The Department’s 45-Day Review Following the Revocation of Proclamations 9645 and 9983

Ned Price, Department Spokesperson

On January 20, President Biden signed Proclamation 10141, “Ending Discriminatory Bans on Entry to the United States.” President Biden has made clear that the now-rescinded Proclamations 9645 and 9983 were a stain on our national conscience, contravened our values, jeopardized our alliances and partnerships, separated loved ones, and undermined our national security.

Applicants from the affected countries may no longer be denied on the basis of nationality, and the Department has taken a number of steps to ensure that applicants previously refused visas under Proclamations 9645 and 9983 will not have future visa applications prejudiced in any way by those prior decisions.

As part of Proclamation 10141, President Biden directed the State Department, within 45 days, to provide a report including a proposal for individuals whose immigrant visa applications were denied due to Proclamations 9645 or 9983 and seek to have their applications reconsidered. The Department has provided the results of our review to the White House.

The Department explored every possible avenue under the law for providing relief to affected individuals.  Those whose immigrant visa applications received a final refusal on or after January 20, 2020 due to the Proclamations may seek re-adjudication without resubmitting their application forms or paying any additional fees, provided the underlying visa petitions remain valid. Under current regulations, those whose immigrant visa applications were denied prior to January 20, 2020 may also be reconsidered, but these individuals must submit new applications and pay a new application fee.

FY 2017 – FY 2020 Diversity Visa applicants who were not issued visas are statutorily barred from being issued visas based on their selection as Diversity Visa applicants in those fiscal years, as the deadlines for visa issuance in those fiscal years have expired.

As the Department works to serve affected applicants as quickly as possible, the health and safety of our workforce and customers remains paramount. The COVID-19 pandemic, and the health safeguards it has necessitated, continue to severely impact the number of visas our embassies and consulates abroad are able to process. Our team in Washington and around the world continue to work tirelessly to find ways to increase the number of immigrant visa appointments, and will continue to do so in the coming months.

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    Many states use flexibilities in the Elementary and Secondary Education Act (ESEA), as amended, in identifying low-performing schools and student subgroups (e.g., students from major racial and ethnic groups and low-income students) that need support and improvement. For example, states must identify all public high schools failing to graduate at least one-third of their students. According to GAO's state plan analysis, four states used ESEA's flexibilities to set higher graduation rates (i.e., 70-86 percent) for purposes of state accountability. Similarly, while ESEA requires states to identify schools in which students in certain subgroups are consistently underperforming, 12 states assess the performance of additional student subgroups. Although states are generally required to set aside a portion of their federal education funding for school improvement activities (see figure), states have some discretion in how they allocate these funds to school districts. According to GAO's survey, 27 states use a formula to allocate funds. GAO also found that in at least 34 states, all school districts that applied for federal funds received them in school year 2018-2019, but states had discretion regarding which schools within those districts to fund and at what level. Funding for School Improvement through the Elementary and Secondary Education Act (ESEA) Title I, Part A Note: For more details, see figure 2 in GAO-21-199. A majority of the 50 states and the District of Columbia responding to our survey reported having at least moderate capacity to support school districts' school improvement activities. Education provides various types of technical assistance to build local and state capacity such as webinars, in-person training, guidance, and peer networks. About one-half of states responding to GAO's survey sought at least one type of technical assistance from Education's program office and various initiatives, and almost all of those found it helpful. For example, Education's Regional Educational Laboratories (REL) help states use data and evidence, access high-quality research to inform decisions, identify opportunities to conduct original research, and track progress over time using high-quality data and methods. Several states most commonly reported finding the following assistance by RELs to be helpful: in-person training (26), webinars (28), and reviews of existing research studies to help select interventions (24). The Elementary and Secondary Education Act (ESEA) requires states to have statewide accountability systems to help provide all children significant opportunity to receive a fair, equitable, and high-quality education, and to close educational achievement gaps high-quality education. These systems must meet certain federal requirements, but states have some discretion in how they design them. For example, ESEA requires states to identify low-performing schools and student subgroups for support and improvement. Senate Report 115-289 accompanying the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2019, includes a provision for GAO to review states' school improvement activities. This report addresses (1) how states identify and allocate funds for schools identified for support and improvement; and (2) the extent to which states have capacity to support districts' school improvement activities and how helpful states find Education's technical assistance. GAO analyzed the most current approved state accountability plans from all 50 states and the District of Columbia as of September 2020. The information in these plans predates the COVID-19 pandemic and represents a baseline from which to compare school improvement activities going forward. GAO also surveyed and received responses from all 50 states and the District of Columbia. GAO also conducted follow-up interviews with officials in three states selected based on variation in reported capacity and geographic diversity. For more information, contact Jacqueline M. Nowicki at (617) 788-0580 or nowickij@gao.gov.
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  • Disaster Resilience: FEMA Should Take Additional Steps to Streamline Hazard Mitigation Grants and Assess Program Effects
    In U.S GAO News
    From fiscal years 2010 through 2018, the Federal Emergency Management Agency (FEMA) obligated over $11 billion through four grant programs that fund state and local hazard mitigation efforts. FEMA awarded about 88 percent of this amount through the two grant programs that fund hazard mitigation post-disaster. State and local officials from selected jurisdictions reported challenges with FEMA's hazard mitigation grant programs. Specifically, officials GAO interviewed from 10 of the 12 jurisdictions said grant application processes were complex and lengthy. To address this, FEMA officials augmented guidance and began monitoring application review time frames for one program and said they intend to assess two other programs to identify opportunities to streamline. However, they did not have a documented plan for doing so. By developing and implementing a plan to identify ways to streamline applications and reviews for all four programs, FEMA could reduce barriers to investments in hazard mitigation. Officials from eight of the 12 jurisdictions also cited challenges with applicants' technical capacity to successfully apply for grants. To address this, FEMA developed training and guidance, but GAO found that these resources are listed on different parts of its website and can be difficult for state and local officials to locate. Creating a centralized inventory of resources could improve applicant capacity to successfully develop mitigation projects and apply for grants. Examples of Hazard Mitigation Projects FEMA has assessed some effects of grant-funded hazard mitigation projects, but could expand efforts and better share results. FEMA uses benefit-cost analysis, which estimates the benefits over the life of a project, and post-disaster loss avoidance studies, which estimate project benefits from actual hazard events, to assess project effects. However, the loss avoidance studies have been limited to hurricanes, floods, and tornados, and have not assessed wildfires, winter storms, or other disasters. FEMA officials stated that they would like to expand these studies but do not have specific plans to do so. In addition, FEMA requires some states to assess the effectiveness of their mitigation projects, but does not share these studies. Developing a plan to conduct loss avoidance studies for other hazards and sharing the state studies could help FEMA and stakeholders make better informed mitigation investment decisions. The rising number of natural disasters and increasing reliance on federal assistance are key sources of federal fiscal exposure. FEMA has four grant programs to increase disaster resilience through hazard mitigation projects. The Additional Supplemental Appropriations for Disaster Relief Act, 2019, included a provision for GAO to review the federal response to disasters in 2018. This report addresses 1) FEMA's use of grants to support hazard mitigation; 2) challenges reported by selected jurisdictions applying for grants; and 3) how FEMA has assessed the effects of its hazard mitigation projects and shared the results. GAO analyzed FEMA's grant data for fiscal years 2010 through 2018 to capture the most complete recent data, conducted nongeneralizable site visits with 12 state and local jurisdictions selected to capture a range of grant funding levels and hazards, reviewed FEMA grant documents, and interviewed FEMA mitigation officials. GAO is making six recommendations, including that FEMA develop a plan to assess and streamline its hazard mitigation grant programs, create a centralized inventory of related resources, develop a plan to conduct more loss avoidance studies, and share state studies on hazard mitigation effectiveness. The Department of Homeland Security concurred with our recommendations. For more information, contact Chris Currie at (404) 679-1875 or CurrieC@gao.gov.
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  • Disaster Response: Agencies Should Assess Contracting Workforce Needs and Purchase Card Fraud Risk
    In U.S GAO News
    The efforts of selected agencies to plan for disaster contracting activities and assess contracting workforce needs varied. The U.S. Forest Service initiated efforts to address its disaster response contracting workforce needs while three agencies—the U.S. Army Corps of Engineers (USACE), the U.S. Coast Guard, and Department of the Interior (DOI)—partially addressed these needs. The Environmental Protection Agency indicated it did not have concerns fulfilling its disaster contracting responsibilities. Specifically, GAO found the following: USACE assigned clear roles and responsibilities for disaster response contracting activities, but has not formally assessed its contracting workforce to determine if it can fulfill these roles. The Coast Guard has a process to assess its workforce needs, but it does not account for contracting for disaster response activities. DOI is developing a strategic acquisition plan and additional guidance for its bureaus on how to structure their contracting functions, but currently does not account for disaster contracting responsibilities. Contracting officials at all three of these agencies identified challenges executing their regular responsibilities along with their disaster-related responsibilities during the 2017 and 2018 hurricane and wildfire seasons. For example, Coast Guard contracting officials stated they have fallen increasingly behind since 2017 and that future disaster response missions would not be sustainable with their current workforce. GAO's strategic workforce planning principles call for agencies to determine the critical skills and competencies needed to achieve future programmatic results. Without accounting for disaster response contracting activities in workforce planning, these agencies are missing opportunities to ensure their contracting workforces are equipped to respond to future disasters. The five agencies GAO reviewed from above, as well as the Federal Emergency Management Agency (FEMA), collectively spent more than $20 million for 2017 and 2018 disaster response activities using purchase cards. GAO found that two of these six agencies—Forest Service and EPA—have not completed fraud risk profiles for their purchase card programs that align with leading practices in GAO's Fraud Risk Framework. Additionally, five of the six agencies have not assessed or documented how their fraud risk for purchase card use might differ in a disaster response environment. DOI completed such an assessment during the course of our review. An Office of Management and Budget memorandum requires agencies to complete risk profiles for their purchase card programs that include fraud risk. GAO's Fraud Risk Framework states managers should assess fraud risk regularly and document those assessments in risk profiles. The framework also states that risk profiles may differ in the context of disaster response when managers may have a higher fraud risk tolerance since individuals in these environments have an urgent need for products and services. Without assessing fraud risk for purchase card programs or how risk may change in a disaster response environment, agencies may not design or implement effective internal controls, such as search criteria to identify fraudulent transactions. The 2017 and 2018 hurricanes and California wildfires affected millions of people and caused billions of dollars in damages. Extreme weather events are expected to become more frequent and intense due to climate change. Federal contracts for goods and services play a key role in disaster response and recovery, and government purchase cards can be used by agency staff to buy needed items. GAO was asked to review federal response and recovery efforts related to recent disasters. This report examines the extent to which selected agencies planned for their disaster response contracting activities, assessed their contracting workforce needs, and assessed the fraud risk related to their use of purchase cards for disaster response. GAO selected six agencies based on contract obligations for 2017 and 2018 disasters; analyzed federal procurement and agency data; reviewed agencies' policies on workforce planning, purchase card use, and fraud risk; and analyzed purchase card data. FEMA was not included in the examination of workforce planning due to prior GAO work. GAO is making 12 recommendations, including to three agencies to assess disaster response contracting needs in workforce planning, and to five agencies to assess fraud risk for purchase card use in support of disaster response. For more information, contact Marie A. Mak at (202) 512-4841 or makm@gao.gov.
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  • Chemical Security: Overlapping Programs Could Better Collaborate to Share Information and Identify Potential Security Gaps
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    Eight federal programs addressing chemical safety or security from four departments or agencies that GAO reviewed contain requirements or guidance that generally align with at least half of the Department of Homeland Security's (DHS) 18 Chemical Facility Anti-Terrorism Standards (CFATS) program standards. At least 550 of 3,300 (16 percent) facilities subject to the CFATS program are also subject to other federal programs. Analyses of CFATS and these eight programs indicate that some overlap, duplication, and fragmentation exists, depending on the program or programs to which a facility is subject. For example, six federal programs' requirements or guidance indicate some duplication with CFATS. CFATS program officials acknowledge similarities among these programs' requirements or guidance, some of which are duplicative, and said that the CFATS program allows facilities to meet CFATS program standards by providing information they prepared for other programs. more than 1,600 public water systems or wastewater treatment facilities are excluded under the CFATS statute, leading to fragmentation. While such facilities are subject to other programs, those programs collectively do not contain requirements or guidance that align with four CFATS standards. According to DHS, public water systems and wastewater treatment facilities are frequently subject to safety regulations that may have some security value, but in most cases, these facilities are not required to implement security measures commensurate to their level of security risk, which may lead to potential security gaps. The departments and agencies responsible for all nine of these chemical safety and security programs—four of which are managed by DHS, three by the Environmental Protection Agency (EPA), and one each managed by the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) and the Department of Transportation (DOT)—have previously worked together to enhance information collection and sharing in response to Executive Order 13650, issued in 2013. This Executive Order directed these programs to take actions related to improving federal agency coordination and information sharing. However, these programs have not identified which facilities are subject to multiple programs, such that facilities may be unnecessarily developing duplicative information to comply with multiple programs. Although CFATS allows facilities to use information they prepared for other programs, CFATS program guidance does not specify what information facilities can reuse. Finally, DHS and EPA leaders acknowledged that there are differences between CFATS requirements and the security requirements for public water systems and wastewater treatment facilities, but they have not assessed the extent to which potential security gaps may exist. By leveraging collaboration established through the existing Executive Order working group, the CFATS program and chemical safety and security partners would be better positioned to minimize unnecessary duplication between CFATS and other programs and better ensure the security of facilities currently subject to fragmented requirements. Facilities with hazardous chemicals could be targeted by terrorists to inflict mass casualties or damage. Federal regulations applicable to chemical safety and security have evolved over time as authorizing statutes and regulations established programs for different purposes, such as safety versus security, and with different enforcement authorities. GAO has reported that such programs may be able to achieve greater efficiency where overlap exists by reducing duplication and better managing fragmentation. GAO was asked to review issues related to the effects that overlap, duplication, and fragmentation among the multiple federal programs may have on the security of the chemical sector. This report addresses the extent to which (1) such issues may exist between CFATS and other federal programs, and (2) the CFATS program collaborates with other federal programs. GAO analyzed the most recent available data on facilities subject to nine programs from DHS, EPA, ATF, and DOT; reviewed and analyzed statutes, regulations, and program guidance; and interviewed agency officials. GAO is making seven recommendations, including that DHS, EPA, ATF, and DOT identify facilities subject to multiple programs; DHS clarify guidance; and DHS and EPA assess security gaps. Agencies generally agreed with six; EPA did not agree with the recommendation on gaps. GAO continues to believe it is valid, as discussed in the report. For more information, contact Nathan Anderson at (206) 287-4804 or AndersonN@gao.gov.
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    The Department of Veterans Affairs (VA) has implemented contracts with Optum and TriWest to set up networks of community providers as part of the new Veterans Community Care Program (VCCP). However, the two contractors' processes for implementing eligibility restrictions established by the VA MISSION Act, as outlined in their policies and reflected in their contracts, may not consistently exclude all ineligible providers from participating in the VCCP. The VA MISSION Act prohibits providers from participating in the VCCP if they have lost a state medical license, for example, as a result of revocation or termination for cause or due to concerns about poor quality of care. However, VA's contracts with these contractors do not require the verification of providers' history of license sanctions, including a revoked license, in all states during credentialing. Only one of the two contractors has a process that includes verifying providers' licensure history in all states and neither has a sufficient process for continuously monitoring provider licenses. Contractor Processes for Implementing VA MISSION Act Restrictions on Community Care Provider Eligibility In May 2019, VA began tracking providers who do not meet the eligibility restrictions established by the VA MISSION Act. However, this tracking does not address providers removed from VA prior to this date. As of September 2020, VA had deactivated 136 ineligible VA providers from VCCP participation. GAO reviewed data going back to July 1, 2016 and identified an additional 227 providers that had been removed from VA employment and are potentially providing care in the VCCP. VA stated it has no plans to further review these providers. VA officials said these providers were eligible to participate in the VCCP because they were removed from VA employment before the VA MISSION Act restrictions were effective. Thus, there is a continued risk that former VA providers associated with quality of care concerns are participating in the VCCP. The VA MISSION Act of 2018 established a new community care program, the VCCP, aimed at providing care to veterans when it could not reasonably be delivered by providers at VA medical facilities. The act also requires VA to exclude from participation in the VCCP providers who lost a license for violating medical license requirements in any state or who VA removed from employment for quality of care concerns or otherwise suspended from VA employment. The VA MISSION Act included provisions for GAO to report on the implementation of restrictions on certain health care providers' participation in the VCCP. This report examines, among other issues, VA and contractor processes to implement these eligibility restrictions on provider participation in the VCCP. GAO reviewed VA's contracts and contractor policies related to VCCP provider credentialing, interviewed VA and contractor officials, and assessed the provider credentialing requirements and processes. In addition, GAO collected data on former VA providers and compared these data to the database of VCCP providers. GAO is making three recommendations to VA, including that VA require its contractors to have credentialing and monitoring policies that ensure compliance with VA MISSION Act license restrictions and that it assess the risk to veterans when former VA providers with quality concerns continue to provide VCCP care. VA generally agreed with GAO's three recommendations. For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.
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    In U.S GAO News
    What GAO Found About 1.6 percent of the total available budget authority government-wide was cancelled from fiscal year 2009 to fiscal year 2019, averaging $23.9 billion per year. The variations in cancelled appropriations from year to year can be explained largely by trends in four departments. Together they represent 86 percent of the total government-wide cancelled appropriations, but their rate of cancellations were within a few percentage points of the government-wide rate. Four Agencies Represent the Majority of Total Cancellations from FY2009–FY2019 Cancelled appropriations for the six case study accounts GAO reviewed largely resulted from program-specific factors: Actual program needs were less than estimated. For example, actual versus projected troop levels and warfront movements can contribute to cancelled appropriations at the Department of Defense (DOD). Some program funds are only for specific purposes. For example, Department of Health and Human Services (HHS), Administration for Children and Families officials reported that some states declined funding for a teen sex and pregnancy prevention program, and the agency did not have the authority to redirect those funds for other purposes. Some programs' costs are more unpredictable than others. Contract and acquisition costs can be unpredictable . When final costs are less than originally estimated, agencies may have to cancel the difference. In contrast, agencies with a higher proportion of personnel expenses, which are relatively predictable, can more easily avoid cancelled appropriations. All of GAO's case study agencies have procedures in place to help limit discretionary cancelled appropriations. For example, the Army established a program that helps reduce cancelled appropriations by providing management with metrics and tools to help prevent them. Why GAO Did This Study Laws limit the time that agencies have available to use fixed-term appropriations for obligations and expenditures. However, agencies do not always obligate and outlay these funds in time, which ultimately results in cancelled appropriations. Efforts to limit the amount of cancelled appropriations result in more accurate budget estimation and fiscal projections, a more efficient appropriations process, and better service to the public. The National Defense Authorization Act for Fiscal Year 2020 includes a provision for GAO to review the status of cancelled appropriations. This report addresses (1) the extent of appropriations that were cancelled in fiscal years 2009 through 2019 and how the rate of cancelled appropriations and other characteristics differ across agencies, (2) factors that contribute to the level of cancelled appropriations in selected accounts at agencies, and (3) efforts selected agencies make to prevent the cancellation of funds. To provide government-wide trends, GAO analyzed Department of the Treasury and Office of Management and Budget data. GAO also analyzed related documents from six case study accounts at DOD, HHS, and the U.S. Department of Agriculture; and interviewed officials at these agencies. The selected accounts included the three with the most cancelled appropriations government-wide and three additional accounts to represent the major categories of federal spending: personnel, acquisitions, grants, and contracts. For more information, contact Jeff Arkin at (202) 512-6806 or arkinj@gao.gov.
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  • DOD Financial Management: Continued Efforts Needed to Correct Material Weaknesses Identified in Financial Statement Audits
    In U.S GAO News
    The Department of Defense (DOD) continues to face financial management issues and challenges that have prevented it from obtaining a clean audit opinion on the fair presentation of its financial statements. Specifically, financial statement auditors issued disclaimers of opinion on DOD's and the military services' fiscal year 2018 and 2019 financial statements. These disclaimers resulted from numerous material weaknesses based on thousands of notices of findings and recommendations (NFR) that the auditors issued. Of the 2,409 NFRs issued to DOD and its components in fiscal year 2018, DOD's auditors were able to close 623 (26 percent) in fiscal year 2019; the remaining 1,786 (74 percent) remained open. These results provide useful insights on DOD's remediation progress since beginning department-wide full audits in fiscal year 2018; it is important for DOD to equal or exceed this progress in the future. Financial statement audits have value beyond the audit opinion and can help management save resources and improve military readiness. DOD leadership identified a number of benefits that resulted from these financial statement audits. For example, the Navy identified a warehouse that was not in its property records that contained approximately $126 million in aircraft parts. The Navy was able to fill over $20 million in open orders for these parts. By using these parts, aircraft were repaired quicker and made available for use, which improved military readiness. To help guide and prioritize department-wide efforts, DOD identified eight audit remediation priority areas (four in 2019 and four in 2020), seven of which specifically related to material weaknesses that its auditor reported. The military services also developed methodologies to prioritize NFRs and determined that over half of their fiscal year 2018 NFRs are high priority and significant to their financial statement audits. DOD and its components have taken steps to develop corrective action plans (CAP) to address NFRs. However, most of the CAPs that GAO tested did not include at least one data element or evidence that a root-cause analysis was performed, as directed by Office of Management and Budget (OMB) and other related guidance, in part, because DOD guidance and monitoring efforts did not clearly identify the need for such documentation. As a result, DOD and its components may lack sufficient information and assurance that their remediation efforts will resolve the underlying causes associated with the NFRs and related material weaknesses. Based on these issues, DOD and its components are at increased risk that their actions may not effectively address identified deficiencies in a timely manner. DOD developed an NFR Database that contains useful information on deficiencies that financial auditors identified and actions to address them, which has improved its ability to monitor and report on audit remediation efforts using dashboard reports based on real-time data contained in the database. However, certain database information on which these reports are based may not be accurate, reliable, and complete. For example, although DOD reviews NFR Database information monthly, it does not follow up on instances of outdated information or other exceptions identified to ensure components resolve them timely. Without complete and reliable information on DOD's audit remediation efforts, internal and external stakeholders may not have quality information to effectively monitor and measure DOD's progress. DOD is responsible for about half of the federal government's discretionary spending, yet it remains the only major federal agency that has been unable to receive a clean audit opinion on its financial statements. After years of working toward financial statement audit readiness, DOD underwent full financial statement audits in fiscal years 2018 and 2019. This report, developed in connection with fulfilling GAO's mandate to audit the U.S. government's consolidated financial statements, examines the (1) actions taken by DOD and the military services to prioritize financial statement audit findings; (2) extent to which DOD and its components developed CAPs to address audit findings in accordance with OMB, DOD, and other guidance; and (3) extent to which DOD improved its ability to monitor and report on audit remediation efforts. GAO reviewed documentation and interviewed officials about DOD's and the military services' audit remediation prioritization, monitoring, and reporting. GAO selected a generalizable sample of 98 NFRs to determine whether CAPs to address them were developed according to established guidance. GAO is making five recommendations to DOD to improve the quality of CAPs to address audit findings and information in the NFR Database and related reports provided to internal and external stakeholders to monitor and assess audit remediation efforts. DOD concurred with three of GAO's recommendations, partially concurred with one recommendation, and disagreed with one recommendation. GAO continues to believe that all the recommendations are valid. For more information, contact Asif A. Khan at (202) 512-9869 or khana@gao.gov.
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    The roles and responsibilities of the Centers for Disease Control and Prevention (CDC) during a multistate foodborne illness outbreak include analyzing federal foodborne illness surveillance networks to identify outbreaks, leading investigations to determine the food causing the outbreak, and communicating with the public. CDC also works to build and maintain federal, state, territorial, and local capacity to respond to foodborne illness outbreaks by awarding funds to state and local public health agencies and through other initiatives. In identifying and responding to multistate foodborne illness outbreaks, CDC faces challenges related to clinical methods and communication, and it has taken some steps to respond to these challenges. One challenge stems from the increasing clinical use of culture-independent diagnostic tests (CIDTs). CIDTs diagnose foodborne illnesses faster and cheaper than traditional methods, but because they do not create DNA fingerprints that can specify a pathogen, they may reduce CDC's ability to identify an outbreak. A CDC working group recommended in May 2018 that CDC develop a plan to respond to the increasing use of CIDTs. By developing a plan, CDC will have greater assurance of continued access to necessary information. CDC also faces a challenge in balancing the competing needs for timeliness and accuracy in its outbreak communications while maintaining public trust. CDC has an internal framework to guide its communications decisions during outbreaks, and it recognizes that stakeholders would like more transparency about these decisions. By making its framework publicly available, CDC could better foster public trust in its information and guidance during outbreaks. CDC has taken steps to evaluate its performance in identifying and responding to multistate outbreaks. Specifically, CDC has developed general strategic goals (see fig.) and taken initial steps to develop performance measures. However, CDC has not yet established other elements of a performance assessment system—an important component of effective program management. CDC's Use of Elements of Program Performance Assessment Systems In particular, CDC has not set specific performance goals, used performance measures to track progress, or conducted a program evaluation of its multistate foodborne illness outbreak investigation efforts. By implementing all elements of a performance assessment system, CDC could better assess its progress toward meeting its goals, identify potentially underperforming areas, and use that information to improve its performance. CDC has estimated that each year, one in six people in the United States gets a foodborne illness, 128,000 are hospitalized, and 3,000 die. CDC data show increases in the number of reported multistate foodborne illness outbreaks—groups of two or more linked cases in multiple states—in recent years. Such outbreaks are responsible for a disproportionate number of hospitalizations and deaths, compared with single-state outbreaks. GAO was asked to review CDC's response to multistate foodborne illness outbreaks. This report examines (1) CDC's roles and responsibilities, (2) challenges that CDC faces and the extent to which it has addressed these challenges, and (3) the extent to which CDC evaluates its performance. GAO reviewed agency documents and data; conducted site visits and case studies; and interviewed federal, state, and local public health officials, as well as representatives of stakeholder groups. GAO is recommending that CDC (1) develop a plan to respond to the increasing use of CIDTs, (2) make publicly available its decision-making framework for communicating about multistate foodborne illness outbreaks, and (3) implement all the elements of a performance assessment system. CDC concurred with all three recommendations. For more information, contact Steve D. Morris at (202) 512-3841 or morriss@gao.gov.
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