Recommendation: The Secretary of HHS should direct ACF to provide additional guidance and technical assistance to states to address known challenges and enhance their understanding of CAPTA requirements, including the requirements for health care providers to notify CPS of substance-affected infants and the development of a plan of safe care for these infants.

Agency: Department of Health and Human Services
Status: Open

Comments: HHS did not agree with this recommendation. The agency stated that it clarified guidance in the areas we raised. HHS also believes it is necessary to allow states the flexibility to meet the requirements in the context of their state CPS program. However, we found that states reported issues with the guidance and it did not address a key ongoing challenge regarding CAPTA requirements. HHS indicated that it will continue to provide technical assistance to states and fund demonstration sites to establish or enhance collaboration across community agencies and courts. Although continuing to provide technical assistance to states should be beneficial, our findings demonstrate that additional guidance is also needed. We continue to believe our recommendation is warranted. As of February 2020, the agency continues to disagree.

Recommendation: The Secretary of Education should direct the Office of Academic Improvement to expand its performance measures for the 21st Century program to address all program objectives. Specifically, Education should establish performance measures related to key behavioral, including student attendance and disciplinary incidents, and socio-emotional outcomes.

Agency: Department of Education
Status: Open

Comments: Education neither agreed nor disagreed with our recommendations; rather, it generally noted that it will keep our recommendations in mind as it continues to implement changes in the program as a result of ESSA. We will monitor the agency's progress and consider closing it when the agency provides documentation that these efforts are complete.

Recommendation: The Secretary of Education should direct the Office of Academic Improvement to conduct federal-level data checks on the accuracy of 21st Century program data submitted by states. Such checks could test for logical relationships between fields. Education should also publicly disclose and address any data limitations it identifies, as appropriate.

Agency: Department of Education
Status: Open

Comments: Education neither agreed nor disagreed with this recommendation, but stated that it was taking some actions to enhance program data. We will monitor the agency's progress and consider closing it when the agency provides documentation that these efforts are complete.

Recommendation: The Secretary of Education should direct the Office of Academic Improvement to provide written, non-regulatory guidance to states on developing and conducting high-quality 21st Century state evaluations to help address the difficulties states face in measuring program performance and effectiveness.

Agency: Department of Education
Status: Open

Comments: Education neither agreed nor disagreed with this recommendation, but identified steps it plans to take to implement it. We will monitor the agency's progress and consider closing it when the agency provides documentation that these efforts are complete.

Recommendation: The Secretary of Education should direct the Office of Academic Improvement to use the information it collects from its monitoring visits and ongoing interactions with states to share effective practices across states for sustaining their 21st Century programs once program funding ends. This information could be shared using existing mechanisms such as Education's meetings with 21st Century state coordinators.

Agency: Department of Education
Status: Open

Comments: Education neither agreed nor disagreed with this recommendation, but identified steps it plans to take to implement it. We will monitor the agency's progress and consider closing it when the agency provides documentation that these efforts are complete.

Recommendation: To help ensure that the pilot programs for disconnected youth can be effectively implemented over the lifetime of the initiative, the Director of OMB should coordinate with relevant federal agencies to identify and estimate expected annual financial and staff resource contributions from each agency, including during the implementation and evaluation phases of the pilots.

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

Comments: As of May 2020, the Office of Management and Budget (OMB) and relevant federal agencies described steps they have taken that could address the intent of this recommendation. However, they have not yet shared documentation so that we can independently verify those actions. Since we issued our report in April 2017, federal agencies discontinued contributing financial resources to support joint pilot program activities, such as start-up grants, general technical assistance, or evaluations. According to OMB staff and officials at several agencies in August 2018, that change in contributions began with the fiscal year 2018 pilots. At that time, they all told us that relevant agencies would continue to provide staff support to the pilots, as needed. In April 2020, officials from the Department of Education (Education)-the lead agency for overall performance partnership efforts-informed us that six pilots remain active, through September 2020, and were able to provide information about staff resource contributions. For example, Education officials told us that two of the department's employees devote less than 10 percent of their time to support those six pilots. We have requested additional information from Education to better understand staff resource commitments and contributions from other agencies involved in those six pilots.

Recommendation: To ensure that federal agencies involved in the disconnected youth pilots are able to evaluate pilot outcomes and ultimately communicate to Congress whether and to what extent the flexibilities tested by the pilots should be integrated into broader efforts, the Director of OMB should coordinate with relevant federal agencies to identify criteria or standards for assessing scalability, and collect data needed to address those criteria or standards.

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

Comments: As of May 2020, the Office of Management and Budget (OMB) and relevant federal agencies described steps they have taken that could address this recommendation. However, they have not yet shared documentation so that we can independently verify those actions. In August 2018, OMB staff told us that they were coordinating relevant work with the Department of Health and Human Services (HHS) and the Department of Labor (DOL), which is leading the national evaluation for the disconnected youth pilot programs. OMB staff told us this group was studying specific criteria or standards that could be used for assessing the scalability of the disconnected youth pilot programs. In April 2020, DOL officials told us that the department was examining issues related to scalability in products it is developing as part of the national evaluation. For example, the officials informed us that DOL plans to publish a report in summer 2020 that examines the effects of flexibilities tested by individual pilot programs, and their potential to be scaled. Furthermore, DOL officials told us that the department, in coordination with OMB, HHS, and other relevant agencies, had drafted, but not yet finalized, a memorandum that identifies criteria for assessing scalability. We have requested copies of relevant DOL evaluation products and the memorandum. When provided, we will assess the extent to which they address our recommendation.

Recommendation: To better align program goals with agency missions and improve program administration and oversight, Congress should consider designating the Department of Housing and Urban Development as a joint administrator of the program responsible for oversight. As part of the deliberation, Congress also should direct HUD to estimate the costs to monitor and perform the additional oversight responsibilities, including a discussion of funding options.

Agency: Congress
Status: Open

Comments: As of June 2020, Congress had not enacted legislation to give HUD an oversight role for LIHTC.

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

Agency: Department of Transportation
Status: Open

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

Recommendation: To establish accountability for meeting the programs' goal of increasing the participation of traditionally underrepresented groups in the highway construction workforce, the Secretary of Transportation should direct the FHWA Administrator to create and implement an oversight mechanism that (1) holds states accountable for meeting federal training criteria and (2) clearly stipulates how FHWA will assess state program effectiveness, including what type of program achievement data states are to submit and how such data will be used. This oversight mechanism should include assessing the effectiveness of its division offices in overseeing state activities.

Agency: Department of Transportation
Status: Open

Comments: FHWA has taken initial steps to implement a mechanism for state oversight, which includes collecting program implementation information from each state. FHWA plans to convene a working group to review this information and provide feedback to states on their programs. FHWA officials then anticipate sharing best practices and essential requirements for the program through webinars and other technical assistance. As of August 2019, FHWA has gathered information from states and is in the early stages of implementing this oversight mechanism.

Recommendation: In light of the need for accurate and complete information on children's access to health services under Medicaid and CHIP, the requirement that states report information to CMS on certain aspects of their Medicaid and CHIP programs, and problems with accuracy and completeness in this state reporting, the Administrator of CMS should work with states to identify additional improvements that could be made to the CMS 416 and CHIP annual reports, including options for reporting on the receipt of services separately for children in managed care and fee-for-service delivery models, while minimizing reporting burden, and for capturing information on the CMS 416 relating to children's receipt of treatment services for which they are referred.

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

Comments: In August 2019, CMS stated that the agency's long-term plan is to use the Transformed Medicaid Statistical Information System (T-MSIS) to analyze information on children's receipt of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services. As of June 2020, CMS had developed a new CMS-416 reporting form that gives states the option of having CMS calculate the measures for the report using T-MSIS. CMS stated that it intends to implement this option for states for fiscal year 2020 CMS-416 reports, which are due in April 2021. As of August 2020, the new CMS-416 form was undergoing Paperwork Reduction Act review. CMS is also exploring using T-MSIS to generate the Core Set of Children's Health Care Quality Measures for Medicaid and CHIP, some of which are included in the CHIP annual report. As of June 2020, CMS had begun a pilot test to generate five of the Core Set measures using 2018 T-MSIS data. GAO considers this recommendation open and will continue to monitor CMS's progress towards its long-term goal of using T-MSIS to monitor children's receipt of EPSDT services.

Recommendation: In order to develop an approach to decision making and the development of evidence on high-clockspeed trends affecting highway safety that are characterized by uncertainty, the Secretary of Transportation should consider and evaluate practices and principles for making decisions under conditions of uncertainty and for using data in such decision making and, on that basis, develop an approach to guide decision making on high-clockspeed trends that, although somewhat uncertain, may affect highway safety.

Agency: Department of Transportation
Status: Open

Comments: In GAO-09-56, GAO recommended the Secretary of Transportation consider and evaluate practices and principles for making conditions under uncertainty and for using data in light of issues encountered in developing evidence on high-clockspeed trends affecting highway safety that are characterized by uncertainty. GAO had studied driver distraction involving electronic devices, in particular cell phones with texting capability and identified these evolving electronic devices as a high clockspeed trend. DOT reports several actions on distracted driving, specifically: (1) an Executive Order to federal employees not to engage in text messaging while driving government-owned vehicles; when using electronic equipment supplied by the government while driving; or while driving privately owned vehicles when they are on official business; (2) the Secretary called on state and local governments to (a) make distracted driving part of their state highway plans, (b) pass state and local laws against distracted driving in all types of vehicles, (c) back up public awareness campaigns with high-visibility enforcement actions; (3) the Secretary directed the Department to establish an on-line clearinghouse on the risks of distracted driving and also (4) pledged to continue the Department's research on how to best combat distracted driving. DOT also notes that the Department's www.distraction.gov website provides information on the latest data on distracted driving and that 34 states have passed laws against texting and driving since the 2009 announcement by the Secretary of DOT.

Recommendation: The Secretary of Transportation should evaluate whether or not new approaches to data collection are needed to better track new trends related to highway safety.

Agency: Department of Transportation
Status: Open

Comments: DOT has not responded to this recommendation.

Recommendation: In order to improve the information available to the Congress for reauthorization, the Secretary of Transportation should analyze and report on trends currently anticipated to affect highway safety through 2020 and beyond in a systematic fashion--including information on high-clockspeed trends, discussion of evidence about these and other individual trends, their implications and potential interactions, and DOT responses.

Agency: Department of Transportation
Status: Open

Comments: DOT has not responded to this recommendation, but DOT announced a distracted driving summit September 30-October 1, 2009, with a limited number of invitees, and invited the GAO Assistant Director on this report to participate. U.S. Transportation Secretary Ray LaHood stated that the purpose of the summit is to "to address the dangers of text-messaging and other distractions behind the wheel." The summit will include "senior transportation officials, elected officials, safety advocates, law enforcement representatives and academics" who will convene in Washington, DC "to discuss ideas about how to combat distracted driving."

Recommendation: In order to improve the information available to the Congress for reauthorization, the Secretary of Transportation should determine, in consultation with relevant congressional committees, schedules for periodic reporting that will be sufficiently frequent to update the Congress on fast-changing trends.

Agency: Department of Transportation
Status: Open

Comments: DOT has not responded to this recommendation.

Recommendation: To help states identify and address quality-of-care concerns among individuals with developmental disabilities receiving Medicaid HCBS waiver services, the Administrator of CMS should encourage states to (1) include death as a critical incident and conduct mortality reviews if they do not already do so and (2) broaden their mortality review processes if they already include death as a critical incident and conduct mortality reviews.

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

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

Recommendation: To help further the progress toward meeting the goals of IPIA and determining states' role in assisting federal agencies to report a national improper payment estimate on federal programs, the Director, Office of Management and Budget, should expand IPIA guidance to provide criteria that federal agencies should consider when developing a plan or methodology for estimating a national improper payment estimate for state-administered programs, such as criteria that address the nature and extent of data and documentation needed from the states to calculate a national improper payment estimate.

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

Comments: The Office of Management and Budget (OMB) concurred with this recommendation. Since the issuance of the GAO report, OMB has made several revisions to its OMB Circular No. A-123, Appendix C "Requirements for Effective Measurement and Remediation of Improper Payments." The latest revision is dated June 26, 2018. The intent of OMB Circular No. A-123, Appendix C, is to ensure that federal agencies focus on prevention and have the proper incentives to improve their improper payment rates. In August 2020, OMB provided us its improper payment guidance on sampling and estimation in place at the time of the GAO audit. Based on this documentation, we sent a follow-up request to OMB for additional information. We are currently waiting to hear back from OMB so we can continue with our review. We will continue to monitor the agency's actions to address this recommendation.