Federal Reports

Under a contract monitored by the National Credit Union Administration OIG, KPMG, an independent certified public accounting firm, performed an audit of NCUA’s financial statements, which includes the Share Insurance Fund, the Operating Fund, the Central Liquidity Facility, and the Community Development Revolving Loan Fund, as of and for the years ending December 31, 2020 and 2019.

The Medicare and Medicaid programs cover care in nursing homes for eligible beneficiaries. Sections 1819 and 1919 of the Social Security Act (the Act) establish requirements for CMS and States to perform surveys of nursing homes to determine whether they meet Federal participation requirements. For Medicare and Medicaid, these statutory participation and survey requirements are implemented in Federal regulations at 42 CFR part 483, subpart B, and 42 CFR part 488, subpart E, respectively.Nursing homes are required to comply with all Federal, State, and local laws, regulations, and codes, as well as accepted professional standards and principles (42 CFR § 483.70). Federal regulations on life safety (42 CFR § 483.90) require that nursing homes comply with standards set forth in the National Fire Protection Association (NFPA) Life Safety Code (NFPA 101) and Health Care Facilities Code (NFPA 99). CMS lists applicable requirements on Form CMS 2786R, Fire Safety Survey Report. Federal regulations on emergency preparedness (42 CFR § 483.73) include specific requirements for nursing homes’ emergency preparedness plans and reference the Standard for Emergency and Standby Power Systems (NFPA 110) as part of these requirements. CMS lists applicable requirements on its Emergency Preparedness Surveyor Checklist. The Fire Safety Survey Report and Emergency Preparedness Surveyor Checklist are used when CMS or a designated agency performs a nursing home survey. The results of each survey are reported and added to CMS’s Automated Survey Processing Environment (ASPEN) system.

We have performed audits in several States, including New York, in response to a congressional request concerning deaths and abuse of residents with developmental disabilities in group homes. Federal waivers permit States to furnish an array of home and community-based services to Medicaid beneficiaries with developmental disabilities so that they may live in community settings and avoid institutionalization. CMS requires States to implement a critical incident reporting system to protect the health and welfare of Medicaid beneficiaries receiving waiver services.Our objective was to determine whether New York ensured that community-based providers complied with Federal Medicaid waiver and State requirements for reporting and monitoring critical incidents involving Medicaid beneficiaries with developmental disabilities residing in community-based settings.

The West Calumet Housing Complex (WCHC), located in East Chicago, IN, was a public housing development that opened in 1972 on top of a former lead smelting plant. HUD and other agencies missed multiple opportunities to identify site contamination at WCHC. As a result, WCHC residents continued living in unsafe conditions for decades, and inadequate oversight led to the lead poisoning of children in WCHC. Between 2005 and 2015, a child living in WCHC had nearly a three times greater chance of having elevated blood lead levels than children living in other areas of East Chicago. HUD has partnered with and relied on the Environmental Protection Agency (EPA) to identify contaminated HUD-funded properties and develop a mitigation strategy for those properties. In 2016, EPA provided HUD a list of HUD-funded properties on or near contaminated sites. Since then, EPA and HUD have updated this list. While HUD has taken steps to improve communication with EPA, it can do more with the information it receives to understand how contaminated sites might impact HUD-funded properties. As a result of HUD’s approach to identifying contaminated sites, residents of those contaminated properties might experience prolonged exposure to potential contaminants. HUD may be unaware of other situations like WCHC. Therefore, HUD needs to take more action and develop a strategy to identify and mitigate those situations. We offer four recommendations to help HUD (1) develop and implement strategies to research properties and determine whether site contamination should be considered in future environmental reviews and then (2) monitor those reviews.