Federal Reports

The Medicaid "health home" option allows States to create programs that provide care coordination and care management for beneficiaries with chronic health conditions. Health homes are not physical spaces. Rather, they are a healthcare model in which providers work together to coordinate and manage beneficiaries' care at a reasonable cost.

What We Looked AtPreventing accidents in railroad operations that result from employees' illicit drug and/or alcohol impairment is critical to ensuring the safety of the traveling public. Illicit drug use discovered during investigation of fatal railroad accidents and a recent increase in the percentage of railway workers testing positive for drug use underscore the importance of the Federal Railroad Administration's (FRA) oversight of railroads' drug and alcohol testing programs. Given the importance of drug and alcohol testing to protecting transportation safety, our office is conducting a series of reviews on drug testing programs within the transportation industry. Our objectives for this self-initiated audit were to assess FRA's (1) review and approval of railroads' random alcohol and drug testing program plans, and (2) controls for enforcing compliance with the plans and minimum annual random alcohol and drug testing rates.What We FoundFRA has not adequately reviewed and approved railroads' drug and alcohol testing plans as required or documented its review and approval process. Our review found that FRA reviewed and approved incomplete plans that do not fully adhere to FRA regulations. Specifically, we reviewed 102 drug and alcohol testing plans from applicable railroads and determined that approximately 51 percent of the reviewed and approved plans were incomplete and did not contain key elements required by FRA regulations. In addition, FRA's ability to verify and enforce railroads' compliance with drug and alcohol testing requirements is limited by internal control weaknesses. For example, FRA's program guidance for overseeing drug and alcohol testing compliance is outdated and does not reflect current regulations or provide for supervisor review. FRA has also not established a process for following up on action items issued to railroads during compliance audits to verify they undertake recommended actions. Furthermore, FRA procedures do not fully meet its drug and alcohol testing compliance audit goals.Our RecommendationsFRA concurred with all four of our recommendations to improve its guidance and oversight of the drug and alcohol testing program and proposed appropriate actions and completion dates.

As part of our annual audit plan, we audited the allocation of labor expenses in the Tennessee Valley Authority’s (TVA) Information Technology (IT) organization. Our audit objective was to determine if financial transactions for labor charged to Operations and Maintenance and Capital general ledger accounts under the IT organization during fiscal year 2018 received the proper accounting treatment. We were unable to determine if financial transactions for labor charged to Operations and Maintenance and Capital general ledger accounts under the IT organization during fiscal year 2018 received the proper accounting treatment. TVA’s IT had informal processes in place to compare forecast to actual project costs on a monthly and quarterly basis to ensure labor charges received the proper accounting treatment. While the description of these variance review processes appeared adequate, we found (1) they were not documented, and (2) limited evidence was provided to show the described processes were followed. TVA management agreed with our recommendations.

IPERA Determination

Harris County, Texas needs additional technical assistance and monitoring to ensure grants management comply with Federal procurement regulations. The County’s procurement policies, procedures, and business practices were not adequate to expend disaster grant funds in accordance with Federal procurement regulations and Federal Emergency Management Agency (FEMA) guidelines. We recommended FEMA disallow $2.7 million in ineligible costs and require Texas to work with the County to incorporate Federal procurement regulations when using Federal funds, and review procurement activities before the County awards future contracts. We made three recommendations that will help improve the procurement capability of Harris County, Texas. FEMA concurred with all three recommendations.