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CMS’s Controls Related to Hospital Preparedness for an Emerging Infectious Disease Were Well-Designed and Implemented but Its Authority Is Not Sufficient for It To Ensure Preparedness at Accredited Hospitals
We recommend that the Centers for Medicare & Medicaid Services make regulatory changes to allow it to require accreditation organizations to perform special surveys of hospitals selected by CMS after it issues new substantive participation requirements or guidance that it determines warrant additional validation to ensure timely compliance.
We recommend that the Centers for Medicare & Medicaid Services make regulatory changes to allow it to require accreditation organizations to perform special surveys of hospitals selected by CMS during a public health emergency to address the risks presented by the emergency.
Audit of the Reimbursement for Department of Defense Mission Assignments for Coronavirus Disease–2019 Pandemic Response in the U.S. Northern Command Area of Responsibility
Rec. 1: The DoD OIG recommended that the Deputy Comptroller (Program/Budget), Office of the Under Secretary of Defense (Comptroller)/Chief Financial Officer, DoD, in coordination with DoD Component comptrollers, initiate a review of all COVID-19 pandemic response mission assignments to ensure reimbursement requests for costs incurred are submitted in accordance with DoD policy.
Rec. 2.a: The DoD OIG recommended that the Director, Army Budget, Office of the Assistant Secretary of the Army (Financial Management and Comptroller), immediately require tasked units to review costs incurred for mission assignments 4480DR-NY-DOD-10, 4480DR-NY-DOD-11, 4480DR-NY-DOD-12, and 4481DR-WA-DOD-02 as of July 31, 2020, for completeness and accuracy, and submit reimbursement requests for those costs with required documentation to the Federal Emergency Management Agency in accordance with DoD policy.
Rec. 2.b: The DoD OIG recommended that the Assistant Director of the Office of Budget Fiscal Management, Office of the Assistant Secretary of the Navy (Financial Management and Comptroller), immediately require tasked units to review costs incurred for mission assignments 4482DR-CA-DOD-01, 4482DR-CA-DOD-02, and 4488DR-NJ-DOD-04 as of July 31, 2020, for completeness and accuracy, and submit reimbursement requests for those costs with required documentation to the Federal Emergency Management Agency in accordance with DoD policy.
Rec. 2.c: The DoD OIG recommended that the Deputy for Budget, Office of the Assistant Secretary of the Air Force (Financial Management and Comptroller), immediately require tasked units to review costs incurred for mission assignment 4480DR-NY-DOD-10 as of July 31, 2020, for completeness and accuracy, and submit reimbursement requests for those costs with required documentation to the Federal Emergency Management Agency in accordance with DoD policy.
Rec. 2.d: The DoD OIG recommended that the Comptroller of the United States Marine Corps immediately require tasked units to review costs incurred for 4482DR-CA-DOD-01, 4482DR-CA-DOD-02, and 4488DR-NJ-DOD-04 as of July 31, 2020, for completeness and accuracy, and submit reimbursement requests for those costs with required documentation to the Federal Emergency Management Agency in accordance with DoD policy.
Rec. 2.e: The DoD OIG recommended that the Comptroller of the National Guard Bureau immediately require tasked units to review costs incurred for mission assignments 4480DR-NY-DOD-05, 4481DR-WA-DOD-05, 4482DR-CA-DOD-07, and 4491DR-MD-DOD-01 as of July 31, 2020, for completeness and accuracy, as well as any additional costs incurred and identified after July 31, 2020, and submit reimbursement requests for those costs with required documentation to the Federal Emergency Management Agency in accordance with DoD policy.
Rec. 3.a.1: The DoD OIG recommended that the Director, Army Budget, Office of the Assistant Secretary of the Army (Financial Management and Comptroller), in coordination with the Financial Management Augmentation Team, develop and provide to tasked units, an Army-specific desk manual for mission assignments that includes, at a minimum, step-by-step procedures for initial set-up, real-time cost input, cost tracking, cost reporting, and submitting partial and final billings to ensure compliance with DoD policy.
Rec. 3.a.2: The DoD OIG recommended that the Director, Army Budget, Office of the Assistant Secretary of the Army (Financial Management and Comptroller) train tasked-unit personnel on how to navigate the Army-specific desk manual and apply the procedures appropriately.
Rec. 3.b.1: The DoD OIG recommended that the Assistant Director of the Office of Budget Fiscal Management, Office of the Assistant Secretary of the Navy (Financial Management and Comptroller), in coordination with the Financial Management Augmentation Team, develop and provide to tasked units, a Navy-specific desk manual for mission assignments that includes, at a minimum, step-by-step procedures for initial set-up, real-time cost input, cost tracking, cost reporting, and submitting partial and final billings to ensure compliance with DoD policy.
Rec. 3.b.2: The DoD OIG recommended that the Assistant Director of the Office of Budget Fiscal Management, Office of the Assistant Secretary of the Navy (Financial Management and Comptroller) train tasked-unit personnel on how to navigate the Navy-specific desk manual and apply the procedures appropriately.
Rec. 3.d.1: The DoD OIG recommended that the Comptroller of the United States Marine Corps, in coordination with the Financial Management Augmentation Team, develop and provide to tasked units, a Marine Corps-specific desk manual for mission assignments that includes, at a minimum, step-by-step procedures for initial set-up, real-time cost input, cost tracking, cost reporting, and submitting partial and final billings to ensure compliance with DoD policy.
Rec. 3.d.2: The DoD OIG recommended that the Comptroller of the United States Marine Corps train tasked-unit personnel on how to navigate the Marine Corps-specific desk manual and apply the procedures appropriately.
Rec. 3.e.1: The DoD OIG recommended that the Comptroller of the National Guard Bureau, in coordination with the Financial Management Augmentation Team, develop and provide to tasked units a National Guard-specific desk manual for mission assignments that includes, at a minimum, step-by-step procedures for initial set-up, real-time cost input, cost tracking, cost reporting, and submitting partial and final billing to ensure compliance with DoD policy.
Rec. 3.e.2: The DoD OIG recommended that the Comptroller of the National Guard Bureau train tasked-unit personnel on how to navigate the National Guard-specific desk manuals and apply the procedures appropriately.
Rec. 3.c.1: The DoD OIG recommended that the Deputy for Budget, Office of the Assistant Secretary of the Air Force (Financial Management and Comptroller), in coordination with the Financial Management Augmentation Team, develop and provide to tasked units, an Air Force-specific desk manual for mission assignments that includes, at a minimum, step-by-step procedures for initial set-up, real-time cost input, cost tracking, cost reporting, and submitting partial and final billings to ensure compliance with DoD policy.
Rec. 3.c.2: The DoD OIG recommended that the Deputy for Budget, Office of the Assistant Secretary of the Air Force (Financial Management and Comptroller) train taskeDODIG-unit personnel on how to navigate the Air Force-specific desk manual and apply the procedures appropriately.
Performance Audit of the Implementation of OMB COVID-19 Flexibilities – Florida International University
Resolve the $1,252 in questioned Award Cash Management $ervice drawdowns for which FIU has not agreed to reimburse NSF and direct FIU to repay or otherwise remove the sustained questioned costs from its NSF awards.
Direct FIU to provide documentation supporting that it has repaid or otherwise credited the $14,167 of questioned costs for which it has agreed to reimburse NSF.
Direct FIU to update its administrative and management processes and internal control procedures surrounding the Award Cash Management $ervice for awards with expiring appropriations. Updated processes should ensure FIU appropriately documents how it calculates the final draw amounts for awards with expiring appropriations, to ensure it only uses the draws to cover costs incurred before the appropriation expired.
Direct FIU to strengthen its award set-up processes and procedures to ensure it cannot charge costs to an active award if the Federal appropriations for the award have expired.
Resolve the $791 in questioned fringe benefit costs for which FIU has not agreed to reimburse NSF and direct FIU to repay or otherwise remove the sustained questioned costs from its NSF awards.
Direct FIU to provide documentation supporting that it has repaid or otherwise credited the $5,934 of questioned promotional and salary costs for which it has agreed to reimburse NSF.
Direct FIU to establish clear guidance regarding the <span class="tx-tooltip" tabindex="0">
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of participant support cost funding. This guidance should address: a. Allowable uses of participant support cost funding. b. How to verify personnel did not apply fringe benefit rates to participant stipends or other non-salary expenses.
Direct FIU to strengthen its monitoring procedures surrounding costs charged to its NSF Research Experiences for Undergraduates programs. Updated procedures should ensure FIU charges costs associated with promotional and/or other unallowable items to nonFederal funding sources.
Direct FIU to update its current practices to ensure it only applies fringe benefits using fringe benefit rates that have been approved by its cognizant audit agency.
Performance Audit of the Implementation of OMB COVID-19 Flexibilities – State University of New York at Stony Brook
Direct Stony Brook to provide documentation supporting that it has repaid or otherwise credited the $20,530 of questioned Award Cash Management $ervice drawdowns associated with unspent funds.
Direct Stony Brook to update its administrative and management processes and internal control procedures surrounding the Award Cash Management $ervice for awards with expiring appropriations. Updated processes could include validating that Stony Brook only draws down funding based on immediate cash needs and/or adequately documents that any Award Cash Management $ervice draws in excess of its actual expenses support immediate cash needs.
Direct Stony Brook to provide documentation supporting that it has repaid or otherwise credited the $6,913 in questioned travel costs for which it has agreed to reimburse NSF.
Direct Stony Brook to provide additional guidance to ensure personnel reimburse NSF timely for cash drawn down for unused travel advances.
Direct Stony Brook to provide documentation supporting that it has repaid or otherwise credited the $3,898 in questioned travel costs for which it has agreed to reimburse NSF.
Direct Stony Brook to strengthen its monitoring procedures and internal controls surrounding the allocation of travel expenses to sponsored projects. Processes could include reviewing and assessing the allocation of all travel expenses charged to NSF awards.
Direct Stony Brook to separately track its on-campus and off-campus activities so that it can appropriately apply the approved on-campus and off-campus indirect cost rates.
Direct Stony Brook to update its current budget proposal process to eliminate the use of blended indirect cost rates.
Direct Stony Brook to update its current award set-up practices to require that, when setting up accounts established for NSF awards, personnel ensure that the accounts apply indirect costs using the rates that were established in the Negotiated Indirect Cost Rate Agreement in effect as of the date of the NSF grant award, rather than using the rates included within the original grant proposal.
Direct Stony Brook to update its current award set-up practices to remove the establishment of indirect cost budget caps.
Performance Audit of the Implementation of OMB COVID-19 Flexibilities – University of New Mexico
Resolve the $17,269 in questioned unreasonable per diem, airfare, and ground transportation costs for which UNM has not agreed to reimburse NSF and direct UNM to repay or otherwise remove the sustained questioned costs from its NSF awards.
Direct UNM to strengthen its administrative and management procedures for reviewing travel expenses incurred on sponsored projects. Updated procedures could include periodic training for Principal Investigators to ensure they understand when NSF Grant Officer approval should be requested and how to appropriately document that only reasonable costs were charged to NSF awards.
Direct UNM to strengthen its policies and procedures regarding the reasonableness of per diem expenses incurred when employees are temporarily relocated for a period longer than 30 days.
Resolve the $3,613 in questioned tuition costs for which UNM has not agreed to reimburse NSF and direct UNM to repay or otherwise remove the sustained questioned costs from its NSF awards.
Direct UNM to provide documentation supporting that it has repaid or otherwise credited the $83 of questioned travel costs for which it has agreed to reimburse NSF.
Direct UNM to strengthen its controls surrounding the approval of expense reimbursements to ensure approvers appropriately verify that travelers are reimbursed at the appropriate U.S. General Services Administration per diem rate(s).
Direct UNM to strengthen its policies and procedures surrounding the use of participant support cost funding to cover tuition remission expenses. Specifically, UNM should update its current tuition remission policies and procedures to ensure that it does not use participant support costs to cover costs associated with credit hours that do not benefit student participants.
Direct UNM to update its award set-up practices to require that, when setting up accounts established for NSF awards, personnel ensure that the accounts apply indirect costs using the rates that were established in the Negotiated Indirect Cost Rate Agreement in effect as of the date of the NSF grant award, rather than using the rates included within the original grant proposal.
Direct UNM to require subawardees to apply indirect costs using the rates that were established in the Negotiated Indirect Cost Rate Agreement in effect as of the date of the subaward agreement, rather than using the rates included within the subaward budget and proposal.
Evaluation of Access to Department of Defense Information Technology and Communications During the Coronavirus Disease-2019 Pandemic
Rec. 1.a: The DoD OIG recommended that the Assistant Secretary of Defense for Homeland Defense and Global Security revise the "DoD Implementation Plan for Pandemic Influenza" to update the planning assumptions in the DoD Implementation Plan for Pandemic Influenza to include the use of telework for essential and non-essential personnel and to align the DoD Implementation Plan for Pandemic Influenza with the DoD Telework Policy, Enclosure 3, Section 3(i)(2).
Rec. 1.b: The DoD OIG recommended that the Assistant Secretary of Defense for Homeland Defense and Global Security revise the "DoD Implementation Plan for Pandemic Influenza" to require DoD Components to update their Pandemic Plans to include the revised assumptions regarding telework for essential and non-essential personnel and the resources required to support the teleworking workforce.
Rec. 2: The DoD OIG recommended that the Under Secretary of Defense for Policy, in coordination with the Under Secretary of Defense for Personnel and Readiness, establish management oversight procedures to verify that DoD Components have performed the testing, training, and exercise requirements of the DoD Implementation Plan for Pandemic Influenza and the DoD Telework Policy. The oversight procedures should assess the ability of DoD Components to support Government-wide mandated telework, including the results from tests of network and communications systems and telework exercises with personnel.
Onsite Surveys of Nursing Homes During the COVID-19 National Emergency: March 23-May 30, 2020
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.
Evaluation of Department of Defense Medical Treatment Facility Challenges During the Coronavirus Disease-2019 (COVID-19) Pandemic
Rec. 1.a: The DoD OIG recommended that the Under Secretary of Defense for Personnel and Readiness, in conjunction with the Assistant Secretary of Defense for Health Affairs and Secretaries of the Military Departments, establish a working group within 30 days of this report's publication, to address the personnel, supplies, testing capabilities, information technology, communication, and lines of authority challenges that we identified during the Coronavirus Disease-2019 pandemic that exist between the Services and the Defense Health Agency. The working group should establish milestones to develop guidance for coordinating the staffing of multi-Service military treatment facilities during a pandemic.
Rec. 1.b: The DoD OIG recommended that the Under Secretary of Defense for Personnel and Readiness, in conjunction with the Assistant Secretary of Defense for Health Affairs and Secretaries of the Military Departments, establish a working group within 30 days of this report's publication, to address the personnel, supplies, testing capabilities, information technology, communication, and lines of authority challenges that we identified during the Coronavirus Disease-2019 pandemic that exist between the Services and the Defense Health Agency. The working group should establish milestones to consolidate Coronavirus Disease-2019 reporting requirements and recipients to reduce duplication and inconsistent requirements.
Rec. 1.c: The DoD OIG recommended that the Under Secretary of Defense for Personnel and Readiness, in conjunction with the Assistant Secretary of Defense for Health Affairs and Secretaries of the Military Departments, establish a working group within 30 days of this report's publication, to address the personnel, supplies, testing capabilities, information technology, communication, and lines of authority challenges that we identified during the Coronavirus Disease-2019 pandemic that exist between the Services and the Defense Health Agency. The working group should establish milestones to create a pandemic-related informational website and a toll-free number for beneficiaries to find Coronavirus Disease-2019-related information and ensure the website and toll-free number are advertised and maintained.
Rec. 1.d: The DoD OIG recommended that the Under Secretary of Defense for Personnel and Readiness, in conjunction with the Assistant Secretary of Defense for Health Affairs and Secretaries of the Military Departments, establish a working group within 30 days of this report's publication, to address the personnel, supplies, testing capabilities, information technology, communication, and lines of authority challenges that we identified during the Coronavirus Disease-2019 pandemic that exist between the Services and the Defense Health Agency. The working group should establish milestones to issue clarifying guidance for defining essential personnel for civilian healthcare workers.
Rec. 1.e: The DoD OIG recommended that the Under Secretary of Defense for Personnel and Readiness, in conjunction with the Assistant Secretary of Defense for Health Affairs and Secretaries of the Military Departments, establish a working group within 30 days of this report's publication, to address the personnel, supplies, testing capabilities, information technology, communication, and lines of authority challenges that we identified during the Coronavirus Disease-2019 pandemic that exist between the Services and the Defense Health Agency. The working group should establish milestones to update contracts to allow for more flexibility regarding the use of contracted personnel during extenuating circumstances, such as a pandemic.