Comparative Effectiveness Research: Patient-Centered Outcomes Research Institute and HHS Continue Activities and Plan New Efforts

What GAO Found

GAO found that the Patient-Centered Outcomes Research Institute (PCORI)—a federally funded, nonprofit corporation—and the Department of Health and Human Services (HHS) have continued to perform comparative clinical effectiveness research (CER) activities required by law since our prior report issued in 2015. CER evaluates and compares health outcomes, risks, and benefits of medical treatments, services, or items. The requirements direct PCORI and HHS to, among other things, fund CER and disseminate and facilitate the implementation of CER findings.

GAO’s analysis of PCORI and HHS documents show that they allocated a total of about $3.6 billion for CER activities and program support during fiscal years 2010 through 2019 from the Patient Centered Outcomes Research Trust Fund (Trust Fund). Specifically, PCORI allocated about $2 billion for research awards and another $542 million for other awards, to be paid over multiple years. HHS allocated about $598 million for activities such as the dissemination and implementation of CER findings. PCORI and HHS also allocated about $470 million for program support.

PCORI and HHS Allocations for Comparative Clinical Effectiveness Research (CER) Activities, Fiscal Years 2010 through 2019

aTotals may not add up due to rounding.

bPCORI and HHS allocated $457 million and $13 million for program support, respectively.

PCORI assessed the effectiveness of its activities using performance measures and targets. Since fiscal year 2017, when early CER projects were completed, PCORI officials reported that the institute met its performance targets, such as an increased number of research citations of its CER findings in news and online sources. HHS described accomplishments or assessed the effectiveness of its dissemination and implementation activities. PCORI and HHS officials told GAO they are planning comprehensive evaluations of their CER dissemination and implementation activities as part of their strategic plans for the next 10 years.

Why GAO Did This Study

The 2010 Patient Protection and Affordable Care Act (PPACA) authorized establishment of PCORI to conduct CER and improve its quality and relevance. PPACA also established new requirements for HHS to, among other things, disseminate findings from federally funded CER and coordinate federal programs to build data capacity for this research. To fund CER activities, PPACA established the Trust Fund, which provided a total of about $3.6 billion to PCORI and HHS for CER activities during fiscal years 2010 through 2019. The Further Consolidated Appropriations Act, 2020, added new CER requirements and extended funding at similar levels through fiscal year 2029.

PPACA and the Appropriations Act 2020 included provisions that GAO review PCORI and HHS’s CER activities. This report describes (1) the CER activities PCORI and HHS carried out to meet legislative requirements, (2) how PCORI and HHS allocated funding to those CER activities, and (3) PCORI and HHS efforts to evaluate the effectiveness of their CER dissemination and implementation activities, such as changes in medical practice.

GAO reviewed legislative requirements and PCORI and HHS documentation and data for fiscal years 2010-2019. GAO also interviewed PCORI and HHS officials and obtained information from nine selected stakeholder groups that were familiar with PCORI’s or HHS’s CER activities. These groups included payer, provider, and patient organizations. GAO incorporated technical comments from PCORI and HHS as appropriate.

For more information, contact John Dicken at (202) 512-7114 or dickenj@gao.gov.

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    The U.S. Center for SafeSport (the Center), an independent nonprofit organization, was established in response to concerns about the consistency of investigations conducted and resolutions reached by amateur sports organizations of allegations of misconduct and abuse. According to Center staff, their response to allegations of misconduct are guided by the SafeSport Code, which establishes acceptable standards of conduct for all individuals who participate in U.S. Olympic and Paralympic events and training, Standard Operating Procedures (SOPs), and other tools. The SafeSport Code defines the scope of the Center's jurisdiction, establishes the standard of proof for its decisions, identifies types of prohibited conduct, describes possible temporary measures and sanctions, and outlines the resolution process and requirements to report to law enforcement. SOPs outline intake and investigation staff roles and responsibilities and provide a step-by-step guide of processes, and a case management system is used by intake and investigation staff to document their work. The Center seeks to ensure its intake and investigation process is fair by taking steps to ensure anonymity and privacy; providing opportunities for claimants (the persons alleged to have experienced misconduct) and respondents (the individuals accused of misconduct) to participate in investigations; and providing parties with the right to consult with an advisor and to seek arbitration of sanctions or other measures imposed by the Center. The Center refers to allegations of misconduct as cases when it establishes that it has enough information to proceed with intake and investigation. From February 2018 through June 2020, the Center created and resolved 3,909 cases. Most of the Center’s cases were resolved through administrative closure or jurisdictional closure. Administrative closure may occur as a result of insufficient evidence, claimants who elect not to participate in the resolution process, or other factors. Jurisdictional closure occurs when the Center does not have jurisdiction or the Center chooses not to exercise its discretionary jurisdiction, as defined in the SafeSport Code. As of June 30, 2020, approximately 1,300 individuals were listed in the Center’s Centralized Disciplinary Database; this number includes individuals placed on temporary restriction(s) or temporary suspension, as well as individuals suspended or rendered permanently ineligible to participate. On February 14, 2018, the Protecting Young Victims from Sexual Abuse and Safe Sport Authorization Act of 2017 was enacted, which codified the Center’s jurisdiction over the U.S. Olympic and Paralympic Committee and its affiliated organizations with regard to safeguarding amateur athletes against abuse in sports. It also required the Center to develop resources and policies to prevent abuse of amateur athletes. The Center investigates and resolves allegations of sexual misconduct by coaches, trainers, managers, peers, and others that may be in violation of the Center’s policies and procedures. In addition, the Center may, at its discretion, investigate and resolve allegations of other policy violations, including non-sexual child abuse and emotional and physical misconduct. The Center plays a key role in ensuring the safety of amateur athletes, many of whom are minors, who participate in Olympic, Paralympic, and Pan-American events and training. GAO was asked to describe the process the Center uses in responding to, investigating, and resolving allegations of misconduct. This report describes (1) how the Center responds to allegations of misconduct in amateur athletics and seeks to ensure its process for investigating and resolving allegations is fair, and (2) what is known about incidents reported to the Center from February 2018 through June 2020. GAO reviewed documents relevant to Center intake and investigation policies and practices and interviewed the Center's leadership, including individuals responsible for the intake and investigation of allegations of misconduct. In addition, GAO requested summary data for the period February 2018 through June 2020—the most recent data available—including information about allegations of misconduct and abuse, and the investigation and resolution of cases. For more information, contact Kathy A. Larin at (202) 512-7215 or larink@gao.gov.
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  • Decennial Census: Bureau Should Assess Significant Data Collection Challenges as It Undertakes Planning for 2030
    In U.S GAO News
    What GAO Found In March 2020, the Census Bureau (Bureau) delayed the start of field data collection because of COVID-19 safety, and then revised several operational timelines in response to the pandemic and Department of Commerce (Commerce) decisions. Nationally the Bureau reported completing more than 99 percent of nonresponse follow-up cases (households that have not responded to the census) by October 15, 2020. The Bureau attributes the use of technology as among the reasons it completed the work by this date. The Bureau, however, had lower completion percentages ranging between 94 and 99 for 10 local geographic areas, in part because of natural disasters and COVID-19. For example, according to the Bureau, in Shreveport, Louisiana, short-term closures stemming from the hurricane impacted data collection for 82,863 housing units. As a mitigation strategy, the Bureau shifted the Shreveport operation to telephone enumeration and brought in more than 1,200 enumerators from travel teams. Despite these efforts, the Bureau was unable to complete 22,588 cases in Shreveport before data collection ended. For these cases the Bureau will need to rely on alternate methods including imputation, which draws data from similar nearby households to determine whether a housing unit exists, whether it is occupied, and, if so, by how many people. In addition to the challenges brought on by natural disasters, the Bureau encountered other difficulties during nonresponse follow-up, such as, the inability of supervisors to reassign open cases in a timely fashion. GAO found that census field supervisors did not have the authority to reassign cases and had to wait for the field manager to make those reassignments. Bureau officials told GAO it would consider the reassignment of cases as it moves towards planning for the 2030 Census. To monitor nonresponse follow-up, the Bureau used quality control procedures, such as real-time monitoring of enumerator activities by supervisors and training assessments. However, GAO found the Bureau did not have proper controls in place, allowing some enumerators to work without having passed the required training assessment. The Bureau agreed that additional controls were necessary. The Bureau planned to count individuals living in group quarters, such as skilled-nursing and correctional facilities, between April 2, 2020, and June 5, 2020, but revised those dates to July 1, 2020, through September 3, 2020. The pandemic made it difficult to count group quarters. For example, Bureau staff found it challenging to locate a point of contact at some group quarters because facilities were closed due to the pandemic. Bureau officials told us that in December 2020 they decided to re-contact more than 24,000 out of approximately 272,000 group quarter facilities to collect data, and that imputation would be used to count individuals at the remaining facilities still reporting a zero population count. The Bureau is updating plans to assess operations and identify resulting lessons learned from the 2020 Census. As part of its planning for 2030, it will be important for the Bureau to assess the impact of the 2020 late design changes and the operations' challenges that arose. Why GAO Did This Study The 2020 Census was conducted under extraordinary circumstances. In response to the COVID-19 pandemic and related Commerce decisions, the Bureau made a series of late changes to the design of the census. As GAO previously reported, these changes introduced risks to the quality of data that the Bureau provides for congressional apportionment and redistricting purposes. GAO was asked to review the Bureau's implementation of the 2020 Census. This report assesses the Bureau's implementation of the: (1) nonresponse follow-up operation, (2) group quarters enumeration, and (3) plans to assess those operations. To address these objectives, GAO conducted a series of surveys of all 248 census offices during the collection of data for those operations. GAO also monitored the cost and progress of operations and interviewed census field supervisors for each operation.
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    In U.S GAO News
    Section 3610 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act generally authorizes agencies at their discretion to reimburse a contractor for the cost of paid leave incurred during the pandemic so that it can maintain its workforce in a ready state. Between March 2020—when the CARES Act was enacted—and early July 2020, the Office of Management and Budget (OMB) and each of the seven other agencies in GAO's review issued guidance to implement section 3610. While largely similar, GAO's work identified some differences across these guidance documents, including the extent to which the rates used to calculate these reimbursements could include profit or fees. OMB issued additional guidance on July 14, 2020, that addressed these differences and clarified how agencies should handle each situation. For example, OMB noted that profit or fees should generally not be reimbursed but provided options for addressing situations in which removing profit or fees would be burdensome. OMB advised agencies to report the amount reimbursed using section 3610 authority via contract modifications to the Federal Procurement Data System-Next Generation (FPDS-NG). After excluding reported obligations identified by agency officials as not associated with section 3610 authority, the reported data indicated that agencies made relatively little use of the authority through July 2020 (see figure). However, the Department of Energy (DOE) reimbursed contractors for almost $550 million in paid leave costs, stating it used existing obligations rather than adding funding via a contract modification. As a result, these amounts were not reported to FPDS-NG as section 3610 reimbursements. Obligations Using Section 3610 Authority Reported to the Federal Procurement Data System-Next Generation by Selected Agencies from January 31 to July 20, 2020 Agency officials and industry representatives GAO interviewed identified several factors that limited section 3610 obligations to date, including the absence of dedicated funding. With the exceptions of the Department of Defense (DOD) and DOE, agency officials GAO met with either did not expect a large amount or were uncertain about the level of future requests for section 3610 reimbursements. DOD officials stated that they expected requests amounting to billions of dollars. In March 2020, Congress passed the CARES Act, which provides over $2 trillion in emergency assistance and healthcare response for individuals, families, and businesses affected by COVID-19. The CARES Act also includes a provision for GAO to review federal contracting pursuant to authorities provided in the Act. This report addresses the implementation of section 3610 of the CARES Act, which authorizes federal agencies to reimburse contractors for paid leave related to the COVID-19 pandemic through September 30, 2020. This report describes (1) the extent to which section 3610 implementation guidance provided by selected federal agencies and OMB differs and (2) the extent to which selected federal agencies reported use of section 3610 authority through July 20, 2020. GAO reviewed relevant guidance issued by OMB and the seven federal agencies with contract obligations greater than $10 billion in fiscal year 2019; interviewed cognizant officials from OMB and each agency; and reviewed comments provided by and spoke with representatives from four industry associations. GAO also analyzed public procurement data reported by selected agencies to FPDS-NG through July 20, 2020 on the use of section 3610 authority. GAO will continue to assess how agencies are implementing section 3610 authority as part of a series of planned reports regarding the federal response to COVID-19. For more information, contact Timothy J. DiNapoli at (202) 512-4841 or dinapolit@gao.gov.
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  • The Nation’s Fiscal Health: Effective Use of Fiscal Rules and Targets
    In U.S GAO News
    In fiscal year 2019, debt held by the public reached 79 percent of gross domestic product (GDP). The government's fiscal response to COVID-19 combined with the severe economic contraction from the pandemic will substantially increase federal debt. The Congressional Budget Office (CBO) projected that debt held by the public will reach 98 percent of GDP by the end of fiscal year 2020. The nation's fiscal challenges will require attention once the economy has substantially recovered and public health goals have been attained. GAO has previously reported that a long-term plan is needed to put the government on a sustainable fiscal path. Other countries have used well-designed fiscal rules and targets—which constrain fiscal policy by controlling factors like expenditures or revenue—to contain excessive deficits. For example, Germany's constitution places limits on its deficits. The U.S. federal government has previously enacted fiscal rules, such as those in the Budget Control Act of 2011. However, current fiscal rules have not effectively addressed the misalignment between spending and revenues over time. GAO identified key considerations to help Congress if it were to adopt new fiscal rules and targets, as part of a long-term plan for fiscal sustainability (see table). Key Considerations for Designing, Implementing, and Enforcing Fiscal Rules and Targets Setting clear goals and objectives can anchor a country's fiscal policy. Fiscal rules and targets can help ensure that spending and revenue decisions align with agreed-upon goals and objectives. The weight given to tradeoffs among simplicity, flexibility, and enforceability depends on the goals a country is trying to achieve with a fiscal rule. In addition, there are tradeoffs between the types and combinations of rules, and the time frames over which the rules apply. The degree to which fiscal rules and targets are binding, such as being supported through a country's constitution or nonbinding political agreements, can impact their permanence, as well as the extent to which ongoing political commitment is needed to uphold them. Integrating fiscal rules and targets into budget discussions can contribute to their ongoing use and provide for a built-in enforcement mechanism. The budget process can include reviews of fiscal rules and targets. Fiscal rules and targets with limited, well-defined exemptions, clear escape clauses for events such as national emergencies, and adjustments for the economic cycle can help a country address future crises. Institutions supporting fiscal rules and targets need clear roles and responsibilities for supporting their implementation and measuring their effectiveness. Independently analyzed data and assessments can help institutions monitor compliance with fiscal rules and targets. Having clear, transparent fiscal rules and targets that a government communicates to the public and that the public understands can contribute to a culture of fiscal transparency and promote fiscal sustainability for the country. Source: GAO analysis of literature review and interviews. | GAO-20-561 Our nation faces serious challenges at a time when the federal government is highly leveraged in debt by historical norms. The imbalance between revenue and spending built into current law and policy have placed the nation on an unsustainable long-term fiscal path. Fiscal rules and targets can be used to help frame and control the overall results of spending and revenue decisions that affect the debt. GAO was asked to review fiscal rules and targets. This report (1) assesses the extent to which the federal government has taken action to contribute to long-term fiscal sustainability through fiscal rules and targets, and (2) identifies key considerations for designing, implementing, and enforcing fiscal rules and targets in the U.S. GAO compared current and former U.S. fiscal rules to literature on the effective use of rules and targets; reviewed CBO reports and relevant laws; and interviewed experts. GAO conducted case studies of national fiscal rules in Australia, Germany, and the Netherlands. Congress should consider establishing a long-term fiscal plan that includes fiscal rules and targets, such as a debt-to-GDP target, and weigh GAO's key considerations to ensure proper design, implementation, and enforcement of these rules and targets. The Department of the Treasury and other entities provided technical comments, which GAO incorporated as appropriate. For more information, contact Jeff Arkin, at (202) 512-6806 or arkinj@gao.gov.
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  • Reagan National Airport: Information on Effects of Federal Statute Limiting Long-Distance Flights
    In U.S GAO News
    Airlines serving Ronald Reagan Washington National Airport (Reagan National) are subject to, among other federal operational requirements, (1) a “perimeter rule,” limiting nonstop flights to a distance of 1,250 miles unless there is an exemption, and (2) a “slot” or operating authorization requirement for each takeoff and landing. GAO found that while the 40 daily beyond-perimeter flights to or from Reagan National accounted for about 6 percent of flights and 10 percent of passengers at the airport in 2019, the additional flights may have had some limited effects, including further reducing the airport's landside capacity (e.g., ticketing and gates). GAO's analysis of the Department of Transportation's (DOT) data from 2010 through 2019 showed that airlines used larger aircraft on beyond-perimeter flights carrying, on average, about 75 more passengers than within-perimeter flights. While these larger aircraft may use more capacity, they did not contribute to a substantial increase in flight delays at Reagan National. The beyond-perimeter flights may have also had other effects, such as drawing a few flights and passengers from Washington Dulles International Airport (Dulles). 2020 Beyond-Perimeter Flight Exemptions at Ronald Reagan Washington National Airport Several factors—existing slot control rules; capacity at Reagan National; and potential effects on noise, other area airports, passengers, and airline competition—should be considered in any decision to modify Reagan National's perimeter rule, according to GAO's prior work and stakeholder interviews. GAO examined these factors under three scenarios: (1) no changes to the current perimeter rule or beyond-perimeter flights, (2) adding a small number of beyond-perimeter flights, and (3) completely lifting the perimeter rule. Many stakeholders who provided a perspective did not support changes to the perimeter rule, citing concerns about increased congestion at Reagan National or drawing passengers from other airports, primarily Dulles. Some stakeholders supported adding a small number of beyond-perimeter flights, citing increased competition if airlines added service to existing routes. No stakeholders supported lifting the perimeter rule, saying it would disadvantage airlines with a small number of flights at Reagan National. Regardless of their position on the rule, many stakeholders said airlines would add beyond-perimeter flights if allowed. Reagan National's perimeter and slot control rules were designed in part, respectively, to help increase use of Dulles and manage congestion at Reagan National by limiting the number of flights. On three occasions—2000, 2003, and 2012—federal statutes have provided exemptions to the perimeter rule, collectively allowing 40 daily beyond-perimeter flights (20 round trips) at Reagan National. Of these exemptions, 32 were new beyond-perimeter flights and eight allowed airlines to convert existing slots to beyond-perimeter flights. The Metropolitan Washington Airports Authority (MWAA) operates Reagan National and Dulles, and DOT and the Federal Aviation Administration (FAA) oversee these rules. GAO was asked to update its past work on the perimeter rule. This report describes (1) the effects of beyond-perimeter flights at Reagan National, and (2) key considerations if additional beyond-perimeter flights are allowed. GAO analyzed DOT data for the most recent 10-year period (2010 through 2019) on passengers and flights at Reagan National and Dulles, and MWAA data on airport capacity at Reagan National in 2019. GAO also reviewed relevant statutes and regulations, and interviewed DOT and FAA officials, and a non-generalizable sample of 32 stakeholders: 9 airlines, 4 airport authorities, 7 academics, 5 associations, 5 community groups, and 2 consumer advocates. Selected airlines included those that operate out of Reagan National or Dulles; other stakeholders were recommended or selected, in part, from prior GAO work and their expertise on the topic. For more information, contact Heather Krause at (202) 512-2834 or krauseh@gao.gov.
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  • Medicaid Information Technology: Effective CMS Oversight and States’ Sharing of Claims Processing and Information Retrieval Systems Can Reduce Costs
    In U.S GAO News
    The Centers for Medicare and Medicaid Services (CMS) has reimbursed billions of dollars to states for the development, operation, and maintenance of claims processing and information retrieval systems—the Medicaid Management Information Systems (MMIS) and Eligibility and Enrollment (E&E) systems. Specifically, from fiscal year 2008 through fiscal year 2018, states spent a total of $44.1 billion on their MMIS and E&E systems. CMS reimbursed the states $34.3 billion of that total amount (see figure). Money Spent by States and Reimbursed by CMS from 2008–2018 for Medicaid Management Information Systems (MMIS) and Eligibility and Enrollment (E&E) Systems For fiscal years 2016 through 2018, CMS approved 93 percent and disapproved 0.4 percent of MMIS funding requests, while for E&E it approved 81 percent and disapproved 1 percent of the requests. The remaining 6.6 percent of MMIS requests and 18 percent of E&E requests were either withdrawn by states or were pending. 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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  • Space Acquisitions: DOD Faces Challenges and Opportunities with Acquiring Space Systems in a Changing Environment
    In U.S GAO News
    What GAO Found The Department of Defense (DOD) is making changes to its space-related processes and organization that will present both opportunities and challenges to the way it acquires its space systems. GAO has reported over the past decades on challenges DOD faces in its space acquisitions—including schedule delays, multibillion-dollar cost increases, significant reductions in capabilities, and in some cases cancelation—and made recommendations that have improved program outcomes. For example, DOD took actions to implement a GAO recommendation to use an incremental approach to acquiring space launch services. DOD's modified approach reduced risk by allowing it to incorporate knowledge gained from early launch competitions to inform subsequent competitions. Many of the most troubled programs are nearing completion, and DOD is starting new programs to develop the next generation of capabilities, some of which are being acquired under a streamlined acquisition process known as the middle-tier of acquisition pathway (see table below). Starting new programs is an opportunity to learn from past mistakes and take measures to put programs on successful paths. GAO's work has shown that in many cases, DOD is attempting to do so. Selected New DOD Space Programs and Near-Term Estimated Costs Dollars in billions New program Current estimated costs for 5-year middle-tier effort Evolved Strategic SATCOM (ESS) Protected satellite communications $1.4 Future Operationally Resilient Ground Evolution (FORGE) Ground control for Next Generation Overhead Persistent Infrared satellites $3.0 Next Generation Overhead Persistent Infrared (OPIR) Block 0 Missile warning, infrared intelligence, surveillance, and reconnaissance $8.4 Protected Tactical SATCOM (PTS) Protected satellite communications $1.0 Source: Department of Defense (DOD) data. | GAO-21-520T However, DOD faces challenges because it will be starting these new programs amid significant changes to the acquisition environment. Some of these changes are external to DOD, such as increased threats to on-orbit space systems. But over the past several years, DOD also initiated substantial organizational and acquisition process changes. While the Space Force offers an important opportunity to streamline lines of authority, accountability, and decision-making and avoid duplication of effort, many details will require careful consideration. In addition, adopting leading practices for acquisition, as previously recommended, could help DOD achieve faster delivery of new capabilities, especially if DOD balances new, streamlined acquisition processes with sufficient oversight to help ensure program success. Why GAO Did This Study DOD space systems provide critical capabilities that support military and other government operations. Space systems can be expensive to acquire and field, costing billions of dollars each year. The U.S. Space Force was recently established as the sixth branch of the U.S. military. As planned, the Space Force will consolidate leadership, planning, and management for some DOD space programs, as appropriate and authorized. This statement discusses the challenges and opportunities DOD faces as it acquires space systems amid changes to the acquisition environment. This statement is based on GAO reports issued over the past 10 years on DOD space programs. It also draws on recent work supporting GAO's 2021 annual report on the progress of major defense acquisition programs.
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  • World Press Freedom Day
    In Crime Control and Security News
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    In Crime News
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  • Assistant Attorney General John C. Demers Delivers Remarks Announcing People’s Republic of China Related Arrests
    In Crime News
    Good morning.  Today, I’m joined by FBI Director Chris Wray and, remotely, by the  Acting U.S. Attorney for the Eastern District of New York, Seth DuCharme, to announce charges against eight individuals for acting as agents of the People’s Republic of China while taking part in an illegal Chinese law enforcement operation known as Fox Hunt here in the United States.  Five of these individuals were arrested across the country this morning.  The rest, we believe, are in China.
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  • Secretary Antony J. Blinken at a Virtual Meeting with Japanese Business Leaders 
    In Crime Control and Security News
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  • Justice Department Settles Sexual Harassment Lawsuit Against Cincinnati, Ohio Landlord
    In Crime News
    The Justice Department today announced that landlord John Klosterman and his wife, Susan Klosterman, will pay $177,500 to resolve a Fair Housing Act lawsuit alleging that John Klosterman sexually harassed female tenants since at least 2013 at residential properties the couple owned in Cincinnati, Ohio. 
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  • Justice Department Announces National Response Center and Offer to Bring Assistance to Minneapolis Police Department to Support Law Enforcement and Safe Communities Through Fair Policing
    In Crime News
    The Justice Department, in an announcement by Assistant Attorney General for the Civil Rights Division Eric S. Dreiband, Principal Deputy Assistant Attorney General of the Office of Justice Programs (OJP) Katharine T. Sullivan, and U.S. Attorney for the District of Minnesota Erica H. MacDonald, unveiled a new National Response Center Initiative and offered the assistance to the Minneapolis Police Department (MPD) to support law enforcement, and review, enhance and reform policies and practices to prevent the use of excessive force. The BJA Law Enforcement Training and Technical Assistance Response Center will be a national resource for all state, local, and tribal law enforcement agencies.
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  • U.S. Government Collects $7 Million in Iranian Assets for Victims of Terrorism Fund
    In Crime News
    The Justice Department announced the United States has collected $7 million of Iranian funds that will be allocated to provide compensation to American victims of international state-sponsored terrorism.
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  • Cameroonian Citizen Extradited from Romania to Face Covid-19-Related Fraud Charges
    In Crime News
    A citizen of Cameroon was extradited to the U.S. yesterday to face federal charges for his alleged involvement in a fraud scheme perpetrated against American consumers.
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