Open Recommendations

We recommend that the Washington State Health Care Authority strengthen its MMIS edits to limit the reporting of an encounter for a tier-1 health home service to only once in a beneficiary's lifetime and ensure that only one encounter per beneficiary is reported each month.

We recommend that the Washington State Health Care Authority determine the portion of the remaining $1,367,120 that should have been claimed for managed-care health home service expenditures based on the portion of the MCOs' capitation payment rate that was specifically attributable to health home services, and refund any unallowable amounts.

We recommend the DHS OCHCO designate, direct, and oversee component representatives to maintain rosters of essential employees in each category defined by existing DHS policy.

We recommend the DHS OCHCO designate, direct, and oversee component representatives to maintain rosters of essential employees in each category defined by existing DHS policy.

Complete the expansion study for Access to Financial Institutions and assess the effectiveness of lowering the countable liquid resource tolerance to $0.

(U) Rec. 1: The DoD OIG recommended that the Secretary of Defense establish policy and procedures for implementing basing actions of a unified combatant command. The policy should include potential internal controls to ensure that basing action decisions are transparent and based on verified data. The policy should direct that a candidate location's ability to achieve "Full Operational Capability" within a specific timeframe or other appropriate measurement be incorporated for all future basing actions.

Embassy Sofia, in coordination with the Bureau of Overseas Buildings Operations, should perform seismic safety evaluations of its residential properties in accordance with Department standards.

Embassy Sofia should administer facility management expendable supplies in accordance with Department standards.

CMS should ensure that participating States submit accurate quarterly reports.

OIG recommends that the Bureau of Administration revise the Federal Assistance Directive to require Grants Officers (GO) and Grants Officer Representatives (GOR) to fully use the State Assistance Management System Domestic’s Post-Award Activities function to upload and review documentation for all post-award tasks, such as the review of Performance Progress Reports and Federal Financial Reports, GOR reports, annual reviews, other monitoring activities; and to document workflows for submitting, reviewing, and monitoring post-award activities among the GO, GOR, and award recipient.

Concurrent with the implementation of Recommendation 1, OIG recommends that the Bureau of Administration require bureaus to perform quarterly reviews of the State Assistance Management System Domestic’s Post-Award Activities function reports. The reviews should verify that Grants Officers and Grants Officer Representatives have complied with oversight requirements such as the review of Performance Progress Reports and Federal Financial Reports, GOR reports, annual reviews, and other monitoring activities.

Concurrent with the implementation of Recommendation 1, OIG recommends that the Bureau of Administration require bureaus to designate an official to review the State Assistance Management System’s Post-Award Activities function reports to verify that Grants Officers and Grants Officer Representatives comply with oversight requirements.

OIG recommends that the Bureau of Administration modify the State Assistance Management System user training to include guidance on documenting the Grants Officer and Grants Officer Representative workflows within the State Assistance Management System using the Post-Award Activities function.

Following implementation of Recommendation 5, OIG recommends that the Bureau of Administration analyze the results of the survey to identify the reasons hindering the use of State Assistance Management System Domestic's Post-Award Activities function, including technical issues that need to be addressed and if appropriate, develop and implement a corrective action plan to increase the use of the State Assistance Management System Domestic's Post-Award Activities function.

OIG recommends that the Bureau of Administration develop and implement a communications strategy that provides Grants Officer Representatives with specific and detailed requirements for financial monitoring to improve their understanding of and compliance with those requirements. This communications strategy should underscore the importance of reviewing the Federal Financial Report to ensure that the amount of funds expended is commensurate with the work accomplished on the award.

OIG recommends that the Bureau of Administration develop and implement a communications strategy that provides Grants Officers with specific and detailed requirements for financial monitoring to improve their understanding of and compliance with those requirements. This communications strategy should underscore the critical importance of reviewing and approving the Federal Financial Report in a timely manner within the Payment Management System, rather than allowing a default approval. It should further remind Grants Officers that Grants Officer Representatives could be delegated Federal Financial Report approval responsibility within the Payment Management System to ensure timely approval of reports.

OIG recommends that the Bureau of Administration develop and implement a communications strategy that provides Grants Officers with specific and detailed audit requirements for foreign for-profit organizations to improve their understanding of and compliance with those requirements. This communications strategy should underscore the critical importance of requiring, obtaining, and reviewing audit reports to inform risk assessments and to formulate monitoring plans.

Update the AHTF Program application guide with the revised performance measures and implement processes to assess the outcome of its AHTF Program performance measures.

Establish procedures to enhance the review process of progress reports to analyze the completeness, accuracy, and success of the AHTF Program.

Rec. 2.b: The DoD OIG recommended that the Director of the Federal Electronic Health Record Modernization Program Office, in coordination with the Director of the Defense Health Agency; Program Executive Director for Electronic Health Record Modernization Integration; and Program Manager for DoD Healthcare Management System Modernization develop and implement a plan for migrating legacy patient health care information needed for a patient's complete electronic health record once the Federal Electronic Health Record Modernization Program Office determines the health care data domains of patient health care information that constitutes a complete patient electronic health record.

Rec. 2.c: The DoD OIG recommended that the Director of the Federal Electronic Health Record Modernization Program Office, in coordination with the Director of the Defense Health Agency; Program Executive Director for Electronic Health Record Modernization Integration; and Program Manager for DoD Healthcare Management System Modernization develop and implement a plan for creating interfaces that would allow medical devices to connect and transfer patient health care information to Cerner Millennium.

Rec. 2.d: The DoD OIG recommended that the Director of the Federal Electronic Health Record Modernization Program Office, in coordination with the Director of the Defense Health Agency; Program Executive Director for Electronic Health Record Modernization Integration; and Program Manager for DoD Healthcare Management System Modernization develop and implement a plan to modify Cerner Millennium user roles to ensure users are granted access to only the patient health care information necessary to perform their job responsibilities.

Rec. 1: The DoD OIG recommended that the Director of the Defense Health Agency, in coordination with DoD health care providers, assess the functionality of Military Health System GENESIS to determine whether the concerns identified by the survey respondents still exist, and if the concerns still exist, develop and implement plans of action to address the concerns.

CMS should update and broaden its lists of hospital-acquired conditions to capture common, preventable, and high-cost harm events.

CMS should explore expanding the use of patient safety metrics in pilots and demonstrations for health care payment and service delivery, as appropriate.