Secretary Antony J. Blinken With Mike Allen of Axios on HBO Max

Antony J. Blinken, Secretary of State

Washington, D.C.

Ben Franklin Room

SECRETARY BLINKEN:  Mike Allen.

QUESTION:  Mr. Secretary, welcome back.

SECRETARY BLINKEN:  Good to see you.

QUESTION:  Mr. Secretary, thank you for welcoming Axios on HBO into the State Department, the Benjamin Franklin State Dining Room.

SECRETARY BLINKEN:  That’s right.

QUESTION:  So you’ve said that job one for you is restoring partnerships and alliances.  That’s been harder than it sounded.

SECRETARY BLINKEN:  Well, it was a challenge, especially in the first couple of months.  Hard to travel because of COVID, so a lot of it was getting on the phone, starting to re-engage with partners.  We’ve finally been able to travel, and I’m finding that there’s been a real thirst and a welcoming of U.S. engagement.  I think it’s a reflection of the fact that our partners see the same thing that we do.  If you’re looking at all of the really big problems that we’re trying to solve that actually have an impact on our people’s lives – like the pandemic, like climate change, like emerging technologies that are changing lives in different ways – no one country can do it alone.  We have to find ways to cooperate, to collaborate, to do it together.  So there’s a lot of welcoming of the United States being back in the game.

QUESTION:  When you say back in the game, the implication is the previous administration, out of the game.

SECRETARY BLINKEN:  Well, look, I’m focused on looking forward.  When we’re not engaged, then one of two things is likely to happen.  Some other country is likely to try to engage in our place —

QUESTION:  China.

SECRETARY BLINKEN:  For example, and maybe not in a way that advances are interests and values.

QUESTION:  And is that already happening?

SECRETARY BLINKEN:  We’ve certainly seen that.  We’ve certainly seen —

QUESTION:  With China?

SECRETARY BLINKEN:  — China try to fill voids where we’ve been relatively disengaged.  Or maybe just as bad, no one does it and then you are likely to have chaos before you have anything else – nature, of course, a vacuum.

QUESTION:  Naftali Bennett, who is poised to be the next prime minister of Israel, has said that he’s opposed to a two-state solution.  He says that based on security concerns, it would be suicide for Israel.  So what’s the path?

SECRETARY BLINKEN:  Well, first, let’s see what actually happens in Israel in terms of the government —

QUESTION:  But you agree that that’s expected?

SECRETARY BLINKEN:  That seems to be expected, but again, I’m not doing politics, I’m going to focus on the policy, so we’ll see.  We will work, as we always have, with whatever the Israeli government is.  When it comes to two states, our President’s been very clear about this.  We see a two-state solution as the best and probably only means to ensure that, going forward, Israel remains not only a secure but a Jewish and democratic state, and the Palestinians have the state to which they’re entitled.

But the conditions right now are not – are not there.  We’ve just come off of the violence in Gaza and elsewhere.  We’re working very hard not only to make sure that the ceasefire stays in place, but to start to deal with the humanitarian situation in Gaza.  And over time, if we can build a little bit more hope, a little bit more trust, a little bit more confidence, maybe then the conditions are in place to re-engage on two states.

QUESTION:  The department said in May that you hadn’t personally seen the evidence Israel says it has that Hamas was occupying the tower in Gaza – that they’d took down – that had news organizations including the AP in it.  What happens if there turns out to be no smoking gun?

SECRETARY BLINKEN:  Two things.  First, President Biden has been very clear Israel has the right to defend itself and it was on the receiving end of indiscriminate rocket attacks coming from Gaza going after Israeli civilians.  And —

QUESTION:  So you were fine with that building being taken down?

SECRETARY BLINKEN:  Any country would defend itself and Israel has the right.  However, having said that, Israel as a democracy I think has an added burden to make sure it is doing everything possible to avoid civilian causalities.  And that’s what is expected of us; it’s expected of Israel.  We have our own experience with this, and I think one of the things that we found ourselves, speaking only for the United States, is that the more transparency you can provide, the more legitimacy you’re going to have.

QUESTION:  So based on that, do you think that we’ll see clear evidence?

SECRETARY BLINKEN:  All I can tell you is we’ve had information shared in intelligence channels, which I can’t, for obvious reasons, comment on.

QUESTION:  Did you find it convincing?

SECRETARY BLINKEN:  I can’t comment on it.  But I do think from our own experience, the more transparency, the better.

QUESTION:  China.  Can we win an open-ended arms race with Beijing?

SECRETARY BLINKEN:  Well, we don’t want to be in an arms race with Beijing or anyone.

QUESTION:  We are.  We are.

SECRETARY BLINKEN:  What we want – no, we’re in a very stiff competition.  Look, the relationship with China is both the most complicated and most consequential that we have.  There are adversarial aspects to it, there are competitive aspects, there are cooperative aspects.  And we have tremendous sources of strength when it comes to each one of those aspects.  We have our allies and partners, but most important, we have ourselves.

QUESTION:  Mr. Secretary, what are the implications if Beijing is found to have been covering up a Wuhan lab leak?

SECRETARY BLINKEN:  We have to get to the bottom of what happened.  There’s accountability, but from my perspective the most important thing, and the most important reason we have to get to the bottom of this, is that’s the only way we’re going to be able to prevent the next pandemic, or at least do a better job in mitigating it.  What the government didn’t do in the early days and still hasn’t done is given us the transparency we need, the international community – access for inspectors and experts, the sharing of information in real time.  That has to happen.

QUESTION:  So to get those answers, to do a proper investigation, you’re going to need – the U.S. is going to need access to the labs.  Will you demand that?  Will you put teeth on it?  Will you even go as far as sanctions on China if they keep inspectors out?

SECRETARY BLINKEN:  I think the international community is clear that we have to have – the international community has to have access, it has to have information, it has to have meaningful international —

QUESTION:  So what’s the real pressure the U.S. will put on China for access to the lab?

SECRETARY BLINKEN:  If China denies the information, denies the access, denies the transparency that’s needed, it is —

QUESTION:  And you kind of expect that?

SECRETARY BLINKEN:  Well, let’s see.  Because —

QUESTION:  That’s been the history.

SECRETARY BLINKEN:  Mike, at the end of the day it’s profoundly in China’s interest to do this as well, because, look, it suffered too in the outbreak of this pandemic.  It presumably has an interest as well, especially if it purports to be a responsible international actor, to do everything it can to provide all the information it has to make sure we can hopefully prevent this from happening again.

QUESTION:  The Trump administration had a number of executive orders cracking down on people who were tied to the Chinese Communist Party – we’re talking about export bans.  How are you thinking about that and will you be tougher?

SECRETARY BLINKEN:  Look, I think the Trump administration was right to look at that.  And we’re —

QUESTION:  And to act on it?

SECRETARY BLINKEN:  And to act on it.  And we’re reviewing all of that as we speak.  And for example, it’s very important that we not – American companies or individuals – aid and abet, for example, China’s ability to use surveillance technology to repress its own people, or to export that technology to allow other autocratic or authoritarian governments from doing the same thing.  I think that’s very important.

QUESTION:  Last stop on the tour, Russia.  With these cyber attacks, President Putin is thumbing his nose at the U.S. – blatant disrespect.  What is the U.S. going to do about it?

SECRETARY BLINKEN:  Well, what we’re going to do about it is to do what President Biden has already done, which is to make very clear —

QUESTION:  But it’s not working.  We’ve had our food supply threatened, we’ve had our energy supply threatened, now transportation threatened.

SECRETARY BLINKEN:  Look, there are – we would prefer to have a more stable, predictable relationship with Russia.  We’ve made that clear.  But we’ve made equally clear that if Russia chooses to act aggressively or recklessly toward us or toward our allies and partners, we’ll respond.

When it comes to these ransomware attacks, of course, we’ve already talked to the Russians about this.  One of the things we’re seeing is that criminal enterprises seem to be engaged in these attacks.  And it is an obligation on the part of any country, including Russia, if it has a criminal enterprise acting from its territory against anyone else, to do what’s necessary to stop it, to bring it to justice.

QUESTION:  And yet, Mr. Secretary, Putin is clearly completely undeterred.

SECRETARY BLINKEN:  One of the reasons that the President will be meeting with President Putin in a week’s time is not in spite of these aggressions, these attacks, it’s because of them, to tell him directly and clearly what he can expect from the United States if aggressive, reckless actions toward us continue.  Equally, though, to make clear that if Russia by its actions chooses a different course, we would prefer a more stable, predictable relationship.  There are things we can do together that would advance the security of our people, the Russian people, people around the world – strategic stability, arms control.  So we’re going to explore that.  We have to test the proposition, and the best way to do that is for the two presidents to meet face to face.

QUESTION:  Are you optimistic that after that summit that there will be a, as you put it, “more stable” relationship?

SECRETARY BLINKEN:  This is going to be a test of that proposition.  I can’t tell you whether I’m optimistic or not about the results of that test, but it’s important to do that.  And also, I don’t think we’re going to know after one meeting, but we’ll have some indications and we’ll see.  We’re prepared either way.

QUESTION:  What do you mean by prepared?

SECRETARY BLINKEN:  Well, as I said, we’re prepared if Russia chooses to continue reckless and aggressive action – we’re prepared to deal with that, as we have – on the other hand, if it chooses a different course, we’re prepared to engage.

More from: Antony J. Blinken, Secretary of State

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    Hospital outpatient departments perform a wide range of procedures, including diagnostic and surgical procedures, which may use drugs that Medicare considers to function as supplies. If the drug is new, and its cost is high relative to Medicare's payment for the procedure, then hospitals can receive a separate “pass-through” payment for the drug in addition to Medicare's payment for the procedure. These pass-through payments are in effect for 2 to 3 years. When the pass-through payments expire, Medicare no longer pays separately for the drug, and payment for the drug is “packaged” with the payment for the related procedure. The payment rate for the procedure does not vary by whether or not the drug is used. Medicare intends this payment rate to be an incentive for hospitals to furnish services efficiently, such as using the most cost-efficient items that meet the patient's needs. Examples of Types of Drugs that Medicare Considers to Function as Supplies GAO's analysis of Medicare data showed that higher payments were associated with six of seven selected drugs when they were eligible for pass-through payments versus when their payments were packaged. For example, one drug used in cataract removal procedures was eligible for pass-through payments in 2017. That year, Medicare paid $1,824 for the procedure and $463 for the drug pass-through payment—a total payment of $2,287. If a hospital performed the same cataract removal procedure when the drug was packaged the following year, there was no longer a separate payment for the drug. Instead, Medicare paid $1,921 for the procedure whether or not the hospital used the drug. Of the seven selected drugs, GAO also reviewed differences in use for four of them that did not have limitations on Medicare coverage during the time frame of GAO's analysis, such as coverage that was limited to certain clinical trials. GAO found that hospitals' use of three of the four drugs was lower when payments for the drugs were packaged. This was consistent with the financial incentives created by the payment system. In particular, given the lower total payment for the drug and procedure when the drug is packaged, hospitals may have a greater incentive to use a lower-cost alternative for the procedure. Hospitals' use of a fourth drug increased regardless of payment status. The financial incentives for that drug appeared minimal because the total payment for it and its related procedure was about the same when it was eligible for pass-through payments and when packaged. Other factors that can affect use of the drugs include the use of the drugs for certain populations and whether hospitals put the drugs on their formularies, which guide, in part, whether the drug is used at that hospital. The Department of Health and Human Services reviewed a draft of this report and provided technical comments, which GAO incorporated as appropriate. Medicare makes “pass-through” payments under Medicare Part B when hospital outpatient departments use certain new, high-cost drugs. These temporary payments are in addition to Medicare's payments for the procedures using the drugs. They may help make the new drugs accessible for beneficiaries and also allow Medicare to collect information on the drugs' use and costs. The Consolidated Appropriations Act, 2018 included a provision for GAO to review the effect of Medicare's policy for packaging high-cost drugs after their pass-through payments have expired. This report describes (1) the payments associated with selected high-cost drugs when eligible for pass-through payments versus when packaged, and (2) hospitals' use of those drugs when eligible for pass-through payments versus when packaged. GAO reviewed federal regulations on pass-through payments and Medicare payment files for all seven drugs whose pass-through payments expired in 2017 or 2018 and that were subsequently packaged. All of these drugs met Medicare's definition for having a high cost relative to Medicare's payment rate for the procedure using the drug. GAO also reviewed Medicare claims data on the use of the drugs for 2017 through 2019 (the most recent available). To supplement this information, GAO also interviewed Medicare officials, as well officials from 11 organizations representing hospitals, physicians, and drug manufacturers, about payment rates, use, reporting, and clinical context for the drugs. For more information, contact James Cosgrove at (202) 512-7114 or cosgrovej@gao.gov.
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  • Federal Tactical Teams: Characteristics, Training, Deployments, and Inventory
    In U.S GAO News
    Within the executive branch, GAO identified 25 federal tactical teams, and the characteristics of these teams varied. The 25 tactical teams were across 18 agencies, such as agencies within the Departments of Homeland Security, Justice, Energy, and the Interior. The number of reported team members per team ranged from two to 1,099. More than half (16 of 25) of the teams reported that they are composed of team members working for the team on a collateral basis. Most teams (17 of 25) had multiple units across various locations. Photos of Federal Tactical Teams in Action Tactical teams generally followed a similar training process, with initial training, specialty training, and ongoing training requirements. Nearly all teams (24 of 25) reported that new team members complete an initial tactical training course, which ranged from 1 week to 10 months. For example, potential new team members of the Federal Bureau of Investigation's Hostage Rescue Team complete a 10-month initial training that includes courses on firearms; helicopter operations; and surveillance, among others. Nearly all teams (24 of 25) reported offering specialized training to some team members, such as in sniper operations and breaching. Nearly all teams (24 of 25) also reported having ongoing training requirements, ranging from 40 hours per year to over 400 hours per year. The number and types of deployments varied across the 25 tactical teams for fiscal years 2015 through 2019. The number of reported deployments per tactical team during this time period ranged from 0 to over 5,000. Teams conducted different types of deployments, but some types were common among teams, such as: supporting operations of other law enforcement entities, such as other federal, state, and local law enforcement (16 of 25); providing protection details for high-profile individuals (15 of 25); responding to or providing security at civil disturbances, such as protests (13 of 25); and serving high-risk search and arrest warrants (11 of 25). Four teams reported that they had deployed in response to the Coronavirus 2019 (COVID-19) pandemic, and 16 teams reported deployments related to nationwide civil unrest and protests in May and June 2020. Tactical teams reported having various types of firearms, tactical equipment, and tactical vehicles in their inventories. Team members generally have a standard set of firearms (e.g., a pistol, a backup pistol, and a rifle), but some may also have specialized firearms (e.g., a shotgun designed to breach doors). Tactical teams also have a variety of tactical equipment, such as night vision devices to maintain surveillance of suspects or tactical robots that can go into locations to obtain audio and video information when team members cannot safely enter those locations. Tactical teams may also have tactical vehicles, such as manned aircraft (e.g., helicopters) and armored vehicles to patrol locations. The figure below identifies the number of tactical teams that reported having such items in their inventories. Number of Federal Tactical Teams That Reported Having Firearms, Tactical Equipment, and Tactical Vehicles in Their Inventories, as of January 2020 Appendix I of the report provides details on each of the 25 tactical teams, such as each team's mission; staffing; types and frequency of training; and number and types of deployments from fiscal years 2015 through 2019. This is a public version of a sensitive report issued in August 2020. Information deemed to be sensitive by the agencies in this review, such as the quantities of firearms, tactical equipment, and tactical vehicles in team inventories, has been omitted from this report. Many federal agencies employ law enforcement officers to carry out the agency's law enforcement mission and maintain the security of federal property, employees, and the public. Some of these agencies have specialized law enforcement teams—referred to as federal tactical teams in this report—whose members are selected, trained, equipped, and assigned to prevent and resolve critical incidents involving a public safety threat that their agency's traditional law enforcement may not otherwise have the capability to resolve. This report provides information on the (1) federal tactical teams and their characteristics; (2) training team members receive; (3) deployments of such teams from fiscal years 2015 through 2019; and (4) firearms, tactical equipment, and tactical vehicles in team inventories, as of January 2020. To identify federal tactical teams, GAO contacted executive branch agencies with at least 50 federal law enforcement officers. GAO administered a standardized questionnaire and data collection instrument to the identified teams to gather information on team missions, staffing, training, deployments, and inventories. GAO reviewed team documents, such as standard operating procedures, and interviewed agency officials. GAO collected descriptive information on reported deployments as of June 2020 in response to COVID-19 and nationwide civil unrest, which were ongoing during the review. GAO incorporated agency technical comments as appropriate. For more information, contact Gretta L. Goodwin at (202) 512-8777 or goodwing@gao.gov.
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  • Aircraft Noise: Information on a Potential Mandated Transition to Quieter Airplanes
    In U.S GAO News
    Based on Federal Aviation Administration (FAA) data and GAO estimates, most U.S. large commercial jet airplanes are certificated at the minimum required stage 3 noise standards, but nearly all of them are able to meet more stringent noise standards. Sixty-three percent of large commercial airplanes in the United States are certificated as meeting the stage 3 standards; however, 87 percent of them were manufactured with technologies that are able to meet more recent and stringent stage 4 or 5 standards as currently configured, according to FAA's 2017 analysis. By analyzing updated data from airlines and aviation manufacturers, GAO estimated that this proportion is even higher: 96 percent of large commercial airplanes are able to meet stage 4 or 5 standards (see figure). According to FAA officials and aviation stakeholders, the primary reason many large commercial airplanes certificated as stage 3 produce lower than stage 3 noise levels is because engine and airframe technology has outpaced the implementation of noise standards. More recently, some airlines have accelerated retirement of certain airplanes, some of which are certificated as stage 3, due to the decrease in travel amid the COVID-19 pandemic. For the generally smaller regional commercial jets (i.e., generally with less than 90 seats), 86 percent are able to meet stage 4 or stage 5 standards, according to manufacturers' data. With regard to general aviation (which are used for personal or corporate flights), 73 percent of the jet airplanes in that fleet are able to meet the more stringent stage 4 or 5 standards, according to manufacturers' data. GAO Estimate of The Number of Large Airplanes in the U.S. Commercial Fleet That Are Able to Meet Stage 3 or Stage 4 and 5 Noise Standards, January 2020 According to stakeholders GAO interviewed, a phase-out of jet airplanes that are certificated as meeting stage 3 standards would provide limited noise reduction and limited other benefits, and could be costly and present other challenges. A phase-out could require recertificating the vast majority of stage 3 airplanes to comply with stage 4 or 5 standards. This process could be costly for operators and manufacturers but would provide little reduction in noise. Further, airplanes currently unable to meet more stringent standards would require modifications or face retirement. For older airplanes that could not be recertificated to meet stage 4 or 5 standards, some operators could incur costs for replacement airplanes sooner than originally planned. Although stakeholders indicated that a phase-out would not substantially reduce noise, they identified other limited benefits newer airplanes generate, such as reduced greenhouse gas emissions and fuel consumption. Although advances in technology have led to quieter aircraft capable of meeting increasingly stringent noise standards, airport noise remains a concern. FAA regulates aircraft noise by ensuring compliance with relevant noise standards. In 1990, federal law required large jet airplanes to comply with stage 3 noise standards by 1999, leading to a phase-out of the noisiest airplanes (stage 1 and 2 airplanes). Later, federal law required smaller airplanes to comply with stage 3 standards by 2016. The FAA Reauthorization Act of 2018 included a provision for GAO to review a potential phase-out of stage 3 airplanes—the loudest aircraft currently operating in the United States. This report describes (1) the proportion of stage 3 airplanes in the U.S. fleet, and what proportion of these stage 3 airplanes are able to meet more stringent noise standards and (2) selected stakeholders' views on the potential benefits, costs, and challenges of phasing out stage 3 airplanes. GAO reviewed FAA's analysis of December 2017 fleet data, analyzed January 2020 fleet data from select airlines and airframe and engine manufacturers, and interviewed FAA officials. GAO also interviewed a non-generalizable sample of 35 stakeholders, including airlines; airframe and engine manufacturers; airports; and industry associations, selected based on fleet and noise data, stakeholder recommendations, or prior GAO knowledge. For more information, contact Heather Krause at (202) 512-2834 or krauseh@gao.gov.
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  • Financial Stability: Agencies Have Not Found Leveraged Lending to Significantly Threaten Stability but Remain Cautious Amid Pandemic
    In U.S GAO News
    In the years before the economic shock from the COVID-19 pandemic, the Financial Stability Oversight Council (FSOC) and others assessed the potential risks to financial stability that leveraged loans and collateralized loan obligation (CLO) securities may pose. Generally, leveraged loans are those made to businesses with poor credit and high debt, and CLO securities are backed by these loans. FSOC and others found that riskier borrower profiles and looser underwriting standards left leveraged lending market participants vulnerable to losses in the event of a downturn. After the COVID-19 shock in March 2020, loans suffered record downgrades and increased defaults, but the highest-rated CLO securities remained resilient. Although regulators monitoring the effects of the pandemic remain cautious, as of September 2020, they had not found that leveraged lending presented significant threats to financial stability. Based on regulators' assessments, leveraged lending activities had not contributed significantly to the distress of any large financial entity whose failure could threaten financial stability. Large banks' strong capital positions have allowed them to manage their leveraged lending exposures, and the exposure of insurers and other investors also appeared manageable. Mutual funds experienced redemptions by investors but were able to meet them in part by selling leveraged loan holdings. While this may have put downward pressure on already-distressed loan prices, based on regulators' assessments, distressed leveraged loan prices did not pose a potential threat to financial stability. Present-day CLO securities appear to pose less of a risk to financial stability than did similar securities during the 2007–2009 financial crisis, according to regulators and market participants. For example, CLO securities have better investor protections, are more insulated from market swings, and are not widely tied to other risky, complex instruments. FSOC monitors leveraged-lending-related risks primarily through its monthly Systemic Risk Committee meetings, but opportunities exist to enhance FSOC's abilities to respond to financial stability threats. FSOC identified leveraged lending activities as a source of potential risk to financial stability before the COVID-19 shock and recommended continued monitoring and analysis. However, FSOC does not conduct tabletop or similar scenario-based exercises where participants discuss roles and responses to hypothetical emergency scenarios. As a result, FSOC is missing an opportunity to enhance preparedness and test members' coordinated response to financial stability risks. Further, as GAO reported in 2016, FSOC does not generally have clear authority to address broader risks that are not specific to a particular financial entity, such as risks from leveraged lending. GAO recommended that Congress consider better aligning FSOC's authorities with its mission to respond to systemic risks, but Congress had not done so as of September 2020. GAO maintains that changes such as broader designation authority would help FSOC respond to risks from activities that involve many regulators, such as leveraged lending. The market for institutional leveraged loans grew from an estimated $0.5 trillion in 2010 to $1.2 trillion in 2019, fueled largely by investor demand for CLO securities. Some observers and regulators have drawn comparisons to the pre-2008 subprime mortgage market, noting that loan origination and securitization may similarly spread risks to the financial system. These fears are being tested by the COVID-19 pandemic, which has significantly affected leveraged businesses. This report examines assessments by regulators, FSOC, and others—both before and after the COVID-19 shock to the economy—of the potential risks to financial stability stemming from leveraged lending activities, and the extent to which FSOC monitors and responds to risks from broad-based activities like leveraged lending, among other objectives. GAO examined agency and private data on market size and investor exposures; reviewed agency, industry, and international reports; and interviewed federal financial regulators and industry participants. GAO recommends that the Secretary of the Treasury, as Chairperson of FSOC, conduct scenario-based exercises intended to evaluate capabilities for responding to crises. GAO also reiterates its 2016 recommendation (GAO-16-175) that Congress consider legislative changes to align FSOC's authorities with its mission. FSOC neither agreed nor disagreed with the recommendation, but said that it would take further actions if it determined necessary. For more information, contact Michael E. Clements at (202) 512-8678 or ClementsM@gao.gov.
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  • Medicare and Medicaid: COVID-19 Program Flexibilities and Considerations for Their Continuation
    In U.S GAO News
    What GAO Found In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for overseeing Medicare and Medicaid, made widespread use of program waivers and other flexibilities to expand beneficiary access to care. Some preliminary information is available on the effects of these waivers. Specifically: Medicare. CMS issued over 200 waivers and cited some of their benefits in a January 2021 report. For example, CMS reported that: Expansion of hospital capacity. More than 100 new facilities were added through the waivers that permitted hospitals to provide care in non-hospital settings, including beneficiaries' homes. Workforce expansion. Waivers and other flexibilities that relaxed certain provider enrollment requirements and allowed certain nonphysicians, such as nurse practitioners, to provide additional services expanded the provider workforce. Telehealth waivers. Utilization of telehealth services—certain services that are normally provided in-person but can also be provided using audio and audio-video technology—increased sharply. For example, utilization increased from a weekly average of about 325,000 services in mid-March to peak at about 1.9 million in mid-April 2020. Medicaid. CMS approved more than 600 waivers or other flexibilities aimed at addressing obstacles to beneficiary care, provider availability, and program enrollment. GAO has reported certain flexibilities such as telehealth as critical in reducing obstacles to care. Examples of other flexibilities included: Forty-three states suspended fee-for-service prior authorizations, which help ensure compliance with coverage and payment rules before beneficiaries can obtain certain services. Fifty states and the District of Columbia waived certain provider screening and enrollment requirements, such as criminal background checks. While likely benefitting beneficiaries and providers, these program flexibilities also increase certain risks to the Medicare and Medicaid programs and raise considerations for their continuation beyond the pandemic. For example: Increased spending. Telehealth waivers can increase spending in both programs, if telehealth services are furnished in addition to in-person services. Program integrity. The suspension of some program safeguards has increased the risks of fraud, waste, and abuse that GAO previously noted in its High-Risk report series. Beneficiary health and safety. Although telehealth has enabled the safe provision of services, the quality of telehealth services has not been fully analyzed. Why GAO Did This Study Medicare and Medicaid—two federally financed health insurance programs—spent over $1.5 trillion on health care services provided to about 140 million beneficiaries in 2020. Recognizing the critical role of these programs in providing health care services to millions of Americans, the federal government has provided for increased funding and program flexibilities, including waivers of certain federal requirements, in response to the COVID-19 pandemic. The CARES Act includes a provision for GAO to conduct monitoring and oversight of the federal government's response to the COVID-19 pandemic. In response, GAO has issued a series of government-wide reports from June 2020 through March 2021. GAO is continuing to monitor and report on these services. This testimony summarizes GAO's findings from these reports related to Medicare and Medicaid flexibilities during the COVID-19 pandemic, as well as preliminary observations from ongoing work related to telehealth waivers in both programs. Specifically, the statement focuses on what is known about the effects of these waivers and flexibilities on Medicare and Medicaid, and considerations regarding their ongoing use. To conduct this work, GAO reviewed federal laws, CMS documents and guidance, and interviewed federal and state officials. GAO also interviewed six provider and beneficiary groups, selected based on their experience with telehealth services. GAO obtained technical comments from CMS and incorporated them as appropriate. For more information, contact Jessica Farb at (202) 512-7114 or farbj@gao.gov or Carolyn L. Yocom at (202) 512-7114 or yocomc@gao.gov.
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    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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    In U.S GAO News
    What GAO Found The Federal Aviation Administration (FAA) recently updated and streamlined its launch and reentry licensing regulations but has made less progress on other key commercial space transportation regulations. The new licensing regulations, issued in December 2020, replaced prescriptive requirements—in which a certain technology or action was required—with a performance-based regulatory framework, which provides applicants flexibility in how they achieve required outcomes, such as a specific level of safety. Given its focus on the licensing regulations, FAA placed on hold revisions to other regulations governing commercial space transportation—revisions which, according to FAA officials, are warranted given the industry's evolution. For example, FAA has not yet begun to revise its financial responsibility regulations, which require launch companies conducting FAA-licensed launches to purchase insurance to cover damage to third parties in case of a launch mishap. According to FAA officials, revising these regulations is their next planned rulemaking and when finalized, will respond to GAO's recommendations to improve FAA's methodologies for evaluating and calculating potential third-party losses from launch and reentry mishaps and help ensure the federal government is not exposed to greater liability than expected. FAA also faces ongoing challenges regulating an evolving industry. In particular, as GAO previously reported, FAA continues to face the challenge of whether and when to regulate the safety of crew and spaceflight participants. While some companies have announced plans to take tourists to space within the next several years, FAA is prohibited by statute from regulating crew and passenger safety before 2023, except in response to events that caused or posed a risk of serious or fatal injury. However, FAA has taken some steps in anticipation of the expiration of the statutory moratorium, such as working with its industry advisory committee to develop and disseminate human spaceflight best practices. FAA also has taken some steps to help the agency keep pace with changes in the industry. For example, in response to recommendations GAO made in 2019, FAA recently assessed its workforce to identify skills and competencies that are needed among its workforce and is working to improve its workload projections to better account for the full range of its regulatory activities and the timeline of its licensing process. Such efforts are critical for ensuring FAA can better anticipate and respond to the growing and evolving commercial space industry and FAA's emerging workforce needs. Why GAO Did This Study The commercial space transportation industry provides launch services for government and private customers that carry objects, such as satellites and vehicles with scientific research, or passengers to or from space. Continued growth and evolution in the industry is expected as reliance on space-based applications increases. Within FAA, the Office of Commercial Space Transportation (AST) is charged both with overseeing the industry, including licensing and monitoring launch vehicle operations, and promoting the industry. This statement describes FAA's efforts to update regulations governing commercial space transportation; challenges FAA faces regulating an evolving industry; and steps FAA has taken to help ensure it is positioned to meet the needs of the evolving industry. This statement is based largely on GAO's body of work on commercial space transportation, including GAO-19-437 issued in May 2019. To update this information, GAO interviewed FAA officials and reviewed applicable statutes, regulations and selected industry documents.
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