Recommendation: The OHS Director should require Head Start grantees to document that water provided to children has been tested for lead. OHS could determine various ways that are feasible and efficient for grantees to satisfy this requirement; for example, verification could be done through OHS' current grantee data collection or monitoring processes. (Recommendation 1)

Agency: Department of Health and Human Services
Status: Open

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

Recommendation: The Assistant Secretary for the Administration for Children and Families should direct OCC and OHS to develop an agreement with EPA on their roles and responsibilities in implementing the Memorandum of Understanding on Reducing Lead Levels in Drinking Water in Schools and Child Care Facilities. For example, these agreements may include the ways in which guidance and information will be shared with states and Head Start grantees, such as through webinars or email, and how frequently. (Recommendation 2)

Agency: Department of Health and Human Services
Status: Open

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

Recommendation: The Assistant Administrator of the Office of Water should develop an agreement with HHS's Offices of Child Care and Head Start on their roles and responsibilities in implementing the Memorandum of Understanding on Reducing Lead Levels in Drinking Water in Schools and Child Care Facilities. For example, these agreements may include the ways in which guidance and information will be shared with states and Head Start grantees, such as through webinars or email, and how frequently. (Recommendation 3)

Agency: Environmental Protection Agency
Status: Open

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

Recommendation: The Assistant Administrator of the Office of Water should direct the Office of Water to specify how it will track progress toward the outcomes of the Memorandum of Understanding on Reducing Lead Levels in Drinking Water in Schools and Child Care Facilities and determine how it will regularly monitor and update the MOU. For example, the Office of Water could develop performance measures for each of the MOU's outcomes. In addition, the Office of Water could submit annual reports on progress toward achieving the MOU's outcomes or it could plan to update the agreement at specific intervals. (Recommendation 4)

Agency: Environmental Protection Agency
Status: Open

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

Recommendation: The Secretary of Labor should ensure that DOL has a procedure to help the agency analyze reasons for delays in processing National Dislocated Worker Grant applications and grant modifications. (Recommendation 1)

Agency: Department of Labor
Status: Open

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

Recommendation: The Secretary of Labor should identify and implement additional mechanisms to allow EAA grantees to share information about innovative and best practices with each other, such as DOL hosting an in-person or virtual national convening for grantees. (Recommendation 2)

Agency: Department of Labor
Status: Open

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

Recommendation: The Secretary of Labor should work with the Federal Co-Chair of the ARC to identify and implement mechanisms that allow for information sharing between the two agencies regarding their EAA programs, including sharing grant decisions. (Recommendation 3)

Agency: Department of Labor
Status: Open

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

Recommendation: The Federal Co-Chair of the ARC should work with the Secretary of Labor to identify and implement mechanisms that allow for information sharing between the two agencies regarding their EAA programs, including sharing grant decisions. (Recommendation 4)

Agency: Appalachian Regional Commission
Status: Open

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

Recommendation: The Federal Co-Chair of the ARC should develop a plan for addressing issues related to performance data for POWER Initiative grants. (Recommendation 5)

Agency: Appalachian Regional Commission
Status: Open

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

Recommendation: The Secretary of Labor should, as part of the Department's evidence building processes, prioritize improving the quality of evidence on the impact of job training for dislocated workers. (Recommendation 6)

Agency: Department of Labor
Status: Open

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

Recommendation: The Secretary of Labor should identify the expected time frame for providing the first report to Congress that is responsive to the WIOA requirement for an annual report that includes research and evaluation findings. In addition, the agency should communicate this time frame to relevant congressional committees. (Recommendation 7)

Agency: Department of Labor
Status: Open

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

Recommendation: The Director of the Office of Workers' Compensation Programs should direct the Division of Federal Employees' Compensation to send a reminder to all FECA recipients as they approach retirement that they may want to obtain FERS retirement benefits estimates for comparisons with FECA, including annuity estimates from their employing agencies and estimates of their Thrift Savings Plan and Social Security benefits. (Recommendation 1)

Agency: Department of Labor
Status: Open

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

Recommendation: The Director of the Office of Workers' Compensation Programs should direct the Division of Federal Employees' Compensation to coordinate with the Social Security Administration to take steps to modernize and improve the process of manually generating benefit amounts with and without federal earnings and exchanging information between the agencies to enable the provision of offset estimates to FECA recipients upon request and to reduce the potential for human error in applying offsets. (Recommendation 2)

Agency: Department of Labor
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 Social Security should direct the Office of Earnings and International Operations to coordinate with the Division of Federal Employees' Compensation to take steps to modernize and improve the process of manually generating benefit amounts with and without federal earnings and exchanging information between the agencies to enable the provision of offset estimates to FECA recipients upon request and to reduce the potential for human error in applying offsets. (Recommendation 3)

Agency: Social Security Administration
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 the Administration for Children and Families (ACF) should establish an ongoing process to proactively share information and best practices with states about programs it administers that are available to serve kin caregivers, especially in states with a relatively large share of grandparent caregivers. This could be achieved, for example, by leveraging regional office staff to provide additional assistance and information sharing, particularly related to kinship navigator programs. (Recommendation 1)

Agency: Department of Health and Human Services: Administration for Children and Families
Status: Open

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

Recommendation: The Administrator for the Administration for Community Living (ACL) should establish an ongoing process to proactively share information and best practices with states about using National Family Caregiver Support Program (NFCSP) funds to serve older relative caregivers of children, especially in states with a relatively large share of grandparent caregivers. This could be achieved, for example, by leveraging regional office staff to share information from states and area agencies on aging that have successfully used this program to serve older relative caregivers. (Recommendation 2)

Agency: Department of Health and Human Services: Administration for Community Living
Status: Open

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

Recommendation: The Secretary of Defense should ensure that the Secretaries of the Military Departments revise AFI 36-3026, Volume 1, to provide detailed guidance for financial determinations and to establish consistent medical standards for all of the military services to use in determining the dependency status of incapacitated adult children, including what household and personal expenses and income are allowable, how these are to be calculated, and what medical documentation is required. (Recommendation 1)

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation and indicated that it would develop and apply a single set of financial and medical standards across the Department. DOD indicated that these standards would be published in an upcoming policy memorandum.

Recommendation: The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in coordination with the Secretaries of the Military Departments and the Director of the Defense Finance and Accounting Service, identifies and implements the most effective means to provide information to families of incapacitated adult children to assist them in completing the dependency determination process. Such methods could include providing additional application instructions to families, making improvements to the DD Form 137-5, Dependency Statement – Incapacitated Child Over Age 21, such as providing detailed explanations of allowable expenses and how they should be calculated, providing detailed information about available support services, and providing additional and more advance notice to families. (Recommendation 2)

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with this recommendation and noted that existing instructional tools exist to help families navigate the dependency determination process. However, DOD indicated that a Under Secretary of Defense for Personnel and Readiness user group will identify additional means to improve the information available to military families.

Recommendation: The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness clearly defines oversight responsibilities of the Department of Defense Human Resources Activity and the military services for the incapacitated adult child dependency process, including the consistent tracking, monitoring, and reporting of reliable data on incapacitated adult child dependency applications and determinations across the military services for use in data-driven decision-making. (Recommendation 3)

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with this recommendation and stated that while current DOD guidance does not include specific oversight responsibilities for the incapacitated adult child program DOD concurred with the need for a single office to provide oversight of the program. DOD noted that the Under Secretary of Defense for Personnel and Readiness would identify the office and assign responsibility within 60 days of our report.

Recommendation: The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness directs the Department of Defense Human Resources Activity to exercise its oversight responsibilities for the incapacitated adult child dependency process, as clarified, including the use of consistent and reliable data on applications and determinations for data-driven decision-making to identify and address deficiencies and to inform program efforts. (Recommendation 4)

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with this recommendation, however DOD noted that it would address the recommendation after it takes action on our recommendation related to defining oversight responsibilities for the incapacitated adult child dependency determination process.

Recommendation: The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness clarifies the definition of a nondependent family member in DOD Instruction 1315.19 and the circumstances under which nondependent family members should be considered for services provided by the Exceptional Family Member Program. (Recommendation 5)

Agency: Department of Defense
Status: Open

Comments: DOD concurred with this recommendation and stated that it will review its policy to determine if the definition of a nondependent family member continues to be current and appropriate.

Recommendation: The Secretary of Defense should ensure that the Secretaries of the Military Departments revise military service-level policy to ensure consistency with the DOD Instruction 1315.19 definition of nondependent family members and the circumstance under which a nondependent family member should be considered for services provided by the Exceptional Family Member Program. (Recommendation 6)

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with this recommendation and stated that if DOD determines the current definition of a nondependent family member is no longer appropriate, it will ensure that Service-level policies will be revised to be consistent with the definition.

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 Secretary of HHS, in consultation with the Council on Economic Mobility, should make information that would assist state and local entities in developing and implementing two-generation poverty reduction approaches readily available across federal programs and offices. (Recommendation 1)

Agency: Department of Health and Human Services
Status: Open

Comments: HHS agreed with this recommendation. The agency stated that through its coordination of the Council on Economic Mobility it will promote poverty reduction approaches that aim to provide more integrated, person-centered service delivery. It will also work to identify opportunities for collaboration, promising practices, and successful models that promote economic mobility and will develop strategies for promoting them, such as through technical assistance. We will monitor the progress of these efforts.

Recommendation: The Director of OCC should establish internal written policies to effectively implement and document the State Plan review and approval process for future review and approval periods. (Recommendation 1)

Agency: Department of Health and Human Services: Administration for Children and Families: Office of the Child Care Bureau
Status: Open

Comments: In September 2020, OCC told us it has been working on establishing written policies (e.g., internal guidance documents and checklists) to implement and document the State Plan review and approval process. OCC expects to complete this work for the FY2022-2024 Plan period. We will continue to monitor OCC's efforts to implement this recommendation.

Recommendation: The Director of OCC should define the informational needs related to the results of program-integrity activities. (Recommendation 2)

Agency: Department of Health and Human Services: Administration for Children and Families: Office of the Child Care Bureau
Status: Open

Comments: In September 2020, OCC told us that it is developing the next CCDF State/Territory Plan Preprint due for submission by states and territories July 1, 2021. According to OCC, it plans to incorporate its information needs regarding the results of program integrity into the Preprint document as it develops the document. We will continue to monitor OCC's progress in implementing this recommendation.

Recommendation: The Director of OCC should communicate externally to the states its informational needs related to the results of states' program-integrity activities. (Recommendation 3)

Agency: Department of Health and Human Services: Administration for Children and Families: Office of the Child Care Bureau
Status: Open

Comments: In September 2020, OCC told us that it is developing the next CCDF State/Territory Plan Preprint due for submission by states and territories July 1, 2021. According to OCC, it plans to communicate its information needs regarding the results of program integrity activities to states and territories as part of the Preprint Training activities - including webinars and peer-to-peer virtual meetings - so Lead Agencies understand what is expected for them to address in the CCDF Plan. We will continue to monitor OCC's progress in implementing this recommendation.

Recommendation: The Director of OCC should communicate internally to staff its informational needs related to the results of states' program-integrity activities. (Recommendation 4)

Agency: Department of Health and Human Services: Administration for Children and Families: Office of the Child Care Bureau
Status: Open

Comments: In September 2020, OCC told us that it is developing the next CCDF State/Territory Plan Preprint due for submission by states and territories July 1, 2021. According to OCC, it plans to communicate its information needs regarding the results of program integrity activities to staff in both regional and central offices as part of the Preprint Training activities so staff understand what is expected for Lead Agencies to address in the CCDF Plan. We will continue to monitor OCC's progress in implementing this recommendation.

Recommendation: The Director of OCC should develop documented criteria to guide the review of CAPs submitted by states to ensure that proposed corrective actions are aimed at root causes of improper payments and are effectively implemented. (Recommendation 5)

Agency: Department of Health and Human Services: Administration for Children and Families: Office of the Child Care Bureau
Status: Open

Comments: In September 2020, OCC told us it revised the CAP Review Tool to in response to our recommendation. OCC also told us that it plans to implement the revised CAP Review Tool beginning September 2020 to document the review of CAPs submitted for the most recent ACF-404 reporting cycle (June 2020). We asked OCC to provide documentation showing the revised CAP Review Tool is responsive to our recommendation. We will update this recommendation status after reviewing the documentation OCC provides.

Recommendation: The Director of OCC should timely complete its effort to develop established written policies for the CAP follow-up process to ensure that OCC's oversight and monitoring of CAPs is carried out consistently. (Recommendation 6)

Agency: Department of Health and Human Services: Administration for Children and Families: Office of the Child Care Bureau
Status: Open

Comments: In September 2020, OCC told us it developed draft written policies for the CAP follow-up process to ensure that OCC's oversight and monitoring of CAPs is carried out consistently. However, due to the impact of the COVID-19 on staffing capacity, OCC has not presented the draft policies to regional offices for feedback. OCC told us it plans to finalize the written policies for the CAP follow-up process by December 2020. We will continue to monitor OCC's progress in implementing this recommendation.

Recommendation: The Director of OCC should develop and document criteria to assess the effectiveness of states' program-integrity control activities. (Recommendation 7)

Agency: Department of Health and Human Services: Administration for Children and Families: Office of the Child Care Bureau
Status: Open

Comments: In September 2020, OCC told us it analyzed information gathered from federal and state resources to develop and document criteria to be used to assess the effectiveness of states' program integrity control activities. We asked OCC to provide us the document showing all criteria to be used to assess the effectiveness of states' program integrity control activities. We will update this recommendation status after reviewing the documentation OCC provides.

Recommendation: The Director of OCC should evaluate the feasibility of collecting information from the Grantee Internal Controls Self-Assessment Instrument (Self-Assessment Instrument) and Fraud Toolkit, such as during its Monitoring System process, to monitor the effectiveness of states' program-integrity control activities. (Recommendation 8)

Agency: Department of Health and Human Services: Administration for Children and Families: Office of the Child Care Bureau
Status: Open

Comments: In September 2020, OCC told us it is working to make the Self-Assessment Instrument and Fraud Toolkit more user-friendly to encourage increased use within the state CCDF program. With increased usage, OCC believes it will be in a better position to assess how the collection of data from these two instruments can be incorporated into the Onsite Monitoring System or other oversight activity. OCC told us it anticipates completing work to implement this recommendation by December 2020. We will continue to monitor OCC's progress in implementing this recommendation.

Recommendation: The Assistant Secretary for ACF should ensure that ACF conducts a fraud risk assessment to provide a basis for the documentation and development of an antifraud strategy that describes the CCDF program's approach to address prioritizing fraud risks identified. (Recommendation 9)

Agency: Department of Health and Human Services: Administration for Children and Families
Status: Open

Comments: In September 2020, HHS told us it anticipates completing the initial fraud risk assessment for the CCDF program by December 2020. We will continue to monitor HHS's efforts to implement this recommendation.

Recommendation: The Director of the Office of Workers' Compensation Programs should develop and implement procedures for coal mine operator self-insurance renewal that clarifies how long an operator is authorized to self-insure; when an operator must submit its renewal application and supporting documentation; and the conditions under which an operator's self-insurance authority would not be renewed. (Recommendation 1)

Agency: Department of Labor: Office of Workers' Compensation Programs
Status: Open

Comments: DOL agreed with this recommendation and said it is acting to implement it to achieve further improvements in ensuring the effective oversight of coal mine operator insurance. DOL reported that it would ensure letters granting or renewing self-insurance authority will inform operators that their authorization expires in one year and that they must submit renewal information three months in advance of the expiration date.

Recommendation: The Director of the Office of Workers' Compensation Programs should develop and implement procedures for self-insured coal mine operator appeals that identify time lines for self-insured operators to submit documentation supporting their appeals and that identify a goal for how much time DOL should take to make appeals decisions. (Recommendation 2)

Agency: Department of Labor: Office of Workers' Compensation Programs
Status: Open

Comments: DOL agreed with this recommendation and said it is acting to implement it to achieve further improvements in ensuring the effective oversight of coal mine operator insurance. DOL reported that it will ensure letters denying self-insurance will inform operators that they have a 30-day appeal period (limited to one extension) and that DOL has set a goal of resolving all appeals within 90 days of the denial letter.

Recommendation: The Director of the Office of Workers' Compensation Programs should develop and implement a process to monitor operator compliance with commercial insurance requirements and periodically evaluate the effectiveness of this process. This process should be designed to detect errors and omissions in reporting insurance coverage using complete, accurate, and consistently recorded data. (Recommendation 3)

Agency: Department of Labor: Office of Workers' Compensation Programs
Status: Open

Comments: DOL agreed with this recommendation and said it is acting to implement it to achieve further improvements in ensuring the effective oversight of coal mine operator insurance. DOL reported that it will modify existing computer systems to identify lapses or cancellations of commercial insurance coverage, and require operators identified as having lapsed or cancelled coverage to obtain or provide proof of coverage within 30 days.

Recommendation: The Secretary of Defense, in collaboration with the Secretaries of the military departments, should expand the scope of the department's centralized database on problematic sexual behavior in children and youth, which is under development, to also track information on all incidents involving the abuse of a child (physical, sexual, emotional, and neglect) reported to the Family Advocacy Program or investigated by a military law enforcement organization, regardless of whether the offender was another child, an adult, or someone in a noncaregiving role at the time of the incident. (Recommendation 1)

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

Comments: DOD did not concur with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of Defense, in collaboration with the Secretaries of the military departments, should, as part of the ongoing development of the centralized database, identify and define the elements to be tracked by each responsible organization, such as the Family Advocacy Program and military law enforcement. (Recommendation 2)

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

Comments: DOD concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of Defense, in collaboration with the Secretaries of the military departments, should develop a plan for how it will use the data it will collect in the centralized database to help ensure data-driven decision-making is used to inform program efforts. (Recommendation 3)

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

Comments: DOD concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of Defense, in collaboration with the Secretaries of the military departments, should establish a reliable schedule for the development and implementation of the centralized database on problematic sexual behavior in children and youth that includes key activities, the timeframes and resources needed to execute them, and GAO-identified practices for developing and maintaining a reliable schedule. (Recommendation 4)

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

Comments: DOD concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of Defense, in collaboration with the Secretaries of the military departments, should direct the service Family Advocacy Programs and military law enforcement organizations to document in their respective databases the date that they notified the other entity of a reported incident of child abuse. (Recommendation 5)

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

Comments: DOD partially concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of Defense, in collaboration with the Secretaries of the military departments, should issue guidance that describes the process through which the service Family Advocacy Programs are to receive and incorporate information into their central registries regarding child abuse allegations and determinations involving their servicemembers and dependents that were recorded by another service's installation Family Advocacy Program. Such guidance should include a mechanism to monitor that the process is occurring consistently. (Recommendation 6)

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

Comments: DOD partially concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Army should develop a process to monitor how reported incidents of child abuse are screened at installations to help ensure that all reported child abuse incidents that should be presented to an Incident Determination Committee are consistently presented and therefore tracked. (Recommendation 7)

Agency: Department of Defense: Department of the Army: Office of the Secretary
Status: Open

Comments: The Army concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Navy should develop a process to monitor how reported incidents of child abuse are screened at installations to help ensure that all reported child abuse incidents that should be presented to an Incident Determination Committee are consistently presented and therefore tracked. (Recommendation 8)

Agency: Department of Defense: Department of the Navy: Office of the Secretary
Status: Open

Comments: The Navy concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Navy should ensure that the Commandant of the Marine Corps develops a process to monitor how reported incidents of child abuse are screened at installations to help ensure that all reported child abuse incidents that should be presented to an Incident Determination Committee are consistently presented and therefore tracked. (Recommendation 9)

Agency: Department of Defense: Department of the Navy: Office of the Secretary
Status: Open

Comments: The Navy concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Air Force should develop a process to monitor how reported incidents of child abuse are screened at installations to help ensure that all reported child abuse incidents that should be presented to an Incident Determination Committee are consistently presented and therefore tracked. (Recommendation 10)

Agency: Department of Defense: Department of the Air Force: Office of the Secretary of the Air Force
Status: Open

Comments: The Air Force concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in coordination with the Director of the Department of Defense Education Activity, clarifies Department of Defense Education Activity guidance to define what types of incidents must be reported as "serious incidents" to help ensure that all serious incidents of which Department of Defense Education Activity leadership needs to be informed are accurately and consistently reported by school administrators. (Recommendation 11)

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

Comments: DOD concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of Defense, in collaboration with the Secretaries of the military departments, should expand the voting membership of the Incident Determination Committee to include medical personnel with the requisite knowledge and experience. (Recommendation 12)

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

Comments: DOD partially concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Army should establish efforts to comprehensively inform victims' families about how reported incidents of child abuse will be addressed following the report, such as a comprehensive guide that explains the process the Family Advocacy Program and military law enforcement organizations will follow, and available victim services. (Recommendation 13)

Agency: Department of Defense: Department of the Army: Office of the Secretary
Status: Open

Comments: The Army concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Navy should establish efforts to comprehensively inform victims' families about how reported incidents of child abuse will be addressed following the report, such as a comprehensive guide that explains the process the Family Advocacy Program and military law enforcement organizations will follow, and available victim services. (Recommendation 14)

Agency: Department of Defense: Department of the Navy: Office of the Secretary
Status: Open

Comments: The Navy concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Navy should ensure that the Commandant of the Marine Corps establishes efforts to comprehensively inform victims' families about how reported incidents of child abuse will be addressed following the report, such as a comprehensive guide that explains the process the Family Advocacy Program and military law enforcement organizations will follow, and available victim services. (Recommendation 15)

Agency: Department of Defense: Department of the Navy: Office of the Secretary
Status: Open

Comments: The Navy partially concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Air Force should establish efforts to comprehensively inform victims' families about how reported incidents of child abuse will be addressed following the report, such as a comprehensive guide that explains the process the Family Advocacy Program and military law enforcement organizations will follow, and available victim services. (Recommendation 16)

Agency: Department of Defense: Department of the Air Force: Office of the Secretary of the Air Force
Status: Open

Comments: The Air Force concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of Defense, in collaboration with the Secretaries of the military departments, should clarify, in guidance, the circumstances under which commanders may exercise their authority to remove a child from a potentially unsafe home on an overseas installation. (Recommendation 17)

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

Comments: DOD concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in coordination with the Director of the Defense Health Agency, establishes processes that help ensure children who are sexually abused overseas have timely access to a certified pediatric sexual assault forensic examiner to conduct the examination. Initiatives could include certifying pediatricians or adult sexual assault forensic examiners as pediatric examiners during mandatory training or establishing shared regional assets. (Recommendation 18)

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

Comments: DOD concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of Defense, in collaboration with the Deputy Attorney General, should seek avenues to improve communication between the military criminal investigative organizations and United States Attorneys for relevant cases involving child victims to help ensure that investigators are notified when prosecution is declined, including the reasons for the declination when appropriate, such as details about any investigative deficiencies. (Recommendation 19)

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

Comments: DOD concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Army should seek to develop a memorandum of understanding with the National Children's Alliance that makes children's advocacy center services available to all Army installations and thereby increase awareness of those services across the department. (Recommendation 20)

Agency: Department of Defense: Department of the Army: Office of the Secretary
Status: Open

Comments: The Army partially concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Navy should continue to develop a memorandum of understanding with the National Children's Alliance that makes children's advocacy center services available to all Navy installations and thereby increase awareness of those services across the department. (Recommendation 21)

Agency: Department of Defense: Department of the Navy: Office of the Secretary
Status: Open

Comments: The Navy partially concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Navy should ensure that the Commandant of the Marine Corps continues to develop a memorandum of understanding with the National Children's Alliance that makes children's advocacy center services available to all Marine Corps installations and thereby increase awareness of those services across the service. (Recommendation 22)

Agency: Department of Defense: Department of the Navy: Office of the Secretary
Status: Open

Comments: The Navy concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Secretary of the Air Force should seek to develop a memorandum of understanding with the National Children's Alliance that makes children's advocacy center services available to all Air Force installations and thereby increase awareness of those services across the department. (Recommendation 23)

Agency: Department of Defense: Department of the Air Force: Office of the Secretary of the Air Force
Status: Open

Comments: The Air Force concurred with this recommendation. As of April 2020, this recommendation remains open.

Recommendation: The Commissioner of the Social Security Administration should clarify policies and procedures to remind staff that a diagnosis of a substance use disorder is not necessary to conduct a Drug Addiction and Alcoholism evaluation. (Recommendation 1)

Agency: Social Security Administration
Status: Open

Comments: SSA agreed with this recommendation. The agency stated that it had revised related policies in February 2020, and had planned to issue guidance and video-on-demand training to further clarify policies and procedures in this area. However, SSA said its efforts to maintain mission critical activities amid the COVID-19 pandemic have delayed further implementation of this recommendation and a specific implementation date could not be provided at this time.

Recommendation: The Commissioner of the Social Security Administration should ensure that staff document their rationale for decisions involving the Drug Addiction and Alcoholism evaluation process. (Recommendation 2)

Agency: Social Security Administration
Status: Open

Comments: SSA agreed with this recommendation. The agency said it had planned to issue guidance reinforcing its policy on properly documenting decisions involving the Drug Addiction and Alcoholism evaluation process. However, SSA said its efforts to maintain mission critical activities amid the COVID-19 pandemic have delayed implementation of this recommendation and a specific implementation date could not be provided at this time.

Recommendation: The Chief Executive Officer of CNCS should develop an approach to ensure that all relevant participants are involved in the agency-wide process for prioritizing evidence needs. (Recommendation 1)

Agency: Corporation for National and Community Service
Status: Open

Comments: In comments on a draft of this report, the Corporation for National and Community Service (CNCS) neither agreed nor disagreed with this recommendation. Subsequently, in a June 2020 letter, CNCS stated that it agreed with our recommendation and described planned actions to strengthen its agency-wide evidence prioritization process. Among these planned actions were proposed changes to CNCS's approach for involving key participants from across the agency in the process. However, as of October 2020, CNCS had not yet provided us with documentation that would allow us to (1) assess the extent to which they address our recommendation and (2) confirm that these proposed changes were approved. We will continue to monitor CNCS's actions to address this recommendation.

Recommendation: The Chief Executive Officer of CNCS should define roles and responsibilities for all relevant participants involved in the agency-wide process for prioritizing evidence needs. (Recommendation 2)

Agency: Corporation for National and Community Service
Status: Open

Comments: In comments on a draft of this report, the Corporation for National and Community Service (CNCS) neither agreed nor disagreed with this recommendation. Subsequently, in a June 2020 letter, CNCS stated that it agreed with our recommendation and described planned actions to strengthen its agency-wide evidence prioritization process. Among these planned actions were workforce planning and hiring based on the knowledge, skills, and abilities needed for CNCS to address its evidence priorities. The letter stated that once those actions were completed, CNCS would revisit the roles and responsibilities of participants involved in the agency's evidence-building activities. We will continue to monitor CNCS's actions to address this recommendation.

Recommendation: The Chief Executive Officer of CNCS should revise written guidance for the agency-wide process for prioritizing evidence needs to ensure it identifies all relevant participants and their respective roles and responsibilities. (Recommendation 3)

Agency: Corporation for National and Community Service
Status: Open

Comments: In comments on a draft of this report, the Corporation for National and Community Service (CNCS) neither agreed nor disagreed with this recommendation. Subsequently, in a June 2020 letter, CNCS stated that it agreed with our recommendations and described planned actions to strengthen its agency-wide evidence prioritization process. However, as of October 2020, CNCS had not yet provided us with documentation that would allow us to (1) confirm that these proposed changes were approved and (2) assess the extent to which written guidance for the revised process addresses our recommendation. We will continue to monitor CNCS's actions to address this recommendation.

Recommendation: The Secretary of Labor should develop an approach to ensure that all relevant participants are involved in the department-wide process for prioritizing evidence needs. (Recommendation 6)

Agency: Department of Labor
Status: Open

Comments: In a November 2019 letter providing comments on a draft of this report, the Department of Labor (DOL) agreed with this recommendation. The letter further described actions DOL planned to take to address it. DOL stated that in fiscal year 2020 it would update its written guidance to formalize the involvement of relevant participants in department-wide evidence-building activities. However, as of October 2020, DOL had not yet provided us with documentation that would allow us to assess the extent to which its updated guidance addresses our recommendation. We will continue to monitor DOL's actions to address this recommendation.

Recommendation: The Secretary of Labor should revise written guidance for the department-wide process for prioritizing evidence needs to ensure it identifies all relevant participants and their respective roles and responsibilities. (Recommendation 7)

Agency: Department of Labor
Status: Open

Comments: In a November 2019 letter providing comments on a draft of this report, the Department of Labor (DOL) agreed with this recommendation. The letter further described actions DOL planned to take to address it. DOL stated that in fiscal year 2020 it would update its written guidance to formalize the involvement of relevant participants in department-wide evidence-building activities. However, as of October 2020, DOL had not yet provided us with documentation that would allow us to assess the extent to which its updated guidance addresses our recommendation. We will continue to monitor DOL's actions to address this recommendation.

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 Director of OCS, in developing the new performance management approach for the CSBG program, should ensure that its performance framework includes information on (1) details for how the national measure is linked to and used to assess the three national program goals, (2) descriptions of how the updated state and local performance outcome measures align with national program goals, and (3) a written plan for how OCS will assess the reliability of state performance outcome data. (Recommendation 1)

Agency: Department of Health and Human Services: Office of Community Services
Status: Open

Comments: HHS agreed with this recommendation and and stated that it plans to take actions to better align its performance measures with the three national performance goals outlined in the new CSBG Theory of Change. We commend HHS for its plans to address this recommendation, but encourage the agency to focus on aligning its performance outcomes with the three national goals of the CSBG program as established by the CBBG Act, which are similar but not identical to the three goals outlined in the new CSBG Theory of Change. HHS also stated that it would implement additional actions to assess the reliability of state performance outcome data.

Recommendation: The Secretary of Education should develop an online clearinghouse of sample documents from states and localities who wish to share them, past webinar recordings and their related documents, and links to other relevant resources that all SEAs can access. (Recommendation 1)

Agency: Department of Education
Status: Open

Comments: Education agreed with this recommendation. The agency said that its Office of Elementary and Secondary Education will restructure its entire website to better organize its information, and create a new web page to house all foster care-related information and resources. Additionally, Education said this office will launch a virtual portal through which SEA foster care points of contact may collaborate and share resources. We will consider closing this recommendation when these efforts are complete.

Recommendation: The Attorney General should direct the Bureau of Justice Assistance to enhance quality checks to ensure the accuracy of information in its 180-day reports about Public Safety Officers' Benefits claims related to public safety officers affected by 9/11. (Recommendation 1)

Agency: Department of Justice
Status: Open

Comments: The Bureau of Justice Assistance agreed with this recommendation. The agency said it will develop and implement quality checks to confirm the accuracy of information reported in the 180-day reports related to PSOB 9/11 claims. We will consider closing this recommendation when this effort is completed.

Recommendation: The Administrator of ACL should take steps to better centralize access to and promote awareness of information on promising practices or other useful information pertinent to serving rural older adults.

Agency: Department of Health and Human Services: Administration for Community Living
Status: Open

Comments: HHS agreed with this recommendation, stating that it would encourage its resource centers to identify promising practices and other information specific to rural communities so that these resources would be searchable. In December 2019, ACL stated that it would continue to list all resource centers on its website so that anyone can find resources specific to any topic funded by ACL. The agency also noted that it would begin implementation of this action with new resource centers funded with FY 2020 appropriations. GAO continues to encourage ACL to centralize access to information pertinent to rural older adults by making it easily searchable across these websites or compiling it in other ways and promoting awareness of this information.

Recommendation: The Administrator of FNS should make information on their website regarding student SNAP eligibility requirements easier to understand and more accessible, as a resource for colleges and state SNAP agencies. (Recommendation 1)

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

Comments: FNS partially concurred with this recommendation and in September 2019, the agency stated that it will take actions to address the recommendation by February 2020. First, FNS said it would review the information regarding student SNAP eligibility on its website and, where possible, revise this information to reduce legal and technical language. FNS also stated it will evaluate the placement of student SNAP eligibility content on its website and assess alternatives to increase accessibility of this information for colleges and state SNAP agencies. We continue to believe that changes to FNS's existing information are needed to improve the clarity and accessibility of information about SNAP student eligibility requirements on FNS's website. Once we receive additional information about improvements to FNS's website, we will update the status of this recommendation.

Recommendation: The Administrator of FNS should coordinate with its regional offices to collect and review information about existing SNAP flexibilities and examples of approaches state SNAP agencies are taking to assist eligible college students to access SNAP benefits, and share such information with state SNAP agencies. (Recommendation 2)

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

Comments: FNS partially concurred with this recommendation and, in September 2019, stated that it is currently evaluating strategies to address this recommendation utilizing existing resources. Specifically, FNS stated that by August 2020, it will assess suitable mechanisms (e.g., policy memos, webinars, conferences) for information sharing with state SNAP agencies and disseminate that material as resources allow. We continue to believe that FNS needs to work with its regional offices to identify and share additional information about state approaches to assist eligible college students with access to SNAP benefits. Once we receive additional information about FNS's information sharing activities, we will update the status of this recommendation.

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 Commissioner of Education's Rehabilitation Services Administration should work with state VR agencies to determine whether and what additional information and assistance VR agencies may find helpful regarding on-demand training, such as online videos, to employers on disability issues. (Recommendation 1)

Agency: Department of Education
Status: Open

Comments: Education disagreed with this recommendation, noting that state VR agencies have the primary responsibility for determining how best to meet employers' needs, promote mainstream employment, and collaborate with other workforce programs in their states. Education recognized the importance of providing information and technical assistance to state VR agencies to help them serve employers, while stressing that it is a state matter how to best meet the training needs of employers. The agency did not provide an update in FY19.

Recommendation: The Commissioner of Education's Rehabilitation Services Administration should work with state VR agencies to determine how to most effectively disseminate information about the circumstances in which individuals who are employed may be eligible for career advancement services. (Recommendation 2)

Agency: Department of Education
Status: Open

Comments: Education disagreed with this recommendation, noting that state VR agencies have the primary responsibility for determining how best to meet employers' needs, promote mainstream employment, and collaborate with other workforce programs in their states. The agency recognized the importance of expanding career advancement opportunities for individuals with disabilities in accordance with the Rehabilitation Act as amended by WIOA. At the same time, Education said it is up to states to determine how to most effectively disseminate information about their services. Education noted it will continue to work with state VR agencies to determine what additional information may be necessary about the circumstances in which individuals who are employed may be eligible for career advancement services. The agency did not provide an update in FY19.

Recommendation: The Commissioner of Education's Rehabilitation Services Administration should work with state VR agencies to develop more complete information on when and how VR agencies should assess employment settings, including settings supported by the AbilityOne program, to determine if they meet the definition of competitive integrated employment. (Recommendation 3)

Agency: Department of Education
Status: Open

Comments: Education disagreed with this recommendation. The agency stated that it is a state matter to determine whether an employment location qualifies as an "integrated setting" for the purpose of the VR program, and that it is not Education's role to inform states as to when and how to make such determinations. Nevertheless, Education said it will continue to work with the states to determine if additional information would help them assess employment locations. The agency did not provide an update in FY19.

Recommendation: The Commissioner of Education's Rehabilitation Services Administration should encourage local areas to clarify and document the roles and responsibilities of partner agencies in working with employers and provide sample language of how local areas may document roles and responsibilities in their MOUs. (Recommendation 4)

Agency: Department of Education
Status: Open

Comments: Education neither agreed nor disagreed with this recommendation. Education said it believes that state workforce development agencies are in the best position to lead employer engagement efforts, but will continue to collaborate with other federal partners to provide technical assistance to states in this area, including examples of state- and local-level collaboration on employer engagement. The agency did not provide an update in FY19.

Recommendation: The Commissioner of Education's Rehabilitation Services Administration should, in setting the employer performance measurement approaches with DOL after the pilot is concluded, take into account VR agencies' concerns and key attributes of successful performance measures, including clarity in what is meant by employer services, coverage of the VR agencies' core program activities, and consideration of factors outside of VR agencies' control. (Recommendation 5)

Agency: Department of Education
Status: Open

Comments: Education neither agreed nor disagreed with this recommendation. Education said it will work with DOL to ensure that state VR agencies' concerns are considered when the performance measure for effectiveness in serving employers is finalized. The agency did not provide an update in FY19.

Recommendation: The Assistant Secretary of DOL's Employment and Training Administration should encourage local areas to clarify and document the roles and responsibilities of partner agencies in working with employers and provide sample language of how local areas may document roles and responsibilities in their MOUs. (Recommendation 6)

Agency: Department of Labor
Status: Open

Comments: DOL agreed with this recommendation, noting that local workforce boards and one-stop partners are in the best position to lead employer engagement, but that it will collaborate with federal partners in providing related technical assistance. In June 2019, DOL shared with GAO a local workforce area memorandum of understanding (MOU) that documents the workforce system partners' roles and responsibilities for engaging with employers. DOL has posted this MOU on its technical assistance web site, so it is available to other local workforce areas. However, in order to close the recommendation as implemented, GAO will need DOL to demonstrate that the agency has actively encouraged local workforce areas to document the roles and responsibilities of workforce partners--including the vocational rehabilitation program--for working with employers, through a Training and Employment Guidance Letter or other such guidance.

Recommendation: The Assistant Secretary of DOL's Employment and Training Administration should, in setting the employer performance measurement approaches with Education after the pilot is concluded, take into account VR agencies' concerns and key attributes of successful performance measures, including clarity in what is meant by employer services, coverage of the VR agencies' core program activities, and consideration of factors outside of VR agencies' control. (Recommendation 7)

Agency: Department of Labor
Status: Open

Comments: DOL agreed with this recommendation and said it will coordinate with Education to ensure state VR agencies' concerns are considered in defining the performance measure. In June 2019, DOL told us the two agencies expected to complete their evaluation of the pilot performance measures for effectiveness in serving employers by June 30, 2020, and then make a final decision about which measures to put in place. DOL also said the two federal agencies are working to consider VR agencies' concerns during this pilot, and have developed a crosswalk to identify appropriate VR services that count towards this measure. For GAO to close this recommendation as implemented, DOL will have to demonstrate that the finalized performance measures have taken into account VR agencies' concerns, including clarity in what is meant by employer services, coverage of the VR agencies' core program activities, and consideration of factors outside of VR agencies' control.

Recommendation: The Secretary of Labor should systematically collect sufficient information on state profiling systems, possibly through DOL's new UI state self-assessment process, to identify states at risk of poor profiling system performance. For instance, DOL could collect information on challenges states have experienced using and maintaining their profiling systems, planned changes to the systems, or state processes for assessing the systems' performance. (Recommendation 1)

Agency: Department of Labor
Status: Open

Comments: The Department of Labor agreed with this recommendation and said it would take action to address it. In June 2020, DOL reported that agency staff and a contractor had made significant progress in implementing plans to revise the self-assessment tool. First, staff and the contractor gathered feedback and recommendations for improvements to the tool through focus group sessions with states in each region. DOL also reported that the contractor has been developing revised questions for inclusion in the updated self-assessment tool. While agency work on the project was temporarily halted due to the agency's focus on issuing guidance and providing technical assistance to states concerning various new UI programs of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. 116-136), officials said the contract has been extended to November 2020, and staff plan to resume work on the project soon. GAO will monitor the agency's progress and update the status of this recommendation, as appropriate.

Recommendation: The Secretary of Labor should develop a process to use information on state risks of poor profiling system performance to provide technical assistance to states that need to improve their systems. DOL may also wish to tailor its technical assistance based on state service delivery goals and technical capacity. (Recommendation 2)

Agency: Department of Labor
Status: Open

Comments: The Department of Labor agreed with this recommendation and said it would take action to address it. In June 2020, DOL said that it was committed to using the information collected by the new self-assessment tool to develop standard operating procedures for capturing and maintaining the profiling assessment tracking information. These activities are dependent on the revisions to the self-assessment tool discussed in DOL's update for recommendation 1. We will monitor the agency's progress and update this recommendation as appropriate.

Recommendation: The Secretary of Labor should update agency guidance to ensure that it clearly informs states about the range of allowable profiling approaches. (Recommendation 3)

Agency: Department of Labor
Status: Open

Comments: The Department of Labor agreed with this recommendation and committed to publishing an Unemployment Insurance Program Letter (UIPL) regarding the implementation and maintenance of acceptable state profiling systems. In June 2020, DOL reported that efforts to develop the UIPL had been delayed, due in part to the intersection of the Worker Profiling and Reemployment Services (WPRS) program and the now permanent Reemployment Services and Eligibility Assessments (RESEA) program. Agency officials said they remain committed to publishing the UIPL and noted that they were developing an analysis of statistical modeling approaches that states can consider using and providing a framework for a simplified and low-cost approach to testing these different modeling techniques using their own state data. While agency officials said they were not able to devote the needed time to completing the UIPL due to the impact of the COVID-19 pandemic on the UI program, officials said their goal was to publish the UIPL by the end of 2020. We will monitor the agency's progress in implementing this recommendation, and update its status, as appropriate.

Recommendation: The Assistant Secretary of DOL's Employment and Training Administration should provide states with information about its determination that the use of state formal warning policies is no longer permissible under federal law. (Recommendation 1)

Agency: Department of Labor
Status: Open
Priority recommendation

Comments: DOL agreed with this recommendation. The agency stated that it would take action to provide states with information about its determination that the use of state formal warning policies is no longer permissible under federal law. As of December 2019, DOL reported that it is developing new guidance that states can no longer use formal warnings. We will consider closing this recommendation when the agency completes this effort.

Recommendation: The Assistant Secretary of DOL's Employment and Training Administration should monitor states' efforts to discontinue the use of formal warning policies. (Recommendation 2)

Agency: Department of Labor
Status: Open

Comments: DOL agreed with this recommendation and stated that it would monitor states' efforts to discontinue the use of formal warning policies. In December 2019, DOL reported that it has been developing new guidance that more explicitly informs states that formal warning policies are not permissible. We will consider closing this recommendation when the agency completes this effort and monitors states' compliance with the guidance.

Recommendation: The Assistant Secretary of DOL's Employment and Training Administration should clarify information on work search verification requirements in its revised Benefit Accuracy Measurement procedures. The revised procedures should include an explanation of what DOL considers to be sufficient verification of claimants' work search activities. (Recommendation 3)

Agency: Department of Labor
Status: Open
Priority recommendation

Comments: DOL agreed with this recommendation and stated that it would clarify information on work search verification requirements in its revised Benefit Accuracy Measurement procedures. In December 2019, DOL reported that it is developing new guidance with instructions to clarify work search verification requirements. To fully implement this recommendation, DOL should finalize and publish these instructions on verifying claimants' work search activities and provide the clear directions to states.

Recommendation: The Assistant Secretary of DOL's Employment and Training Administration should monitor states' compliance with the clarified work search verification requirements. (Recommendation 4)

Agency: Department of Labor
Status: Open

Comments: DOL agreed with this recommendation and stated that it would monitor states' compliance with clarified work search verification requirements. In December 2019, DOL reported that it is working with the Office of Management and Budget on its draft work search guidance that will more explicitly inform states that formal warning policies are not permissible. We will close this recommendation when DOL publishes these instructions, providing states with clear directions, and monitors their compliance with the guidance.

Recommendation: The Deputy Commissioner for Hearings Operations should evaluate the costs versus the benefits of changing system limitations that hinder users' ability to correctly and efficiently identify and transfer batches of cases. (Recommendation 2)

Agency: Social Security Administration
Status: Open

Comments: SSA agreed and in May 2019 stated that it is in the early stages of developing and rolling out a new case processing system to replace its Case Processing and Management System called the Hearings and Appeals Case Processing System (HACPS). HACPS will provide end-to-end disability claims processing infrastructure to support the full life-cycle of a disability claim and give users greater flexibility in correctly and accurately transferring cases to and from hearing sites process. It will include hearings and appeals case processing functionality. In early 2020, SSA reported that there were six releases of HACPS from November 2018 through September 2019 and they expect full implementation by early FY 2021.

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.

Recommendation: The Secretary of Defense should direct the Office of Special Needs (OSN) to assess the extent to which each Service is (1) providing sufficient resources for an appropriate number of family support providers, and (2) developing services plans for each family with special needs, and to include these results as part of OSN's analysis of any gaps in services for military families with special needs in each annual report issued by the Department to the congressional defense committees. (Recommendation 1)

Agency: Department of Defense
Status: Open

Comments: DOD agreed with this recommendation. In April 2019, DOD officials noted they plan to pilot a staffing tool that will help the Services determine the number of family support providers needed at each installation. The pilot currently includes multiple Services and is expected to last two years. DOD officials also noted that DOD is in the process of standardizing its case management processes for military families with special needs through its family needs assessment form. Among other things, this form is meant to help family support providers address requirements for individualized services plans and gain a better understanding of each family's current needs and goals. In its 2018 annual report to the congressional defense committees, DOD noted the National Defense Authorization Act for Fiscal Year 2010 requirement to develop and continuously update an individualized services plan for each military family with special needs. However, DOD said OSN may propose legislative changes to this requirement that would require an individualized services plan to be developed and updated only for those families that request services from family support providers. As of June 2020, we will consider closing this recommendation when the staffing tool is finalized and OSN has assessed each Service's number of family support providers and efforts to develop services plans.

Recommendation: The Secretary of Defense should direct the Office of Special Needs (OSN) to develop common performance metrics for assignment coordination and family support, in accordance with leading practices for performance measurement. (Recommendation 2)

Agency: Department of Defense
Status: Open

Comments: DOD agreed with this recommendation. In April 2019, DOD officials noted that each Service submits data for assignment coordination and family support to the EFMP data repository on a quarterly basis. According to DOD officials, in 2018, the data repository was expanded to include a full year of quarterly data for each Service, and OSN is currently developing additional performance metrics for assignment coordination and family support. DOD also noted that it will continue to use the data repository to identify gaps and trends related to assignment coordination and family support, including collecting data from each installation. As of June 2020, we await documentation that OSN has developed performance metrics for assignment coordination and family support and uses them to identify gaps and trends across the Services.

Recommendation: The Secretary of Defense should implement a systematic process for evaluating the results of monitoring activities conducted by each Service's EFMP. (Recommendation 3)

Agency: Department of Defense
Status: Open

Comments: DOD agreed with this recommendation. In April 2019, DOD said the family support component is monitored and evaluated through the each Service's certification process which includes specific standards for the EFMP. In addition, OSN participated in a monitoring site visit to Marine Corps Base Quantico in December 2018 and plans to participate in additional site visits that are coordinated by each Service's certification team. As of June 2020, we will consider closing this recommendation when DOD implements a process to evaluate the results of each Service's certification process.

Recommendation: The Board should work with SSA to explore options for obtaining data electronically and limiting the reliance of the financial interchange process on manual data entry. (Recommendation 1)

Agency: Railroad Retirement Board
Status: Open

Comments: RRB reported taking steps to implement this recommendation. In January 2020, the agency received a cost estimate from SSA for a proposed data exchange. In May 2020, RRB and SSA held an inaugural conference call and reached an understanding of the technical requirements to move forward with a data exchange. As of June 2020, RRB reports that systems analysts at SSA are developing the procedures and systems necessary for an electronic data exchange. GAO will close this recommendation when the data system is implemented.

Recommendation: The Board should produce written documentation on the financial interchange process such that a knowledgeable third party could carry out and replicate its process consistently without further explanation. (Recommendation 2)

Agency: Railroad Retirement Board
Status: Open

Comments: As of June 2020, RRB reports that it has been working to draft documentation of the financial interchange calculation process, and sharing drafts of this documentation with SSA for its review. SSA has requested revisions in this documentation and RRB plans to hire additional staff to implement GAO's recommendation. GAO will close this recommendation once RRB finalizes its documentation of the financial interchange calculation process.

Recommendation: The Board should produce formal policies on how the work of staff performing the financial interchange is reviewed. (Recommendation 5)

Agency: Railroad Retirement Board
Status: Open

Comments: As of June 2020, RRB reports that it is in the process of developing formal review policies and plans to include them in its written documentation of the financial interchange process. GAO will close this recommendation once RRB's formal review policy is complete.

Recommendation: The Commissioner of SSA should work with RRB to explore options for electronically sharing data and limiting the reliance of the financial interchange process on manual data entry. (Recommendation 6)

Agency: Social Security Administration
Status: Open

Comments: SSA reported that it received a data exchange request from RRB in October 2018. RRB proposed to send SSA a file of beneficiary and earnings data, and receive calculations for sample financial interchange cases. RRB and SSA discussed options for exchanging information electronically. In early 2020, SSA reported that it is developing a Rough Order of Magnitude/Cost Estimate for electronically sharing data and limiting the reliance of the financial interchange process on manual data entry under its existing agreement. The agency has no timeline to complete this effort.

Recommendation: The Commissioner of SSA should take additional steps to provide oversight of financial interchange calculations at the individual-case level. This could include periodically reviewing a subset of these cases. (Recommendation 7)

Agency: Social Security Administration
Status: Open

Comments: In September 2020, SSA reported that it has developed plans to review of a subset of financial interchange calculations as the individual-case level. SSA anticipates that this review will take place following the completion of RRB's fiscal year 2021-2022 financial interchange calculations. We will close this recommendation once SSA's review successfully takes place.

Recommendation: The Secretary of HHS should, consistent with its existing statutory authority, take additional steps to provide oversight of financial interchange calculations at the individual-case level. If the Secretary concludes that there are limitations in its authority in this area, the Secretary should seek to obtain the necessary additional authority. (Recommendation 8)

Agency: Department of Health and Human Services
Status: Open

Comments: As of July 2020, HHS continues to disagree with this recommendation. HHS officials said that RRB is responsible for certifying its costs through the financial interchange, and that they believe the department lacks the authority to question RRB's calculations. We continue to believe that HHS would be better positioned to ensure that the transfers it makes and receives through the interchange are calculated correctly if it reviews case-level calculations. We will close this recommendation if HHS seeks the authority to review financial interchange calculations or takes other steps to ensure the accuracy of financial interchange calculations performed by RRB.

Recommendation: To improve RRB's ability to make accurate disability benefit eligibility determinations, including CDRs, and to decrease the potential for making improper payments, Congress should consider granting RRB access to the Department of Health and Human Services' quarterly earnings information from the National Directory of New Hires database. (Matter for Consideration 1)

Agency: Congress
Status: Open

Comments: As of March 2020, no legislation has been enacted resulting from this matter to Congress. RRB's (the Board) fiscal year 2020 budget proposal included a legislative proposal to provide the Board access to the NDNH. Although the Board reported that the resulting proposed legislation drafted by HHS - the entity that maintains the NDNH - would, if enacted, provide access to the NDNH, the Board opposed the proposal in part because it would not waive associated fees to access the NDNH, and concluded access to the NDNH would not be cost-effective. In January 2020, the Board informed GAO it is not currently seeking legislation to gain access to the NDNH, resulting in the Board continuing to use earnings data that may be outdated in its continuing disability reviews, but that it may seek access in the future.

Recommendation: To enhance RRB's ability to manage and oversee its CDR program, RRB should routinely compile and analyze CDR program data, such as the number of cases selected for review, the number of beneficiaries in each medical improvement category, outcomes, and the costs and benefits of conducting CDRs, to improve program oversight. (Recommendation 3)

Agency: Railroad Retirement Board
Status: Open

Comments: RRB agreed with this recommendation. In June 2020, RRB reported that its Program Evaluation and Management Services (PEMS) section will compile and analyze all relevant CDR program case and cost data to better oversee CDRs. RRB said that its first analysis would cover CDR's adjudicated from April 2019 through September 2020; as of June 2020 they had adjudicated 107 CDR cases. In addition, RRB reported that its monthly reporting on CDRs to the Director of Disability includes information on the type of CDR completed, the medical improvement category for medical CDR, and the disposition of the CDR. In August 2018, the agency had reported that it began reporting in October 2017 weekly pending CDR type action cases to the Director of Programs, and that it had begun tracking CDR reason codes for each medical improvement category. To close this recommendation, RRB will need to include an analysis of the costs and benefits of conducting CDRs, including any overpayments or underpayments processed, and share its complete analysis of CDRs through September 2020 after it is completed. At that point GAO will review the analysis and decide if it provides a sufficient bases for program oversight.

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: GAO recommends that the Director of OMB consider developing a goal that addresses a coordinated federal approach to child well-being among its next set of cross-agency priority (CAP) goals, including working with relevant agencies to ensure their strategic plans include goals and objectives related to the CAP goal. (Recommendation 1)

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

Comments: OMB neither agreed nor disagreed with this recommendation. In November 2017, OMB staff noted that the agency was developing its next set of CAP goals, which are usually reserved for a limited set of priorities, and expects to announce these goals concurrent with the FY19 budget. As part of the process, agency staff said they consult relevant Congressional committees and other stakeholders. As of September 2019, OMB had not provided an update on its efforts.

Recommendation: The Acting Commissioner of the Social Security Administration should analyze the SEIE data to determine why a large proportion of transition-age youth on SSI with reported earnings did not benefit from the SEIE and, if warranted, take actions to ensure that those eligible for the incentive benefit from it.

Agency: Social Security Administration
Status: Open

Comments: SSA agreed with this recommendation. In August 2018, the agency reported that it was evaluating the accuracy of its SEIE data and once completed, the agency would analyze these data to determine whether there are significant numbers of students with earnings who are not benefiting from the SEIE. In February 2020, SSA reported that it was still working to resolve the issues with SEIE data identified during GAO's audit. SSA does not currently have a timeline for completing its analysis of its SEIE data. SSA also reported that it has submitted legislative proposals in several Presidential Budgets, most recently in fiscal year 2021, that would eliminate earnings reporting for youth, which would prevent similar concerns in the future. GAO will close this recommendation when SSA analyzes SEIE data and, if warranted, takes actions needed to ensure those eligible for SEIE benefit from it, or when all students with earnings receive SEIE because SSA's legislative proposal was enacted.

Recommendation: The Acting Commissioner of the Social Security Administration should analyze options to improve communication about SSA-administered work incentives and the implications of work on SSI benefits, with a goal of increasing understanding of SSI program rules and work incentives among transition-age youth and their families. This should include, but not necessarily be limited to, updating SSAs procedures for staff meeting with SSI applicants, recipients, and their families to regularly and consistently discuss - when applicable--how work incentives can prevent reductions in benefit levels and how work history is considered during eligibility redeterminations.

Agency: Social Security Administration
Status: Open

Comments: SSA disagreed with this recommendation. In August 2018, SSA noted it already requires staff to meet with SSI recipients regularly and instructs staff to discuss relevant work incentives, and that there is no indication that staff are not providing youth with appropriate work incentive information. However, SSA did not explain how it knows or ensures that staff are providing this information and SSA policies do not instruct staff to consistently convey information to youth and families on how work may or may not affect age 18 redetermination. SSA also reported that Work Incentives Planning and Assistance (WIPA) projects must prioritize working with youth who are referred to them. While we recognize the important role that WIPA projects play in providing work incentives counseling to SSI youth, as we previously reported, WIPA projects have limited capacity for serving youth along with other SSI recipients and disability insurance beneficiaries. In June 2019, SSA reported it had updated a brochure-containing information in English or Spanish on age-18 redeterminations, impact of earnings on benefits, work incentives and contact information to include information on SSA work incentives that may allow recipients who work to keep their Medicaid benefits. As of February 2020, the agency reported that it began sending this brochure to approximately 358,000 youth between the ages of 14 and 17 who receive SSI, and made this brochure available on its website. SSA also reported that it has begun exploring ways to better utilize social media to reach youth. While these are positive steps, we previously reported that written information may not be sufficient for conveying complex information. GAO continues to believe that SSA field office staff are both obliged and best-positioned to explain these rules. Moreover, in response to an SSA request for information in January 2018, SSA received public feedback on how it might improve transition outcomes for youth on SSI through better communication, suggesting that SSA's current communication strategies may not be sufficiently effective. We will consider closing this recommendation when SSA has taken further steps to ensure field staff are providing consistent and accurate information.

Recommendation: The Acting Commissioner of the Social Security Administration should work with the Secretary of Education to determine the extent to which youth on SSI are not receiving transition services through schools that can connect them to VR agencies and services.

Agency: Social Security Administration
Status: Open

Comments: SSA partially agreed with this recommendation, but after discussing it with the Department of Education, reported that significant challenges exist to pursuing certain implementation approaches. In December 2019, SSA reported that it continues to support research to identify the connection between youth on SSI and the receipt of VR services through its Retirement and Disability Research Consortia and its Analyzing Relationships Between Disability, Rehabilitation, and Work programs. SSA also reported that until very recently, data on open VR cases were unavailable at the national level; thus, it has not been possible to actively monitor SSI and VR participation in a timely manner. However, SSA reported that the agency will explore the possibility of using newly available data on open VR cases as resources allow. Determining the extent to which SSI youth are receiving or have access to services may help youth on SSI achieve employment and, potentially, self-sufficiency.

Recommendation: The Acting Commissioner of the Social Security Administration should explore various options for increasing connections to VR agencies and services, including their potential costs and benefits. One option, among others, could be to expand the Ticket to Work program to include youth.

Agency: Social Security Administration
Status: Open

Comments: SSA agreed with this recommendation and, in August 2018, SSA officials reported that they had taken several steps to explore and pursue options for increasing youths' connections to vocational rehabilitation agencies and services. Specifically, officials previously reported that they published a request for information (RFI) in the Federal Register in January 2018 that asks, among other things, for strategies to connect youth receiving Supplemental Security Income (SSI) with vocational rehabilitation agencies and about options for programs like a Ticket to Work for youth. In July 2019, SSA reported receiving and analyzing almost 200 responses to its RFI and indicated that it plans to discuss its findings with federal partners and other stakeholders. SSA officials also previously reported that the agency reviewed the Social Security Act and that the law precludes SSA from directly or indirectly referring youth on SSI to vocational rehabilitation agencies. Therefore, as of December 2019, the agency reported that it has submitted legislative proposals in several presidential budgets, including its fiscal year 2021 budget justification, that would allow SSA to refer youth to vocational rehabilitation agencies. SSA officials also reported that the agency has initiated demonstration projects to determine whether youth on SSI benefit from referrals to vocational rehabilitation agencies and commissioned reports related to services for youth.. According to information provided in July 2019, one of SSA's demonstration projects analyzes an experimental intervention to improve the outcomes of children receiving SSI by providing personalized information to families about the likelihood that a child will not continue on SSI as an adult, as well as resources to help these youth with the transition to employment. The resources offered will include: math tutoring, SAT/ACT test preparation, and help with applying for vocational rehabilitation services. In addition, according to information SSA provided in July and December 2019, the agency's second demonstration project will involve testing direct referrals to VR in one state for 19 year olds who are or may become SSI or Social Security Disability Insurance beneficiaries, and involves data sharing between SSA and the state on individuals eligible to participate in the project. This project is scheduled to begin recruiting participants in January 2020. SSA also reported that it has commissioned two reports on youth services that will help it identify implementable polices related to youth. Exploring the potential costs and benefits of employment support services for youth who receive or are at risk of being disability program beneficiaries as adults may help SSA develop programs to support the self-sufficiency of these youth. However, to date, SSA has not indicated that it has explored, or it may be too soon to explore, the costs and benefits of any of the options SSA has considered for increasing access to vocational rehabilitation agencies for youth on SSI.

Recommendation: To implement the goals and policy priorities of the 2020 Federal Youth Transition Plan, the Federal Partners in Transition (FPT) workgroup--the Secretaries of HHS, Education, Department of Labor, and the Commissioner of the Social Security Administration--should develop a long-term implementation plan that includes milestones and specific agency roles and assignments.

Agency: Department of Education
Status: Open

Comments: In June 2020, the Department of Labor (DOL) reported additional efforts by member federal agencies of the Federal Partners in Transition (FPT) to collaborate to make progress towards meeting the policy priorities outlined in the 2020 Federal Youth Transition Plan. In addition, DOL has reported that it has formalized and assigned certain FPT roles and responsibilities, is currently evaluating the 2020 plan priorities, is developing a charter to further define FPT milestones and federal agency roles and responsibilities, and will update the Office of Disability Employment Policy (ODEP) website to highlight FPT milestones and timelines. We are encouraged by this additional progress and anticipate we will close the recommendation once DOL provides the approved charter and updates the ODEP website as specified.

Recommendation: To implement the goals and policy priorities of the 2020 Federal Youth Transition Plan, the Federal Partners in Transition (FPT) workgroup--the Secretaries of HHS, Education, Department of Labor, and the Commissioner of the Social Security Administration--should develop a long-term implementation plan that includes milestones and specific agency roles and assignments.

Agency: Department of Health and Human Services
Status: Open

Comments: In July 2020, the HHS reported additional efforts by member federal agencies of the Federal Partners in Transition (FPT) to collaborate to make progress towards meeting the policy priorities outlined in the 2020 Federal Youth Transition Plan. In addition, HHS has reported that it has formalized and assigned certain FPT roles and responsibilities, is currently evaluating the 2020 plan priorities, is developing a charter to further define FPT milestones and federal agency roles and responsibilities, and the Office of Disability Employment Policy (ODEP) website will be updated to highlight FPT milestones and timelines. We are encouraged by this additional progress and anticipate we will close the recommendation once approved charter is provided and updates to the ODEP website are made as specified.

Recommendation: To implement the goals and policy priorities of the 2020 Federal Youth Transition Plan, the Federal Partners in Transition (FPT) workgroup--the Secretaries of HHS, Education, Department of Labor, and the Commissioner of the Social Security Administration--should develop a long-term implementation plan that includes milestones and specific agency roles and assignments.

Agency: Social Security Administration
Status: Open

Comments: In November 2019, SSA again reported that it meets on a monthly basis in both the Federal Partners in Transition (FPT) steering and general meetings, and that these meetings have created a working, structured, collaborative effort to address the audit recommendation and meet the policy priorities outlined in the FPT 2020 plan. SSA noted that the voluntary, ad-hoc nature of the FPT precludes definitive role assignments and implementation plans. We continue to maintain that being a voluntary initiative does not preclude the FPT from establishing long-term milestones and clarifying roles and responsibilities. Further, a long-term plan can be changed, and need not be definitive. Without a long-term implementation plan that includes milestones and specific agency roles and assignments, it is less likely that the priorities outlined in the 2020 Plan will be achieved.

Recommendation: To implement the goals and policy priorities of the 2020 Federal Youth Transition Plan, the Federal Partners in Transition (FPT) workgroup--the Secretaries of HHS, Education, Department of Labor, and the Commissioner of the Social Security Administration--should develop a long-term implementation plan that includes milestones and specific agency roles and assignments.

Agency: Department of Labor
Status: Open

Comments: In June 2020, the Department of Labor (DOL) reported additional efforts by member federal agencies of the Federal Partners in Transition (FPT) to collaborate to make progress towards meeting the policy priorities outlined in the 2020 Federal Youth Transition Plan. In addition, DOL has reported that it has formalized and assigned certain FPT roles and responsibilities, is currently evaluating the 2020 plan priorities, is developing a charter to further define FPT milestones and federal agency roles and responsibilities, and will update the Office of Disability Employment Policy (ODEP) website to highlight FPT milestones and timelines. We are encouraged by this additional progress and anticipate we will close the recommendation once DOL provides the approved charter and updates the ODEP website as specified.

Recommendation: To ensure the agency has sufficient information about risks to SSI program integrity when making decisions about efforts to address them, the Commissioner of the Social Security Administration should conduct a risk assessment of the current manual process for connecting and adjusting claim records of SSI recipients who live in households with other SSI recipients, and, as appropriate, take steps to make cost-effective improvements to SSA's claims management system to address identified risks.

Agency: Social Security Administration
Status: Open

Comments: In September 2020, SSA stated that it will include its current manual process for connecting and adjusting claims records for SSI recipients who live in households with other SSI recipients as a potential risk in the agency's upcoming Fraud Risk Assessment of the SSI program. According to SSA officials, the Fraud Risk Assessment will assess the current manual process based on its inherent risks, existing controls to reduce the risks, and the residual effects if the agency implements a process to connect SSI recipients' records. In addition, officials said they will determine a risk response as part of this assessment. SSA anticipates conducting the Fraud Risk Assessment of the SSI program by the end of calendar year 2020.

Recommendation: To help improve tribes' ability to maintain safe, stable, and permanent care for children, the Secretary of Health and Human Services should direct the Children's Bureau to explore the reasons for low tribal participation and identify actions to increase this participation in the title IV-E Guardianship Assistance Program.

Agency: Department of Health and Human Services
Status: Open

Comments: HHS agreed with this recommendation. HHS reported that it would take several actions: 1) task the Tribal Workgroup with identifying reasons for low tribal participation in GAP and identifying actions to increase participation in GAP; 2) improve its website offerings on Tribal IV-E, including providing the briefing materials as well direct IV-E and pass-through related products created by the CB Central and Regional Offices and the Capacity Building Center for Tribes; 3) improve coordination with non-governmental organizations that provide technical assistance and direct outreach to tribes for Title IV-E; and 4) encourage states to work with tribes on GAP. HHS noted that some states have already developed GAP frequently asked questions, practice guides, and other GAP support products to raise awareness and engage tribal interest in GAP. GAO awaits documentation that these actions have been completed. The agency also hopes to host a national tribal consultation to solicit feedback and determine priorities to address tribal participation in GAP; and develop a strategy for serving tribes interested in and implementing IV-E, including GAP, to be posted on the website. GAO will close this recommendation when the agency shows that these efforts have been completed.

Recommendation: To help college financial aid administrators more effectively implement eligibility rules for unaccompanied homeless youth, the Secretary of Education should make available an optional worksheet or form that college financial aid administrators can voluntarily use to document unaccompanied homeless youth status or encourage the use of existing forms that are available.

Agency: Department of Education
Status: Open

Comments: Education agreed that it would be helpful to make forms developed by outside organizations knowledgeable about homelessness issues available for financial aid administrators to use for documenting the status of unaccompanied homeless youth. Education also said that it plans to highlight the availability of these forms and provide guidance at its annual conference and in updates to the Federal Student Aid Handbook. Education noted that it will not endorse the use of a specific form but that it will highlight forms that already exist that may be useful to financial aid administrators. In July 2020, Education reported that it planned to update the Federal Student Aid Handbook by the spring of 2021 to inform financial aid administrators about the availability of such forms that have been developed by outside entities. We will close this recommendation when Education provides GAO with the updated handbook.

Recommendation: To help ensure vulnerable unaccompanied children receive child advocate services, the Secretary of the Department of Health and Human Services should direct ORR to develop a monitoring process that includes: (1) regularly reviewing referrals to the program contractor, including identifying which care providers in locations with a child advocate program do not make referrals; and (2) reviewing information on the children the program contractor determines it is unable to serve.

Agency: Department of Health and Human Services
Status: Open

Comments: In June 2016, the Office of Refugee Resettlement (ORR) reported that it was working with the child advocate contractor to develop standard operating procedures (SOP) to assign child advocates for children. In February 2020, ORR reported that the finalized SOPs are being implemented. Agency officials stated that they are reviewing program referrals through monthly reporting and calls with the contractor. ORR officials also said they allow the contractor to determine which unaccompanied children are provided a child advocate and there are insufficient resources to assign advocates to all children that are referred. In August 2020, ORR reported that the agency is in the process of developing a new case management system that will enhance its monitoring of the child advocate program, including the ability to analyze child advocate referral data. This system is expected to be fully operational in late 2021.

Recommendation: To ensure effective and appropriate recovery of DI overpayments and administration of penalties and sanctions, the Acting Commissioner of the Social Security Administration should clarify its policy for assessing the reasonableness of expenses used in determining beneficiaries' repayment amounts to help ensure that withholding plans are consistently established across the agency and accurately reflect individuals' ability to pay.

Agency: Social Security Administration
Status: Open

Comments: As of June 2020, SSA reported taking a number of steps to address this recommendation. According to SSA, it updated its guidance in 2017 to help ensure that staff consistently process various requests from overpaid individuals. SSA also reported that it is taking additional steps to update instructions on how staff should consider whether expenses reported by individuals are reasonable when approving withholding plans. The agency expects these instructions to be complete by the end of fiscal year 2021. We will close this recommendation once SSA releases additional guidance on assessing the reasonableness of expenses.

Recommendation: To ensure effective and appropriate recovery of DI overpayments and administration of penalties and sanctions, the Acting Commissioner of the Social Security Administration should adjust the minimum withholding rate to 10 percent of monthly DI benefits to allow quicker recovery of debt.

Agency: Social Security Administration
Status: Open
Priority recommendation

Comments: SSA agreed with this recommendation and in 2017 estimated that this change would result in an additional $213 million in collections over a 5-year period. The fiscal year 2021 President's budget submission contained a legislative proposal to make this change, and budgets since 2017 have contained similar proposals. As of June 2020, SSA reported that it plans to continue to submit similar legislative proposals. SSA also included the proposal in its regulatory agenda, noting that the change can also be implemented via regulatory change. We will close this recommendation once SSA achieves resolution from Congress on its legislative proposal or from its own regulatory efforts.

Recommendation: To ensure effective and appropriate recovery of DI overpayments and administration of penalties and sanctions, the Acting Commissioner of the Social Security Administration should consider adjusting monthly withholding amounts according to cost of living adjustments or charging interest on debts being collected by withholding benefits. Should SSA determine that it is necessary to do so, it could pursue legislative authority to use recovery tools that it is currently unable to use.

Agency: Social Security Administration
Status: Open

Comments: Although SSA initially disagreed with this recommendation, the agency reassessed its response in June 2019 and decided to take additional actions. As of June 2020, SSA is developing a system to track debts (the Debt Management Product) which will have the ability to store, track, and apply interest and penalties to overpayment debts. SSA also reports that it is seeking a regulatory change to clarify procedures to charge interest on debts. While SSA is pursuing these measures to position itself to charge interest on debts, the agency has not yet decided whether it will ultimately do so. We will close this recommendation once SSA makes a decision on how to proceed with charging interest on overpayment debts.

Recommendation: To improve SSA's ability to detect, prevent, and recover potential DI benefit overpayments due to the concurrent receipt of FECA benefits, the Commissioner of Social Security should strengthen internal controls designed to prevent DI overpayments due to the concurrent receipt of FECA benefits by implementing the alternative that provides the greatest net benefits.

Agency: Social Security Administration
Status: Open
Priority recommendation

Comments: As of January 2020, SSA had taken steps to strengthen internal controls, as GAO recommended in July 2015, but it had not completed its efforts. In January 2020, SSA told GAO that it continues to work with DOL to establish a computer matching agreement to support the FECA data exchange and the agreement is pending at DOL for final review and signature. According to SSA, if the agreement is established, SSA will use the FECA benefit data to improve efficiencies in its ability to offset/reduce DI benefits when an individual is concurrently receiving FECA benefits. GAO will continue to monitor SSA's work in this area. SSA following through with these plans will help the agency identify and prevent potential DI overpayments.

Recommendation: To assist states that rely on or are planning to contract with an MCO to administer Medicaid prescription benefits, and to help provide effective oversight of psychotropic medications prescribed to children in foster care, the Secretary of Health and Human Services should issue guidance to state Medicaid, child-welfare, and mental-health officials regarding prescription-drug monitoring and oversight for children in foster care receiving psychotropic medications through MCOs.

Agency: Department of Health and Human Services
Status: Open

Comments: In an October 2018 written response, Health and Human Services (HHS) noted that they released 2017-2018 Drug Utilization Review Summaries for Prescription Drug Fee-For-Service Programs as it relates to national statistics on state oversight of psychotropic medications, as well as new state requirements to report on their Medicaid managed care organizations. However, as of August 2019, HHS confirmed they have not issued any guidance to state Medicaid, child-welfare, and mental-health officials regarding prescription-drug monitoring and oversight for children in foster care receiving psychotropic medications through MCOs, as we recommended. We continue to believe that additional HHS guidance that helps states implement oversight strategies within the context of a managed-care environment is needed to help ensure appropriate monitoring of psychotropic medications prescribed to children in foster care.

Recommendation: To help ensure the department maintains its critical skills and competencies, when planning for and implementing future civilian workforce actions, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to involve functional community managers and to the extent possible, use information from gap assessments of its critical skills and competencies as they are completed to make informed decisions for possible future reductions or justify the size of the force that it has.

Agency: Department of Defense
Status: Open

Comments: As of September 2017, the Associate Director, Total Force Requirements & Sourcing Policies; OUSD(P&R), stated that the Department has taken some actions and that there are ongoing efforts in this area. As of November 2019, DOD has taken no further action. We will continue to monitor DOD's progress in implementing this recommendation.

Recommendation: To ensure that federal funding efficiently and effectively responds to the countercyclical nature of the Medicaid program, Congress may wish to consider enacting an FMAP formula that is targeted for variable state Medicaid needs and provides automatic, timely, and temporary increased FMAP assistance in response to national economic downturns.

Agency: Congress
Status: Open

Comments: As of September 2020, no legislation had been enacted. GAO has testified on at least one bill that had been introduced in the Congress that would implement this Matter for Congressional Consideration. On February 10, 2016, GAO testified on considerations related to the Medicaid funding formula. See Medicaid: Changes to Funding Formula Could Improve Allocation of Funds to States GAO-16-377T January 26, 2016. We also cited this report in our discussion on Medicaid funding during economic downturns in Medicaid: Key Policy and Data Considerations for Designing a Per Capita Cap on Federal Funding (GAO-16-726). We cited this Matter in Opportunities to Improve the Federal Recovery and Response Efforts (GAO-20-625) and in COVID-19: Brief Update on Initial Federal Response to the Pandemic (GAO-20-708).

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: To enhance the provision of dental care to children covered by Medicaid and CHIP, and to help ensure that HHS's Insure Kids Now Web site is a useful tool to help connect children covered by Medicaid and CHIP with participating dentists who will treat them, the Secretary of HHS should require states to verify that dentists listed on the Insure Kids Now Web site have not been excluded from Medicaid and CHIP by the HHS-OIG, and periodically verify that excluded providers are not included on the lists posted by the states.

Agency: Department of Health and Human Services
Status: Open

Comments: As of September 2020, CMS has not indicated taking steps to require states to ensure excluded providers are not listed on the Insure Kids Now website, nor has it indicated taking steps to periodically verify that providers excluded from Medicaid and CHIP are not on the list. CMS has said that it relies on states to provide accurate lists of eligible dentists and that data issues prevent the agency from independently verifying that excluded providers are not included on the Insure Kids Now website. We continue to believe that CMS should require states to ensure that excluded providers are not listed on the website and periodically verify that excluded providers are not included on the lists posted by the states, so that the website does not present inaccurate information about providers available to serve Medicaid-covered children.

Recommendation: To the extent that the CDBG program continues to be the primary vehicle used to provide post-disaster assistance for permanent housing, Congress may wish to consider providing more specific direction regarding the distribution of disaster-related CDBG assistance that states are to provide for homeowners and renters. If Congress wishes to change the proportion of assistance directed to homeowners and rental property owners in future recovery efforts, Congress could, for example, require states to demonstrate to HUD that they are adequately addressing the needs of both homeowners and renters with their CDBG allocation and other resources as a condition for receiving funds. Alternatively, Congress could direct HUD to develop a formula that accounts for the housing needs of both homeowners and renters. Such a formula could be used by states to determine the proportions of their disaster CDBG funds that should be used for housing, specifically rental housing. Further, the formula could also reflect the anticipated production levels of other programs that provide permanent housing assistance, such as the Low-Income Housing Tax Credit program.

Agency: Congress
Status: Open

Comments: Since 1993, Congress has appropriated Community Development Block-Disaster Recovery (CDBG-DR) funding in the wake of numerous presidentially-declared disasters, including, most recently, $2.431 billion in Public Law 116-20, the majority of which amount is for disasters that occurred in 2018 and 2019. Similar to previous CDBG-DR appropriations, the CDBG-DR appropriation in Public Law 116-20, enacted June 6, 2019, neither requires states to demonstrate to HUD that they adequately addressed the needs of both homeowners and renters nor, alternatively, directs HUD to develop a formula that accounts for the housing needs of both homeowners and renters. A bill introduced and reported out of committee in the 115th Congress, HR 4557, required HUD to disapprove a state action plan that detailed a grantee's use of funds if, among other reasons, the plan did not provide an equitable allocation of resources among homeowners, renters, and persons experiencing homelessness. A draft bill, whose provisions were essentially identical to HR 4557, was the focus of a hearing during the 116th Congress.

Recommendation: Given the potential for improving compliance now and in the future, Congress may wish to provide IRS with the authority to use math error checks to identify and correct returns with ineligible (1) IRA "catch-up" contributions, and (2) contributions to traditional IRAs from taxpayers over age 70-1/2.

Agency: Congress
Status: Open

Comments: As of March 2020, Congress has expanded IRS's math error authority in certain circumstances, but not as broadly as GAO suggested in February 2010. Section 208 of division Q of the Consolidated Appropriations Act, 2016 (Public Law 114-113 enacted in December 2015) gave IRS the authority to use math error authority if (1) a taxpayer claimed the Earned Income Tax Credit, Child Tax Credit, or the American Opportunity Tax Credit (AOTC) during the period in which a taxpayer is not permitted to claim such credit as a consequence of either having made a prior fraudulent or reckless claim; or (2) a taxpayer omitted information required to be reported because the taxpayer made prior improper claims of the Child Tax Credit or the AOTC. While expanding math error authority is consistent with what GAO suggested in February 2010, GAO maintains that a broader authorization of math error authority with appropriate controls would enable IRS to correct obvious noncompliance, would be less intrusive and burdensome to taxpayers than audits, and would potentially help taxpayers who underclaim tax benefits to which they are entitled. If Congress decides to extend broader math error authority to IRS, controls may be needed to ensure that this authority is used properly such as requiring IRS to report on its use of math error authority. The Administration also requested that Congress expand IRS's math error authority as part of the Service's Congressional Budget Justification and Annual Performance Report and Plan for fiscal year 2019. Specifically, the Administration requested authority to correct a taxpayer's return in the following circumstances: 1) the information provided by the taxpayer does not match the information contained in government databases; 2) the taxpayer has exceeded the lifetime limit for claiming a deduction or credit; or 3) the taxpayer has failed to include with his or her return certain documentation that is required by statute. As of April 2019, the Congress had not provided IRS with such authority.

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 better account for physicians practicing in underserved areas through the use of J-1 visa waivers, the Secretary of Health and Human Services should collect and maintain data on waiver physicians--including information on their numbers, practice locations, and practice specialties--and use this information when identifying areas experiencing physician shortages and placing physicians in these areas.

Agency: Department of Health and Human Services
Status: Open

Comments: HHS concurred with our recommendation, commenting that the department's goal was to assure that the limited resources of the J-1 visa waiver program and other programs addressing areas and populations with limited access to health care professionals are targeted most effectively. In 2013, HHS indicated that it was considering the best approach to collect information to identify J-1 visa physicians practicing in underserved areas. As of February 2018, however, HHS reported that it does not have the capacity to track physicians practicing in underserved areas through the use of J-1 visa waivers, citing reasons such as the number of federal entities and states involved in the process. While we recognize that collecting and maintaining these data requires coordination with other agencies, we continue to believe that without data on waiver physicians, HHS--the federal agency with primary responsibility for addressing physician shortages--will lack the information needed to consider waiver physicians working in underserved areas when placing providers in these areas under other programs. As of August 2019, HHS officials have not informed us of actions taken to implement this recommendation. We are leaving this recommendation open until the department collects and maintains data on waiver physicians and considers those physicians in its efforts to address physician shortages.

Recommendation: To meet its fiduciary responsibility of ensuring that section 1115 waivers are budget neutral, the Secretary of Health and Human services should better ensure that valid methods are used to demonstrate budget neutrality, by developing and implementing consistent criteria for consideration of section 1115 demonstration waiver proposals.

Agency: Department of Health and Human Services
Status: Open
Priority recommendation

Comments: As of January 2020, the Department of Health and Human Services (HHS) had taken some action to address GAO's 2002 recommendation. In August 2018, HHS issued written guidance through a State Medicaid Directors Letter documenting four key changes it made in 2016 to its budget neutrality policy. These changes addressed some, but not all of the questionable methods GAO identified in its reports. To fully address this recommendation, HHS should also address these other questionable methods, such as setting demonstration spending limits based on hypothetical costs-what the state could have paid-rather than payments actually made by the state. GAO has found that the use of hypothetical costs has the potential to inflate spending limits and thus threatens budget neutrality of demonstrations