GAO

GAO-21-240R, U.S. Army Corps of Engineers: Information on the Navigation and Ecosystem Sustainability Program, January 22, 2021

The U.S. Army Corps of Engineers (Corps) has taken steps to implement its Navigation and Ecosystem Sustainability Program (NESP)—a dual-purpose program for navigation improvements and ecosystem restoration along the Upper Mississippi River system. Specifically, in 2004 the Corps identified 24 navigation improvement projects and 1,010 ecosystem restoration projects and proposed a plan for implementing them. For example, the Corps plans to construct or extend 12 locks to facilitate commercial barge traffic along the river system (see fig.), which the states of Illinois, Iowa, Minnesota, Missouri, and Wisconsin have generally relied on as their principal conduit for export-bound agricultural products. The Corps also plans to restore floodplains along the river system and backwaters that provide habitat for hundreds of species of wildlife. While the total estimated program cost is $7.9 billion, as of October 2020, the Corps has initiated technical studies and designs for 47 NESP projects at a cost of approximately $65 million. Barge Tow at Lock and Dam 15 in Rock Island, Illinois However, the Corps has identified several challenges facing the program, and it has taken steps to mitigate them. Specifically, the Corps was unable to implement NESP projects for 7 years because the program did not receive funding in fiscal years 2011 through 2017, in part because the Corps identified other projects as higher priorities. To mitigate this challenge, the Corps reprogrammed funding to help ensure projects could be executed when funds became available. Another challenge is that the Corps has not yet established partnership agreements that are needed for some NESP ecosystem projects. Corps officials said that about 15 to 20 percent of the ecosystem projects will require partnership agreements in which partners commit to share 35 percent of the project costs, typically through the purchase of land for the project. The officials said that partners may be reluctant to make financial commitments to projects while NESP funding is uncertain. Furthermore, the partnership agreements can take up to 18 months to put in place. To help expedite program implementation, Corps officials said they have pursued projects in fiscal year 2020 that can begin without a commitment from project partners. The Upper Mississippi River system provides approximately $1 billion in annual benefits to the nation’s economy through boating, fishing, and other uses, according to a Corps report. It also supports more than 2.5 million acres of aquatic, wetland, forest, grassland, and agricultural habitats. In 1986, Congress declared its intent to recognize the system as a nationally significant commercial navigation system and a nationally significant ecosystem. However, the Upper Mississippi River’s navigation system has faced significant delays in commercial boating and barge traffic, and human activity has caused a decline in environmental quality, according to a 2004 Corps report. The Corps initiated studies in 1989 and 1990 to identify ways to improve the river system. The Corps issued a feasibility report in 2004 that identified improvement projects, and in 2007 Congress formally authorized NESP and the projects identified in the report. GAO was asked to review NESP. This report describes (1) the steps the Corps has taken to implement NESP and (2) the challenges the Corps has identified to fully implementing the program and steps the Corps is taking to address these challenges. To conduct this work, GAO reviewed Corps reports, documents, and data from fiscal year 2005—the year in which the Corps began implementing NESP projects—through fiscal year 2020. GAO also interviewed Corps officials. For more information, contact Mark Gaffigan at (202) 512-3841 or gaffiganm@gao.gov.

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GAO-21-93, Rural Hospital Closures: Affected Residents Had Reduced Access to Health Care Services, December 22, 2020

GAO found that when rural hospitals closed, residents living in the closed hospitals' service areas would have to travel substantially farther to access certain health care services. Specifically, for residents living in these service areas, GAO's analysis shows that the median distance to access some of the more common health care services increased about 20 miles from 2012 to 2018. For example, the median distance to access general inpatient services was 3.4 miles in 2012, compared to 23.9 miles in 2018—an increase of 20.5 miles. For some of the less common services that were offered by a few of the hospitals that closed, this median distance increased much more. For example, among residents in the service areas of the 11 closed hospitals that offered treatment services for alcohol or drug abuse, the median distance was 5.5 miles in 2012, compared to 44.6 miles in 2018—an increase of 39.1 miles to access these services (see figure). Median Distance in Miles from Service Areas with Rural Hospital Closures to the Nearest Open Hospital that Offered Certain Health Care Services, 2012 and 2018 Notes: GAO focused its analysis on the health care services offered in 2012 by the 64 rural hospitals that closed during the years 2013 through 2017 and for which data were available. For example, in 2012, 64 closed hospitals offered general inpatient services, 62 offered emergency department services, 11 offered treatment services for alcohol or drug abuse, and 11 offered services in a coronary care unit. To examine distance, GAO calculated “crow-fly miles” (the distance measured in a straight line) from the geographic center of each closed rural hospital's service area to the geographic center of the ZIP Code with the nearest open rural or urban hospital that offered a given service. GAO also found that the availability of health care providers in counties with rural hospital closures generally was lower and declined more over time, compared to those without closures. Specifically, counties with closures generally had fewer health care professionals per 100,000 residents in 2012 than did counties without closures. The disparities in the availability of health care professionals in these counties grew from 2012 to 2017. For example, over this time period, the availability of physicians declined more among counties with closures—dropping from a median of 71.2 to 59.7 per 100,000 residents—compared to counties without closures—which dropped from 87.5 to 86.3 per 100,000 residents. Rural hospitals face many challenges in providing essential access to health care services to rural communities. From January 2013 through February 2020, 101 rural hospitals closed. GAO was asked to examine the effects of rural hospital closures on residents living in the areas of the hospitals that closed. This report examines, among other objectives, how closures affected the distance for residents to access health care services, as well as changes in the availability of health care providers in counties with and without closures. GAO analyzed data from the Department of Health and Human Services (HHS) and the North Carolina Rural Health Research Program (NC RHRP) for rural hospitals (1) that closed and those that were open during the years 2013 through 2017, and (2) for which complete data generally were available at the time of GAO's review. GAO also interviewed HHS and NC RHRP officials and reviewed relevant literature. GAO defined hospitals as rural according to data from the Federal Office of Rural Health Policy. GAO defined hospital closure as a cessation of inpatient services, the same definition used by NC RHRP. GAO defined service areas with closures as the collection of ZIP Codes that were served by closed rural hospitals and service areas without closures as the collection of ZIP Codes served only by rural hospitals that were open. GAO provided a draft of this report to HHS for comment. The Department provided technical comments, which GAO incorporated as appropriate. For more information, contact James Cosgrove at (202) 512-7114 or cosgrovej@gao.gov.

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GAO-21-188R, Health Care Funding: Federal Obligations to and Funds Received by Certain Organizations Involved in Health-Related Services, 2016 through 2018, December 21, 2020

GAO reviewed federal funding provided to various organizations that offer health-related services, such as voluntary family planning and activities related to the treatment and prevention of HIV/AIDs. In total, the organizations in our review received almost $16 billion through grants or cooperative agreements from the Department of Health and Human Services or U.S. Agency for International Development from 2016 through 2018; nearly all of this funding was received by federally qualified health centers. (See table.) Reported Amounts of Funds Received through Federal Grants or Cooperative Agreements by Organizations in GAO’s Review, 2016-2018 Dollars in millions Federal agency 2016 2017 2018 Total Department of Health and Human Services (HHS)       Federally qualified health centers (FQHC) 4,891.03 5,251.93 5,291.81 15,434.77       Planned Parenthood Federation of America (PPFA) 94.86 106.12 103.51 304.49       International Planned Parenthood Federation (IPPF) 2.30 2.05 1.20 5.55       Marie Stopes International (MSI) 0.00 0.00 0.00 0.00 Total HHS 4,988.19 5,360.10 5,396.52 15,744.81 U.S. Agency for International Development (USAID)       FQHC 0.00 0.00 0.00 0.00       PPFA 0.00 0.00 0.00 0.00       IPPF 2.13 5.48 7.80 15.41       MSI 36.64 34.20 15.62 86.46 Total USAID 38.77 39.68 23.42 101.87 Total (HHS and USAID) 5,026.96 5,399.78 5,419.94 15,846.68 Source: GAO analysis of HHS, PPFA and USAID, data. | GAO-21-188R We provided a draft of this report to the Secretary of Health and Human Services and the USAID Administrator for comment. HHS did not have any comments. USAID provided technical comments, which we incorporated as appropriate. GAO is not making any recommendations. In order to achieve their programmatic goals, federal agencies provide funding to various organizations that, in turn, use those funds to implement programs and activities aligned with those goals. For example, federal agencies may award funding through grants or cooperative agreements for programs. The organizations that are awarded the funding receive and spend the funds over a period of time. GAO was asked to report on federal funding for certain organizations that provide health-related services. This report describes the extent of federal funding through grants and cooperative agreements for federally qualified health centers, Planned Parenthood Federation of America, International Planned Parenthood Federation, and Marie Stopes International from 2016 through 2018. GAO obtained and reviewed information on federal funding from the Department of Health and Human Services and the U.S. Agency for International Development—the primary sources of federal funds to the organizations in our review. GAO also obtained available information from each of the organizations. For more information, contact James Cosgrove at 202-512-7114 or cosgrovej@gao.gov.  

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GAO-21-99, Close Air Support: Actions Needed to Enhance Friendly Force Tracking Capabilities and Fully Evaluate Training, January 21, 2021

The Department of Defense (DOD) has made progress implementing initiatives to enhance capabilities that are used to identify friendly force locations during close air support (CAS) missions, but GAO identified additional actions that are needed to strengthen these efforts. Specifically, DOD has made limited progress in implementing 10 changes the department approved to address gaps in the interoperability of digital communications systems used to conduct CAS, hindering efforts to improve the speed and accuracy of information exchanges. DOD's efforts to assess the interoperability of digital systems used to perform CAS have been limited in scope. GAO found that DOD had formally assessed two out of 10 approved changes during joint service and multinational events, and these assessments were not conducted in a training environment that replicated capabilities of near-peer adversaries. DOD implemented a new capability in the U.S. Central Command area of responsibility to help identify the positions of friendly forces during CAS missions. However, GAO found that DOD did not provide adequate training for personnel who operate it or conduct an evaluation to resolve implementation challenges that have hampered its performance. DOD conducts evaluations of training programs for forces that participate in CAS missions, but GAO identified two areas where DOD can improve its efforts. First, the Army and Marine Corps have not systematically evaluated the effectiveness of periodic training for ground observers providing targeting information due to a lack of centralized systems for tracking training data and the absence of designated entities to monitor service-wide training. Second, the use of contract aircraft for training increased substantially between 2017 and 2019, but DOD has not fully evaluated the use of non-military contract aircraft to train air controllers for CAS (see fig.). GAO found that differences between U.S. military aircraft and contract aircraft (e.g., airspeed) can result in a misalignment of aircraft capabilities for certain types of training events. Without evaluating CAS training fully, DOD cannot have assurance that its forces are prepared to conduct CAS missions safely and effectively. Number of Hours Non-Military Aircraft Were Used to Train for Close Air Support for Fiscal Years 2017 through 2019 The use of ordnance delivered by aircraft to support U.S. military forces that are in close proximity to enemy forces on the ground requires detailed planning, seamless communications, and effective training. Mistakes in communications or procedures used to identify and maintain an awareness of the positions of friendly forces on the battlefield during CAS can result in the loss of U.S. military personnel. Senate Report 116-48 and House Report 116-120, accompanying bills for the National Defense Authorization Act for Fiscal Year 2020, included provisions for GAO to evaluate issues related to friendly-force identification capabilities in CAS missions. Among other things, this report evaluates the extent to which DOD has (1) implemented initiatives to enhance friendly-force identification capabilities during CAS, and (2) evaluated training for forces that participate in CAS. GAO analyzed documentation and interviewed officials regarding DOD efforts to develop and implement friendly force tracking capabilities for CAS; reviewed CAS training programs; and analyzed training data, including the number of hours that DOD used non-military contract aircraft for CAS training from 2017 through 2019. GAO is making 11 recommendations to DOD, including that DOD implement and assess initiatives to improve the interoperability of digital systems used in CAS and take additional steps to evaluate the training for certain forces that participate in CAS missions. DOD concurred with the recommendations. For more information, contact Cary Russell at (202) 512-5431 or RussellC@gao.gov.

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GAO-21-12, Chemical Security: Overlapping Programs Could Better Collaborate to Share Information and Identify Potential Security Gaps, January 21, 2021

Eight federal programs addressing chemical safety or security from four departments or agencies that GAO reviewed contain requirements or guidance that generally align with at least half of the Department of Homeland Security's (DHS) 18 Chemical Facility Anti-Terrorism Standards (CFATS) program standards. At least 550 of 3,300 (16 percent) facilities subject to the CFATS program are also subject to other federal programs. Analyses of CFATS and these eight programs indicate that some overlap, duplication, and fragmentation exists, depending on the program or programs to which a facility is subject. For example, six federal programs' requirements or guidance indicate some duplication with CFATS. CFATS program officials acknowledge similarities among these programs' requirements or guidance, some of which are duplicative, and said that the CFATS program allows facilities to meet CFATS program standards by providing information they prepared for other programs. more than 1,600 public water systems or wastewater treatment facilities are excluded under the CFATS statute, leading to fragmentation. While such facilities are subject to other programs, those programs collectively do not contain requirements or guidance that align with four CFATS standards. According to DHS, public water systems and wastewater treatment facilities are frequently subject to safety regulations that may have some security value, but in most cases, these facilities are not required to implement security measures commensurate to their level of security risk, which may lead to potential security gaps. The departments and agencies responsible for all nine of these chemical safety and security programs—four of which are managed by DHS, three by the Environmental Protection Agency (EPA), and one each managed by the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) and the Department of Transportation (DOT)—have previously worked together to enhance information collection and sharing in response to Executive Order 13650, issued in 2013. This Executive Order directed these programs to take actions related to improving federal agency coordination and information sharing. However, these programs have not identified which facilities are subject to multiple programs, such that facilities may be unnecessarily developing duplicative information to comply with multiple programs. Although CFATS allows facilities to use information they prepared for other programs, CFATS program guidance does not specify what information facilities can reuse. Finally, DHS and EPA leaders acknowledged that there are differences between CFATS requirements and the security requirements for public water systems and wastewater treatment facilities, but they have not assessed the extent to which potential security gaps may exist. By leveraging collaboration established through the existing Executive Order working group, the CFATS program and chemical safety and security partners would be better positioned to minimize unnecessary duplication between CFATS and other programs and better ensure the security of facilities currently subject to fragmented requirements. Facilities with hazardous chemicals could be targeted by terrorists to inflict mass casualties or damage. Federal regulations applicable to chemical safety and security have evolved over time as authorizing statutes and regulations established programs for different purposes, such as safety versus security, and with different enforcement authorities. GAO has reported that such programs may be able to achieve greater efficiency where overlap exists by reducing duplication and better managing fragmentation. GAO was asked to review issues related to the effects that overlap, duplication, and fragmentation among the multiple federal programs may have on the security of the chemical sector. This report addresses the extent to which (1) such issues may exist between CFATS and other federal programs, and (2) the CFATS program collaborates with other federal programs. GAO analyzed the most recent available data on facilities subject to nine programs from DHS, EPA, ATF, and DOT; reviewed and analyzed statutes, regulations, and program guidance; and interviewed agency officials. GAO is making seven recommendations, including that DHS, EPA, ATF, and DOT identify facilities subject to multiple programs; DHS clarify guidance; and DHS and EPA assess security gaps. Agencies generally agreed with six; EPA did not agree with the recommendation on gaps. GAO continues to believe it is valid, as discussed in the report. For more information, contact Nathan Anderson at (206) 287-4804 or AndersonN@gao.gov.

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GAO-21-5, Higher Education: Department of Education Should Further Assess College Access Grant Programs, December 17, 2020

Why This Matters The Department of Education gives grants to schools and organizations that provide disadvantaged students with services to help them attend college. These eight grant programs are collectively known as “TRIO”, named for the original three programs. Congress provides over $1 billion each year to these programs, but Education could do more to understand how well these grants work to help students. Key Takeaways Education could improve the information it has about TRIO programs in two areas: (1) grantee performance data, and (2) program assessments. Schools and organizations report data to Education to show how the TRIO grants they receive have been working. For example, organizations that receive grants to encourage students to complete college report on the numbers and percentages of students who received services and earned degrees.  Education evaluates grantees’ performance using the self-reported data, but has done little to verify the data. Accurate performance data are important because returning grantees can earn points for past performance in the next grant competition—increasing the likelihood that they will receive new grants. Almost 80 percent of recent TRIO grants went to returning grantees.  Therefore, grantees may have an incentive to report a more positive picture than warranted. Officials from an organization representing TRIO grantees told us there is a risk that some grantees may report inaccurate information.  As for assessing the individual TRIO programs, studies of some programs are outdated. In addition, Education has never assessed the effectiveness of three of the seven TRIO programs that serve students, and did not have any new assessments planned as of August 2020. How GAO Did This Study We analyzed data from Education about TRIO grantees and applicants. We also reviewed relevant federal laws and regulations and agency documents, and interviewed Education officials and other TRIO stakeholders. Education should take additional steps to ensure the reliability of grantees' performance data and develop a plan for assessing the effectiveness of the TRIO programs that serve students. Education generally agreed with our recommendations. For more information, contact Melissa Emrey-Arras at (617) 788-0534 or emreyarrasm@gao.gov.

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GAO-21-145, GPS Modernization: DOD Continuing to Develop New Jam-Resistant Capability, But Widespread Use Remains Years Away, January 19, 2021

The Department of Defense (DOD) is closer to being able to use military code (M-code)—a stronger, more secure signal for the Global Positioning System (GPS) designed to meet military needs. However, due to the complexity of the technology, M-code remains years away from being widely fielded across DOD. M-code-capable receiver equipment includes different components, and the development and manufacture of each is key to the modernization effort. These include: special M-code application-specific integrated circuit chips, special M-code receiver cards, being developed under the Air Force Military GPS User Equipment (MGUE) programs, and the next generation of GPS receivers capable of using M-code signals from GPS satellites. DOD will need to integrate all of these components into different types of weapon systems (see figure for notional depiction of integration for one system). Integration across DOD will be a considerable effort involving hundreds of different weapon systems, including some with complex and unique integration needs or configurations. Global Positioning System User Equipment Integration The Air Force is almost finished—approximately one year behind schedule—developing and testing one M-code card for testing on the Marine Corps Joint Light Tactical Vehicle and the Army Stryker vehicle. However, one card intended for use in aircraft and ships is significantly delayed and missed key program deadlines. The Air Force is revising its schedule for testing this card. The M-code card development delays have had ripple effects on GPS receiver modernization efforts and the weapon systems that intend to use them. For example, an Air Force receiver modernization effort that depends on the new technology will likely breach its schedule and incur additional costs because of the delay. In turn, DOD planned to incorporate that receiver into its F/A-18 fighter aircraft, AV-8B strike aircraft, and the MH-53E helicopter, but it no longer plans to do so because of the delay. DOD has not yet determined the full extent of the development effort to widely integrate and field M-code receivers across the department. The amount of additional development and integration work is expected to vary for each weapon system and could range from a few weeks to several years. DOD is taking steps to enable fielding modernized receivers that use M-code cards by working to identify integration and production challenges. DOD has been developing the capability to use its more jam-resistant military-specific GPS signal for 2 decades. The Air Force launched the first GPS satellite capable of broadcasting the M-code signal in 2005, but is only now completing development of the software and other equipment needed to use it. The GPS modernization effort spans DOD and the military services, but an Air Force program office is developing M-code cards for eventual production and integration into weapon systems. The National Defense Authorization Act for Fiscal Year 2016 included a provision that the Air Force provide quarterly reports to GAO on next-generation GPS acquisition programs, and that GAO brief congressional defense committees. Since 2016, GAO has provided briefings and reported on various aspects of GPS. This report discusses DOD's progress and challenges (1) developing M-code receiver cards, and (2) developing receivers and taking other steps to make M-code-capable receivers available for fielding. GAO reviewed schedules and cost estimates for the Air Force's MGUE programs; military service and DOD M-code implementation data; and test and integration plans for aircraft, ships, and ground vehicles. GAO also reviewed strategies for continued access to microelectronics and interviewed officials from the MGUE programs, military services, and DOD, and representatives from microelectronics developers. For more information, contact Jon Ludwigson at (202) 512-4841 or ludwigsonj@gao.gov.

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GAO-21-151, Federal Rulemaking: Selected EPA and HHS Regulatory Analyses Met Several Best Practices, but CMS Should Take Steps to Strengthen Its Analyses, December 17, 2020

GAO reviewed 11 Executive Order (EO) 13771 rules—five significant Environmental Protection Agency (EPA) rules and six economically significant Department of Health and Human Services (HHS) rules. Seven of the 11 rules modified (i.e. repealed, amended, or delayed) existing rules (see table). GAO found that analyses for most of the seven rules monetized the same types of benefits and costs as analyses for the rules they modified, an indicator of consistency in the regulatory analyses. For example, one EPA rule modified an earlier rule that had established requirements for chemical risk management programs. EPA monetized anticipated changes to industry compliance costs for both rules. Where agencies monetized similar types of benefits and costs for both reviewed rules and modified rules, the value of some estimates differed, in part, because agencies had updated analytical assumptions, such as the number of entities subject to requirements or relevant wage data. Topics and Characteristics of 11 Environmental Protection Agency (EPA) and Department of Health and Human Services (HHS) Rules Selected for Review Agency Topics Modified existing rule(s) Monetized costs exceeded benefits EPA Risk management programs ● ○   Railroad ties as non-waste fuels ● ○   Chemical data reporting ● ●   Mercury reporting ○ ●   Effluent from dental offices ○ ● HHS, FDA Food labeling ● ○   Agricultural water requirements ● ● HHS, CMS End-stage renal disease treatment ● ●   Home health quality reporting ● ●   Patient discharge planning ○ ●   Diabetes prevention and appropriate use of imaging services ○ ● Legend: ● = Yes; ○ = No Source: GAO analysis of EPA, Food and Drug Administration (FDA), and Centers for Medicare & Medicaid Services (CMS) data. | GAO-21-151 Regulatory analyses for eight of the 11 rules GAO reviewed projected that monetized costs would exceed monetized benefits, though each identified other factors that may have led decision makers to determine that the total benefits justified the total costs, such as important, non-quantified effects. These eight analyses met about half of the selected best practices for economic analysis. However, some analyses developed by HHS's Centers for Medicare & Medicaid Services (CMS) did not fully meet best practices associated with analyzing regulatory alternatives, assessing important effects, and providing transparency. It is particularly important that agencies develop quality analyses for economically significant rules, such as those finalized by CMS. By meeting these best practices, CMS could help the public and other parts of government provide effective feedback and mitigate potential conflict with entities affected by rules. It could also help CMS assess whether a rule's benefits justify the costs. EO 13771 generally requires executive agencies to identify two rules for repeal for each new rule issued. Since EO 13771 went into effect in 2017, executive agencies have taken regulatory actions expected to generate over $50 billion in savings to society. Quality regulatory analysis provides agency decision makers and the public with a thorough assessment of the benefits and costs of different regulatory options. GAO was asked to review regulatory analyses for rules finalized under EO 13771. For selected agencies, this report examines (1) how the calculated economic effects of selected rules differed, if at all, from those of rules they modified; and (2) the extent to which agencies met best practices in analyzing the economic effects of selected rules for which monetized costs exceed monetized benefits. GAO reviewed analyses for 11 rules—and the rules they modified— finalized by EPA and HHS, the two agencies that finalized the most economically significant EO 13771 rules through fiscal year 2019. GAO compared analyses to selected best practices in GAO's Assessment Methodology for Economic Analysis . GAO recommends that CMS take steps to ensure its future regulatory analyses are consistent with best practices for analyzing alternatives, assessing important effects, and providing transparency. EPA said it appreciated GAO's findings. HHS generally agreed with the report, and CMS agreed with the recommendation directed to it. For more information, contact Yvonne D. Jones at (202) 512-6806 or jonesy@gao.gov.

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GAO-21-90, Elder Justice: HHS Could Do More to Encourage State Reporting on the Costs of Financial Exploitation, December 18, 2020

Most state Adult Protective Services (APS) agencies have been providing data on reports of abuse to the Department of Health and Human Services (HHS), including data on financial exploitation, although some faced challenges collecting and submitting these data. Since states began providing data to HHS's National Adult Maltreatment Reporting System (NAMRS) in 2017, they have been voluntarily submitting more detailed data on financial exploitation and perpetrators each year (see figure). However, some APS officials GAO interviewed in selected states said collecting data is difficult, in part, because victims are reluctant to implicate others, especially family members or other caregivers. APS officials also said submitting data to NAMRS was challenging initially because their data systems often did not align with NAMRS, and caseworkers may not have entered data in the system correctly. HHS has provided technical assistance and grant funding to help states address some of these challenges and help provide a better picture of the prevalence of the various types of financial exploitation and its perpetrators nationwide. Number of States That Provide Data on Financial Exploitation and Perpetrators to NAMRS Studies estimate some of the costs of financial exploitation to be in the billions, but comprehensive data on total costs do not exist and NAMRS does not currently collect cost data from APS agencies. The Consumer Financial Protection Bureau found actual losses and attempts at elder financial exploitation reported by financial institutions nationwide were $1.7 billion in 2017. Also, studies published from 2016 to 2020 from three states—New York, Pennsylvania, and Virginia—estimated the costs of financial exploitation could be more than $1 billion in each state alone. HHS does not currently ask states to submit cost data from APS casefiles to NAMRS, though officials said they have begun to reevaluate NAMRS with state APS agencies and other interested parties, including researchers, and may consider asking states to submit cost data moving forward. Adding cost data to NAMRS could make a valuable contribution to the national picture of the cost of financial exploitation. Recognizing the importance of these data, some APS officials GAO interviewed said their states have developed new data fields or other tools to help caseworkers collect and track cost data more systematically. HHS officials said they plan to share this information with other states to make them aware of practices that could help them collect cost data, but they have not established a timeframe for doing so. Elder financial exploitation—the fraudulent or illegal use of an older adult's funds or property—has far-reaching effects on victims and society. Understanding the scope of the problem has thus far been hindered by a lack of nationwide data. In 2013, HHS worked with states to create NAMRS, a voluntary system for collecting APS data on elder abuse, including financial exploitation. GAO was asked to study the extent to which NAMRS provides information on elder financial exploitation. This report examines (1) the status of HHS's efforts to compile nationwide data through NAMRS on the extent of financial exploitation and the challenges involved, and (2) what is known about the costs of financial exploitation to victims and others. GAO analyzed NAMRS data from fiscal year 2016 through 2019 (the most recent available); reviewed relevant federal laws; and interviewed officials from HHS, other federal agencies, elder abuse prevention organizations, and researchers. GAO also reviewed APS documents and spoke with officials in eight states, selected based on their efforts to study, collect, and report cost data; and reviewed studies on financial exploitation. GAO recommends that HHS (1) work with state APS agencies to collect and submit cost data to NAMRS, and (2) develop a timeframe to share states' tools to help collect cost data. HHS did not agree with the first recommendation, but GAO maintains that it is warranted, as discussed in the report. HHS agreed with the second recommendation. For more information, contact Kathryn A. Larin at (202) 512-7215 or larink@gao.gov.

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GAO-21-175, DHS Annual Assessment: Most Acquisition Programs Are Meeting Goals but Data Provided to Congress Lacks Context Needed For Effective Oversight, January 19, 2021

As of September 2020, 19 of the 24 Department of Homeland Security (DHS) programs GAO assessed that had DHS approved acquisition program baselines were meeting their currently established goals. However, of the 24 programs, ten had been in breach of their cost or schedule goals, or both, at some point during fiscal year 2020. A few programs experienced breaches related to external factors, such as the COVID-19 pandemic, while others breached their baseline goals because of acquisition management issues. Five of these programs rebaselined to increase costs or delay schedules, but the remaining five were still in breach status as of September 2020 (see table). Further, GAO found that some of the 19 programs that were meeting their currently established goals—including the U.S. Coast Guard's Offshore Patrol Cutter program—are at risk of future cost growth or schedule slips. DHS Major Acquisition Programs In Breach of Approved Cost or Schedule Goals (or Both) As of September 2020. Program (estimated life-cycle cost) Breach Type National Cybersecurity Protection System ($5,908 million) Schedule Homeland Advanced Recognition Technology ($3,923 million) Cost and Schedule Grants Management Modernization ($289 million) Cost and Schedule National Bio Agro-Defense Facility ($1,298 million) Schedule Medium Range Surveillance Aircraft ($15,187 million) Schedule Source: GAO analysis of Department of Homeland Security (DHS) data. | GAO-21-175 Note: The life-cycle cost information is the current acquisition program baseline cost goal as of September 2020. Programs may revise cost goals, if necessary, when the new baseline is approved. GAO found that supplemental guidance for the development of acquisition documents generally aligned with requirements in DHS's acquisition management policy. However, guidance for developing acquisition documentation in DHS's Systems Engineering Life Cycle Instruction and accompanying Guidebook does not reflect current requirements in DHS's acquisition management policy. DHS officials stated that the information related to development of acquisition documents—including the systems engineering life cycle tailoring plan—should be consistent across all of DHS's policies, instructions, and guidebooks. Inconsistent agency-wide guidance can lead to a lack of clarity on when programs should submit their program documentation. The Joint Explanatory Statement accompanying a bill to the DHS Appropriations Act, 2019, directed DHS to provide quarterly briefings on summary ratings for all major acquisition programs. While DHS is meeting this direction with summary ratings, the ratings do not include contextual information, such as programs' cost, schedule, or performance risks. This type of information would help Congress understand how the ratings relate to potential program outcomes. Determining what additional risk information is needed for DHS's major acquisition programs along with the reporting timeframes and the appropriate mechanism to provide the information, would help ensure that decision makers have needed context. DHS plans to spend more than $7 billion on its portfolio of major acquisition programs—with life-cycle costs over $300 million— in fiscal year 2021 to help execute its many critical missions. The Explanatory Statement accompanying the DHS Appropriations Act, 2015, included a provision for GAO to review DHS's major acquisitions on an ongoing basis. This report, GAO's sixth review, assesses the extent to which (1) DHS's major acquisition programs are meeting baseline goals, (2) DHS's guidance for developing acquisition documentation is consistent with DHS acquisition policy, and (3) DHS is reporting relevant information to Congress on its portfolio of major acquisition programs. GAO assessed 24 acquisition programs, including DHS's largest programs that were in the process of obtaining new capabilities as of April 2018, and programs GAO or DHS identified as at risk of poor outcomes. GAO assessed cost and schedule progress against baselines; assessed DHS's congressional reporting requirements; and interviewed DHS officials and congressional appropriations committee staff. GAO is making one recommendation for DHS to align acquisition guidance with policy, and one matter for Congress to consider determining what additional information it needs to perform oversight. DHS concurred with our recommendation. For more information, contact Marie A. Mak at (202) 512-4841 or makm@gao.gov.

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GAO-21-156, Chemical Assessments: Annual EPA Survey Inconsistent with Leading Practices in Program Management, December 18, 2020

The Environmental Protection Agency's (EPA) Integrated Risk Information System (IRIS) Program has not produced timely chemical assessments, and most of its 15 ongoing assessments have experienced delays. As we reported in March 2019, the IRIS Program has taken some actions to make the assessment process more transparent, such as increasing communication with EPA offices and releasing supporting documentation for review earlier in the draft development process, but the need for greater transparency in some steps of the assessment process remains. Specifically, the IRIS Program does not publicly announce when assessment drafts move to certain steps in their development process or announce reasons for delays in producing specific assessments. Without such information, stakeholders who may be able to help fill data and analytical gaps are unable to contribute. This could leave EPA without potential support that could help overcome delays. Delays of Milestones by Quarter for a Selection of the Integrated Risk information System's Assessments in Development 2019 - 2024 In mid-2018, EPA's Office of Research and Development (ORD) instituted changes to the way it solicits nominations for chemical assessments prepared by the IRIS Program but did so without providing sufficient guidance or criteria, raising questions about its ability to meet EPA user needs. For example, ORD issued a new survey to EPA program and regional offices but did not provide them with guidance for selecting chemicals for nomination, and ORD did not make explicit the criteria it was using for selecting nominations to include in the IRIS Program's list of assessments in development. Furthermore, despite a significant decline in survey participation between 2018 and 2019, EPA did not indicate whether the agency has assessed the quality of information generated by the survey. Leading program management practices state that agency management should internally communicate the necessary, quality information to achieve the entity's objectives and should monitor and evaluate program activities. Without evaluating the quality of the information produced by the survey, ORD cannot know if the survey is achieving its intended purpose and whether ORD has the information necessary to meet user needs. EPA's IRIS Program prepares chemical toxicity assessments that contain EPA's scientific position on the potential human health effects of exposure to chemicals; at present, the IRIS database contains more than 570 chemical assessments. In March 2019, GAO reported on the IRIS Program's changes to increase transparency about its processes and methodologies, including the use of systematic review. However, GAO also found that EPA decreased the number of ongoing assessments in December 2018 from 22 to 13 and continued to face challenges in producing timely assessments. This report evaluates (1) EPA's progress in completing IRIS chemical assessments since 2018; and (2) EPA's recent actions to manage the IRIS Program, and the extent to which these actions help the Program meet EPA user needs. GAO reviewed and analyzed EPA documents and interviewed officials from EPA; GAO also selected three standards for program management, found commonalities among them, and compared ORD's management of the IRIS Program against these leading practices. GAO is making five recommendations, including that EPA provide more information publicly about where chemical assessments are in the development process; and issue guidance for selecting chemicals for nomination and criteria for selecting nominations for assessment. EPA partially agreed with two of our recommendations and disagreed with the other three. For more information, contact J. Alfredo Gómez at (202) 512-3841 or gomezj@gao.gov.

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