Recommendation: The Secretary of Labor should ensure that BLS explores cost-efficient ways to evaluate the data sources currently used to produce subpopulation indexes, such as by engaging more directly with other stakeholders or seeking input from its advisory groups and other knowledgeable entities about approaches to expand data collection in a cost-efficient manner. (Recommendation 1)

Agency: Department of Labor
Status: Open

Comments: The Department of Labor agreed with this recommendation and stated that it would continue to investigate improvements to subpopulation indexes.

Recommendation: The Secretary of Labor should ensure that BLS explores the use of already collected National Accounts data to produce more accurate, timely, and relevant CPIs. (Recommendation 2)

Agency: Department of Labor
Status: Open

Comments: The Department of Labor (DOL) disagreed with this recommendation, stating that the National Accounts data are not a replacement for Consumer Expenditure Survey data. We agree that the National Accounts data are not a wholesale replacement for the Consumer Expenditure Survey data, but it would still be useful to examine National Accounts data as an augmenting, alternative source of data to supplement or enrich the Consumer Expenditure Survey. Such an effort could potentially lead to more accurate, timely, and relevant CPIs. Although DOL noted that the Consumer Expenditure Survey is a continuous survey and that data are received quarterly, most CPIs still rely on expenditure weights based on Consumer Expenditure Survey data that are up to 4 years out-of-date. In addition, the Consumer Expenditure Survey faces increasing costs and declining response rates. DOL said it is exploring ways to accelerate the data collection and processing time and that it periodically investigates the frequency of updating expenditure weights. This is a laudable effort that we believe warrants further action to explore additional opportunities for improvement, such as researching the extent to which there are instances or categories for which the National Accounts data could be used to produce more up-to-date expenditure weights than the Consumer Expenditure Survey.

Recommendation: The Commissioner of Internal Revenue should assess options for updating Publications 590-A and 590-B to either include more information or direct taxpayers to other resources for IRA owners with investments in unconventional assets. Such information could include: storage requirements for IRA investments in certain precious metals; valuation methods for hard-to-value IRA assets; the Department of Labor's process for granting exemptions to IRA prohibited transactions rules; and IRA investments with the potential to create unrelated business income tax liabilities. (Recommendation 1)

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

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

Recommendation: The Commissioner of Internal Revenue, building on forthcoming compliance research using new IRA asset data, should evaluate the feasibility of requiring disclosure for high-risk IRA asset types associated with abusive schemes as transactions of interest. (Recommendation 2)

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

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

Recommendation: The Commissioner of Internal Revenue should develop resources (such as training materials or job aids) for Small Business/Self-Employed examiners conducting IRA owner audits that explain how IRAs with unconventional assets can generate unrelated business income tax liability, and how examiners can refer cases to unrelated business income experts in IRS for assistance. (Recommendation 3)

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

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

Recommendation: To better understand the available opportunities for collecting inmate health care utilization data, BOP should conduct a cost-effectiveness analysis of potential solutions, and take steps toward implementation of the most effective solution.

Agency: Department of Justice: Bureau of Prisons
Status: Open

Comments: BOP agreed with GAO's June 2017 recommendation and has begun to take steps to address it. In 2018, BOP contracted with a management consulting firm to improve organizational alignment and strengthen data analytics capabilities. This firm is also examining data analytics solutions and by late March 2020 is expected to make recommendations to BOP to support a request for purchase (RFP) for the most cost-effective one. BOP anticipates the RFP will then follow within the subsequent three months. This contracting work is a positive step that should help BOP identify the most cost-effective solution to collect health care utilization data. BOP is still in the early stages of implementing this action, therefore it is too soon to assess whether its efforts will fully address GAO's recommendation. However, once these actions are completed, BOP could be better positioned to find a solution for collecting the needed data.

Recommendation: To better understand the available opportunities for controlling health care costs, BOP should implement its guidance to conduct "spend analyses" of BOP's health care spending, using data sources already available

Agency: Department of Justice: Bureau of Prisons
Status: Open

Comments: BOP agreed with GAO's June 2017 recommendation and has begun to take steps to address it. In 2018, BOP contracted with a management consulting firm to identify opportunities to improve organizational alignment and strengthen data analytics capabilities. As part of this effort, BOP also contracted with a health care finance expert, who began working with BOP Health Services Division in June 2019. The expert has met with subject matter experts across disciplines to identify reliable sources for medical cost data, including medical activities data, staffing data, and medical cost data to support conducting spend analyses. BOP expects this effort to be completed by late spring 2020. This contracting work is a positive step toward implementing BOP's spend analysis guidance; however, since BOP has not yet completed this effort, it is too soon to assess whether BOP's efforts will fully address GAO's recommendation. Once BOP has completed this effort, it could be better positioned to identify opportunities for controlling health care costs.

Recommendation: To determine the actual or likely effectiveness of its ongoing or planned health care cost control initiatives, BOP should evaluate the extent to which its initiatives achieve their cost control aim.

Agency: Department of Justice: Bureau of Prisons
Status: Open

Comments: BOP agreed with GAO's June 2017 recommendation and has begun to take steps to address it. In 2018, BOP contracted with a management consulting firm to identify opportunities to improve organizational alignment and strengthen data analytics capabilities. As part of this effort, BOP also contracted with a health care finance expert, who began working with BOP Health Services Division in June 2019. BOP is working with this expert to validate existing financial data sources and apply a standardized cost accounting model to evaluate the cost effectiveness of key health care cost control initiatives. According to BOP, the model is being developed in phases with the initial phase expected to be completed by late March 2020. The second phase of the model is scheduled to launch in October 2020. This is a positive step that will better position BOP to evaluate its health care cost control initiations. Since BOP has not yet completed this effort, it is therefore too soon to assess whether its efforts will fully address GAO's recommendation. However, once BOP has completed this effort, it could help BOP evaluate the effectiveness of its health care cost control initiatives.

Recommendation: To enhance its strategic planning for and implementation of health care cost control efforts, BOP should incorporate elements of a sound planning approach and (1) establish a means of measuring progress toward and effectiveness of its activities for its current strategic objectives and goals related to controlling health care costs; and (2) identify the resources and investments necessary for implementation of its planned health care cost control initiatives.

Agency: Department of Justice: Bureau of Prisons
Status: Open

Comments: BOP agreed with GAO's June 2017 recommendation and has begun to take steps to address it. In October 2018, BOP initiated a contract with an external group of public administration experts to examine BOP's organizational structure and its lines of authority. The group completed its study and issued a report in October 2019, which included recommendations for BOP. According to BOP, the Health Services Division is in the process of creating a Strategic Plan Advisory Group, which will implement recommendations in the October 2019 report, and will establish a 2020-2025 Strategic Plan. The Strategic Plan Advisory Group will also evaluate metrics, including those related to financial performance that will, according to BOP, enable it to identify the resources and investments to help control health care costs. This action is a positive step that could help BOP enhance its strategic planning for and implementation of health care cost control efforts. However, BOP is in the early stages of implementing this recommendation; thus it is too soon to assess if BOP will find the most effective method for enhancing its strategic planning.

Recommendation: To improve the reliability and utility of its Federal Medical Center mission analyses, BOP should document the analyses and findings that underlie its recommendations.

Agency: Department of Justice: Bureau of Prisons
Status: Open

Comments: In June 2017, BOP agreed with GAO's recommendation. However, BOP decided to end the Federal Medical Center mission analyses process. Instead, in September 2018 BOP established a Medical Referral Center (MRC) Executive Advisory Board, made up of BOP's Health Services Division leadership and wardens from all seven MRCs. According to BOP, the Board plans to develop and implement dashboard metrics by the end of calendar year 2020 to monitor essential functions at the centers, which it hopes will improve management of the inmate health care system. In the meantime, BOP reports that the Board has already developed and implemented the MRC pipeline patient dashboard, which permits the MRC wardens to monitor incoming patients in advance of arrival and to maximize the best patient care and housing until treatment is complete. In addition, the Board has developed and implemented the Memory Disorder Unit at one if its MRCs. This resulted in BOP making more efficient use its inpatient beds, as inmates that were housed in community hospitals could return to a BOP inpatient setting. While these steps might not fulfill the recommendation as worded, they have already resulted in some improvements to the utility of the MRCs, and therefore the intent of the recommendation. We will continue to monitor progress on this effort to ensure BOP develops and implements the metrics as planned.

Recommendation: The U.S. Trade Representative should, with appropriate experts in Commerce, OMB, and GSA, improve the U.S. methodology for providing federal government procurement statistics to the WTO to ensure both accurate and more timely reporting, consistent with GPA requirements--for example, by providing preliminary estimates and updated values of covered federal procurement or by using an alternative methodology that bases measures of covered government procurement on actual annual obligations, if USTR determines that such an approach is consistent with WTO obligations.

Agency: Executive Office of the President: Office of the United States Trade Representative
Status: Open

Comments: In February 2017 we reported that the United States had revised its approach to statistical reporting to the World Trade Organization (WTO) about covered federal government procurement from an "award values" methodology to an actual "cumulative obligations" approach in October 2015. The "cumulative obligations" methodology resulted in a more accurate measure of covered federal procurement, but it introduced a 6-year delay in reporting. We found this reporting delay inconsistent with the 2014 WTO Agreement on Government Procurement (GPA) requirement of reporting within 2 years of the end of the reporting period. We recommended that the U.S. Trade Representative (USTR) should, with appropriate experts in Commerce, Office of Management and Budget, and General Services Administration, improve the U.S. methodology for providing covered federal government procurement statistics to the WTO to ensure both accurate and more timely reporting, consistent with GPA requirements--for example, by providing preliminary estimates and updated values of covered federal procurement or by using an alternative methodology that bases measures of covered government procurement on actual annual obligations, if USTR determines that such an approach is consistent with WTO obligations. Following the issuance of our report, in December 2017 USTR reported that they had worked with other agencies to improve their methods. While they decided to continue to report statistics using the "cumulative obligations" methodology they decided to also report "partially reported" (preliminary) statistics to improve the timeliness of U.S. reporting. This preliminary data was to be based on the same data used in the "cumulative obligations" methodology but can be submitted within two years of the end of the reporting period and therefore comply with GPA statistical reporting obligations. USTR submitted preliminary statistics for FY 2015 on November 15, 2017; for FY 2016 on October 31, 2018; and for FY 2017 on October 29, 2019. USTR will later update these statistics to reflect the "final" total value in 2021. GAO will continue to monitor this recommendation until that time.

Recommendation: To support its strategic and open data goals, the Director of OPM should improve the availability of the EHRI payroll data--for example, by preparing the data for analytics, making them available through online tools such as FedScope, and including them among the EHRI data sources on the OPM website and Data.gov.

Agency: Office of Personnel Management
Status: Open
Priority recommendation

Comments: OPM agreed with the recommendation. In December 2018, OPM told us it will establish a plan to make payroll data available through analytical tools such as FedScope no later than the fourth quarter of fiscal year 2019. To fully implement the recommendation, OPM will need to improve the availability of payroll data-either from the existing EHRI system or the new employee digital record-by ensuring the data are prepared and made available for analytics research.

Recommendation: To improve internal controls for data quality, the Director of OPM should consistently monitor system-generated error and edit check reports and ensure that timely action is taken to address identified issues.

Agency: Office of Personnel Management
Status: Open
Priority recommendation

Comments: OPM agreed with the recommendation. In December 2018, OPM reported that it plans to begin follow-up efforts with agencies and shared service providers on payroll data errors and anomalies and to notify data providers of problems. To fully implement the recommendation, OPM will need to follow up with shared services centers and agencies regarding issues identified with the payroll data they submit to EHRI. These steps will help ensure the quality of historical and current payroll data. They will also ensure that system detected errors are resolved and do not compound over time.

Recommendation: To integrate the payroll data into the larger suite of EHRI databases, the Director of OPM should develop a schedule for executing these plans.

Agency: Office of Personnel Management
Status: Open

Comments: OPM concurred with our recommendation, but has not yet developed a plan for integrating payroll into the larger suite of EHRI databases.

Recommendation: To integrate the payroll data into the larger suite of EHRI databases, the Director of OPM should evaluate existing internal control activities and develop new control activities for EHRI payroll data, such as implementing transactional edit checks that leverage the information in the other EHRI datasets.

Agency: Office of Personnel Management
Status: Open

Comments: While OPM concurred with our recommendation, the agency has not evaluated or implemented, for Payroll data, the control activities and edit checks that are currently used to support the reliability of the other EHRI datasets.

Recommendation: To help lessen confusion among the public and policy makers regarding federal data on sexual violence, the Director of OMB should establish a federal interagency forum on sexual violence statistics. The forum should consider the broad range of differences across the data collection efforts to assess which differences enhance or hinder the overall understanding of sexual violence in the United States.

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

Comments: At the time of our report, OMB neither agreed nor disagreed with this recommendation but stated that it did not believe convening a forum was the most strategic use of resources because agencies were not far enough along with their data collection efforts. We disagree with OMB's assertion because 7 of the 10 data collection efforts have been in place for more than 10 years, and several have been in place for multiple decades. As of December 2019, OMB has not provided information on any new efforts to establish a federal interagency forum on sexual violence statistics.

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

Agency: Congress
Status: Open

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

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

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

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

Recommendation: To determine how the use of RRCs and home confinement contribute to its goal of helping inmates successfully reenter society, and to better enable BOP to adjust its policies and procedures for the optimal use of these alternatives, as necessary and within statutory requirements, the Director of BOP should develop performance measures by which to help assess program outcomes.

Agency: Department of Justice: Bureau of Prisons
Status: Open

Comments: In November 2017, BOP reported that it developed a revised Statement of Work (SOW) for use with its RRC contractors that requires the contractors to track and report to BOP on, among other things, the number of placements into and releases from RRCs and home confinement; revocations from RRCs or home confinement; and RRC and home confinement residents that have secured full, part-time, or temporary employment. In a March 2019 update, BOP stated that it awarded nine contracts under the 2017 SOW and plans to use the data required under the SOW to conduct annual performance appraisals for RRCs after each performance period and intends to use this information in the future to track outcomes of the programs (e.g., employment, housing, individualized goals of offender). In a May 2020 update, BOP stated that that it had just received the first quarter of data from many of its RRC providers and that it continues to work with the providers to refine the data to determine if it can be utilized to develop performance measures. BOP stated that it anticipates being able to provide an update on this phase of their effort in September 2020. While the collection of this data is an important step, to fully implement this recommendation, BOP also needs to define and develop performance measures by which it can use such data to report and assess outcomes program-wide. We will continue to monitor BOP's ongoing efforts.

Recommendation: In order to ensure complete, analyzable records regarding research grant award decisions are available for management and analysis, the Secretary of Energy should direct DOE's grant-making agencies to implement additional data collection efforts, which should include: (1) Retaining complete records of pre-proposal, proposal, and award data, including a record of proposal disposition, in linked electronic files to facilitate aggregate, statistical analysis of the grant-making process, including the calculation of success rates. (2) Collecting demographic, education, and career information from applicants, on a voluntary basis, that is not available to proposal reviewers but is used for analysis of success rates.

Agency: Department of Energy
Status: Open

Comments: DOE generally agreed with this recommendation. DOE's Office of Science began collecting investigator demographics during the second quarter of fiscal year 2015 and already retained complete records that enabled the calculation of success rates. According to DOE officials, since September 2017, the other three grant-making components included in our audit have been taking various actions to implement the recommendation. These three components, the Office of Nuclear Energy (NE), the Advanced Research Projects Agency-Energy (ARPA-E), and the Office of Energy Efficiency and Renewable Energy (EERE), all complete steps to ensure that they retain complete grant life cycle information for each individual award, including complete records of pre-proposal, proposal, and award data in linked electronic files, thus fulfilling the first part of our recommendation. In 2019, EERE coordinated the development of a Federal Register Notice (FRN) regarding data collection jointly with NE and ARPA-E. The FRN drafted by EERE was finalized and published on February 11, 2020 (Vol. 85, Issue 28, Pages 7759-7760 [FR DOC# 2020-02674]). Under the proposed information collection request, an interface will be implemented in DOE grant application systems to allow external users to voluntarily provide a minimal amount of demographic information to comply with this recommendation, pursuant to review by the Office of Management and Budget. On June 30th, DOE officials shared with GAO the draft FRN for the 30-day notice and request for public comment prior to implementation.

Recommendation: To comply with Title IX enforcement requirements, the Secretary of the Department of Defense, which funds STEM research at universities, should direct the Director of the Office of Diversity Management and Equal Opportunity to ensure that Title IX compliance reviews of DOD's grantees are periodically conducted.

Agency: Department of Defense
Status: Open

Comments: DOD agreed with this recommendation and noted it is in the process of revising current DOD guidance which will address its Title IX enforcement requirements. In September 2017, a DOD official stated that the agency is in the process of formulating instructions related to both Title IX and Title VI that they believe will address the recommendation regarding Title IX enforcement. In a memorandum issued in December 2017, a DOD official described the agency's corrective action plan (CAP), including drafting an updated rule for the Code of Federal Regulations and the development and issuance of internal DOD policy documents regarding Title IX enforcement requirements. Both of these activities were expected to be completed by June 2019. DOD reported in March 2020 that it is continuing to revise current DOD guidance to address its Title IX enforcement requirements. The Director of DOD's Office of Diversity, Equity, and Inclusion (ODEI) stated in a letter to GAO that the revised Titile IX policy is in the early stages of DOD's policy process. ODEI expressed its commitment to developing the revised policy and ensuring Title IX compliance reviews are conducted as per the revised policy and GAO's recommendation. In September of 2020, DoD sent an update indicating that they will issue a policy memorandum, specifically outlining the requirement for DoD Components who provide financial assistance to educational programs or activities conduct periodic compliance reviews. This is expected to be complete by December 31, 2020.

Recommendation: To reduce the cost of the crop insurance program and achieve budgetary savings for deficit reduction or other purposes, Congress should consider reducing premium subsidies for the highest income participants.

Agency: Congress
Status: Open

Comments: As of May 2020, Congress has not acted on this matter.

Recommendation: To help the Department of Health and Human Services better control spending and encourage efficient delivery of care, Congress should consider requiring Medicare to pay PCHs as it pays PPS teaching hospitals, or provide the Secretary with the authority to otherwise modify how Medicare pays PCHs. To generate cost savings from any reduction in outpatient payments to PCHs, Congress should also provide that all forgone outpatient payment adjustment amounts be returned to the Supplementary Medical Insurance Trust Fund.

Agency: Congress
Status: Open

Comments: As of March 2020, no legislative action had been identified that changes how PCHs are paid for inpatient services, as GAO suggested in February 2015. The 21st Century Cures Act-Pub. L. No. 114-255, ?16002, 130 Stat. 1033, 1325 (2016), enacted in December 2016-slightly reduces the additional payments to PCHs for outpatient services furnished on or after January 1, 2018, and returns savings to the Supplementary Medical Insurance Trust Fund. However, the law does not substantively change how PCHs are paid for outpatient services, which differs from how Medicare pays PPS teaching hospitals. Until Medicare pays these cancer hospitals in a way that encourages greater efficiency, Medicare remains at risk for overspending.

Recommendation: To improve the CSA program, the Secretary of Transportation should direct the FMCSA Administrator to revise the SMS methodology to better account for limitations in drawing comparisons of safety performance information across carriers; in doing so, the Secretary of Transportation should direct the FMCSA Administrator to conduct a formal analysis that specifically identifies: (1) limitations in the data used to calculate SMS scores including variability in the carrier population and the quality and quantity of data available for carrier safety performance assessments, and (2) limitations in the resulting SMS scores including their precision, confidence, and reliability for the purposes for which they are used.

Agency: Department of Transportation
Status: Open
Priority recommendation

Comments: FMCSA did not agree with our recommendation, disputing the methodology and conclusions in our report. However, we continue to believe that addressing Safety Measurement System (SMS) methodology limitations has merit and could help the agency better target FMCSA's resources to the carriers that pose the highest risk of crashing. For example, we found FMCSA requires a minimum level of information for a carrier to receive an SMS score; however, this requirement is not strong enough to produce sufficiently reliable scores. As a result, FMCSA identified many carriers as high risk that were not later involved in a crash, potentially causing FMCSA to miss opportunities to intervene with higher risk carriers. To fully implement this recommendation, FMCSA should revise SMS methodology to account for data limitations that limit comparisons so that the FMCSA is better positioned to identify and mitigate carriers that pose the greatest safety risks. FMCSA has recently developed and tested a new methodological approach that could potentially account for the limitations we identified. While FMCSA has not yet committed to deploying the new methodology, they hope to do so some time in 2020.

Recommendation: To improve the CSA program, the Secretary of Transportation should direct the FMCSA Administrator to ensure that any determination of a carrier's fitness to operate properly accounts for limitations we have identified regarding safety performance information.

Agency: Department of Transportation
Status: Open

Comments: The Federal Motor Carrier Safety Administration (FMCSA) agreed with the basic principles that GAO addressed in this area, but disagreed with GAO's characterization of FMCSA's proposed Safety Fitness Determination (SFD) rule. In January 2016, FMCSA issued a notice of proposed rulemaking (NPRM), which proposed a revised methodology for issuance of a safety fitness determination for motor carriers. Specifically, the new methodology would have determined when a motor carrier is not fit to operate commercial motor vehicles in or affecting interstate commerce based on the carrier's on-road safety data; an investigation; or a combination of both. However, in July 2018, in part due to a review of SMS by the National Academies of Science congressionally mandated evaluation of SMS, FMCSA announced that the enhancements previously proposed will not be completed.

Recommendation: The Secretary of the Interior should direct the Director of the Bureau of Land Management to take steps, including making changes to AFMSS, and in any new system that replaces AFMSS, to improve the ability of staff to identify wells that are a high priority for environmental inspection and to incorporate information on the inspection history of wells into the environmental inspection prioritization process.

Agency: Department of the Interior
Status: Open

Comments: BLM concurred with the recommendation and has initiated action to update its application for permit to drill (APD) permit processing system. This new system will be known as AFMSS II and, when fully implemented, may address GAO's recommendations. Currently, BLM's actions are insufficient to close this recommendation because they have not completed the updates to AFMISS. Specifically, BLM has not completed its update of AFMSS II to cover environmental inspections. We will continue to follow up with BLM as the agency continues to take action to improve its well tracking system. BLM said it intends to update AFMSS II to cover environmental issues and projects that the remaining AFMSS II related tasks ensuring the system's full deployment will be completed by March 2020. In October 2019, we requested an update on BLM's timeframes.

Recommendation: The Secretary of the Interior should direct the Director of the Bureau of Land Management to take steps to ensure that environmental violations or problems and enforcement actions are documented in a consistent manner.

Agency: Department of the Interior
Status: Open

Comments: In August 2018, BLM informed us that the agency has taken several corrective actions to address the implementation of the recommendation, which will be accomplished related to the redesign of its Automated Fluid Minerals Support System (AFMSS). However, the agency reported that this system will not be completed until March 2020. In October 2019, we requested an update on BLM's timeframes.

Recommendation: To increase beneficiaries' awareness of providers' financial interest in a particular treatment, Congress should consider directing the Secretary of Health and Human Services to require providers who self-refer IMRT services to disclose to their patients that they have a financial interest in the service.

Agency: Congress
Status: Open

Comments: In August 2013, to increase beneficiaries' awareness of providers' financial interest in a particular treatment, we suggested that Congress should consider directing the Secretary of Health and Human Services to require providers who self-refer IMRT services to disclose to their patients that they have a financial interest in the service. As of June 2020, Congress has not implemented this suggestion.

Recommendation: The Administrator of CMS should insert a self-referral flag on its Medicare Part B claims form, require providers to indicate whether the IMRT service for which a provider bills Medicare is self-referred, and monitor the effects that self-referral has on costs and beneficiary treatment selection.

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

Comments: In August 2013, we recommended that the Administrator of the Centers for Medicare & Medicaid Services (CMS) insert a self-referral flag on its Medicare Part B claims form, require providers to indicate whether the intensity-modulated radiation therapy (IMRT) service for which a provider bills Medicare is self-referred, and monitor the effects that self-referral has on costs and beneficiary treatment selection. The Department of Health and Human Services (HHS) did not concur with this recommendation, noting that CMS does not believe that this recommendation will address overutilization that occurs as a result of self-referral, would be complex to administer, and may have unintended consequences. We continue to believe that such a flag on Part B claims would likely be the easiest and most cost-effective way for CMS to identify self-referred IMRT services and monitor the effects of self-referral. As of June 2020, CMS has not provided any additional information about actions it has taken to address this recommendation.

Recommendation: To improve the awareness, use, and usefulness of SaferProducts.gov, the CPSC should implement cost-effective usability improvements to SaferProducts.gov, taking into account the results of any existing usability testing or any new testing CPSC may choose to conduct.

Agency: Consumer Product Safety Commission
Status: Open

Comments: The Commission has taken some steps to address this recommendation by making usability improvements to SaferProducts.gov that we identified in our consumer testing in our report. For example, in 2015, the Commission addressed issues identified with the search functionality of the website by improving the advanced search function to enable searches by injury, time period, and location. In August 2018, the Commission clarified the purpose of SaferProducts.gov by adding the tagline (brief text that gives users an immediate idea of what the site does) "Report. Search. Protect." to its website. As of August 2019, CPSC has explored further ways to improve the usability of SaferProducts.gov. Specifically, in February 2019, CPSC published a request for information from the public on how to improve SaferProducts.gov. In March 2019, CPSC held a public hearing to obtain a feedback on how the design of SaferProducts.gov and process of submitting safety reports could be improved. For example, two consumer groups recommended that CPSC further improve the website's search function to yield more relevant and streamlined results and that it be designed for better use on mobile devices. Based on this input, CPSC is in the process of developing a plan for re-designing SaferProducts.gov using modern web-design standards, which includes improving the website's layout and styling, search capabilities, and functionality on mobile devices. According to CPSC, its staff plans to explore cost-effective resources to assess usability and identify further improvements to the website, such as coordinating with the General Services Administration on the design aspects of SaferProducts.gov and using other federal best practices to inform this process. However, no such cost-effective changes have yet been made to the website. According to officials, CPSC plans to begin this re-design in 2019 or 2020 pending available future funding. Until the Commission fully addresses this recommendation, it remains open. We will continue to monitor the Commission's progress in implementing our recommendation.

Recommendation: In order to improve CMS's ability to identify self-referred advanced imaging services and help CMS address the increases in these services, the Administrator of CMS should insert a self-referral flag on its Medicare Part B claims form and require providers to indicate whether the advanced imaging services for which a provider bills Medicare are self-referred or not.

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

Comments: HHS did not concur with this recommendation. CMS believes that a new checkbox on the claim form identifying self-referral would be complex to administer and providers may not characterize referrals accurately. We continue to believe that such a flag on Part B claims would likely be the easiest and most cost-effective way for CMS to identify self-referred advanced imaging services and monitor the behavior of those providers who self-refer these services, even though the agency has no plans to take further action. As of January 2020, CMS continues to indicate it will not take additional actions to address this recommendation.

Recommendation: In order to improve CMS's ability to identify self-referred advanced imaging services and help CMS address the increases in these services, the Administrator of CMS should determine and implement a payment reduction for self-referred advanced imaging services to recognize efficiencies when the same provider refers and performs a service.

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

Comments: HHS did not concur with this recommendation, noting that CMS did not believe that a payment reduction would address overutilization that occurs as a result of self-referral and that the agency's multiple procedure payment reduction policy for advanced imaging already captures efficiencies inherent in providing multiple advanced imaging services by the same physician. Further, CMS does not think a payment reduction for self-referred services would be effective. For example, the agency believes that providers in self-referring arrangements could avoid this reduction by having one provider refer an advanced imaging service while having another perform the service. Finally, CMS questioned whether implementing our recommendation would violate the Medicare statute prohibiting paying a differential by physician specialty for the same service. Our recommendation, however, refers to specific self-referral arrangements in which the same provider refers and performs an imaging service, and therefore would not be addressed by CMS's multiple procedure payment reduction policy. As noted in our report, this payment reduction would affect about 10 percent of advanced imaging services referred by self-referring providers. In addition, while CMS raised questions about whether implementing our recommendation would violate Medicare's prohibition on paying a differential by physician specialty for the same service, our report shows that self-referring providers generally referred more MRI and CT services, regardless of differences in specialties, and CMS did not indicate how this recommendation would implicate the prohibition on paying a differential by specialty. We continue to believe that CMS should determine and implement a payment reduction to recognize efficiencies for advanced imaging services referred and performed by the same provider. As of January 2020, the agency has no plans to take further action regarding this recommendation.

Recommendation: In order to improve CMS's ability to identify self-referred advanced imaging services and help CMS address the increases in these services, the Administrator of CMS should determine and implement an approach to ensure the appropriateness of advanced imaging services referred by self-referring providers.

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

Comments: HHS did not concur with this recommendation, according to its fiscal year 2021 budget justification. To fully implement this recommendation, CMS should determine and implement an approach to ensure the appropriateness of advanced imaging services referred by self-referring providers.

Recommendation: In order to maintain progress in maximizing the efficiency of existing data sources, and to improve the broader efficiency of the federal statistical system and improve communication among agencies and others, the Director of OMB, in consultation with the Chief Statistician, should work with the ICSP, when OMB next updates guidance on agency survey and statistical information collection and dissemination methods, to include additional details on actions agencies can take to meet requirements to identify duplication, to consult with persons outside of the agency, and address other requirements as appropriate.

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

Comments: In March 2020, OMB staff reported that Federal Committee on Statistical Methodology has been developing two new products, featured in the Federal Data Strategy 2020 Action Plan, that they believe will be responsive to this recommendation when completed. They are (1) an update to Statistical Working Paper 22 on statistical disclosure limitation methodology, and (2) guidance on measuring and reporting data quality.

Recommendation: In order to maintain progress in maximizing the efficiency of existing data sources, and to improve the broader efficiency of the federal statistical system and improve communication among agencies and others, the Director of OMB, in consultation with the Chief Statistician, should work with the ICSP to create new methods or enhance existing methods to improve the dissemination of information and resources produced by interagency statistical committees. For example, such enhancements could include increasing the timeliness and availability of information on websites to better capture the full range of products and identify committee priorities.

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

Comments: In March 2020, OMB staff reported that Federal Committee on Statistical Methodology has been developing two new products, featured in the Federal Data Strategy 2020 Action Plan, that they believe will be responsive to this recommendation when completed. They are (1) an update to Statistical Working Paper 22 on statistical disclosure limitation methodology, and (2) guidance on measuring and reporting data quality.

Recommendation: In order to maintain progress in maximizing the efficiency of existing data sources, and to increase the reliability of the information presented on the Reginfo.gov website and in OMB's internal system, the Director of OMB, in consultation with the Chief Statistician, should work with the ICSP to implement quality-control procedures designed to identify and remedy any differences between cost and burden information provided on the website and in the related supporting statement documentation that underlies this information.

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

Comments: OMB staff reported that because it publishes cost and burden information in Federal Register notices, PRA statements, and on RegInfo.gov, the public is able to identify discrepancies and bring them to OMB's attention. We believe that the responsibility to identify these discrepancies should belong to OMB and not the public.

Recommendation: To help improve the effectiveness of the Bureau's outreach and enumeration efforts, especially for HTC populations, should they be used again in the 2020 Census, and improve the Bureau's marketing/outreach efforts, the Secretary of Commerce should require the Under Secretary for Economic Affairs as well as the Director of the U.S. Census Bureau to develop mechanisms to increase coordination and communication between the partnership and local census office staff. Possible actions include offering more opportunities for joint training, establishing protocols for coordination, and more effectively leveraging the partnership contact database to better align partnership outreach activities with local needs.

Agency: Department of Commerce
Status: Open
Priority recommendation

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

Recommendation: To help improve the effectiveness of the Bureau's outreach and enumeration efforts, especially for HTC populations, should they be used again in the 2020 Census, and to improve some of the Bureau's key efforts to enumerate HTC populations, the Secretary of Commerce should require the Under Secretary for Economic Affairs as well as the Director of the U.S. Census Bureau to determine the factors that led to the staffing issues observed during SBE and take corrective actions to ensure more efficient SBE staffing levels in 2020.

Agency: Department of Commerce
Status: Open

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

Recommendation: To help improve the effectiveness of the Bureau's outreach and enumeration efforts, especially for HTC populations, should they be used again in the 2020 Census, and to improve some of the Bureau's key efforts to enumerate HTC populations, the Secretary of Commerce should require the Under Secretary for Economic Affairs as well as the Director of the U.S. Census Bureau to evaluate the extent to which each special enumeration activity improved the count of traditionally hard-to-enumerate groups and use the results to help inform decision making on spending for these programs in 2020.

Agency: Department of Commerce
Status: Open
Priority recommendation

Comments: The Department generally agreed with this recommendation. In 2012, the Bureau reported on assessments of many 2010 special enumeration activities such as the Service-Based Enumeration and the Be Counted/Questionnaire Assistance Center Programs. These assessments revealed the number of persons counted and spending for the special enumeration activities. Separately, the Bureau issued results of the 2010 Census Coverage Measurement Program that described the level of coverage of various hard-to-enumerate populations generally without attributing coverage to specific enumeration activities. Since 2015, the Bureau has issued annual updates of its 2020 Census Operational Plans, which have not provided details of plans for various special enumeration activities. In April 2017 Bureau officials provided us with evaluation results of its 2010 communication efforts and other documents related to ongoing efforts to reduce errors in the census. As of August 2020, we are in communication with Bureau officials about steps they are taking to implement this recommendation. To fully implement this recommendation, the Bureau needs to demonstrate how it is relying on data about how various special enumeration activities of historically hard-to-enumerate groups contributed to census coverage in 2010 to inform its design for the 2020 Census.

Recommendation: To improve the Bureau's use of its master schedule to manage the 2020 decennial census, the Secretary of Commerce should require the Director of the U.S. Census Bureau to include estimates of the resources, such as labor, materials, and overhead costs, in the 2020 integrated schedule for each activity as the schedule is built, and prepare to carry out other steps as necessary to conduct systematic schedule risk analyses on the 2020 schedule.

Agency: Department of Commerce
Status: Open
Priority recommendation

Comments: Commerce neither agreed nor disagreed with this recommendation. Regarding GAO's 2013 assessment of the Bureau's schedule (GAO-14-59), Bureau officials stated that they hoped to begin identifying the resources needed for each activity in their schedules by early 2014. Bureau officials announced they had completed the 2020 Census schedule in July 2016, and have since periodically described their intent to link resources to activities within their schedules. However, as of May 2018, when the Bureau had not taken these steps. Senior Bureau officials stated that it would require additional staffing in order to plan for and implement this recommendation. In July 2018 (GAO-18-589) we reported again on the status of the Bureau's scheduling, stating that when the Bureau has resource loaded its schedule, it will be able to use the schedule more effectively as a management tool. The Bureau took steps toward assigning resources to its master activity schedule for the 2020 Census, but effectively ran out of time to do so. Assigning resources to large complex schedules is easier to do early in schedule development process, as we recommended the Bureau do in 2009 for its 2020 Census schedule. This recommendation will remain open pending the Bureau taking steps in developing its 2030 schedule with appropriate resources linked to it.

Recommendation: To support the triennial review program's goal of having grantees consistently meet more federal requirements, the Secretary of Transportation should direct the FTA to ensure that additional outcome and quality performance measures are balanced with the existing measures for assessing the timeliness of the triennial review program so that one priority is not emphasized at the expense of others.

Agency: Department of Transportation
Status: Open

Comments: Federal Transit Administration (FTA) anticipates adding a performance measurement, called reduction in repeat findings, that relates to assessing the quality of the review. This has been added to FTA's new Quality Review program focused on improving its Triennial Review program.