Reconsider travel to Japan due to COVID-19.
Read the Department of State’s COVID-19 page before you plan any international travel.
The Centers for Disease Control and Prevention (CDC) has issued a Level 3 Travel Health Notice for Japan due to COVID-19.
Japan has resumed most business operations (including day cares and schools). COVID-19 is still a serious concern in Tokyo and across many areas of Japan, and restrictions on entry remain in effect. Visit the Embassy’s COVID-19 page for more information on COVID-19 in Japan.
Read the country information page.
If you travel to Japan, you should:
- See the U.S. Embassy’s web page regarding COVID-19.
- Visit the CDC’s webpage on Travel and COVID-19.
- Avoid contact with sick people.
- Discuss travel to Japan with your healthcare provider. Older adults and travelers with underlying health issues may be at risk for more severe disease.
- Avoid touching your eyes, nose, or mouth with unwashed hands
- Clean your hands often by washing them with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer that contains at 60%–95% alcohol. Soap and water should be used if hands are visibly dirty.
- Enroll in the Smart Traveler Enrollment Program (STEP) to receive Alerts and make it easier to locate you in an emergency.
- Follow the Department of State on Facebook and Twitter.
- Review the Crime and Safety Report for Japan.
- Prepare a contingency plan for emergency situations. Review the Traveler’s Checklist
Last Update: Reissued with updates to COVID-19 information.
- COVID-19: Federal Agencies’ Initial Reentry and Workplace Safety PlanningBy Sam NewsOctober 25, 2021What GAO Found Federal agencies adopted a maximum telework posture following the March 2020 national emergency declaration related to COVID-19. In April 2020, Office of Management and Budget (OMB) guidance established a framework for agencies to plan for the reentry of employees to the workplace and cognizant agencies issued guidance in 2020 on how to plan for the eventual return of the workforce to office locations. In response to the call for office reentry, the 24 Chief Financial Officer (CFO) Act agencies developed reentry plans. Agencies' 2020 reentry plans varied considerably. All the agencies developed phased approaches for reentry, though agencies did not progress through the established phases at the same rate and the characteristics of each phase differed by agency. None of the agencies' plans consistently covered all aspects of recommended federal guidance. For example, reentry planning documents for 10 or more agencies did not fully address employee training on reentry, office ventilation controls, and face covering requirements, as recommended by federal guidance. In January 2021, the new administration established the Safer Federal Workforce Task Force (Task Force) to provide guidance to agencies and required a 25 percent capacity limit for federal buildings, subject to exceptions with approval. It also issued guidance directing agencies to submit plans addressing a set of model workplace safety principles to the Task Force. Agencies' workplace safety plans, in contrast to initial reentry plans, were generally consistent with the updated federal guidance. Agencies' plans cited most safety principles described in the guidance, including the occupancy limit and additional safety measures to protect the workforce, such as face mask requirements and optimized ventilation and air filtration. Agencies also established COVID-19 coordination teams, as required by January 2021 guidance. These teams developed and monitored agency plans, led decision-making regarding safety procedures and exceptions, and coordinated with external groups, including the Task Force. Federal oversight and coordination were limited for 2020 reentry planning but increased under 2021 guidance related to workplace safety. Initial reentry guidance did not include clear oversight roles and responsibilities. As a result, there was no government-wide oversight or review of initial agency reentry plans. Guidance issued in January 2021 established model safety principles and specific roles for the Task Force, directing Task Force members to guide and oversee agency COVID-19 workplace safety efforts. This increased clarity and oversight and supported consistency in workplace safety planning. The Task Force also used approaches to coordinate workplace safety planning that GAO previously identified as beneficial to support and sustain effective interagency collaboration. For example, the Task Force is made up of relevant participants, including agencies with expertise in health, emergency response, and employee safety. The Task Force supported agencies' COVID-19 response efforts and contributed input to agency workplace safety plans. Updated guidance released in June 2021 indicates that the Task Force and its members plan to continue these oversight and coordination efforts for continued workplace safety and updated reentry planning. Why GAO Did This Study The federal government employs approximately 2.8 million civilian workers, a workforce that plays an important role in maintaining vital government services. The White House, OMB, and other cognizant agencies issued guidance to support federal agencies as they developed tailored plans for bringing the federal workforce back to offices and safely conducting on-site work. The CARES Act included a provision for GAO to monitor and oversee the federal government's response to the COVID-19 pandemic. This report (1) examines agencies' approaches to initial reentry planning, (2) assesses the extent to which agencies' workplace safety plans are consistent with federal guidance, and (3) examines the coordination and oversight of federal reentry and workplace safety planning across the government. GAO analyzed federal guidance from cognizant agencies to identify crosscutting themes for reentry planning, and reviewed OMB guidance on workplace safety principles. GAO assessed workplace safety plans, reentry plans, and relevant documentation from the 24 CFO Act agencies against the themes and principles identified in guidance and interviewed agency officials. GAO also reviewed guidance to identify oversight and coordination responsibilities and reviewed prior GAO work on pandemic preparedness and interagency collaboration. For more information, contact Michelle B. Rosenberg at (202) 512-6806 or email@example.com.[Read More…]
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- DaVita Inc. and Former CEO Indicted in Ongoing Investigation of Labor Market Collusion in Health Care IndustryBy Sam NewsJuly 15, 2021A federal grand jury in Denver returned a two-count indictment charging DaVita Inc. and its former CEO, Kent Thiry, for conspiring with competing employers not to solicit certain employees. DaVita owns and operates outpatient medical care centers across the country, focusing on dialysis and kidney care. These charges are the result of the Antitrust Division’s ongoing investigation into employee allocation agreements in the health care industry. DaVita’s co-conspirator Surgical Care Affiliates LLC and its related entity (collectively SCA) were charged in January, and that case is pending in the Northern District of Texas.[Read More…]
- Court Orders Georgia Defendants to Stop Selling Vitamin D Products as Treatments for Covid-19 and Other DiseasesBy Sam NewsJanuary 8, 2021A federal court entered a permanent injunction barring a Georgia company from selling unapproved vitamin D products touted as treatments for COVID-19, the Department of Justice announced today.[Read More…]
- Former Bank Executive Sentenced to Prison for $15 Million Construction Loan FraudBy Sam NewsNovember 10, 2020A former Kansas bank executive was sentenced to 60 months in prison today for his role in carrying out a bank fraud scheme to obtain a $15 million construction loan from 26 Kansas banks.[Read More…]
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- Indian Health Service: Actions Needed to Improve Oversight of Federal Facilities’ Decision-Making About the Use of FundsBy Sam NewsNovember 12, 2020The Indian Health Service's (IHS) oversight of federally operated health care facilities' decision-making process about the use of funds has been limited and inconsistent. Funds include those from appropriations, as well as payments from federal programs, such as Medicaid and from private insurance, for care provided by IHS to American Indians and Alaska Natives (AI/AN). While some oversight functions are performed at IHS headquarters, the agency has delegated primary responsibility for the oversight of health care facilities' decision-making about the use of funds to its area offices. Area office officials said the oversight they provide has generally included (1) reviewing facilities' scope of services, and (2) reviewing facilities' proposed expenditures. However, GAO's review found that this oversight was limited and inconsistent across IHS area offices, in part, due to a lack of consistent agency-wide processes. While IHS officials from all nine area offices GAO interviewed said they reviewed facilities' scope of services and coordinated with tribes when doing so, none reported systematically reviewing the extent to which their facilities' services were meeting local health needs, such as by incorporating the results of community health assessments. Such assessments can involve the collection and assessment of data, as well as the input of local community members and leaders to identify and prioritize community needs. These assessments can be used by facilities to assess their resources and identify priorities for facility investment. While IHS has identified such assessments as a priority, the agency does not require federally operated facilities to conduct such assessments or require the area offices to use them as they review facilities' scope of services. To ensure that facilities are effectively managing their resources, IHS has a process to guide its review of facilities' proposed construction projects that cost at least $25,000. However, IHS does not have a similar process to guide its oversight of other key proposed expenditures, such as those involving the purchase of major medical equipment, the hiring of providers, or the expansion of services. Specifically, GAO found limitations and inconsistencies with respect to requiring a documented justification for proposed expenditures; documenting the review and approval of decisions; and conducting an impact assessment on patient access, cost, and quality of care. The limitations and inconsistencies that GAO found in IHS's oversight are driven by the lack of consistent oversight processes across the area offices. Without establishing a systematic oversight process to compare federally operated facilities' current services to population needs, and to guide the review of facilities' proposed expenditures, IHS cannot ensure that its facilities are identifying and investing in projects to meet the greatest community needs, and therefore that federal resources are being maximized to best serve the AI/AN population. IHS, an agency of the Department of Health and Human Services, provides care to AI/AN populations through a system of federally operated and tribally operated health care facilities. AI/AN have experienced long standing problems accessing needed health care services. GAO has previously reported that IHS has not been able to pay for all eligible health care services; however, the resources available to federally operated facilities have recently grown. This report assesses IHS oversight of federal health care facilities' decision-making about the use of funds. GAO reviewed IHS policies and documents; and interviewed IHS officials from headquarters, nine area offices, and three federally operated facilities (two hospitals and one health clinic). GAO recommends that IHS develop processes to guide area offices in (1) systematically assessing how federally operated facilities will effectively meet the needs of their patient populations, and (2) reviewing federal facilities' spending proposals. HHS concurred with these recommendations. For more information, contact Jessica Farb at (202) 512-7114 or firstname.lastname@example.org.[Read More…]
- Appeals Court Upholds 27 Month Prison Sentence Of Former Penn National Horse TrainerBy Sam NewsJanuary 15, 2021The U.S. Attorney’s Office for the Middle District of Pennsylvania announced that on Jan. 11, 2021, the U.S. Court of Appeals for the Third Circuit affirmed both the conviction and 27-month prison sentence of Murray Rojas, age, 54, of Grantville, Pennsylvania. That sentence was imposed by Senior U.S. District Court Judge Sylvia H. Rambo on May 6, 2019, after Rojas was convicted by a jury on multiple counts of causing prescription animal drugs to become misbranded in violation of the Federal Food, Drug, and Cosmetic Act (FDCA), as well as conspiracy to commit misbranding.[Read More…]
- Remarks by Assistant Attorney General Eric Dreiband on the Announcement of Olmstead Settlement with the State of North DakotaBy Sam NewsDecember 14, 2020Good afternoon and thank you for joining us. Today, we are pleased to announce that the Department of Justice and the State of North Dakota have reached a comprehensive settlement agreement to ensure compliance with the Americans with Disabilities Act. The agreement commits North Dakota to expand services for individuals with disabilities so, when appropriate, they will be able to choose to remain in their own homes, near family and friends, while receiving the services they need, instead of entering or remaining in nursing facilities to receive care.[Read More…]
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- COVID-19: Federal Efforts Could Be Strengthened by Timely and Concerted ActionsBy Sam NewsSeptember 21, 2020In the government’s ongoing response to the COVID-19 pandemic, the Congress and the administration have taken action on multiple fronts to address challenges that have contributed to catastrophic loss of life and profound economic disruption. These actions have helped direct much-needed federal assistance to support many aspects of public life, including local public health systems and private-sector businesses. However, the nation faces continued public health risks and economic difficulties for the foreseeable future. Among other challenges, the public health system, already strained from months of responding to COVID-19 cases, will face the additional task of managing the upcoming flu season. At the same time, many of the federal, state, and local agencies responsible for responding to the ongoing public health emergency are called on to prepare for and respond to the current hurricane season. Timely and concerted federal leadership will be required in responding to these and other challenges. GAO has identified lessons learned and issues in need of continued attention by the Congress and the administration, including the need to collect reliable data that can drive decision-making; to establish mechanisms for accountability and transparency; and to protect against ongoing cyber threats to patient information, intellectual property, public health data, and intelligence. Attention to these issues can help to make federal efforts as effective as possible. GAO has also identified a number of opportunities to help the federal government prepare for the months ahead while improving the ongoing federal response: Medical Supply Chain The Department of Health and Human Services (HHS) and the Federal Emergency Management Agency (FEMA), with support from the Department of Defense (DOD), have taken numerous, significant efforts to mitigate supply shortages and expand the medical supply chain. For example, the agencies have coordinated to deliver supplies directly to nursing homes and used Defense Production Act authorities to increase the domestic production of supplies. However, shortages of certain types of personal protective equipment and testing supplies remain due to a supply chain with limited domestic production and high global demand. The Food and Drug Administration (FDA) and FEMA have both identified shortages, and officials from seven of the eight states GAO interviewed in July and August 2020 identified previous or ongoing shortages of testing supplies, including swabs, reagents, tubes, pipettes, and transport media. Testing supply shortages have contributed to delays in turnaround times for testing results. Delays in processing test results have multiple serious consequences, including delays in isolating those who test positive and tracing their contacts in a timely manner, which can in turn exacerbate outbreaks by allowing the virus to spread undetected. In addition, states and other nonfederal entities have experienced challenges tracking supply requests made through the federal government and planning for future needs. GAO is making the following recommendations: HHS, in coordination with FEMA, should immediately document roles and responsibilities for supply chain management functions transitioning to HHS, including continued support from other federal partners, to ensure sufficient resources exist to sustain and make the necessary progress in stabilizing the supply chain. HHS, in coordination with FEMA, should further develop and communicate to stakeholders plans outlining specific actions the federal government will take to help mitigate supply chain shortages for the remainder of the pandemic. HHS and FEMA—working with relevant stakeholders—should devise interim solutions, such as systems and guidance and dissemination of best practices, to help states enhance their ability to track the status of supply requests and plan for supply needs for the remainder of the COVID-19 pandemic response. HHS and the Department of Homeland Security (DHS) objected to GAO’s initial draft recommendations. GAO made revisions based on their comments. GAO maintains that implementation of its modified recommendations is both warranted and prudent. These actions could contribute to ensuring a more effective response by helping to mitigate challenges with the stability of the medical supply chain and the ability of nonfederal partners to track, plan, and budget for ongoing medical supply needs. Vaccines and Therapeutics Multiple federal agencies continue to support the development and manufacturing of vaccines and therapeutics to prevent and treat COVID-19. These efforts are aimed at accelerating the traditional timeline to create a vaccine (see figure). Traditional Timeline for Development and Creation of a Vaccine Note: See figure 5 in the report. As these efforts proceed, clarity on the federal government’s plans for distributing and administering vaccine, as well as timely, clear, and consistent communication to stakeholders and the public about those plans, is essential. DOD is supporting HHS in developing plans for nationwide distribution and administration of a vaccine. In September 2020, HHS indicated that it will soon send a report to Congress outlining a distribution plan, but did not provide a specific date for doing so. GAO recommends that HHS, with support from DOD, establish a time frame for documenting and sharing a national plan for distributing and administering COVID-19 vaccine, and in developing such a plan ensure that it is consistent with best practices for project planning and scheduling and outlines an approach for how efforts will be coordinated across federal agencies and nonfederal entities. DOD partially concurred with the recommendation, clarifying that it is supporting HHS in developing plans for nationwide distribution and administration of vaccine. HHS neither agreed nor disagreed with the recommendation, but noted factors that complicate the publication of a plan. GAO maintains that a time frame is necessary so all relevant stakeholders will be best positioned to begin their planning.On September 16, 2020, HHS and DOD released two documents outlining a strategy for any COVID-19 vaccine. GAO will evaluate these documents and report on them in future work.GAO will also continue to conduct related work, including examining federal efforts to accelerate the development and manufacturing of COVID-19 vaccines and therapeutics. COVID-19 Data Data collected by the Centers for Disease Control and Prevention (CDC) suggest a disproportionate burden of COVID-19 cases, hospitalizations, and deaths exists among racial and ethnic minority groups, but GAO identified gaps in these data. To help address these gaps, on July 22, 2020, CDC released a COVID-19 Response Health Equity Strategy. However, the strategy does not assess whether having the authority to require states and jurisdictions to report race and ethnicity information is necessary to ensure CDC can collect such data. CDC’s strategy also does not specify how it will involve key stakeholders, such as health care providers, laboratories, and state and jurisdictional health departments. GAO recommends that CDC (1) determine whether having the authority to require the reporting of race and ethnicity information for cases, hospitalizations, and deaths is necessary for ensuring more complete data, and if so, seek such authority from Congress; (2) involve key stakeholders to help ensure the complete and consistent collection of demographic data; and (3) take steps to help ensure its ability to comprehensively assess the long-term health outcomes of persons with COVID-19, including by race and ethnicity. HHS agreed with the recommendations. In addition, HHS’s data on COVID-19 in nursing homes do not capture the early months of the pandemic. HHS’s Centers for Medicare & Medicaid Services (CMS) began requiring nursing homes to report COVID-19 data to CDC by May 17, 2020, starting with information as of May 8, 2020, but made reporting prior to May 8, 2020 optional. By not requiring nursing homes to submit data from the first 4 months of 2020, HHS is limiting the usefulness of the data in helping to understand the effects of COVID-19 in nursing homes. GAO recommends that HHS, in consultation with CMS and CDC, develop a strategy to capture more complete data on COVID-19 cases and deaths in nursing homes retroactively back to January 1, 2020. HHS partially agreed with this recommendation by noting the value of having complete data, but expressed concern about the burden of collecting it. GAO maintains the importance of collecting these data to inform the government’s continued response and recovery, and HHS could ease the burden by incorporating data previously reported to CDC or to state or local public health offices. Economic Impact Payments The Department of the Treasury’s (Treasury) Internal Revenue Service (IRS) has issued economic impact payments (EIP) to all eligible individuals for whom IRS has the necessary information to do so; however, not everyone eligible was able to be initially identified. To help ensure all eligible recipients received their payments in a more timely manner, IRS took several actions to address challenges GAO reported on in June, including a policy change—reopening the Non-Filers tool registration period for federal benefit recipients and extending it through September 30—that should allow some eligible recipients to receive supplemental payments for qualifying children sooner than expected. However, Treasury and IRS lack updated information on how many eligible recipients have yet to receive these funds. The lack of such information could hinder outreach efforts and place potentially millions of individuals at risk of missing their payment. GAO recommends that Treasury, in coordination with IRS, (1) update and refine the estimate of eligible recipients who have yet to file for an EIP to help target outreach and communications efforts and (2) make estimates of eligible recipients who have yet to file for an EIP, and other relevant information, available to outreach partners to raise awareness about how and when to file for EIP. Treasury and IRS neither agreed nor disagreed with the recommendations and described actions they are taking in concert with the recommendations to notify around 9 million individuals who may be eligible for an EIP. Coronavirus Relief Fund The Coronavirus Relief Fund (CRF) is the largest program established in the four COVID-19 relief laws that provides aid to states, the District of Columbia, localities, tribal governments, and U.S. territories. Audits of entities that receive federal funds, including CRF payments, are critical to the federal government’s ability to help safeguard those funds. Auditors that conduct single audits follow guidance in the Single Audit Act’s Compliance Supplement, which the Office of Management and Budget (OMB) updates and issues annually in coordination with federal agencies. OMB issued the 2020 Compliance Supplement in August 2020, but the Compliance Supplement specified that OMB is still working with federal agencies to identify the needs for additional guidance for auditing new COVID-19-related programs, including the CRF payments, as well as existing programs with compliance requirement changes. According to OMB, an addendum on COVID-19-related programs, including the CRF payments, will be issued in the fall of 2020. Further delays in issuing this guidance could adversely affect auditors’ ability to issue consistent and timely reports. GAO recommends that OMB, in consultation with Treasury, issue the addendum to the 2020 Compliance Supplement as soon as possible to provide the necessary audit guidance, as many single audit efforts are underway. OMB neither agreed nor disagreed with the recommendation. Guidance for K-12 Schools State and local school district officials tasked with reassessing their operating status and ensuring their school buildings are safe are generally relying on guidance and recommendations from federal, state, and local public health and education officials. However, portions of CDC’s guidance on reopening K-12 schools are inconsistent, and some federal guidance appears misaligned with CDC’s risk-based approach on school operating status. Based on GAO’s review, Education has updated the information and CDC has begun to do so. GAO recommends that CDC ensure that, as it makes updates to its guidance related to schools’ operating status, the guidance is cogent, clear, and internally consistent. HHS agreed with the recommendation. Tracking Contract Obligations Federal agencies are tracking contract actions and associated obligations in response to COVID-19 using a National Interest Action (NIA) code in the Federal Procurement Data System-Next Generation. The COVID-19 NIA code was established in March 2020 and was recently extended until March 31, 2021, while a draft of this report recommending that DHS and DOD extend the code beyond September 30, 2020, was with the agencies for comment. GAO has identified inconsistencies in establishing and closing these codes following previous emergencies, and has continued concerns with the criteria that DHS and DOD rely on to determine whether to extend or close a code and whether the code meets long-term needs. GAO recommends that DHS and DOD make updates to the 2019 NIA Code Memorandum of Agreement so as to enhance visibility for federal agencies, the public, and Congress on contract actions and associated obligations related to disaster events, and to ensure the criteria for extending or closing the NIA code reflect government-wide needs for tracking contract actions in longer-term emergencies, such as a pandemic. DHS and DOD did not agree, but GAO maintains implementation of its recommendation is essential. Address Cybersecurity Weaknesses Since March 2020, malicious cyber actors have exploited COVID-19 to target organizations that make up the health care and public health critical infrastructure sector, including government entities, such as HHS. GAO has identified numerous cybersecurity weaknesses at multiple HHS component agencies, including CMS, CDC, and FDA, over the last 6 years, such as weaknesses in key safeguards to limit, prevent, and detect inappropriate access to computer resources. Additionally, GAO’s March 2019 high-risk update identified cybersecurity and safeguarding the systems supporting the nation’s critical infrastructure, such as health care, as high-risk areas. As of July 2020, CMS, FDA, and CDC had made significant progress by implementing 350 (about 81 percent) of the 434 recommendations GAO issued in previous reports to address these weaknesses. Based on the imminent cybersecurity threats, GAO recommends that HHS expedite implementation of GAO’s prior recommendations regarding cybersecurity weaknesses at its component agencies. HHS agreed with the recommendation. As of September 10, 2020, the U.S. had over 6.3 million cumulative reported cases of COVID-19 and over 177,000 reported deaths, according to federal agencies. The country also continues to experience serious economic repercussions and turmoil. Four relief laws, including the CARES Act, were enacted as of September 2020 to provide appropriations to address the public health and economic threats posed by COVID-19. As of July 31, 2020, the federal government had obligated a total of $1.6 trillion and expended $1.5 trillion of the COVID-19 relief funds as reported by federal agencies on USAspending.gov. The CARES Act includes a provision for GAO to report bimonthly on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This third report examines key actions the federal government has taken to address the COVID-19 pandemic and evolving lessons learned relevant to the nation’s response to pandemics. GAO reviewed data, documents, and guidance from federal agencies about their activities and interviewed federal and state officials, as well as industry representatives. GAO is making 16 new recommendations for agencies that are detailed in this Highlights and in the report. For more information, contact A. Nicole Clowers at (202) 512-7114 or email@example.com.[Read More…]
- Acting Attorney General Jeffrey A. Rosen Regarding the Overrunning of the U.S. Capitol BuildingBy Sam NewsJanuary 6, 2021Acting Attorney General Jeffrey A. Rosen issued the following statement: "The violence at our Nation’s Capitol Building is an intolerable attack on a fundamental institution of our democracy. From the outset, the Department of Justice has been working in close coordination with the Capitol Police and federal partners from the Interior Department, the Department of Homeland Security, and the National Guard, as well as the Metropolitan Police and other local authorities. Earlier this afternoon, the Department of Justice sent hundreds of federal law enforcement officers and agents from the FBI, ATF, and the U.S. Marshals Service to assist the Capitol Police in addressing this unacceptable situation, and we intend to enforce the laws of our land."[Read More…]
- Fiscal Year 2022 Performance PlanBy Sam NewsMay 28, 2021This report presents the Government Accountability Office's (GAO) Performance Plan for Fiscal Year 2022. In the spirit of the Government Performance and Results Act, this annual plan informs the Congress and the American people about what we expect to accomplish on their behalf in the coming fiscal year. It sets forth our plan to make progress toward achieving our strategic goals for serving the Congress and the American people. This framework not only shows the relationship between our strategic goals and strategic objectives, but also show major themes that could potentially affect our work.[Read More…]
- Colorado Businessman Indicted for Employment Tax FraudBy Sam NewsApril 21, 2021A federal grand jury in Denver, Colorado, returned an indictment charging a Bow Mar, Colorado, businessman with tax evasion, failing to pay over employment taxes, and failing to file tax returns.[Read More…]
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- Medicaid: Data Completeness and Accuracy Have Improved, Though Not All Standards Have Been MetBy Sam NewsJanuary 14, 2021GAO found that the completeness and accuracy of Transformed Medicaid Statistical Information System (T-MSIS) data have improved. Over the past decade, the Centers for Medicare & Medicaid Services (CMS) has been implementing T-MSIS, which is the agency's initiative to improve state-reported data available for overseeing Medicaid. CMS's assessment of two key T-MSIS data sources reflect these improvements. I. Priority items. Priority items are areas of data CMS identified as critical for program oversight, such as beneficiary eligibility and managed care. CMS's assessment of states' data submissions for the first 12 priority items identified significant improvement in meeting CMS data standards over a 22-month period. CMS's assessments of additional priority items similarly indicate improved completeness and accuracy. Improvements in the Number of States Meeting CMS Standards for Transformed Medicaid Statistical Information System Priority Items One through 12 Number of priority items that met standards Number of states as of October 2018 Number of states as of August 2020 10 or more 6 41 7 to 9 26 10 6 or less 18 0 Source: GAO analysis of the Centers for Medicare & Medicaid Services (CMS) priority item data. │ GAO-21-196 Note: CMS assessed data from all 50 states and the District of Columbia. CMS excluded Wisconsin from its October 2018 assessment, because the state had not submitted sufficient data. II. Analytic files. Analytic files are publicly available, research-ready T-MSIS data. GAO's review of CMS's assessments found that all states submitted some data for 67 of the 69 topics relevant to their Medicaid programs. This is an improvement from what GAO found in 2017, when none of the six states reviewed submitted all T-MSIS data applicable to their programs. GAO also found that states' data for 52 of the 69 topics were acceptable—meaning that CMS determined most states' data did not have significant problems that would affect their usability. While CMS's assessments of priority item and analytic file data indicate improvement in the completeness and accuracy of T-MSIS data, GAO also found that these assessments highlight areas where data do not meet the agency's standards. For example, 30 states did not submit acceptable data for inpatient managed care encounters. Accurate encounter data are critical to ensuring that Medicaid managed care beneficiaries obtain covered services and that payments to managed care organizations are appropriate. GAO has made at least 13 recommendations related to improving T-MSIS data and expediting their use for program oversight. CMS has addressed five of these recommendations, and has not fully addressed eight—including recommendations to improve data for overseeing payments to providers and managed care organizations. Implementing these recommendations would help CMS strengthen program oversight through improved T-MSIS data. Since adding Medicaid to its High Risk List in 2003, GAO has identified multiple limitations in program data affecting CMS's ability to ensure beneficiaries' access to care and proper payments to health care providers. CMS intends T-MSIS be a national repository of data to manage and oversee Medicaid, which served approximately 77 million individuals at an estimated cost of $673 billion in fiscal year 2020. Prior GAO work found issues with the completeness and accuracy of T-MSIS data and recommended that CMS expedite efforts to improve T-MSIS data and to use them for program oversight. CMS has taken steps to improve T-MSIS data and has made some T-MSIS data publicly available. Yet, questions remain about the usability of T-MSIS data for program oversight. Under the Comptroller General's authority, GAO initiated this review to examine what is known about the completeness and accuracy of T-MSIS data. GAO reviewed CMS's assessments of two T-MSIS data sources: (1) states' submissions of T-MSIS priority items; and (2) the 2016 T-MSIS analytic files, which was the most recent analytic file data available when GAO began this work. GAO also reviewed CMS documents, prior GAO reports, and reports published by others examining T-MSIS data. GAO interviewed officials from CMS and seven states selected based on variation in their progress submitting complete and accurate priority item data, among other factors. The Department of Health and Human Services provided technical comments on a draft of this report, which GAO incorporated. For more information, contact Carolyn L. Yocom at (202) 512-7114 or firstname.lastname@example.org.[Read More…]