Some Courts Slow Reopening Plans as COVID Cases Rise

At a time when some states are backtracking on plans to restore business and government operations, a number of federal courts also are slowing plans to reopen courthouse doors as coronavirus (COVID-19) case numbers escalate in many states.

In recent weeks, federal courts, especially in Sun Belt “hot spot” states, have issued orders extending courthouse closures, postponement of jury trials, and the use of video and teleconferencing for most or all proceedings. Most of the orders cited rising COVID-19 numbers.

“Unfortunately, the last month has seen an increase in the rate of spread across the state, and the rolling seven-day average of new cases is at an all-time high,” wrote Chief Judge Daniel P. Jordan III, of the U.S. District Court for the Southern District of Mississippi, in a July 1 order. The court postponed all but one jury trial until August.

The Northern District of Texas, which in early June successfully staged a criminal jury trial using social distancing measures, postponed all jury trials scheduled for July in the district’s Dallas courthouse.

Courts in Florida, Arizona, California, Louisiana, Mississippi, Georgia, and South Carolina all have issued orders postponing a return to full courthouse operations. Numerous courts outside the Sun Belt also have slowed resumption of jury trials, even where COVID-19 case counts have plateaued.

“We have definitely hit the pause button,” said Chief Judge James K. Bredar, of the District of Maryland, where local COVID-19 cases have fallen since their peak. He hopes to hold a few small jury trials in August, to test out new safety procedures devised by the court.

Since the pandemic escalated in March, federal courts have responded in varied ways, depending largely on local conditions. While some continued to hold in-person proceedings, many districts closed courthouse buildings or curtailed public entry, conducting most proceedings by video or teleconference.

However, most courts have worked cautiously but diligently to resume in-person courtroom  proceedings, noting that criminal defendants have a constitutional right to a speedy trial. Efforts have included social distancing and mask mandates, building plexiglass barriers into courtrooms, and limiting how many people can share an elevator.

A memo sent to federal courts in late April proposed an exhaustive set of “gating” criteria for courts to consider as they gradually progress through four phases, or, reverse course to move into earlier phases if local conditions deteriorate.

The criteria included local public health agency recommendations, which rely on conditions such as total population, population density, number of people over age 60, the availability of intensive care unit beds, and confirmed cases of COVID-19. 

Even where courts have begun reopening courthouse doors, conditions remain fluid, judges and court staff said. “We are monitoring it daily,” said Chief Judge David C. Nye, of the District of Idaho, who recently reinstated a limit of 50 persons attending any one proceeding at the Boise courthouse after the COVID-19 warning for Boise was revised.

In the District of Arizona, jury trials have been indefinitely postponed in the Flagstaff courthouse, and customer service counters are closed in Phoenix, Tucson, Flagstaff, and Yuma. “The number of daily diagnosed cases of COVID-19 have recently and considerably increased in the State of Arizona resulting from, among other factors, increased community spread,” a June 24 order noted.

In the Eastern District of Louisiana, which includes New Orleans, criminal and civil jury trials have been postponed until Oct. 5. A June 26 order cited “the severity of risks posed to the public, Court staff, and other Court agencies.”

In the Southern District of Florida, which includes Miami, jury trials and grand jury proceedings have been suspended until Oct. 13. “Judges are strongly encouraged to conduct court proceedings by telephone or video conferencing,” a June 29 order said.

And the Southern District of California, which includes San Diego, continued postponement of jury trials until mid-August. “Many of the circumstances giving rise to the judicial emergency have not abated,” said a July 13 order signed by Chief Judge Larry Alan Burns. “To protect the public safety and prevent the spread of COVID-19, the Chief Judge … hereby extends the judicial emergency for an additional period of 30 days.”

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    The 2020 filing season occurred during the global COVID-19 pandemic, introducing challenges that the Internal Revenue Service (IRS) had to respond to quickly to fulfill its mission-essential functions. IRS took steps to protect the integrity of its operations, help ensure the health and safety of its employees, and provide relief to taxpayers. For example, IRS closed all its processing and service facilities for several weeks before re-opening with health and safety measures and extended the filing season deadline to July 15, 2020. IRS's 2020 processing of e-filed returns was generally on par with prior years. However, IRS's overall 2020 performance was significantly impacted by its reliance on manual processes such as for paper returns, and its limited ability to process returns remotely while processing centers were closed. As a result, as of December 2020, IRS had a significant backlog of unprocessed returns and taxpayer correspondence. Additionally, costs increased including interest on delayed refunds which exceeded $3 billion in fiscal year 2020. IRS has not revised its estimates for addressing all of the backlog due to operational uncertainties created by the pandemic. Doing so would help IRS determine how best to address the backlog and perform 2021 filing season activities. Refund Interest Paid to Taxpayers, Fiscal Years 2019 and 2020 GAO also found that about 23 percent of business tax returns were filed on paper even though an e-file option is available. IRS has not comprehensively identified barriers to business-related e-filing nor taken specific actions to increase e-filing. Doing so would help reduce the volume of costly paper-based work and improve services to business filers. Further, during the filing season, IRS transitioned nearly two-thirds of its phone customer service staff to telework, but was unable to do so for returns processing staff because most of its paper-based work is not set up to be performed remotely. As of late October 2020, about one-third of these staff remained on paid leave. Identifying and implementing alternative work assignments for staff that remain on paid leave would better support IRS operations and reduce costs. IRS has not fully identified and assessed all risks to the 2021 filing season—including those exacerbated by the COVID-19 pandemic—consistent with enterprise risk management practices. IRS identified some risks in October 2020 after GAO raised concerns, but did not fully address all essential elements of enterprise risk management, such as identifying options for risk response. Doing so would better position IRS to respond to risks during the 2021 filing season. In early 2021, after receiving a draft of this report, IRS provided additional information on its risk management efforts. GAO will review this information to determine if these efforts are sufficient to address its recommendation. During the annual tax filing season, generally from January to mid-April, IRS processes more than 150 million individual and business tax returns and provides telephone, correspondence, online, and in-person services to tens of millions of taxpayers. Due to the COVID-19 pandemic and to provide relief to taxpayers, IRS extended the 2020 filing and payment deadline by 3 months to July 15, 2020. GAO was asked to review IRS's performance during the 2020 filing season. This report (1) describes the changes IRS made to operations and services for the 2020 filing season due to the COVID-19 pandemic; (2) assesses IRS's performance on providing customer service and processing individual and business income tax returns during the 2020 filing season and compare to prior filing seasons, where appropriate; and (3) evaluates IRS's plans to prepare for the 2021 filing season. GAO analyzed IRS documents, filing season performance data, and employee timecard data; assessed IRS's plans for the 2021 filing season; and interviewed cognizant officials. GAO is making seven recommendations, including that IRS revise estimates for addressing its backlog; identify and address barriers to e-filing for business taxpayers; identify and consider implementing alternative work assignments for returns processing staff on paid leave; and identify and assess risks to the 2021 filing season. IRS agreed with four recommendations and disagreed with three. GAO believes that the recommendations remain warranted. For more information, contact Jessica Lucas-Judy at (202) 512-6806 or lucasjudyj@gao.gov.
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  • Small Business Contracting: Better Documentation and Reporting Needed on Procurement Center Representatives
    In U.S GAO News
    The Small Business Administration (SBA) does not maintain complete documentation to support data on the activities of procurement center representatives (PCR), which is information used to oversee PCRs and assess their performance. PCRs are responsible for helping small businesses gain access to federal contracting and subcontracting opportunities—for example, by making set-aside recommendations to federal agency contracting officers. SBA area offices generate a monthly report that summarizes data on PCRs' activities and accomplishments, and SBA procedures require PCRs to maintain these reports and the supporting documentation. GAO found that they do not consistently do either. According to SBA officials, in some cases the supporting documentation, which PCRs store on their individual computers or in their offices, either was destroyed or was not maintained after PCRs left their positions. Officials told GAO that SBA recently implemented a new database and established a policy requiring the monthly reports to be maintained in the database. However, SBA has not established a centralized means of maintaining the supporting documentation. A central repository for PCRs to store their supporting documentation would provide greater assurance that the documentation is maintained as required and help SBA verify the accuracy of the data PCRs report on their activities. SBA assigns PCRs to buying activities, divisions in federal agencies that purchase goods and services based on geographic coverage and other factors. Specifically, PCRs are assigned within one of six regional areas to ensure geographic coverage, at specific federal agencies, and at buying activities that have significant opportunities for small business contracting. However, SBA has not submitted required reports to Congress on its rationale for assigning PCRs to cover buying activities. The Small Business Act, as amended, requires that SBA submit a report (1) identifying each area for which SBA has assigned a PCR, (2) explaining why SBA selected the areas for assignment, and (3) describing the activities performed by PCRs. SBA was required to submit the first report to Congress by December 26, 2010, and subsequent reports every 3 years thereafter. SBA officials told GAO they were not aware of the reporting requirement. As a result, Congress lacks the information these reports were intended to provide, information that could be useful for its oversight of PCRs. The Small Business Act establishes tools to enhance procurement opportunities for small businesses, such as set-asides and requirements that large contractors set goals for using small business subcontractors. SBA's PCRs advocate for the inclusion of small businesses during the procurement process. GAO was asked to examine how PCRs help small businesses gain access to federal contracting and subcontracting opportunities. This report addresses, among other objectives, (1) documentation SBA maintains on the activities of PCRs and (2) how SBA assigns PCRs to cover buying activities and its requirement to report to Congress on these assignments. GAO reviewed SBA policies and procedures, data on PCR assignments, and selected data reported by PCRs and related documentation. GAO also interviewed agency officials. GAO recommends that SBA (1) develop a central repository for PCRs to store the supporting documentation for the data they report on their activities and (2) ensure that it submits required reports to Congress on PCRs' assignments and activities. SBA concurred with both recommendations. For more information, contact William B. Shear at (202) 512-8678 or shearw@gao.gov.
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  • High-Performance Computing: NNSA Could Improve Program Management Processes for System Acquisitions
    In U.S GAO News
    What GAO Found The National Nuclear Security Administration's (NNSA) analysis of alternatives (AOA) process for its $600 million El Capitan HPC acquisition did not fully follow agency policy that states that AOA processes should be consistent with GAO best practices, where possible, and any deviations must be justified and documented. According to GAO best practices, a reliable AOA process should meet four characteristics: it should be comprehensive, well documented, unbiased, and credible. As seen in the table, the AOA process for El Capitan partially met one of these characteristics and minimally met the other three. NNSA did not justify or document the deviations from these best practices, as required by NNSA policy. GAO also found that the AOA process was conducted by the contractor that manages the El Capitan acquisition program, contrary to agency policy and guidance stating that AOAs should be conducted by an independent entity. Without following AOA best practices where possible; justifying and documenting any deviations; and ensuring AOA processes are conducted by an independent entity, as required, NNSA cannot be assured of a reliable assessment of options for meeting critical mission needs. Extent to Which the National Nuclear Security Administration (NNSA) Met the Characteristics of a Reliable Analysis of Alternatives (AOA) Process AOA characteristic GAO assessment Example of deviation Comprehensive Partially met Cost estimates are incomplete and did not follow best practices. Well documented Minimally met The alternatives' descriptions are not detailed enough for a robust analysis. Unbiased Minimally met NNSA had a predetermined solution, acquiring an HPC system, before performing the AOA process. Credible Minimally met The selection criteria appear to have been written for the preferred alternative. Source: GAO analysis of NNSA information. | GAO-21-194 GAO found that, in the second year of the El Capitan acquisition program's 5-year acquisition life cycle, NNSA has fully implemented selected key practices related to program monitoring and control. However, NNSA has only partially implemented key practices related to requirements management. Specifically, El Capitan program officials did not update and maintain acquisition program documents to include current requirements. NNSA officials stated that once the program developed its program plan early in the program's life cycle, they did not require the program to update and maintain that program plan. However, NNSA's own program management policy requires programs to update program documents throughout the duration of the program. Without updating and maintaining El Capitan program documents to include current requirements, NNSA officials may be limited in their ability to ensure that all mission requirements are met. Why GAO Did This Study NNSA is responsible for maintaining the nation's nuclear stockpile. To analyze the performance, safety, and reliability of nuclear weapons, it acquires high-performance computing (HPC) systems to conduct simulations. The latest system, El Capitan, is expected to be fully deployed by March 2024. The committee report accompanying the Energy and Water Development and Related Agencies Appropriations Act, 2019, includes a provision for GAO to review NNSA's management of its Advanced Simulation and Computing program. This report examines, among other things, (1) the extent to which NNSA's AOA process for the El Capitan acquisition met best practices and followed agency policy and guidance and (2) the extent to which NNSA is implementing selected acquisition best practices in carrying out the El Capitan acquisition program. GAO reviewed documents and interviewed NNSA officials and laboratory representatives involved in carrying out the AOA and acquisition processes.
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  • Gender Pay Differences: The Pay Gap for Federal Workers Has Continued to Narrow, but Better Quality Data on Promotions Are Needed
    In U.S GAO News
    The overall pay gap between men and women in the federal workforce has narrowed considerably, from 19 cents on the dollar in 1999 to 7 cents in 2017, but the current pay gap is greater for certain groups of women, according to GAO's analysis of data from the Office of Personnel Management (OPM). Two trends help explain why the pay gap has narrowed: (1) men and women have become more similar in measurable factors related to pay, such as occupation; and (2) women have earned slightly higher rates of pay increases than men. In 2017, most of the overall pay gap—or 6 of 7 cents on the dollar—was not explained by differences between men and women in measurable factors (see figure). This unexplained portion of the pay gap may be due to factors not captured in the data GAO analyzed, such as work experience outside the federal government, or factors that cannot be measured, such as discrimination and individual choices. In 2017, the overall and unexplained gaps were greater for certain groups. For example, compared to White men, the unexplained gap was greater for Hispanic/Latina, Black, and American Indian or Alaska Native women than for White and Asian, Native Hawaiian, or Pacific Islander women. Pay Gap between Men and Women in the Federal Workforce, 1999 to 2017 OPM and the U.S. Equal Employment Opportunity Commission (EEOC) have taken steps to analyze data on the pay gap and help agencies address it. From 2014 to 2016, OPM implemented a government-wide strategy to address the pay gap, and officials said their future efforts will include monitoring the pay gap periodically. EEOC annually collects workforce data from agencies and provides related technical assistance, and officials said they plan to expand these efforts. These data include promotions by gender and race and ethnicity, which EEOC and agencies use to identify potential barriers to career advancement, but GAO found these data were not sufficiently complete. Of the 51 data tables GAO requested, 35 were either missing or had at least one incomplete data element. EEOC officials said this is partly due to promotion applicants not being required to provide demographic information. However, EEOC has not fully assessed the reliability of these data and generally does not follow up with agencies about missing data between technical assistance visits. Without taking steps to assess and improve the quality of these data in a timelier manner, EEOC may miss opportunities to ensure equal opportunity for all promotion applicants. As the nation's largest employer, the federal government employed about 2.7 million workers in 2019. Although the pay gap between men and women in the federal workforce is smaller than it is for the entire U.S. workforce and has narrowed over time, studies show that pay disparities continue to exist. GAO was asked to explore the current status of pay equity in the federal workforce. This report examines how the pay gap between men and women in the federal workforce has changed since 1999, and what factors account for any remaining gap; and the extent to which OPM and EEOC have monitored and taken steps to address the pay gap in the federal workforce, including assessing potential disparities in promotions; among other objectives. GAO analyzed OPM's Enterprise Human Resources Integration data on about 2.1 million federal employees from September 1999 to September 2017 (the most recent reliable data available at the time of GAO's review); reviewed federal agency promotion data collected by EEOC for fiscal years 2015 through 2017 (the most recent available data); and interviewed OPM and EEOC officials and reviewed relevant documentation. GAO recommends that EEOC take steps to assess the quality of federal agency promotion data and address missing data with agencies in a timelier manner. EEOC neither agreed nor disagreed with GAO's recommendation. For more information, contact Cindy Brown Barnes at (202) 512-7215 or brownbarnesc@gao.gov.
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  • Weapon Systems Cybersecurity: Guidance Would Help DOD Programs Better Communicate Requirements to Contractors
    In U.S GAO News
    Since GAO's 2018 report, the Department of Defense (DOD) has taken action to make its network of high-tech weapon systems less vulnerable to cyberattacks. DOD and military service officials highlighted areas of progress, including increased access to expertise, enhanced cyber testing, and additional guidance. For example, GAO found that selected acquisition programs have conducted, or planned to conduct, more cybersecurity testing during development than past acquisition programs. It is important that DOD sustain its efforts as it works to improve weapon systems cybersecurity. Contracting for cybersecurity requirements is key. DOD guidance states that these requirements should be treated like other types of system requirements and, more simply, “if it is not in the contract, do not expect to get it.” Specifically, cybersecurity requirements should be defined in acquisition program contracts, and criteria should be established for accepting or rejecting the work and for how the government will verify that requirements have been met. However, GAO found examples of program contracts omitting cybersecurity requirements, acceptance criteria, or verification processes. For example, GAO found that contracts for three of the five programs did not include any cybersecurity requirements when they were awarded. A senior DOD official said standardizing cybersecurity requirements is difficult and the department needs to better communicate cybersecurity requirements and systems engineering to the users that will decide whether or not a cybersecurity risk is acceptable. Incorporating Cybersecurity in Contracts DOD and the military services have developed a range of policy and guidance documents to improve weapon systems cybersecurity, but the guidance usually does not specifically address how acquisition programs should include cybersecurity requirements, acceptance criteria, and verification processes in contracts. Among the four military services GAO reviewed, only the Air Force has issued service-wide guidance that details how acquisition programs should define cybersecurity requirements and incorporate those requirements in contracts. The other services could benefit from a similar approach in developing their own guidance that helps ensure that DOD appropriately addresses cybersecurity requirements in contracts. DOD's network of sophisticated, expensive weapon systems must work when needed, without being incapacitated by cyberattacks. However, GAO reported in 2018 that DOD was routinely finding cyber vulnerabilities late in its development process. A Senate report accompanying the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review DOD's implementation of cybersecurity for weapon systems in development. GAO's report addresses (1) the extent to which DOD has made progress in implementing cybersecurity for weapon systems during development, and (2) the extent to which DOD and the military services have developed guidance for incorporating weapon systems cybersecurity requirements into contracts. GAO reviewed DOD and service guidance and policies related to cybersecurity for weapon systems in development, interviewed DOD and program officials, and reviewed supporting documentation for five acquisition programs. GAO also interviewed defense contractors about their experiences with weapon systems cybersecurity. GAO is recommending that the Army, Navy, and Marine Corps provide guidance on how programs should incorporate tailored cybersecurity requirements into contracts. DOD concurred with two recommendations, and stated that the third—to the Marine Corps—should be merged with the one to the Navy. DOD's response aligns with the intent of the recommendation. For more information, contact W. William Russell at (202) 512-4841 or russellw@gao.gov.
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  • Fake Title – Maintenance (4/18)
    In U.S GAO News
    GAO Email Notification Test We are testing our notification distribution process for GAO reports. If you are able to read this information the link contained in the email notification link worked. Please confirm that you received the email notification from GAOReports@gao.gov and used the link to access the prepublication site by contacting Andrea Thomas at thomasa@gao.gov (202) 512-3147 John Miller at millerj@gao.gov (202) 512-3672 Thank you
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  • Home Foreclosure Sales: FHA, Rural Housing Service, and VA Could Better Align Program Metrics with Their Missions
    In U.S GAO News
    By 2019, the number of foreclosed properties—known as real estate-owned (REO) properties—that federal entities owned declined to historically low levels because of the housing market recovery and the sale of many of the properties (see figure). Real Estate-Owned Properties of Selected Federal Entities, 2004–2019 Note: Fannie Mae and Freddie Mac are the government-sponsored enterprises shown here. Data for the enterprises and FHA are calendar year; for VA and RHS, fiscal year ending September 30. The entities GAO reviewed each have processes to oversee their REO maintenance contractors' activities and performance, including internal and external performance reviews and on-site inspections. Entities generally have standardized maintenance policies for REO properties across the country, such as emergency repairs for broken windows and routine maintenance requirements for the frequency of cutting grass. GAO found that the performance of contractors whose documentation GAO reviewed generally met entities' standards and requirements. However, entities' oversight of contractors identified instances of underperformance in maintenance. For instance, the Federal Housing Administration (FHA) recouped almost $3 million from seven property maintenance contractors for work below quality standards from 2017 to 2020. The REO program metrics of FHA, the Department of Veterans Affairs (VA), and the Rural Housing Service (RHS) focus on required financial goals, such as minimizing losses, but do not always align fully with other program goals or agency missions. For example, FHA does not collect comprehensive information on REO property sales to public-sector homeowners or local nonprofits—missing an opportunity to measure the extent to which its REO program supports its goal to strengthen neighborhoods and communities. Similarly, VA and RHS lack metrics that would show whether their REO programs align with their broader agency missions to serve veterans and rural homebuyers, respectively. Incorporating additional metrics could help FHA, VA, and RHS ensure that their REO programs assist in meeting their agencies' missions. Poor maintenance of foreclosed properties can negatively affect communities and threaten neighborhood stability. FHA, VA, RHS, and Freddie Mac are among the federal entities owning foreclosed properties through REO programs. GAO was asked to review how these federal entities monitor REO property conditions. The objectives this report examines include trends in the number of REO properties; oversight of maintenance contractors; and whether metrics used to assess REO program performance align with entities' missions. GAO reviewed and analyzed reports and data on the number of REO properties and documentation on FHA, Freddie Mac, VA, and RHS oversight of REO property maintenance from 2017 to 2020. GAO also analyzed data on REO reimbursements to contractors for maintenance activities. GAO recommends that FHA, VA, and RHS consider additional REO program metrics that measure how the programs support their respective missions of strengthening communities and serving veterans and rural homeowners. The entities generally agreed with the recommendation. For more information, contact John H. Pendleton at (202) 512-8678 or pendletonj@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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  • COVID-19: Critical Vaccine Distribution, Supply Chain, Program Integrity, and Other Challenges Require Focused Federal Attention
    In U.S GAO News
    Since November 2020, the number of COVID-19 cases in the U.S. has rapidly increased, further straining health care systems across the country. Between December 31, 2020, and January 13, 2021, new reported COVID-19 cases averaged about 225,000 per day—over 7 and 3 times higher than the surges the nation experienced during the spring and summer of 2020, respectively. (See figure.) The country also continues to experience serious economic repercussions and turmoil as a result of the pandemic. As of December 2020, there were more than 10.7 million unemployed individuals, compared to nearly 5.8 million individuals at the beginning of the calendar year. Until the country better contains the spread of the virus, the pandemic will likely remain a significant obstacle to more robust economic activity. Reported COVID-19 Cases per Day in the U.S., Through January 13, 2021 As of January 2021, 27 of GAO’s 31 previous recommendations remained unimplemented. GAO remains deeply troubled that agencies have not acted on recommendations to more fully address critical gaps in the medical supply chain. While GAO recognizes federal agencies continue to take some steps, GAO underscores the importance of developing a well-formulated plan to address critical gaps for the remainder of the pandemic, especially in light of the recent surge in cases. In addition, implementation of GAO’s recommendation concerning the importance of clear and comprehensive vaccine distribution and communication plans remains a work in progress. Moreover, slow implementation of GAO’s recommendations relating to program integrity, in particular those made to the Small Business Administration (SBA) and Department of Labor (DOL), creates risk of considerable improper payments, including those related to fraud, and falls far short of transparency and accountability expectations. See appendix III for the status of GAO’s past recommendations. GAO is pleased that the Consolidated Appropriations Act, 2021—enacted in December of 2020—requires a number of actions that are consistent with several of GAO’s prior recommendations, including those related to the medical supply chain, vaccines and therapeutics, and COVID-19 testing. GAO will monitor the implementation of the act’s requirements. GAO’s new recommendations are discussed below. COVID-19 Testing Diagnostic testing for COVID-19 is critical to controlling the spread of the virus, according to the Centers for Disease Control and Prevention. GAO found that the Department of Health and Human Services (HHS) has not issued a comprehensive and publicly available national testing strategy. HHS’s national strategy documents are not comprehensive because they only partially address the characteristics that GAO has found to be desirable in an effective national strategy. For example, testing strategy documents do not always provide consistent definitions and benchmarks to measure progress, not all documents clearly define the problem and risks, and there is limited information on the types of resources required for future needs. Furthermore, some of the documents have not been made public. While the national testing strategy is formally outlined in a publicly available document, HHS has provided only Congress with the COVID-19 Testing Strategy Reports, which detail the implementation of the testing strategy. Stakeholders who are involved in the response efforts told GAO they were unaware of the existence of a national strategy or did not have a clear understanding of the strategy. Without a comprehensive, publicly available national strategy, HHS is at risk of key stakeholders and the public lacking crucial information to support an informed and coordinated testing response. GAO is recommending that HHS develop and make publicly available a comprehensive national COVID-19 testing strategy that incorporates all six characteristics of an effective national strategy. Such a strategy could build upon existing strategy documents that HHS has produced for the public and Congress to allow for a more coordinated pandemic testing approach. HHS partially concurred with this recommendation and agreed that it should take steps to more directly incorporate some of the elements of an effective national strategy. Vaccines and Therapeutics Multiple federal agencies, through Operation Warp Speed, continue to support the development and manufacturing of vaccines and therapeutics to prevent and treat COVID-19. As of January 8, 2021, two of the six vaccines supported by Operation Warp Speed have been authorized for emergency use, and vaccine distribution and administration have begun. (See figure below). However, distribution and administration fell short of expectations set for the end of the year. As of December 30, 2020, Operation Warp Speed had distributed (shipped) about 12.4 million doses of COVID-19 vaccine and providers reported administering about 2.8 million initial doses, according to Centers for Disease Control and Prevention data. In September 2020, GAO stressed the importance of having a plan that focused on coordination and communication and recommended that HHS, with the support of the Department of Defense, establish a time frame for documenting and sharing a national plan for distributing and administering COVID-19 vaccine, and among other things, outline an approach for how efforts would be coordinated across federal agencies and nonfederal entities.To date, this recommendationhas not been fully implemented. GAO reiterates the importance of doing so. Effective coordination and communication among federal agencies, commercial partners, jurisdictions, and providers is critical to successfully deploying COVID-19 vaccines and managing public expectations, especially because the initial supply of vaccine has been limited. Status of Development of Six Operation Warp Speed COVID-19 Vaccine Candidates, as of January 8, 2021 Medical Supply Chain The pandemic has highlighted vulnerabilities in the nation’s medical supply chain, which includes personal protective equipment and other supplies necessary to treat individuals with COVID-19. The Strategic National Stockpile (SNS) is an important piece of HHS’s recently developed strategy to improve the medical supply chain to enhance pandemic response capabilities. However, the department has yet to develop a process for engaging about the strategy with key nonfederal stakeholders that have a shared role for providing supplies during a pandemic, such as state and territorial governments and the private sector. GAO’s work has noted the importance of directly and continuously involving key stakeholders, including Congress, in the development of successful agency reforms and helping to harness ideas, expertise, and resources. To improve the nation’s response and preparedness for pandemics, GAO recommends that HHS establish a process for regularly engaging with Congress and nonfederal stakeholders—including state, local, tribal, and territorial governments and private industry—as the agency refines and implements its supply chain strategy for pandemic preparedness, to include the role of the SNS. HHS generally concurred with this recommendation and noted that the department regularly engages with Congress and nonfederal stakeholders. GAO maintains that capitalizing on existing relationships to engage these critical stakeholders as HHS refines and implements a supply chain strategy, to include the role of the SNS, will improve a whole-of-government response to, and preparedness for, pandemics. In August 2020, the President issued an Executive Order directing agencies to take steps toward the goal of strengthening domestic drug manufacturing and supply chains. Federal agencies have started implementing the Executive Order, but expressed concerns about their ability to implement some of the provisions. In particular, GAO found that federal agencies do not have complete and accessible information to identify supply chain vulnerabilities and to report the manufacturing supply chains of drugs that were procured by the agency. To help it identify and mitigate vulnerabilities in the U.S. drug supply chain, GAO recommends that the Food and Drug Administration (FDA) ensure drug manufacturing data obtained are complete and accessible, including by working with manufacturers and other federal agencies, such as the Department of Defense and the Department of Veterans Affairs and, if necessary, seek authority to obtain complete and accessible information. HHS neither agreed nor disagreed with this recommendation. COVID-19 Data for Health Care Indicators The federal government does not have a process to help systematically define and ensure the collection of standardized data across the relevant federal agencies and related stakeholders to help respond to COVID-19, communicate the status of the pandemic with citizens, or prepare for future pandemics. As a result, COVID-19 information that is collected and reported by states and other entities to the federal government is often incomplete and inconsistent. The lack of complete and consistent data limits HHS’s and others’ ability to monitor trends in the burden of the pandemic across states and regions, make informed comparisons between such areas, and assess the impact of public health actions to prevent and mitigate the spread of COVID-19. Further, incomplete and inconsistent data have limited HHS’s and others’ ability to prioritize the allocation of health resources in specific geographic areas or among certain populations most affected by the pandemic. To improve the federal government’s response to COVID-19 and preparedness for future pandemics, GAO recommends that HHS immediately establish an expert committee comprised of knowledgeable health care professionals from the public and private sectors, academia, and nonprofits or use an existing one to systematically review and inform the alignment of ongoing data collection and reporting standards for key health indicators. HHS partially concurred with this recommendation and agreed that it should establish a dedicated working group or other mechanism with a focus on addressing COVID-19 data collection shortcomings. Drug Manufacturing Inspections FDA is responsible for overseeing the safety and effectiveness of all drugs marketed in the U.S., including those manufactured overseas, and typically conducts more than 1,600 inspections of foreign and domestic drug manufacturing establishments every year. In light of the COVID-19 pandemic, since March 2020, FDA has limited domestic and foreign inspections for the safety of its employees. (See figure below.) FDA has used alternative inspection tools to maintain some oversight of drug manufacturing quality while inspections are paused, including inspections conducted by foreign regulators, requesting and reviewing records and other information, and sampling and testing. Although FDA has determined that inspections conducted by certain European regulators are equivalent to an FDA inspection, other tools provide useful information but are not equivalent to an FDA inspection. As a result, FDA could be faced with a backlog of inspections, threatening the agency’s goal to maximize inspections prioritized by its risk-based site selection model each year. GAO recommends that FDA (1) ensure that inspection plans for future fiscal years identify, analyze, and respond to the issues presented by the backlog of inspections that could jeopardize its goal of risk-driven inspections, and (2) fully assess the agency’s alternative inspection tools and consider whether these tools or others could provide the information needed to supplement regular inspection activities or help meet the agency’s drug oversight objectives when inspections are not possible in the future. FDA concurred with both recommendations. Number of FDA-Conducted Domestic and Foreign Drug Manufacturing Establishment Inspections, Fiscal Years 2019–2020, by Month Federal Contracting Federal agencies are using other transaction agreements to respond to the pandemic, which are contracting mechanisms that can enable agencies to negotiate terms and conditions specific to a project. GAO found that HHS misreports its other transaction agreements related to COVID-19 as procurement contracts, including other transaction agreements with about $1.5 billion obligated for Operation Warp Speed and other medical countermeasures. HHS’s approach is inconsistent with federal acquisition regulations and limits the public’s insight into the agency’s contract spending. To ensure consistent tracking and transparency of federal contracting activity related to the pandemic, GAO recommends that HHS accurately report data in the federal procurement database system and provide information that would allow the public to distinguish between spending on other transaction agreements and procurement contracts. HHS concurred with this recommendation. Oversight of Worker Safety and Health GAO identified concerns about federal oversight of worker safety and health amid the COVID-19 pandemic. Specifically, the Occupational Safety and Health Administration (OSHA) has adapted its enforcement methods for COVID-19 to help protect agency employees from the virus and address resource constraints, such as by permitting remote inspections in place of on-site inspections of workplaces. However, gaps in OSHA’s oversight and tracking of its adapted enforcement methods prevent the agency from assessing the effectiveness of its enforcement methods during the pandemic, ensuring that its adapted enforcement methods do not miss violations, and ensuring that employers are addressing certain identified violations. To improve its oversight, GAO recommends that OSHA (1) develop a plan, with time frames, to implement the agency’s oversight processes for COVID-19-adapted enforcement methods, and (2) ensure that its data system includes comprehensive information on use of these enforcement methods to inform these processes. The agency neither agreed nor disagreed with these recommendations. Additionally, OSHA’s data do not include comprehensive information on workplace exposure to COVID-19. For example, OSHA does not receive employer reports of all work-related hospitalizations related to COVID-19, as disease symptoms do not appear within the required reporting time frames. Employers may also face challenges determining whether COVID-19 hospitalizations or fatalities are work-related because of COVID-19’s incubation period and the difficulties in tracking the source of exposure. GAO recommends that OSHA determine what additional datamay be neededfrom employers or other sources to better target the agency’s COVID-19 enforcement efforts. The agency neither agreed nor disagreed with this recommendation. Assistance for Fishery Participants The CARES Act appropriated $300 million in March 2020 to the Department of Commerce (Commerce) to assist eligible tribal, subsistence, commercial, and charter fishery participants affected by COVID-19, which may include direct relief payments. After administrative fees were assessed, $298 million of the $300 million appropriated was obligated for fishery participants.Widespread restaurant closures in the spring of 2020 led to a decrease in demand for seafood, adversely affecting the fisheries industry. As of December 4, 2020, all funds had been obligated and only about 18 percent ($53.9 million) of the CARES Act funding obligated for fishery participants had been disbursed, which is inconsistent with Office of Management and Budget guidance on the importance of agencies distributing CARES Act funds in an expedient manner. Commerce’s National Oceanic and Atmospheric Administration (NOAA) officials said they expect that the vast majority of funds will be disbursed to fisheries participants by early 2021. However, the agency does not have the needed information centralized to help ensure that funds are being disbursed expeditiously and efficiently. GAO recommends that NOAA develop a mechanism to track the progress of states, tribes, and territories in meeting established timelines to disburse funds in an expedited and efficient manner. NOAA concurred with this recommendation. Program Integrity GAO continues to identify areas to improve program integrity and reduce the risk of improper payments for programs funded by the COVID-19 relief laws now that federal agencies have obligated a total of $1.9 trillion and expended $1.7 trillion of the $2.7 trillion appropriated for response and recovery efforts as of November 30, 2020. Federal relief programs remain vulnerable to significant risk of fraudulent activities because of the need to quickly provide funds and other assistance to those affected by COVID-19 and its economic effects. In this report, GAO identifies concerns about overpayments and potential fraud in the unemployment insurance (UI) system, specifically in the federally funded Pandemic Unemployment Assistance (PUA) program, which provides UI benefits to individuals not otherwise eligible for these benefits, such as self-employed and certain gig economy workers. As of January 11, 2021, states that had submitted data to DOL reported more than $1.1 billion in PUA overpayments from March through December 2020. While DOL requires states to report data on PUA overpayments, as of the beginning of 2021, the agency was not tracking the amount of overpayments recovered, limiting insight into the effectiveness of states’ efforts to recoup federal funds. To better track the recovery of federal funds, GAO recommends that DOL collect data from states on the amount of PUA overpayments recovered. DOL concurred with this recommendation, and has taken the first step toward implementing it by issuing new guidance and updated instructions for states to report PUA overpayment recovery data. GAO also remains concerned about SBA’s management of internal controls and fraud risks in the Economic Injury Disaster Loans (EIDL) program. COVID-19 relief laws made qualifying small businesses and nonprofit organizations adversely affected by COVID-19 eligible for financial assistance from the EIDL program. Some approval requirements were also relaxed, such as requiring each applicant to demonstrate that it could not obtain credit elsewhere, through December 31, 2021. As of December 31, 2020, SBA officials said they had approved about 3.7 million applications for loans related to COVID-19, totaling about $200 billion. SBA rapidly processed loans and advances to millions of small businesses affected by COVID-19. GAO’s analysis of SBA data shows that the agency approved EIDL loans and advances for potentially ineligible businesses. For example, SBA approved at least 3,000 loans totaling about $156 million to potentially ineligible businesses in industries that SBA policies state were ineligible for the EIDL program, such as insurance and real estate development, as of September 30, 2020. GAO recommends that SBA develop and implement portfolio-level data analytics across EIDL loans and advances made in response to COVID-19 as a means to detect potentially ineligible and fraudulent applications. SBA neither agreed nor disagreed with this recommendation. As of January 15, 2021, the U.S. had about 23 million cumulative reported cases of COVID-19 and more than 387,000 reported deaths, according to the Centers for Disease Control and Prevention. The country also continues to experience serious economic repercussions. Four relief laws, including the CARES Act, were enacted as of November 2020 to provide appropriations to address the public health and economic threats posed by COVID-19. As of November 30, 2020, of the $2.7 trillion appropriated by these four laws, the federal government had obligated a total of $1.9 trillion and expended $1.7 trillion of the COVID-19 relief funds, as reported by federal agencies. In December 2020, the Consolidated Appropriations Act, 2021, provided additional federal assistance for the ongoing response and recovery. The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines the federal government’s continued efforts to respond to and recover from the COVID-19 pandemic. GAO reviewed data, documents, and guidance from federal agencies about their activities and interviewed federal and state officials and stakeholders. GAO completed its audit work on January 15, 2021. GAO is making 13 new recommendations for agencies that are detailed in this Highlights and in the report. For more information, contact A. Nicole Clowers at (202) 512-7114 or clowersa@gao.gov.
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