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 Administrator of the Food and Nutrition Service should establish a process to plan and conduct regular fraud risk assessments for the school meals programs that align with the leading practices in the Fraud Risk Framework. (Recommendation 1)

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

Comments: As of September 12, 2019, USDA stated that it will undertake, over the course of the next year, a re-evaluation of its existing research and oversight activity to measure and assess fraud risk, its efforts to manage that risk, and its work to minimize the occurrence and impact of fraudulent activity on the school meal programs. USDA also stated that it will look to GAO's Fraud Risk Framework as a model for this effort. USDA expects this effort to include some new activity, such as a deeper examination of the underlying causes of program error in the agency's periodic studies of improper payments. USDA also views this as an opportunity to clarify and highlight how the agency's existing approach to risk management currently addresses fraud risk. USDA agrees that it is appropriate to review and refine its existing controls on a regular basis and recognizes that a more formalized assessment of fraud risk is likely to uncover gaps in existing activity that point to opportunities for further agency action. USDA commits to the development of a response to the effort that is appropriate to the scale of the identified risk and the broader mission of the school meal programs. In September 2020, USDA stated that it has been reviewing agency research and administrative data, as well as conducting new analysis. USDA is concluding work on its risk assessment and plans to circulate it within the agency for review soon. We will continue to monitor USDA's progress in this area.

Recommendation: The Commissioner of FDA should ensure that the FVM Program develops performance measures with associated targets and time frames for all eight of FDA's food safety- and nutrition-related objectives. (Recommendation 2)

Agency: Department of Health and Human Services: Food and Drug Administration
Status: Open

Comments: As of August 2020, FDA had not fully implemented our recommendation, although the agency reported taking several steps. For example, FDA stated that implementation of Food Safety Modernization Act (FSMA) based preventive controls standards is a top priority for the agency and a key component of the Foods and Veterinary Medicine Program's strategic plan, and for this reason, FSMA-related performance metrics have been prioritized. In addition, FDA reported that in September 2019, the agency published an online Food Safety Dashboard, whose purpose is to measure the progress of each of the FSMA rules, and FDA provides regular updates to the dashboard to promote transparency to the public. FDA also stated that as of June 2020, the dashboard contains measures related to Preventive Controls and Current Good Manufacturing Practice Rules and Imported Food Safety Program, and it includes data for human and animal food and, in some cases, data starting in FY 2017. FDA added that since the FSMA rules have staggered compliance dates, the measures associated with the rules are developed in phases, and over time, the Food Safety Dashboard will be populated with additional data to show more FSMA-related outcomes. However, the recommendation is not fully implemented since our recommendation included the related objectives within the Foods and Veterinary Medicine Program's strategic plan. In August 2020, FDA told us that given the agency's 2018 reorganization, FDA has aligned the performance measures and dashboard with the FSMA rules, and the current alignment covers most of the food safety objectives within the strategic plan. FDA also reported that it is reviewing the strategic plan to ensure alignment with FDA's current priorities and structure, including the recently released New Era of Smarter Food Safety Blueprint. We will follow up with FDA and provide an update in FY 2021.