Open Recommendations

We recommend that the Washington State Department of Social and Health Services follow up with the 20 nursing homes reviewed in this audit to ensure that these nursing homes have taken corrective actions to address the life safety, emergency preparedness, and infection control deficiencies identified.

We recommend that the Washington State Department of Social and Health Services provide training to State surveyors to ensure that deficiencies related to life safety, emergency preparedness, and infection control are consistently identified.

Rec. 2.b: The DoD OIG recommended that the Director of the Defense Health Agency increase the number of required Prescription Monitoring Program candidate reviews for the Managed Care Support Contractors, while also implementing standard Prescription Monitoring Program processes and review requirements for all DoD medical treatment facilities to include the number of candidates to review.

Rec. 2.c: The DoD OIG recommended that the Director of the Defense Health Agency implement procedures to review DoD medical treatment facility and Managed Care Support Contractor compliance with the Prescription Monitoring Program requirements in Defense Health Agency Instructions and the TRICARE Operations Manual.

Rec. 3.c: The DoD OIG recommended that the Director of the Defense Health Agency develop and implement a process to obtain medical documentation for DoD beneficiaries from DoD medical treatment facilities and other agencies or health insurance providers to support routine monitoring and medical reviews of at-risk beneficiaries.

We recommend that the Connecticut Department of Social Services continue to coordinate with the Department of Developmental Services to provide training for staff of DDS and private group homes on how to monitor and report reasonable suspicions of abuse and neglect, especially in light of the significant staff hiring and retention problems in Connecticut group homes.

We recommend that the Connecticut Department of Social Services continue to coordinate with the Department of Developmental Services to use the new analytical procedures to identify potential cases of abuse or neglect involving Medicaid enrollees with developmental disabilities that incurred injuries and are treated in hospital emergency room settings.

We recommend that the Manager, ORNL Site Office, ensure that UT-Battelle:2. Maintains PRVs in the data centers in accordance with its Procedure.

We recommend that the Pennsylvania Department of Human Services expand the pilot program to other regions to periodically match Medicaid claims with diagnosis codes indicating potential abuse or neglect to 24-hour reportable incidents recorded in the incident reporting system.

We recommend that the Pennsylvania Department of Human Services continue working with community-based providers to ensure that all community-based providers' staff identify and understand the requirements for reporting 24-hour reportable incidents within required timeframes.

We recommend that the Pennsylvania Department of Human Services continue working with supports coordinators to ensure they verify with the community-based provider that incidents that they are aware of are reported in the EIM system.

We recommend that the Pennsylvania Department of Human Services provide targeted training to community-based providers that repeatedly do not report 24-hour reportable incidents.

(U) Rec. B.1.a: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Mid?Atlantic, and the Commanding Officer, Naval Facilities Engineering Systems Command Mid?Atlantic update the Norfolk Naval Shipyard master plan to comply with the 5?year requirement in accordance with DoD Instruction 4165.70, "Real Property Management," April 6, 2005 Incorporating Change 1, August 31, 2018).

(U) Rec. B.1.a: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Mid?Atlantic, and the Commanding Officer, Naval Facilities Engineering Systems Command Mid?Atlantic update the Norfolk Naval Shipyard master plan to comply with the 5?year requirement in accordance with DoD Instruction 4165.70, "Real Property Management," April 6, 2005 Incorporating Change 1, August 31, 2018).

(U) Rec. B.1.b: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Mid?Atlantic, and the Commanding Officer, Naval Facilities Engineering Systems Command Mid?Atlantic update the Norfolk Naval Shipyard master plan to include a military installation resiliency component in accordance with section 2864, title 10, United States Code, and Unified Facilities Criteria 2?100?01, "Installation Master Planning," September 30, 2020 (Change 1, April 8, 2022).

(U) Rec. B.1.b: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Mid?Atlantic, and the Commanding Officer, Naval Facilities Engineering Systems Command Mid?Atlantic update the Norfolk Naval Shipyard master plan to include a military installation resiliency component in accordance with section 2864, title 10, United States Code, and Unified Facilities Criteria 2?100?01, "Installation Master Planning," September 30, 2020 (Change 1, April 8, 2022).

(U) Rec. B.1.c: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Mid-Atlantic, and the Commanding Officer, Naval Facilities Engineering Systems Command Mid-Atlantic review and document the prioritization of Norfolk Naval Shipyard's future master planning efforts to ensure compliance with Federal and DoD requirements.

(U) Rec. B.1.c: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Mid?Atlantic, and the Commanding Officer, Naval Facilities Engineering Systems Command Mid?Atlantic review and document the prioritization of Norfolk Naval Shipyard's future master planning efforts to ensure compliance with Federal and DoD requirements.

(U) Rec. B.2.a: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Hawaii, and the Commanding Officer, Naval Facilities Engineering Systems Command Hawaii update the Joint Base Pearl Harbor?Hickam master plan to comply with the 5?year requirement in accordance with DoD Instruction 4165.70, "Real Property Management," April 6, 2005 (Incorporating Change 1, August 31, 2018).

(U) Rec. B.2.a: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Hawaii, and the Commanding Officer, Naval Facilities Engineering Systems Command Hawaii update the Joint Base Pearl Harbor?Hickam master plan to comply with the 5?year requirement in accordance with DoD Instruction 4165.70, "Real Property Management," April 6, 2005 (Incorporating Change 1, August 31, 2018).

(U) Rec. B.2.b: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Hawaii, and the Commanding Officer, Naval Facilities Engineering Systems Command Hawaii update the Joint Base Pearl Harbor?Hickam master plan to include a military installation resiliency component in accordance with section 2864, title 10, United States Code, and Unified Facilities Criteria 2?100?01, "Installation Master Planning," September 30, 2020 (Change 1, April 8, 2022).

(U) Rec. B.2.b: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Hawaii, and the Commanding Officer, Naval Facilities Engineering Systems Command Hawaii update the Joint Base Pearl Harbor?Hickam master plan to include a military installation resiliency component in accordance with section 2864, title 10, United States Code, and Unified Facilities Criteria 2?100?01, "Installation Master Planning," September 30, 2020 (Change 1, April 8, 2022).

(U) Rec. B.2.c: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Hawaii, and the Commanding Officer, Naval Facilities Engineering Systems Command Hawaii review and document the prioritization of Joint Base Pearl Harbor?Hickam's future master planning efforts to ensure compliance with Federal and DoD requirements.

(U) Rec. B.2.c: The DoD OIG recommended that the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Hawaii, and the Commanding Officer, Naval Facilities Engineering Systems Command Hawaii review and document the prioritization of Joint Base Pearl Harbor?Hickam's future master planning efforts to ensure compliance with Federal and DoD requirements.

(U) Rec. B.3: The DoD OIG recommended that the Commanding Officer, Naval Facilities Engineering Systems Command Hawaii, in coordination with the Commander, Pearl Harbor Naval Shipyard, direct planning officials to apply environmental threat policies, such as DoD Directive 4715.21 and relevant Unified Facilities Criteria, when developing and executing projects to address the risks identified during the master planning process for the existing dry docks at Pearl Harbor Naval Shipyard.

(U) Rec. B.3: The DoD OIG recommended that the Commanding Officer, Naval Facilities Engineering Systems Command Hawaii, in coordination with the Commander, Pearl Harbor Naval Shipyard, direct planning officials to apply environmental threat policies, such as DoD Directive 4715.21 and relevant Unified Facilities Criteria, when developing and executing projects to address the risks identified during the master planning process for the existing dry docks at Pearl Harbor Naval Shipyard.

(U) Rec. B.4.a: The DoD OIG recommended that once the Shipyard Infrastructure Optimization Program Area Development Plan has been completed, the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Northwest and the Commanding Officer, Naval Facilities Engineering Systems Command Northwest incorporate the results of the Shipyard Infrastructure Optimization Program Puget Sound Naval Shipyard Area Development Plan into the Naval Base Kitsap master plan to comply with the 5?year requirement in accordance with DoD Instruction 4165.70, "Real Property Management," April 6, 2005 (Incorporating Change 1, August 31, 2018).

(U) Rec. B.4.a: The DoD OIG recommended that once the Shipyard Infrastructure Optimization Program Area Development Plan has been completed, the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Northwest and the Commanding Officer, Naval Facilities Engineering Systems Command Northwest incorporate the results of the Shipyard Infrastructure Optimization Program Puget Sound Naval Shipyard Area Development Plan into the Naval Base Kitsap master plan to comply with the 5?year requirement in accordance with DoD Instruction 4165.70, "Real Property Management," April 6, 2005 (Incorporating Change 1, August 31, 2018).

(U) Rec. B.4.b: The DoD OIG recommended that once the Shipyard Infrastructure Optimization Program Area Development Plan has been completed, the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Northwest and the Commanding Officer, Naval Facilities Engineering Systems Command Northwest update the Naval Base Kitsap master plan to include a military installation resiliency component in accordance with section 2864, title 10, United States Code and Unified Facilities Criteria 2?100?01, "Installation Master Planning," September 30, 2020 (Change 1, April 8, 2022).

(U) Rec. B.4.b: The DoD OIG recommended that once the Shipyard Infrastructure Optimization Program Area Development Plan has been completed, the Commander, Navy Installations Command, in coordination with the Commander, Navy Region Northwest and the Commanding Officer, Naval Facilities Engineering Systems Command Northwest update the Naval Base Kitsap master plan to include a military installation resiliency component in accordance with section 2864, title 10, United States Code and Unified Facilities Criteria 2?100?01, "Installation Master Planning," September 30, 2020 (Change 1, April 8, 2022).

(U) Rec. B.5: The DoD OIG recommended that the Commanding Officer, Naval Facilities Engineering Systems Command Northwest, in coordination with the Commander, Puget Sound Naval Shipyard, direct planning officials to apply environmental threat policies, such as DoD Directive 4715.21 and relevant Unified Facilities Criteria, when developing and executing projects to address the risks identified during the master planning process for the existing dry docks at Puget Sound Naval Shipyard.

(U) Rec. B.5: The DoD OIG recommended that the Commanding Officer, Naval Facilities Engineering Systems Command Northwest, in coordination with the Commander, Puget Sound Naval Shipyard, direct planning officials to apply environmental threat policies, such as DoD Directive 4715.21 and relevant Unified Facilities Criteria, when developing and executing projects to address the risks identified during the master planning process for the existing dry docks at Puget Sound Naval Shipyard.

(U) Rec. B.6.a: The DoD OIG recommended that the Program Executive Officer, Program Executive Office Industrial Infrastructure, in coordination with the Commander, Naval Facilities Engineering Systems Command, issue clear and comprehensive guidance that at a minimum identifies and defines Navy planner roles, responsibilities, tasks, and expectations within Naval Facilities Engineering Systems Command and Shipyard Infrastructure Optimization Program to execute master and project planning processes.

(U) Rec. B.6.b: The DoD OIG recommended that the Program Executive Officer, Program Executive Office Industrial Infrastructure, in coordination with the Commander, Naval Facilities Engineering Systems Command, issue clear and comprehensive guidance that at a minimum establishes a defined structure to communicate decisions on master planning and project development processes to all Navy planners located at the shipyards.

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff document veterans’ care coordination needs within the Community Care Coordination Plan note for consults assigned a level of care coordination above basic.

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff act on consults no later than two business days after receipt and document accordingly.

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff schedule community care appointments in a timely manner.

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff make three attempts to retrieve medical documentation from non-VA providers.

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff document veterans care coordination needs within the Community Care Coordination Plan note for consults assigned a level of care coordination above basic.

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff schedule community care appointments in a timely manner.

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff make three attempts to retrieve medical documentation from non-VA providers.

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff act on consults no later than two business days after receipt and document accordingly.

We recommend that the Louisiana Department of Health advise nursing homes to verify that contracted employees' background checks are completed in a timely manner and in accordance with applicable requirements.

We recommend that the Louisiana Department of Health advise nursing homes to contractually require staffing companies to conduct background check searches that include State police records and to adjudicate the results of background checks in accordance with Federal and State requirements.

We recommend that the Louisiana Department of Health advise nursing homes to ensure that all background checks are conducted by authorized agencies and include a search of State police records.

We recommend that the Louisiana Department of Health conduct routine monitoring of nursing homes' compliance with background check requirements.

We recommend that the Louisiana Department of Health make training or informational material available to nursing homes on the applicable Federal and State regulations for background checks of employees.

(U) Rec. 1: The DoD OIG recommended that the Director of the Defense Health Agency identify all specialties, by location, where the managed care support contractor provider network is not meeting DoD access to care standards and, in coordination with the managed care support contractors, develop and implement a plan to bring those provider networks into compliance with the DoD access to care requirements.

(U) Rec. 2.a: The DoD OIG recommended that the Director of the Defense Health Agency, in coordination with the Service Surgeons General, conduct a survey of TRICARE beneficiaries, civilians, and contractors stationed overseas about their access to health care services. The survey should, at a minimum, include the following: i. the overseas locations that have a relatively high number of beneficiaries with concerns about their access to health care. ii. the clinical specialties in overseas locations that beneficiaries have the greatest difficulty accessing. iii. the reasons beneficiaries have difficulties obtaining access to health care in each location and for each…

(U) Rec. 2.c: The DoD OIG recommended that the Director of the Defense Health Agency, in coordination with the Service Surgeons General, use the results of the surveys to develop and implement a plan to address the identified issues.