Open Recommendations

In order to mitigate risks to the Station's structural integrity, ensure the risks associated with cracks and leaks in the Service Module Transfer Tunnel are identified and mitigated prior to agreeing to an ISS life extension.

The Chief Administrative Officer review jurisdiction-level fleet policies and standardize jurisdictional best practices across the AOC where appropriate;

The Chief Administrative Officer, in coordination with AOC organization leaders, review and revise AOC-wide and jurisdictional policies to include standards for vehicle utilization, and guidance for implementing these standards while maintaining jurisdiction-level operational flexibility.

We recommend the Chief Administrative Officer develop and implement additional policies and procedures that:a) ensure adherence to vehicle utilization reporting,b) include a more formal scheduled vehicle maintenance program, andc) collect, track, monitor and analyze fleet costs throughout the vehicle lifecycle at the vehicle level.

We recommend the Director of CISA develop an implementation plan to conduct periodic assessments for monitoring theprogress of goals and activities and complete annual updates on action items, as required by the Cyber Action Plan and associated 2015 and 2018memorandums.

We recommend the Director of CISA conduct centralized tracking and completion of signed closeout summaries to reconcile the ongoing,outstanding, and open tasks and activities, as required by the Cyber Action Plan and associated 2015 and 2018 memorandums.

We recommend the Director of CISA establish performance measures to ensure the effectiveness and completion of the CyberAction Plan and associated 2015 and 2018 memorandum activities.

We recommend the Director of CISA establish the DHS governance structure and ensure it consists of an Executive Committee thatmeets at least semi-annually and a Steering Committee that meets at least quarterly, as required.

We recommend that the Centers for Medicare & Medicaid Services update its PDE guidance to address margin under sponsor delivery models in which a sponsor owns a pharmacy.

Develop information reports to identify beneficiaries in death suspense for prolonged periods and instruct management to ensure technicians take appropriate actions on the cases.

Verify and post death information, where appropriate, for the remaining beneficiaries in the State Death population.

Establish systems criteria to identify Old-age, Survivors and Disability Insurance beneficiaries in Address Suspense who are likely deceased, such as identifying beneficiaries suspended for prolonged periods who do not have activity on any Social Security Administration (SSA) records since their suspension. Once established, SSA should update policy to instruct technicians to search for death information.

Develop systems controls to alert technicians when SSA receives death information from sources, such as Centers for Medicare and Medicaid Services and the Department of the Treasury (Treasury), for beneficiaries in suspended payment status.

Revise policy to instruct technicians to conduct additional searches for death information when developing suspension actions.

Clarify policy for establishing dates of death for beneficiaries suspended based on a report from Treasury of a returned payment for death.

We recommend that the Office of Intergovernmental and External Affairs develop and distribute to staff a quick reference document that includes: o key staff responsibilities for coordinating and vouchering both invitational and staff travel in accordance with the FTR and the HHS Travel Policy Manual and the resources available to staff for ensuring that travel card transactions are compliant with these Federal travel regulations and o a requirement that staff and supervisors read and sign the HHS Traveler Agreement.

We recommend that the Office of Intergovernmental and External Affairs establish an oversight program that includes the following: o approving officials reviewing and signing travel authorizations and vouchers only after verifying that the types of expenses claimed are authorized and allowable, the amounts claimed are accurate, and the required receipts are attached to the voucher, o Program Coordinators verifying that all cardholders take the initial IBA card training course, and o Program Coordinators regularly using the online reporting capabilities provided by the servicing bank to monitor for potential travel card misuse and delinquency trends.

CMS should provide training for nursing homes on Federal requirements for facility-initiated discharge notices.

CMS should assess the effectiveness of its enforcement of inappropriate facility-initiated discharges.

CMS should implement its deferred initiatives to address inappropriate facility-initiated discharges.

ACL should assist State Ombudsman programs in establishing a data-collection system for facility-initiated discharge notices

ACL should establish guidance for analysis and reporting of data collected by State Ombudsman programs from facility-initiated discharge notices.

ACL and CMS should coordinate to strengthen safeguards to protect nursing home residents from inappropriate facility-initiated discharges.

ACL and CMS should ensure that all State Ombudsmen, State agencies, and CMS ROs have an ongoing venue to share information about facility-initiated discharges and potentially other systemic problems in nursing homes.

Develop a departmentwide human capital plan or evaluate and revise existing plans to guide the recruitment, retention, and skill development of staff involved in IT acquisitions. The plan should include related metrics to measure plan implementation and effectiveness.