Strengthening Transatlantic Ties with Georgia

Office of the Spokesperson

“The United States and Georgia have a strong strategic partnership built upon shared values and a deep love of freedom, independence, and unity. The United States remains steadfast in its commitment to Georgia’s sovereignty and territorial integrity within its internationally recognized borders, and we support the Georgian people’s clear choice to embrace Euro-Atlantic integration.”

– Secretary of State Michael R. Pompeo, May 25, 2020

Secretary of State Michael R. Pompeo will meet with President Salome Zourabichvili, Prime Minister Giorgi Gakharia, Minister of Foreign Affairs David Zalkaliani, and Patriarch of the Georgian Orthodox Church His Holiness Ilia II, November 18, 2020, in Tbilisi. Secretary Pompeo will also meet with representatives of Georgia’s civil society.

THE UNITED STATES SUPPORTS GEORGIA’S DEEPENING EURO-ATLANTIC TIES

  • Since gaining its independence, Georgia has made impressive progress fighting corruption, developing modern state institutions, and enhancing global security. The United States established diplomatic relations with Georgia in 1992 following Georgia’s independence from the Soviet Union in 1991.
  • The United States is committed to helping Georgia deepen its Euro-Atlantic ties and strengthen its democratic institutions and processes. The United States supports Georgia’s sovereignty and territorial integrity within its internationally recognized borders and condemns Russia’s 2008 invasion of the Georgian regions of Abkhazia and South Ossetia, which remain occupied by Russia today. As a participant in the Geneva International Discussions on the conflict in Georgia, the United States continues to play an active role in support of these principles.
  • The Trump Administration has worked to strengthen our bilateral ties. The U.S.-Georgia Charter on Strategic Partnership remains an important platform for our discussions with bilateral working groups on democracy; defense and security; economic, trade, and energy issues; and people-to-people and cultural exchanges. An indicator of the comprehensive nature of our partnership was the provision by the United States of more than $127 million in Department of State and USAID foreign assistance to Georgia for Fiscal Year 2019.
  • The United States and Georgia have a robust program of people-to-people exchanges ranging from high schoolers under the FLEX program to visiting scholars under Fulbright. The Embassy also supports robust English language training for more than 600 students throughout Georgia. There are more than 5,000 registered alumni of U.S. educational and professional exchanges in Georgia, including senior government officials, key civil society figures, and leading artists.
  • Georgia is a member of the U.S.-initiated International Religious Freedom or Belief Alliance, which is committed to promoting and protecting international religious freedom for all people around the world.

THE UNITED STATES AND GEORGIA ARE PARTNERS IN INTERNATIONAL SECURITY

  • Beyond our bilateral relationship, the United States supports Georgia’s NATO aspirations and deeply values the contributions Georgia is already making to the alliance’s operations, including as one of the largest contributors to Resolute Support Mission in Afghanistan. Georgia’s 32nd Battalion will deploy to Afghanistan in support of the Resolute Support Mission in early December. Ministry of Defense (MOD) leadership has stated that Georgia will stay in Afghanistan as long as the United States does.
  • Georgian soldiers have served bravely, and we honor the Georgians who have sacrificed their lives or have been wounded in pursuit of global peace and security.
  • The United States is committed to supporting Georgia in achieving its goal of developing its capabilities to defend itself against future aggression, and the United States is one Georgia’s primary security partners.
  • The Georgia Defense Readiness Program (GDRP) is a U.S.-Georgia bilateral program that focuses on improving the combat readiness of the Georgian Defense Forces and developing Georgia’s institutional capacity to generate units prepared to accomplish assigned national missions, particularly territorial defense. GDRP runs through the end of calendar year 2021.
  • The United States and Georgia are working together to determine how best to build off the success of this program in their future bilateral security cooperation.
  • The National Guard from the U.S. state of Georgia is Georgia’s state partner under the State Partnership Program, a relationship that started 26 years ago.
  • Over the last six years, the United States has provided close to $100 million in security assistance to Georgia. The assistance includes funds to acquire NATO standard weapons, purchase individual equipment, enhance Georgia’s maritime domain awareness, improve the combat readiness of Georgian Defense Forces, and strengthen Georgia’s Special Forces. Georgia also receives approximately $2 million a year in International Military Education and Training funding, with more than 60 percent of MOD and Georgia Defense Force leadership being U.S. military education graduates.

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    A federal court in the Northern District of California entered an order today authorizing the IRS to serve a John Doe summons on Payward Ventures Inc., and Subsidiaries d/b/a Kraken (Kraken) seeking information about U.S. taxpayers who conducted at least the equivalent of $20,000 in transactions in cryptocurrency during the years 2016 to 2020. The IRS is seeking the records of Americans who engaged in business with or through Kraken, a digital currency exchanger headquartered in San Francisco, California.
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    In Crime Control and Security News
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  • Genetics, Diagnosis, Treatment: NIH Takes On Sickle Cell Disease
    In Human Health, Resources and Services
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  • Justice Department Settles Disability Discrimination Claims Against 19 Building Owners
    In Crime News
    The Justice Department today announced that it reached a single agreement with 19 building owners* who rent space in their buildings to stores and restaurants. 
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  • Canadian National Charged with Alien Smuggling Conspiracy and Attempting to Bring Aliens to the United States
    In Crime News
    Cooperation efforts between United States and Turks and Caicos Islands law enforcement authorities culminated in today’s extradition to the United States of a Canadian national who has been charged with alien smuggling offenses.
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  • Three Individuals Affiliated With the Oath Keepers Indicted in Federal Court for Conspiracy to Obstruct Congress on Jan. 6, 2021
    In Crime News
    Three individuals associated with the Oath Keepers, a paramilitary organization focused on recruitment of current and former military, law enforcement, and first responder personnel, were indicted today in federal court in the District of Columbia for conspiring to obstruct Congress, among other charges.
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  • Justice Department Files Statement of Interest in Michigan Religious Schools’ Challenge to COVID-19 Closing Order
    In Crime News
    The Justice Department today filed a statement of interest in federal district court in Kalamazoo, Michigan, arguing that the Free Exercise Clause of the Constitution requires the state of Michigan to justify why it cannot provide exemptions to its school closing order for in-person instruction at religious high schools when it provides exemptions for trade and technical instruction in person, college sports teams, and other educational activities.
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  • Tax Cuts and Jobs Act: Future Rulemaking Should Provide Greater Detail on Paperwork Burden and Economic Effects of International Business Provisions
    In U.S GAO News
    What GAO Found GAO's interviews with officials representing eight selected U.S.-based companies revealed considerable uncertainty in how the international business provisions of Public Law 115-97—commonly known as the Tax Cuts and Jobs Act of 2017 (TCJA)—may be affecting business planning decisions. Some companies reported making specific changes, such as moving intellectual property back to the U.S. in response to a new deduction for income earned from certain foreign-derived sales of property or services attributed to assets located in the U.S. Preliminary studies on another provision taxing net income earned by foreign subsidiaries exceeding a specified threshold of certain assets hypothesized that this provision could encourage moving tangible property outside the U.S. Other business representatives emphasized the importance of nontax factors in business planning decisions, such as entering foreign markets where executives believe potential customers may be located. The Department of the Treasury (Treasury) and the Internal Revenue Service (IRS) proposed eight regulations and finalized six of them to implement four international provisions of TCJA between December 2017 and October 2020 (the most current information available at the time of GAO's review) and used guidance to supplement the regulations. The agency generally complied with legal requirements for issuing regulations and offered public comment opportunities for some guidance. However, Treasury and IRS did not fully address expectations set in government-wide guidance related to Paperwork Reduction Act (PRA) burden estimates, economic analysis requirements for regulations, and public comment on significant guidance: IRS generally did not provide specific estimates of the incremental paperwork burden of TCJA's international regulations and instead estimated the total burden for all business tax forms. The Office of Information and Regulatory Affairs' PRA guide says agencies should estimate the time and money required for an information collection. GAO's interviews with representatives of selected companies show why it is important for IRS to consider burden because representatives reported challenges, such as gathering required information from foreign subsidiaries. Anticipated economic benefits and costs of Treasury's and IRS's regulations were generally not quantified. An executive order requires agencies to provide such information to the extent feasible for regulations with the largest anticipated economic effects. As a result, Treasury and IRS made important decisions about regulations, such as whether to allow foreign military sales to be eligible for a U.S. deduction, without more specific information about the potential economic effects. IRS did not provide an opportunity for public comment before issuing revenue procedures related to TCJA's international provisions. The Office of Management and Budget identified ensuring public comment opportunities for significant guidance when appropriate as a leading practice that agencies should follow. The President recently directed a government-wide review of agency guidance processes. Why GAO Did This Study TCJA made sweeping changes to taxing U.S. corporations' international activities: (1) a transition tax on untaxed overseas earnings of foreign subsidiaries that accrued prior to 2017; (2) a tax on the net income earned by foreign subsidiaries exceeding a specified threshold of certain assets; (3) a deduction for income from certain foreign-derived sales of property or services exceeding a specified threshold of certain assets; and (4) a tax on certain payments made to a related foreign party referred to as base erosion payments. GAO was asked to review IRS's implementation of TCJA and early effects of the law. This report: (1) describes how TCJA's international provisions may be affecting U.S.-based corporations' international business activities; and (2) assesses IRS's and Treasury's development of relevant regulations and guidance to implement the provisions. GAO interviewed representatives from eight companies' tax departments randomly selected from among the 100 largest U.S.-based companies and compared relevant regulations and guidance against procedural requirements.
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  • Medicaid: CMS Needs to Implement Risk-Based Oversight of Puerto Rico’s Procurement Process
    In U.S GAO News
    Like other U.S. territories and states, Puerto Rico implements major functions of its Medicaid program by procuring services from contractors, such as the delivery of managed care services to Medicaid beneficiaries. In 2018, procurement costs represented $2.4 billion of Puerto Rico's $2.5 billion in total Medicaid expenditures. A 2019 federal indictment alleging Puerto Rico officials unlawfully steered Medicaid contracts to certain individuals has raised concerns about Puerto Rico's Medicaid procurement process, including whether this process helps ensure appropriate competition. The Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services, is responsible for overseeing the Medicaid program. CMS requires states and territories to use the same process for Medicaid procurements as they do for their non-federal procurements. However, CMS has not taken steps to ensure Puerto Rico has met this requirement. Instead, CMS has relied on Puerto Rico to oversee the territory's procurement process and to attest to its compliance. CMS approved Puerto Rico's attestation of compliance in 2004 and has not required subsequent updates. CMS officials told GAO that states and territories are in the best position to ensure compliance with their respective procurement laws. GAO and others have found that competition is a cornerstone of procurement. Using competition can reduce costs, improve contractor performance, curb fraud, and promote accountability. GAO reviewed selected Puerto Rico Medicaid procurements against federal procurement standards designed to promote competition and reduce risks of fraud. States and territories are generally not required to meet such standards. However, GAO and others have found that such standards can indicate whether a state's or territory's procurement process includes necessary steps to achieve fair competition. GAO found that seven of the eight selected Puerto Rico procurements did not include important steps to promote competition and mitigate the risk for fraud, waste, and abuse, underscoring the need for federal oversight. Competitive procurements. The requests for proposals for two of the three competitive procurements GAO reviewed did not include certain information on factors used to evaluate proposals and make awards. In contrast, Puerto Rico's managed care procurement—the largest procurement reviewed—included this information. Noncompetitive procurements. None of the five noncompetitive procurements GAO reviewed documented circumstances to justify not using competitive procurements, such as a lack of competition or an emergency. Puerto Rico officials explained that territorial law allows noncompetitive procurement for professional services regardless of circumstances. Because CMS does not oversee Puerto Rico's procurement process, the agency lacks assurance that Puerto Rico's Medicaid program is appropriately managing the risk of fraud, waste, and abuse. Procurements that did not include important steps to promote competition could have unnecessarily increased Medicaid costs, reducing funding for Medicaid services to beneficiaries. States' and U.S. territories' Medicaid procurement processes can directly affect their ability to prevent fraud, waste, and abuse in the program. A 2019 federal indictment alleging fraudulent Medicaid procurements in Puerto Rico has raised questions about the program's oversight. The Consolidated Appropriations Act, 2020 includes a provision for GAO to review oversight of Puerto Rico's Medicaid procurement process and its use of competition. This report examines CMS oversight of Puerto Rico's procurement process from its initial steps through the award, and how it helps ensure competition. GAO reviewed federal regulations, guidance, and Puerto Rico's December 2020 procurement reform plan; interviewed Puerto Rico and federal officials; and reviewed eight awards that represented about 97 percent of the costs of Puerto Rico's procurements in effect as of April 2020. These procurements were selected based on variation in cost, use of competition, and other factors. GAO assessed whether CMS addressed risks in Puerto Rico's procurement process by reviewing selected procurements against certain federal standards that apply to other non-federal entities and aim to mitigate the risk of fraud, waste, and abuse. GAO also assessed CMS's policies and procedures against federal internal control standards. GAO recommends that CMS implement risk-based oversight of the Medicaid procurement process in Puerto Rico. The Department of Health and Human Services concurred with this recommendation. For more information, contact Carolyn L. Yocom at (202) 512-7114 or YocomC@gao.gov.
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  • Secretary Pompeo’s Call with Philippine Secretary of Foreign Affairs Locsin
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  • Opioid Use Disorder: Treatment with Injectable and Implantable Buprenorphine
    In U.S GAO News
    Of the medications used to treat opioid use disorder (OUD), only buprenorphine is both a controlled substance and available as an injection or implant. Buprenorphine is used to treat patients with OUD because it reduces or eliminates opioid withdrawal symptoms and blunts the euphoria or dangerous side effects of other opioids, such as heroin. When used to treat OUD, buprenorphine, in any form, is subject to additional laws and regulations that are overseen by the Drug Enforcement Administration (DEA), within the Department of Justice (DOJ) and the Substance Abuse and Mental Health Services Administration (SAMHSA), within the Department of Health and Human Services (HHS). To ensure patient safety when injectable and implantable buprenorphine is used, the Food and Drug Administration (FDA), within HHS has also required drug companies to establish risk evaluation and mitigation strategies to help ensure the benefits of these medications outweigh their risks. Providers and pharmacies must follow a number of specific steps based on federal requirements when providing treatment with injectable and implantable buprenorphine. Providers are responsible for prescribing, storing, and administering injectable and implantable buprenorphine, while pharmacies are responsible for dispensing these medications (see figure). Representatives GAO interviewed from provider groups and pharmacies said they did not find the steps involved in treating patients to be difficult overall. However, they stated that careful and timely coordination with each other and patients is needed at key steps of the process to ensure that the patient receives treatment. Representatives from provider groups and pharmacies reported that the risk of diversion of injectable and implantable buprenorphine is low. For example, all of the provider groups GAO spoke with said that diversion of injectable or implantable buprenorphine is unlikely, and representatives from three of the six provider groups said that the design of these formulations reduces opportunities for diversion due to how they are administered. Process for Treating Opioid Use Disorder with Injectable and Implantable Buprenorphine The use of injectable and implantable buprenorphine to treat OUD is relatively low compared to oral forms of buprenorphine. HHS has reported that about 7,250 prescriptions were issued for injectable and implantable buprenorphine in fiscal year 2019, compared to over 700,000 patients who received buprenorphine prescriptions for oral formulations to treat OUD or pain in that year. In 2018, SAMHSA estimated that about one-quarter of the estimated 2 million people with OUD had received some form of substance use treatment in the prior year. One form of treatment—medication-assisted treatment (MAT)— combines behavioral therapy with the use of certain medications. HHS has identified expanding access to treatment for OUD as an important strategy for reducing opioid morbidity and mortality, which includes increasing the number of injectable and implantable buprenorphine prescriptions. Congress included a provision in the SUPPORT Act for GAO to review access to and the potential for the diversion of controlled substances administered by injection or implantation. This report focuses on injectable and implantable controlled substances that can be used to treat OUD and specifically, describes the process for treating OUD with injectable and implantable buprenorphine and what is known about their use. GAO reviewed laws, regulations, and documentation from DEA, FDA, and SAMHSA governing the process of providing treatment with buprenorphine and interviewed officials from those agencies. GAO also interviewed representatives from stakeholder groups representing MAT providers; drug companies that manufacture injectable or implantable buprenorphine; and pharmacies that dispense these medications. HHS and DOJ reviewed a draft of this report, and GAO incorporated their technical comments, as appropriate. For more information, contact James Cosgrove at (202) 512-7114 or cosgrovej@gao.gov.
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  • Owner of Oil Chem Inc. Pleads Guilty to Violating the Clean Water Act
    In Crime News
    The president and owner of Oil Chem Inc. pleaded guilty in federal court in Flint, Michigan, to a criminal charge of violating the Clean Water Act stemming from illegal discharges of landfill leachate — totaling more than 47 million gallons — into the city of Flint sanitary sewer system over an eight and a half year period.
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  • GAO Audits Involving DOD: Status of Efforts to Schedule and Hold Timely Entrance Conferences
    In U.S GAO News
    GAO began 42 new audits that involved the Department of Defense (DOD) in the third quarter of fiscal year 2020. Of the 42 requested entrance conferences (i.e., initial meetings between agency officials and GAO staff) for those audits, DOD scheduled 41 within 14 days of notification and held all 42 entrance conferences within 30 days of notification. Scheduling was delayed for one entrance conference, which was scheduled 21 days after notification, because DOD and GAO were working to reach agreement on the primary action officer, which is the appropriate office or component within the department that coordinates DOD's response to the audit. The entrance conference was held 8 days after it was scheduled. Entrance conferences allow GAO to communicate its audit objectives and enable agencies to assign key personnel to support the audit work. GAO's agency protocols govern GAO's relationships with audited agencies. These protocols assist GAO in scheduling entrance conferences with key agency officials within 14 days of receiving notice of a new audit. The ability of the Congress to conduct effective oversight of federal agencies is enhanced through the timely completion of GAO audits. In past years, DOD experienced difficulty meeting the protocol target for the timely facilitation of entrance conferences. In Senate Report 116-48 accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020, the Senate Armed Services Committee included a provision for GAO to review DOD's scheduling and holding of entrance conferences. In this report, GAO's agency protocols govern GAO's relationships with audited agencies. These protocols assist GAO in scheduling entrance conferences with key agency officials within 14 days of receiving notice of a new audit. The ability of the Congress to conduct effective oversight of federal agencies is enhanced through the timely completion of GAO audits. In past years, DOD experienced difficulty meeting the protocol target for the timely facilitation of entrance conferences. In Senate Report 116-48 accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020, the Senate Armed Services Committee included a provision for GAO to review DOD's scheduling and holding of entrance conferences. In this report, GAO evaluates the extent to which DOD scheduled entrance conferences within 14 days of receiving notice of a new audit, consistent with GAO's agency protocols, and held those conferences within 30 days. This is the third of four quarterly reports that GAO will produce on this topic for fiscal year 2020. In the first two quarterly reports, GAO found that DOD had improved its ability to meet the protocol target. GAO analyzed data on GAO audits involving DOD and initiated in the third quarter of fiscal year 2020 (April 1, 2020, through June 30, 2020). Specifically, GAO identified the number of notification letters requesting entrance conferences that were sent to DOD during that time period. GAO determined the number of days between when DOD received the notification letter for each new audit and when DOD scheduled the entrance conference and assessed whether DOD scheduled entrance conferences within 14 days of notification, which is the time frame identified in GAO's agency protocols. GAO also determined the date that each requested entrance conference was held by collecting this information from the relevant GAO team for each audit and assessed whether DOD held entrance conferences for new audits within 30 days of notification, which was the time frame identified in the mandate for this review For more information, contact Elizabeth Field at (202) 512-2775 or Fielde1@gao.gov.
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  • Secretary Pompeo to Deliver Remarks to the Media in the Press Briefing Room
    In Crime Control and Security News
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  • FY 2020 Excise Tax: Agreed-Upon Procedures Related to Distributions to Trust Funds
    In U.S GAO News
    The procedures that GAO agreed to perform on fiscal year 2020 net excise tax distributions to the Airport and Airway Trust Fund (AATF) and the Highway Trust Fund (HTF) and the results of those procedures are described in the enclosures to this report. The sufficiency of these procedures is solely the responsibility of the Department of Transportation (DOT) Office of Inspector General (OIG). The Internal Revenue Service (IRS) is responsible for certifying quarterly net excise tax collections to be distributed to the AATF and the HTF. The Department of the Treasury's Office of Tax Analysis (OTA) is responsible for developing reasonable estimates of net excise tax collections to be distributed to the AATF and the HTF. These IRS certifications and OTA estimates are the basis of the net excise tax distributions to the AATF and the HTF. GAO was not engaged to perform, and did not perform, an examination or review. Accordingly, GAO does not express such an opinion or conclusion. The purpose of this report is solely to describe agreed-upon procedures related to information representing the basis of amounts distributed from the general fund to the AATF and the HTF during fiscal year 2020, and the report is not suitable for any other purpose. IRS agreed with the findings related to the procedures performed concerning excise tax distributions to the AATF and the HTF during the fiscal year 2020. OTA stated that it had no comments on the report. GAO performed agreed-upon procedures solely to assist the DOT OIG in ascertaining whether the net excise tax revenue distributed to the AATF and the HTF for the fiscal year ended September 30, 2020, is supported by information from the Department of the Treasury, including IRS's excise tax receipt certifications and OTA's estimates. DOT OIG is responsible for the sufficiency of these agreed-upon procedures to meet its objectives, and GAO makes no representation in that respect. The procedures that GAO agreed to perform were related to information representing the basis of amounts distributed from the General Fund to the AATF and the HTF during fiscal year 2020, including (1) IRS's quarterly AATF and HTF excise tax certifications prepared during fiscal year 2020 and (2) OTA's estimates of excise tax amounts to be distributed to the AATF and the HTF for the third and fourth quarters of fiscal year 2020. For more information, contact Cheryl E. Clark at (202) 512-3406 or clarkce@gao.gov.
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  • Veterans Affairs: VA Needs to Address Persistent IT Modernization and Cybersecurity Challenges
    In U.S GAO News
    The Department of Veterans Affairs (VA) has faced challenges in its efforts to accomplish three critical information technology (IT) modernization initiatives: the department's health information system, known as the Veterans Health Information Systems and Technology Architecture (VistA); a system for the Family Caregiver Program, which is to support family caregivers of seriously injured post-9/11 veterans; and the Veterans Benefits Management System (VBMS) that collects and stores information and is used for processing disability benefit claims. Specifically, GAO has reported on the challenges in the department's three previous unsuccessful attempts to modernize VistA over the past 20 years. However, VA has recently deployed a new scheduling system as part of its fourth effort to modernize VistA and the next deployment of the system, including additional capabilities, is planned in October 2020. VA had taken steps to address GAO's recommendations from its 2014 report to implement a replacement system for the Family Caregiver Program. However, in September 2019, GAO reported that VA had yet to implement a new IT system that fully supports the Family Caregiver Program and that it had not yet fully committed to a date by which it will certify that the new IT system fully supports the program. In September 2015, GAO reported that VA had made progress in developing and implementing VBMS, but also noted that additional actions could improve efforts to develop and use the system. For example, VBMS was not able to fully support disability and pension claims, as well as appeals processing. GAO made five recommendations aimed at improving VA's efforts to effectively complete the development and implementation of VBMS; however, as of September 2020, VA implemented only one recommendation. VA's progress in implementing key provisions of the Federal Information Technology Acquisition Reform Act (commonly referred to as FITARA) has been uneven. Specifically, VA has made progress toward improving its licensing of software and achieving its goals for closing unneeded data centers. However, the department has made limited progress toward addressing requirements related to IT investment risk management and Chief Information Officer authority enhancement. Until the department implements the act's provisions, Congress' ability to effectively monitor VA's progress and hold it fully accountable for reducing duplication and achieving cost savings will be hindered. In addition, since fiscal year 2016, GAO has reported that VA faces challenges related to effectively implementing the federal approach to, and strategy for, securing information systems; effectively implementing information security controls and mitigating known security deficiencies; and establishing elements of its cybersecurity risk management program. GAO's work stressed the need for VA to address these challenges as well as manage IT supply chain risks. As VA continues to pursue modernization efforts, it is critical that the department take steps to adequately secure its systems. The use of IT is crucial to helping VA effectively serve the nation's veterans. The department annually spends billions of dollars on its information systems and assets—VA's budget for IT now exceeds $4 billion annually. However, over many years, VA has experienced challenges in managing its IT projects and programs, which could jeopardize its ability to effectively support key programs such as the Forever GI Bill. GAO has previously reported on these IT management challenges at VA. GAO was asked to testify on its prior IT work at VA. Specifically, this testimony summarizes results and recommendations from GAO's issued reports that examined VA's efforts in (1) modernizing VistA, a system for the Family Caregiver Program, and VBMS; (2) implementing FITARA; and (3) addressing cybersecurity issues. In developing this testimony, GAO reviewed its recently issued reports that addressed IT management issues at VA and GAO's biannual high-risk series. GAO also incorporated information on the department's actions in response to recommendations. GAO has made numerous recommendations in recent years aimed at improving VA's IT system modernization efforts, implementation of key FITARA provisions, and cybersecurity program. VA has generally agreed with the recommendations and has begun to address them. For more information, contact Carol C. Harris at (202) 512-4456 or harriscc@gao.gov.
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  • Medicaid Long-Term Services and Supports: Access and Quality Problems in Managed Care Demand Improved Oversight
    In U.S GAO News
    At the state and federal levels, GAO found weaknesses in the oversight of Medicaid managed long-term services and supports (MLTSS), which assist individuals with basic needs like bathing or eating. Through various monitoring approaches, six selected states identified significant problems in their MLTSS programs with managed care organization (MCO) performance of care management, which includes assessing beneficiary needs, authorizing services, and monitoring service provision to ensure quality and access to care. State efforts may not be identifying all care management problems due to limitations in the information they use to monitor MCOs, allowing some performance problems to continue over multiple years. Performance Problems in Managed Care Organization (MCO) Care Management, Identified by Selected States GAO found that the Centers for Medicare & Medicaid Services' (CMS) oversight of state implementation of its 2016 requirements, and of access and quality in MLTSS more broadly, was limited. This hinders the agency's ability to hold states and MCOs accountable for quality and access problems beneficiaries may face. Oversight did not detect quality and access problems. GAO identified cases where CMS learned about problems not through its regular oversight, but instead from beneficiary complaints, media reports, or GAO. CMS officials said that states had not reported these problems to the agency. Lack of national oversight strategy and assessment of problems in MLTSS. Weaknesses in oversight reflect a broader area of concern—namely, that CMS lacks a strategy for oversight. CMS also has not assessed the nature and extent of access and quality problems across states. Without a strategy and more robust information, CMS risks being unable to identify and help address problems facing beneficiaries. As of July 2020, CMS had convened a new workgroup focused on MLTSS oversight, though the goals and time frames for its work were unclear. An increasing number of states are using managed care to deliver long-term services and supports in their Medicaid programs, thus delegating decisions around the amounts and types of care beneficiaries receive to MCOs. Federal guidance requires that MLTSS programs include monitoring procedures to ensure the appropriateness of those decisions for this complex population, which includes adults and children who may have physical, cognitive, and mental disabilities. GAO was asked to review care management in MLTSS programs. Among other things, this report examines state monitoring of care management, and CMS oversight of state implementation of 2016 requirements related to MLTSS quality and access. GAO examined documentation of monitoring procedures and problems identified in six states selected for variation in program age and location. GAO reviewed federal regulations and oversight documents, interviewed state and federal Medicaid officials, and assessed CMS's policies and procedures against federal internal control standards. GAO is making two recommendations to CMS to (1) develop a national strategy for overseeing MLTSS, and (2) assess the nature and prevalence of MLTSS quality and access problems across states. CMS did not concur with the recommendations. GAO maintains the recommendations are warranted, as discussed in this report. For more information, contact at (202) 512-7114 or yocomc@gao.gov.
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  • Judicial Security Legislation Stalls, Awaits Congressional Action in 2021
    In U.S Courts
    On Wednesday afternoon, the United States Senate considered but failed to act on the Daniel Anderl Judicial Security and Privacy Act of 2020, legislation that would enhance the security protections for federal judges nationwide.
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    In Crime News
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