Open Recommendations

We recommend that CMS issue clarifying guidance to States to help ensure that they correctly use the Medicare HAC list to identify PPCs.

We recommend that CMS issue clarifying guidance to States to help ensure that they acquire from all inpatient hospital providers the information necessary to determine whether Medicare crossover claims contain PPCs and fully understand how to determine whether a crossover claim containing a PPC requires a payment adjustment.

We recommend that CMS issue clarifying guidance to States to help ensure that they identify PPCs on inpatient claims from all inpatient hospitals.

We recommend that CMS issue clarifying guidance to States to help ensure that they understand how and when to apply the “reasonably isolate” language in 42 CFR § 447.26(c)(3)(ii) as it relates to the limitation of reduction in payment for PPCs.

Complete, within 30 days of the issuance of this audit report, the review for preventing duplication of benefits associated with its 2008 CDBG-DR grant and pursue appropriate remedies for any instances of noncompliance found.

We recommend the Assistant Secretary for OSHA revise OSHA’s Debt Collection Procedures to comply with OMB Circular A-129.

We recommend that the Missouri Department of Health and Senior Services follow up with the 20 nursing homes to ensure that corrective actions have been taken regarding the life safety and emergency preparedness deficiencies identified in this report.

We recommend that the Missouri Department of Health and Senior Services work with CMS to develop standardized life safety training for nursing home staff.

We recommend that the Missouri Department of Health and Senior Services conduct more frequent surveys at nursing homes that have a history of multiple high-risk deficiencies and follow up to ensure that corrective actions have been taken.

We recommend that the Missouri Department of Health and Senior Services expand training of nursing home staffs with specific attention to the updating of emergency preparedness plan templates to address facility-specific preparations.

SAMHSA should work closely with States and territories during the no-cost extension period to address barriers to timely spending and to ensure that administrative cost caps are not exceeded

SAMHSA should require States that receive grants for OUD treatment to specifically report how many patients are receiving MAT

OCFO should review and update the Contract File Content Checklist to reflect current documents maintained in the file.

ASD should review and update the COR Appointment Letter as needed and specifically address the maintenance of electronic contract files.

OCFO should revise EEOC Order 360.001 as needed to assist CORs in performing their duties and include implementation guidance for contract administration activities, such as submitting contract modifications.

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to develop and implement effective policies and procedures that include guidance for Texas and its LEAs to track student enrollment in the event of a disaster in order to document and accurately report data.

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to develop and implement policies and procedures to ensure it collects accurate and complete data on displaced students that can be used for Federal reporting requirements related to the Emergency Impact Aid program.

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to revise, for any future Emergency Impact Aid program grants, (1) its reasonableness check for displaced student data counts to identify and follow up with LEAs regarding student counts that are identical in applications and weekly submissions, or that increase over all four quarters; and (2) its annual desk reviews to include steps to review Emergency Impact Aid program displaced student count data

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to provide support for the unsupported displaced student data counts at Houston, Goose Creek, and Spring, or return $10,551,519 million in Emergency Impact Aid program funds received based on unsupported displaced student count data. This amount includes $874,665 of duplicated unsupported funds noted in Finding 2.

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to identify all LEAs with reported displaced student counts, including Spring, that matched PEIMS data or that increased by quarter; review support for all, or a statistically valid sample of students reported as displaced by quarter; and return any funds related to unsupported displaced student counts.

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to provide support showing that the three LEAs we reviewed properly used Emergency Impact Aid program funds for students reported as students with disabilities or return $1.94 million to the Department. This amount includes $874,665 of duplicated unsupported funds noted in Finding 1.

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to provide support demonstrating that employees in Houston and Goose Creek worked at schools with displaced students or return $750,088 to the Department

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to determine whether other Texas LEAs that received Emergency Impact Aid program funds separately accounted for Emergency Impact Aid program funds received for the benefit of displaced students reported as students with disabilities. For all, or a statistical sample, of these LEAs that did not separately account for these funds, review support to determine whether they properly used these funds and return any funds that were not properly used.

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to develop procedures for providing guidance and monitoring of future emergency funding from the Department to ensure that (1) award notifications to the LEAs identify Emergency Impact Aid program funds by student type (including children with disabilities) and (2) as part of annual desk reviews, it determines whether LEAs separately recorded and tracked these funds

We recommend that the Assistant Secretary for the Office of Elementary and Secondary Education require Texas to develop controls to provide reasonable assurance that LEAs use funds received for displaced students for activities and services related to serving displaced students.