GAO

Veterans Health Care: Addressing High Risk Concerns for Oversight and Accountability Are Key to Ensuring Quality of Care and Patient Safety

What GAO Found GAO's work has identified a range of concerns with the Department of Veterans Affairs' (VA) oversight and accountability of its health care system, including those related to quality of care and patient safety. Since GAO added VA health care to its High-Risk List in 2015, GAO has made 131 recommendations related to VA's oversight and accountability, almost half of all GAO's recommendations for VA health care. Recent examples of quality of care and patient safety recommendations include the following: VA has faced challenges in ensuring that its providers deliver safe and effective care to veterans. In February 2021, GAO identified 227providers that had been removed from VA employment but were potentially providing care in a community care network. GAO recommended that VA take actions to assess and address the situation.VA implemented this recommendation by reviewing and excluding 155providers from participating in VA's community care networks. In recent years, there have been reports of veterans dying by suicide on VA campuses—in locations such as inpatient settings, parking lots, and on the grounds of VA cemeteries. In September 2020, GAO found that VA lacks accurate information on the number of suicides and comprehensive analyses of the underlying causes. While VA agreed with two of GAO's recommendations to address these issues, VA still needs to provide documentation of key actions taken by the committee it established to improve its understanding of on-campus suicides. In June 2019, GAO found that VA's oversight of its regional health care networks was limited. GAO recommended that VA develop a process for assessing the overall performance of its networks to be able to better determine if a network's performance is positive, if it is functioning poorly, or if it requires remediation. While VA concurred with GAO's recommendation, VA still needs to provide documentation of the process developed to assess the overall performance of these networks in managing medical centers. Since the last high-risk update in March 2021, VA has taken steps to address some of the oversight and accountability concerns identified by GAO. In May 2021, VA published a revised high-risk action plan for addressing VA health care concerns. However, VA is still in the beginning stages of developing its plan to address root causes such as a fragmented oversight and accountability infrastructure and will need clearly defined metrics to ensure it is effective. Fully addressing oversight and accountability concerns also requires sustained leadership attention as well as leadership stability. However, the Under Secretary for Health position responsible for managing VA health care has not had permanent leadership since January 2017. While VA takes steps to address its needed transformation, it should continue to implement recommendations GAO has made in the oversight and accountability area, given the number of these similar types of recommendations and the need to ensure quality of care and patient safety. Why GAO Did This Study VA operates one of the nation's largest health care systems. GAO's work, along with that of VA's Office of Inspector General and others, has cited longstanding issues with VA's oversight of its health care system. In 2015, GAO added VA health care to its High-Risk List, in which one broad area of concern was inadequate oversight and accountability. In its latest high-risk update in March 2021, GAO noted continued concern over VA's ability to ensure the safety and protection of patients and staff, as well as to oversee its programs. This statement describes the oversight and accountability issues GAO's work has identified related to quality care and patient safety, and the status of VA's efforts to address its high-risk designation. This statement is based on GAO's body of work in this area. GAO’s Fiscal Year 2021 Rating for the Inadequate Oversight and Accountability Area For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.

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Disaster Recovery: Efforts to Identify and Address Barriers to Receiving Federal Recovery Assistance

What GAO Found GAO's past work has shown areas where improvements can be made to federal disaster recovery programs to help disaster survivors and state, local, territorial, and tribal governments. While these programs are not typically targeted toward only to low income or vulnerable populations, GAO's prior work and recommendations identified areas that could help these populations. Specifically, GAO reported in October 2021 that the Federal Emergency Management Agency's (FEMA) flood mapping investments for fiscal years 2012 through 2020 were lower for communities with higher levels of social vulnerability and underserved populations than communities with lower levels of social vulnerability and underserved populations, other factors being equal. GAO recommended that FEMA better use flood risk data to prioritize flood mapping for vulnerable communities; in September 2020, GAO found that disaster survivors, including low-income individuals, faced numerous challenges obtaining aid and understanding the Individuals and Households Program, a FEMA program that provides housing assistance and other needs assistance to individuals affected by a major disaster or emergency. GAO recommended, among other things, that FEMA simplify and streamline the disaster assistance process for survivors; in 2019, GAO found that officials from entities that partnered with FEMA reported challenges following the 2017 hurricanes providing assistance to individuals who are older or who have disabilities. GAO recommended that FEMA revise its application process to better serve survivors with disabilities. FEMA is taking actions to address many of these recommendations. GAO conducted a literature review as part of its preliminary work and found limited research to describe recovery outcomes and specific characteristics related to participation in the six recovery programs in its review. However, some studies and stakeholder perspectives provided insight. For example, a study of counties in one state found greater levels of flood mitigation in communities with larger tax revenues and greater budgets for emergency management. In addition, officials representing states said small towns and rural areas may lack resources to contract for disaster recovery services. Similarly, representatives from voluntary organizations said that conditions of socioeconomic vulnerability—such as lower-income households or homelessness—may present barriers to participating in federal recovery programs. GAO's preliminary work found that the six federal recovery programs in GAO's review have taken some actions that could help officials identify and address potential access barriers and disparate outcomes. However, programs lack key information—data and analysis—that would allow them to determine if access barriers and disparate recovery outcomes exist. Moreover, the programs have not taken action to determine (1) the universe of data need to support this kind of analysis and (2) sources and methods to obtain those data when the programs do not already collect them, including overcoming key challenges. GAO will complete its evaluation of the areas above and issue a final report in the coming months. Why GAO Did This Study Each year, disasters affect hundreds of American communities and cause billions of dollars of damage. Disaster recovery is a complex process with many factors that affect individual and community outcomes, including in various socioeconomic and demographic groups. Recently, federal actions have focused on equitable administration of federal recovery assistance. This statement is based on preliminary observations from GAO's forthcoming report on federal actions to identify and address potential access barriers and disparate outcomes, which is currently at FEMA, HUD, and SBA for comment. It also discusses prior GAO work and recommendations issued from 2019 through 2021 related to various federal recovery programs and vulnerable populations. To develop the preliminary observations, GAO conducted a literature review and interviewed officials at the three federal agencies with historically large disaster recovery programs and reviewed relevant documents. GAO also interviewed recovery stakeholders representing state, local, tribal, and nonprofit interests.

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COVID-19: Additional Actions Needed to Improve Accountability and Program Effectiveness of Federal Response

What GAO Found As the nation continues to respond to, and recover from, the COVID-19 pandemic, increases in COVID-19 cases in July, August, and September 2021, primarily due to the Delta variant of the virus, have hampered these efforts. From the end of July 2021 to September 23, 2021, the number of new cases reported each day generally exceeded 100,000, according to Centers for Disease Control and Prevention (CDC) data. This was a daily case count not seen since February 2021 (see figure). Reported COVID-19 Cases per Day in the U.S., Mar. 1, 2020–Sept. 23, 2021 Meanwhile, COVID-19 vaccination efforts continue. As of September 23, 2021, about 64 percent of the U.S. population eligible for vaccination (those 12 years and older), or almost 183 million individuals, had been fully vaccinated, according to CDC. The government must remain vigilant and agile to address the evolving COVID-19 pandemic and its cascading impacts. Furthermore, as the administration implements the provisions in the COVID-19 relief laws, the size and scope of these efforts—from distributing funding to implementing new programs—demand strong accountability and oversight. In that vein, GAO has made 209 recommendations across its body of COVID-19 reports issued since June 2020. As of September 30, 2021, agencies had addressed 33 of these recommendations, resulting in improvements including increased oversight of relief payments to individuals and improved transparency of decision-making for emergency use authorizations for vaccines and therapeutics. Agencies partially addressed another 48 recommendations. GAO also raised four matters for congressional consideration, three of which remain open. In this report, GAO is making 16 new recommendations, including recommendations related to fiscal relief funds for health care providers, recovery funds for states and localities, worker safety and health, and assessing fraud risks to unemployment insurance programs. GAO’s recommendations, if swiftly and effectively implemented, can help improve the government’s ongoing response and recovery efforts as well as help it to prepare for future public health emergencies. GAO’s new findings and recommendations, where applicable, are discussed below. Relief for Health Care Providers A total of $178 billion has been appropriated to the Provider Relief Fund (PRF) to reimburse eligible providers for health care–related expenses or lost revenues attributable to COVID-19. As of August 31, 2021, the Department of Health and Human Services (HHS) had allocated and disbursed about $132.5 billion of this amount and had allocated but not yet disbursed about $21.5 billion; the remaining $24.1 billion was unallocated and undisbursed. On September 10, 2021, HHS announced that $17 billion of the previously unallocated $24.1 billion would be allocated for a general distribution to a broad range of providers who could document COVID-related revenue loss and expenses. HHS expected to begin disbursing the funds in December 2021. As of September 2021, HHS’s Health Resources and Services Administration (HRSA) had not established time frames for implementing and completing post payment reviews for all PRF payments. In addition, the agency had not finalized procedures for recovery of overpayments or recovered the bulk of the overpayments that it had already identified. Without post-payment oversight to help ensure that relief payments are made only to eligible providers in correct amounts and to identify unused payments or payments not properly used, HHS cannot fully address stated payment integrity risks for the PRF and seek to recover overpayments, unused payments, or payments not properly used. GAO recommends that HRSA take steps to finalize and implement post-payment oversight. Specifically, HRSA should establish time frames for completing post-payment reviews to promptly address identified risks and identify overpayments made from the PRF, such as payments made in incorrect amounts or payments to ineligible providers; and it should finalize procedures and implement post-payment recovery of any PRF overpayments, unused payments, or payments not properly used. HHS—which includes HRSA—partially agreed with these recommendations. Coronavirus State and Local Fiscal Recovery Funds In March 2021, the American Rescue Plan Act of 2021 (ARPA) appropriated $350 billion to the Department of the Treasury (Treasury) to provide payments from the Coronavirus State and Local Fiscal Recovery Funds (CSLFRF). The CSLFRF allocates funds to states, the District of Columbia, localities, tribal governments, and U.S. territories to cover a broad range of costs stemming from the COVID-19 pandemic’s fiscal effects. According to Treasury data, it had distributed approximately $240 billion from the CSLFRF to recipients as of August 31, 2021 (see figure). Coronavirus State and Local Fiscal Recovery Funds Allocations and Treasury Distributions as of Aug. 31, 2021, by Recipient Type Note: For more details, see the Coronavirus State and Local Fiscal Recovery Funds enclosure in appendix I.aNon-entitlement units of local government are local governments typically serving populations of less than 50,000.As of July 2021, some of the 48 states that responded to GAO’s survey reported that they had somewhat less than or much less than sufficient capacity to report on their use of CSLFRF allocation consistent with federal requirements (17 of 48 states), capacity to disburse the funds (13 of 48 states), and apply appropriate internal controls and respond to inquiries about requirements (10 of 48 states). In addition, most states (44 of 48) reported that they had taken or planned to take additional steps—such as hiring new staff or reassigning existing staff—to help them manage their CSLFRF allocations. As of August 2021, Treasury was developing—but had not finalized or documented—key internal processes and control activities to monitor recipients’ use of their CSLFRF allocations for allowable purposes and to respond to internal control and compliance findings. According to officials, these internal processes and control activities were in the development stage, partly because of the short time frame since ARPA’s enactment and because Treasury’s Office of Recovery Programs, established in April 2021, continues to work to recruit and onboard key team members. Until Treasury properly designs and documents policies and procedures to guide CSLFRF program officials and other responsible oversight parties in the Office of Recovery Programs, there is a risk that key control activities needed to help ensure program management fulfills its recipient monitoring and oversight responsibilities may not be established or applied effectively and consistently. This risk may be particularly acute with respect to monitoring state and local recipients that face capacity challenges in managing their CSLFRF allocations in accordance with federal requirements, as some survey respondents noted. GAO recommends that Treasury design and document timely and sufficient policies and procedures for monitoring CSLFRF recipients to provide assurance that recipients are managing their allocations in compliance with laws, regulations, agency guidance, and award terms and conditions. Treasury agreed with the recommendation. Unemployment Insurance Fraud Risk Management GAO continues to have concerns about potential fraud in the unemployment insurance (UI) program, including concerns about Department of Labor (DOL) efforts to assess and manage program fraud risks. During the pandemic, fraudulent and potentially fraudulent activity has increased substantially and new types of fraud have emerged, according to DOL officials. For example, in June 2021, DOL’s Office of Inspector General reported that it had identified nearly $8 billion in potentially fraudulent UI benefits paid from March 2020 through October 2020. Improper payments have also been a long-standing concern in the regular unemployment insurance program, suggesting that the program may be vulnerable to fraud. While DOL continues to identify and implement strategies to address potential fraud and has some ongoing program integrity activities, it has not comprehensively assessed fraud risks in alignment with leading practices identified in GAO’s Fraud Risk Framework, which by law must be incorporated in guidelines established by the Office of Management and Budget for agencies. DOL has not clearly assigned defined responsibilities to a dedicated entity for designing and overseeing fraud risk management activities. Without a dedicated entity with defined responsibilities to lead antifraud initiatives, including the process of assessing fraud risks to UI programs, DOL may not be strategically managing UI fraud risks. GAO recommends that DOL designate a dedicated entity and document its responsibilities for managing the process of assessing fraud risks to the unemployment insurance program, consistent with leading practices as provided in GAO’s Fraud Risk Framework. This entity should have, among other things, clearly defined and documented responsibilities and authority for managing fraud risk assessments and for facilitating communication among stakeholders regarding fraud-related issues. DOL neither agreed nor disagreed with this recommendation. DOL also has not comprehensively assessed UI fraud risks in alignment with leading practices identified in GAO’s Fraud Risk Framework. These leading practices call for federal managers to plan regular fraud risk assessments and determine their fraud risk profile, among other things. Such assessments would provide reasonable assurance that DOL has identified the most significant fraud risks for the regular UI program that will exist after the pandemic. For example, some fraud risks identified in the CARES Act UI programs may continue to exist in the regular UI program after the temporary UI programs expire. GAO recommends that DOL (1) identify inherent fraud risks facing the unemployment insurance program, (2) assess the likelihood and impact of inherent fraud risks facing the program, (3) determine fraud risk tolerance for the program, (4) examine the suitability of existing fraud controls in the program and prioritize residual fraud risks, and (5) document the fraud risk profile for the program. DOL neither agreed nor disagreed with these recommendations. FEMA’s Disaster Relief Fund and Assistance to State, Local, Tribal, and Territorial Governments The Federal Emergency Management Agency (FEMA) has used the Disaster Relief Fund to respond to the COVID-19 pandemic—the first time the fund has been used during a nationwide public health emergency. For example, from September 1, 2020 to August 31, 2021, FEMA obligated a total of approximately $26.8 billion through one type of disaster assistance, Public Assistance, for emergency protective measures, such as eligible medical care, the purchase and distribution of food, and distribution of personal protective equipment. GAO found that FEMA inconsistently interpreted and applied its policies for expenses eligible for COVID-19 Public Assistance within and across its 10 regions. For example, officials in one state said that FEMA at one point had deemed the provision of personal protective equipment at correctional facilities as ineligible for reimbursement in their region but that states in other regions had received reimbursement for the same expense. These inconsistencies were due to, among other things, changes in policies as FEMA used the Public Assistance program for the first time to respond to a nationwide emergency. FEMA officials stated that it was difficult to ensure consistency in policies as different states and regions are not experiencing the same things at the same time. FEMA is likely to receive applications for reimbursement for a larger number of projects than it estimated earlier in 2021, given the surge in COVID-19 cases this summer. To improve the consistency of the agency’s interpretation and application of the COVID-19 Public Assistance policy, GAO recommends that FEMA further clarify and communicate eligibility requirements nationwide. GAO also recommends that FEMA require the agency’s Public Assistance employees in the regions and at its Consolidated Resource Centers to attend training on changes to COVID-19 Public Assistance policy. The Department of Homeland Security—which includes FEMA— agreed with both of these recommendations. Loans for Aviation and Other Eligible Businesses Treasury has executed 35 loan agreements with certain aviation businesses and other businesses deemed critical to maintaining national security. These loans have totaled about $22 billion of the $46 billion authorized by the CARES Act for loans and loan guarantees to such businesses. As directed by the CARES Act, Treasury required certain loan recipients to provide financial assets, such as warrants that give the federal government an option to buy shares of stock at a predetermined price before a specified date, to protect taxpayer interests. According to Treasury officials, it is likely that, if the airline industry continues to recover and borrowers do not default, the warrants could have higher values than the predetermined price Treasury would have to pay to act on them. Treasury has not exercised any of the warrants for stock it received from nine businesses, nor has it developed policies and procedures for determining when to act on the warrants to benefit the taxpayer. GAO recommends that Treasury develop policies and procedures to determine when to act on warrants obtained as part of the loan program for aviation and other eligible businesses to benefit the taxpayers. Treasury agreed with this recommendation. Payroll Support Assistance to Aviation Businesses As of September 2021, Treasury had made payments totaling $59 billion of $63 billion provided for the Payroll Support Programs to support aviation business. These payments were to be used exclusively for the continuation of wages, salaries, and benefits. Similar to Treasury’s requirement for loans for aviation and other eligible businesses, Treasury required certain Payroll Support Program recipients to provide warrants, as allowed by the CARES Act. As of September 2021, 14 recipients had provided a total of 58 million warrants. As Treasury continues to hold these warrants for stock purchases, the warrants may increase in value as the airline industry recovers. Treasury has not exercised any of the warrants for stock it holds in the 14 businesses, nor has it documented policies and procedures to guide when to act on the warrants to fulfill the statutory purpose to provide appropriate compensation to the federal government. GAO recommends that Treasury develop policies and procedures to determine when to act on warrants obtained as part of the Payroll Support Program to provide appropriate compensation to the federal government. Treasury agreed with this recommendation. COVID-19 Testing Use is increasing for antigen tests, one of two types of COVID-19 diagnostic and screening tests for which HHS’s Food and Drug Administration has issued emergency use authorizations. These “rapid” antigen tests typically have a turnaround time of about 30 minutes or less for results, compared with 1 to 3 days for molecular tests, the second type of test HHS authorized. Antigen tests can be conducted at doctors’ offices or in homes or other settings; some antigen tests can be conducted without a prescription. Since June 2020, HHS has worked to encourage and improve the reporting of antigen testing data to local, state, and federal health officials. However, HHS officials told GAO reporting of antigen test results is incomplete, which prevents HHS from using antigen testing data for COVID-19 surveillance. HHS is taking additional steps aimed at improving reporting of antigen test data. For example, officials told GAO that HHS will continue to make enhancements to data reporting by building reporting methods into the testing process, such as for testing in schools and workplaces. HHS is also considering surveillance approaches to supplement or enhance current surveillance efforts. For example, HHS is exploring wastewater surveillance approaches, which provide data that can complement and confirm other forms of surveillance for COVID-19 and an efficient pooled community sample that is particularly useful in areas where timely COVID-19 clinical testing is underutilized or unavailable, according to HHS officials. Worker Safety and Health The Occupational Safety and Health Administration (OSHA) faced challenges in enforcing workplace safety and health standards during the COVID-19 pandemic, but the agency has not assessed lessons learned or promising practices. According to inspectors from area offices, they faced challenges related to resources and to communication and guidance, such as a lack of timely guidance from OSHA headquarters. GAO recommends that OSHA assess—as soon as feasible and, as appropriate, periodically thereafter—various challenges related to resources and to communication and guidance that the agency has faced in its response to the COVID-19 pandemic and take related actions as warranted. The Department of Labor—which includes OSHA—partially agreed with this recommendation. Advance Child Tax Credit Payments ARPA temporarily expanded eligibility for the child tax credit (CTC) to additional qualified individuals by eliminating a requirement that individuals must earn a minimum amount annually to be eligible. ARPA also temporarily increased the maximum amount of the CTC from $2,000 per qualifying child to $3,000 or $3,600, depending on the child’s age. As required by ARPA, the Internal Revenue Service (IRS) and Treasury are responsible for issuing half of the CTC through periodic advance payments, known as advance CTC payments. IRS reported disbursing more than 106 million advance payments totaling over $45.5 billion as of September 25, 2021 (see figure). Dollar Amount and Count of Advance Child Tax Credit Payments, by Month, as of Sept. 25, 2021 IRS is conducting and planning several outreach efforts to increase the public’s awareness of advance CTC payments. However, IRS and Treasury have not developed a comprehensive estimate of individuals who are potentially eligible for advance CTC payments and the agencies have not set a participation goal. Such an estimate would enable Treasury and IRS to measure the tax credit’s participation rate, providing greater clarity regarding populations at risk of not receiving the payments. GAO recommends that Treasury, in coordination with IRS, estimate the number of individuals, includingnonfilers, who are eligible for advance CTC payments, measure the 2021 participation rate based on that estimate, and use that estimate to develop targeted outreach and communications efforts for the 2022 filing season; the participation rate could include individuals who opt in and out of the advance payments. Treasury neither agreed nor disagreed with this recommendation. Child Nutrition Child nutrition programs administered by the Department of Agriculture’s Food and Nutrition Service (FNS) supply cash reimbursements to schools or other programs for meals and snacks provided to eligible children nationwide. In fiscal year 2019, before the pandemic, the four largest programs—the National School Lunch Program, School Breakfast Program, Summer Food Service Program, and Child and Adult Care Food Program—along with other child nutrition programs, received $23.1 billion in federal funds. During a typical year, two of these programs—the National School Lunch Program and the School Breakfast Program—subsidize meals for nearly 30 million children in approximately 95,000 elementary and secondary schools nationwide. As of July 2021, FNS officials were unable to provide a plan showing how FNS intends to comprehensively analyze lessons learned during the pandemic, such as from operational and financial challenges. Further, according to FNS officials, while the School Meals Operations study—launched in spring 2021—is surveying school districts and state agencies that administer the federal child nutrition programs, the study is not gathering local perspectives directly from child care centers and day care homes or other local program sponsors that are not school districts. As a result, FNS may miss opportunities to identify lessons learned and will lack comprehensive information to aid its future planning. GAO recommends that the Department of Agriculture document its plan to analyze lessons learned from operating child nutrition programs during the COVID-19 pandemic. This plan should include a description of how the department will gather perspectives of key stakeholders, such as Child and Adult Care Food Program institutions and nonschool Summer Food Service Program sponsors. The Department of Agriculture—which includes FNS—agreed with this recommendation. Why GAO Did This Study As of September 23, 2021, the U.S. had about 43 million reported cases of COVID-19 and about 699,000 reported deaths, according to CDC. The country also continues to experience economic repercussions from the pandemic. Six relief laws, including the CARES Act, had been enacted as of August 31, 2021, to address the public health and economic threats posed by COVID-19. As of that same date (the most recent for which government-wide data was available), the federal government had obligated a total of $3.9 trillion and expended $3.4 trillion of the $4.8 trillion in COVID-19 relief funds that had been appropriated by these six laws, as reported by federal agencies. The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines the federal government’s continued efforts to respond to, and recover from, the COVID-19 pandemic. GAO reviewed data, documents, and guidance from federal agencies about their activities. GAO also interviewed federal and state officials, stakeholders from organizations for localities, and other stakeholders.

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COVID-19: Federal Agencies' Initial Reentry and Workplace Safety Planning

What GAO Found Federal agencies adopted a maximum telework posture following the March 2020 national emergency declaration related to COVID-19. In April 2020, Office of Management and Budget (OMB) guidance established a framework for agencies to plan for the reentry of employees to the workplace and cognizant agencies issued guidance in 2020 on how to plan for the eventual return of the workforce to office locations. In response to the call for office reentry, the 24 Chief Financial Officer (CFO) Act agencies developed reentry plans. Agencies' 2020 reentry plans varied considerably. All the agencies developed phased approaches for reentry, though agencies did not progress through the established phases at the same rate and the characteristics of each phase differed by agency. None of the agencies' plans consistently covered all aspects of recommended federal guidance. For example, reentry planning documents for 10 or more agencies did not fully address employee training on reentry, office ventilation controls, and face covering requirements, as recommended by federal guidance. In January 2021, the new administration established the Safer Federal Workforce Task Force (Task Force) to provide guidance to agencies and required a 25 percent capacity limit for federal buildings, subject to exceptions with approval. It also issued guidance directing agencies to submit plans addressing a set of model workplace safety principles to the Task Force. Agencies' workplace safety plans, in contrast to initial reentry plans, were generally consistent with the updated federal guidance. Agencies' plans cited most safety principles described in the guidance, including the occupancy limit and additional safety measures to protect the workforce, such as face mask requirements and optimized ventilation and air filtration. Agencies also established COVID-19 coordination teams, as required by January 2021 guidance. These teams developed and monitored agency plans, led decision-making regarding safety procedures and exceptions, and coordinated with external groups, including the Task Force. Federal oversight and coordination were limited for 2020 reentry planning but increased under 2021 guidance related to workplace safety. Initial reentry guidance did not include clear oversight roles and responsibilities. As a result, there was no government-wide oversight or review of initial agency reentry plans. Guidance issued in January 2021 established model safety principles and specific roles for the Task Force, directing Task Force members to guide and oversee agency COVID-19 workplace safety efforts. This increased clarity and oversight and supported consistency in workplace safety planning. The Task Force also used approaches to coordinate workplace safety planning that GAO previously identified as beneficial to support and sustain effective interagency collaboration. For example, the Task Force is made up of relevant participants, including agencies with expertise in health, emergency response, and employee safety. The Task Force supported agencies' COVID-19 response efforts and contributed input to agency workplace safety plans. Updated guidance released in June 2021 indicates that the Task Force and its members plan to continue these oversight and coordination efforts for continued workplace safety and updated reentry planning. Why GAO Did This Study The federal government employs approximately 2.8 million civilian workers, a workforce that plays an important role in maintaining vital government services. The White House, OMB, and other cognizant agencies issued guidance to support federal agencies as they developed tailored plans for bringing the federal workforce back to offices and safely conducting on-site work. The CARES Act included a provision for GAO to monitor and oversee the federal government's response to the COVID-19 pandemic. This report (1) examines agencies' approaches to initial reentry planning, (2) assesses the extent to which agencies' workplace safety plans are consistent with federal guidance, and (3) examines the coordination and oversight of federal reentry and workplace safety planning across the government. GAO analyzed federal guidance from cognizant agencies to identify crosscutting themes for reentry planning, and reviewed OMB guidance on workplace safety principles. GAO assessed workplace safety plans, reentry plans, and relevant documentation from the 24 CFO Act agencies against the themes and principles identified in guidance and interviewed agency officials. GAO also reviewed guidance to identify oversight and coordination responsibilities and reviewed prior GAO work on pandemic preparedness and interagency collaboration. For more information, contact Michelle B. Rosenberg at (202) 512-6806 or rosenbergm@gao.gov.

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Federal Hiring: OPM Should Collect and Share COVID-19 Lessons Learned to Inform Hiring During Future Emergencies

What GAO Found The CARES Act provided temporary hiring authorities to six agencies with responsibilities for responding to the public health and economic crisis caused by COVID-19. A hiring authority is the law, executive order, or regulation that allows an agency to hire a person into the federal civil service. In addition, as of September 30, 2020, five agencies received direct hiring authority (DHA) from the Office of Personnel Management (OPM) in response to the pandemic. DHAs allow agencies to expedite hiring by eliminating competitive rating and ranking procedures and veterans' preference for specific positions. Also, in March 2020, OPM authorized the use of COVID-19 Schedule A hiring authority, which allows agencies to fill positions for up to 1 year as needed in response to, or as a result of, COVID-19. GAO found that the number of staff hired by 10 selected agencies using these three temporary COVID-19 hiring authorities varied. Figure 1: Availability of COVID-19 Hiring Authorities and Total Number of Hires Made at Selected Agencies, March through December 2020 aCOVID-19 Schedule A hiring authority allows agencies to fill positions for up to 1 year as needed in response to, or as a result of, COVID-19. bAgency received approval to amend an existing authority so hires were not all related to COVID-19. cCommerce's CARES Act hiring authority is limited to the Economic Development Administration. The selected agencies described a few lessons learned that could help other agencies improve the use of hiring authorities in future emergencies including: (1) collaborating with internal stakeholders to maximize information sharing across the agency; and (2) creating an inventory of hiring needs and available authorities to assist in addressing agency workforce needs. OPM intends to conduct reviews in fiscal year 2022 that may provide insight into agencies' use of hiring authorities in response to the pandemic. However, according to OPM officials, the agency has not yet developed plans to collect and share lessons learned on the use of COVID-19 related hiring authorities. Collecting and sharing lessons learned would help OPM understand how the various hiring authorities could be used during future emergencies and identify opportunities to improve the hiring process. Why GAO Did This Study The COVID-19 pandemic has had far-reaching effects on federal programs and operations. To address this public health crisis, Congress and the administration made several hiring authorities available to agencies to hire staff with the needed skills to effectively respond to the pandemic. The CARES Act includes a provision for GAO to report on ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines: (1) the new hiring authorities provided to federal agencies for COVID-19 response and the extent to which selected agencies have used them; (2) selected agencies' experiences using those hiring authorities, including lessons learned; and (3) OPM's efforts to assess agencies' use of the COVID-19 related hiring authorities. GAO reviewed documents and interviewed officials from OPM and the 10 agencies that were provided hiring authorities in the CARES Act or DHA for the public health emergency from OPM between March 1 and September 30, 2020. The documents reviewed included data on the agencies' hiring and OPM policies and guidance for its oversight of agencies' use of hiring authorities.

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Northern Triangle of Central America: The 2019 Suspension and Reprogramming of U.S. Funding Adversely Affected Assistance Projects

What GAO Found Starting in March 2019, the Trump administration suspended most new foreign assistance funding from the U.S. Agency for International Development (USAID) and the Department of State to El Salvador, Guatemala, and Honduras—the “Northern Triangle” of Central America—for up to 14 months and reprogrammed approximately $396 million (85 percent) of fiscal year 2018 funding to other countries. In June 2020, the administration ended the suspension of assistance funding. After the end of the suspension, USAID adjusted its assistance portfolio to implement projects that focused on deterring migration and designed new indicators to assess the relationship between its assistance projects and migration from the region. Officials from State and USAID said their overall assistance approach of promoting prosperity, good governance, and security remained the same after the suspension. Although some previously funded projects continued operating as planned, the 2019 suspension and reprogramming of assistance funding adversely affected 92 of USAID's 114 projects and 65 of State's 168 projects. Both USAID and State reported that commonly experienced adverse effects on project implementation were delays from planned timeframes and decreased frequency, quality, or types of services provided to beneficiaries (see figure). USAID and State/INL Northern Triangle Projects Reporting One or More Adverse Effects Due to the 2019 Suspension and Reprogramming of Assistance Funding USAID and State reported missing some of their performance targets due to the 2019 suspension and reprogramming of assistance funding. For example, USAID reported missing 19 percent (35 of 182) of its targets in fiscal year 2019, while State reported missing 30 percent (three of 10). Why GAO Did This Study The U.S. has funded assistance to the Northern Triangle of Central America for many years. This assistance aims to promote prosperity, good governance, and security in the region; to address the causes of migration; and to combat transnational crime. In March 2019, the administration suspended foreign assistance funding from the Northern Triangle countries until the governments in the region agreed to take actions to reduce the number of migrants coming to the U.S. border. GAO was asked to review the effects of the 2019 suspension and reprogramming of assistance funding to the Northern Triangle. This report (1) identifies the funding appropriated by Congress for the Northern Triangle that was suspended and reprogrammed to other countries, and how the approach to U.S. assistance to the region changed after March 2019; (2) examines the effects of suspending and reprogramming assistance funding on project implementation; and (3) examines the extent to which the suspension and reprogramming of assistance funding affected the ability of U.S. agencies to meet their foreign assistance performance targets for the region. GAO analyzed agency funding data and performance and monitoring reports, surveyed agency project managers, and interviewed agency officials as well as selected implementing partners in the U.S. and in the Northern Triangle countries. For more information, contact Chelsa Kenney at (202) 512-2964 or kenneyc@gao.gov.

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FEMA Flood Maps: Better Planning and Analysis Needed to Address Current and Future Flood Hazards

What GAO Found The Federal Emergency Management Agency's (FEMA) Risk Mapping, Assessment, and Planning (Risk MAP) program has increased its development of flood maps and other flood risk products, but faces challenges ensuring they comprehensively reflect current and future flood hazards. For example, its flood risk products do not reflect hazards such as heavy rainfall and the best available climate science. These products include maps—known as Flood Insurance Rate Maps—and nonregulatory flood risk products such as estimates of flood damage in an area. FEMA's Risk MAP program is addressing some of these challenges, but many may require years to address. However, Risk MAP has been operating under an out-of-date plan that does not reflect new goals, objectives, activities, performance measures, and associated timeframes. Updating its program plan to include these elements could help FEMA effectively manage and coordinate its efforts to incorporate current and future flood hazards in a timely way. Example of River Flooding FEMA does not periodically assess the usefulness of its nonregulatory flood risk products, which are intended to help communities increase their resilience to floods. According to FEMA, it has invested millions of dollars in developing Risk MAP nonregulatory products; however, the agency has not assessed the usefulness of these products in increasing community resilience since 2016. Establishing mechanisms for periodically assessing the usefulness of its nonregulatory products could help FEMA ensure it is investing in products that address community need and have a meaningful impact on enhancing flood resilience. FEMA prioritizes mapping projects with input from all levels of government and FEMA regional offices, but could better use available data to inform its mapping efforts. FEMA's decision-making process has emphasized directing resources to areas with greatest flood risks. Additionally, in 2020, FEMA established a strategic priority for considering socially-vulnerable populations as part of disaster resilience. According to GAO's statistical analyses of data from the Risk MAP program and FEMA's publicly available disaster risk assessment tools, FEMA's mapping investments for fiscal years 2012 to 2020 were greater where flood risks were higher, but were lower for areas of higher socially-vulnerable populations. By considering ways to leverage available data into its annual process for prioritizing its flood mapping investments, FEMA could enhance its ability to make well-informed decisions that meet agency and federal priorities and disaster resilience goals. Why GAO Did This Study FEMA is responsible for producing and updating Flood Insurance Rate Maps and nonregulatory products to show areas of greatest flood hazards and help guide floodplain management actions under the National Flood Insurance Program. While FEMA has mapped millions of miles of the nation's streams and coastlines, questions have been raised about whether its flood risk products provide a comprehensive picture of flood risk. The Additional Supplemental Appropriations for Disaster Relief Act of 2019 required GAO to review issues related to 2018 disasters. As part of this body of work, this report addresses (1) the extent FEMA has developed Flood Insurance Rate Maps and nonregulatory products that reflect current and future flood hazards, (2) the extent FEMA has assessed its efforts to enhance flood resilience, and (3) how FEMA prioritizes its mapping resources to create and update Flood Insurance Rate Maps. GAO reviewed agency documents and strategic plans; analyzed FEMA data; and interviewed FEMA, selected states and localities, and flood mapping experts.

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Alternatives to Radioactive Materials: A National Strategy to Support Alternative Technologies May Reduce Risks of a Dirty Bomb

What GAO Found GAO examined six common medical and industrial applications that use high-risk radioactive materials—identified through agency and expert reports—and found that three applications already have technically viable alternative technologies in many circumstances and for which there is market acceptance. For example, x-ray provides a technically viable alternative to replace cesium-137 blood irradiators, one of the common applications. Another of the applications has a technically viable alternative, though only in certain limited circumstances, and the two remaining applications do not yet have viable alternatives. For example, alternatives to replace americium-241 used in oil and gas well logging equipment, another common application, are still under development. Irradiator with Radioactive Material (left) and Alternative Technology (right) Users of applications that employ high-risk radioactive materials identified six factors they take into account when determining whether to adopt alternative technologies: technical viability of alternatives, device cost, costs to convert (such as facility renovations), disposal of radioactive materials, regulatory requirements, and liability and other potential costs associated with possessing high-risk radioactive materials. An accident at the University of Washington in May 2019 shows that liability and other potential costs would likely range from millions to billions of dollars if radioactive materials were accidentally released or used in a dirty bomb. These largely uninsured socioeconomic costs are an implicit fiscal exposure for the federal government, which could be expected to provide financial assistance. Several federal agencies and interagency entities support research and promote adoption of alternative technologies. For example, the National Nuclear Security Administration (NNSA) has removed 355 irradiators since 2004 and subsidized the replacement of some with x-ray technology. Congress also established the goal for the NNSA to eliminate the use of cesium-137 blood irradiators in the United States by 2027. At the same time, the Nuclear Regulatory Commission licenses radioactive materials for irradiators, consistent with its mission. Currently, no strategy exists to guide federal efforts to find alternatives and reduce risk. A strategy to support alternative technologies would ensure a cohesive federal approach and potentially reduce the implicit fiscal exposure associated with addressing socioeconomic damage from a dirty bomb. Why GAO Did This Study Radioactive material, which is dangerous if mishandled, is found in many medical and industrial applications. In the hands of terrorists, it could be used to construct a radiological dispersal device, or dirty bomb, that uses conventional explosives to disperse the material. Replacing technologies that use dangerous radioactive materials with safer alternatives may help protect people and reduce potential socioeconomic costs from remediation and evacuation of affected residents. Senate Report 116-102 included a provision for GAO to review alternative technologies to applications that use radioactive materials. This report examines (1) the potential for adopting alternative technologies in the United States for the six most commonly used medical and industrial applications; (2) factors affecting adoption of alternative technologies; and (3) federal activities relating to alternative technologies in the United States. GAO reviewed relevant documents to identify potential alternative technologies, conducted interviews with users of applications that employ radioactive material to identify factors affecting adoption of alternatives, and interviewed federal officials to discuss current federal activities relating to alternative technologies.

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GAO: A Century of Strategic Evolution to Meet Congressional Needs

GAO’s Evolution of Expertise and Services Over the last century, GAO has strategically adapted its services and products—all with an eye towards informing congressional decision-making and improving government operations through nonpartisan and fact-based work. GAO continues to evolve to meet the needs of Congress. From establishing a team to serve as the lead for its science and technology work, to growing its cybersecurity expertise, to developing quick-read products, GAO strives to anticipate or respond to changing congressional needs and emerging issues.  For example, one of GAO’s newest products, the “Science and Technology Spotlight,” explains emerging science and technology with its associated opportunities and challenges, and relevant policy considerations. GAO’s unique mission and structure, diverse and talented workforce, and external network makes it well-positioned to continue to support Congress into the future. The agency’s highly-skilled workforce and well-developed professional network that spans the globe enable GAO to anticipate emerging issues, challenges, and opportunities and craft strategic plans for serving the Congress and the country. GAO’s History and Impact The Budget and Accounting Act of 1921 established GAO as an independent agency to investigate how federal dollars are spent.  Early in GAO’s history, it conducted reviews of federal payments and focused on conducting financial reviews. By the 1970s, the size, scope, and complexity of the federal government had expanded, and congressional interest in whether government programs were meeting their objectives was growing. Consequently, GAO shifted its efforts to evaluating the efficiency and effectiveness of federal programs. In 2004, GAO changed its name from the General Accounting Office to the Government Accountability Office to better reflect this expanded role. Today, GAO’s work spans all federal programs and spending—from agriculture to space programs, banking regulation to public health, and cybersecurity to international aid. We also do financial audits of the US government and assessments of its fiscal outlook. The impact of this work is significant: since 2005, GAO’s findings and recommendations have resulted in $1 trillion in financial benefits and more than 21,000 operational benefits for the U.S. government. Over the past 5 years, GAO’s average return on investment is $165 for every $1 invested in GAO. In this testimony, GAO describes the wide range of services it provides to Congress, how these services have evolved to meet congressional needs, and how it is positioned to meet future needs and challenges. For more information, contact A. Nicole Clowers at (202) 512-4400 or clowersa@gao.gov.

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Weapon System Requirements: Joint Staff Lacks Reliable Data on the Effectiveness of Its Revised Joint Approval Process

What GAO Found The Department of Defense (DOD) sets the foundation of its weapon system acquisitions in documented requirements for new or enhanced capabilities. DOD's Joint Staff uses the Joint Capabilities Integration and Development System (JCIDS) process to manage the review and approval of capability requirements documents. The Joint Requirements Oversight Council (JROC) oversees the process. At congressional direction, the Joint Staff revised the process in November 2018, reducing the JROC's role to focus on documents addressing requirements of multiple departments, while increasing the role of military departments for their unique capability documents. GAO found that the Joint Staff lacks reliable data on the total number of programs that have completed the revised process. In addition, GAO found that Joint Staff data for the time to validate selected capability documents were also unreliable. Capability documents move through the JCIDS process in the Joint Staff's Knowledge Management and Decision Support (KM/DS) information system. GAO found discrepancies between KM/DS data and data from those that submit documents, known as sponsors. Joint Staff officials stated that deficiencies with the KM/DS system are at the root of its data issues. A detailed plan addressing these deficiencies will better position the Joint Staff to assess if the revised process is achieving stated JCIDS objectives. See figure below. The Joint Staff cannot assess the JCIDS process because it lacks reliable data and a baseline to measure timeliness. Joint Staff guidance provides a notional length of time of 103 days to review documents in the JCIDS process, but this is not evidence-based. Joint Staff officials stated they have not measured the actual length of time that documents take to go through the JCIDS process. GAO analysis and sponsor officials confirmed that none of the selected capability documents completed the process within 103 days. Sponsor officials noted that certain issues can add time to the review process and emphasized document quality over fast review and approval. However, without a data-driven baseline that reflects issues that affect the length of time to validate capability documents, Joint Staff officials are not able to assess JCIDS' efficiency and effectiveness. Discrepancies between Joint Staff and Sponsor Validation Timeline Data Note: One selected program is not included in the figure because the sponsor withdrew it from the process. Why GAO Did This Study In the National Defense Authorization Act for Fiscal Year 2017, Congress mandated revisions to the JCIDS process by modifying the scope of the JROC's responsibilities. The accompanying Senate Armed Services Committee report noted that these changes were, in part, to improve the timeliness of the JCIDS process. House Armed Services Committee report 116-120 included a provision for GAO to review the revisions to the JCIDS process. This report examines (1) key revisions to the process, (2) how many programs have been through the revised process and how long it took, and (3) the Joint Staff's ability to assess the timeliness of the process. GAO reviewed JCIDS policies and guidance, and interviewed relevant DOD officials. GAO also selected a nongeneralizable sample of 12 capability documents from across the Air Force, Army, and Navy. GAO analyzed data associated with these documents from the Joint Staff's KM/DS information system and compared it to data provided by military department officials to determine the Joint Staff's ability to assess the timeliness of the document review process.

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COVID-19 Pandemic: Observations on the Ongoing Recovery of the Aviation Industry

What GAO Found The COVID-19 pandemic severely affected the aviation and aerospace sectors that depend on commercial passenger travel. As demand for air travel plummeted and remained low throughout 2020, effects cascaded across sectors including U.S. passenger airlines, airports, aviation manufacturers, and repair station operators. For example, in response to reduced demand, airlines parked or retired a substantial portion of their aircraft fleet, which, in turn, reduced demand for aircraft maintenance services. Aircraft Temporarily Stored at Denver International Airport in 2020 In response to the pandemic's effects, aviation stakeholders reported that they acted quickly to mitigate financial losses and position themselves to maintain business viability until demand increased. Stakeholders' actions included: managing costs, such as by implementing early retirement programs; raising funds in the private market to increase liquidity; and taking steps to mitigate COVID-19's spread among employees and customers. Stakeholders also noted the importance of the over $100 billion in payroll support payments, loans, and other financial assistance provided through COVID-19 relief legislation. The Federal Aviation Administration (FAA) reported taking quick action to help the aviation industry adjust operations in response to the pandemic. These actions included providing temporary relief from some regulatory requirements—such as airline crewmember medical certifications—and issuing guidance to airlines and airports on mitigating COVID-19 risks. FAA has phased out many of these relief measures. Although airlines experienced a rebound in demand for U.S. leisure travel in 2021, operational challenges and concerns about the COVID-19 Delta variant have slowed recovery. Forecasts suggest that industry recovery will be uneven as business and international air travel—the most profitable segments—are likely to lag. Stakeholders identified areas of concern for policymakers to consider, such as strengthening aviation workforce pipelines, as they determine how or whether to continue to assist the industry in evolving market conditions. Further, developing a national aviation-preparedness plan for communicable disease, as GAO recommended, would provide greater coordination among federal and industry stakeholders and help better prepare the U.S. for future pandemics. Why GAO Did This Study International flight restrictions, local stay-at-home orders, and a general fear of contracting and spreading COVID-19 through air travel had a sudden and profound effect on the U.S. aviation industry. According to Department of Transportation (DOT) statistics, passenger traffic in April 2020 was 96 percent lower system-wide than April 2019, and remained 60 percent below 2019 traffic levels throughout 2020. This report examines (1) immediate effects of the COVID-19 pandemic on businesses across the aviation industry; (2) actions those businesses took in response; (3) actions the FAA took to help the industry respond to the pandemic; and (4) the outlook for industry recovery, among other issues. GAO reviewed DOT airline operational and financial data from calendar years 2019 through 2020, financial statements from various aviation-related businesses, FAA regulations and operational guidance, and industry recovery forecasts. GAO conducted a generalizable survey of 1,136 smaller airports. GAO also interviewed officials from FAA and representatives from a judgmental sample of 47 aviation and aerospace industry stakeholders selected based on location and industry sector.

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