Attorney General Merrick B. Garland Announces New Effort to Reduce Violent Crime

Attorney General Merrick B. Garland today announced a new Department of Justice effort to help protect our communities from the recent increase in major violent crimes.

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    What GAO Found Traditional public schools were the most commonly available schooling option for military families near military installations, similar to schools available to U.S. families in general, according to GAO's analysis of Department of Education 2018-19 data. Over 90 percent of installations had at least one public schooling option nearby—such as a charter or magnet school—in addition to traditional public schools (see figure). Similar to U.S. schools in general, rural installations generally had fewer schooling options compared to their more highly populated urban counterparts. In addition, about one-half of the military installations GAO analyzed are in states that offer private school choice programs that provide eligible students with funding toward a non-public education. At least two of these states have private school choice programs specifically for military families. Public School Options within Average Commuting Distance of Military Installations, School Year 2018-19 Note: According to GAO's analysis of the Department of Transportation's 2017 National Household Travel Survey, the average commuting distance for rural and urban areas is 20 miles and 16 miles, respectively. For the purposes of this report, the term “military installations” refers to the 890 DOD installations and Coast Guard units included in GAO's analysis. Military families in GAO's review commonly reported considering housing options and school features when choosing schools for their children; however, they weighed these factors differently to meet their families' specific needs. For example, one reason parents said that they accepted a longer commute was to live in their preferred school district, while other parents said that they prioritized a shorter commute and increased family time over access to specific schools. Military families also reported considering academics, perceived safety, elective courses, and extracurricular activities. To inform their schooling decisions, most parents said that they rely heavily on their personal networks and social media. Why GAO Did This Study Approximately 650,000 military dependent children in the U.S. face various challenges that may affect their schooling, according to DOD. For example, these children transfer schools up to nine times, on average, before high school graduation. Military families frequently cite education issues for their children as a drawback to military service, according to DOD. GAO was asked to examine the schooling options available to school-age dependents of active-duty servicemembers. This report describes (1) available schooling options for school-age military dependent children in the U.S.; and (2) military families' views on factors they consider and resources they use when making schooling decisions. GAO analyzed data on federal education, military installation locations, and commuting patterns to examine schooling options near military installations. GAO also conducted six discussion groups with a total of 40 parents of school-age military dependent children; and interviewed officials at nine military installations that were selected to reflect a range of factors such as availability of different types of schooling options, rural or urban designation, and geographic region. In addition, GAO reviewed relevant federal laws and guidance, and interviewed officials from DOD, the Coast Guard, and representatives of national advocacy groups for military children. For more information, contact Jacqueline M. Nowicki at (617) 788-0580 or nowickij@gao.gov.
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    The 340B Drug Pricing Program (340B Program) requires drug manufacturers to sell outpatient drugs at a discount to covered entities—eligible hospitals and other entities participating in the program—in order for their drugs to be covered by Medicaid. Participation in the 340B Program has grown from nearly 9,700 covered entities in 2010 to 12,700 in 2020. The Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA) administers the program and oversees covered entities' compliance with 340B Program requirements through annual audits, among other efforts. If audits identify noncompliance with program requirements, HRSA issues findings to covered entities and requires them to take corrective action to continue participating in the 340B Program (see table). Audit Findings Issued to Covered Entities by the Health Resources and Services Administration (HRSA) for Fiscal Years 2012-2019, as of September 2020 340B Program findings of noncompliance Number Eligibility of covered entities. Failure to maintain eligibility-related requirements (e.g., covered entities' oversight of their contract pharmacies). 561 Diversion of 340B drugs to ineligible patients. 340B drugs distributed to individuals who are not eligible patients of a covered entity (e.g., patients' health records are not maintained by the covered entity). 546 Duplicate discounts. Prescribed drugs that may have been subject to both the 340B price and a Medicaid rebate. 429 Total 1,536 Source: GAO analysis of information received from HRSA. | GAO-21-107 HRSA officials told GAO that, beginning in fall 2019, the agency started issuing findings only when audit information presents a clear and direct violation of the requirements outlined in the 340B Program statute. HRSA officials explained that guidance, which is used to interpret provisions of the 340B statute for the purposes of promoting program compliance among covered entities, does not provide the agency with appropriate enforcement capability. For example, HRSA officials reported that there were instances among fiscal year 2019 audits in which the agency did not issue findings for a failure to comply with guidance related to contract pharmacies in part because the 340B statute does not address contract pharmacy use and, therefore, there may not have been a clear statutory violation. In addition to audits, HRSA provides education to covered entities about 340B Program requirements and has implemented other efforts to identify noncompliance. For example, HRSA requires all covered entities to recertify their eligibility to participate in the 340B Program annually (e.g., self-attesting to compliance); and uses a self-disclosure process through which covered entities can disclose and correct self-identified instances of noncompliance. Covered entities can realize substantial savings through 340B Program price discounts, enabling them to stretch federal resources to reach more eligible patients and provide more comprehensive services. GAO was asked to provide information on HRSA's efforts to oversee covered entities' compliance with 340B Program requirements. This report describes (1) the audit findings that HRSA issued to address covered entity noncompliance with 340B Program requirements; and (2) other efforts HRSA uses to help ensure that covered entities comply with 340B Program requirements. GAO reviewed documentation, including relevant federal laws and regulations and HRSA's policies, procedures, and guidance, related to 340B Program oversight. GAO also reviewed HRSA data on the number and type of audit findings made from audits finalized during fiscal years 2012 through 2019 as of September 2020—the latest data available at the time of the audit. GAO also interviewed officials from HRSA, agency contractors, and 340B Program stakeholders. GAO provided a draft of this report to HHS for review. The agency provided written and technical comments on the draft, both of which were incorporated as appropriate. For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.
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    What GAO Found GAO's preliminary work has identified a number of management and operational challenges, including frequent leadership turnover, since fiscal year 2015 that have impeded the overall effectiveness of the Department of Homeland Security (DHS) Office of Inspector General (OIG). DHS OIG senior leaders have acknowledged that these challenges have contributed to organizational weaknesses, and have taken steps to begin addressing some of them. GAO's preliminary work has identified issues in the following areas, among others: Strategic planning: DHS OIG has not consistently developed strategic plans, which are a necessary input for developing the organization's other guiding documents and governance framework. Specifically, DHS OIG has operated for 4 of the past 6 years without a strategic plan, and the plan it adopted for fiscal years 2018–2019 included some, but not all, of the elements considered standard for federal entities. In 2020, DHS OIG contracted with a nonprofit academy of government experts to develop a strategic plan for fiscal years 2021–2025, with expected delivery in June 2021. Quality assurance: Internal and external reviews have reported on concerns about quality assurance in some of DHS OIG's work. In 2017 and 2018, after an internal review found that some reports issued by DHS OIG may not have adhered to the professional standards cited, DHS OIG retracted 13 audit reports that had been issued over a 5-year period. In 2018, an external review determined that DHS OIG needed to improve its system of quality control. Though DHS OIG concurred with all of the recommendations from that external review, it did not fully implement them. In addition, DHS OIG has not established roles and responsibilities for an organization-wide quality assurance program. Moreover, GAO's preliminary work indicates that current staff allocations may limit DHS OIG's quality assurance reviews to focusing on audit work and not on the other types of work it produces, including inspections, evaluations, special reviews, and management alerts. Timeliness: DHS OIG project time frames for work from its offices of Audits and Special Reviews and Evaluations have increased over the 4 fiscal years GAO assessed. For example, in fiscal year 2017, 79 of 102 Office of Audits projects were completed in 1 year or less and eight of 102 took more than 18 months. In fiscal year 2020, seven of 67 reports were completed in 1 year or less and more than half (35 of 67) took more than 18 months. In addition, DHS OIG has not assessed time frames for work completed by these offices, though timeliness in reporting is a key element of effective oversight and DHS OIG staff considered it an organizational weakness. GAO will complete its evaluation of these and other management and operational areas, and will issue a final report in the coming months. Why GAO Did This Study DHS OIG has a critical role in providing independent and objective oversight of DHS, which encompasses multiple operational and support components. OIGs are expected to maintain high standards of professionalism and integrity in light of their mission, according to quality standards developed by the community of federal Inspectors General. However, DHS OIG has faced a number of challenges that have affected its ability to carry out its oversight mission effectively. This statement is based on GAO's draft report on DHS OIG's management and operations, which is currently at the agency for comment. It provides preliminary observations on DHS OIG's strategic planning processes; quality assurance processes; and reporting time frames for work from DHS OIG's offices of Audits and Special Reviews and Evaluations. To develop these preliminary observations, GAO reviewed relevant federal laws and quality standards for federal OIGs as well as DHS OIG documentation, including organizational policies; internal communications such as emails and memoranda; and DHS OIG's semiannual reports to Congress and published reports. GAO also analyzed DHS OIG project data from fiscal years 2015 through 2020, and interviewed DHS OIG leaders and other staff.
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    In U.S GAO News
    The Autonomic Logistics Information System (ALIS) is integral to supporting F-35 aircraft operations and maintenance. However, F-35 personnel at 5 locations GAO visited for its March 2020 report cited several challenges. For example, users at all 5 locations we visited stated that electronic records of F-35 parts in ALIS are frequently incorrect, corrupt, or missing, resulting in the system signaling that an aircraft should be grounded in cases where personnel know that parts have been correctly installed and are safe for flight. At times, F-35 squadron leaders have decided to fly an aircraft when ALIS has signaled not to, thus assuming operational risk to meet mission requirements. GAO found that DOD had not (1) developed a performance-measurement process for ALIS to define how the system should perform or (2) determined how ALIS issues were affecting overall F-35 fleet readiness, which remains below warfighter requirements. DOD recognizes that ALIS needs improvement and plans to leverage ongoing re-design efforts to eventually replace ALIS with a new logistics system. However, as DOD embarks on this effort, it faces key technical and programmatic uncertainties (see figure). Uncertainties about the Future F-35 Logistics Information System These uncertainties are complicated and will require significant planning and coordination with the F-35 program office, military services, international partners, and the prime contractor. For example, GAO reported in March 2020 that DOD had not determined the roles of DOD and the prime contractor in future system development and management. DOD had also not made decisions about the extent to which the new system will be hosted in the cloud as opposed to onsite servers at the squadron level. More broadly, DOD has experienced significant challenges sustaining a growing F-35 fleet. GAO has made over 20 recommendations to address problems associated with ALIS, spare parts shortages, limited repair capabilities, and inadequate planning. DOD has an opportunity to re-imagine the F-35's logistics system and improve operations, but it must approach this planning deliberately and thoroughly. Continued attention to these challenges will help ensure that DOD can effectively sustain the F-35 and meet warfighter requirements. The F-35 Lightning II is DOD's most ambitious and costly weapon system in history, with total acquisition and sustainment costs for the three U.S. military services who fly the aircraft estimated at over $1.6 trillion. Central to F-35 sustainment is ALIS—a complex system that supports operations, mission planning, supply-chain management, maintenance, and other processes. A fully functional ALIS is critical to the more than 3,300 F-35 aircraft that the U.S. military services and foreign nations plan to purchase. Earlier this year, DOD stated that it intends to replace ALIS with a new logistics system. This statement highlights (1) current user challenges with ALIS and (2) key technical and programmatic uncertainties facing DOD as it re-designs the F-35's logistics system. This statement is largely based on GAO's March 2020 report on ALIS ( GAO-20-316 ), as well as previous F-35 sustainment work. GAO previously recommended that DOD develop a performance-measurement process for ALIS, track how ALIS is affecting F-35 fleet readiness, and develop a strategy for re-designing the F-35's logistics system. GAO also suggested that Congress consider requiring DOD to develop a performance-measurement process for its logistics system. DOD concurred with GAO's recommendations and is taking actions to address them. For more information, contact Diana C. Maurer at (202) 512-9627 or maurerd@gao.gov.
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    Why This Matters Air quality sensors are essential to measuring and studying pollutants that can harm public health and the environment. Technological improvements have led to smaller, more affordable sensors as well as satellite-based sensors with new capabilities. However, ensuring the quality and appropriate interpretation of sensor data can be challenging. The Technology What is it? Air quality sensors monitor gases, such as ozone, and particulate matter, which can harm human health and the environment. Federal, state, and local agencies jointly manage networks of stationary air quality monitors that make use of sensors. These monitors are expensive and require supporting infrastructure. Officials use the resulting data to decide how to address pollution or for air quality alerts, including alerts during wildfires or on days with unhealthy ozone levels. However, these networks can miss pollution at smaller scales and in rural areas. They generally do not measure air toxics—more localized pollutants that may cause cancer and chronic health effects—such as ethylene oxide and toxic metals. Two advances in sensor technologies may help close these gaps. First, newer low-cost sensors can now be deployed virtually anywhere, including on fences, cars, drones, and clothing (see fig. 1). Researchers, individuals, community groups, and private companies have started to deploy these more affordable sensors to improve their understanding of a variety of environmental and public health concerns. Second, federal agencies have for decades operated satellites with sensors that monitor air quality to understand weather patterns and inform research. Recent satellite launches deployed sensors with enhanced air monitoring capabilities, which researchers have begun to use in studies of pollution over large areas. Figure 1. There are many types of air quality sensors, including government-operated ground-level and satellite-based sensors, as well as low-cost commercially available sensors that can now be used on a variety of platforms, such as bicycles, cars, trucks, and drones. How does it work? Low-cost sensors use a variety of methods to measure air quality, including lasers to estimate the number and size of particles passing through a chamber and meters to estimate the amount of a gas passing through the sensor. The sensors generally use algorithms to convert raw data into useful measurements (see fig. 2). The algorithms may also adjust for temperature, humidity and other conditions that affect sensor measurements. Higher-quality devices can have other features that improve results, such as controlling the temperature of the air in the sensors to ensure measurements are consistent over time. Sensors can measure different aspects of air quality depending on how they are deployed. For example, stationary sensors measure pollution in one location, while mobile sensors, such as wearable sensors carried by an individual, reflect exposure at multiple locations. Satellite-based sensors generally measure energy reflected or emitted from the earth and the atmosphere to identify pollutants between the satellite and the ground. Some sensors observe one location continuously, while others observe different parts of the earth over time. Multiple sensors can be deployed in a network to track the formation, movement, and variability of pollutants and to improve the reliability of measurements. Combining data from multiple sensors can increase their usefulness, but it also increases the expertise needed to interpret the measurements, especially if data come from different types of sensors. Figure 2. A low-cost sensor pulls air in to measure pollutants and stores information for further study. How mature is it? Sensors originally developed for specific applications, such as monitoring air inside a building, are now smaller and more affordable. As a result, they can now be used in many ways to close gaps in monitoring and research. For example, local governments can use them to monitor multiple sources of air pollution affecting a community, and scientists can use wearable sensors to study the exposure of research volunteers. However, low-cost sensors have limitations. They operate with fewer quality assurance measures than government-operated sensors and vary in the quality of data they produce. It is not yet clear how newer sensors should be deployed to provide the most benefit or how the data should be interpreted. Some low-cost sensors carry out calculations using artificial intelligence algorithms that the designers cannot always explain, making it difficult to interpret varying sensor performance. Further, they typically measure common pollutants, such as ozone and particulate matter. There are hundreds of air toxics for which additional monitoring using sensors could be beneficial. However, there may be technical or other challenges that make it impractical to do so. Older satellite-based sensors typically provided infrequent and less detailed data. But newer sensors offer better data for monitoring air quality, which could help with monitoring rural areas and pollution transport, among other benefits. However, satellite-based sensor data can be difficult to interpret, especially for pollution at ground level. In addition, deployed satellite-based sensor technologies currently only measure a few pollutants, including particulate matter, ozone, sulfur dioxide, nitrogen dioxide, formaldehyde, and carbon monoxide. Opportunities Improved research on health effects. The ability to track personal exposure and highly localized pollution could improve assessments of public health risks. Expanded monitoring. More dense and widespread monitoring could help identify pollution sources and hot spots, in both urban and rural areas. Enhanced air quality management. Combined measurements from stationary, mobile, and satellite-based sensors can help officials understand and mitigate major pollution issues, such as ground-level ozone and wildfire smoke. Community engagement. Lower cost sensors open up new possibilities for community engagement and citizen science, which is when the public conducts or participates in the scientific process, such as by making observations, collecting and sharing data, and conducting experiments. Challenges Performance. Low-cost sensors have highly variable performance that is not well understood, and their algorithms may not be transparent. Low-cost sensors operated by different users or across different locations may have inconsistent measurements. Interpretation. Expertise may be needed to interpret sensor data. For example, sensors produce data in real time that may be difficult to interpret without health standards for short-term exposures. Data management. Expanded monitoring will create large amounts of data with inconsistent formatting, which will have to be stored and managed. Alignment with needs. Few of the current low-cost and satellite-based sensors measure air toxics. In addition, low-income communities, which studies show are disproportionally harmed by air pollution, may still face challenges deploying low-cost sensors. Policy Context and Questions How can policymakers leverage new opportunities for widespread monitoring, such as citizen science, while also promoting appropriate use and interpretation of data? How can data from a variety of sensors be integrated to better understand air quality issues, such as environmental justice concerns, wildfires, and persistent ozone problems? How can research and development efforts be aligned to produce sensors to monitor key pollutants that are not widely monitored, such as certain air toxics? For more information, contact Karen Howard at (202) 512-6888 or HowardK@gao.gov.
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  • Nuclear Security Enterprise: NNSA Should Use Portfolio Management Leading Practices to Support Modernization Efforts
    In U.S GAO News
    What GAO Found The National Nuclear Security Administration (NNSA) has partially implemented selected leading practices to manage the work necessary to maintain and modernize the nation's nuclear weapons stockpile. GAO found that NNSA is in the early stages of initiating its portfolio management processes and has partially implemented leading practices, such as establishing a clearly defined portfolio of work. For example, NNSA officials stated that its Weapons Activities appropriations account is a portfolio of work. However, NNSA has not developed clearly defined and appropriately empowered governance roles, such as a portfolio manager, for its Weapons Activities portfolio. As NNSA continues to develop its approach to portfolio management, establishing a portfolio management framework—consistent with selected leading practices—may allow NNSA to fully implement all leading practices, better define how program offices will pursue strategic stockpile modernization objectives, and optimize portfolio performance in the event that budget trade-offs become necessary. NNSA's offices have undertaken four separate efforts to identify and assess the capabilities needed across the nuclear security enterprise to meet its stockpile maintenance and modernization mission, but NNSA has not developed a comprehensive or complete capability assessment that could support its portfolio management approach (see fig.). NNSA undertook three of these four independent efforts to identify and assess capabilities in response to different legislative direction and did not incorporate information on all elements of a capability (knowledge, human capital, and infrastructure) in any of the individual efforts. Working across the agency to conduct a comprehensive, complete capability assessment would provide NNSA with a portfolio-level view of the enterprise's capabilities and needs, allowing for planning that considers interdependencies that have been missed in the past when planning focused on individual programs or projects. Relationship between Capability Assessment and Portfolio Management Why GAO Did This Study NNSA is simultaneously modernizing the nation's nuclear weapons stockpile and the infrastructure on which weapons research and production programs depend. These efforts include multi-billion-dollar defense programs and projects that provide the capabilities needed for maintenance and modernization programs. Congress previously directed NNSA to identify its needed capabilities. The Senate report accompanying the National Defense Authorization Act for Fiscal Year 2020 includes a provision for GAO to review NNSA's approach to managing its defense programs and to identifying capabilities. This report examines the extent to which NNSA (1) used selected portfolio management leading practices to manage its maintenance and modernization programs and projects and (2) developed a comprehensive and complete capability assessment to support portfolio management. GAO reviewed NNSA documentation related to portfolio management and capabilities and compared it with leading practices and legislative requirements. GAO also interviewed NNSA officials from six agency offices.
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  • Elder Justice: HHS Could Do More to Encourage State Reporting on the Costs of Financial Exploitation
    In U.S GAO News
    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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  • Heavy Lift Helicopter Program: Navy Should Address Cost and Schedule Risks
    In U.S GAO News
    Fifteen years into development, the CH-53K program has made progress in testing the aircraft. Program documentation indicates that there is a moderate risk of not demonstrating the required levels of reliability or payload carrying weight by the end of operational testing. The technical issues identified during testing caused program milestones to slip. For example, the full-rate production decision was delayed by nearly 7 years—from December 2015 to November 2022. CH-53K total program costs also increased by nearly $15.3 billion since the program began due to technical issues and a quantity increase fielded helicopters from 156 to 200. The program faces several challenges going forward. First, the schedule for completing the development of the CH-53K does not meet all of the leading practices, which makes the schedule unreliable. Specifically, GAO found that the master schedule is not fully credible or well-constructed. For example, the schedule indicates there is more flexibility in the schedule than it truly has, which can affect the ability to change allocated resources appropriately to meet schedule milestones. Second, the program faces potential further cost increases due to concurrency—or overlap between testing and procurement—which has increased due to delays in the completion of testing. In previous reviews of weapon systems, GAO found that while some concurrency is understandable, it can also result in cost increases and schedule delays, and deny timely, critical information to policy makers. Concurrency, coupled with plans for increased numbers of helicopters to be produced, beyond the six per year currently being built, could result in costly retrofits to helicopters built before the completion of operational testing. This testing will provide decision makers needed information on the resolution of the technical issues facing the program (see figure). CH-53K Helicopter Testing and Procurement, Fiscal Years 2017-2030 The Marine Corps is replacing its aging CH-53E helicopters with the CH-53K heavy-lift helicopter. Designed as an evolution of the CH-53E, the CH-53K is intended to transport armored vehicles, equipment, and personnel from ships to deep inland locations. The CH-53K program office is overseen by the Department of the Navy. As we have previously reported, the program has experienced delayed milestones and cost increases from almost its inception in 2005, in part, due to technical issues. GAO was asked to review the CH-53K program. This report examines the program's (1) progress toward completing testing and demonstrating system experience, (2) schedule and cost performance to date, and (3) potential future challenges. GAO analyzed cost, schedule, performance, test, manufacturing, and planning documents; and interviewed officials from the CH-53K program office, other defense offices—such as the Defense Contract Management Agency—the testing community, and the prime contractor, Sikorsky. GAO recommends that the Navy take steps to ensure the CH-53K schedule is credible and well-constructed, and that the Navy should not exceed the current annual procurement of six helicopters per year until the completion of initial operational test and evaluation. The Department of Defense did not concur with these recommendations. GAO continues to believe that the recommendations are valid, as discussed in this report. For more information, contact Jon Ludwigson at (202) 512-4841 or ludwigsonj@gao.gov.
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  • Justice Department Releases Report On Modernizing The Administrative Procedure Act
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    WASHINGTON – The Justice Department released a report today on the need for Congress to update and improve the Administrative Procedure Act (APA), the 74-year-old statute setting forth the procedures agencies must follow when regulating individuals, businesses, non-profits, and state and local government entities. The report, entitled Modernizing the Administrative Procedure Act, discusses how the administrative state has developed in ways not foreseen by the APA in 1946, how the APA might be legislatively improved, and how this Administration’s improvements to agencies’ regulatory processes could inform modernizing the APA. The Justice Department, which significantly shaped the original APA, hopes that the ideas and insights discussed in the report will encourage and inform much needed action by Congress to modernize the APA.
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  • Department of Defense: Eating Disorders in the Military
    In U.S GAO News
    The Department of Defense (DOD) screens for eating disorders for all applicants entering into the military but does not specifically screen servicemembers for eating disorders after entrance. However, after joining the military, servicemembers receive annual health screenings, and medical personnel may be able to diagnose eating disorders during in-person physical exams. Service branch behavioral health specialists told GAO that DOD medical personnel are trained to notice signs of eating disorders, such as changes in vital signs and emaciated appearance. DOD is examining ways to improve its screening of eating disorders in the military and recently expanded the available research funding for eating disorders in its Peer-Reviewed Medical Research Program (PRMRP). DOD provides health care services to approximately 9.5 million eligible beneficiaries, including services to treat those diagnosed with eating disorders, through TRICARE, DOD’s regionally structured health care system. Servicemembers can obtain these services at military treatment facilities—referred to as direct care—or receive care purchased from civilian providers—referred to as purchased care. DOD officials told us that the specialized level of care necessary to treat eating disorders is available to TRICARE beneficiaries through purchased care, rather than direct care. The Defense Health Agency (DHA), which oversees the TRICARE program, uses two contractors to develop regional provider networks. According to the two TRICARE contractors’ data for purchased care, as of spring 2020, there were 166 eating disorder facilities located in 32 states throughout the country and the District of Columbia. The facilities vary by geographic location, population served, and level of treatment provided: Geography: About half of the 166 facilities (79) are located in the following five states: California (24), Florida (18), Illinois (15), Texas (13), and Virginia (nine).  Population: Of the 166 eating disorder facilities, over three-quarters provide treatment to both adult (132 facilities) and child and adolescent (132 facilities) populations. Level of Treatment: Most facilities provide inpatient hospitalization programs, which are for serious cases requiring medical stabilization (81 facilities); partial hospitalization, which are day programs providing treatment 5 to 7 days a week (133 facilities); or intensive outpatient programs, which are treatment programs providing therapy 2 to 6 days a week (107 facilities). About one-fifth of the facilities (35) provide residential treatment services, which are living accommodations providing intensive therapy and 24-hour supervision. TRICARE contractors have met with some challenges entering into contracts with eating disorder treatment facilities in certain areas of the country, according to DHA officials and both contractors. However, both contractors told GAO they consider it their responsibility to ensure beneficiaries receive the care they need regardless of the location of the facility. No access-to-care complaints related to eating disorder treatment were reported by TRICARE beneficiaries, according to the most recent DHA data for years 2018 through 2019. Eating disorders are complex conditions affecting millions of Americans and involve dangerous eating behaviors, such as the restriction of food intake. They can have a severe impact on heart, stomach, and brain functionality, and they significantly raise the risk of mortality. Many with eating disorders also experience co-occurring conditions such as depression. Research has yielded a range of estimates of the number of servicemembers with an eating disorder, due to differences in research methods. For example, a 2018 DOD study concluded that servicemembers likely experienced eating disorders at rates that are comparable to rates in the general population, while other survey-based research suggested the number of servicemembers with eating disorders may be higher than those with a medical diagnoses of such disorders. The potential effects that eating disorders can have on the health and combat readiness of servicemembers and their dependents underscores the importance of screening and treating this population. GAO was asked to provide information on eating disorders among servicemembers and their dependents. To describe how DOD screens for eating disorders among servicemembers, GAO reviewed DOD policies related to health screening and interviewed behavioral health specialists from the military branches. To understand approaches and challenges with implementing screening in a military environment, any planned or ongoing DOD-sponsored research related to this topic, and available eating disorder treatment, GAO interviewed representatives from the Eating Disorder Coalition, Uniformed Services University of Health Sciences, and the University of Kansas. To describe how DOD provides eating disorder treatment to servicemembers and their dependents, GAO interviewed DHA officials and TRICARE contractors and reviewed the TRICARE policy manual to identify the types of eating disorder diagnoses and treatments that are covered through direct and purchased care. GAO received data from the two TRICARE contractors related to the availability of eating disorder treatment services as of spring 2020. For more information, contact Sharon Silas at (202) 512-7114 or Silass@gao.gov.
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