Federal Reports

New Hampshire implemented most of the new criminal background check requirements established under the Child Care and Development Block Grant Act. However, certain criminal background check requirements for childcare providers remained unimplemented as of March 1, 2018, and significant challenges may delay full implementation until 2019 or 2020. Specifically, these challenges include unavailable finances and staff to process the background checks, data system limitations, and required changes to State laws or policies and procedures. New Hampshire currently has until September 30, 2018, to implement the new criminal background check requirements. The outstanding challenges may mean that New Hampshire will not fully implement all of the requirements before the deadline and, therefore, New Hampshire may request an additional 1-year waiver from the Administration for Children and Families to address the challenges and comply with the new requirements.

Our objectives were to (1) assess the maturity of National Oceanic and Atmospheric Administration’s (NOAA’s) Polar Follow-On program missions’ system design for indications of cost, schedule or performance issues that would threaten the ability of the Joint Polar Satellite System (JPSS) program to execute to its baselines; (2) determine the extent to which NOAA has complied with requirements to report JPSS development costs; and (3) review NOAA efforts to plan for future satellite technologies.

The VA Office of Inspector General (OIG) conducted a healthcare inspection in response to a complaint that a primary care provider (PCP1) at a Veteran Integrated Service Network (VISN) 20 Facility (Facility) continued to prescribe controlled substances to a patient at high-risk for overdose. The OIG substantiated that PCP1 was aware the patient was getting controlled substances from outside pharmacies and had a history of benzodiazepine abuse, and family members reported that the patient was abusing controlled substances. The OIG substantiated that PCP1 prescribed the patient controlled substances when he was no longer the patient’s designated PCP and despite nonadherence to an Opioid Agreement. The OIG could not substantiate that PCP1 had a reputation among Facility staff of prescribing narcotics “recklessly.” The OIG did not substantiate that providers warned PCP1 about his prescribing practices. The OIG reviewed the Facility’s processes, policies, and procedures about controlled substance prescribing and identified limitations in controlled substance prescribing oversight. The Facility did not have regular processes in place for reviewing controlled substance prescribing for individual patients. The Facility lacked formalized processes and referral mechanisms for interdisciplinary collaboration for patients with complex clinical pain. The Facility had policies for state prescription drug monitoring programs (PDMP) and urine toxicology screens, although no mechanisms to monitor provider responses to positive PDMP and toxicology results. The Facility Board that is responsible for controlled substance safety oversight responsibility for patient record flags was not well defined and lacked established protocols and procedures. The Facility did not comply with the Veterans Health Administration’s peer review directive. The OIG made one recommendation to the VISN Director to review the patient’s care and provider’s practice and seven recommendations to the Facility Director related to prescribing practices and peer review processes.