Attorney General Merrick Garland Recognizes Individuals and Organizations for Service to Crime Victims

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  • المساعدات المُقَدّمة للضفة الغربية وقطاع غزة: في حالة إستئناف التمويل، فإن زيادة الرقابة على إمتثال الجهة الفرعية الحاصلة على المنح لسياسات وإجراءات مكافحة الارهاب الخاصة بالوكالة الأمريكية للتنمية الدولية قد يُقلل من المخاطر
    In U.S GAO News
    This is the Arabic language highlights associated with GAO-21-332, which issued on Monday, March 29. لماذا أجرى مكتب مساءلة الحكومة ھذه الدراسة قدمت الحكومة الأمريكية منذ عام 1993 أكثر من 6.3 مليار دولار على شكل مساعدات ثنائية للفلسطينيين في الضفة الغربية وقطاع غزة. ووفقا للوكالة الأمريكية للتنمية الدولية ووزارة الخارجية الأمريكية، تم إيقاف تمويل صندوق الدعم الاقتصادي (ESF) منذ يناير/ كانون الثاني 2019 بسبب مجموعة من الإجراءات السياساتية والقانونية. إن الوكالة الأمريكية للتنمية الدولية مسؤولة بشكل رئيسي عن إدارة المساعدات المقدمة من صندوق الدعم الاقتصادي للضفة الغربية وقطاع غزة وضمان الامتثال لسياساته وإجراءاته الخاصة بمكافحة الإرهاب. تتضمن قوانين التخصيص للسنوات المالية 2015-2019 أحكاماً لمكتب مساءلة الحكومة لمراجعة استخدامات أموال صندوق الدعم الاقتصادي الخاصة ببرنامج الضفة الغربية وقطاع غزة. كما طُلِبَ من مكتب مساءلة الحكومة مُراجعة كيف يؤثر وقف هذه المساعدات على موارد التوظيف في الوكالة الأمريكية للتنمية الدولية. يدرس هذا التقرير (1) حالة مساعدات صندوق الدعم الاقتصادي المقدمة من الوكالة الأمريكية للتنمية الدولية للبرنامج في السنوات المالية 2015-2019، وذلك اعتباراً من 30 سبتمبر/ أيلول 2020؛ (2) الخطوات التي اتخذتها الوكالة الأمريكية للتنمية الدولية تجاه المشاريع الجارية ومستويات التوظيف عندما توقفت مساعدات صندوق الدعم الاقتصادي؛ (3) مدى امتثال الوكالة الأمريكية للتنمية الدولية لسياساتها وإجراءاتها الخاصة بمكافحة الإرهاب للسنوات المالية 2015-2019. وقد راجع مكتب مساءلة الحكومة القوانين وسياسات الوكالة وإجراءاتها ووثائقها وبياناتها وقام بتقييم عيّنة قابلة للتعميم من 245 من الجهات الفرعية الحاصلة على المنح للتأكد من الامتثال لسياسات واجراءات الوكالة الأمريكية للتنمية الدولية الخاصة بمكافحة الإرهاب. النتائج التي توصل إليها مكتب مساءلة الحكومة قدمت الحكومة الأمريكية مساعدات للفلسطينيين في الضفة الغربية وقطاع غزة لتعزيز السلام في الشرق الأوسط منذ عام 1993، جزئيا من خلال البرامج التي تُديرها الوكالة الأمريكية للتنمية الدولية ويمولها صندوق الدعم الاقتصادي. وقد توقف هذا التمويل منذ 31 يناير/ كانون الثاني 2019. وبحلول 30 سبتمبر/ أيلول 2020، كانت الوكالة الأمريكية للتنمية الدولية قد انفقت معظم أموال صندوق الدعم الاقتصادي التي تم تخصيصها لبرنامج الضفة الغربية وقطاع غزة في السنوات المالية 2015-2019. على وجه التحديد، انفقت الوكالة الأمريكية للتنمية الدولية 487.3 مليون دولار من أصل 540.4 مليون دولار من مساعدات صندوق الدعم الاقتصادي للبرنامج في السنتين الماليتين 2015 و2016. وأعادت إدارة الرئيس ترامب برمجة الـ 230.1 مليون دولار التي كانت مخصصة للسنة المالية 2017 لبرامج أخرى ولم تخصص مبالغ للسنتين الماليتين 2018 و2019. وأعلنت السلطة الفلسطينية في شهر ديسمبر/ كانون الأول 2018 بأنها لن تقبل المساعدة بعد 31 يناير/ كانون الثاني 2019 بسبب مخاوف لديها بشأن قانون توضيح مكافحة الإرهاب (Anti-Terrorism Clarification Act) لعام 2018. ووفقاً لمسؤولين من وزارة الخارجية الأمريكية والوكالة الأمريكية للتنمية الدولية فإن القانون يتضمن أحكاماً يمكن أن تجعل الجهات المتلقية للمساعدات من صندوق الدعم الاقتصادي خاضعة لدعاوى قضائية أمريكية. وفي شهر يناير/ كانون الثاني 2021، أعلنت إدارة الرئيس بايدن نيتها إستئناف تقديم المساعدات الأمريكية للبرامج في الضفة الغربية وقطاع غزة. اتخذت الوكالة الأمريكية للتنمية الدولية عدة خطوات بشأن المشاريع الجارية ومستويات التوظيف في بعثتها في الضفة الغربية وقطاع غزة بعد توقف تقديم المساعدة للبرنامج اعتبارا من 31 يناير/ كانون الثاني 2019. وقد أوقفت الوكالة الأمريكية للتنمية الدولية 27 مشروعاً جارياً. كما توقفت الوكالة الأمريكية للتنمية الدولية عن إعادة شغل الوظائف المصرح بها في بعثتها في الضفة الغربية وقطاع غزة، واقترحت تخفيضا في قوة العمل، ووضعت حوالي 50 موظفا في مَهام مؤقتة لأنشطة أخرى. ووفقا للوكالة الأمريكية للتنمية الدولية، فإنه اعتبارا من شهر مايو/ أيار 2019، طلبت لجان الكونجرس من الوكالة الأمريكية للتنمية الدولية تعليق تخفيض الوظائف المُخطط له انتظاراً لاستمرار المداولات. وفي حين أن الوكالة الأمريكية للتنمية الدولية لم تنهِ عمل موظفيها، إلا أن عدد موظفي البعثة انخفض بنسبة 39 بالمئة من ديسمبر/ كانون الأول 2017 وحتى سبتمبر/ أيلول 2020 بسبب مُغادرة الموظفين للبعثة وعمليات النقل والاستقالات. تُحدد سياسات وإجراءات مكافحة الإرهاب للوكالة الأمريكية للتنمية الدولية والخاصة بالضفة الغربية وقطاع غزة ثلاثة متطلبات لمُتلقي التمويل من صندوق الدعم الاقتصادي: الفحص بالنسبة للعديد من الجهات غير الأمريكية التي تتلقى المساعدات، وشهادات مكافحة الإرهاب لمُتلقي المِنَح أو الاتفاقيات التعاونية، وأحكام إلزامية تهدف لمنع الدعم المالي للإرهاب في جميع مِنَح المساعدات للجهات الرئيسية والفرعية. توصل مكتب مساءلة الحكومة إلى أنه بالنسبة للسنوات المالية 2015-2019، امتثلت الوكالة الأمريكية للتنمية الدولية بشكل كامل لجميع المتطلبات الثلاثة عند منح المساعدات للجهات الرئيسية، غير أنها لم تتأكد بشكل متسق من إمتثال الجهات الفرعية الحاصلة على المساعدات. بالإضافة لذلك، أظهر تحليل مكتب مساءلة الحكومة لعيّنة المنح الفرعية القابلة للتعميم ومراجعات الامتثال الخاصة بالوكالة الأمريكية للتنمية الدولية وجود فجوات في الامتثال لمتطلبات الفحص والأحكام الإلزامية على مستوى المنح الفرعية. فعلى سبيل المثال، توصل التحليل الذي أجراه مكتب مساءلة الحكومة لمُراجعات الامتثال الخاصة بالوكالة الأمريكية للتنمية الدولية إلى أن 13 من أصل 86 تقريراً كان فيها حالة أو أكثر من عدم قيام الجهة الرئيسية الحاصلة على المنح بتضمين الأحكام الإلزامية، والتي تُغطي 420 من المنح الفرعية. قدمت الوكالة الأمريكية للتنمية الدولية تدريباً للجهات الرئيسية الحاصلة على المنح سابقاً على تقديم المساعدة حول متطلبات مكافحة الإرهاب بالنسبة للجهات التي تحصل على المنح الفرعية، غير أنها لم تتحقق من أن الجهات الحاصلة على المنح لديها إجراءات للامتثال لهذه المتطلبات. وبالإضافة لذلك، أجرت الوكالة الأمريكية للتنمية الدولية مراجعات للامتثال لاحقة على تقديم المنح الفرعية تمت بعد انتهاء المنحة الفرعية في بعض الأحيان، حيث كان الأوان قد فات لاتخاذ اجراءات تصحيحية. و في حالة استئناف تمويل صندوق الدعم الاقتصادي، فإن التحقق من أن الجهات الرئيسية الحاصلة على المنح لديها هذه الاجراءات، وإجراء مراجعات للامتثال لاحقة على تقديم المساعدة في وقت يسمح بإجراء التصحيحات من شأنه أن يضع الوكالة الأمريكية للتنمية الدولية في وضع أفضل بالنسبة لتقليل مخاطر تقديم المساعدة للكيانات أو الافراد المرتبطين بالإرهاب. توصيات مكتب مساءلة الحكومة يوصي مكتب مساءلة الحكومة، في حالة استئناف التمويل، أن تقوم الوكالة الأمريكية للتنمية الدولية بـ (1) التحقق من أن الجهات الرئيسية الحاصلة على المساعدة لديها إجراءات لضمان الامتثال للمتطلبات قبل تقديم المنح للجهات الفرعية، و (2) إجراء مراجعات الامتثال بعد منح المساعدات في وقت يسمح بإجراء التصحيحات قبل إنتهاء المنحة. وقد وافقت الوكالة الأمريكية للتنمية الدولية على هذه التوصيات. هذه نسخة بلغة أجنبية لتقرير صدر في مارس/ آذار2021. أﻧﻈﺮ اﻟﻮﺛﯿﻘﺔ21-332-GAO. ﻟﻠﻤﺰﯾﺪ ﻣﻦ اﻟﻤﻌﻠﻮﻣﺎت،ﯾﺮُ ﺟﻰ اﻻﺗﺼﺎل ﺑـ ﻻﺗﯿﺸﺎ ﻟﻮف Latesha Love ﻋﻠﻰ رﻗﻢ اﻟﮭﺎﺗﻒ: 4409-512 (202)، أو ﻣﻦ ﺧﻼل اﻹﯾﻤﯿﻞ: lovel@gao.gov
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    In U.S GAO News
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    In U.S GAO News
    The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) analyzes national-level data by birth sex to assess health outcomes for women veterans. For example, it analyzes frequency data to identify their most common health conditions. However, VHA is limited in its assessment of health outcomes for the lesbian, gay, bisexual, and transgender (LGBT) veteran population because it does not consistently collect sexual orientation or self-identified gender identity (SIGI) data. VHA officials stated that providers may record veterans' sexual orientation—which can be used to identify lesbian, gay, and bisexual veterans—in non-standardized clinical notes in electronic health records. However, without a standardized field, providers may not be consistently collecting these data, and VHA does not know the total number of these veterans in its system. VHA officials recognize the importance of consistently collecting these data, but have yet to develop and implement a field for doing so. VHA collects SIGI data—which can be used in part to identify transgender veterans—in enrollment, administrative, and electronic health record systems. Although VHA has worked to improve the collection of these data, GAO found inconsistencies in how VHA records SIGI and, according to VA, 89 percent of veterans' records lack SIGI information. VHA added a field to collect this information in the administrative system; however, these data are not linked to electronic health records. As such, VHA providers cannot see the data during clinical visits when determining the appropriate services for transgender veterans, such as screening certain transgender men for breast and cervical cancers, as required by VHA policy. VHA's plan to link SIGI data across both systems has been postponed several times, and the data remain unlinked. VHA Sexual Orientation and Self-Identified Gender Identity (SIGI) Data Collection Limitations, Fiscal Year 2020 Until VHA can more consistently collect and analyze sexual orientation and SIGI data for the veteran population served, it will have a limited understanding of the health care needs of LGBT veterans, including any disparities they may face. VHA provides care to a diverse population of veterans, including women and LGBT veterans. These veterans may experience differences in health outcomes that are closely linked with social or economic disadvantage, and VA considers it important to analyze the services they receive as well as their health outcomes to improve health equity. House Report 115-188 included a provision for GAO to review VA's data collection and reporting procedures for information on veterans' gender and sexual orientation. This report describes how VHA assesses health outcomes for women veterans and examines the extent to which VHA assesses health outcomes for LGBT veterans. GAO reviewed VHA directives and VHA's Health Equity Action Plan. GAO interviewed officials from VHA's Women's Health Services and LGBT Health Program, VHA researchers who focus on women and LGBT veterans, and representatives from other health care systems with experience collecting gender and sexual orientation information. GAO is making four recommendations to VA to consistently collect sexual orientation and SIGI data, and analyze these data to assess health outcomes for LGBT veterans. VA concurred with GAO's recommendations and identified actions it is taking to address them. For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.
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    In U.S GAO News
    Under the Small Business Innovation Research (SBIR) program, participating agencies can make awards to small businesses majority-owned by multiple venture capital operating companies, hedge funds, or private equity firms (investment companies and funds). In fiscal years 2019 and 2020, four of the 11 agencies participating in the program received proposals from small businesses majority-owned by investment companies and funds (i.e., qualified small businesses), and three of the four made awards to such small businesses. Specifically, the Department of Health and Human Services' National Institutes of Health (NIH), the Department of the Navy within the Department of Defense (DOD), and the Department of Education made a combined 45 awards worth $31.6 million to qualified small businesses during this period. As in previous years, NIH made the most awards and awarded the most funds to qualified small businesses in fiscal years 2019 and 2020. The Department of Energy's Advanced Research Projects Agency-Energy opened its SBIR awards to qualified small businesses, but did not issue any awards to them during fiscal years 2019 and 2020. Since 2011, when qualified small businesses became eligible for SBIR awards, participating SBIR agencies have considered whether to allow qualified small businesses to participate in the program. Consistent with what GAO found in December 2018, in fiscal years 2019 and 2020, agencies cited several reasons for not allowing qualified small businesses to participate in their SBIR program. For example, officials at the National Aeronautics and Space Administration and the Department of Homeland Security said that they did not pursue the option because qualified small businesses have not expressed much interest in their SBIR programs. In contrast, two component agencies within DOD—the Departments of the Navy and the Air Force—decided to allow qualified small businesses to receive awards and the Department of the Army within DOD was considering doing so. For example, Air Force program officials told us they found that providing SBIR funding to qualified small businesses would expand the Air Force's investment in cutting-edge technologies with both commercial and military uses. NIH—the agency that has made the majority of awards to qualified small businesses—has continued to make awards to qualified small businesses in its SBIR program, as these businesses are subject to the same standard reporting requirements as all other SBIR award recipients. NIH officials also noted that SBIR recipients provide information on specific project impacts, such as technology transfer and commercialization activities, and NIH cited development of a long-release capsule for medication as an example of a successful outcome from an award to a qualified small business. The SBIR program enables federal agencies to support research and development (R&D) projects carried out by small businesses. Participating agencies are required to spend a certain percentage of their extramural R&D obligations on their SBIR program each year. Eleven federal agencies participate in the SBIR program. To qualify for SBIR awards, a small business must meet certain ownership and other eligibility criteria. The Small Business Act, as amended, authorizes agencies to allow participation in their SBIR programs by qualified small businesses. Upon providing a written determination to the Administrator of the Small Business Administration (SBA)—the agency that oversees the SBIR program—and specified congressional committees, agencies may make SBIR awards to qualified small businesses. The Small Business Act, as amended, includes a provision for GAO to conduct a study of the impact of requirements relating to the involvement of investment companies and funds in the SBIR program and submit a report to Congress regarding the study every 3 years. GAO's first review covered fiscal years 2013 and 2014, and in December 2018, GAO issued its second report on this issue, for fiscal years 2015 through 2018. This third report addresses (1) SBIR participating agencies' awards to small businesses that are majority-owned by multiple investment companies and funds in fiscal years 2019 and 2020 and (2) reasons participating agencies cited for allowing or not allowing the participation of qualified small businesses in the SBIR program. GAO reviewed agencies' data on the participation of qualified small businesses and conducted interviews with or obtained written answers from program managers from the 11 participating agencies and SBA. For more information, contact Candice N. Wright at (202) 512-6888 or wrightc@gao.gov.
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    In U.S GAO News
    The six Intelligence Community (IC)-element Offices of Inspectors General (OIG) that GAO reviewed collectively received 5,794 complaints from October 1, 2016, through September 30, 2018, and opened 960 investigations based on those complaints. Of the 960 investigations, IC-element OIGs had closed 873 (about 91 percent) as of August 2019, with an average case time ranging from 113 to 410 days to complete. Eighty-seven cases remained open as of August 2019, with the average open case time being 589 days. The number of investigations at each IC-element OIG varied widely based on factors such as the number of complaints received and each OIG's determination on when to convert a complaint into an investigation. An OIG may decide not to convert a complaint into an investigation if the complaint lacks credibility or sufficient detail, or may refer the complainant to IC-element management or to another OIG if the complaint involves matters that are outside the OIG's authority to investigate. Four of the IC-element OIGs—the Central Intelligence Agency (CIA) OIG, the Defense Intelligence Agency (DIA) OIG, the National Reconnaissance Office (NRO) OIG, and the National Security Agency (NSA) OIG—have a 180-days or fewer timeliness objective for their investigations. The procedures for the remaining two OIGs—the Inspector General of the Intelligence Community (ICIG) and the National Geospatial-Intelligence Agency (NGA) OIG—state that investigations should be conducted and reported in a timely manner. Other than those prescribed by statute, the ICIG and NGA OIG have not established timeliness objectives for their investigations. Establishing timeliness objectives could improve the OIGs' ability to efficiently manage investigation time frames and to inform potential whistleblowers of these time frames. All of the selected IC-element OIG investigations units have implemented some quality assurance standards and processes, such as including codes of conduct and ethical and professional standards in their guidance. However, the extent to which they have implemented processes to maintain guidance, conduct routine quality assurance reviews, and plan investigations varies (see table). Implementation of Quality Assurance Standards and Practices by Selected IC-element OIG Investigations Units   ICIG CIA OIG DIA OIG NGA OIG NRO OIG NSA OIG Regular updates of investigation guidance or procedures — — — ✓ — ✓ Internal quality assurance review routinely conducted — — ✓ — — — External quality assurance review routinely conducted — ✓ — — — — Required use of documented investigative plans ✓ ✓ ✓ ✓ — ✓ Legend: ✓ = standard or practice implemented; — = standard or practice not implemented. Source: GAO analysis of IC-element OIG investigative policies and procedures. | GAO-20-699 The Council of Inspectors General on Integrity and Efficiency's (CIGIE) Quality Standards for Investigations states that organizations should facilitate due professional care by establishing written investigative policies and procedures via handbooks, manuals, or similar mechanisms that are revised regularly according to evolving laws, regulations, and executive orders. By establishing processes to regularly update their procedures, the ICIG, CIA OIG, DIA OIG, and NRO OIG could better ensure that their policies and procedures will remain consistent with evolving laws, regulations, Executive Orders, and CIGIE standards. Additionally, CIGIE's Quality Standards for Federal Offices of Inspector General requires OIGs to establish and maintain a quality assurance program. The standards further state that internal and external quality assurance reviews are the two components of an OIG's quality assurance program, which is an evaluative effort conducted by reviewers independent of the unit being reviewed to ensure that the overall work of the OIG meets appropriate standards. Developing quality assurance programs that incorporate both types of reviews, as appropriate, could help ensure that the IC-element OIGs adhere to OIG procedures and prescribed standards, regulations, and legislation, as well as identify any areas in need of improvement. Further, CIGIE Quality Standards for Investigations states that case-specific priorities must be established and objectives developed to ensure that tasks are performed efficiently and effectively. CIGIE's standards state that this may best be achieved, in part, by preparing case-specific plans and strategies. Establishing a requirement that investigators use documented investigative plans for all investigations could facilitate NRO OIG management's oversight of investigations and help ensure that investigative steps are prioritized and performed efficiently and effectively. CIA OIG, DIA OIG, and NGA OIG have training plans or approaches that are consistent with CIGIE's quality standards for investigator training. However, while ICIG, NRO OIG, and NSA OIG have basic training requirements and tools to manage training, those OIGs have not established training requirements for their investigators that are linked to the requisite knowledge, skills, and abilities, appropriate to their career progression, and part of a documented training plan. Doing so would help the ICIG, NRO OIG, and NSA OIG ensure that their investigators collectively possess a consistent set of professional proficiencies aligned with CIGIE's quality standards throughout their entire career progression. Most of the IC-element OIGs GAO reviewed consistently met congressional reporting requirements for the investigations and semiannual reports GAO reviewed. The ICIG did not fully meet one reporting requirement in seven of the eight semiannual reports that GAO reviewed. However, its most recent report, which covers April through September 2019, met this reporting requirement by including statistics on the total number and type of investigations it conducted. Further, three of the six selected IC-element OIGs—the DIA, NGA, and NRO OIGs—did not consistently document notifications to complainants in the reprisal investigation case files GAO reviewed. Taking steps to ensure that notifications to complainants in such cases occur and are documented in the case files would provide these OIGs with greater assurance that they consistently inform complainants of the status of their investigations and their rights as whistleblowers. Whistleblowers play an important role in safeguarding the federal government against waste, fraud, and abuse. The OIGs across the government oversee investigations of whistleblower complaints, which can include protecting whistleblowers from reprisal. Whistleblowers in the IC face unique challenges due to the sensitive and classified nature of their work. GAO was asked to review whistleblower protection programs managed by selected IC-element OIGs. This report examines (1) the number and time frames of investigations into complaints that selected IC-element OIGs received in fiscal years 2017 and 2018, and the extent to which selected IC-element OIGs have established timeliness objectives for these investigations; (2) the extent to which selected IC-element OIGs have implemented quality standards and processes for their investigation programs; (3) the extent to which selected IC-element OIGs have established training requirements for investigators; and (4) the extent to which selected IC-element OIGs have met notification and reporting requirements for investigative activities. This is a public version of a sensitive report that GAO issued in June 2020. Information that the IC elements deemed sensitive has been omitted. GAO selected the ICIG and the OIGs of five of the largest IC elements for review. GAO analyzed time frames for all closed investigations of complaints received in fiscal years 2017 and 2018; reviewed OIG policies, procedures, training requirements, and semiannual reports to Congress; conducted interviews with 39 OIG investigators; and reviewed a selection of case files for senior leaders and reprisal cases from October 1, 2016, through March 31, 2018. GAO is making 23 recommendations, including that selected IC-element OIGs establish timeliness objectives for investigations, implement or enhance quality assurance programs, establish training plans, and take steps to ensure that notifications to complainants in reprisal cases occur. The selected IC-element OIGs concurred with the recommendations and discussed steps they planned to take to implement them. For more information, contact Brenda S. Farrell at (202) 512-3604, farrellb@gao.gov or Brian M. Mazanec at (202) 512-5130, mazanecb@gao.gov.
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GAO estimates that CMS had some level of supporting evidence of its review for about 74 percent of MMIS requests and about 99 percent of E&E requests. However, GAO estimates that about 100 percent of E&E requests and 68 percent of MMIS requests lacked pertinent information that would be essential for indicating that a complete review had been performed. Among CMS requirements for system implementation funding is that states submit an alternatives analysis, feasibility study, and cost benefit analysis. However, GAO found that about 45 percent of such requests it sampled for fiscal years 2016 through 2018 did not include these required documents. The above weaknesses were due, in part, to a lack of formal, documented procedures for reviewing state funding requests. CMS also lacked a risk-based process for overseeing systems after federal funds were provided. CMS provided helpful comments and recommendations to states in selected cases, but in other instances it did not. In two states that had contractors struggling to deliver successful projects, state officials said they had not received recommendations or technical assistance from CMS. The states eventually terminated the projects after spending a combined $38.5 million in federal funds. According to CMS officials, they rely largely on states to oversee systems projects. This perspective is consistent with a 2018 Office of Management and Budget (OMB) decision that federal information technology (IT) grants totaling about $9 billion annually would no longer be tracked on OMB's public web site on IT investment performance. Accordingly, the CMS and Health and Human Services chief information officers (CIO) are not involved in overseeing MMIS or E&E projects. Similarly, 21 of 47 states responding to GAO's survey reported that their state CIO had little or no involvement in overseeing their MMISs. Such non-involvement of officials with duties that should be heavily focused on successful acquisition and operation of IT projects could be hindering states' ability to effectively implement systems. To improve oversight, CMS has begun a new outcome-based initiative that focuses the agency's review of state funding requests on the successful achievement of business outcomes. However, as of February 2020, CMS had not yet established a timeline for including MMIS and E&E systems in the new outcome-based process. CMS had various initiatives aimed at reducing duplication of Medicaid systems (see table). Description and Status of Centers for Medicare and Medicaid Services Initiatives Aimed at Reducing Duplication by Sharing, Leveraging, and Reusing Medicaid Information Technology Initiative Description Implementation status Number of surveyed states reporting use of the initiative Reuse Repository Used by states to collect and share reusable artifacts. Made available in August 2017. As of January 2020, CMS was no longer supporting this initiative. 25 of the 50 reporting states Poplin Project Was to provide free, open-source application program interfaces for states to use in developing their modular Medicaid systems. Initiative never fully implemented. As of January 2020, CMS was no longer supporting this initiative. Three of the 50 reporting states Open Source Provider Screening Module Open-source module for states to use at no charge. Made available in August 2018. As of January 2020, CMS was no longer supporting this initiative. One of the 50 states reported attempting to use the module. Medicaid Enterprise Cohort Meetings A forum where states can discuss sharing, leveraging, and/or reuse of Medicaid technologies. As of January 2020, Cohort meetings were being held on a monthly basis. 47 of the 50 states reported participating in the meetings. Source: GAO analysis of agency data. | GAO-20-179 However, as of January 2020, the agency was no longer supporting most of these initiatives because they failed to produce the desired results. CMS regulations and GAO's prior work have highlighted the importance of reducing duplication by sharing and reusing Medicaid IT. To illustrate the potential for reducing duplication, 53 percent of state Medicaid officials responding to our survey reported using the same contractor to develop their MMIS. Nevertheless, selected states are taking the initiative to share systems or modules. Further support by CMS could result in additional sharing initiatives and potential cost savings. The Medicaid program is the largest source of health care funding for America's most at-risk populations and is funded jointly by states and the federal government. GAO was asked to assess CMS's oversight of federal expenditures for MMIS and E&E systems used for Medicaid. This report examines (1) the amount of federal funds that CMS has provided to state Medicaid programs to support MMIS and E&E systems, (2) the extent to which CMS reviews and approves states' funding requests for the systems and oversees the use of these funds, and (3) CMS's and states' efforts to reduce potential duplication of Medicaid IT systems. GAO assessed information related to MMIS and E&E systems, such as state expenditure data, federal regulations, and CMS guidance to the states for submitting funding requests, states' system funding requests, and IT project management documents. GAO also evaluated a generalizable sample of approved state funding requests from fiscal years 2016 through 2018 to analyze, among other things, CMS's review and approval process and conducted interviews with agency and state Medicaid officials. GAO also reviewed relevant regulations and guidance on promoting, sharing, and reusing MMIS and E&E technologies; and surveyed 50 states and six territories (hereafter referred to as states) regarding the MMIS and E&E systems, and assessed the complete or partial responses received from 50 states. GAO is making nine recommendations to improve CMS's processes for approving and overseeing the federal funds for MMIS and E&E systems and for bolstering efforts to reduce potential duplication. Among these recommendations are that CMS should develop formal, documented procedures that include specific steps to be taken in the advanced planning document review process and instructions on how CMS will document the reviews; develop, in consultation with the HHS and CMS CIOs, a documented, comprehensive, and risk-based process for how CMS will select IT projects for technical assistance and provide recommendations to assist states that is aimed at improving the performance of the systems; encourage state Medicaid program officials to consider involving state CIOs in overseeing Medicaid IT projects; establish a timeline for implementing the outcome-based certification process for MMIS and E&E systems; and identify, prior to approving funding for systems, similar projects that other states are pursuing so that opportunities to share, leverage, or reuse systems or system modules are considered. In written comments on a draft of this report, the department concurred with eight of the nine recommendations, and described steps it had taken and/or planned to take to address them. The department did not state whether it concurred with GAO's recommendation to encourage state officials to consider involving state CIOs in Medicaid IT projects. HHS stated that it was unable to discern evidence as to whether a certain structure contributed to a specific outcome. GAO believes, consistent with federal law, that CIOs are critically important to the success of IT projects. For more information, contact Vijay D’Souza at (202) 512-6240 or dsouzav@gao.gov.
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  • Global Health Security: USAID and CDC Funding, Activities, and Assessments of Countries’ Capacities to Address Infectious Disease Threats before COVID-19 Onset
    In U.S GAO News
    Pour la version française de cette page, voir GAO-21-484. What GAO Found As of March 31, 2020, the U.S. Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC) had obligated a combined total of more than $1.2 billion and disbursed about $1 billion for global health security (GHS) activities, using funds appropriated in fiscal years 2015 through 2019. USAID and CDC supported activities to help build countries' capacities in 11 technical areas related to addressing infectious disease threats. The obligated funding supported GHS activities in at least 34 countries, including 25 identified as Global Health Security Agenda (GHSA) partner countries. U.S.-Supported Activities in Ethiopia to Strengthen Global Health Security U.S. officials' assessments of 17 GHSA partner countries' capacities to address infectious disease threats showed that at the end of fiscal year 2019, most countries had some capacity in each of the 11 technical areas but faced various challenges. U.S. interagency country teams produce biannual capacity assessments that USAID and CDC headquarters officials use to track the countries' progress. According to fiscal year 2019 assessment reports, 14 countries had developed or demonstrated capacity in most technical areas. In addition, the reports showed the majority of capacities in each country had remained stable or increased since 2016 and 2017. The technical area antimicrobial resistance showed the largest numbers of capacity increases—for example, in the development of surveillance systems. GAO's analysis of the progress reports found the most common challenges to developing GHS capacity were weaknesses in government institutions, constrained resources, and insufficient human capital. According to agency officials, some challenges can be overcome with additional U.S. government funding, technical support, or diplomatic efforts, but many other challenges remain outside the U.S. government's control. This is a public version of a sensitive report that GAO issued in February 2021. Information that USAID and CDC deemed sensitive has been omitted. Why GAO Did This Study The outbreak of Coronavirus Disease 2019 (COVID-19) in December 2019 demonstrated that infectious diseases can lead to catastrophic loss of life and sustained damage to the global economy. USAID and CDC have led U.S. efforts to strengthen GHS—that is, global capacity to prepare for, detect, and respond to infectious disease threats and to reduce or prevent their spread across borders. These efforts include work related to the multilateral GHSA initiative, which aims to accelerate progress toward compliance with international health regulations and other agreements. House Report 114-693 contained a provision for GAO to review the use of GHS funds. In this report, GAO examines, for the 5 fiscal years before the onset of the COVID-19 pandemic, (1) the status of USAID's and CDC's GHS funding and activities and (2) U.S. agencies' assessments, at the end of fiscal year 2019, of GHSA partner countries' capacities to address infectious disease threats and of challenges these countries faced in building capacity. GAO analyzed agency, interagency, and international organization documents. GAO also interviewed agency officials in Washington, D.C., and Atlanta, Georgia, and in Ethiopia, Indonesia, Senegal, and Vietnam. GAO selected these four countries on the basis of factors such as the presence of staff from multiple U.S. agencies. In addition, GAO analyzed interagency assessments of countries' capacities to address infectious disease threats in fiscal year 2019 and compared them with baseline assessments from 2016 and 2017. For more information, contact David Gootnick at (202) 512-3149 or gootnickd@gao.gov.
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  • Higher Education: Children’s Savings Account Programs Can Help Families Build Savings and Envision College
    In U.S GAO News
    Eighty-two Children's Savings Account (CSA) programs operated and had collectively enrolled about 700,000 children in 2019, according to survey data from the nonprofit organization Prosperity Now. These programs—operated by states, cities, and other organizations—use a variety of strategies to enroll families, especially those with lower incomes, and help them save and prepare for college. For example, CSA programs enroll families by partnering with trusted organizations (e.g., schools) or through automatic enrollment, according to the Consumer Financial Protection Bureau (CFPB) and CSA experts. In addition, these programs help families build savings once children are enrolled by, for example, providing initial deposits or financial education. While experts GAO interviewed said savings may be modest given lower-income families' and programs' limited resources, CSA programs also aim to help lower-income families prepare for college, such as by increasing financial knowledge. There is evidence that CSA program strategies have positive short-term effects on families, including those with lower incomes. These effects include increased CSA program enrollment and participation, amounts saved, and educational expectations, based on research GAO reviewed (see figure). For example, strategies such as automatically enrolling families and providing financial contributions (e.g., initial deposits) may help CSA programs reach more families and encourage saving. Several studies of a CSA program that used both these strategies found increases in the number of children enrolled and the amount saved by enrolled families. One study found that families who were enrolled for 7 years saved over four times more of their own money, on average, than families who were not enrolled—$261 compared to $59. When including financial contributions from the CSA program, enrolled families had about six times more total savings ($1,851) compared to other families ($323). Enrollment and participation in CSA programs may also increase families' educational expectations for their children. For example, a study found that parents with children enrolled in one CSA program were nearly twice as likely to expect their children to attend college. However, information on college enrollment and other long-term effects on families participating in CSA programs is limited because most of the children have not yet reached college age. Effects of CSA Program Strategies in Three Commonly Assessed Areas Rising college costs have outpaced federal grant aid and placed more of the financial burden on students and their families. CSA programs help families, especially lower-income families, save for college—and other postsecondary education—by providing financial contributions and possibly other supports. A Senate Appropriations Committee report included provisions for GAO to examine various aspects of college savings account programs and their effectiveness. This report examines (1) the number of CSA programs and how they use strategies to help families, especially lower-income families, save and prepare for college; and (2) what is known about the effects of these strategies on families, including lower-income families. GAO reviewed 2016–2019 annual CSA program survey data collected by the nonprofit Prosperity Now. GAO also analyzed CFPB documents and the findings of 33 peer-reviewed studies from 2010 through 2019—and one working paper from 2017—that met GAO's criteria for inclusion, for example, used data from the United States. In addition, GAO interviewed officials from CFPB, the Department of Education, and four organizations that have expertise on these programs. For more information, contact Melissa Emrey-Arras at (617) 788-0534 or emreyarrasm@gao.gov.
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