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Open Recommendations

Substance Misuse Treatment and Recovery: Federal Guidance Needs to Address Work Arrangements for Those Living in Residential Facilities
GAO-24-106101
Jul 08, 2024
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2 Open Recommendations
Agency Affected Recommendation Status
Department of Health and Human Services The Assistant Secretary of SAMHSA should incorporate single state agencies (SSA) into existing guidance development processes or develop a formal process to proactively consult SSAs about the information they need regarding how work should be incorporated into substance misuse treatment and recovery, and use the SSA feedback from such processes to inform the development of publicly available guidance. (Recommendation 1)
Open
HHS agreed with this recommendation. HHS noted that informational guidance it develops would focus on how work should be incorporated into substance use disorder treatment and separately how work should be addressed with respect to recovery housing. We will monitor the progress of their efforts.
Department of Health and Human Services The Assistant Secretary of SAMHSA should explicitly state in SUPTRS Block Grant application materials (1) that incorporating work into a treatment facility resident's treatment plan should involve an individualized assessment to determine if and when work is appropriate, and that requiring work as a condition for accessing treatment services is not acceptable, and (2) if and when requiring work as a condition of accessing services is acceptable at recovery housing. (Recommendation 2)
Open
HHS agreed with this recommendation. The agency stated that it would incorporate a statement in the fiscal years 2025-2026 SUPTRS Block Grant application materials to address the recommendation. We will monitor the progress of their efforts.

Family Child Care Networks: Actions Needed to Better Assess Quality Improvement Efforts
GAO-23-105640
Jun 09, 2023
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2 Open Recommendations
Agency Affected Recommendation Status
Office of Child Care The Director of OCC should provide written guidance to states on developing performance measures for CCDF quality activities that reflect appropriate attributes of successful performance measures, such as linkage to goals, clarity, and measurable targets. (Recommendation 1)
Open
HHS agreed with this recommendation and identified steps to implement it. Specifically, HHS said that OCC will further support more effective performance measures by providing training and technical assistance to grant recipients on how to develop effective benchmarks and performance measures that include goals, clarity, and measurable targets. As of December 2023, HHS reported that OCC was in the process of adding two full-time staff to provide training and technical assistance and develop guidance and resources to help states establish effective performance measures and benchmarks. In addition, HHS reported that OCC was revising the form for CCDF State Plans - in which states specify their performance measures - to clarify what states must submit and help states produce better performance measures.
Office of Child Care The Director of OCC should assess and report to Congress and the public on states' progress in improving the quality of child care. For example, OCC could provide Congress with the number of states that met their targets for their selected quality activities as established in their CCDF plans. (Recommendation 2)
Open
HHS agreed with this recommendation and identified steps to implement it. Specifically, HHS said that OCC will explore strategies for conducting analysis and reporting to Congress on states' progress toward setting and achieving meaningful quality improvement goals, using available data and resources from existing administrative data collections. As of December 2023, HHS reported that OCC was exploring data sources for assessing and reporting on states' progress in improving the quality of child care.

Subminimum Wage Program: DOL Could Do More to Ensure Timely Oversight
GAO-23-105116
Feb 24, 2023
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3 Open Recommendations
Agency Affected Recommendation Status
Wage and Hour Division The Administrator of DOL's Wage and Hour Division should set and track timeliness goals for intermediate steps and overall duration for processing 14(c) applications. (Recommendation 1)
Open
In September 2024, the Department of Labor's Wage and Hour Division (WHD) stated that it set timeliness goals for intermediate steps of the application review process to ensure suitable movement through the overall review process. The agency also stated that it set a timeliness goal for the overall duration of processing 14(c) applications--which is to issue or deny a certificate or move the application into a more comprehensive review within 120 days of receipt. WHD stated that it has tracked its performance relative to its established timeliness goals and seen a reduction in the overall processing time of 14(c) applications. WHD stated that it will provide a copy of its Certification Procedures Manual by December 2024. We will review the status of this recommendation when we receive supporting documentation of the agency's timeliness goals and its tracking of such goals.
Wage and Hour Division The Administrator of DOL's Wage and Hour Division should externally communicate its goals for processing 14(c) applications to employers and other program stakeholders, and its progress toward meeting these goals. (Recommendation 2)
Open
As of September 2024, the Department of Labor's Wage and Hour Division (WHD) posted an updated fact sheet on certification application policies and procedures on its website. The fact sheet includes the agency's goal to process timely and complete applications within 120 days. WHD stated that based on internal reporting, the agency has seen a positive impact on its overall processing time for submitted applications and reduced the number of "pending" applications as reported on its website. We will consider this recommendation closed when WHD provides additional documentation demonstrating that it has externally communicated with employers and other program stakeholders about its progress toward meeting these goals.
Wage and Hour Division The Administrator of DOL's Wage and Hour Division should solicit feedback from 14(c) employers regarding the online application and take appropriate action to address any limitations to help improve the overall timeliness of certificate application processing. (Recommendation 3)
Open
In September 2024, the Department of Labor's Wage and Hour Division (WHD) created a new email address for employers who have feedback on the online application systems, including suggestions for improvement to the forms instruction page. The agency included the updated email address in its fact sheet on certificate application policies and procedures. However, the agency did not identify any actions it has taken to address any limitations with the online system. We continue to believe that the agency should take appropriate action to address any limitations to help improve the overall timeliness of processing certificate applications. We will consider this recommendation closed when WHD provides additional documentation that it has taken appropriate action to address any identified limitations to help improve the overall timeliness of processing applications.

Older Adults and Adults with Disabilities: Federal Programs Provide Support for Preventing Falls, but Program Reach is Limited
GAO-22-105276
Jul 27, 2022
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2 Open Recommendations
Agency Affected Recommendation Status
Centers for Disease Control and Prevention The Director of the CDC should expand the scope of its analysis of Behavioral Risk Factor Surveillance System (BRFSS) data to include the prevalence of falls and fall-related injuries among adults under age 65 who may be at higher risk of falls, including adults with disabilities, and, as appropriate, share findings with ACL and other agencies overseeing relevant programmatic efforts. For example:

  • CDC could analyze existing BRFSS data on adults aged 45 to 64 and share findings, as appropriate.
  • CDC could propose asking adults aged 18 to 44 the two BRFSS fall-related questions, as part of the survey update process.

(Recommendation 1)
Open
CDC agreed with this recommendation. As of January 2023, CDC officials said they have begun exploring options to expand the scope of the BRFSS data analysis for adults under age 65. Specifically, CDC is analyzing BRFSS data on falls among adults with disabilities aged 45 to 64. CDC will also consider how best to disseminate these findings, such as through targeted outreach to key partners, publications, and email outreach to those who subscribe to CDC updates on older adult falls prevention.
Administration for Community Living The Administrator of ACL should share and highlight information on falls risk and related resources for adults with disabilities who are younger than 60 more prominently among its disability network to inform state and local planning efforts. For example, to the extent possible and appropriate, ACL could work with CDC to highlight relevant falls data and leverage existing resources on falls prevention. (Recommendation 3)
Open
ACL agreed with this recommendation. As of December 2023, ACL officials said ACL's Administration on Disabilities has compiled promising practices related to falls prevention and are in the process of developing a dissemination plan for the information. Further, ACL's disability programs are beginning to participate in the Housing and Services Resource Center's training and technical assistance activities related to falls prevention. ACL officials have also met with CDC staff who work on falls prevention to discuss activities they could do jointly. ACL officials said they identified evidence-based falls prevention materials to share with CDC and with ACL's disability networks. ACL plans to continue meeting with CDC to discuss data-related actions. We encourage ACL to work with CDC to highlight relevant falls data for adults with disabilities who are younger than 60.
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