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: Congress should consider requiring that states notify parents/guardians of changes in students' federal special education rights when a student with a disability is moved from public to private school by their parent.

Agency: Congress
Status: Open

Comments: As of August 2019, Congress has not considered this matter.

Recommendation: The Assistant Secretary for Special Education and Rehabilitative Services should review information provided by states related to changes in federal special education rights when a parent places a student with a disability in a private school and work with states to correct inaccurate information.

Agency: Department of Education: Office of Special Education and Rehabilitative Services
Status: Open
Priority recommendation

Comments: Education generally agreed with this recommendation. However, the agency believes it is necessary to review the full documents containing information provided by states, so that it can determine the context in which the information was presented. We will coordinate with Education as appropriate to facilitate such a review. As of March 2020, the agency worked with relevant states to improve the information provided, and reviewed states' revised information to parents about federal rights of children with disabilities who are placed by parents in private schools. Education stated that this effort did not identify any inaccurate or inconsistent information. However, some states appear not to have modified language that Education previously identified as inaccurate. Education did not explain why it has determined that this information is now accurate. To fully address this recommendation, Education should either provide this explanation or have these states correct any inaccurate information.

Recommendation: To help districts address key challenges in meeting MOE and mitigate unintended consequences that may affect services for students with disabilities, while preserving the safeguard for funding for students with disabilities, Congress should consider options for a more flexible MOE requirement. This could include adopting a less stringent MOE requirement to align with the MOE requirements in other education programs or adding to or modifying exceptions. For example, current exceptions could be changed to allow one-time increases in spending without changing a district's MOE baseline in order to encourage pilot innovations or to allow certain spending decreases (e.g., state caps on teacher benefits), as long as a district can demonstrate the decrease does not negatively affect services.

Agency: Congress
Status: Open

Comments: As of February 2020, Congress has not taken legislative action on this issue.

Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to develop an updated plan for VBMS that includes (1) a schedule for when VBA intends to complete development and implementation of the system, including capabilities that fully support disability claims, pension claims, and appeals processing and (2) the estimated cost to complete development and implementation of the system.

Agency: Department of Veterans Affairs
Status: Open
Priority recommendation

Comments: The Department of Veterans Affairs (VA) concurred with our recommendation and as of January 2020, is continuing to develop requirements for VBMS in order to develop functionality to replace legacy information systems. In addition, the department subsequently provided us with expected completion dates for implementation of claims and appeals processing, but has not provided a schedule for the implementation of pension claims processing. To fully implement this recommendation, the department needs to provide the expected completion date for pension claims processing and an estimate of the cost to complete remaining development and implementation of VBMS.

Recommendation: To improve VA's efforts to effectively complete the development and implementation of VBMS, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits and the Chief Information Officer to reduce the incidence of high- and medium-priority level defects that are present at the time of future VBMS releases.

Agency: Department of Veterans Affairs
Status: Open

Comments: The Department of Veterans Affairs (VA) concurred with this recommendation and reiterated its plans and procedures for decreasing the incidences of defects in each system release. However, while the most recent VBMS release (i.e., May 2019) showed a decrease in the number of high- and medium-priority level defects, the release in February 2019 showed an increase in the number of high- and medium-priority defects. In addition, both the February 2019 and May 2019 releases showed the presence of the highest severity defects--critical--which have extensive user impact and workarounds do not exist. We will continue to monitor VA's actions and progress in response to this recommendation.

Recommendation: To improve performance management of the Telecommunications Relay Service, following the establishment of TRS's performance goals, the Chairman of the Federal Communications Commission should conduct a robust risk assessment that can help FCC design a comprehensive internal-control system.

Agency: Federal Communications Commission
Status: Open

Comments: FCC indicated that a draft document was under review to implement this recommendation and would be approved before the end of FY-19. However, in September 2019, when we asked FCC for an update, we did not receive one. We will continue to communicate with FCC about the status of this recommendation.

Recommendation: Depending on the outcome of the litigation, the Secretary of Labor should take steps to ensure the agency will be positioned to conduct a meaningful retrospective review consistent with the Executive Order at an appropriate time. These steps should be taken in consultation with the Centers for Medicare & Medicaid Services, and could include, for example, identifying metrics that could be used to evaluate the rule, and implementing a plan to gather and analyze the necessary data.

Agency: Department of Labor
Status: Open

Comments: The Department of Labor's Wage and Hour Division (WHD) agreed with this recommendation and reported that it is working to develop data collection plans and explore a potential evaluation that is focused on the Home Care Rule. As part of this effort, WHD noted that it will continue to work with HHS and other federal partners. In FY16, WHD reported that such an evaluation of how stakeholders and affected industries have responded to the rule would be beneficial. However, litigation has delayed implementation and enforcement of the rule significantly, and WHD believes an evaluation at this stage would be premature and would be unlikely to fully and accurately capture stakeholders' responses to the rule and the resulting impacts. Delaying the evaluation would allow WHD to monitor the results of its own investigations and the effects of ongoing compliance assistance, both of which would be extremely difficult to measure at this early stage. In 2017, WHD reported that it will continue to monitor early implementation to determine the appropriate start for any evaluation and lay the groundwork for future assessment, including a plan for how to identify data that would inform such as an assessment. In 2018, WHD reported that it is too early in the implementation phase of the rule to conduct an evaluation of the rule's impact. The Department and WHD continue to engage with HHS to understand stakeholders' responses to the rule. WHD also continues to lay the groundwork for any future assessment by working to identify data sources that would inform such as an assessment.

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

Agency: Department of Transportation
Status: Open

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

Recommendation: To help ensure appropriate payments to MA plans, the Administrator of CMS should take steps to improve the accuracy of the adjustment made for differences in diagnostic coding practices between MA and Medicare FFS. Such steps could include, for example, accounting for additional beneficiary characteristics, including the most current data available, identifying and accounting for all years of coding differences that could affect the payment year for which an adjustment is made, and incorporating the trend of the impact of coding differences on risk scores.

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

Comments: CMS indicated in January 2020 that it has no plans to take further action regarding our recommendation. CMS stated that, given the complexity of measuring coding changes attributable to plan behavior and the difficulty of measuring countervailing factors, there is not a single correct factor within the viable range of adjustment factors. In addition, the agency noted that there is policy discretion with respect to the appropriate adjustment factor for the payment year. In the Medicare Advantage Call Letter of April 2019, CMS stated that it will apply the statutory minimum adjustment of 5.90 percent for calendar year 2020. As of February 2020, CMS had not provided any documentation of its analysis and the basis for its determination. Although the application of the 5.90 percent adjustment and other recent changes CMS has made to its methodology for calculating the diagnostic coding adjustment (i.e., the exclusion of diagnosis codes that were differentially reported in Medicare fee-for-service and Medicare Advantage) likely brings CMS's adjustment closer to what GAO's analysis projects to be an accurate adjustment, a modified methodology that incorporates more recent data, accounts for all relevant years of coding differences, and incorporates the effect of coding difference trends would better ensure an accurate adjustment in future years. Until CMS shows the sufficiency of the diagnostic coding adjustment or implements an adjustment based on analysis using an updated methodology, payments to Medicare Advantage plans may not accurately account for differences in diagnostic coding between these plans and traditional Medicare providers.