HHS-OIG's Oversight of COVID-19 Response and Recovery

Certain For-Profit Nursing Homes May Not Have Complied With Federal Requirements Regarding the Infection Preventionist Position (A-01-22-00001)

Examine whether for-profit nursing homes nationwide complied with Federal requirements pertaining to (infection preventionists) IPs.

• Not all for-profit nursing homes that we reviewed met Federal requirements. Seventy-six of the 100 for-profit nursing homes in our sample complied with Federal requirements pertaining to IPs.
• We estimated that 2,568 for-profit nursing homes nationwide (approximately 1 in 4) may not have complied with Federal requirements pertaining to IPs during our audit period.

Massachusetts Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements (A-02-24-01001)

Examine whether Massachusetts completed Medicaid eligibility actions during its unwinding period in accordance with Federal and State requirements.

• Of the 352,408 enrollees covered during our audit period (April through September 2023), we sampled 140 enrollees and determined that 3 enrollees had their Medicaid eligibility incorrectly determined.
• We estimated that Massachusetts incorrectly renewed Medicaid eligibility for 7,040 of the 190,043 Medicaid enrollees whose eligibility was renewed during our audit period.

CDC Provided Oversight and Assistance, but Recipients Faced Challenges in Implementing a COVID-19 Vaccine Confidence Strategy (A-06-22-04004)

Determine whether the Centers for Disease Control and Prevention (CDC) provided oversight and assistance to recipients in developing and implementing strategies that followed the CDC's Vaccine Confidence strategy.

• CDC provided oversight and assistance to the recipients in developing and implementing a vaccine confidence strategy by utilizing recipient data, conducting periodic outreach through webinars and technical assistance calls, among other things.

Determine how much of the American Rescue Plan (ARP) award funds each of the recipients had expended at the time of our audit.

• Of the nearly $244 million in funding to the 64 recipients, more than $116 million, or nearly 48 percent, had been expended as of March 4, 2024.

Determine any potential challenges or barriers that the recipients faced when spending the ARP award funds.

• We identified challenges or barriers that the recipients faced in developing and implementing a vaccine confidence strategy, including (1) language and location barriers, (2) lengthy contract processes, and (3) COVID-19 fatigue.

Heluna Health May Not Have Used California's CDC COVID-19 Funds in Accordance With Award Requirements (A-04-22-02037)

Determine whether Heluna Health used its Centers for Disease Control and Prevention (CDC) COVID-19 funding in accordance with award requirements.

• Heluna Health may not have used its COVID-19 funding in accordance with award requirements. For 139 of the 146 sample items we reviewed, costs charged to the award were generally in compliance with award requirements; however, 3 were not.

Selected CDC Racial and Ethnic Approaches to Community Health Program Recipients Generally Complied With Federal Requirements But Did Not Meet All Targets and Charged Some Unallowable Costs (A-02-22-02001)

Determine whether selected recipients used their Racial and Ethnic Approaches to Community Health (REACH) program funding in accordance with Federal requirements and award terms.

• The selected recipients generally used their REACH program funding in accordance with Federal requirements and award terms.
• However, the recipients did not meet all targeted performance measures, and some charged or may have charged unallowable costs.

Potential Vulnerabilities in CMS Oversight of Medicare Add-on Payments for COVID-19 Tests Show That Oversight of Incentive Payments Could Be Improved (A-09-22-03015)

Analyze data related to add-on payments for COVID-19 tests and determine whether there were any vulnerabilities in the Centers for Medicare & Medicaid Services' (CMS') oversight of these payments.

We identified the following potential vulnerabilities related to CMS' oversight of add-on payments for COVID-19 tests:

• CMS requirements related to supporting documentation for add-on payments were vague, and laboratory documentation was inconsistent.
• CMS and Medicare Administrative Contractors did not perform adequate reviews of claims for add-on payments.

California Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements (A-09-24-02001)

Examine whether California completed Medicaid eligibility actions during its unwinding period in accordance with Federal and State requirements.

• Of the 140 enrollees we sampled covered under our audit period (April 1 through August 31, 2023), determined that California incorrectly completed Medicaid eligibility actions for 9 enrollees.
• We estimated that California incorrectly renewed eligibility or incorrectly terminated coverage for 78,853 of the 1,830,923 enrollees during our audit period.

Ohio Generally Completed Medicaid Eligibility Actions During the Unwinding Period in Accordance With Federal and State Requirements (A-05-23-00019)

Examine whether Ohio completed Medicaid eligibility actions during its unwinding period in accordance with Federal and State requirements.

• Of the 140 enrollees we sampled covered under our audit period (April 1 through August 31, 2023), we determined that 9 enrollees had their Medicaid enrollment incorrectly determined.
• We estimated that Ohio either incorrectly renewed or terminated Medicaid eligibility for 78,486 of the 1,211,991 Medicaid enrollees during our audit period.

Missouri May Not Have Used All CARES Act Funds for the Older Americans Act Nutrition Services Program in Accordance With Federal and State Requirements (A-07-22-04130)

Determine whether Missouri used Coronavirus Aid, Relief, and Economic Security Act (CARES Act) funds for the Older Americans Act (OAA) Nutrition Services Program in accordance with Federal and State requirements.

• Missouri may not have used all CARES Act funds for the OAA Nutrition Services Program in accordance with Federal and State requirements. Specifically, none of the 10 Area Agencies on Aging in Missouri could give us separate accounting records that delineated the CARES Act expenditures to support the charges against the Federal award for these nutrition services.

CMS Could Improve Its Procedures for Setting Medicare Clinical Diagnostic Laboratory Test Rates Under the Clinical Laboratory Fee Schedule for Future Public Health Emergencies (A-01-21-00506)

Determine whether the Centers for Medicare & Medicaid Services' (CMS') procedures for clinical diagnostic laboratory test (CDLT) rate setting could be improved for future public health emergencies (PHEs).

• CMS's procedures for CDLT rate setting could be improved for future PHEs. Specifically, CMS could improve its: (1) communication with laboratory associations and the Medicare administrative contractors' (MACs') pricing coordinators, and (2) procedures to provide the MACs with additional flexibility when they set interim CDLT rates to respond to a PHE.

IHS Did Not Coordinate Supply Service Center Operations Before and During the COVID-19 Pandemic and Should Consider Upgrading Supply Centers’ Inventory Management Systems and Implementing Policies and Procedures To Enhance Coordination and Alignment (A-07-22-04131)

Determine whether the Indian Health Service (IHS) coordinated National Supply Service Center (NSSC) and Gallup Regional Supply Service Center (GRSSC) operations to provide for the effective distribution of medical and other supplies.

• IHS did not coordinate NSSC and GRSSC operations to provide for the effective distribution of medical and other supplies.

Determine whether the GRSSC distributed medical and other supplies effectively.

• The GRSSC did not demonstrate that it distributed medical and other supplies effectively during our audit period.

New Jersey Significantly Improved Its Oversight of Medicaid Adult Partial Care Services Except for Those Provided Using Telehealth During the COVID-19 Public Health Emergency (A-02-22-01007)

Determine whether New Jersey adequately implemented the recommendations made in our prior audit report and ensured Medicaid adult partial care services complied with Federal and State requirements.

• New Jersey adequately implemented the procedural recommendations made in our prior report.
• However, New Jersey has not refunded our recommended disallowance of $94.8 million in Federal Medicaid funds.

HRSA Made Some Potential Overpayments to Providers Under the Phase 2 General Distribution of the Provider Relief Fund Program A-09-22-06001

Determine whether Provider Relief Fund (PRF) payments under the Phase 2 General Distribution were correctly calculated by the Health Resources and Services Administration (HRSA), supported by appropriate documentation, and made to eligible providers.

• For all 150 sampled providers, HRSA made PRF payments to eligible providers.
• However, for 17 of the 150 sampled providers, HRSA made PRF payments that were not correctly calculated (15 sampled providers) or were not supported by appropriate documentation (2 sampled providers).

Lessons Learned During the Pandemic Can Help Improve Care in Nursing Homes (OEI-02-20-00492)

Examine the challenges that nursing homes faced during the pandemic and the strategies they used to address the challenges.

• Nursing homes faced challenges related to staffing, costs, testing protocols, personal protective equipment compliance, vaccination rates, and implementing effective infection control practices.
• Many nursing homes used outside staffing agencies to fill gaps, which had significant downsides. To retain and hire staff, nursing homes tried changing the work environment and using incentives, but success was mixed.

Medicare Generally Paid for Evaluation and Management Services Provided via Telehealth During the First 9 Months of the COVID-19 Public Health Emergency That Met Medicare Requirements (A-01-21-00501)

Determine whether physicians and other practitioners that provided evaluation and management (E/M) services via telehealth complied with Medicare requirements.

• Physicians and other practitioners that provided E/M services via telehealth generally complied with Medicare requirements. For 105 of the 110 sampled E/M services provided via telehealth, providers complied with Medicare requirements. However, for the remaining five sampled E/M services, providers did not comply with Medicare requirements.

CDC Has Improved the Nursing Homes Reporting Process for COVID-19 Data in NHSN, but Challenges Remain (OEI-06-22-00030)

Examine nursing home experiences enrolling in and reporting required data to the National Healthcare Safety Network (NHSN) COVID-19 Module.

• Despite CDC efforts, both CDC and nursing homes experienced difficulties during a mass enrollment of more than 12,000 facilities into NHSN to begin reporting COVID-19 data in May 2020.

Assess Centers for Disease Control and Prevention (CDC) efforts to facilitate nursing home reporting to NHSN.

• CDC struggled to support nursing homes during mass enrollment into NHSN in 2020 and as COVID-19 reporting requirements changed throughout the pandemic. CDC has improved the nursing home reporting process and guidance, but some challenges remain.

HHS Did Not Ensure Foundational Cybersecurity Controls Were in Place Prior to Implementation of HHS Protect and Use of a Contractor's Cloud Service (A-18-20-06800R)

Determine whether HHS implemented foundational cybersecurity controls in order to ensure the integrity and availability of HHS Protect and the U.S. Healthcare COVID-19 Portal.

• HHS did not ensure that select cybersecurity controls were in place prior to the launch of HHS Protect.
• Additionally, HHS had not completed the Federal Risk and Authorization Management Program security assessment and authorization tasks for its contractor’s cloud service that provided HHS access to and use of hospital data collected via the U.S. Healthcare COVID-19 Portal.

Medicare Generally Paid Acute-Care Hospitals for Inpatient Stays for Medicare Enrollees Diagnosed With COVID-19 in Accordance With Federal Requirements (A-09-21-03009)

Determine whether Medicare paid acute-care hospitals in accordance with Federal requirements for inpatient stays for enrollees diagnosed with COVID-19.

• Of the 149 sampled claims for inpatient stays for enrollees diagnosed with COVID-19, 146 claims complied with Federal requirements; however, the remaining 3 claims did not comply with the requirements. As a result, Medicare improperly paid hospitals $18,911.

Kentucky Experienced Challenges in Meeting Federal and State Foster Care Program Requirements During the COVID-19 Pandemic (A-06-22-07001)

Determine whether Kentucky complied with Federal and State foster care program requirements related to background checks and caseworker visits during the COVID-19 pandemic and identify any vulnerabilities or gaps in policies or procedures that could place children at risk.

• Kentucky did not always comply with State and Federal requirements related to background checks and caseworker visits to foster homes during the pandemic, even when those requirements had been modified to provide flexibility.
• Kentucky completed and documented home studies in accordance with State regulations.

HHS's Oversight of Automatic Provider Relief Fund Payments Was Generally Effective but Improvements Could Be Made (A-02-20-01025)

Determine whether HHS ensured that Phase 1 General Distribution automatic Provider Relief Fund (PRF) payments were properly calculated and disbursed only to eligible providers.

• Generally, HHS's oversight was effective in ensuring that most of the approximately $39.3 billion in automatic PRF payments were properly calculated and disbursed to eligible providers.
• However, HHS did not ensure that approximately $2.16 billion (5.5 percent) in automatic PRF payments were properly calculated as intended. Also, HHS did not prevent more than $247 million in payments (less than 1 percent) from being disbursed to ineligible providers and did not utilize all readily available lists to identify these providers.

CDC's Internal Control Weaknesses Led to Its Initial COVID-19 Test Kit Failure, but CDC Ultimately Created a Working Test Kit (A-04-20-02027)

Review the Centers for Disease Control and Prevention's (CDC's) process for developing COVID-19 test kits.

• Some of the initial COVID-19 test kits that CDC developed and distributed to public health laboratories (PHLs) could not be verified by the PHLs, and CDC initially identified multiple potential causes of this failure.
• Ultimately, CDC developed a viable COVID-19 test kit within 2 months of China publishing the genome sequence of the novel virus that caused the COVID-19 outbreak.

Determine factors that contributed to the initial COVID-19 test kit failure.

• We identified weaknesses in CDC's COVID-19 test kit development processes and the agencywide laboratory quality processes that may have contributed to the failure of the initial COVID-19 test kits.

The Strategic National Stockpile Was Not Positioned To Respond Effectively to the COVID-19 Pandemic (A-04-20-02028)

Determine whether the Strategic National Stockpile, under the direction of the Administration for Strategic Preparedness and Response, was effective in responding to the COVID-19 pandemic.

• The Stockpile was operationally effective in distributing its limited inventory in response to the COVID-19 pandemic, based on established policies and procedures and consistent with its statutory obligations.
• However, the Stockpile's strategic effectiveness and its ability to meet COVID-19 demands was impacted by external and internal factors outside of its control.

CDC Provided Oversight and Assistance; However, ELC Recipients Still Faced Challenges in Implementing COVID-19 Screening Testing Programs (A-05-22-00010)

Determine what oversight and assistance regarding the implementation of COVID-19 screening testing programs that the Centers for Disease Control and Prevention (CDC) provided to recipients of Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) program funds.

• CDC provided oversight and assistance to the ELC recipients in implementing the COVID-19 screening testing programs by utilizing recipient data and conducting periodic outreach through webinars and technical assistance calls, among other things.
• However, based on the ELC recipients' responses to the OIG survey, we identified challenges the recipients encountered in implementing the screening testing programs within their jurisdictions.

Home Health Agencies Rarely Furnished Services Via Telehealth Early in the COVID-19 Public Health Emergency (A-05-21-00026)

Determine whether home health services furnished via telehealth early in the COVID-19 public health emergency (PHE) were provided and billed in accordance with Medicare requirements.

• Home health agencies (HHAs) rarely furnished services via telehealth early in the COVID-19 PHE. However, for the few claims in our sample with services furnished via telehealth, HHAs did not fully comply with Medicare requirements for providing them.

Four States Reviewed Received Increased Medicaid COVID-19 Funding Even Though They Terminated Some Enrollees' Coverage for Unallowable or Potentially Unallowable Reasons (A-06-21-09002)

Determine whether selected States met the requirements to receive a temporary increase to their Federal medical assistance percentage (FMAP) rates.

The four States we reviewed (Texas, Minnesota, New York, and Florida) did not meet all of the requirements to receive the increased COVID-19 FMAP because:

• all four States terminated Medicaid enrollees' coverage for unallowable or potentially unallowable reasons.
• Minnesota may have inappropriately charged some enrollees cost-sharing for COVID-19 testing, services, and treatment.

HRSA Had An Effective Process To Identify And Monitor High-Risk Health Centers That Received COVID-19 Grant Funds (A-01-21-01503)

Determine whether the Health Resources and Services Administration (HRSA) had an effective process to identify and monitor high-risk health centers that received COVID-19 grant funds.

• HRSA had effective processes to identify and monitor the health centers that received COVID-19 grant funds.

Key Strategies That States Used for Managing Medicaid and Marketplace Enrollment During the COVID-19 PHE (OEI-09-20-00590)

Highlight strategies that State Medicaid agencies and State-based Marketplaces described as beneficial for their applicants, enrollees, and enrollment staff during the COVID-19 public health emergency.

Medicaid agencies and Marketplaces described strategies and detailed specific actions that States used to:

• expand outreach efforts,
• improve applications and support,
• simplify eligibility determinations, and
• adapt program operations.

Telehealth During 2020 Helped Ensure End-Stage Renal Disease Patients Received Care, But Limited Information Related to Telehealth Was Documented (A-05-22-00015)

For telehealth services related to end-stage renal disease (ESRD) and provided during the COVID-19 public health emergency, determine what information regarding the services was documented in the medical records.

• Providers documented limited information related to telehealth services in the medical records.

Determine whether the claims for these services met certain Medicare requirements.

• The ESRD-related telehealth service claim lines generally met certain Medicare requirements.

Although IHS Allocated COVID-19 Testing Funds To Meet Community Needs, It Did Not Ensure That the Funds Were Always Used in Accordance With Federal Requirements (A-07-20-04123)

Determine whether Indian Health Service (IHS) ensured that COVID-19 testing funds were allocated to meet community needs.

• IHS ensured that COVID-19 testing funds from the Families First Act and Paycheck Protection Act used existing allocation methodologies to meet community needs through use of the existing recurring base formulae, which took into consideration programs' populations and health care needs.

Determine whether COVID-19 testing funds were used by IHS Direct, Tribal, and Urban Indian Organization (UIO) programs for testing and testing-related services in accordance with Federal requirements.

• However, IHS did not ensure that COVID-19 testing funds were always used by Direct, Tribal, and UIO programs for testing and testing-related services in accordance with Federal requirements. For example, 5 of the 10 sampled programs used a combined $480,437 ($19,912 from one Direct program and $460,525 from Tribal and UIO programs) on expenses that did not support COVID-19 testing or testing-related activities.

HRSA Made COVID-19 Uninsured Program Payments to Providers on Behalf of Individuals Who Had Health Insurance Coverage and for Services Unrelated to COVID-19 (A-02-21-01013)

Determine whether claims for COVID-19 testing and treatment services reimbursed through the Uninsured Program (UIP) complied with Federal requirements.

• UIP payments totaling $294,294 for 58 of the 300 patients we sampled were improper because they were made on behalf of individuals who had health insurance coverage or were made for testing and treatment services that were not provided or were unrelated to COVID-19.
• On the basis of our sample results, we estimated that nearly $784 million of $4.2 billion (or 19 percent) of UIP payments made to providers during our audit period were improper for 19.2 million patients.
• We determined that providers in the sample had effective processes to ensure that they did not engage in balance billing or charge patients any type of cost-sharing.

Targeted Provider Relief Funds Allocated to Hospitals Had Some Differences with Respect to the Ethnicity and Race of Populations Served (OEI-05-20-00580)

Understand how early Provider Relief Fund (PRF) Targeted Distributions correlated with racial, ethnic, and economic characteristics of the communities providers serve.

• Communities with greater concentrations of Hispanic/Latino residents were associated with less PRF per person than communities with smaller concentrations of Hispanic/Latino residents.
• In nonrural areas, communities with greater concentrations of Non-Hispanic Black residents were associated with more PRF per person than communities with smaller concentrations of Non-Hispanic Black residents; however, this pattern did not occur in rural areas.
• In the allotment targeted to rural hospitals (about $9.7 billion), communities with greater concentrations of Hispanic/Latino residents or Non-Hispanic Black residents were associated with less PRF per person than communities with smaller concentrations of Hispanic/Latino Residents or Non-Hispanic Black residents.

Alaska Experienced Challenges in Meeting Federal and State Foster Care Program Requirements During the COVID-19 Pandemic (A-06-21-07006)

Determine whether Alaska complied with Federal and State foster care program requirements related to background checks and caseworker visits during the COVID-19 pandemic.

• Alaska did not always comply with State and Federal requirements related to background checks and caseworker visits to foster homes during the COVID-19 pandemic, even when those requirements had been modified to provide flexibility.

Identify any vulnerabilities or gaps in policies or procedures that could place children at risk.

• We did not identify any vulnerabilities or gaps in Alaska's policies or procedures.

Seventeen of Thirty Selected Health Centers Did Not Use or May Not Have Used Their HRSA COVID-19 Supplemental Grant Funding in Accordance With Federal Requirements (A-02-21-02005)

Determine whether selected health centers used their COVID-19 supplemental grant funding in accordance with Federal requirements and grant terms.

• Seventeen of the 30 selected health centers did not use or may not have used a portion of their COVID-19 supplemental grant funding in accordance with Federal requirements and grant terms.
• Specifically, 10 health centers charged unallowable costs totaling $787,152 and 13 health centers may not have properly allocated salary and fringe benefits costs totaling $15,056,835 to their COVID-19 supplemental grant funding. (The total exceeds 17 because 6 health centers had more than 1 deficiency.) These funds could have been used to support health centers activities related to COVID-19 response, including providing essential testing services to monitor and suppress COVID-19.

Montana Generally Complied With Requirements for Telehealth Services During the COVID-19 Pandemic (A-07-21-03250)

Determine whether Montana and Medicaid providers complied with Federal and State requirements when claiming Medicaid reimbursement for telehealth services during the COVID-19 pandemic.

• Over 99.9 percent of the lines we reviewed complied with Federal and State requirements. However, some Medicaid providers claimed services that did not comply with requirements for telehealth services.
• Specifically, we identified 121 lines totaling $9,589 (Federal share), each of which had 1 of the following types of errors: documentation did not support that services were performed; services were required to be face-to-face but were instead performed and billed as telehealth; or services were performed but providers incorrectly added a modifier or place of service code to indicate that the services were performed via telehealth.

Medicare Improperly Paid Providers for Some Psychotherapy Services, Including Those Provided via Telehealth, During the First Year of the COVID-19 Public Health Emergency (A-09-21-03021)

Determine whether providers met Medicare requirements and guidance when billing for psychotherapy services, including services provided via telehealth.

• Providers did not meet Medicare requirements and guidance when billing for some psychotherapy services. For 128 of the 216 sampled enrollee days reviewed, providers did not meet requirements. For 54 sampled enrollee days, providers did not meet Medicare guidance.
• Based on our sample results, we estimated that of the $1 billion that Medicare paid for psychotherapy services, providers received $580 million in improper payments for services that did not comply with Medicare requirements.

Challenges With Data From Federal Vaccination Partners Hinder Efforts by State and Local Immunization Programs To Combat COVID-19 (OEI-05-22-00010)

Identify the extent to which the immunization databases of States and local immunization programs receive COVID-19 vaccination data from Federal agencies and retail pharmacy partners.

• Many State and local immunization programs reported having incomplete individual-level data for the more than 250 million COVID-19 vaccine doses administered by Federal agencies and retail pharmacies that receive vaccines directly from CDC. These programs rely on individual-level data in their immunization databases to manage vaccination campaigns.

Early Challenges Highlight Areas for Improvement in COVID-19 Vaccination Programs (OEI-04-21-00190)

Describe awardee-reported challenges in the early stages of their COVID-19 vaccination programs.

• State and local immunization programs distributing COVID-19 vaccines faced numerous challenges, including (1) achieving logistical efficiency, (2) obtaining complete vaccine data from providers, (3) combating vaccine hesitancy with public health messaging, and (4) overseeing vaccine providers.

Describe awardee-reported mitigation strategies for addressing challenges in the early stages of their COVID-19 vaccination programs.

• For each type of challenge, awardees reported using a variety of strategies to mitigate the challenge.

More Than a Thousand Nursing Homes Reached Infection Rates of 75 Percent or More in the First Year of the COVID-19 Pandemic; Better Protections Are Needed for Future Emergencies (OEI-02-20-00491)

Provide objective data about nursing homes, particularly those with extremely high infection rates, to learn from their experiences in order to better prepare for current and future public health emergencies.

• Nursing homes had a surge of COVID-19 and likely COVID-19 cases during the spring of 2020 and a greater surge during the fall, well after they were known to be vulnerable.
• More than 1,300 nursing homes had extremely high infection rates—75 percent or more of their Medicare residents—during these surges.
• Nursing homes with extremely high infection rates experienced an average overall mortality rate approaching 20 percent—roughly double that of other nursing homes.
• High COVID-19 transmission in a county did not always lead to nursing homes in that county reaching extremely high infection rates.

ASPR Could Improve Its Oversight of the Hospital Preparedness Program to Ensure Crisis Standards of Care Comply With Federal Nondiscrimination Laws (A-01-21-01502)

Determine whether the Administration for Strategic Preparedness and Response’s (ASPR’s) oversight of the Hospital Preparedness Program (HPP) could be improved with respect to recipients adopting Crisis Standards of Care (CSCs) that comply with Federal nondiscrimination laws.

• Although ASPR has taken steps to improve its oversight of the HPP by promoting the adoption of nondiscriminatory CSCs that comply with Federal nondiscrimination laws, it can take additional steps.
• The HPP cooperative agreement did not previously specify that States should consider Federal nondiscrimination laws when developing CSCs because prior to the COVID-19 pandemic, ASPR did not identify CSC compliance with Federal nondiscrimination laws as a high-risk area.
• CSCs that do not comply with Federal nondiscrimination laws increase the risk that individuals could be denied access to lifesaving care during a public health emergency.

Illinois Generally Complied With Requirements for Claiming Medicaid Reimbursement for Telehealth Payments During COVID-19 (A-05-21-00035)

Determine whether Illinois complied with Federal and State requirements when claiming Medicaid reimbursement for telehealth payments during COVID-19.

• Illinois generally made telehealth payments that were in accordance with Federal and State requirements.
• Of the 584,492 Medicaid fee-for-service telehealth payments in our population, 583,960 payments were in compliance with the requirements, but the remaining 532 payments were not in compliance with applicable requirements.

Labs With Questionably High Billing for Additional Tests Alongside COVID-19 Tests Warrant Further Scrutiny (OEI-09-20-00510)

Identify labs with questionably high billing for respiratory, genetic, and/or allergy tests on Medicare Part B claims that included COVID-19 tests.

• Certain labs billed Medicare Part B for questionably high levels of add-on tests alongside COVID-19 tests in 2020. This significantly increased the payments they received for claims that included COVID-19 tests.
• Such high levels of billing for add-on tests raise concern about potential waste or fraud, suggesting a need for further scrutiny of billing by these labs.

Insights on Telehealth Use and Program Integrity Risks Across Selected Health Care Programs During the Pandemic (OEI-02-22-00150)

Assess telehealth utilization and fraud, waste, and abuse risks across six Federal agencies during the first year of the pandemic.

• During the first year of the pandemic, 13 times as many individuals used telehealth services than in the year prior, totaling 37 million users and costing programs more than $6 billion.
• Offices of Inspectors General (OIGs) for the agencies identified risks of fraud, waste, and abuse associated with billing of telehealth services.
• The OIGs found that many of the programs lack complete, reliable data on the impact of telehealth on quality of care and the billing of services. This data is critical to conducting oversight of fraud, waste, and abuse.
• While these programs have safeguards in place to oversee telehealth services, additional safeguards could strengthen their integrity.

The Number of Beneficiaries Who Received Medicare Part B Clinical Laboratory Tests Decreased During the First 10 Months of the COVID-19 Pandemic (A-09-21-03004)

Identify changes in the number of beneficiaries who received Medicare Part B lab tests during the first 10 months of the COVID-19 pandemic—specifically, the number of beneficiaries who received: (1) all lab tests and (2) lab tests associated with certain chronic medical conditions common among Medicare beneficiaries (i.e., diabetes, kidney disease, and heart disease).

• The number of beneficiaries who received Part B lab tests decreased for: (1) all lab tests and (2) lab tests associated with certain chronic medical conditions.

During the Initial COVID-19 Response, HHS Personnel Who Interacted With Potentially Infected Passengers Had Limited Protections (OEI-04-20-00360)

Assess the Centers for Disease Control and Prevention’s (CDC’s) recommended infection prevention and control protections for Department of Health and Human Services (HHS) personnel who were interacting with potentially infected passengers at quarantine stations and quarantine sites during the initial COVID-19 response (i.e., January through March 2020).

• Initially, CDC recommended limited protections for HHS staff who were interacting with passengers entering the United States. During the period we reviewed, CDC’s understanding of COVID-19 was evolving, and the protections improved but still contained some vulnerabilities. As a result, HHS personnel may have been at increased risk of COVID-19 exposure and may have inadvertently spread COVID-19.

Payments Made to Providers Under the COVID-19 Accelerated and Advance Payments Program Were Generally in Compliance with the CARES Act and Other Federal Requirements (A-05-20-00053)

Determine whether payments from the COVID-19 Accelerated and Advanced Payments (CAAP) Program were made to providers in compliance with the Coronavirus Aid, Relief, and Economic Security (CARES) Act and other Federal requirements.

• The Centers for Medicare & Medicaid Services (CMS) generally made CAAP Program payments to providers in compliance with the CARES Act and other Federal requirements. Although CMS' Medicare Administrative Contractors (MACs) erroneously approved CAAP Program payments to nine providers under bankruptcy, the MACs immediately identified their errors, stopped payments to six providers, and recovered improper payments made to the other three providers.

Home Health Agencies Used Multiple Strategies To Respond to the COVID-19 Pandemic, Although Some Challenges Persist (OEI-01-21-00110)

Identify home health agencies' (HHAs') key challenges to providing patient care during the COVID-19 pandemic and key strategies HHAs used to address the challenges.

• The challenges faced by the surveyed HHAs included the novel nature of the virus as well as issues with staffing, infection control, supply shortages, emergency planning, and other matters.
• HHAs developed strategies to respond to challenges during the COVID-19 pandemic, including providing new incentives to maintain staff and seeking alternative sources of personal protective equipment. However, staffing challenges persist.

IHS Did Not Always Provide the Necessary Resources and Assistance To Help Ensure That Tribal Programs Complied With All Requirements During Early COVID-19 Vaccination Program Administration (A-07-21-04125)

Determine whether Indian Health Service (IHS) followed the provisions of both its Memorandum of Agreement (MOA) and Vaccine Plan to coordinate the distribution, allocation, and administration of COVID-19 vaccines to Tribal health programs.

• IHS did not fulfill all of the provisions outlined in the MOA and its Vaccine Plan to help ensure that the vaccination program was implemented appropriately at Tribal programs. Consequently, Tribal programs did not always comply with all program requirements during early program implementation.

HHS's and HRSA's Controls Related to Selected Provider Relief Fund Program Requirements Could Be Improved (A-09-21-06001)

Determine whether the Department of Health and Human Services (HHS) and the Health Resources and Services Administrations (HRSA) controls had related to selected Provider Relief Fund (PRF) program requirements ensured that providers received the correct payments from the Phase 1 General Distribution.

• In the context of unprecedented challenges from the COVID-19 national emergency, HHS and HRSA developed controls related to selected PRF program requirements designed to ensure that providers received the correct PRF payments from the Phase 1 General Distribution in a fast, fair, and transparent manner.
• However, we determined that some of these controls could be improved. HHS and HRSA did not have certain procedures, and some of their procedures had weaknesses.

End-Stage Renal Disease Network Organizations' Reported Actions Taken in Response to the COVID-19 Pandemic (A-05-20-00051)

Identify what actions the End-Stage Renal Disease Network Organizations took during the COVID-19 pandemic to aid dialysis clinics and patients and to keep the Centers for Medicare & Medicaid Services (CMS) informed about quality-of-care issues.

• The 18 Network Organizations that we surveyed provided information about the actions they took to address the additional demands on clinics during the pandemic. Network Organizations also reported to us challenges they encountered in taking those actions during the pandemic.
• Network Organizations also kept CMS informed of quality-of-care issues by communicating through established communication processes and processes modified for better use during the pandemic.

FDA Repeatedly Adapted Emergency Use Authorization Policies to Address the Need for COVID-19 Testing (OEI-01-20-00380)

Assess the effectiveness of the Food and Drug Administration’s (FDA’s) use of emergency use authorization (EUA) to authorize tests for COVID-19.

• From January through May 2020, FDA repeatedly adapted its approach to how it used EUAs to address COVID-19 testing challenges and to expedite access to tests. However, these efforts to increase test availability sometimes came at a cost to test quality.

FDA’s Work with the Tri-Agency Task Force for Emergency Diagnostics Helped Labs Implement COVID-19 Tests (OEI-01-20-00381)

Determine the extent to which Food and Drug Administration’s (FDA’s) engagement with the Tri-Agency Task Force for Emergency Diagnostics helped facilitate laboratories’ ability to implement COVID-19 tests.

• As FDA carried out its responsibilities during the first months of the COVID-19 pandemic, the Task Force served as a forum for FDA to collaborate and coordinate with the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services to facilitate emergency test implementation in labs.

IHS's National Supply Service Center Was Generally Effective in Providing Supplies to Facilities During the COVID-19 Pandemic, but Its Internal Controls Could Be Improved (A-07-20-04124)

Determine whether Indian Health Services' (IHS') National Supply Service Center (NSSC) effectively distributed medical supplies and equipment in response to the COVID-19 pandemic.

• The NSSC was generally effective in facilitating the distribution of medical supplies and equipment during the COVID-19 pandemic. However, we noted that the NSSC's internal controls could be improved.

Certain Life Care Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness (A-01-20-00004)

Assess whether selected Life Care Centers of America (Life Care) nursing homes complied with Federal requirements for infection prevention and control and emergency preparedness.

• Selected Life Care nursing homes in 11 states may not have complied with the requirements. Specifically, 23 of the 24 nursing homes selected had possible deficiencies.

The IHS Telehealth System Was Deployed Without Some Required Cybersecurity Controls (A-18-21-03100)

Determine whether the Indian Health Service (IHS) implemented select cybersecurity controls to protect its telehealth system.

• Although IHS deployed a national telehealth system, which increased the availability of health care services during the COVID-19 pandemic, it did not complete select IT controls as required prior to deploying its telehealth system.

Certain Medicare Beneficiaries, Such as Urban and Hispanic Beneficiaries, Were More Likely Than Others to Use Telehealth During the First Year of the COVID-19 Pandemic (OEI-02-20-00522)

Ciertos beneficiarios de Medicare, como los beneficiarios urbanos e hispanos, fueron más propensos que otros a usar los servicios de telesalud durante el primer año de la pandemia de COVID-19 (OEI-02-20-00522)

Examine the characteristics of beneficiaries who used telehealth during the first year of the pandemic

• Beneficiaries in urban areas were more likely than those in rural areas to use telehealth.
• Dually eligible, Hispanic, younger, and female beneficiaries were also more likely than others to use telehealth.
• Older beneficiaries were more likely to use certain audio-only services, as were dually eligible and Hispanic beneficiaries.

Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks (OEI-02-20-00720)

Assess the program integrity risks associated with Medicare telehealth services.

• We identified 1,714 providers out of approximately 742,000 whose billing for telehealth services poses a high risk to Medicare.
• Each of these providers had concerning billing on at least one of seven measures we developed that may indicate fraud, waste, or abuse.

Identify ways to safeguard Medicare from fraud, waste, and abuse related to telehealth.

• We offer recommendations to the Centers for Medicare & Medicaid Services to strengthen oversight of telehealth services.

HHS Did Not Fully Comply With Federal Requirements and HHS Policies and Procedures When Awarding and Monitoring Contracts for Ventilators (A-02-20-02002)

Determine whether the Administration for Strategic Preparedness and Response (ASPR) awarded and monitored contracts for the production of ventilators in accordance with Federal requirements and HHS policies and procedures.

• ASPR did not consistently award and monitor contracts for ventilators for use in responding to the COVID-19 pandemic in accordance with Federal requirements and HHS policies and procedures. Therefore, ASPR could not determine whether the use of taxpayer funds was reasonable.

Certain Nursing Homes May Not Have Complied With Federal Requirements for Infection Prevention and Control and Emergency Preparedness (A-01-20-00005)

Determine whether the selected nursing homes complied with Federal requirements for infection prevention and control and emergency preparedness.

• Selected nursing homes may not have complied with the requirements. Specifically, 28 of the 39 nursing homes had possible deficiencies.

CDC Found Ways To Use Data To Understand and Address COVID-19 Health Disparities, Despite Challenges With Existing Data (OEI-05-20-00540)

• Identify limitations in the racial, ethnic, and socioeconomic data used by the Centers for Disease Control and Prevention (CDC) that are associated with COVID-19 testing, cases, hospitalizations, and deaths.

• CDC’s data had limitations and provided an incomplete picture of COVID-19 disparities. Data were sometimes missing, inconsistent, inaccurate, not clearly defined, or not consistently collected.

• Examine how CDC uses these data in its response to COVID-19 disparities.

• CDC worked to understand and address COVID-19 disparities using the data, despite challenges with this information.

• Describe CDC’s challenges, successes, and lessons learned in using these data and supporting jurisdictions and Tribal Epidemiology Centers in response to the COVID-19 pandemic.

• CDC took steps to supplement and improve these data.

An Estimated 91 Percent of Nursing Home Staff Nationwide Received the Required COVID-19 Vaccine Doses, and an Estimated 56 Percent of Staff Nationwide Received a Booster Dose (A-09-22-02003)

Identify the COVID-19 vaccination status of nursing home staff as of the week ended March 27, 2022.

• Ninety-one percent of staff nationwide had received the vaccine doses required by the Centers for Medicare & Medicaid Services.
• Fifty-six percent of staff nationwide had received a booster dose.
• Six percent of staff nationwide had been granted a religious exemption.

Office of Refugee Resettlement's Influx Care Facility and Emergency Intake Sites Did Not Adequately Safeguard Unaccompanied Children From COVID-19 (A-06-21-07002)

Determine whether the influx care facilities and emergency intake sites had procedures in place to test for and protect against the spread of COVID-19 and, as appropriate, report testing and results to the Office of Refugee Resettlement (ORR) and State and local health entities.

Most facilities lacked:

• procedures for COVID-19 testing of children, employees, and volunteers;
• measures to protect against the spread of COVID-19; and/or
• procedures to report required testing and results to ORR and State and local health entities.

Selected Dialysis Companies Implemented Additional Infection Control Policies and Procedures To Protect Beneficiaries and Employees During the COVID-19 Pandemic (A-05-20-00052)

Determine whether, to protect high-risk beneficiaries with end-stage renal disease (ESRD) during the COVID-19 pandemic, selected dialysis companies implemented additional infection control policies and procedures in accordance with Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) guidance.

• The selected dialysis companies had infection control policies and procedures in place to protect ESRD beneficiaries and employees. When recommended by CMS and CDC, the companies implemented additional policies and procedures.

HHS Should Improve Internal Coordination Regarding Unaccompanied Children (OEI-BL-20-00670)

Assess coordination within the Department of Health and Human Services during the development and early implementation of a March 2020 public health order affecting unaccompanied noncitizen children.

• The Centeres for Disease Control and Prevention did not coordinate with the Office of Refugee Resettlement on development or implementation of a public health order that significantly affected unaccompanied children.

National Snapshot of Trends in the National Domestic Violence Hotline's Contact Data Before and During the COVID-19 Pandemic (A-09-21-06000)

Identify trends in the Hotline’s contact data before and during the pandemic, challenges that the Hotline faced during the pandemic.

• The number of contacts that used online chat to reach the Hotline increased by 19 percent. The number of contacts that identified with the Asian ethnicity group increased by 24 percent. The need for protective/restraining order assistance increased by 40 percent.

Identify challenges that the Hotline faced during the pandemic and actions that it took to address those challenges while continuing to support those affected by domestic violence.

The Hotline experienced challenges:

• connecting victims to providers and resources that were operating at a limited capacity because of the pandemic,
• tracking the unique impact of the pandemic on victims to better serve contacts' needs, and
• addressing a decrease in contact volume from victims who may have needed help but did not contact the Hotline because they were in closer proximity to their abusers as a result of shelter-in-place orders.

Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic (OEI-02-20-00520)

Provide insight into the use of telehealth in both Medicare fee-for-service and Medicare Advantage during the first year of the COVID-19 pandemic.

• Over 28 million Medicare beneficiaries (more than 2 in 5) used telehealth during the first year of the pandemic.
• Beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the prior year.
• Beneficiaries’ use of telehealth peaked at the beginning of the pandemic and remained high through early 2021.
• Beneficiaries most commonly used telehealth for office visits during the first year of the pandemic.

The Assistant Secretary for Administration Awarded and Managed Five Sole Source Contracts for COVID-19 Testing in Accordance With Federal and Contract Requirements (A-05-21-00014)

Determine whether HHS’ Assistant Secretary for Administration (ASA) awarded and managed five COVID-19 testing contracts in accordance with applicable Federal regulations, as well as contract terms and conditions.

• ASA awarded and managed the contracts in accordance with Federal regulations and contract requirements.

COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of Non-COVID-19 Tests Decreased Significantly (OEI-09-21-00240)

Provide an analysis of Medicare Part B payments for lab tests in 2020.

• Medicare Part B spent $1.5 billion on COVID-19 tests in 2020. At the same time, spending on non-COVID-19 tests declined by $1.2 billion. The result was a net spending increase of 4 percent.
• The decrease in utilization of non-COVID-19 tests raises questions about the potential impacts on beneficiary health.

Most Medicare beneficiaries received telehealth services only from providers with whom they had an established relationship (OEI-02-20-00521)

Describe the extent to which Medicare beneficiaries had established relationships with providers furnishing their telehealth services.

Identify differences in these relationships between traditional Medicare and Medicare Advantage.

• Eighty-four percent of these beneficiaries received all their telehealth services from providers with whom they had an established relationship.
• Those enrolled in traditional Medicare were more likely to receive services from providers with whom they had an established relationship, compared to beneficiaries in Medicare Advantage.

Changes Made to States’ Medicaid Programs To Ensure Beneficiary Access to Prescriptions During the COVID-19 Pandemic (A-06-20-04007)

Identify actions that selected State Medicaid agencies (States) took, or planned to take, to ensure that Medicaid beneficiaries continued to receive prescription drugs during the COVID-19 pandemic.

• Most States in our review described actions they have taken or planned to take to ensure that Medicaid beneficiaries continued to have access to prescription drugs during the pandemic.
• Most States reviewed responded that they have implemented changes giving physicians greater flexibility to prescribe drugs to both new and established patients following telehealth episodes during the pandemic.
• All States reviewed indicated that they are providing updated guidance to all stakeholders to ensure that beneficiaries can obtain their prescriptions.

Six of Eight Home Health Agency Providers Had Infection Control Policies and Procedures That Complied With CMS Requirements and Followed CMS COVID-19 Guidance To Safeguard Medicare Beneficiaries, Caregivers, and Staff During the COVID-19 Pandemic (A-01-20-00508)

Determine whether eight selected Home Health Agency (HHA) providers had infection control policies and procedures that complied with Centers for Medicare & Medicaid Services (CMS) requirements and followed CMS guidance during the COVID-19 pandemic.

• Six of the selected HHA providers had infection control policies and procedures that complied with CMS requirements and followed CMS guidance to safeguard HHA staff, Medicare beneficiaries, and caregivers during the pandemic.

Indian Health Service Use of Critical Care Response Teams Has Helped To Meet Facility Needs During the COVID-19 Pandemic (OEI-06-20-00700)

Assess Indian Health Service (IHS) use of Critical Care Response Teams (CCRTs) to support IHS and Tribal health care facilities during the COVID-19 pandemic.

• IHS developed the CCRT program as an innovative capacity-building tool to strengthen IHS and Tribal facilities’ response to the COVID-19 pandemic.
• The program is a positive step in IHS’s efforts to promptly respond to the immediate needs of facilities.
• The CCRT model also holds promise for addressing longstanding challenges facing some facilities related to quality of care and staffing.

CMS's COVID-19 Data Included Required Information From the Vast Majority of Nursing Homes, but CMS Could Take Actions To Improve Completeness and Accuracy of the Data (A-09-20-02005)

Determine whether Centers for Medicare & Medicaid Services’ (CMS’s) COVID-19 data for nursing homes were complete and accurate.

• CMS’s COVID-19 data for nursing homes included the required information from the vast majority of nursing homes; however, the data were not complete or accurate for some facilities.
• For about 5 percent of nursing homes, the data did not include all COVID-19 information nursing homes were required to report and/or were not complete or accurate after CMS performed its quality assurance checks.

Medicare Beneficiaries Hospitalized With COVID-19 Experienced a Wide Range of Serious, Complex Conditions (OEI-02-20-00410)

Understand the types of conditions for which Medicare beneficiaries with COVID-19 were being treated and what groups were more likely to be hospitalized with COVID-19.

• Medicare beneficiaries hospitalized with COVID-19 were treated for a wide range of complex conditions such as acute respiratory failure, kidney failure, and sepsis.
• More than half of hospitalized Medicare beneficiaries with COVID-19 received intensive care or mechanical ventilation.
• Dually eligible, Black, Hispanic, or older beneficiaries were disproportionately hospitalized with COVID-19.

States' Backlogs of Standard Surveys of Nursing Homes Grew Substantially During the COVID-19 Pandemic (OEI-01-20-00431)

July 27, 2021

Addendum to: Onsite Surveys of Nursing Homes During the COVID-19 Pandemic: March 23-May 30 (OEI-01-20-00430), December 22, 2020

Provide an update on the backlogs of standard surveys of nursing homes that State Survey Agencies faced during the COVID-19 pandemic.

• States' backlogs of standard nursing home surveys have grown substantially, even after August 2020 when CMS lifted its suspension of those surveys (which it had suspended due to the COVID-19 pandemic).
• Nationally, 71 percent of nursing homes had gone at least 16 months without a standard survey as of May 31, 2021.

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 (A-02-21-01003)

Assess whether the Centers for Medicare and Medicaid Services (CMS) designed and implemented effective internal controls related to hospital preparedness for emerging infectious diseases such as COVID-19.

• CMS's controls were well-designed and implemented to achieve its control objective and respond to risks, but CMS's authority is not sufficient for it to ensure preparedness for emerging infectious diseases including COVID-19 at 4,200 accredited hospitals.

COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes During 2020 (OEI-02-20-00490)

Determine how many Medicare beneficiaries in nursing homes were affected by COVID-19 in 2020.

Understand beneficiaries' characteristics that are associated with greater risk of contracting the virus.

• 2 in 5 Medicare beneficiaries in nursing homes were diagnosed with either COVID-19 or likely COVID-19 in 2020.
• Almost 1,000 more beneficiaries died per day in April 2020 than in April 2019.
• Overall mortality in nursing homes increased to 22 percent in 2020 from 17 percent in 2019.
• About half of Black, Hispanic, and Asian beneficiaries in nursing homes had or likely had COVID-19, and 41 percent of White beneficiaries did.
• Understanding the pandemic's effects on nursing home residents is necessary if tragedies like this are to be averted.

Hospitals Reported That the COVID-19 Pandemic Has Significantly Strained Health Care Delivery: Results of a National Pulse Survey February 22-26, 2021 (OEI-09-21-00140)

March 24, 2021

Provide a national snapshot, from the perspective of hospital administrators, on how responding to the COVID-19 pandemic has affected hospitals' capacity to care for patients, staff, and communities nearly a year after COVID-19 was declared a pandemic.

• Hospital administrators described difficulty balancing the complex and resource-intensive care needed for COVID-19 patients with efforts to resume routine hospital care. Specifically, they described significant challenges related to health care delivery, staffing, vaccinations, and finances.
• Hospitals reported a range of strategies they have used to address their challenges and identified areas in which further government support could help as they continue responding to the pandemic.

Opioid Use in Medicare Part D During the Onset of the COVID-19 Pandemic (OEI-02-20-00400)

February 4, 2021

Describe opioid use in Part D during the onset of COVID-19, focusing on the first 8 months of 2020.

• At least 5,000 Part D beneficiaries per month suffered an opioid overdose.
• Further, almost a quarter of a million beneficiaries received high amounts of opioids.
• During this time, the number of beneficiaries receiving drugs for medication-assisted treatment increased slightly.
• The number of beneficiaries receiving naloxone—a drug that can reverse an opioid overdose—declined through April but increased in the following months.

Federal COVID-19 Testing Report: Data Insights from Six Federal Health Programs

January 14, 2021

Provide information on COVID-19 testing paid for by Medicare Part B from February 1, 2020, to August 31, 2020.

• 5,090,175 beneficiaries received at least one COVID-19 test paid for by Part B, which was 13% of total Part B beneficiaries.
• Part B paid more than $551 million for 7.98 million COVID-19 tests administered.
• Testing of beneficiaries was generally proportional to the demographic characteristics of the Part B population.

Onsite Surveys of Nursing Homes During the COVID-19 Pandemic: March 23-May 30 (OEI-01-20-00430)

December 22, 2020

See also addendum: States' Backlogs of Standard Surveys of Nursing Homes Grew Substantially During the COVID-19 Pandemic (OEI-01-20-00431), July 27, 2021

Determine the number and results of surveys of nursing homes conducted by the Centers for Medicare & Medicaid Services (CMS) and State survey agencies (States) from March 23 through May 30, 2020.

Describe challenges that CMS and States experienced in conducting nursing home oversight during the COVID-19 pandemic and their insights into their experiences.

• States conducted onsite surveys at 31 percent of nursing homes from March 23 through May 30, 2020, fewer than during the same time period in 2019 when States and CMS were under normal operations.
• These surveys resulted in few deficiencies but allowed States to provide nursing homes with guidance and other support.
• States had challenges in securing personal protective equipment and staff to conduct onsite surveys.

Opioid Treatment Programs Reported Challenges Encountered During the COVID-19 Pandemic and Actions Taken To Address Them (A-09-20-01001)

November 23, 2020

Identify challenges that opioid treatment programs (OTPs) have encountered during the COVID-19 pandemic.

Identify actions that OTPs have taken to address those challenges while ensuring the continuity of needed services and protecting the health and safety of their patients and staff.

• OTPs reported challenges related to maintaining pre-pandemic service levels, managing impacts on facility, and implementing and using telehealth, and others.
• OTPs reported actions taken that included encouraging or requiring various personal safety measures for patients and staff, implementing or expanding the use of telehealth to continue providing services, and increasing the number of take-home doses to reduce the number of patients visiting facilities.

Office of Refugee Resettlement Ensured That Selected Care Providers Were Prepared To Respond to the COVID-19 Pandemic (A-04-20-02031)

November 9, 2020

Determine whether Office of Refugee Resettlement (ORR) ensured that selected facilities followed ORR requirements in preparing for and responding to communicable diseases, such as COVID-19.

• The 11 selected facilities that we reviewed were generally prepared to respond to an emergency event, such as the COVID-19 pandemic, in accordance with Federal guidance. Specifically, they had policies and procedures, the capability to quarantine COVID-19 cases in their facilities, and adequate personal protective equipment.

National Snapshot of State Agency Approaches to Child Care During the COVID-19 (A-07-20-06092)

October 1, 2020

Identify the approaches that State agencies adopted to ensure access to safe child care as well as to protect the providers rendering that care in their Child Care and Development Fund (CCDF) programs in response to the COVID-19 pandemic.

• All State agencies reported that they issued guidance to child care providers on protective measures recommended by the Centers for Disease Control and Prevention, and almost all State agencies stated that they were following the provisions of their disaster plans.
• Many State agencies used the flexibilities afforded to them by the Administration for Children and Families (ACF), the cognizant Federal agency, to lessen the impact of COVID-19 on child care providers and to ensure continued access to child care.
• To implement changes to their CCDF programs, many State agencies sought changes in their State requirements, requested waivers from ACF, and submitted CCDF plan amendments.

Top Challenges Facing Federal Agencies: COVID-19 Emergency Relief and Response Efforts

June 17, 2020

Share insight into the top management challenges facing federal agencies that received pandemic-related funding, as identified by Offices of Inspector General.

• Drawing on our past experience, as well as current risk-assessment and work planning, HHS-OIG has identified top challenges to HHS's pandemic response in three broad categories: (1) protecting people, (2) protecting funds, and (3) protecting infrastructure.

Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23-27, 2020 (OEI-06-20-00300)

April 6, 2020

Identify hospitals' challenges and needs in responding to the COVID-19 pandemic in a national snapshot.

• Hospitals reported that their most significant challenges centered on testing and caring for patients with known or suspected COVID-19 and keeping staff safe.
• Hospitals also reported substantial challenges maintaining or expanding their facilities' capacity to treat patients with COVID-19.
• Hospitals described specific challenges, mitigation strategies, and needs for assistance related to personal protective equipment, testing, staffing, supplies and durable equipment; maintaining or expanding facility capacity; and financial concerns.