitability, such as by conducting background checks or credit checks on organizations or key staff that handle beneficiaries' funds or requiring organizations to conduct their own background checks on key staff. (Recommendation 3)

Agency: Social Security Administration
Status: Open

Comments: SSA agreed with this recommendation and identified actions to address it. SSA officials stated that it is first focusing on implementing provisions of the Strengthening Protections for Social Security Beneficiaries Act of 2018 related to background checks for certain individual payees. After completing this work, the agency plans to evaluate conducting criminal background checks and credit checks on organizational payees and their staff. While we agree that implementing background screening pursuant to the law should take precedence, SSA should seek opportunities to implement screening for organizational payees at the earliest opportunity.

Recommendation: The Commissioner of the Social Security Administration should develop and implement mechanisms to systematically obtain and review feedback from organizational payees and communicate findings to SSA management. (Recommendation 4)

Agency: Social Security Administration
Status: Open

Comments: SSA agreed with this recommendation but did not identify plans to address it.

Recommendation: The Commissioner of the Social Security Administration should (a) establish a plan and time frame for periodically reviewing the predictive model's design; (b) consider additional data sources that would allow for additional screening or modeling of potentially high-risk organizational payees; and (c) ensure that subsequent design decisions are documented in sufficient detail so the development process can be more fully understood and replicated, either by SSA or a knowledgeable third party, with minimal further explanation. (Recommendation 5)

Agency: Social Security Administration
Status: Open
Priority recommendation

Comments: SSA agreed with this recommendation in 2019 and identified actions to address it. The agency stated that it would pursue other data sources to develop additional screening tools and models to identify potentially high-risk organizational payees, but that it is unable to incorporate additional data into the existing model. They reported they cannot use new data to modify the existing model, which was built from cases and transactions that occurred many years ago. We recognize that the current model, which focuses on misuse findings and is based on historical data, presents challenges for both updating and including new data sources. Therefore, as SSA considers additional screening tools and models to identify high-risk, low-volume organizational payees, SSA should develop a plan for revising the existing model that allows for more timely updates and results in documentation of related design decisions. In April 2020, SSA officials reported that the agency is finalizing a plan to revise the existing model and would pursue other data sources to develop additional screening tools and models to identify potentially high-risk organizational payees.

Recommendation: The Commissioner of the Social Security Administration should require field offices to contact payees about missing or problematic annual accounting forms within a specific time frame. (Recommendation 6)

Agency: Social Security Administration
Status: Open

Comments: SSA agreed with this recommendation but did not identify plans to address it.

Recommendation: The Commissioner of the Social Security Administration should revise the annual accounting form to enhance its effectiveness. Such revisions could include (but not be limited to) more fully ascertaining the use of collective accounts, adopting stakeholders' recommendations on using the form to collect more meaningful data, and reflecting best practices from behavioral science insights in the design of the form. (Recommendation 7)

Agency: Social Security Administration
Status: Open

Comments: SSA agreed with this recommendation but did not identify plans to address it.

Recommendation: The Commissioner of the Social Security Administration should enhance the eRPS system to ensure that field offices are (a) alerted when collective accounts are due to be reviewed; and (b) able to take action on expired collective account information and thereby avoid payees' continued use of these accounts without oversight. (Recommendation 8)

Agency: Social Security Administration
Status: Open

Comments: SSA agreed with this recommendation and identified actions to address it. SSA officials reported that they would work with staff to ensure staff know where to find alerts for expiring accounts and enhance how eRPS displays information on collective accounts that have already expired. We agree with SSA's proposed actions. However, we adjusted our recommendation to clarify that SSA should enhance eRPS in a manner that ensures staff take action on expired accounts and that payees do not continue to use expired accounts without oversight.

Recommendation: The Commissioner of the Social Security Administration should, as it carries through with its plan to develop a risk assessment for the organizational payee program, ensure that that the plan reflects periodic consideration of findings from onsite reviews and audits. (Recommendation 9)

Agency: Social Security Administration
Status: Open
Priority recommendation

Comments: SSA agreed with this recommendation. In April 2020, SSA officials reported starting its Representative Payee Fraud Risk Assessment. We will consider closing this recommendation when SSA ensures that its risk assessment plan reflects periodic consideration of findings from onsite reviews and audits.

Recommendation: The Under Secretary of Health should require that all failures to meet quality standards are cited as deficiencies on SVH inspections. (Recommendation 2)

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

Comments: VA concurred with this recommendation and, as of July 2020, had taken some initial steps to address the recommendation such as modifying the SVH contractor's contract to stop the practice of using 'recommendations' for low-level deficiencies and beginning the process of revising a VA policy to address this practice.

Recommendation: The Under Secretary of Health should develop guidance for Veterans Affairs Medical Center staff conducting optional onsite CNH reviews. (Recommendation 3)

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

Comments: VA concurred in principle with this recommendation and indicated in January 2020 that it had begun taking actions to address this recommendation such as developing a memo of clarification and planning the release of additional guidance for staff.

Recommendation: The Under Secretary of Health should provide information on the quality of all SVHs that is comparable to the information provided on the other nursing home settings on its Access to Care website. (Recommendation 4)

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

Comments: VA concurred in principle and, as of July 2020, had begun taking some steps to address this recommendation such as exploring options for presenting SVH quality measure data.

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

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

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

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

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

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

Recommendation: The Administrator of CMS should provide guidance and clarify requirements regarding the monitoring and reporting of deficiencies that states using home and community-based services (HCBS) waivers are required to report on their annual reports. (Recommendation 1)

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

Comments: CMS concurred with this recommendation and indicated the agency would provide guidance and clarify requirements regarding the monitoring and reporting of deficiencies in states' annual reports. According to CMS's fiscal year 2021 Budget Justification the agency expects to issue sub-regulatory guidance pertaining to health and welfare of Medicaid beneficiaries in residential facilities by the close of 2020.To fully implement this recommendation, the sub-regulatory guidance should clarify requirements for states' monitoring and reporting of deficiencies in HCBS annual reports. GAO will continue to monitor CMS actions in response to this recommendation.

Recommendation: The Administrator of CMS should establish standard Medicaid reporting requirements for all states to annually report key information on critical incidents, considering, at a minimum, the type of critical incidents involving Medicaid beneficiaries, and the type of residential facilities, including assisted living facilities, where critical incidents occurred. (Recommendation 2)

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

Comments: HHS neither agreed nor disagreed with this recommendation. According to CMS' fiscal year 2021 Budget Justification, the agency expects to issue sub-regulatory guidance pertaining to health and welfare of Medicaid beneficiaries in residential facilities by the close of 2020. To fully implement this recommendation, the sub-regulatory guidance should establish standard Medicaid reporting requirements for all states to report critical incidents annually. GAO will continue to monitor CMS actions in response to this recommendation.

Recommendation: The Administrator of CMS should ensure that all states submit annual reports for HCBS waivers on time as required. (Recommendation 3)

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

Comments: CMS concurred with this recommendation and stated that it will review and update its communications with states to reaffirm reporting requirements and ensure that all HCBS annual reports are submitted on time. According to CMS' fiscal year 2021 Budget Justification, the agency expects to issue sub-regulatory guidance pertaining to the health and welfare of Medicaid beneficiaries in residential facilities by the close of 2020. To fully implement this recommendation, the sub-regulatory guidance should ensure that all states submit annual reports on time. GAO will continue to monitor CMS actions in response to this recommendation.

Recommendation: To help improve the Five-Star System's ability to enable consumers to understand nursing home quality and make distinctions between high- and low- performing homes, the Administrator of CMS should add information to the Five-Star System that allows consumers to compare nursing homes nationally.

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

Comments: HHS did not concur with this recommendation. CMS officials told us in July 2019 that they do not plan to implement this recommendation. We maintain that adding national comparison information is important.

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 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.