Secretary Pompeo’s Meeting with French Foreign Minister Le Drian

Office of the Spokesperson

The below is attributable to Principal Deputy Spokesperson Cale Brown:

Secretary of State Michael R. Pompeo met with French Foreign Minister Jean-Yves Le Drian today in Paris, France.  Secretary Pompeo and Foreign Minister Le Drian emphasized the importance of the Transatlantic alliance and our shared goal of NATO unity.  The Secretary and the Foreign Minister stressed the significance of political reconciliation in Libya under a UN-led political process.  The Secretary discussed our strong alliance in countering the Chinese Communist Party’s malign activity in Europe and human rights abuses in Xinjiang.  Secretary Pompeo also discussed the need to combat violent extremism and highlighted Hizballah’s malign influence in Lebanon as well as U.S. efforts toward a stable and reform-focused government there.  The Secretary and the Foreign Minister underscored our joint efforts on democracy, security, and prosperity in the Sahel.

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    As of January 2021, the Office of Management and Budget (OMB) had not established the Research Policy Board as required by the 21st Century Cures Act. The act requires OMB to establish the Board within 1 year of the December 13, 2016 enactment of the act. The Board is to provide information on the effects of regulations related to federal research requirements. OMB stated that it had not established the Board because of issues with the Department of Health and Human Services’ (HHS) and other federal agencies’ full participation in the Board’s potential activities to develop or implement a modified approach to indirect cost policies. According to OMB, “the Board would necessarily delve into issues related to compliance burden and indirect cost reimbursement to entities that receive federal funding for research.” Specifically, OMB pointed to a statutory provision appearing in annual appropriations bills that it believes prohibits HHS and other agencies from taking action on issues that could implicate certain indirect cost provisions. According to OMB, this provision could, if continued in future bills, “complicate or even possibly prohibit HHS from participating in major elements of the Board’s process.” OMB stated that, without representation of a major research agency such as the National Institutes of Health (NIH), which is part of HHS, “OMB would not be equipped to meet the statutory goals of the Board.” However, HHS stated in October 2020 that the indirect cost provision would not prohibit NIH’s participation on the Board and that the department was not aware of any other appropriations law provision that would prohibit such participation. GAO has no basis to disagree with HHS’s position. The 21st Century Cures Act does not specifically direct the Board to examine issues related to indirect costs, and we identified other issues that may fall within the scope of the Board’s activities. For example, the act specifies five activities that the Board may conduct, including creating a forum for the discussion of research policy or regulatory gaps, and identifying regulatory process improvements and policy changes. The Board could consider examining these or other issues related to streamlining and harmonizing regulations and reducing administrative burden in federally funded research in accordance with the 21st Century Cures Act. By not having established the Board, OMB is missing opportunities for the Board to provide information on the effects of regulations related to requirements for federally funded research, and to make recommendations to harmonize and streamline such requirements. Further, OMB has limited time to establish the Board and the Board may have insufficient time to complete its work before the Board is set to terminate on September 30, 2021. The 21st Century Cures Act requires OMB to establish an advisory committee, to be known as the Research Policy Board, that is responsible for making recommendations on modifying and harmonizing regulation of federally funded research to reduce administrative burden. The Board is to consist of both federal and non-federal members and include not more than 10 members from federal agencies, including officials from OMB, the Office of Science and Technology Policy (OSTP), HHS, the National Science Foundation, and other departments and agencies that support or regulate scientific research, as determined by the OMB Director. The 21st Century Cures Act includes a provision for GAO to conduct an independent evaluation of the Board’s activities. This report examines the steps OMB has taken to establish the Board as required by the 21st Century Cures Act. GAO reviewed written responses and other information from OMB, HHS, and OSTP; the 21st Century Cures Act and other laws related to the Board and its establishment; relevant reports on issues related to administrative burden; and related documents such as memoranda and agency guidance. GAO submitted a draft report containing the results of its evaluation to Congress on December 10, 2020. Congress should consider extending the period of authorization for the Research Policy Board, giving OMB additional time to establish the Research Policy Board and complete its statutory mission under the 21st Century Cures Act. GAO recommends that OMB establish the Research Policy Board as mandated by the 21st Century Cures Act and report to Congress on the Board’s activities. OMB did not agree or disagree with this recommendation. We maintain that the evidence in this report shows the need for our recommendation. For more information, contact John Neumann at (202) 512-6888 or neumannj@gao.gov.
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    GAO found that when rural hospitals closed, residents living in the closed hospitals' service areas would have to travel substantially farther to access certain health care services. Specifically, for residents living in these service areas, GAO's analysis shows that the median distance to access some of the more common health care services increased about 20 miles from 2012 to 2018. For example, the median distance to access general inpatient services was 3.4 miles in 2012, compared to 23.9 miles in 2018—an increase of 20.5 miles. For some of the less common services that were offered by a few of the hospitals that closed, this median distance increased much more. For example, among residents in the service areas of the 11 closed hospitals that offered treatment services for alcohol or drug abuse, the median distance was 5.5 miles in 2012, compared to 44.6 miles in 2018—an increase of 39.1 miles to access these services (see figure). Median Distance in Miles from Service Areas with Rural Hospital Closures to the Nearest Open Hospital that Offered Certain Health Care Services, 2012 and 2018 Notes: GAO focused its analysis on the health care services offered in 2012 by the 64 rural hospitals that closed during the years 2013 through 2017 and for which data were available. For example, in 2012, 64 closed hospitals offered general inpatient services, 62 offered emergency department services, 11 offered treatment services for alcohol or drug abuse, and 11 offered services in a coronary care unit. To examine distance, GAO calculated “crow-fly miles” (the distance measured in a straight line) from the geographic center of each closed rural hospital's service area to the geographic center of the ZIP Code with the nearest open rural or urban hospital that offered a given service. GAO also found that the availability of health care providers in counties with rural hospital closures generally was lower and declined more over time, compared to those without closures. Specifically, counties with closures generally had fewer health care professionals per 100,000 residents in 2012 than did counties without closures. The disparities in the availability of health care professionals in these counties grew from 2012 to 2017. For example, over this time period, the availability of physicians declined more among counties with closures—dropping from a median of 71.2 to 59.7 per 100,000 residents—compared to counties without closures—which dropped from 87.5 to 86.3 per 100,000 residents. Rural hospitals face many challenges in providing essential access to health care services to rural communities. From January 2013 through February 2020, 101 rural hospitals closed. GAO was asked to examine the effects of rural hospital closures on residents living in the areas of the hospitals that closed. This report examines, among other objectives, how closures affected the distance for residents to access health care services, as well as changes in the availability of health care providers in counties with and without closures. GAO analyzed data from the Department of Health and Human Services (HHS) and the North Carolina Rural Health Research Program (NC RHRP) for rural hospitals (1) that closed and those that were open during the years 2013 through 2017, and (2) for which complete data generally were available at the time of GAO's review. GAO also interviewed HHS and NC RHRP officials and reviewed relevant literature. GAO defined hospitals as rural according to data from the Federal Office of Rural Health Policy. GAO defined hospital closure as a cessation of inpatient services, the same definition used by NC RHRP. GAO defined service areas with closures as the collection of ZIP Codes that were served by closed rural hospitals and service areas without closures as the collection of ZIP Codes served only by rural hospitals that were open. GAO provided a draft of this report to HHS for comment. The Department provided technical comments, which GAO incorporated as appropriate. For more information, contact James Cosgrove at (202) 512-7114 or cosgrovej@gao.gov.
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    Most state Adult Protective Services (APS) agencies have been providing data on reports of abuse to the Department of Health and Human Services (HHS), including data on financial exploitation, although some faced challenges collecting and submitting these data. Since states began providing data to HHS's National Adult Maltreatment Reporting System (NAMRS) in 2017, they have been voluntarily submitting more detailed data on financial exploitation and perpetrators each year (see figure). However, some APS officials GAO interviewed in selected states said collecting data is difficult, in part, because victims are reluctant to implicate others, especially family members or other caregivers. APS officials also said submitting data to NAMRS was challenging initially because their data systems often did not align with NAMRS, and caseworkers may not have entered data in the system correctly. HHS has provided technical assistance and grant funding to help states address some of these challenges and help provide a better picture of the prevalence of the various types of financial exploitation and its perpetrators nationwide. Number of States That Provide Data on Financial Exploitation and Perpetrators to NAMRS Studies estimate some of the costs of financial exploitation to be in the billions, but comprehensive data on total costs do not exist and NAMRS does not currently collect cost data from APS agencies. The Consumer Financial Protection Bureau found actual losses and attempts at elder financial exploitation reported by financial institutions nationwide were $1.7 billion in 2017. Also, studies published from 2016 to 2020 from three states—New York, Pennsylvania, and Virginia—estimated the costs of financial exploitation could be more than $1 billion in each state alone. HHS does not currently ask states to submit cost data from APS casefiles to NAMRS, though officials said they have begun to reevaluate NAMRS with state APS agencies and other interested parties, including researchers, and may consider asking states to submit cost data moving forward. Adding cost data to NAMRS could make a valuable contribution to the national picture of the cost of financial exploitation. Recognizing the importance of these data, some APS officials GAO interviewed said their states have developed new data fields or other tools to help caseworkers collect and track cost data more systematically. HHS officials said they plan to share this information with other states to make them aware of practices that could help them collect cost data, but they have not established a timeframe for doing so. Elder financial exploitation—the fraudulent or illegal use of an older adult's funds or property—has far-reaching effects on victims and society. Understanding the scope of the problem has thus far been hindered by a lack of nationwide data. In 2013, HHS worked with states to create NAMRS, a voluntary system for collecting APS data on elder abuse, including financial exploitation. GAO was asked to study the extent to which NAMRS provides information on elder financial exploitation. This report examines (1) the status of HHS's efforts to compile nationwide data through NAMRS on the extent of financial exploitation and the challenges involved, and (2) what is known about the costs of financial exploitation to victims and others. GAO analyzed NAMRS data from fiscal year 2016 through 2019 (the most recent available); reviewed relevant federal laws; and interviewed officials from HHS, other federal agencies, elder abuse prevention organizations, and researchers. GAO also reviewed APS documents and spoke with officials in eight states, selected based on their efforts to study, collect, and report cost data; and reviewed studies on financial exploitation. GAO recommends that HHS (1) work with state APS agencies to collect and submit cost data to NAMRS, and (2) develop a timeframe to share states' tools to help collect cost data. HHS did not agree with the first recommendation, but GAO maintains that it is warranted, as discussed in the report. HHS agreed with the second recommendation. For more information, contact Kathryn A. Larin at (202) 512-7215 or larink@gao.gov.
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