Open Recommendations

We recommend that the Choctaw Nation request and review agency contractor background investigations that comply with the ICPFVPA, including documentation that confirms HHS employees met all background investigation requirements of the ICPFVPA, or perform background investigations on these individuals that comply with the ICPFVPA.

We recommend that the Choctaw Nation perform background investigations, as required by the ICPFVPA, on all employees and temporary employees who currently have contact with Indian children and determine whether these individuals meet the required minimum character standards.

Require Serve DC to develop and implement policies and procedures to appropriately track in its accounting system and obtain supporting documentation for all in-kind match costs associated with AmeriCorps grants and from within the DC government and third parties.

Require Serve DC to implement controls to prepare reports that support and reconcile to the amounts reported to AmeriCorps eGrants. Serve DC should also establish controls to reconcile and document costs recorded in the accounting record to the costs reported on the Federal Financial Report for each grant.

Require that Serve DC develop and implement a mandatory training program including a tracking system to ensure that all subgrantees’ staff have training, capability, and assistance to enter their budgets and costs into its reporting system to meet reporting requirements timely.

We are referring $8,534 in questioned costs for further review and action. The questioned costs consist of
credit card purchases for which LAW did not maintain adequate documentation to support the purposes of
the transactions or explain why they were allowable under LSC regulations and guidance.

We recommend the CISA Director develop and implement comprehensive policies and procedures regarding its collaboration with EPA and other Water and Wastewater Systems Sector stakeholders. These policies and procedures should address: • the Water Sector Liaison’s roles and responsibilities; • what information should be shared with stakeholders; • how often and when divisions should coordinate their communications; and • how best to facilitate information sharing about cyber threats, vulnerabilities, incidents, potential protective measures, and best practices, in both routine and urgent circumstances.

We recommend the CISA Director have an agency-wide requirement to develop and implement standard operating procedures to improve regular communication among CISA divisions relevant to the Water and Wastewater Sector or other critical infrastructure Sectors and share that information and updates on projects, decisions, and lead roles and responsibilities related to the Water and Wastewater Systems Sector and other sectors as appropriate.

Strengthen the Parcel Return Service manifest verification process by incorporating the facility type as a required parameter.

Enhance the Parcel Return Service refund review process to include an automated validation to verify that refunds are warranted, including an assessment of whether the return delivery units that received the packages were active at the time of mailing.

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CDC should take further steps to ensure the quality of nursing home reporting of COVID-19 data to NHSN.

CDC should consider how quality assurance checks can be enhanced to ensure data accuracy, as appropriate.

CDC should improve the user support the NHSN Help Desk provides to nursing homes.

Risk Management

We recommend that Cahaba Government Benefits Administrators, LLC, work with CMS to ensure that its final settlement of contract costs reflects a decrease in Medicare PRB costs of $1,085,470 for CYs 2017 through 2019.

We recommend that Cahaba Safeguard Administrators, LLC, work with CMS to ensure that its final settlement of contract costs reflects a decrease in Medicare PRB costs of $9,806 for CYs 2017 through 2019.

The Under Secretary for Health ensures the identified national program office responsible for oversight of alcohol withdrawal management consider requiring the development and implementation of written guidance for the management of alcohol withdrawal across all inpatient settings, to include: (a) expectations for determining alcohol withdrawal severity, level of care, and when transfer of care is indicated; (b) expected actions of nurses to communicate with prescribers based on patients’ changes in symptoms or alcohol withdrawal severity and when that communication should be followed by a prescribers face-to-face evaluation of a patient; (c) expectations for the evaluation of co-occurring conditions, expert consultation…

The Under Secretary for Health consider the implementation of training for inpatient staff on the administration of standardized alcohol withdrawal severity scales.

Re-evaluate aged seized digital assets to consider whether risks of misstatement related to accurate valuation, existence, and ownership of assets have been adequately addressed considering the evolving nature of digital asset seizures. Based on the results of the evaluation, design and implement processes, procedures, and controls to appropriately account for aged digital assets. (New)

Assess reconciliation, financial reporting review, and other monitoring controls to increase the precision with which period end financial reporting is performed, including the identification and investigation of significant variances for all financial statements. (New)