Briefing With Coordinator for Counterterrorism Ambassador Nathan A. Sales On Terrorist Designations of Al-Shabaab Leaders

Nathan A. Sales, Coordinator for Counterterrorism

Via Teleconference

MR ICE:  Good afternoon, everyone, and thank you for joining us today for this briefing.  Today, the State Department has announced the designation of al-Shabaab leaders Abdullahi Osman Mohamed and Maalim Ayman as Specially Designated Global Terrorists.

To explain that decision and further actions, we have joining us our Coordinator for Counterterrorism Ambassador Nathan Sales, who in addition to that particular role now serves as Special Envoy to the Global Coalition to Defeat ISIS following the retirement of Special Envoy James Jeffrey last week.  Ambassador Sales is going to open, begin with some opening remarks, and then we’ll take a few questions.

Just as a reminder, this briefing is on the record and embargoed until the end of the call.  Just stand by just a moment, please.  I will go ahead and give you a heads up that we are transmitting here in just a moment a statement, an official statement from Secretary Pompeo on this issue, so you should be seeing that hit your inboxes as well during the briefing.

Okay.  Again, a reminder this briefing is on the record but embargoed until the end of the call.  And with that, I’m going to turn it over to Ambassador Sales.  Ambassador Sales.

AMBASSADOR SALES:  Well, thanks very much, J.T., and thanks to everybody who dialed in for today’s announcement.

Today, the State Department has designated two senior al-Shabaab leaders as Specially Designated Global Terrorists, or SDGTs, under Executive Order 13224: Abdullahi Osman Mohamed – who is also known as Engineer Ismail – as well as Maalim Ayman.

As a result of today’s designations, U.S. persons are generally prohibited from engaging in transactions with Mohamed and Ayman, and all of their property and interests in property subject to U.S. jurisdiction are hereby blocked.

As you know, al-Shabaab is a Somalia-based affiliate of al-Qaida – indeed, it’s one of the most dangerous and capable al-Qaida affiliates in the world.  We are aware that al-Shabaab has claimed responsibility for a suicide bombing targeting a Somali police headquarters in Mogadishu earlier today, and we’re looking into these reports.

Today’s designations reinforce the United States commitment to degrading and defeating al-Shabaab, as well as the broader al-Qaida network.

Abdullahi Osman Mohamed is a senior al-Shabaab official and the terrorist group’s senior explosives expert.  He is responsible for the overall management of the group’s explosives operations and manufacturing.  He’s a special adviser to the group’s so-called “emir,” and he is the leader of the group’s media wing, al-Kataib.

Maalim Ayman is the leader of Jaysh Ayman, an al-Shabaab unit that conducts terrorist attacks and operations in Kenya and Somalia.  Ayman was responsible for preparing the January 5th, 2020 attack on Camp Simba in Manda Bay, Kenya that killed one U.S. military service member and two American contractors.

The State Department originally designated al-Shabaab in March 2008 both as a Foreign Terrorist Organization under Section 219 of the Immigration and Nationality Act as well as an SDGT.

Since that initial designation, al-Shabaab has killed numerous civilians throughout East Africa, including a truck bombing in Mogadishu in October 2017 that killed over 500 people, the September 2013 Westgate Mall attack in Kenya that killed more than 70, and the July 2010 suicide bombings in Kampala, Uganda during the World Cup which killed 76, including one U.S. citizen.

Today’s designations are just one part of the administration’s broader efforts to counter terrorism abroad.  We’re bringing all of our tools to this fight – not just sanctions, but also information sharing, counter messaging, combating travel, and building partner capacity to protect soft targets.

Let me be clear: Today’s designations send an unmistakable message that the United States will not hesitate to use our sanctions authorities aggressively, and that we are prepared to target any foreign terrorist group that threatens our citizens, our interests abroad, or our allies.  We aim to disrupt terrorist threats like al-Shabaab with our designations, and today’s actions will do just that.

And with that, I’m happy to take your questions.

MR ICE:  Very good.  Thank you, Ambassador Sales.  Just as a reminder, to get into the question queue, just dial 1 then 0.  That will put you into the queue.

Why don’t we go out to Joseph Haboush with Al Arabiya English?

QUESTION:  (Inaudible) this.  I wanted to ask the – if you could talk about the accuracy of reports that the administration is also preparing to designate the Houthis, the Yemen’s Houthis, as a terrorist organization.  Thank you.

AMBASSADOR SALES:  Yeah, I don’t have anything for you on that, Joseph.  As you know, the State Department doesn’t offer sneak previews of any designations actions that we might or might not be considering.

MR ICE:  Very good.  Let’s go to Conor Finnegan at ABC News.

QUESTION:  Hey, Nathan.  Two questions for you.  First, in your remarks just now you called al-Shabaab one of the most dangerous and capable affiliates of al-Qaida in the world.  Why, then, would the U.S. pull troops out of Somalia?  How do you anticipate that impacting efforts to counter al-Shabaab?

And then secondly, we’ve seen the violence and chaos in Ethiopia.  Do you have any concerns about spillover from Ethiopia to the rest of the region, including Somalia?

AMBASSADOR SALES:  Well, thanks for those questions, Conor.  On the first, I don’t have anything for you on any plans that DOD might or might not be developing.  I’ll defer to colleagues at the Pentagon to discuss their anticipated moves or moves they might not be making.

With respect to the conflict in Ethiopia with the separatist breakaway region, obviously, this is a strategically important part of the world.  The more violence and the more instability there is in the Horn of Africa, the more we have to worry about spillover effects to other parts of the region, other parts of the continent.  So we’ve been grateful to Ethiopia for the role that their armed forces have played in Somalia, helping to promote stability and reduce violence there, and we hope that they will be in a position to continue that role for the foreseeable future.

MR ICE:  Okay.  Thank you.  Let’s go to Jackson Richman at JNS.

QUESTION:  Hi, Nathan.  Thank you for doing this.  My question is: Does the administration plan to enact further sanctions on Iran and/or its proxies?  And also, why hasn’t the – so the administration has sanctioned the ayatollah and Zarif, yet why hasn’t it sanctioned President Rouhani?  Thank you.

AMBASSADOR SALES:  Thanks.  So once again, I’m not going to be able to go into detail about any designations, actions that we might or might not be considering, but I can tell you that this administration has been relentless in its use of sanctions tools to increase pressure on the Iranian regime, not only for its support of terrorism around the world, but for its manifest human rights violations at home.

We remain committed to holding the regime accountable for the bloodshed that they have committed across the world in places like South America, in Europe, in Syria, in Lebanon, in Yemen, and elsewhere.  And make no mistake, we will continue to use our sanctions authorities, given to us by Congress and delegated by the President, as we see fit to protect American foreign policy and national security interests.

MR ICE:  Thank you, Ambassador.  Okay.  Let’s go to the line of Jonathan Landay at Reuters.

QUESTION:  Ambassador, thank you for doing this.  There was a UN report on Somalia, on al-Shabaab’s finances that came out in October.  It talked about 5,000 fighters, that the group itself had last year generated around $21 million, that it still remained fairly strong both financially and militarily.  Could you talk about how strong the threat still posed by al-Shabaab remains, including some of the conditions on the ground and its ability to operate?

AMBASSADOR SALES:  Yeah.  Thanks, Jonathan, for the question.  I think al-Shabaab continues to pose a significant threat inside Somalia and increasingly in the region as well.  We’ve seen, as recently as today, if the reports are confirmed, another suicide attack potentially by an al-Shabaab operative targeting security forces in the capital of Mogadishu.

Unfortunately, we’ve seen far too many of these sorts of incidents perpetrated by al-Shabaab over the years: attacks committed against civilians in Somalia, attacks committed against security services and government personnel in Somalia.  And regrettably, we also see al-Shabaab with ambitions to perpetrate that violence in neighboring Kenya as well.  The attack at Manda Bay is one good example and the attack on hotel and entertainment complexes in Nairobi being another recent example.

And that is why the United States takes seriously our responsibilities to use what tools are available to us to roll back, degrade, and defeat this dangerous terrorist group.  We worked very closely with our partners in Somalia.  We’ve also worked very closely with our partners in Kenya and elsewhere in the region to apply pressure to this group using all instruments of national power: countering terrorist travel, countering terrorist finance through sanctions of the sort that we’ve announced today, as well as boosting crisis response capabilities to put down terrorist attacks in real time as they’re unfolding, and to help law enforcement and prosecutors do a better job of holding terrorists responsible for the crimes they’ve committed in a way that’s consistent with the rule of law.

MR ICE:  Thank you, Ambassador.  Okay.  Let’s go to the line of Muath Alamri at Asharq News.

QUESTION:  Hi.  Good afternoon.  I would like to ask you about Hizballah and Gebran Bassil.  Is there any more sanction on Hizballah and the former minister, Gebran Bassil?  And any news about killing the number-two leader in al-Qaida in Iran?  Thank you.

AMBASSADOR SALES:  Thanks.  I don’t have anything that I can share on either of those points.  What I can tell you is that with respect to Hizballah, the United States has long seen that group for what it is.  It is not a resistance movement; it is not a defender of Lebanon.  It is a terrorist group – full stop – that has helped to prop up the brutal Assad dictatorship in Syria, committed attacks against American and allied interests around the world, and been a force for instability inside Lebanon.

That is why we have not hesitated to use our sanctions authorities and other tools in a robust way against Hizballah and its allies.  The most recent designations, which you mentioned, are the most recent part of our campaign to try and get Lebanon back into the hands of the Lebanese people, not under the thumb of a ruthless terrorist group.

MR ICE:  Thank you, Ambassador.  Okay, let’s go to the line of Christina Ruffini at CBS.

QUESTION:  Hey, Nathan.  You talked to us before about the threat posed by ISIS-Khorasan, ISIS-K.  And I’m wondering if you think the withdrawal of U.S. forces from Iraq or Afghanistan, or even a force reduction there, is likely to help or hurt the efforts to combat ISIS in that theater.  Thanks so much.

AMBASSADOR SALES:  Thanks.  So I’m going to probably give you a version of the same answer I gave to the version of that question that was asked earlier in the call.  I don’t really have anything to add to what DOD might or might not say about its plans.  Defer entirely to DOD about any statements about what it’s thinking or what it’s not thinking.

What I can tell you is that we continue to regard ISIS-K as a substantial terrorist threat, and we’ve worked hard with the Afghan Government to bolster its capabilities, to protect its institutions, and to protect the Afghan people against this threat, including through funding and training and equipping crisis response teams that have been incredibly successful at addressing the ISIS-K threat, including, you’ll recall, the truly ghastly attack on a maternity hospital not too long ago perpetrated by ISIS-K.  It was U.S.-trained crisis response units that were successful at intervening and stopping that attack before it could become even more horrific.

MR ICE:  Thank you, Ambassador.  Okay, let’s go to the line of Courtney McBride at The Wall Street Journal.  Courtney?

QUESTION:  Thank you.  Ambassador Sales, you said you won’t preview potential sanctions, but various groups are warning that an FTO designation for the Houthis could exacerbate the humanitarian crisis in Yemen.  I’m just wondering how you respond to those concerns.

AMBASSADOR SALES:  Well, I’m not going to respond to hypothetical concerns, because that’s all we’re dealing with now is hypotheticals.  I have nothing to add to what others said previously.  Courtney, you’re a smart reporter, we’ve had this conversation a bunch of times in the past, and you can probably predict that I was going to say, once again, we don’t offer any sneak previews or hints or tips about sanctions actions that we might or might not be considering.

MR ICE:  Okay.  Thank you, Ambassador.  Thank you, Courtney.  Let’s go to Nadia Charters at Al Arabiya.

QUESTION:  Thank you, Ambassador, for doing this.  Can you tell us how this designation today will practically curtail Al-Shabaab activities considering that they don’t have assets in the U.S. – correct me if I’m wrong – and they have their illicit way of obtaining funds?  And if I may – thanks you – for the last time, the Houthis – I mean, what will it take to put the Houthis on the list?  Thank you.

AMBASSADOR SALES:  Thanks.  The last question, thanks for asking it again.  You guys can keep asking it as many times as you want, and I’m going to keep giving you the same answer, which is we don’t sneak preview any designations actions that we might or might not be contemplating.

When it comes to Al-Shabaab, we need to use all of our tools to constrain their ability to raise money.  Whether or not they have assets in the United States, sanctions have very powerful secondary consequences because it makes it that much harder for designated individuals or organizations to try and move money through the international financial system.  Much of that is dollar-denominated, and excluding organizations and individuals from the international financial system dries up their costs of moving money and otherwise doing business, which is why we see enormous practical upside to announcing the sanctions of the sort that we announced today – not just on Al-Shabaab, but more broadly our sanctions actions as a general proposition.

MR ICE:  Okay, great.  Let’s go to the line of Joyce Karam at The National.

QUESTION:  Yes, hi.  Thanks for doing this.  I’m just wondering how confident are you that these designations will carry on to the next Biden administration?  I mean, do you have any concerns that policy differences could reverse some of the designations that you guys have taken?  Thanks.

AMBASSADOR SALES:  Well, look, I’m here to talk about the actions that the administration has taken today, not to offer any thoughts about what the future might hold.  We took the action we took today because we see a threat to U.S. national security interests that is posed by Al-Shabaab, and we’re going to continue to use the tools entrusted to us to advance American values and interests.  And that will remain our commitment for as long as we have the privilege of serving the American people.

MR ICE:  Thank you, Ambassador.  Okay, let’s go to Jennifer Hansler at CNN.

QUESTION:  Yes, hi.  I wanted to follow up on the specific consequences of today’s actions.  Did you have proof that these individuals were engaging in the international community?  And how long had this been in the works?

(No response.)

QUESTION:  Hello?

MR ICE:  Ambassador Sales?

(No response.)

OPERATOR:  Please stand by.

MR ICE:  Sorry about that, Jennifer.  Just hold on with us.  We’ll try to get the Ambassador back on the line.

QUESTION:  Sure.

MR ICE:  So, Jennifer, colleagues, I think that at this point we’ve had a technical issue with Ambassador Sales.  If he pops back on, fine, but I think at this point we’ll go ahead – Jennifer, it’s okay – if it’s okay with you, we’ll take your question as a taken question.  If you’d like to send that in to us, we’ll get you a response to that, if that works.

And I think at that point, that should be it for today.  We very much appreciate everyone dialing in and your interest in this issue.  And that concludes our call.  At this point, the embargo is lifted.  Have a good day.

 

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    The 24 agencies participating in the Office of Management and Budget's (OMB) Data Center Optimization Initiative (DCOI) continue to report progress toward meeting OMB's goals for closing data centers and achieving the related cost savings. According to data submitted by the 24 agencies, almost all of them met or planned to meet their closure and cost savings goals for fiscal years 2019 and 2020. As of August 2020, the agencies reported that they expected to achieve 230 data center closures, resulting in $1.1 billion in savings, over the 2-year period. Agencies expected to realize a cumulative total of $6.24 billion in cost savings and avoidances from fiscal years 2012 through 2020. However, agencies have excluded approximately 4,500 data centers from their inventories since May 2019 due to a change in the definition of a data center. Specifically, in June 2019, OMB narrowed the definition of a data center to exclude certain facilities it had previously identified as having potential cybersecurity risks. GAO reported that each such facility provided a potential access point, and that unsecured access points could aid cyber attacks. Accordingly, GAO recommended that OMB require agencies to report those facilities previously reported as data centers so that visibility of the risks of these facilities was retained. However, OMB has not taken action to address the recommendation. Overall, GAO has made 125 recommendations since 2016 to help agencies meet their DCOI goals, but agencies have not implemented 53. The 24 agencies reported varied progress against OMB's data center optimization targets for fiscal year 2020 (see figure). Agency-Reported Progress towards Meeting Office of Management and Budget (OMB) Data Center Optimization Targets, as of August 2020 Notes: Virtualization measures the number of servers and mainframes serving as a virtual host. Advanced energy metering counts data centers with metering to measure energy efficiency. A metric is not applicable if an agency does not have any agency-owned data centers or if its remaining centers are exempted from optimization by OMB. In June 2019, OMB revised the server utilization metric to direct agencies to develop their own definitions of underutilization, and then count their underutilized servers. As a result, agencies adopted widely varying definitions and were no longer required to report actual utilization, a key measure of server efficiency. In December 2014, Congress enacted federal IT acquisition reform legislation known as FITARA, which included provisions related to ongoing federal data center consolidation efforts. OMB's federal Chief Information Officer launched DCOI to build on prior data center consolidation efforts and improve federal data centers' performance. FITARA included a provision for GAO to annually review agencies' data center inventories and strategies. This report addresses (1) agencies' progress on data center closures and the related savings that have been achieved, and agencies' plans for future closures and savings; (2) agencies' progress against OMB's data center optimization targets; and (3) the effectiveness of OMB's metric for server utilization and how the agencies are implementing it. To do so, GAO reviewed the 24 DCOI agencies' data center inventories as of August 2020, their reported cost savings documentation and data center optimization strategic plans, and OMB's revised utilization metric. GAO reiterates that agencies need to address the 53 recommendations previously made to them that have not yet been implemented. GAO is making one new recommendation to OMB to revise its server utilization metric to more consistently address server efficiency. OMB had no comments on the report and the recommendation directed to the agency. Of the 24 DCOI agencies, five agreed with the information in the report, six did not state whether they agreed or disagreed, and 13 had no comments. For more information, contact Carol C. Harris at (202) 512-4456 or harriscc@gao.gov.
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  • Small Business Administration: COVID-19 Loans Lack Controls and Are Susceptible to Fraud
    In U.S GAO News
    In April 2020, the Small Business Administration (SBA) moved quickly to implement the Paycheck Protection Program (PPP), which provides loans that are forgivable under certain circumstances to small businesses affected by COVID-19. Given the immediate need for these loans, SBA worked to streamline the program so that lenders could begin distributing these funds as soon as possible. For example, lenders were permitted to rely on borrowers' self-certifications for eligibility and use of loan proceeds. As a result, there may be significant risk that some fraudulent or inflated applications were approved. Since May 2020, the Department of Justice has publicly announced charges in more than 50 fraud-related cases associated with PPP funds. In April 2020, SBA announced it would review all loans of more than $2 million to confirm borrower eligibility, and SBA officials subsequently stated that they would review selected loans of less than $2 million to determine, for example, whether the borrower is entitled to loan forgiveness. However, SBA did not provide details on how it would conduct either of these reviews. As of September 2020, SBA reported it was working with the Department of the Treasury and contractors to finalize the plans for the reviews. Because SBA had limited time to implement safeguards up front for loan approval, GAO believes that planning and oversight by SBA to address risks in the PPP program is crucial moving forward. SBA's efforts to expedite processing of Economic Injury Disaster Loans (EIDL)—such as the reliance on self-certification—may have contributed to increased fraud risk in that program as well. In July 2020, SBA's Office of Inspector General (OIG) reported indicators of widespread potential fraud—including thousands of fraud complaints—and found deficiencies with SBA's internal controls. In response, SBA maintained that its internal controls for EIDL were robust, including checks to identify duplicate applications and verify account information, and that it had provided banks with additional antifraud guidance. The Department of Justice, in conjunction with other federal agencies, also has taken actions to address potential fraud. Since May 2020, the department has announced fraud investigations related to the EIDL program and charges against recipients related to EIDL fraud. SBA has made or guaranteed more than 14.5 million loans and grants through PPP and EIDL, providing about $729 billion to help small businesses adversely affected by COVID-19. However, the speed with which SBA implemented the programs may have increased their susceptibility to fraud. This testimony discusses fraud risks associated with SBA's PPP and EIDL programs. It is based largely on GAO's reports in June 2020 (GAO-20-625) and September 2020 (GAO-20-701) that addressed the federal response, including by SBA, to the economic downturn caused by COVID-19. For those reports, GAO reviewed SBA documentation and interviewed officials from SBA, the Department of the Treasury, and associations that represent lenders and small businesses. GAO also met with officials from the SBA OIG and reviewed OIG reports. In its June 2020 report, GAO recommended that SBA develop and implement plans to identify and respond to risks in PPP to ensure program integrity, achieve program effectiveness, and address potential fraud. SBA neither agreed nor disagreed, but GAO believes implementation of this recommendation is essential. For more information, contact William B. Shear at (202) 512-4325 or shearw@gao.gov.
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    A Washington man was charged in a criminal complaint unsealed today for fraudulently seeking over $1.1 million in COVID-19 relief guaranteed by the Small Business Administration (SBA) through the Economic Injury Disaster Loan (EIDL) and the Paycheck Protection Program (PPP) under the Coronavirus Aid, Relief and Economic Security (CARES) Act.
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  • Agile Assessment Guide: Best Practices for Agile Adoption and Implementation
    In U.S GAO News
    From September 28, 2020 through September 27, 2021, GAO is seeking input and feedback on this Exposure Draft from all interested parties. Please click on this link https://tell.gao.gov/agileguide to provide us with comment on the Guide. The U.S. Government Accountability Office is responsible for, among other things, assisting Congress in its oversight of the executive branch, including assessing federal agencies' management of information technology (IT) systems. The federal government annually spends more than $90 billion on IT. However, federal agencies face challenges in developing, implementing, and maintaining their IT investments. All too frequently, agency IT programs have incurred cost overruns and schedule slippages while contributing little to mission-related outcomes. Accordingly, GAO has included management of IT acquisitions and operations on its High Risk List. Recognizing the severity related to government-wide management of IT, in 2014, the Congress passed and the President signed federal IT acquisition reform legislation commonly referred to as the Federal Information Technology Acquisition Reform Act, or FITARA. This legislation was enacted to improve agencies' acquisition of IT and enable Congress to monitor agencies' progress and hold them accountable for reducing duplication and achieving cost savings. Among its specific provisions is a requirement for Chief Information Officers (CIOs) at covered agencies to certify that certain IT investments are adequately implementing incremental development as defined in the Office of Management and Budget's capital planning guidance. One such framework for incremental development is Agile software development, which has been adopted by many federal agencies. The Agile Assessment Guide discusses best practices that can be used across the federal government for Agile adoption, execution, and program monitoring and control. Use of these best practices should enable government programs to better transition to and manage their Agile programs. GAO has developed this guide to serve multiple audiences: The primary audience for this guide is federal auditors. Specifically, the guide presents best practices that can be used to assess the extent to which an agency has adopted and implemented Agile methods. Organizations and programs that have already established policies and protocols for Agile adoption and execution can use this guide to evaluate their existing approach to Agile software development. Organizations and programs that are in the midst of adopting Agile software development practices and programs that are planning to adopt such practices can also use this guide to inform their transitions. For more information, contact Carol Harris at (202) 512-4456 or harriscc@gao.gov.
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  • DOD Health Care: DOD Should Monitor Implementation of Its Clinical Practice Guidelines
    In U.S GAO News
    As of October 2020, the Departments of Defense (DOD) and Veterans Affairs (VA) had jointly developed 22 clinical practice guidelines (VA/DOD CPG) that address specific health conditions, including those related to chronic diseases, mental health issues, pain management, and rehabilitation. Such guidelines are important as military and veteran populations may have different health care needs than civilians due to involvement in combat or occupational exposures (e.g., fumes from burn pits) that may amplify physical and psychological stresses. GAO found that DOD and VA considered the health care needs of these populations throughout the guideline development process and that the guidelines include information about these health care needs in different sections. In some cases, the guidelines include treatment recommendations that specifically address the health care needs of the military and veteran populations. In other instances, they may include information about the prevalence of a specific condition for these populations, among other information. Each of the military services (Army, Air Force, and Navy) has its own process for distributing VA/DOD CPGs to providers at their military treatment facilities (MTF). However, DOD's Defense Health Agency (DHA) is in the process of assuming administrative operations—to include distributing guidelines—for all of the military services' MTFs through an incremental transition process that is to be completed by the end of September 2021. While DHA officials acknowledged that they need to develop a uniform distribution process for the guidelines once they complete the transition, MTF providers can currently access the guidelines through VA's designated website and DOD's electronic health record systems. Congress directed DOD to implement VA/DOD CPGs, using means such as providing education and training, and to monitor MTFs' implementation of them. However, GAO found that DHA and the military services are not systematically monitoring MTFs' implementation of these guidelines. While the Army tracks VA/DOD CPG education and training at its MTFs, officials with DHA, the Navy, and the Air Force explained that they have not been monitoring MTF implementation of these guidelines. DHA officials acknowledged that they need to develop a monitoring process as they assume administrative and oversight responsibilities for the military services' MTFs, but have not yet developed a plan to do so. Without a systematic process to monitor MTF implementation of these guidelines, DHA does not know the extent to which MTF providers may be using VA/DOD CPGs to reduce the variability and improve the quality of health care services provided—factors that may contribute to better health outcomes across the military health system. Through DOD's TRICARE program, eligible beneficiaries may receive care from providers at MTFs or from civilian providers. The National Defense Authorization Act for Fiscal Year 2017 required DOD to establish a program to develop, implement, update, and monitor clinical practice guidelines, which are evidence-based treatment recommendations to improve the consistency and quality of care delivered by MTF providers. The Act also included a provision for GAO to assess issues related to the military health system, including the process of ensuring that providers adhere to clinical practice guidelines, and to report annually for 4 years. This is GAO's fourth report based on the Act. This report describes (1) how the process for developing the guidelines considers the health care needs of the military and veteran populations, (2) how they are distributed by the military services to their providers and how providers access them, and (3) the extent to which DHA and the military services monitor MTF implementation of them, among other things. GAO reviewed relevant policies and guidance; analyzed each of the 22 CPGs; and interviewed officials with DOD, the military services, and VA. GAO recommends that DHA work with the military services to develop and implement a systematic process to monitor MTFs' implementation of VA/DOD CPGs. DOD concurred with this recommendation. For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.
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  • 2018 Pacific Island Disasters: Federal Actions Helped Facilitate the Response, but FEMA Needs to Address Long-Term Recovery Challenges
    In U.S GAO News
    The Federal Emergency Management Agency (FEMA) took steps prior to the 2018 disasters in the Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawaii to facilitate response in the region, where time and distance from the continental United States create unique challenges. For instance, FEMA increased the capacity of two Pacific-area supply distribution centers and helped develop area specific disaster response plans. FEMA and its federal partners, such as the Department of Defense (DOD), had varied response roles, which local officials in the CNMI, Guam, and Hawaii considered effective. For example, DOD provided temporary roof repair for disaster survivors in the CNMI. Damage from Typhoon Yutu in the Commonwealth of the Northern Mariana Islands (left) and the Kilauea Volcano Eruption in Hawaii (right) As of October 2020, FEMA obligated $877 million—more than 70 percent of which was for Individual and Public Assistance missions—following the 2018 disasters and made progress addressing some region specific challenges. However, FEMA has not fully addressed housing assistance issues in the CNMI. For example, it experienced delays implementing its Permanent Housing Construction program in the CNMI due to contracting shortfalls and lack of experienced staff. As of October 2020, only about 30 percent of homes were completed and returned to survivors. GAO found that these housing assistance challenges are consistent with lessons learned from prior FEMA missions in other remote areas of the U.S. Developing guidance that addresses lessons learned in the Permanent Housing Construction program could help streamline assistance to disaster survivors. GAO also identified delays in FEMA's obligation of Public Assistance program funds—used to repair or replace disaster-damaged public infrastructure such as utilities, roads, and schools—in the CNMI, Guam, and Hawaii. Specifically, on average, it took over a year for FEMA to approve funds for projects awarded after the 2018 disasters. FEMA and local officials identified potential reasons for the delays, including cost estimation challenges. FEMA established cost factors in the CNMI to account for higher construction costs, and GAO found that FEMA collects some data on the timeliness of individual steps in the process. However, FEMA has not analyzed the data to help identify causes of the delays, which could allow it to target solutions to address them. The CNMI, Guam, and Hawaii experienced an unprecedented number of natural disasters in 2018—including typhoons, earthquakes, mudslides, and volcanic eruptions. FEMA is the lead federal agency responsible for helping states and territories prepare for, respond to, and recover from natural disasters. Due to the remoteness of Hawaii and the Pacific territories, disaster response and recovery can be challenging. Title IX of the Additional Supplemental Appropriations for Disaster Relief Act of 2019 includes a provision for GAO to review FEMA's response and recovery efforts for 2018 natural disasters, including those in the Pacific region. This report examines (1) how FEMA and its federal partners prepared for and responded to the 2018 disasters in the CNMI, Guam, and Hawaii; and (2) the extent to which FEMA assisted the CNMI, Guam, and Hawaii in recovering from the 2018 natural disasters. GAO analyzed program documents, response plans, and data on FEMA obligations, expenditures, and grant process steps as of October 2020; interviewed federal, state, territorial, and local officials; and visited disaster-damaged areas in Hawaii. GAO is making four recommendations, including that FEMA (1) incorporate lessons learned into Permanent Housing Construction guidance; and (2) use performance data to identify and address inefficiencies in the Public Assistance program. The Department of Homeland Security concurred, and FEMA is taking actions in response. For more information, contact Chris Currie at (404) 679-1875 or curriec@gao.gov.
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  • Veterans Community Care Program: Improvements Needed to Help Ensure Timely Access to Care
    In U.S GAO News
    The Department of Veterans Affairs (VA) established an appointment scheduling process for the Veterans Community Care Program (VCCP) that allows up to 19 days to complete several steps from VA providers creating a referral to community care staff reviewing that referral. However, as the figure shows, VA has not specified the maximum amount of time veterans should have to wait to receive care through the program. GAO previously recommended in 2013 the need for an overall wait-time measure for veterans to receive care under a prior VA community care program. Subsequent to VA not implementing this recommendation, GAO again recommended in 2018 that VA establish an achievable wait-time goal as part of its new community care program (the VCCP). Potential Allowable Wait Time to Obtain Care through the Veterans Community Care Program Note: This figure illustrates potential allowable wait times in calendar days for eligible veterans who are referred to the VCCP through routine referrals (non-emergent), and have VA medical center staff—Referral Coordination Team (RCT) and community care staff (CC staff)—schedule the appointments on their behalf. VA has not yet implemented GAO's 2018 recommendation that VA establish an achievable wait-time goal. Under the VA MISSION Act, VA is assigned responsibility for ensuring that veterans' appointments are scheduled in a timely manner—an essential component of quality health care. Given VA's lack of action over the prior 7 years implementing wait-time goals for various community care programs, congressional action is warranted to help achieve timely health care for veterans. Regarding monitoring of the initial steps of the scheduling process, GAO found that VA is using metrics that are remnants from the previous community care program, which are inconsistent with the time frames established in the VCCP scheduling process. This limits VA's ability to determine the effectiveness of the VCCP and to identify areas for improvement. In June 2019, VA implemented its new community care program, the VCCP, as required by the VA MISSION Act of 2018. Under the VCCP, VAMC staff are responsible for community care appointment scheduling; their ability to execute this new responsibility has implications for veterans receiving community care in a timely manner. GAO was asked to review VCCP appointment scheduling. This report examines, among other issues, the VCCP appointment scheduling process VA established and VA's monitoring of that process. GAO reviewed documentation, such as scheduling policies, and referral data related to the VCCP and assessed VA's relevant processes. GAO conducted site visits to five VAMCs in the first region to transition to VA's new provider network, and interviewed VAMC staff and a non-generalizable sample of community providers receiving referrals from those VAMCs. GAO also interviewed VA and contractor officials. GAO recommends that Congress consider requiring VA to establish an overall wait-time measure for the VCCP. GAO is also making three recommendations to VA, including that it align its monitoring metrics with the VCCP appointment scheduling process. VA did not concur with one of GAO's recommendations related to aligning monitoring metrics to VCCP scheduling policy time frames. GAO continues to believe this recommendation is valid, as discussed in the report. For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.
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