GAO

Veterans Health Care: Improvements Needed in Patient Tracking for Non-Biological Implantable Medical Devices

What GAO Found Multiple Veterans Health Administration (VHA) offices are involved in overseeing implantable medical devices received by veterans. VHA's National Center for Patient Safety, the lead office for patient safety issues, is responsible for monitoring device safety issues. This office evaluates patient risk when safety issues are identified and collaborates with VHA's clinical program offices to develop VHA's response. National program offices for clinical specialties such as the National Cardiac Device Surveillance Program and the National Surgery Office are also responsible for overseeing cardiac electronic and orthopedic devices, respectively. GAO found that VHA is unable to ensure that all non-biological implantable medical devices are tracked to individual patients. Such tracking is important so that when a safety issue occurs VHA can ensure patients are notified and receive appropriate care. For the two clinical specialties reviewed, the National Cardiac Surveillance Program was able to effectively track cardiac electronic devices to individual patients, but the National Surgery Office was not able to effectively do so for orthopedic devices. VHA policy requires tracking outside the medical record for cardiac devices but does not require it for orthopedic devices. Accordingly, this gap adversely affects VHA's ability to ensure such tracking is occurring. Example of Knee and Hip Replacement Implantable Medical Devices GAO also found VHA has not fully assessed, across all specialties, its ability to ensure that non-biological implantable medical devices can be effectively tracked to individual patients. Officials with the National Center for Patient Safety and others have recognized the need to develop better tracking capabilities across VHA. An assessment of VHA's ability to track all non-biological implantable medical devices across all clinical specialties could help the agency target and prioritize the most critical devices. This would help ensure these patients receive appropriate care in the event of safety issues. Why GAO Did This Study VHA provided health care to over 6 million veterans in fiscal year 2022. Such care can include receiving an implantable medical device. The approximately 226,000 implants provided each year by VHA include biological implants made from body tissues, such as skin grafts, or non-biological implants made from materials such as plastic or metal. Examples of the latter include pacemakers and hip replacements. The James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 includes a provision for GAO to study VHA's oversight of implantable medical devices. This report (1) describes VHA offices that oversee implantable medical devices; (2) describes VHA's monitoring of implant safety issues; and (3) examines how VHA ensures tracking of non-biological implants to individual patients. GAO reviewed policies, data, safety reports, and other information on non-biological implants with a focus on certain cardiology and orthopedic implants. GAO interviewed officials from VHA and four VA medical centers (and their regional management), selected based on factors such as the volume of cardiology and orthopedic implants, facility size, and location.

Categories -

Bureau of Indian Education: Improved Oversight of Schools' COVID-19 Spending is Needed

What GAO Found The Bureau of Indian Education (BIE) and its schools used federal COVID-19 relief funds mainly to support distance learning and prevent the spread of COVID-19 in schools. For example, BIE spent nearly $60 million of its COVID funds on IT and broadband supports for schools, including student laptops and Wi-Fi equipment for distance learning. Similarly, nearly all of the 70 BIE schools that responded to GAO's survey reported prioritizing their COVID funds for laptops and tablets and for personal protective equipment, cleaning supplies, and COVID tests. Schools generally reported that BIE offered regular guidance and support for spending COVID funds. BIE uses several processes to monitor schools' COVID spending, including reviewing schools' single audit reports, overseeing schools at high risk of financial mismanagement, and monitoring schools' purchase card use for fraud and misuse. However, GAO found that due to insufficient controls, BIE staff did not consistently follow these processes, which limited accountability for use of COVID funds. For example, a little over a quarter of required fiscal year 2021 single audit reports for schools and Tribes that received BIE grant funds were late or not submitted as of November 2023. But BIE did not follow agency standard procedures for applying or increasing financial conditions for 19 of the 28 grantees that failed to submit a timely single audit report that year. Without timely single audit reports, BIE lacks vital information for overseeing schools' financial management. Further, BIE did not conduct sufficient oversight of high-risk schools' COVID spending and lacked the staff capacity to complete all required monitoring. Such oversight is critical for helping schools correct errors and avoid them in the future. Finally, GAO found that for BIE-operated schools, nearly half of COVID fund spending with purchase cards between March 2020 and August 2022 involved elevated risk transactions according to agency data (see figure). Examples of elevated risk transactions include the purchase of gift cards or multiple purchases at the same merchant within a certain number of days that total more than the single purchase limit. However, BIE did not provide evidence that it had investigated these transactions for fraud or misuse. Bureau of Indian Education Schools' COVID Fund Spending with Purchase Cards, March 2020 to August 2022 In addition, GAO found that BIE staff did not consistently use the required tool or procedures for tracking and investigating suspicious transactions. Without addressing these gaps in its oversight of schools' COVID spending, BIE cannot ensure that schools will use remaining COVID funds appropriately to provide students the support they need. Why GAO Did This Study Many of BIE's 183 schools are located in remote tribal lands that faced extraordinary challenges during the COVID-19 pandemic and continue to experience ongoing effects. Congress appropriated about $1.5 billion to help BIE and its schools respond to the pandemic. GAO reviewed the use of COVID-19 relief funds by schools and BIE as part of GAO's responsibilities under the CARES Act. This report examines how BIE and schools spent their COVID funds and BIE's guidance to schools on fund use, and the extent to which BIE oversees schools' fund use. GAO surveyed a generalizable sample of 85 BIE schools, with 70 schools responding, to collect information on their use of COVID funds and the extent to which BIE provided them guidance on spending. GAO also analyzed agency data on BIE schools' purchase card activity; reviewed relevant federal statutes, regulations, and agency policies and procedures for overseeing school COVID spending; and interviewed BIE and school officials.

Categories -

Maternal and Infant Health: HHS Should Strengthen Processes for Measuring Program Performance

What GAO Found The U.S. has the highest rates of maternal and infant death of developed, high-income countries. The Healthy Start program, administered by the Department of Health and Human Services (HHS), has three goals: reduce rates of infant death, improve maternal health outcomes, and reduce racial and ethnic disparities. HHS funded 101 Healthy Start grantees—e.g., health departments and not-for-profit organizations—in the 2019-2024 grant period. In 2022, grantees served nearly 85,000 participants, including pregnant women, partners, and children. Slightly more than half of participants were Black or African American. Grantees are expected to provide one-on-one consultation and health and parenting education classes, as well as connect participants with medical services. Percentage of Healthy Start Participants by Race in 2022 Note: “Other” includes Asian, Native Hawaiian or other Pacific Islander, and multiple races. HHS uses performance data to assess progress toward the first two of Healthy Start's three goals. It has plans to begin stratifying these data by race and ethnicity in 2024 to assess progress toward the third goal: reducing racial and ethnic disparities. HHS is also conducting an evaluation, to be completed in 2025, to assess program progress toward all three goals. Healthy Start data to measure program performance—known as performance measures—align with most GAO-identified key attributes of effective measures. However, the measures do not align with two attributes related to clarity and reliability. For example, HHS's updates to the measures during the 2019-2024 grant period made it challenging for grantees to collect consistent and therefore reliable data. This occurred because HHS lacks a documented process to review its performance measures before implementation. Such a process would help ensure HHS is using measures that are clear and allow for the collection of reliable data. Also, HHS officials said they try to align performance measures across Healthy Start and two related programs. However, HHS lacks a documented process to coordinate the selection of measures used across the programs, and officials could not provide examples of coordination. Implementing a documented process could help ensure that HHS is using the most appropriate measures. Ultimately, this could help HHS gather the best evidence across the programs as they pursue the shared goal of improving health outcomes for mothers and infants. Why GAO Did This Study The Healthy Start program awards funding to organizations in areas with high rates of infant death and other adverse maternal and infant health outcomes. In fiscal year 2022, the Healthy Start program received $131 million in appropriations. The CARES Act included a provision for GAO to review and assess Healthy Start. This report: describes Healthy Start grantees and participants served, examines HHS's efforts to assess progress towards Healthy Start goals, examines the extent to which Healthy Start performance measures meet key attributes of effective measures, and examines HHS' efforts to align Healthy Start performance measures with those of related HHS programs. GAO analyzed Healthy Start and other HHS program documentation and data for the most recent grant period (April 2019–March 2024) and the upcoming period (beginning April 2024), including performance measure information. GAO also interviewed HHS officials and six Healthy Start grantees, selected to vary by factors such as geography and years as a grantee.

Categories -

Space Acquisitions: Analysis of Two DOD Reports to Congress

What GAO Found The Department of Defense (DOD) makes significant investments in space capabilities to meet the nation’s security, economic, and logistical needs. DOD’s space programs—now led by the U.S. Space Force—continue to face many development challenges, which GAO has reported on for several decades. DOD has made various changes to policies that govern its acquisitions. In one such change in January 2020, DOD reissued its foundational acquisition policy, establishing the Adaptive Acquisition Framework, which emphasizes speed and agility in the acquisition process. In response to statutory mandates, the Department of the Air Force (DAF), under which the Space Force is organized, and DOD each released a report that addressed elements to improve DOD space acquisition programs. In May 2020, the DAF transmitted its report on an alternative acquisition system for the Space Force to congressional committees. The report described nine features of the DAF’s proposed space-specific acquisition system, several of which DOD subsequently implemented. In September 2022, DOD published its final report on applying the Adaptive Acquisition Framework to space systems acquisitions and addressed eight required areas of focus. A Falcon 9 Rocket Launches a Satellite from the Space Cape Canaveral Space Force Station Collectively, the acquisition system elements addressed in the reports were aimed at improving the acquisition process for space programs and fell into three categories: acquisitions, budgeting, and requirements. Summary of Proposed Acquisition System Elements in Department of the Air Force Report and DOD Report, by Category Acquisitions Budgeting Requirements Milestone decision authority delegation Separate Space Force budget Modified joint capabilities integration and development system approach New start letter notification proposals Line-Item restructure — List of programs for alternative space acquisition pathways Codification of efficient space procurement — New space acquisition pathway — — Useable end item determination — — Space Force Head of Contracting Activity — — Legend:  — = not applicable Source: GAO analysis of Department of the Air Force and Department of Defense (DOD) information. | GAO-24-106984 GAO found that some of the elements discussed in the two reports align with GAO’s prior findings and recommendations, although the DAF and DOD are no longer pursuing other elements. For example, both reports proposed a new space acquisition pathway to help better manage space acquisition efforts. While GAO has not commented specifically on a space pathway under the Adaptive Acquisition Framework, GAO has noted challenges with developing and acquiring space systems. For instance, in GAO-21-520T, GAO noted that specific characteristics of space programs, such as the cost and complexity of space systems, can cause complications in the acquisition process and have posed challenges to DOD, including schedule delays and cost increases, among others. However, according to DOD officials, the department is no longer pursuing such a pathway because it is not needed due to changes in the way DOD is planning to acquire future space capabilities. As DOD develops the Space Force, it has the opportunity to leverage prior GAO recommendations to strengthen Space Force acquisitions. Why GAO Did This Study The DAF and DOD each produced a report on space acquisition processes. House Report 116-442 and the National Defense Authorization Act for Fiscal Year 2021 include provisions for GAO to review those reports. GAO assessed how elements included in the DAF and DOD reports align with GAO’s prior work and address identified challenges to acquiring space systems. To conduct this work, GAO reviewed and analyzed the reports and compared them to its relevant work on leading practices in acquisitions, weapon system acquisitions, and other related topics. GAO reviewed supporting documentation and interviewed DOD officials. GAO also summarized and updated work previously briefed to congressional committees in 2020 and 2021. For more information, contact Jon Ludwigson at (202) 512-4841 or ludwigsonj@gao.gov.

Categories -

Military Readiness: Comprehensive Approach Needed to Address Service Member Fatigue and Manage Related Efforts

What GAO Found Many service members are not getting the Department of Defense (DOD) recommended 7 or more hours of sleep each day. The department's overarching fatigue-related guidance emphasizes service members obtain at least 7 hours of sleep for optimal performance and readiness. For over a decade, DOD surveys have found that the majority of service members report sleeping 6 or fewer hours per night. Respondents to GAO's nongeneralizable survey cited similar issues. For example, many respondents are sleeping too little, and roughly half of respondents have poor sleep quality regardless of quantity. Survey respondents provided examples of how sleep deprivation has affected their work, from nearly colliding with another aircraft to falling asleep on the job. Service Members on How Sleep Deprivation Has Affected Their Work DOD and the services have taken steps to address fatigue-related issues, such as developing guidance on fatigue management, but DOD faces oversight and enterprise-wide collaboration challenges in managing fatigue. Oversight structure limitations. DOD has not identified and delegated sufficient oversight authority at the department level, and the military services have not assigned leadership to oversee service-level efforts. Without an assessment of DOD's oversight structure and assigning DOD and service-level leadership, DOD will be hindered in its efforts to limit and manage fatigue across the department. Fragmented fatigue-related research. GAO identified nearly 130 fatigue-related research projects the Army, Navy, Marine Corps, and Air Force conducted from 2017 to 2023. Forty-eight of these projects studied the use of wearable devices to track sleep data among other uses, with many of them using the same type of technology or even the same model. Establishing a list of all fatigue-related research will help DOD gain visibility and reduce any fragmentation that may exist, potentially leading to cost savings. Wearable Device Use Across Services for Fatigue-Related Research, 2017—2023 Why GAO Did This Study Fatigue caused by inadequate sleep can negatively affect a service member's performance and has contributed to accidents resulting in deaths and hundreds of millions of dollars in damage to ships, vehicles, and aircraft. DOD recognizes that impairment from fatigue can be equivalent to the effects of alcohol intoxication and significantly increases the risk of physical injury. House Report 117-118, which accompanied a bill for the National Defense Authorization Act for Fiscal Year 2022, includes a provision for GAO to review DOD's efforts to limit sleep deprivation and manage fatigue across the military services. Among other things, this report assesses the extent to which (1) service members are getting adequate sleep and (2) DOD has addressed and managed service member fatigue. GAO analyzed fatigue-related policies and guidance; interviewed cognizant officials; and surveyed service members from selected occupations, including pilots, aviation maintenance personnel, missileers, and motor vehicle operators.

Categories -

Improper Payments: Information on Agencies' Fiscal Year 2023 Estimates

What GAO Found For fiscal year 2023, 14 agencies reported a total estimated $236 billion in improper payments across 71 programs. Agencies reported that about $175 billion (over 74 percent) of this total was the result of overpayments. About $186 billion (approximately 79 percent) was concentrated in five program areas. However, the $236 billion total does not include certain programs that agencies have determined are susceptible to significant improper payments, such as the Department of Health and Human Services' Temporary Assistance for Needy Families. The Department of Housing and Urban Development also did not report improper payment estimates for the Office of Public and Indian Housing's Tenant Based Rental Assistance program and the Office of Multifamily Housing's Project-Based Rental Assistance program. As a result, the government-wide estimate potentially does not represent the full extent of improper payments. Programs Reporting the Largest Percentage of Government-Wide Improper Payments Estimates for Fiscal Year 2023 Agencies reported about $11 billion less in improper payments in fiscal year 2023 than they did the prior fiscal year. Those agencies that reported substantial decreases attributed the declines to factors such as terminating certain programs, implementing mitigation strategies, and suspending eligibility determinations for Medicaid during COVID-19. The Payment Integrity Information Act of 2019 (PIIA) and Office of Management and Budget (OMB) M-21-19 include criteria that executive branch agencies must comply with in assessing risk and estimating and reporting improper payments. In fiscal year 2022, 14 of the 24 Chief Financial Officers Act agencies fully complied with PIIA criteria and related OMB requirements, according to their inspectors general (IG). This was an increase from fiscal year 2021, when 10 agencies were reported compliant. IGs identified various causes for agencies' noncompliance with these criteria, such as inadequate risk assessments and unreliable estimates. Why GAO Did This Study Improper payments—those that should not have been made or were made in the incorrect amount—have consistently been a government-wide issue. Since fiscal year 2003, cumulative improper payment estimates by executive branch agencies have totaled about $2.7 trillion. Reducing improper payments is critical to safeguarding federal funds. GAO has reported on improper payments in its audit reports on the U.S. government's consolidated financial statements since fiscal year 1997. GAO has found that these payments represent a material deficiency or weakness in internal controls. Specifically, GAO has noted that the federal government is unable to determine the full extent of its improper payments or to reasonably assure that appropriate actions are taken to reduce them. House Report 117-389, which accompanied the Legislative Branch Appropriations Act, 2023, includes a provision for GAO to provide quarterly reports on improper payments. This is GAO's fifth such report, and it provides an overview of federal agencies' reported improper payment estimates for fiscal year 2023. Additionally, this report discusses agencies' compliance with legal requirements for reporting and managing improper payments. For more information, contact M. Hannah Padilla at (202) 512-5683 or padillah@gao.gov.

Categories -

Science & Tech Spotlight: At-Home Tools to Diagnose Alzheimer's, Parkinson's, and Related Diseases

Why This Matters Neurodegenerative diseases such as Alzheimer’s and Parkinson’s can make day-to-day tasks challenging because they may affect cognitive, motor, and social function. Neurodegenerative diseases affect about 7 million people in the U.S. Researchers expect cases to increase as the population ages. Earlier detection of these diseases may help health care providers treat patients before the onset of severe symptoms and slow disease progression. Key Takeaways At-home tools may facilitate earlier detection of neurodegenerative diseases. These tools can be a cost-effective way to collect information that is difficult to gather in a clinical setting. Health care providers can use information from at-home tools to help diagnose neurodegenerative disease, but such tools are not a replacement for clinical care. The Technology What is it? At-home tools collect and analyze patient data on certain indicators that relate to cognitive ability—memory, reasoning, and language—and motor function. This includes walking, writing, stability, and the presence of tremors. Tools such as digital cognitive assessments and wearable sensors have the potential to help health care providers detect and diagnose neurodegenerative diseases earlier and more accurately. The tools help assess patients in an environment more reflective of daily life, detect indicators that are challenging to observe in a clinical setting, and collect data on patients’ health over time. Traditional diagnostic approaches—which occur in a clinical setting such as a physician’s office—can be more invasive, less convenient, and may not identify these symptoms until the disease is more advanced. Figure 1: Patient and health care provider use of at-home tools How does it work? Digital cognitive assessments use web- or application-based technologies to gather data on a patient’s cognitive abilities. For example, one activity asks patients to memorize objects and their position in a pictured room. Wearable sensors worn on or near the body measure a range of indicators. Sensors on the hands, wrists, or ankles can collect data on the speed and direction of movements—such as hand tremors, sway, or postural adjustments—that may be indicative of neurodegenerative disease. Smartphones equipped with movement sensors can collect similar data when worn near the body. Researchers found that smartphone sensors can identify whether a person exhibits symptoms associated with Parkinson’s disease based on the way they move. How mature is it? Multiple manufacturers of digital cognitive assessments—which could be administered at-home—have registered with the Food and Drug Administration. However, such at-home assessments are not widely commercially available, and more research is needed on their accuracy. Wearable sensors vary in their maturity and use. Specifically, sensors worn on the body are an established tool to assess mobility. Researchers call for further studies to investigate the accuracy of smartphone-based sensors prior to applying them more broadly in diagnosis. Opportunities Provide data to support early diagnosis. Providers can use data from at-home tools to inform earlier or more appropriate interventions to slow cognitive decline and improve symptom management. As technologies mature, patients could also potentially use insights from at-home tools to decide whether they need to consult a provider. Reduce time and cost. At-home tools can be a practical and cost-effective way to reduce the number of clinic visits in the early stages of a disease when symptoms are still ambiguous. Because the tools can be used remotely, patients can reduce travel time and cost, especially if they live far from a clinic or have limited mobility. Provide easier access to diagnosis. At-home tools could help improve access to diagnostic information if they are self-administered, which can be particularly helpful in instances where a patient has health care access issues. Challenges Limited testing. Some tools were designed for use at the clinic and researchers have conducted limited testing for at-home use. For example, quality control testing of at-home digital cognitive assessments lags behind those delivered in a clinical setting, but testing is critical to understand a tool’s reliability. Digital divide. At-home tools may be less useful and less widely adopted if patients do not understand how they work or do not have devices to access them. This challenge could contribute to disparities in diagnosis. Data privacy and security. Data could be sold, shared without consent, or accessed via data breaches, although data covered by the Health Insurance Portability and Accountability Act of 1996 are provided some additional safeguards. Policy Context and Questions What are the possible policy implications for existing federal programs such as Medicare, Medicaid, and Social Security Insurance? What strategies, if any, might help enhance the benefits and use of at-home tools? What oversight or resources could help ensure the tools do not exacerbate health disparities and the digital divide? What safeguards could protect data privacy and security? Selected GAO Work Science & Tech Spotlight: Wearables, GAO-24-107303 Technology Assessment: Artificial Intelligence in Health Care, GAO-22-104629 Selected References Ohman et al., “Current Advances in Digital Cognitive Assessment for Preclinical Alzheimer’s Disease,”Alzheimer’s and Dementia Diagnosis,Assessment and Disease Monitoring, (2021) doi: 10.1002/dad2.12217. Adams et al., “Digital Technology in Movement Disorders: Updates, Applications, and Challenges,”Current Neurology and Neuroscience Reports,vol. 21, no. 4(2021). For more information, contact Karen L. Howard, PhD at (202) 512-6888 or howardk@gao.gov.

Categories -

Clinical Research: FDA Should Evaluate Its Efforts to Recruit and Retain Its Inspection Workforce

What GAO Found The Food and Drug Administration (FDA) conducts inspections to, among other things, help ensure the quality and integrity of clinical research used to support drugs seeking marketing approval in the U.S. FDA's clinical research inspections peaked in fiscal year 2017 but have since declined. FDA officials attributed this decrease to the COVID-19 pandemic and not having enough investigators. Number of FDA Clinical Research Inspections Related to Drugs, Fiscal Year 2014 through March 1, 2023 From fiscal years 2012 through 2020, FDA classified 3 percent of clinical research inspections as having serious deficiencies that would warrant regulatory actions. Investigators GAO spoke with were frustrated that problems they identified (e.g., failure to follow research protocols) did not result in more serious classifications. FDA is limited in its ability to cite serious deficiencies for a common type of study supporting generic drugs. Specifically, the regulations for these studies do not include certain requirements for basic study conduct, such as record retention and following study protocols. FDA has started the process of revising these regulations. Having effective requirements will be important to help ensure high-quality research. FDA has faced challenges recruiting and retaining investigators, resulting in fewer inspections and a less experienced workforce. For example, FDA was unable to complete about 30 percent of one type of common inspection within the requested time frames from fiscal year 2018 through July 2023, according to agency information. FDA officials and the investigators GAO spoke with identified low compensation and high amounts of travel as contributing to these challenges. FDA has taken steps to increase recruitment and retain investigators, such as increased compensation and student loan repayment. The agency recently made progress recruiting new investigators, but attrition has been a persistent problem and it can take new investigators up to a year to independently conduct inspections. Although FDA made progress, the agency has not formally evaluated its efforts to determine their effectiveness. Such an evaluation could help FDA determine whether it is using the most appropriate tools to maintain its workforce. GAO has cited workforce as a concern across multiple FDA programs and sustained attention in this area will be critical. Why GAO Did This Study Clinical research—clinical trials and other studies involving human subjects—for drugs seeking FDA approval can occur in the U.S. or overseas. During inspections, FDA goes on-site, such as to hospitals or other health care settings, to examine research protocols and records as well as the entity and facility involved in the research. Challenges in other FDA inspection programs contributed to GAO placing FDA medical product oversight on its High-Risk List in 2009. GAO was asked to review FDA's inspections of clinical research. This report, among other objectives, describes inspections FDA conducted from fiscal years 2012 through 2023; describes the frequency with which FDA identified serious deficiencies during inspections; and examines FDA's efforts to maintain its investigator workforce. For this work, GAO examined FDA data and documents and interviewed FDA officials. GAO also interviewed 15 out of about 100 investigators, selected to represent diversity among the different investigator positions and tenure with FDA.

Categories -

Service Members Transitioning to Civilian Life: Agencies Can Improve Warm Handovers for Additional Assistance

What GAO Found To assist certain service members who may be at risk for a difficult transition from military to civilian life, the Department of Defense (DOD) provides them with a person-to-person connection, known as a “warm handover,” to other agencies. These other agencies include the Department of Veterans Affairs (VA) and the Department of Labor (DOL), which can help the service members obtain additional transition services. Through its Transition Assistance Program, DOD ensures these service members receive agency contact information, but does not ensure that a connection with a person actually occurs (see figure). DOD provided at least one warm handover to about 41,000 service members, according to available data from April 1, 2021, to March 31, 2023. However, during this same time period the agency did not provide a warm handover to over 4,300 other service members who were also considered at-risk of having a challenging transition. DOD officials said the agency has not analyzed the reasons why these service members did not receive a warm handover. Without developing a written plan to analyze its data, DOD cannot ensure that the thousands of service members transitioning annually have access to the additional assistance they need and the benefits they have earned. DOD's Warm Handover Process Does Not Ensure Service Members Connect with Agencies for Additional Assistance with Their Transition to Civilian Life Transition Assistance Program counselors and others told GAO that warm handovers could be helpful to some service members, but DOD has not assessed their helpfulness. DOD has recently worked with VA and DOL on pilot projects that will provide some additional information, but these efforts are expected to provide limited information on warm handovers, and other agency efforts to assess the Transition Assistance Program do not focus on warm handovers. Without a plan to assess the helpfulness of warm handovers, program officials may be missing opportunities to ensure they are meeting the needs of service members. Agencies generally collaborated effectively to implement pilot projects aimed at refining warm handovers, but they have not identified criteria to make decisions about scaling all of the piloted approaches. Without identifying specific criteria, these agencies risk not collecting data needed to decide whether and how to scale the piloted approaches to the broader Transition Assistance Program and warm handover processes. Why GAO Did This Study Hundreds of thousands of service members transition from military service to civilian life each year, and some can be at risk for unemployment, homelessness, or gaps in medical care. To help them succeed, DOD provides certain service members with a warm handover to other agencies and organizations for additional assistance. Senate report 117-130 includes a provision for GAO to review DOD's warm handover process. GAO's report addresses the extent to which DOD: (1) ensures that service members receive a warm handover as appropriate, (2) assesses information on the helpfulness of warm handovers, and (3) collaborates with VA and DOL in their efforts to refine the warm handover process. GAO analyzed DOD program data for April 1, 2021, to March 31, 2023, the most recent available. GAO also reviewed relevant federal laws, policies, and agency documents, and interviewed officials from relevant federal agencies and five military installations selected for diversity in numbers of transitioning service members, geographic location, and service branch.

Categories -

Vehicle Repair: Information on Evolving Vehicle Technologies and Consumer Choice

What GAO Found Right-to-repair is the ability of consumers to decide who repairs their products. For vehicles, this means consumers deciding whether to make their own repairs or take their vehicle to repair facilities at independent repair shops or dealerships franchised with automakers. Most automakers have been operating under a 2014 voluntary nationwide right-to-repair agreement. This agreement has generally resulted in independent repair shops not associated with vehicle manufacturers having access to the information, data, and tools needed for vehicle repairs. However, stakeholders GAO interviewed and a nongeneralizable review of complaints suggest that independent repair shops may face some limitations in that access. Advanced vehicle technologies, such as electric vehicles, may make repairs more expensive and complex because they require additional knowledge, equipment, and other investments. Such issues could particularly affect some independent repair shops, that are unable to make such commitments. In addition, according to some independent repair stakeholders GAO interviewed, the use of telematics systems to wirelessly transfer data between vehicles and automakers could give dealerships a competitive advantage over independent repair shops in conducting some repairs. However, industry and independent repair stakeholders GAO interviewed agreed that telematics data are not currently needed to conduct repairs. The Department of Transportation's National Highway Traffic Safety Administration (NHTSA) is focused on vehicle safety and its role in vehicle right-to-repair issues is limited to cybersecurity issues that could affect vehicle safety. The Federal Trade Commission (FTC) is involved in protecting consumers and promoting competition, including in the vehicle repair market. FTC is taking steps to better understand potential vehicle repair limitations by considering new ways to categorize and analyze potentially relevant consumer complaints. If independent repair shops face limitations in access to the information, data, and tools needed for repair or are otherwise disadvantaged compared to dealerships, consumers may have fewer repair choices, which may reduce competition and make repairs more expensive and inconvenient. Why GAO Did This Study GAO was asked to review the effects of changing vehicle technologies on vehicle right-to-repair. This report examines how changes in vehicle technologies are affecting competition and consumer choice in the vehicle repair market and NHTSA's and FTC's actions related to this issue. To conduct this work, GAO conducted a literature search and reviewed relevant publications, conducted a non-generalizable review of vehicle and vehicle repair complaints, and interviewed over 50 industry and consumer-focused stakeholders, including vehicle manufacturers, independent repair shops, and others. For more information, contact Elizabeth Repko at (202) 512-2834 or repkoe@gao.gov.

Categories -