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 Administrator of the Food and Nutrition Service (FNS) should improve how FNS gathers information on the effectiveness of SNAP-Ed interventions, in order to ensure that these interventions are meeting program goals. (Recommendation 1)

Agency: Department of Agriculture
Status: Open

Comments: USDA generally agreed with this recommendation. The agency noted that FNS has efforts underway to comply with the 2018 Farm Bill requirement that the department report annually on the level of coordination between its nutrition education programs.

Recommendation: The Secretary of Agriculture should direct the Under Secretaries for Food, Nutrition, and Consumer Services and for Research, Education, and Economics to develop a formal mechanism, such as a designated individual or group of individuals, for providing cross-department leadership for USDA's nutrition education efforts and facilitating cross-program information sharing. (Recommendation 2)

Agency: Department of Agriculture
Status: Open

Comments: USDA generally agreed with this recommendation. The agency noted that FNS has efforts underway to comply with the 2018 Farm Bill requirement that the department report annually on the level of coordination between its nutrition education programs.

Recommendation: The Secretary of Agriculture should direct the Under Secretaries for Food, Nutrition, and Consumer Services and for Research, Education, and Economics to identify and implement mechanisms to fully leverage the department's nutrition expertise for its nutrition education efforts. (Recommendation 3)

Agency: Department of Agriculture
Status: Open

Comments: USDA generally agreed with this recommendation. The agency noted that FNS has efforts underway to comply with the 2018 Farm Bill requirement that the department report annually on the level of coordination between its nutrition education programs.

Recommendation: The Administrator of FNS should present the uncertainty around its retailer trafficking estimates in future reports by, for example, including the full range of the estimates in the report body and executive summary. (Recommendation 1)

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

Comments: FNS generally agreed with this recommendation, and stated that it will present the uncertainty around the retailer trafficking estimates in the executive summary and main body of all future trafficking reports, instead of presenting the information in appendices, as it did in past reports. In August 2020, FNS stated that it has made this change to the next trafficking report, which is in clearance at USDA. GAO will consider this recommendation implemented when FNS issues its this report.

Recommendation: The Administrator of FNS should continue efforts to improve the agency's retailer trafficking estimates by evaluating (1) whether the factors used to identify stores for possible investigation could help address the bias in its sample, and (2) the accuracy of its assumption of the percentage of SNAP benefits that are trafficked by different types of stores. (Recommendation 2)

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

Comments: FNS generally agreed with this recommendation. FNS stated that it will evaluate whether incorporating additional factors, such as the Watch List score used to identify stores for possible investigation, could improve its estimation methodology. FNS also stated that it will work with the USDA OIG to better understand the methodology the OIG uses to estimate the share of benefits that are trafficked by a retailer who is prosecuted for trafficking, and determine whether it is feasible to apply a similar methodology to the transaction data maintained by FNS in order to improve the accuracy of its assumptions about the percentage of SNAP benefits that are trafficked. In August 2020, FNS noted that it will evaluate the feasibility of this revised methodology for the trafficking estimates covering years 2018 through 2020. GAO will consider this recommendation implemented when FNS provides information on the results of this evaluation.

Recommendation: The Administrator of FNS should assess the benefits and costs of reauthorizing a sample of high-risk stores more frequently than other stores, use the assessment to determine the appropriate scope and time frames for reauthorizing high-risk stores moving forward, and document this decision in policy and on its website. (Recommendation 3)

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

Comments: FNS generally agreed with this recommendation. In August 2020, FNS stated that it included a sample of 471 high-risk stores that had not yet reached their 5-year reauthorization cycle in its fiscal year 2020 reauthorization pool. Once fiscal year 2020 reauthorizations are complete, FNS will analyze the outcomes of these reauthorizations to determine the benefits and costs of reauthorizing some high-risk stores more frequently. At that point, FNS will determine the appropriate scope and time frames for reauthorizing high-risk stores moving forward. GAO will consider this recommendation implemented when FNS completes this work.

Recommendation: The Administrator of FNS should move forward with plans to increase penalties for retailer trafficking. (Recommendation 4)

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

Comments: FNS generally agreed with this recommendation. In August 2020, FNS reported that it has developed a proposed rule to accomplish this change. The agency expects the proposed rule to be published in December 2020.

Recommendation: The Administrator of FNS should establish performance measures for its trafficking prevention activities. (Recommendation 5)

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

Comments: FNS generally agreed with this recommendation. In August 2020, FNS reported that the agency has assessed existing data to develop strategies for trafficking prevention, and is taking a two-pronged approach. First, the agency stated that it has updated training materials and guidance to make them more accessible for staff. Second, the agency stated that it is continuing to assess store applications and reauthorizations for business integrity, including prior fraud and other criminal offenses by store owners or managers, as described in regulations and policy. However, FNS did not indicate whether the agency currently has plans to establish performance measures for its trafficking prevention activities.

Recommendation: The Administrator of the Food and Nutrition Service (FNS) should identify and disseminate strategies to states and service providers for increasing the participation of SNAP recipients referred to the SNAP E&T program. (Recommendation 1)

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

Comments: FNS officials agreed with this recommendation and indicated they are taking steps towards closing it. Specifically, FNS officials said they plan to take the following actions to disseminate strategies on increasing participation among SNAP recipients referred to the SNAP E&T program: 1) update the SNAP E&T Best Practices Study to include strategies on increasing participation by December 2021; 2) publish results from Pilot Projects to Reduce Dependency and Increase Work Requirements and Work Effort Under the Supplemental Nutrition Assistance Program that include information regarding which outreach, referral, and enrollment processes are most effective by 2021; and 3) provide technical assistance through SNAP to Skills with new attention on increasing SNAP E&T participation and engagement among eligible SNAP participants. We will continue to monitor FNS's efforts to disseminate strategies through these mechanisms with a particular focus on ensuring these strategies reach both state officials and service providers.

Recommendation: The Administrator of FNS should take additional steps to address data reliability issues in the state-reported data on SNAP E&T participant characteristics and outcomes, including steps to address imprecise instructions on data collection forms and staff confusion at the state level. (Recommendation 2)

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

Comments: FNS generally agreed with this recommendation. They noted that they have been providing continued technical assistance to states to improve data quality and in October 2018 made updates to the SNAP E&T data report. FNS plans or has additional changes pending to the SNAP E&T data report and SNAP Quality Control guidance that it plans to use to collect improved SNAP E&T data in fiscal year 2021. In addition, FNS plans to leverage results from data and technical assistance grants upon their completion in September 2020 to disseminate best practices to help states improve outcome reporting data. We are encouraged by FNS's efforts in these areas and will evaluate the results of these actions as we continue to monitor the agency's progress in addressing this recommendation.

Recommendation: The Administrator of FNS should determine and communicate to states how the agency will use newly reported outcome and participant characteristics data to assess the effectiveness of state SNAP E&T programs. (Recommendation 3)

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

Comments: FNS officials agreed with this recommendation. FNS officials noted that with the submission of January 2019 outcome reporting measures, the agency has a complete year of data which FNS will use to establish a baseline for each State's SNAP E&T program. However, FNS has not yet articulated how the data will be used to assess effectiveness of the programs, or provided examples of how FNS has used the data to provide feedback on the effectiveness of SNAP E&T programs. We will continue to monitor FNS's efforts to communicate to the states how the outcome data can be used to assess program effectiveness.

Recommendation: Building on ongoing efforts, the Administrator of FNS should develop and implement additional methods to widely distribute information to state agencies on an ongoing basis about successful efforts to adopt data analytics and strategies to leverage existing data, technology, and staff resources to enhance data analytics. (Recommendation 1)

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

Comments: FNS agreed with this recommendation. The agency noted that it has been moving in the general direction of this recommendation and would build on current efforts to address it but noted that state readiness and technical capabilities are limiting factors in the adoption of data analytics.

Recommendation: The Administrator of the Food and Nutrition Service (FNS) should improve its estimate of children's participation in the SFSP by focusing on addressing, at a minimum, data reliability issues caused by variations in the number of operating days of meal sites and in the months in which states see the greatest number of meals served. (Recommendation 1)

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

Comments: In March 2019, Department of Agriculture's Food and Nutrition Service (FNS) submitted its 180-day letter and a subsequent response to report recommendations in GAO-18-369. In its response, FNS stated that it anticipates completing an evaluation of how they calculate SFSP participation by summer 2020. GAO will continue to monitor FNS actions to address this recommendation, including the status of its evaluation and steps taken to improve the agency's estimate of children participating in SFSP. GAO will consider this recommendation closed when FNS provides documentation that it has addressed, at a minimum, data reliability issues in the participation estimate caused by variations in the number of operating days of meal sites and in the months in which states see the greatest number of meals served. FNS plans to provide us with the status of its efforts by the end of FY 2020.

Recommendation: The Administrator of FNS should communicate to all SFSP stakeholders the circumstances it considers in approving requests for flexibility with respect to the requirement that children consume SFSP meals on-site in areas that have experienced crime and violence, taking into account the feasibility of accessing data needed for approval, to ensure safe delivery of meals to children. (Recommendation 2)

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

Comments: In late May 2018, the Department of Agriculture's Food and Nutrition Service (FNS) provided guidance to states regarding changes in policies related to SFSP waivers and demonstration projects and held a webinar to clarify the changes. In March 2019, FNS reported that this guidance and the webinar provided information about participation in the demonstration for exceptional circumstances, which is the means through which FNS had granted states and program providers flexibility for children to consume SFSP meals off-site in areas that had experienced crime and violence. However, the guidance documents do not directly acknowledge that FNS includes areas with crime and violence as exceptional circumstances for purposes of the demonstration, and neither the guidance nor the webinar provided new information about the circumstances FNS considers when granting the flexibility for such areas. GAO will therefore continue to monitor FNS actions to address this recommendation and consider it closed when the agency communicates the circumstances it considers in approving such requests for flexibility with response to the requirement that children consume SFSP meals on-site in areas that have experienced crime and violence. FNS plans to provide us with the status of its efforts by the end of FY 2020.

Recommendation: The Administrator of FNS should evaluate and annually report to Congress, as required by statute, on its use of waivers and demonstration projects to grant states and sponsors flexibility with respect to the requirement that children consume SFSP meals on-site in areas experiencing crime or violence, to improve its understanding of the use and impact of granting these flexibilities on meeting program goals. (Recommendation 3)

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

Comments: In March 2019, Department of Agriculture's Food and Nutrition Service (FNS) reported that it had drafted the report to Congress to meet its statutory requirement summarizing the use of waivers and demonstration projects. FNS also indicated that the report was being reviewed internally, and planned to submit the final report to Congress following that review. GAO will consider closing this recommendation when FNS submits the final report to Congress. FNS plans to provide us with the status of its efforts by the end of FY 2020.

Recommendation: The Administrator of FNS should disseminate information about existing flexibilities available to state agencies to streamline administrative requirements for sponsors participating in the SFSP and other child nutrition programs to help lessen the administrative burden. For example, FNS could re-distribute existing guidance to state agencies that explains available flexibilities and encourage information sharing. (Recommendation 4)

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

Comments: In March 2019, Department of Agriculture's Food and Nutrition Service (FNS) submitted its 180-letter and a subsequent response to recommendations in GAO-18-369. In its response, FNS stated that it plans to address streamlining flexibilities that impact the SFSP and other child nutrition programs in a future regulatory action. GAO will therefore continue to monitor FNS's progress with this rule-making and any other actions taken to address this recommendation. FNS plans to provide us with the status of its efforts by the end of FY 2020.