Somalia Should Hold Elections Immediately

Antony J. Blinken, Secretary of State

The United States is deeply concerned by the electoral impasse in Somalia, which is creating political uncertainty that threatens security, stability, and development in the country.  We call on Somalia’s federal and member state leaders to set aside narrow political objectives, uphold their responsibilities to the people of Somalia, and agree to immediately hold transparent and inclusive elections.

The current impasse undermines progress made to date, delays reforms urgently needed for Somalia to continue on the path to full debt relief, and hinders the fight against terrorism.  The United States supports the right of Somali citizens to protest peacefully and firmly opposes the use of violence by any party.  We urge Somalia’s leaders to safeguard the country’s future and find agreement to immediately conduct parliamentary and presidential elections.

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    GAO's analysis of Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) data show that in fiscal year 2018, 287,547 Medicare fee-for-service beneficiaries had inpatient stays that included care for severe wounds. These wounds include those where the base of the wound is covered by dead tissue or non-healing surgical wounds. About 73 percent of the inpatient stays occurred in acute care hospitals (ACH), and a smaller percentage of stays occurred in post-acute care facilities. Specifically, about 16 percent of stays were at skilled nursing facilities (SNF), and about 7 percent were at long-term care hospitals (LTCH). CMS data show that Medicare spending on stays for severe wound care was $2.01 billion in fiscal year 2018, representing a decline of about 2 percent from fiscal year 2016, when spending was about $2.06 billion. Spending declined as a result of decreases in both the total number of these stays, as well as spending per stay, which both decreased by about 1 percent. The decrease in per stay spending was likely driven, in part, by a change in where beneficiaries received care. CMS data show fewer severe wound care stays in LTCHs, which tend to be paid higher payment rates. At the same time, more severe wound care stays were at two other types of facilities that tend to be paid lower payment rates: ACHs and inpatient rehabilitation facilities. GAO's analysis of CMS data also show that, while the number of LTCHs that billed Medicare for severe wound care decreased by about 7 percent from fiscal years 2016 to 2018, Medicare beneficiaries continued to have access to other severe wound care providers. For example, CMS data show that most beneficiaries resided within 10 miles of an ACH or SNF that provided severe wound care in fiscal year 2018. Figure: Percentage of Medicare Fee-for-Service Beneficiaries Residing within 10 Miles of a Health Care Facility That Provided Any Severe Wound Care, by Facility Type, Fiscal Year 2018 Note: The “other” category includes facilities such as psychiatric hospitals or units. There is limited information on how or whether the decrease in LTCH care for severe wounds may have affected the quality of severe wound care Medicare beneficiaries receive. For example, CMS collects information on the percentage of patients with new or worsened pressure ulcers at post-acute care facilities, but it does not measure the quality of care they receive. Medicare beneficiaries with serious health conditions, such as strokes, are prone to developing severe wounds due to complications that often lead to immobility and prolonged pressure on the skin. These beneficiaries may require a long-term inpatient stay at an ACH or a post-acute care facility, such as an LTCH. LTCHs treat patients who require care for longer than 25 days, on average. In 2018, LTCHs represented about $4.2 billion in Medicare expenditures. Prior to fiscal year 2016, LTCHs received a higher payment rate for treating Medicare beneficiaries than ACHs. Beginning in fiscal year 2016, a dual payment system was phased in that paid LTCHs a rate similar to ACHs for some beneficiaries and a higher rate for beneficiaries that met certain criteria. As this payment system has moved from partial to full implementation, lawmakers had questions about how it may affect beneficiaries' severe wound care. The 21st Century Cures Act included a provision for GAO to review severe wound care provided to Medicare beneficiaries. This report describes facilities where Medicare beneficiaries received severe wound care, Medicare severe wound care spending, and what is known about the dual payment system's effect on access and quality. GAO analyzed Medicare severe wound care access and spending data for fiscal years 2016 and 2018 (the most recent data available); reviewed reports; and interviewed CMS officials, researchers, and national wound care stakeholders. HHS provided technical comments on a draft of this report, which were incorporated as appropriate. For more information, contact James Cosgrove at (202) 512-7114 or cosgrovej@gao.gov.
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    In Crime Control and Security News
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  • Second Member Of “Boogaloo Bois” Pleads Guilty to Conspiracy to Provide Material Support to Hamas
    In Crime News
    A Minnesota man pleaded guilty today to conspiracy to provide material support and resources, namely property, services and weapons, to what he believed was Hamas, a designated foreign terrorist organization, for use against Israeli and U.S. military personnel overseas.
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  • DHS Employee Morale: Some Improvements Made, but Additional Actions Needed to Strengthen Employee Engagement
    In U.S GAO News
    The Department of Homeland Security (DHS) and each of its major components face the same key drivers of employee engagement—as measured by the Office of Personnel Management's Federal Employee Viewpoint Survey (OPM FEVS)—as the rest of the federal government (see table). Higher scores on the OPM FEVS indicate that an agency has the conditions that lead to higher employee engagement, a component of morale. Key Drivers of Employee Engagement across the Federal Government, the Department of Homeland Security (DHS), and within Each DHS Component Agency DHS has implemented department-wide employee engagement initiatives, including efforts to support DHS employees and their families. Additionally, DHS's major operational components, such as U.S. Customs and Border Protection and the Transportation Security Administration, among others, have developed annual action plans to improve employee engagement. However, DHS has not issued written guidance on action planning and components do not consistently include key elements in their plans, such as outcome-based performance measures. Establishing required action plan elements through written guidance and monitoring the components to ensure they use measures to assess the results of their actions to adjust, reprioritize, and identify new actions to improve employee engagement would better position DHS to make additional gains in this area. In addition, approval from the DHS Office of the Chief Human Capital Officer (OCHCO) and component leadership for these plans would help ensure department-wide commitment to improving employee engagement. DHS has faced challenges with low employee morale and engagement—an employee's sense of purpose and commitment—since it began operations in 2003. DHS has made some progress in this area, but data from the 2019 OPM FEVS show that DHS continues to rank lowest among similarly-sized federal agencies. GAO has reported that increasing employee engagement can lead to improved agency performance, and it is critical that DHS do so given the importance of its missions. GAO was asked to review DHS employee morale. This report addresses (1) drivers of employee engagement at DHS and (2) the extent that DHS has initiatives to improve employee engagement and ensures effective engagement action planning. To answer these objectives, GAO used regression analyses of 2019 OPM FEVS data to identify the key drivers of engagement at DHS. GAO also reviewed component employee engagement action plans and met with officials from DHS and component human capital offices as well as unions and employee groups. GAO is making three recommendations. DHS OCHCO should, in its anticipated written guidance, establish the elements required in employee engagement action plans and the approval process for these plans. OCHCO should also monitor components' action planning to ensure they review and assess the results of their actions to improve employee engagement. DHS concurred with GAO's recommendations. For more information, contact Chris Currie at (404) 679-1875 or CurrieC@gao.gov.
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  • Technology Assessment Design Handbook
    In U.S GAO News
    The Technology Assessment (TA) Design Handbook identifies tools and approaches GAO staff and others can consider in the design of robust and rigorous technology assessments. The handbook underscores the importance of TA design (Chapter 1), outlines the process of designing TAs (Chapter 2), and describes approaches for mitigating select TA design and implementation challenges (Chapter 3). While the primary audience of this handbook is GAO staff, other organizations may also find portions of this handbook useful as they consider or conduct TAs. This is an update to the handbook published in December 2019, based on the experiences of GAO teams and a review of relevant literature and comments submitted by external experts and the public between December 2019 and December 2020. The handbook identifies three general design stages, as shown in the figure below. The handbook also highlights seven cross-cutting considerations for designing TAs: the iterative nature of TA design, congressional and policymakers' interests, resources, independence, engaging internal and external stakeholders, potential challenges, and communication strategy. In addition, the handbook provides a high-level process for developing policy options, as a tool for analyzing and articulating a range of possible actions a policymaker could consider that may enhance the benefits or mitigate the challenges of a technology. Steps in developing policy options include, as applicable: determining the potential policy objective; gathering evidence; identifying possible policy options and the relevant dimensions along which to analyze them; analyzing policy options; and presenting the results of the analysis. Summary of Key Stages of Technology Assessment Design We found that GAO TAs can use a variety of design approaches and methods. The handbook includes TA design and methodology examples, along with example objectives commonly found in GAO TAs, such as: describe a technology, assess opportunities and challenges of a technology, and assess policy implications or options. For example, some GAO TAs include an objective related to describing the status and feasibility of a technology, which GAO teams have addressed by using methodologies such as expert panels, interviews, literature and document reviews, site visits, and determining the technology readiness level. Also included in the handbook are examples of TA design and implementation challenges, along with possible mitigation strategies. We identified four general categories of challenges: (1) ensuring that the design and implementation of TAs result in useful products for Congress and other policymakers; (2) determining the policy objective and measuring potential effects; (3) researching and communicating complicated issues; and (4) engaging relevant stakeholders. For example, allowing sufficient time for writing, review, and any needed revisions is one potential mitigation strategy that could help teams write simply and clearly about technical subjects and ensure that the design and implementation of TAs result in useful products for Congress and other policymakers. In 2019, GAO created the Science, Technology Assessment, and Analytics team to expand its work on cutting-edge science and technology issues, and to provide oversight, insight, and foresight for science and technology. TAs can be used to strengthen decision-making, enhance knowledge and awareness, and provide early insights into the potential effects of technology. Systematically designing a TA can enhance its quality, credibility, and usefulness; ensure independence of the analysis; and ensure effective use of resources. Under Comptroller General Authority, we developed this handbook by generally following the format of the 2012 GAO methodology transfer paper, Designing Evaluations. Below is a summary of the approach we used to affirm and document TA design steps and considerations for this handbook. Reviewed select GAO documents, including Designing Evaluations (GAO-12-208G), published GAO TAs, select GAO products using policy analysis approaches to present policy options, and other GAO reports Reviewed select Office of Technology Assessment reports Reviewed select Congressional Research Service reports Reviewed select English-language literature regarding TAs and related to development and analysis of policy options Consulted with external experts and performed outreach, including holding an expert meeting to gather input on TA design, soliciting comments from external experts who contributed to GAO TAs published since 2015, and soliciting comments from the public Reviewed experiences of GAO teams that have successfully assessed and incorporated policy options into GAO products and TA design, including challenges to TA design and implementation and possible solutions GAO is not making any recommendations. For more information, contact Timothy M. Persons or Karen L. Howard at (202) 512-6888 or personst@gao.gov or howardk@gao.gov.
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  • Couple Pleads Guilty to $1.1 Million COVID-Relief Fraud After Falsely Claiming to Be Farmers
    In Crime News
    A Florida couple pleaded guilty for their participation in a scheme to file four fraudulent loan applications seeking more than $1.1 million in forgivable Paycheck Protection Program (PPP) and Economic Injury Disaster Loans (EIDL) loans guaranteed by the Small Business Administration (SBA) under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
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  • Former NGO Procurement Official Sentenced to Prison for Bribery
    In Crime News
    A former non-governmental organization (NGO) official was sentenced today to 40 months in prison for paying bribes to NGO officers in exchange for sensitive procurement information related to NGO contracts funded in part by the U.S. Agency for International Development (USAID).
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