Open Recommendations

We recommend that the North Carolina Department of Health and Human Services, Division of Health Benefits work with CMS to determine and refund the unallowable portion of Federal reimbursement for physician-administered drugs that were not invoiced for rebates after December 31, 2019.

We recommend that the North Carolina Department of Health and Human Services, Division of Health Benefits to strengthen its internal controls to ensure that all physician-administered drugs eligible for rebates are invoiced.

Ensure compliance with segregation standards, including having a basis for use of restraints and providing access to recreation, library, mail, and religious services.

Ensure all unaddressed facility conditions that we identified as deficient (torn bedding and plumbing issues) are corrected.

Ensure facility staff are aware of what criteria constitute a use of force event and reinforce the practice of documenting and reviewing such events.

Ensure paper forms for facility requests are available, collected, logged, and responded to within 3 business days of receipt.

Ensure electronic request and grievance logs are available for inspection, as required.

Ensure classification records document the date and time detainees are classified, as required.

STB perform a review of all employees' leave balances to ensure they are accurate and comply with 5 United States Code (U.S.C.) 6304 requirements.

Management record all equipment purchases that meet its capitalization thresholds as capitalized assets. If the acquired property is not ready to be placed into service, then that property should be classified as Construction in Progress or Other General Property, Plant and Equipment, depending on the circumstances that apply to the purchased items at that time.

Management regularly assess all capitalized property and identify assets that require reclassification, such as when assets are being placed into, or taken out of, service.

Management update its financial reporting and property management policies and procedures to include the recording of new capitalized purchases in accordance with generally accepted accounting principles.

Advise WSDOT as part of stewardship and oversight activities to include change orders in WSDOT's next project management review of SDOT.

Direct the FHWA WA Division to review WSDOT's established process of reviewing subrecipients' supporting documentation for internal staffing charges (e.g., billing records, invoices, timecards) to ensure compliance with 2 CFR 200.403.

The Under Secretary for Health ensures the Office of Mental Health and Suicide Prevention develops, implements, and monitors action plans to meet Intensive Community Mental Health Recovery visit frequency requirements, to include program resource needs and the ongoing role for virtual care.

The Under Secretary for Health requires the Office of Mental Health and Suicide Prevention to develop a process for Intensive Community Mental Health Recovery programs to ensure veterans receiving low-intensity services do not represent greater than 20 percent of caseloads and to distinguish between veterans receiving high- and low-intensity services for accurate and effective program oversight.

CDC should work with awardees to enhance current and future capabilities for provider training and oversight.

CDC should clarify roles and responsibilities within HHS for vaccine public health messaging during a pandemic.

CDC should strengthen reporting of vaccine allocation data and administration data.

CDC should update its plans for mass vaccination programs with strategies that address awardee-reported logistical challenges.

CDC should provide educational outreach to ensure that State and local immunization programs are aware of existing tools to address vaccination campaign needs.

CDC should work with State and local immunization programs and retail pharmacy partners to mitigate reported data gaps and timeliness challenges.

In accordance with Policy 51.101, review and update all compliance policies, including determining whether updates are needed to improve clarity, remove inconsistencies, and ensure harmonization with the Cooperative Agreements.

Develop comprehensive written documentation of the procedures to be performed by Commission staff for reviewing, evaluating, and approving or rejecting compliance transaction packages CNAs submit to PLIMS. The procedures should include roles and responsibilities with an appropriate segregation of duties and documentation requirements in PLIMS. (Finding 1B) For CVR transactions, also incorporate the following:
a. OCD staff protocols and requirements for requesting access to detailed supporting documentation provided by the NPAs to the CNAs to independently verify NPA compliance with statutes, regulations, and Commission policies. The protocols should take into consideration identified risks such as NPA past performance, overall trends…

Develop comprehensive written documentation of the procedures to be performed by Commission OCD staff for reviewing, reconciling, and processing manual compliance reports and transactions submitted by the CNAs and/or NPAs outside of PLIMS (Finding 1B). The procedures should also include the following:
a. Roles and responsibilities with an appropriate segregation of duties.
b. Follow-up on compliance exceptions reported.
c. Reconciliation of manual data to PLIMS.
d. Review of quarterly and annual AR&C extracts, including data supporting the NPA’s 75% ODLH requirement.
e. Documentation requirements, including the use and frequency of PLIMS reports and summarizing compliance findings and actions, preferably in…