Recommendation: The Administrator of CMS should ensure that the Medicare & You publication includes explicit information on the services covered by the Medicare program for beneficiaries with a SUD. (Recommendation 1)

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

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

Recommendation: The Assistant Secretary for Employment and Training should clarify DOL's expectations of the role of state workforce agencies in addressing the employment and training needs of those affected by SUD and how non-targeted WIOA funding can be used to assist job seekers and employers. (Recommendation 1)

Agency: Department of Labor
Status: Open

Comments: DOL agreed with this recommendation. ETA anticipates providing information and technical assistance to help workforce system grantees understand how they can address the impacts of SUD on the workforce. The agency also plans to issue guidance by the end of 2020 to share promising practices and describe how WIOA funds can be used to support job seekers in recovery and employers.

Recommendation: The Assistant Secretary for Employment and Training should share information from targeted grantees with all state workforce agencies, tribal governments, and outlying areas regarding lessons learned and promising practices in addressing the needs of job seekers affected by SUD and potential employers. (Recommendation 2)

Agency: Department of Labor
Status: Open

Comments: DOL agreed with this recommendation, noting that ETA has created resources that are available to all states based on its experience administering some of the targeted grants. ETA officials cited the recently published literature review and companion resource guide, and said they also plan to share the evaluation of the Phase 1 grants widely when it is available, including any resources or tools developed by states that were awarded Phase 1 grants. In addition, ETA plans to host at least one webinar to share additional promising practices from the targeted grants that could be useful to local workforce boards around the country.

Recommendation: The Assistant Secretary for Mental Health and Substance Use should establish procedures to better ensure that mid-performance changes to program priority goals, objectives, and targets are examined across multiple years. (Recommendation 1)

Agency: Department of Health and Human Services: Public Health Service: Substance Abuse and Mental Health Services Administration
Status: Open

Comments: As of October 2019, HHS reported that the Substance Abuse and Mental Health Services Administration (SAMHSA) would add new additional features to its web-based system for overseeing the mental health protection and advocacy programs, with an implementation target date of October 2020. The agency described one new feature as a tracking tool to monitor program requests to revise priority goals, objectives, and targets over multiple years. In the meantime, SAMHSA has developed a manual tracking tool for its project officers to use until the electronic tool is in place. Another new feature is a workflow that will allow project officers, team leaders, and branch chiefs to review and approve changes made by the programs. However, SAMHSA has not yet provided documentation of the latter feature to demonstrate that it has developed procedures for project officers to review the changes over multiple years. Therefore, the agency lacks assurances that its project officers will consistently examine whether a particular program is regularly making changes to benchmarks that may be indicative of a potential performance problem. We will review the web-based tracking tool when available and continue to monitor SAMHSA's efforts to develop procedures for examining changes to benchmarks over multiple years.

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 Defense should direct the Under Secretary of Defense for Personnel and Readiness to incorporate medical screening questions specific to gambling disorder as part of a systematic screening process across DOD, such as DOD's annual Periodic Health Assessment, for behavioral and mental-health issues.

Agency: Department of Defense
Status: Open

Comments: DOD non-concurred with this recommendation. However, the FY 2019 National Defense Authorization Act mandated that DOD implement this recommendation. As of August 2019, DOD had modified the Health Related Behaviors Survey (HRBS) to include questions on gambling and DOD and the Services are in the process of updating the electronic Periodic Health Assessment (PHA) assessment forms to capture the gambling screening data required by the legislation. Once the PHA is updated to include the gambling screening data, we will be able to close this recommendation.

Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to update DOD Instruction 1010.04, Problematic Substance Use by DOD Personnel, to explicitly include gambling disorder as defined in the 2013 Diagnostic and Statistical Manual of Mental Disorders.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation. As of August 2019, DOD stated that this guidance is still in internal DOD coordination. Moreover, guidance related to gambling disorder screening, referral, and treatment needs to be coordinated with the Addictive Substance Misuse Advisory Committee (ASMAC) before issuance, which is anticipated to be July 2020.

Recommendation: The Secretary of Defense should direct the Secretary of the Army to update Army Regulation 600-85, The Army Substance Abuse Program, to explicitly include gambling disorder.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation. As of August 2019, the Army did not have any updates to provide on the status of this recommendation.

Recommendation: The Secretary of Defense should direct the Secretary of the Navy to update Naval Operations Instruction 5350.4D, Navy Alcohol and Drug Abuse Prevention and Control, to explicitly include gambling disorder.

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation. As of August 2019, Navy officials stated that the draft Navy instruction was returned back to the Navy's Drug Detection and Deterrence Program Office to add language regarding the Secretary of the Navy's ban on hemp/CBD products that was announced this month. The Navy has added the language and pushed the instruction out to the main stakeholders for coordination. It is due back to the Director, Navy Staff no later than 30 August 2019 where it will go back into the queue for signature. Navy officials anticipate signature sometime later this fall.

Recommendation: The Commandant of the Coast Guard should update Commandant Instruction M6000.1F, Coast Guard Medical Manual, to classify gambling disorder as an addiction and not as an impulse control issue.

Agency: Department of Homeland Security: United States Coast Guard
Status: Open

Comments: The U.S. Coast Guard/DHS concurred with this recommendation. As of August 2019, the Coast Guard stated that updates to this manual are ongoing. According to Coast Guard officials, including gambling disorder in this manual is one of many significant updates the program is adjudicating for this manual and it's a lengthy clearance process. No timeline was provided for expected issuance.

Recommendation: In order to ensure that federal efforts to prevent the abuse and misuse of prescription pain relievers are an effective and efficient use of limited government resources, the Director of ONDCP should establish outcome metrics and identify resources for conducting outcome evaluations for the national education campaigns about prescription drug abuse and safe storage and disposal proposed in the Prescription Drug Abuse Prevention Plan.

Agency: Office of National Drug Control Policy
Status: Open

Comments: We requested an update from ONDCP on the status of its efforts to implement this recommendation. As of August, 2018, we have not received a response. We will update the status of this recommendation when we receive additional information.

Recommendation: In order to ensure that federal efforts to prevent the abuse and misuse of prescription pain relievers are an effective and efficient use of limited government resources, the Director of ONDCP should develop and implement a plan to evaluate outcomes from the proposed national education campaigns.

Agency: Office of National Drug Control Policy
Status: Open

Comments: We requested an update from ONDCP on the status of its efforts to implement this recommendation. As of August, 2018, we have not received a response. We will update the status of this recommendation when we receive additional information.

Recommendation: In order to ensure that federal efforts to prevent the abuse and misuse of prescription pain relievers are an effective and efficient use of limited government resources, the Director of ONDCP should ensure that federal agencies undertaking similar educational efforts leverage available resources and use coordination mechanisms to share information on the development of their efforts.

Agency: Office of National Drug Control Policy
Status: Open

Comments: We requested an update from ONDCP on the status of its efforts to implement this recommendation. As of August, 2018, we have not received a response. We will update the status of this recommendation when we receive additional information.