Open Recommendations

CMS should Collaborate with States to conduct greater oversight of Medicaid MCOs’ management of specialty drugs; this oversightcould include a review of contract language that allows States to obtain requested information on specialty drug categorizations, specialty drug reimbursement methodologies, and cost management strategies.

Assign responsibility and delegate authority to an office or individual to update and establish a formal policy with procedures, practices, and methodologies identified in the PPE ILSP, to standardize the process for all DHS components to follow for their PPE programs.

Implement a process for approving deviations from established configuration settings.

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We recommend that the Centers for Medicare & Medicaid Services work with Texas to determine whether the source of IGTs and the practice of using debt instruments to fund the non-Federal share of QIPP payments meets program objectives and promotes economy and efficiency in Medicaid.

We recommend that the Centers for Medicare & Medicaid Services reevaluate QIPP to ensure that it operates in a manner that meets program objectives while promoting economy and efficiency in Medicaid.

The Bureau of Global Talent Management, in coordination with the Under Secretary for Management, the Bureaus of Diplomatic Security and Information Resource Management, and the regional bureaus, should conduct an organizational assessment of the information systems security officer program to determine the feasibility of creating full-time overseas positions and implement the results of the assessment with an appropriate reporting structure for those positions.

Complete the process of configuring the scanning tool to account for the approved deviations for the standard baseline configurations.

Ensure all personnel whose responsibilities include access to PII complete annual privacy-role based training.

Direct TAMU to strengthen its administrative and management procedures and internal controls surrounding the purchase of airfare and the approval of travel expense reports. Updated procedures could include: a. Conducting annual training for those individuals responsible for reviewing and approving expense reports within each department. b. Establishing clear guidance regarding the allowability of no-show expenses that do not benefit the project(s) charged. c. Establishing clear guidance regarding how employees that are combining business and personal travel should document that the combined travel did not cause the total airfare expenses to exceed the expenses that TAMU would have incurred if the…

Direct TAMU to establish clear guidance regarding the allowability of publication expenses, including the need to acknowledge NSF funding sources.

Direct TAMU to strengthen its administrative and management processes and internal controls related to establishing and documenting compensation rates for individuals who perform additional work outside the scope of their regular duties. Updated processes could include performing an annual review of TAMU employees, both staff and students, to ensure that TAMU has documented an established rate of pay for each employee that charges salary expenses to sponsored projects.

Direct TAMU to strengthen its administrative and management procedures and internal controls for allocating expenses to sponsored projects. Processes could include: a. Implementing additional procedures requiring the Office of Sponsored Research Services to review and approve all non-salary expenses charged to NSF awards within 90 days of the award’s expiration date. b. Requiring Principal Investigators or other designated staff to review and justify the allocation methodologies used to charge one-time salary payments, supplies for administrative personnel, and publications to sponsored projects. c. Requiring Principal Investigators or other designated staff to provide documented justifications when charging publication costs to Federal awards…

Direct TAMU to provide documentation supporting that it has repaid or otherwise credited the $13,362 of questioned indirect costs for which it has agreed to reimburse NSF.

Direct TAMU to strengthen its administrative and management processes and internal controls for applying indirect costs to Federal awards. Processes could include: a. Requiring that personnel manually review material and supply purchases to evaluate whether TAMU should account for the items as equipment. Specifically, TAMU should consider whether the items purchased have a useful life that exceeds one year and a value that exceeds $5,000, and/or if the items are necessary for the use of an asset that meets those criteria. b. Requiring that personnel manually review purchases from consultants and vendors whose collective billings exceed $25,000 each to ensure…

Direct TAMU to strengthen its administrative and management procedures and internal controls related to procurement processes. Processes could include: a. Conducting annual training for individuals who are responsible for approving service expenses that require a sole-source justification and requisition before the vendor or consultant begins providing the services. b. Implementing a control to flag service expenses from vendors that have invoiced a cumulative total of more than $10,000 to ensure that TAMU has executed a service agreement with each vendor before processing the payment.

CMS should assess the results of infection control surveys and revise the survey as appropriate.

CMS should work with States to help overcome challenges with PPE and staffing.

CMS should clarify expectations for States to complete backlogs of standard surveys and high-priority complaint surveys.

IHS should provide additional guidance and training to facilities on patient protection policies, including the role of law enforcement and the reporting process related to patient abuse.

IHS should improve the process and timeliness for conducting staff background investigations and notifying facilities when staff are approved.

IHS should examine and revise, as needed, the reporting structure in the policies and the incident reporting system to ensure that staff and patients can report abuse anonymously.

IHS should establish and enforce a deadline by which all facilities must fully incorporate the new requirements into their policies and procedures, and actively monitor facility adherence.

The Commissioner, Wage and Investment Division, should develop processes and procedures to retain and provide access to historical ERS data, including actions taken by tax examiners.