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Open Recommendations (138 total)

Buy Indian Act: Bureau of Indian Affairs and Indian Health Service Need Greater Insight into Implementation at Regional Offices

GAO-15-588
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1 Open Recommendations
Agency Affected Recommendation Status
Department of Health and Human Services To ensure consistent implementation of the Buy Indian Act procurement authority across the agencies and to enhance oversight of implementation of the Act at regional offices, the Secretaries of the Interior and Health and Human Services should direct the Bureau of Indian Affairs and Indian Health Service respectively, to collect data on regional offices' implementation of key requirements, such as challenges to self-certification.
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The Department of Health and Human Services (HHS) concurred with this recommendation. HHS's Indian Health Service (IHS) informed GAO that in order to clarify and codify policies related to priority for use of the Buy Indian Act, formal rulemaking was required. In January 2022, IHS announced the publication of a final rule on the Buy Indian Act, which took effect on March 14, 2022. Additionally, IHS is working to update its Indian Health Manual to supplement the Buy Indian Act final rule to address how IHS will report and collect data across regional offices related to Buy Indian Act requirements. GAO requested an update to the status of changes to the Indian Health Manual in 2023, but as of September 2023, HHS did not provide a response.

Scientific Integrity: HHS Agencies Need to Develop Procedures and Train Staff on Reporting and Addressing Political Interference

GAO-22-104613
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1 Open Recommendations
Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of Health and Human Services should ensure that procedures for reporting and addressing potential political interference in scientific decision-making are documented, including adding a definition of political interference, and that the procedures are communicated to the Assistant Secretary for Preparedness and Response. (Recommendation 6)
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As of April 2024, HHS was updating its departmental scientific integrity policy and its operating divisions were also updating their individual scientific integrity policies. The updated policies will include specific provisions prohibiting political interference and will establish procedures for reporting and handling allegations of scientific integrity violations, including those involving alleged political interference. HHS plans to finalize its policy in 2024 and will make the policy publicly available on its website.

Federal Real Property: Agencies Should Provide More Information About Increases in Deferred Maintenance and Repair

GAO-24-105485
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1 Open Recommendations
Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of Health and Human Services should ensure that the department works with its component agencies to evaluate the costs and benefits of increasing the use of models for predicting the outcome of investments, analyzing tradeoffs, and optimizing among competing investments, and employ models when the benefits outweigh the costs. (Recommendation 9)
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Health and Human Services agreed with the recommendation. Health and Human Services noted that models used for investments in its real property portfolio may encounter limitations given the vastly different missions carried out in different facilities. As of March 2024, Health and Human Services officials said that the Department had aligned ongoing efforts of updating policies and frameworks to guide the Department's components in implementing the recommendation. GAO will continue to monitor these efforts.

Workplace Safety and Health: Additional Data Needed to Address Continued Hazards in the Meat and Poultry Industry

GAO-16-337
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1 Open Recommendations
Agency Affected Recommendation Status
Department of Health and Human Services To develop a better understanding of meat and poultry sanitation workers' injuries and illnesses, the Secretary of Health and Human Services should direct the Director of the Centers for Disease Control and Prevention to have the National Institute for Occupational Safety and Health (NIOSH) conduct a study of the injuries and illnesses these workers experience, including their causes and how they are reported. Given the challenges to gaining access to this population, NIOSH may want to coordinate with the Occupational Safety and Health Administration to develop ways to initiate this study.
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HHS concurred with this recommendation and noted the previous difficulties NIOSH has had gaining access to these workplaces and the potential resource commitment involved in conducting such a study. We acknowledge this access challenge and noted in our report that OSHA has negotiated access for NIOSH in other industries, hence the rationale for recommending that NIOSH may want to coordinate with OSHA. In February 2020, NIOSH reported it met with industry associations to discuss areas of mutual interest for research on worker safety in poultry plants. However, according to NIOSH, the advent of COVID-19 and its challenges have limited plans for field studies for FY20. During the COVID-19 epidemic NIOSH informed us that, as of March 2021, its representatives have: (1) created COVID-19 safety guidelines with OSHA and (2) performed more than 30 meat and poultry worksite evaluations focusing on the prevention of COVID-19. NIOSH notes that it continues to have an interest in learning more about and providing assistance to minimize various types of illnesses and injuries that may affect meat and poultry sanitation workers, and at some point in the future they hope to "re-initiate" their interactions with stakeholders such as the National Chicken Council and US Egg & Poultry Association on the study of peracetic acid exposure in the poultry processing industry. In November 2021, NIOSH reported that it has continued to update peracetic acid (PAA) industry partners on the activities surrounding lab and field work on assessing worker exposures; and made progress on the development of two field portable PAA air sampling methods. However, field study activities are on hold due to COVID-19 travel restrictions and personnel assignments in key roles on the CDC COVID response. The PAA field study protocol will be updated to include COVID-19 precautions and an amendment will be submitted to the NIOSH Institutional Review Board for approval prior to re-initiating activities. Our recommendation was aimed at increasing the understanding of the various types of illnesses and injuries that are common among meat and poultry sanitation workers, including their causes and how they are reported. As of July 2023, we await more information on future studies that address this topic.

Domestic Violence: Improved Data Needed to Identify the Prevalence of Brain Injuries among Victims

GAO-20-534
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1 Open Recommendations
Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of HHS should develop and implement a plan to improve data collected on the prevalence of brain injuries resulting from intimate partner violence and use these data to inform HHS's allocation of resources to address the issue. (Recommendation 1)
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HHS initially agreed with this recommendation. However, in April 2022, HHS reported that it subsequently determined it does not have the authority to collect the necessary data--including medical data--on the prevalence of brain injuries resulting from intimate partner violence. Additionally, HHS noted it does not receive additional appropriations to support research and evaluation initiatives. HHS also noted continuing efforts to address brain injuries among domestic violence victims, and we acknowledge the efforts HHS is making to support this important issue. For example, HHS noted that several of its offices and agencies intend to continue supporting training and technical assistance for states, tribes, coalitions, and local domestic violence programs to increase partnerships with medical providers and provide greater access to health care providers for domestic violence survivors. These actions, according to HHS, would provide opportunities for medical identification and treatment of traumatic brain injury resulting from intimate partner violence. In July 2023, HHS reported that the Office of Management and Budget had approved of an additional question to the Centers for Disease Control and Prevention's (CDC) National Intimate Partner and Sexual Violence Survey, which should improve what is known about the prevalence of traumatic brain injuries among victims of intimate partner violence. In our June 2022 report, we noted CDC was planning to add this question to better capture intimate partner violence victims who may have experienced mild brain injury. However, as we also described, the addition of the new question may not ensure a comprehensive estimate of the prevalence of brain injuries resulting from intimate partner violence. For example, the new survey question does not account for individuals with brain injuries caused by strangulation. As a result, we maintain that developing and implementing a plan to improve the department's understanding of the prevalence of brain injuries resulting from intimate partner violence is an important next step. Implementing this recommendation--which could involve HHS and its agencies working together to identify approaches within current authority to augment data collection through surveys or supporting targeted research--would improve the department's understanding about the prevalence of brain injury among intimate partner violence victims.

COVID-19: Pandemic Lessons Highlight Need for Public Health Situational Awareness Network

GAO-22-104600
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1 Open Recommendations
Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of HHS should ensure that the lead operational division for PAHPAIA implementation identifies and documents the IT- and information sharing-related challenges and lessons learned from the COVID-19 pandemic. (Recommendation 9)
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In April 2023, HHS stated that it will work with the relevant internal IT offices and also work with the HHS OCIO to identify and document IT and information-related challenges and lessons learned. The department did not provide a time frame for completing this activity. As of February 2024, HHS stated that it will continue to provide information to GAO in future updates. We will continue to monitor the actions HHS takes to implement this recommendation.

Maternal Health: HHS Should Improve Assessment of Efforts to Address Worsening Outcomes

GAO-24-106271
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1 Open Recommendations
Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of Health and Human Services should ensure that the Office on Women's Health and Office of the Assistant Secretary for Planning and Evaluation performance strategy includes key performance management practices—including near-term goals with quantitative targets and time frames to define intended results and associated performance measures for the near-term goals—to assess the performance of HHS's maternal health efforts against the Maternal Health Blueprint's goals. (Recommendation 1)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Substance-Affected Infants: Additional Guidance Would Help States Better Implement Protections for Children

GAO-18-196
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1 Open Recommendations
Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of HHS should direct ACF to provide additional guidance and technical assistance to states to address known challenges and enhance their understanding of CAPTA requirements, including the requirements for health care providers to notify CPS of substance-affected infants and the development of a plan of safe care for these infants.
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HHS did not agree with this recommendation. The agency stated that it previously clarified its guidance. Also, HHS believes it is necessary for states to have flexibility, within the context of their state CPS programs, to meet Child Abuse Prevention and Treatment Act (CAPTA) requirements. HHS indicated that it will continue to provide technical assistance to states and fund demonstration sites to establish or enhance collaboration across community agencies and courts. Although continuing to provide technical assistance to states should be beneficial, our findings demonstrate that additional guidance is also needed in the areas that we noted. As of March 2021, the agency continues to disagree with our recommendation and believes its previous efforts were sufficient. As of December 2023, we continue to believe our recommendation is warranted.

Biodefense: After-Action Findings and COVID-19 Response Revealed Opportunities to Strengthen Preparedness

GAO-21-513
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1 Open Recommendations
Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of Health and Human Services should work through the Biodefense Steering Committee to ensure that the Biodefense Coordination Team provides guidance for federal and nonfederal partners for how to report on capabilities in after-action reports for exercises and real-world incidents in a consistent manner. (Recommendation 11)
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HHS concurred with our recommendation and described mechanisms that could be used for reporting capabilities in after-action reports. HHS officials participated in a federal interagency effort to review the nation's biodefense strategy. In October 2022, the White House released an updated National Biodefense Strategy and associated implementation plan. As of January 2024, we have started new work to assess the updated National Biodefense Strategy and its associated implementation plan. As part of this work, we will determine if the changes meet the intent of our recommendation, or if agencies need to take action to meet that intent.

Institutional Review Boards: Actions Needed to Improve Federal Oversight and Examine Effectiveness

GAO-23-104721
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1 Open Recommendations
Agency Affected Recommendation Status
Department of Health and Human Services The Assistant Secretary for Health should ensure that OHRP takes steps to ensure the accuracy of protocol data collected in OHRP's IRB registry. This could include updating instructions to IRBs and examining data accuracy for a sample of IRBs. (Recommendation 1.)
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In August 2023, HHS reported that OHRP was taking steps to address this recommendation. First, HHS noted OHRP was working to modify its IRB registration system to prompt IRBs applying for, renewing, or updating their OHRP registration to provide accurate information about the number of protocols they review. Additionally, HHS reported OHRP planned to evaluate its IRB registration instructions as part of the next Paperwork Reduction Act Information Collection Request renewal; the current IRB registration form is approved through June 30, 2025. As of March 2024, we had not yet received updated information from HHS and will update the status when we do.
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