prompt_front: You are given two reports by the government agency.



Question: Write a one-page summary of the report 1.

Report 1: The U S  Constitution does not clearly specify how military bases should be managed  Article II, Section 2, appoints the President as the commander-in-chief, with the implied power to deploy, and redeploy, the armed forces as necessary for national defense  In common practice, this has included the authority to create and close military installations needed to accommodate and train personnel under the President's command  However, Article I, Section 8, charges Congress with the responsibility to raise armies, maintain a Navy, and regulate the militia  Through annual authorization and appropriation legislation, Congress legislates policy for managing DOD real property assets and funds the construction, maintenance, operation, and disposal of military infrastructure  Throughout most of American history, the President has exercised broad, relatively unchallenged authority for opening, closing, or realigning military installations  Congress largely deferred to the Executive branch primarily because the President, as commander-in-chief, is empowered with the responsibility of deploying military forces  Prompted by large-scale closures of World War II era infrastructure during the 1960s and 1970s, Congress enacted legislation in 1977 that effectively limited the Executive branch's ability to close or realign major military installations  The new statute, later codified as 10 U S C  2687 (Section 612 of the Military Construction Authorization Act of 1978, P L  95-82 ), generally required DOD to conduct comprehensive and lengthy assessments of major basing decisions as part of a congressional report-and-wait process  These assessments could be challenged in court on environmental grounds or on questions related to their sufficiency, further lengthening delays  The new legislation effectively halted DOD's ability to close or realign domestic bases of significant size  In the decade that followed the passage of 10 U S C  2687, congressional pressure grew to accommodate DOD basing priorities  By 1988, ongoing negotiations between the Secretary of Defense and the House and Senate Armed Service Committees led to new legislation ( P L  100-526 ) that authorized a limited number of base closures based on the oversight of an independent panel  Though later modified, the effort marked the beginning of the first Base Realignment and Closure (BRAC) process, which was intended to insulate base closings from considerations such as favoritism or other political interference  Widely considered a success, the 1988 BRAC legislation was taken up again and modified in succeeding BRAC rounds; first in 1991, 1993, and 1995; and again in 2005  The modern BRAC process refers to a temporary authority that amends the Defense Base Closure and Realignment Act of 1990 ( P L  101-510 ), hereinafter referred to as the Base Closure Act , and features a framework of elements that entrusts an independent commission with certifying closure and realignment recommendations made by the Secretary of Defense  In general, the process has required the Secretary to submit a list of military installations recommended for closure or realignment to an independent, bipartisan BRAC commission  After analyzing the Secretary's recommendations, the commission may accept, reject, or modify the list  Upon completing its review, the commission forwards its final findings and recommendations to the President  Upon acceptance of commission's recommendations, the President then submits them to Congress  If the President does not submit the recommendations to Congress within the timeframe required under the Base Closure Act, the BRAC process is terminated  Upon receipt of the report from the President, Congress has the opportunity to disapprove of the recommendations in toto through the enactment of a joint resolution  The hallmarks of this framework include establishment of an independent commission whose members are appointed by the President, in consultation with congressional leadership (and the advice and consent of the Senate); reliance on objective and uniform criteria for evaluating basing recommendations; GAO review and certification of DOD data; deliberations that include open hearings, solicitation of feedback, installation visits, and data available for public review; requirement that the commission's final list of closure and realignment actions be accepted or rejected in its entirety; and presidential and congressional off-ramps that would terminate the BRAC process when certain conditions are not met  The timeline to complete an entire BRAC round has varied; however, the most recent one conducted in 2005 took approximately 10 years, from authorization to completion (end of the six-year BRAC implementation period)  Key milestones of a typical BRAC timeline include DOD force structure plan, infrastructure inventory, and analysis of options (up to four years); nomination and confirmation of BRAC commissioners; DOD submission of BRAC recommendations (and associated reports) to the commission; commission deliberations (typically four months); final report sent to the President for approval; 45-day deadline for Congress to reject recommendations in their entirety (Joint Resolution of Disapproval) or allow implementation to begin; DOD implementation (two years to begin; six years to complete); and DOD disposal of real property (indeterminate)  BRAC is often characterized as a cost efficiency measure that enables DOD to more effectively manage its real property assets by allowing it to shed excess infrastructure, but historically, potential costs and savings have been a consideration that have ranked below military value  No BRAC round has established cost savings targets, floors, or ceilings  During BRAC rounds in 1991, 1993, and 1995, Congress required the Secretary of Defense to develop and report a set of objective selection criteria that would be used for identifying bases for closure and realignment  For the 2005 round, Congress amended the BRAC statute to require the Secretary to regard military value (defined below) as the primary consideration  Other factors, such as potential costs and savings, were explicitly categorized as lower priority  Because the amended legislative language reflected longstanding DOD policy, the 2005 BRAC criteria appear almost identical when compared with previous versions, with additional language added for emphasis or included for explanatory examples  The excerpt below indicates the 2005 BRAC selection criteria  Emphasized text (in italics) represents new language not included as part of the 1995 criteria  SEC  2913  SELECTION CRITERIA FOR 2005 ROUND  (a) FINAL SELECTION CRITERIA —The final criteria to be used by the Secretary in making recommendations for the closure or realignment of military installations inside the United States under this part in 2005 shall be the military value and other criteria specified in subsections (b) and (c)  (b) MILITARY VALUE CRITERIA —The military value criteria are as follows: (1) The current and future mission capabilities and the impact on operational readiness of the total force of the Department of Defense, including the impact on joint warfighting, training, and readiness  (2) The availability and condition of land, facilities, and associated airspace (including training areas suitable for maneuver by ground, naval, or air forces throughout a diversity of climate and terrain areas and staging areas for the use of the Armed Forces in homeland defense missions) at both existing and potential receiving locations  (3) The ability to accommodate contingency, mobilization, surge, and future total force requirements at both existing and potential receiving locations to support operations and training  (4) The cost of operations and the manpower implications  (c)  OTHER CRITERIA —The other criteria that the Secretary shall use in making recommendations for the closure or realignment of military installations inside the United States under this part in 2005 are as follows: (1) The extent and timing of potential costs and savings, including the number of years, beginning with the date of completion of the closure or realignment, for the savings to exceed the costs  (2) The economic impact on existing communities in the vicinity of military installations  (3) The ability of the infrastructure of both the existing and potential receiving communities to support forces, missions, and personnel  (4) The environmental impact , including the impact of costs related to potential environ mental restoration, waste management, and environmental compliance activities  The transfer and disposal of DOD real property made available following the implementation of a BRAC round is a complex process that may extend for years beyond the initial six-year implementation window  Disposal may be delayed or otherwise affected by the participation of local and state communities and the degree to which environmental remediation by federal authorities is necessary  The graph below shows the total acreage from previous BRAC rounds yet to be disposed  The Base Closure Act authorizes a variety of conveyance mechanisms not otherwise available for the transfer and disposal of federal property, a process typically performed by the General Services Administration (GSA)  Under a BRAC, conveyance authority is delegated from GSA, through the Secretary of Defense to the various military departments, which receive special approval to supersede GSA regulations with BRAC specific regulations  The primary difference between the routine disposal of federal property and real property conveyed under a BRAC is the role of local communities  Under normal (non-BRAC) circumstances, the General Services Administration (GSA) is directly responsible for disposing of any surplus federal real property, which includes defense property  A military department in possession would, for example, declare property as excess to its needs and turn over the administration of a site to the GSA  The GSA would then follow a number of consecutive steps for disposal of federal property laid out in statute  It would first offer the excess property to other federal agencies  If none expressed an interest, the excess property would be declared surplus   The GSA would then offer the surplus property to state or local governments and non-profits that might use it for a public benefit ( public benefit conveyance) , such as a homeless shelter or medical center  Finally, if the property has neither been transferred nor conveyed in the previous steps, the surplus property would be offered for sale to the public  Under a BRAC, local communities can significantly affect the BRAC property transfer and disposal decisions, which are managed by the Secretary of the responsible military department  Once approved for closure, communities around an installation typically organize a Local Redevelopment Authority (LRA) for the purpose of creating and executing a redevelopment plan for the property  While the plan is not binding on DOD, the Department has been statutorily directed to give the plan considerable weight  DOD makes economic development grants and technical support available through its Office of Economic Adjustment (OEA) to assist LRAs with the process  In recent BRAC rounds, Congress has authorized a special transfer authority that has permitted DOD to transfer title to property at less than fair market value, or even at no cost, if the LRA agrees to certain conditions designed to create employment at the former defense facility  This has been referred to as an Economic Development Conveyance (EDC)  DOD has asserted that savings generated from BRAC are generally the result of avoiding the cost of retaining and operating unneeded infrastructure, with upfront costs eventually offset by annual savings  Between FY2012 and FY2018, the Department consistently argued for a new BRAC, asserting that "absent another BRAC round, the Department will continue to operate some of its installations sub-optimally as other efficiency measures, changing force structure, and technology reduce the number of missions and personnel " Emphasizing the potential cost savings, DOD has suggested a new "efficiency-focused BRAC" could save the Department billions of dollars annually: "Savings from BRAC rounds are real and substantial  The last five BRAC rounds are collectively saving the Department $12B annually  A new efficiency-focused BRAC could save the Department an additional ~$2B annually (based on the '93/'95 rounds) " In its ongoing series of BRAC-related reports, the GAO has noted the unreliability of DOD cost savings estimates  In 2013, GAO concluded that, though the Department had achieved annual recurring savings as the result of the 2005 round, visibility into the outcome has been limited due to missing and inconsistent recordkeeping  Similar studies have raised questions about the data DOD has used to predict and monitor BRAC effectiveness, long-term savings, and outcomes  For example "    the services did not develop baseline operating costs before implementing the BRAC recommendations, which would have enabled it to determine whether savings were achieved " "    We found that DOD's process for providing the BRAC commission with cost and savings estimates was hindered by underestimating recommendation-specific requirements and that DOD did not fully anticipate information technology requirements for many of the recommendations " "The department cannot provide documentation to show to what extent it reduced plant replacement value or vacated leased space as it reported in May 2005 that it was intended to do     In addition, DOD bundled multiple closures     thus limiting visibility into the estimated costs and savings for individual closures and realignments " "    DOD has not reported to Congress how the cleanup of emerging contaminants, especially certain perfluorinated compounds, at installations closed under BRAC will significantly increase the estimated (BRAC) cleanup costs " "    We found that OSD (Office of the Secretary of Defense) did not have a fully developed method for accurately collecting information on costs, savings, and efficiencies achieved specifically from joint basing, and that OSD had not developed a plan to guide joint bases in achieving cost savings and efficiencies    " "    DOD has not committed to take action on some of our recommendations related to implementing any future BRAC rounds, such as improving DOD's ability to estimate potential liabilities, and savings to achieve desired outcomes " In its final report to the President, the 2005 BRAC commission noted DOD's initial estimate of savings had been "vastly overestimated," and suggested that the Department had claimed savings that were "not truly savings in the commonly understood sense of the term " Reflecting on the quality of cost estimates and savings associated with 2005 BRAC round, Anthony Principi, Chairman of the 2005 Defense Base Closure and Realignment Commission, has suggested opportunities exist for the DOD to improve its analysis by adopting more consistent accounting practices and inclusive metrics: To start, DoD has to do a better job estimating the true cost of any closure or realignment     Second, the cost of base realignment actions (COBRA) accounting procedure, used by DoD as a basis of comparison among scenarios, should include cost estimates for environmental restoration not just "clean to current use" standards  In addition, COBRA or some other cost evaluation process should also include transportation and infrastructure costs and burden sharing with the federal government     In addition to refining DOD accounting metrics, some observers have suggested congressional visibility into BRAC cost and long-term effectiveness could be improved by amending the process to require the Department to disclose how closure and realignment recommendations meet expected cost saving and reduced infrastructure targets  A BRAC process is the chief means by which DOD disposes of excess infrastructure  Each year between 2013 and 2017, the Department requested a new BRAC round as a means of realizing greater efficiency and reducing excess infrastructure  It has also attempted to allay concerns related to the 2005 BRAC experience - marked by unexpectedly high costs and complexity - by emphasizing cost savings and efficiencies rather than force transformation  In April 2016, DOD submitted to the House Armed Services Committee an I nfrastructure C apacity R eport (interim version) that assessed 22% of the Department's base infrastructure excess to its needs  The methodology used in the report—required by Section 2815 of the National Defense Authorization Act (NDAA) for FY2016 (P L


Report 2:  114-92)—remained consistent with excess capacity reports submitted prior to the 1998 and 2005 BRAC rounds round  The Department stated its purpose for obtaining "a sense of excess and whether excess remains after various changes, such as (prior) BRAC or force structure reductions " A final infrastructure capacity report, submitted to Congress in October 2017, modified the original excess capacity estimate to 19%  The Department concluded its infrastructure capacity analysis by arguing it had established sufficient justification for a new BRAC round, a process that would allow it to more effectively dispose of excess infrastructure and manage remaining real property assets  The Department believes we have addressed all congressional concerns     The time to authorize another BRAC round is now  The BRAC process requires considerable time to analyze and develop recommendations, have those recommendations reviewed by the independent BRAC Commission, and then implemented over a six-year period of time  The longer authorization is delayed, the longer the Department will be forced to expend valuable resources on unnecessary facilities instead of weapons systems, readiness, and other national security priorities  Critics of the Department's methodology for estimating excess infrastructure have asserted it includes unreasonable research assumptions and metrics, undermining the basis for DOD's conclusion  For example, observers have cited the report's reliance on Cold War baseline values to establish excess capacity, inconsistent application of existing metrics for measuring capacity shortfalls, and overly broad categorization schemes  Some observers have also cited longstanding data management challenges that continue to affect the Department's ability to measure current excess facility inventory and utilization rates  Others have noted the dearth of data that support DOD claims related to BRAC effectiveness and the disposal of excess property  During a news briefing on the FY2019 defense budget, Undersecretary of Defense (Comptroller) David L  Norquist noted that the Department had declined to propose a BRAC round that year, stating that it would work instead to focus on internal reforms while preparing for a financial audit  And so, I think we're looking at doing two things, going forward  One is, working with Congress to find common areas where we can make reforms and changes that don't create the same types of obstacles  The other is that we are undergoing a financial-statement audit that includes a look at property, and assets and investments and improving the accuracy of the data behind it  And as a view of being able to take advantage of the data coming out of that process, to help us make better decision-making on real property  But, yes, you are correct, there is not (a) request for another BRAC round in this budget  In testimony before the Senate Appropriations Committee Subcommittee on Military Construction, Veterans Affairs, and Related Agencies, Lucian Niemeyer, Assistant Secretary of Defense for Energy, Installations and Environment, indicated DOD would be working in FY2019 to improve its excess infrastructure accounting processes and demolish unneeded infrastructure: In lieu of another request for legislation in FY 2019 to authorize an additional Base Realignment and Closure (BRAC) round, we will review our facilities, to include facility usage optimization review to ensure we have a better accounting of excess infrastructure  We also have proposed for FY 2019 increased efforts to demolish unneeded or obsolete facilities over the course of this year  The 2005 BRAC round was unique among all previous rounds due to its relative size, scope and complexity  (See Figure 2 for comparison of major and minor BRAC actions between rounds ) Colloquially called "the mother of all BRACs," the objectives of the 2005 round were primarily about transforming military infrastructure; however, unanticipated expenses have played a role in shaping subsequent congressional views of the BRAC process and, according to many observers, dampened support for consideration of a new round  Savings estimates submitted during the 2005 round were overvalued by as much as 67%, according to GAO analysis, with one-time implementation costs rising from $21 to $35 1 billion  GAO found that the $14 1 billion increase was due primarily to the rising cost of new construction associated with subsidiary projects not included in the original BRAC implementation plan  Referring to the implementation of the 2005 round, Assistant Secretary Niemeyer, noted, "BRAC legislation effectively limited the ability of Congress to oversee BRAC implementation costs and the Department made deliberate decisions to use BRAC implementation as a recapitalization tool, expanding facility requirements and associated costs " To address congressional concerns about spiraling costs in new BRAC rounds, DOD has periodically proposed legislative language that would constrain the Secretary's ability to recommend BRAC actions that would not yield savings within 20 years and to emphasize recommendations that would yield net savings within five years  Each year, Congress appropriates funding for the Department of Defense Base Closure Account, part of the Military Construction Defense-Wide appropriation  With no BRAC round authorized or underway, the primary purpose of continuing BRAC appropriations is to fund the environmental cleanup and caretaker functions at bases that were closed under prior rounds (see Figure 3 )  In FY2020, the Trump Administration has requested $278 5 million for BRAC continuing environmental and caretaker costs, with $158 3 million provided for the Navy (57%), $66 1 million for the Army (24%), and $54 million for the Air Force (19%)  The total request represents a $63 million decrease (19%) from FY2019 enacted levels ($342 million)  In FY2018, Congress urged DOD to accelerate environmental remediation at BRAC sites  In report language, appropriators stated that additional funds were provided to speed environmental remediation at installations closed under previous rounds  Accelerated cleanup —The agreement includes additional funding to accelerate environmental remediation at installations closed during previous Base Realignment and Closure (BRAC) rounds  Priority should be given to those sites with newly identified radiological cleanup cost  There are many factors hindering the cleanup of BRAC sites  However, strategic investments can lead to quicker clean-ups and faster turnover of DOD property to the local community  Therefore, the Department is directed to submit to the congressional defense committees a spend plan for the additional BRAC funds not later than 30 days after enactment of this Act  Congressional authorizers and appropriators have regularly inserted language into annual defense legislation that would disallow the use of funds for the purpose of a new BRAC round  In FY2019, for example, though DOD did not propose a BRAC, authorizers inserted language into the annual NDAA that prohibited a new round: SEC  2703  Prohibition on Conducting Additional Base Realignment and Closure (BRAC) Round  Nothing in this Act shall be construed to authorize an additional Base Realignment and Closure (BRAC) round  A similar provision was included in the final FY2019 defense appropriations bill: SEC  8122  None of the funds made available by this Act may be used to propose, plan for, or execute a new or additional Base Realignment and Closure (BRAC) round  In 2017, Members in both chambers proposed legislation that would have authorized a new round of base closures  Though no legislation for a full BRAC was enacted, a provision included the following year in the final FY2019 NDAA  Under the new scenario described by Section 2702 of the John S  McCain National Defense Authorization Act for Fiscal Year 2019 ( H R  5515 , P L  115-232 ), BRAC-like actions are authorized within the confines of a state based on the recommendation of the governor and support of local communities affected by the proposed actions  Unlike a traditional BRAC process, the new authorities would forgo the creation of an independent review panel  The Secretary of Defense is, instead, required to deliver a report of planned BRAC actions to congressional defense committees and, following a 90-day waiting period, begin implementation  For details, please refer to "In-State BRAC" in Appendix A of this report  The BRAC related legislative proposals above illustrate the flexibility Congress has for amending or adopting the template of past BRAC processes that DOD has called "the only fair, objective, and comprehensive process to achieve these goals (eliminating excess infrastructure) " Congress may consider whether future legislative proposals for base closures and realignments will adopt the lessons learned from previous rounds while retaining the basic framework, or fundamentally alter the process  No BRAC legislation has so far been proposed in the 116 th Congress  Additionally, the Department has asserted that it does not intend to use the new BRAC-like authorities authorized by Section 2702 of the FY2019 NDAA  To date, DOD has received no state requests under this authority  Appendix A  Legislative References BRAC Authorizing Legislation 1988 Round The Defense Authorization Amendments and Base Closure and Realignment Act, enacted October 24, 1988 (P L 100-526) 1991, 1993, 1995 Rounds National Defense Authorization Act for Fiscal Year 1991, enacted November 5, 1990 (P L  107-107, Base Closure and Realignment Act of 1990, Title XXIX) 2005 Round National Defense Authorization Act for Fiscal Year 2002, ( P L  101-510 ; amended the Defense Base Closure and Realignment Act of 1990 ( P L  101-510 ) 10 U S C  2687, 10 U S C  993 Summary In 1977, Congress enacted 10 U S C  2687, the first statutory restriction on the President's ability to close or realign military installations  Amended over the years, the statute has retained its essential elements, establishing procedures the Secretary of Defense must follow before closing a military installation where a threshold number (currently 300) of civilian personnel are authorized to be employed, or realigning an installation that involves a reduction by more than 50% (or 1,000) of civilian workers  A more recent statute, 10 U S C  993, introduced additional reporting requirements that would restrict the Secretary's ability to realign installations if the plan would affect more than 1,000 assigned members of the Armed Forces  In-State BRAC Section 2702 of the John S  McCain National Defense Authorization Act for Fiscal Year 2019 ( H R  5515 , P L  115-232 ) authorizes new in-state BRAC authorities  Text of the provision is included below in its entirety  SEC  2702  ADDITIONAL AUTHORITY TO REALIGN OR CLOSE CERTAIN MILITARY INSTALLATIONS  (a) Authorization —Notwithstanding sections 993 or 2687 of title 10, United States Code, and subject to subsection (d), the Secretary of Defense may take such actions as may be necessary to carry out the realignment or closure of a military installation in a State during a fiscal year if— (1) the military installation is the subject of a notice which is described in subsection (b); and (2) the Secretary includes the military installation in the report submitted under paragraph (2) of subsection (c) with respect to the fiscal year  (b) Notice From Governor of State —A notice described in this subsection is a notice received by the Secretary of Defense from the Governor of a State (or, in the case of the District of Columbia, the Mayor of the District of Columbia) in which the Governor recommends that the Secretary carry out the realignment or closure of a military installation located in the State, and which includes each of the following elements: (1) A specific description of the military installation, or a specific description of the relevant real and personal property  (2) Statements of support for the realignment or closure from units of local government in which the installation is located  (3) A detailed plan for the reuse or redevelopment of the real and personal property of the installation, together with a description of the local redevelopment authority which will be responsible for the implementation of the plan  (c) Response to Notice — (1) Mandatory response to governor and congress —Not later than 1 year after receiving a notice from the Governor of a State (or, in the case of the District of Columbia, from the Mayor of the District of Columbia), the Secretary of Defense shall submit a response to the notice to the Governor and the congressional defense committees indicating whether or not the Secretary accepts the recommendation for the realignment or closure of a military installation which is the subject of the notice  (2) Acceptance of recommendation —If the Secretary of Defense determines that it is in the interests of the United States to accept the recommendation for the realignment or closure of a military installation which is the subject of a notice received under subsection (b) and intends to carry out the realignment or closure of the installation pursuant to the authority of this section during a fiscal year, at the time the budget is submitted under section 1105(a) of title 31, United States Code, for the fiscal year, the Secretary shall submit a report to the congressional defense committees which includes the following: (A) The identification of each military installation for which the Secretary intends to carry out a realignment or closure pursuant to the authority of this section during the fiscal year, together with the reasons the Secretary of Defense believes that it is in the interest of the United States to accept the recommendation of the Governor of the State involved for the realignment or closure of the installation  (B) For each military installation identified under subparagraph (A), a master plan describing the required scope of work, cost, and timing for all facility actions needed to carry out the realignment or closure, including the construction of new facilities and the repair or renovation of existing facilities  (C) For each military installation identified under subparagraph (A), a certification that, not later than the end of the fifth fiscal year after the completion of the realignment or closure, the savings resulting from the realignment or closure will exceed the costs of carrying out the realignment or closure, together with an estimate of the annual recurring savings that would be achieved by the realignment or closure of the installation and the timeframe required for the financial savings to exceed the costs of carrying out the realignment or closure  (d) Limitations — (1) Timing —The Secretary may not initiate the realignment or closure of a military installation pursuant to the authority of this section until the expiration of the 90-day period beginning on the date the Secretary submits the report under paragraph (2) of subsection (c)  (2) Total costs —Subject to appropriations, the aggregate cost to the government in carrying out the realignment or closure of military installations pursuant to the authority of this section for all fiscal years may not exceed $2,000,000,000  In determining the cost to the government for purposes of this section, there shall be included the costs of planning and design, military construction, operations and maintenance, environmental restoration, information technology, termination of public-private contracts, guarantees, and other factors contributing to the cost of carrying out the realignment or closure, as determined by the Secretary  (e) Process for Implementation —The implementation of the realignment or closure of a military installation pursuant to the authority of this section shall be carried out in accordance with section 2905 of the Defense Base Closure and Realignment Act of 1990 (title XXIX of P L  101-510 ; 10 U S C  2687 note) in the same manner as the implementation of a realignment or closure of a military installation pursuant to the authority of such Act  (f) State Defined —In this section, the term ``State'' means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, American Samoa, Guam, the United States Virgin Islands, and the Commonwealth of the Northern Mariana Islands  (g) Termination of Authority —The authority of the Secretary to carry out a realignment or closure pursuant to this section shall terminate at the end of fiscal year 2029  Appendix B  BRAC Acreage Disposal Status, By State

ground_truth: The number of individuals receiving long term care services from Medicaid in community residential settings is expected to grow. These settings, which include assisted living facilities, provide a range of services that allow aged and disabled beneficiaries, who might otherwise require nursing home care, to remain in the community. State Medicaid programs and CMS, the federal agency responsible for overseeing the state programs, share responsibility for ensuring that beneficiaries' health and welfare is protected. GAO was asked to examine state and federal oversight of assisted living services in Medicaid. This report (1) describes state spending on and coverage of these services, (2) describes how state Medicaid agencies oversee the health and welfare of beneficiaries in these settings, and (3) examines the extent that CMS oversees state Medicaid agency monitoring of assisted living services. GAO surveyed all state Medicaid agencies and interviewed officials in a nongeneralizeable sample of three states with varied oversight processes for their assisted living programs. GAO reviewed regulations and guidance, and interviewed CMS officials. State Medicaid agencies in 48 states that covered assisted living services reported spending more than $10 billion (federal and state) on assisted living services in 2014. These 48 states reported covering these services for more than 330,000 beneficiaries through more than 130 different programs. Most programs were operated under Medicaid waivers that allow states to target certain populations, limit enrollment, or restrict services to certain geographic areas. With respect to oversight of their largest assisted living programs, state Medicaid agencies reported varied approaches to overseeing beneficiary health and welfare, particularly in how they monitored critical incidents involving beneficiaries receiving assisted living services. State Medicaid agencies are required to protect beneficiary health and welfare and operate systems to monitor for critical incidents—cases of potential or actual harm to beneficiaries such as abuse, neglect, or exploitation. Twenty-six state Medicaid agencies could not report to GAO the number of critical incidents that occurred in assisted living facilities, citing reasons including the inability to track incidents by provider type (9 states), lack of a system to collect critical incidents (9 states), and lack of a system that could identify Medicaid beneficiaries (5 states). State Medicaid agencies varied in what types of critical incidents they monitored. All states identified physical, emotional, or sexual abuse as a critical incident. A number of states did not identify other incidents that may indicate potential harm or neglect such as medication errors (7 states) and unexplained death (3 states). State Medicaid agencies varied in whether they made information on critical incidents and other key information available to the public. Thirty-four states made critical incident information available to the public by phone, website, or in person, while another 14 states did not have such information available at all. Oversight of state monitoring of assisted living services by the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), is limited by gaps in state reporting. States are required to annually report to CMS information on deficiencies affecting beneficiary health and welfare for the most common program used to provide assisted living services. However, states have latitude in what they consider a deficiency. States also must describe their systems for monitoring critical incidents, but CMS does not require states to annually report data from their systems. Under federal internal control standards, agencies should have processes to identify information needed to achieve objectives and address risk. Without clear guidance on reportable deficiencies and no requirement to report critical incidents, CMS may be unaware of problems. For example, CMS found, after an in-depth review in one selected state seeking to renew its program, that the state lacked an effective system for assuring beneficiary health and welfare, including reporting insufficient information on the number of unexpected or suspicious beneficiary deaths. The state had not reported any deficiencies in annual reports submitted to CMS in 5 prior years. GAO recommendations to CMS include clarifying state requirements for reporting program deficiencies and requiring annual reporting of critical incidents. HHS concurred with GAO's recommendations to clarify deficiency reporting and stated that it would consider annual reporting requirements for critical incidents after completing an ongoing review.

prompt_front: You are given two reports by the government agency.



Question: Write a one-page summary of the report 2.

Report 1: Federal and state Medicaid spending on long-term care continues to increase; for example it increased from $146 billion in 2013 to $158 billion in 2015  Individuals seeking long-term care generally need care that is, by definition, longer term in nature and more costly than other types of care  Spending on long-term care services provided in home and community settings, including assisted living facilities, exceeds the amount spent on institutional settings such as nursing homes  State Medicaid programs may cover certain medical and non-medical services that assisted living facilities provide; however, the Medicaid statute does not provide for coverage of room and board charges of an assisted living facility  In their federal-state partnership, both CMS and states play important roles in the oversight of Medicaid  CMS is responsible for oversight of state Medicaid programs  To conduct this oversight, CMS issues program requirements in the form of regulations and guidance, approves changes states make to their programs, provides technical assistance to states, collects and reviews required information and data from states and, in some cases, reviews individual state programs  States are responsible for the day-to-day administration of their Medicaid programs, including monitoring and oversight of the different HCBS programs through which they cover assisted living services, within broad federal rules and requirements  Each state is required to identify and designate a single state agency to administer or supervise the administration of its Medicaid program  The state Medicaid agency may partially or fully delegate the administration and oversight of the state’s HCBS programs to another state agency or other entity, such as a state unit on aging, a mental health department, or other state departments or agencies with jurisdiction over a specific population or service  However, the state Medicaid agency is ultimately accountable to the federal government for compliance with the HCBS requirements  Under different authorizing provisions of federal law, states have considerable flexibility to establish multiple HCBS programs including those covering assisted living services  A state Medicaid program can have multiple HCBS programs operating under different federal authorities  CMS is responsible for ensuring that states meet the requirements associated with their HCBS programs under these different authorities  Key to states’ monitoring of the health and welfare of Medicaid beneficiaries is their tracking of, and response to, incidents that may cause harm to a beneficiary’s health or welfare, such as abuse, neglect, or exploitation—commonly referred to as critical incidents  Such monitoring is required for most HCBS programs; however, we previously found that requirements for states related to oversight of the health and welfare of beneficiaries in different types of HCBS programs varied, and recommended that CMS take steps to harmonize those requirements across programs  The most common HCBS programs with the most stringent federal requirements are HCBS waiver programs  These programs serve beneficiaries who are eligible for an institutional level of care; that is, beneficiaries must have needs that rise to the level of care usually provided in a nursing facility, hospital, or other institution  CMS oversees states’ HCBS waiver programs specifically by reviewing and approving applications and reviewing HCBS program reports that states submit  HCBS waiver program applications include specific requirements implementing various statutory and regulatory provisions  (See text box below ) One requirement is that states have the necessary safeguards in place to protect the health and welfare of beneficiaries receiving services covered by HCBS waiver programs  For each of their HCBS waiver programs, states must demonstrate to CMS that they are meeting various requirements CMS has established regarding beneficiary health and welfare  The Six Requirements States Must Demonstrate for Home- and Community-Based Services Waiver Programs 1  Administrative authority: The Medicaid agency retains ultimate administrative authority and responsibility for the operation of the waiver program by exercising oversight of the performance of waiver functions by other state and local/regional non-state agencies (if appropriate) and contracted entities  2  Level of care: The state demonstrates that it implements the processes and instrument(s) specified in its approved waiver for evaluating/re-evaluating an applicant’s/waiver participant’s level of care consistent with care provided in a hospital, nursing facility, or intermediate care facility  3  Qualified providers: The state demonstrates that it has designed and implemented an adequate system for assuring that all waiver services are provided by qualified providers  4  Service plan: The state demonstrates it has designed and implemented an effective system for reviewing the adequacy of service plans for the waiver participants  5  Health and welfare: The state demonstrates it has designed and implemented an effective system for assuring waiver participant health and welfare  6  Financial accountability: The state must demonstrate that it has designed and implemented an adequate system for insuring financial accountability of the waiver program  CMS also provides ongoing oversight of state HCBS programs through annual reports that states must submit for each of their HCBS waiver programs as well as renewal reports submitted about two years before an HCBS waiver is scheduled to end  The state reports are intended to provide CMS with information on the operation of state HCBS waiver programs  In contrast to long-term care services provided in nursing facilities, less is known at the federal level about the oversight and quality of care in assisted living facilities  Generally, states establish their own licensing and oversight requirements for assisted living facilities  As a result, the requirements for assisted living facilities and the type and frequency of oversight can vary across states  In contrast, nursing homes must meet a comprehensive set of federal requirements in order to receive payment for long-term care services for Medicaid and Medicare beneficiaries in addition to state requirements  CMS contracts with state entities to regularly inspect nursing facilities and investigate complaints to assess whether nursing homes meet these federal quality requirements  Annually CMS publishes a comprehensive report on nursing homes that serve Medicaid and Medicare beneficiaries, including the extent that beneficiaries are at risk for harm, based on these investigations and inspections  In addition, CMS publicly reports a summary of each nursing home’s quality data using a five-star quality rating based on health inspection results, staffing data, and quality measure data  The goal of this rating system is to help consumers make meaningful distinctions among high- and low-performing nursing homes  This type of standardized framework for oversight, investigation and inspections, and reporting on quality of care concerns does not exist for assisted living facilities and other types of HCBS providers  Forty-eight state Medicaid agencies reported collectively spending about $10 billion in state and federal Medicaid funds for assisted living services in 2014, according to our survey  The other 3 states reported that they did not pay for assisted living services  We estimate that this spending for services provided by assisted living facilities represents 12 4 percent of the $80 6 billion Medicaid spent on HCBS in all settings that year  More than 330,000 Medicaid beneficiaries received assisted living services, based on data reported to us by the 48 states  Nationally, the average spending per beneficiary on assisted living services in the 48 states in 2014 was about $30,000; states provided these HCBS services through fee-for-service and managed care delivery models  Fee-for-service spending comprised 81 percent of total spending on assisted living services and managed care spending was about 19 percent of the total  The cost per beneficiary reported by surveyed states also varied based on payment type; average per beneficiary cost was $31,000 for fee-for-service and $27,000 for managed care  About 21 percent of Medicaid assisted living enrollment was for beneficiaries receiving these services under a managed care delivery model  (See table 1 ) Average per-beneficiary spending varied significantly across the states  For example, for the nine states with the lowest spending per beneficiary, average Medicaid spending ranged from about $1,700 to about $9,500 per beneficiary  In contrast, in the nine states with the highest per- beneficiary spending, the average spending ranged from about $43,000 to $108,000 per beneficiary  (See Figure 1 ) For more information on each state’s enrollment, total spending, and average per beneficiary spending on assisted living services, see appendix I  The 48 states that reported covering assisted living services in 2014 said they did so through 132 different programs  The majority of the states, 31 of the 48, reported administering more than one program that covered assisted living services  As illustrated in table 2 below, of the different types of HCBS programs under which states can provide coverage for assisted living services, HCBS waivers were the most common type of program they used  Specifically, 39 states and 69 percent of the programs that provided assisted living services, were operated under the HCBS waiver program  (See appendix II for additional details on each state’s number of programs by program type and total number of HCBS programs that covered assisted living facility services in 2014 ) Almost all of the 48 states that covered assisted living services did so for two groups of Medicaid beneficiaries eligible through their programs  In 45 of 48 states, aged beneficiaries received services provided by assisted living facilities  Similarly, in 43 of 48 states, physically disabled beneficiaries received services  (See Figure 2 ) In 38 or more of the 48 states that covered assisted living services, six types of services were provided  For example, 45 states covered assistance with activities of daily living, such as bathing and dressing; 44 states covered medication administration; and 41 states covered coordination of meals  (See Figure 3 ) State Medicaid agency approaches for oversight of assisted living services varied widely in terms of who provided the oversight for their largest programs, according to their responses to our survey  Thirteen of the 48 state Medicaid agencies reported delegating administrative responsibilities, including oversight of beneficiary health and welfare, to other state or local agencies  State Medicaid agencies may delegate the administration of programs to government or other agencies through a written agreement; however, state Medicaid agencies retain the ultimate oversight responsibility for those delegated functions  For example, among the 13 states that delegated HCBS program administration, the administering agencies were those that provided services to the aged, disabled, or both of these populations, such as the states’ Departments of Aging  (See text box, below, for examples of states’ delegation ) Examples of State Medicaid Agencies’ Delegation of Authority for Administration of Home- and Community-based Services’ Programs Covering Assisted Living Services Georgia’s Elderly & Disabled Waiver Program was operated in 2014 by the Georgia Department of Human Services Division of Aging Services, a separate agency of the state that was not a division/unit of the Medicaid agency  The Georgia Medicaid Agency maintained a formal interagency agreement with the Division of Aging Services which describes by function the required deliverables to support compliance and a schedule for delivery of reports  Nebraska’s Waiver for Aged and Adults and Children with Disabilities is operated by the state Medicaid agency Division of Medicaid and Long Term Care  The majority of services are provided by independent contractors in order to allow service delivery in the rural and frontier areas of the state  The state Medicaid agency contracts with the Area Agencies on Aging, Independent Living Centers, and Early Development Network agencies to perform a variety of operational and administrative functions including authorizing services and monitoring the delivery of services  States also varied in the types of information they reported reviewing as part of the oversight of assisted living services, and the extent to which state Medicaid agencies review the information when another agency is responsible for administration  For example, other entities outside the state Medicaid agency—such as the agency delegated to administer an HCBS program, or a contractor that manages provider enrollment—may check to ensure a provider is allowed to deliver services to Medicaid beneficiaries; in such cases, however, the state Medicaid agency might not be aware of the results of such checks  As illustrated in table 3, in all 48 states the types of information generally reviewed by either the state Medicaid agency, the agency delegated administrative responsibilities, or other agencies were: critical incident reports, the HHS Office of Inspector General’s list of excluded providers, patient service plans, and information on concerns about care received directly from patients, relatives, caregivers or the assisted living facility itself  In many cases, the state Medicaid agency did not review all information sources reviewed by other agencies  For example, although all critical incident reports were reviewed in the 48 states by either the state Medicaid agency, the agency delegated administrative responsibilities, or another agency; in 16 of those states, the state Medicaid agency was not involved in those reviews, according to responses to our survey  Instead, the critical incident reports were reviewed by another entity designated responsible for the HCBS program in the state or another state entity with regulatory responsibility over the assisted living facility  Such reviews, including any critical incidents found, may not have been communicated back to the state Medicaid agency, according to responses to our survey  State Medicaid agencies also varied in reporting the extent to which they were made aware or notified when enforcement actions were taken as a result of concerns with beneficiary care identified by other entities  Various oversight actions may be taken by the state Medicaid agency, the agency delegated to administer an HCBS program, or a state regulatory agency, such as a state agency responsible for licensing and inspecting various types of HCBS providers  When delegated agencies or other licensing agencies take corrective action, the state Medicaid agency may not be aware unless notified by the agencies taking that action  For example, in 23 states, the investigation of potential incidents related to beneficiary health and welfare was delegated to another agency but in only 6 of these states was the state Medicaid agency always notified of such an investigation based on our survey  (See table 4 and text box below ) Example of a Collaborative Approach to Monitoring and Ensuring Quality Care Specifically for Assisted Living Facilities In 2009, the Wisconsin Coalition for Collaborative Excellence in Assisted Living was formed to redesign the way quality is ensured and improved for individuals residing in assisted living communities  This public/private coalition utilizes a collective impact model approach that brings together the state, the industry, the consumer, and academia to identify and implement agreed upon approaches designed to improve the outcomes of individuals living in Wisconsin assisted living communities  The core of the coalition is the implementation of an association developed, department approved, comprehensive quality assurance, quality improvement program  For their largest HCBS programs that covered assisted living services, the 48 states varied in how they monitored “critical incidents” that caused actual or potential harm to Medicaid beneficiaries in assisted living facilities  Specifically, the 48 states varied in their ability to report the number of critical incidents; how they defined incidents, and the extent to which they made information on such incidents readily available to the public  These states varied in whether they could provide us the number of critical incidents involving beneficiaries for their largest programs covering assisted living services, and for those that could report, the number of incidents they reported varied widely  In 26 of the 48 states the Medicaid agencies were unable to report, for their largest program covering assisted living services, the number of critical incidents that had occurred in assisted living facilities in 2014  The remaining 22 states reported a total of 22,921 critical incidents involving Medicaid beneficiaries in their largest programs covering assisted living services  The number of critical incidents reported in these states ranged from 1 to 8,900  For six of these states the number of critical incidents reported was more than 1,000, (See text box, below, for examples of selected state processes managing critical incidents ) Selected States’ Processes for Managing Beneficiary Harm or Potential Harm in Assisted Living Facilities Georgia: According to state officials in 2014 there was no centralized or comprehensive system for capturing and tracking the data on actual and potential violations  State officials acknowledged the lack of a centralized system prevents the Division of Community Health from tracking the status of each problem  Nebraska: According to state officials, Nebraska’s Adult Protective Services operates an electronic system that coordinates across state social service programs  When Adult Protective Services initiates an investigation of reported harm to an assisted living resident, the state Medicaid agency is automatically notified  Reasons state Medicaid agencies reported for being unable to provide us with the number of critical incidents included limitations in the data or data systems for tracking them  Nine states reported an inability to track incidents by provider type, and thus distinguish critical incidents in assisted living facilities from other providers of home and community based services  States also cited lacking a system to collect critical incidents (9 states), and that the system for reporting could not identify whether a resident was a Medicaid beneficiary (5 states)  Even in the 32 states where the state Medicaid agencies reported reviewing information about critical incidents, 20 states were unable to provide the actual number of critical incidents that occurred in assisted living facilities  State Medicaid agencies’ definitions of critical incidents also varied  As illustrated in Figure 4, all 48 states cited physical assault, emotional abuse, and sexual assault or abuse as a critical incident in their largest programs providing assisted living services in 2014  However, for other types of incidents, several states did not identify the incident as critical, including discharge and eviction from the facility (not a critical incident in 24 states), medication errors (not a critical incident in 7 states), and unauthorized use of seclusion, (not a critical incident in 6 states)  For other serious incidents, a relatively small number of states did not identify the incident as critical, such as unexplained death (not a critical incident in 3 states) and missing beneficiaries (not a critical incident in 2 states)  See appendix IV for a full list of the beneficiary-related incidents and the number of states that identify each as critical  Although half of the 48 states that cover assisted living services did not consider discharges or evictions to be critical incidents, according to state responses to our survey, 42 states offered certain protections related to involuntary discharge of Medicaid residents who live in assisted living facilities  The majority of protections consisted of a lease agreement requirement that applied to other housing contracts in the state, such as providing residents with eviction notices  Other protections included an appeals process (10 states) and a requirement for the facility to find an alternative location for the resident (10 states)  State Medicaid agencies also varied in whether they made information on critical incidents and other key information readily available to the public  (See table 5 ) Beneficiaries seeking care in an assisted living facility may want to know the number of critical incidents related to a particular facility  Through our survey we found that states differed in the availability of information related to health and welfare that was available to the public  For example, 34 of the 48 states reported that they made critical incident information available to the public by phone, website, or in person, and the remaining 14 states did not have such information available at all  Although all 48 states had information in some form on which assisted facilities accepted Medicaid beneficiaries, 8 states could not provide this information by phone and 22 states could not provide the information in person  In recent years, CMS has taken steps to improve oversight of beneficiary health and welfare in HCBS programs by adding new HCBS waiver application requirements for state monitoring of beneficiary health and welfare  CMS requires state waiver applications to include specific requirements that implement various statutory and regulatory provisions, including a provision that states assure that they will safeguard the health and welfare of Medicaid beneficiaries  In March 2014, CMS added unexplained death to the events that states must be able to identify and address on an ongoing basis, as part of their efforts to prevent instances of abuse, neglect, and exploitation, and added four new requirements for states to protect beneficiary health and welfare  (See table 6 ) In its guidance implementing the 2014 requirements, CMS noted that state associations and state representatives’ work groups had agreed that “health and welfare is one of the most important assurances to track, and requires more extensive tracking to benefit the individuals receiving services, for instance by using data to prevent future incidents ” As a condition for approval of their HCBS waiver applications for each of the requirements, states must identify and agree with CMS on the type of information they will collect to provide as evidence that they will meet the requirements  However, according to CMS officials, each state Medicaid agency has wide discretion over the information it will collect and report to demonstrate that it is meeting the health and welfare requirements and protecting beneficiaries  Although CMS added the additional requirements in 2014 for safeguarding beneficiary health and welfare, the agency generally did not change requirements for how it oversees state monitoring efforts once HCBS waivers are approved  We found a number of limitations in CMS’s oversight of approved HCBS waivers that undermine the agency’s ability to effectively monitor state oversight of HCBS waivers  These limitations include: unclear guidance on what states should identify and report annually related to any identified program deficiencies; lack of requirements on states to regularly provide CMS information on critical incidents; and CMS’s inconsistent enforcement of the requirement that states submit annual reports  Unclear guidance on what states should identify and report annually related to any identified program deficiencies  Federal law requires states to provide CMS with information annually on an HCBS waiver’s impact on (1) the type and amount, and cost of services provided and (2) the health and welfare of Medicaid beneficiaries receiving waiver services  CMS reporting requirements give states latitude to determine what to report as health and welfare deficiencies found through state monitoring of their HCBS programs  With respect to health and welfare, CMS’s State Medicaid Manual directs states when preparing their annual reports to “check the appropriate boxes regarding the impact of the waiver on the health and welfare” of beneficiaries and to describe relevant information  States are required to provide a brief description of the state process for monitoring beneficiary safeguards, use check boxes to indicate that beneficiary health and welfare safeguards have been met, and identify whether deficiencies were detected during the monitoring process  If states determine that deficiencies were identified through monitoring, states are required to “provide a summary of the significant areas where deficiencies were detected” and an explanation of the actions taken to address deficiencies and ensure the deficiencies do not recur  CMS’s written instructions for completing the HCBS annual report do not provide further guidance regarding reporting of deficiencies  For example, the reporting instructions do not describe or identify 1) what states are supposed to report as deficiencies, 2) how they are to identify which deficiencies are most significant, and 3) the extent to which states need to explain the steps taken to ensure that deficiencies do not recur  The lack of clarity is inconsistent with federal internal control standards, in particular, the need for federal agencies to have processes that identify information needed to achieve objectives and address risk  Without clear instructions as to what states must report, states’ annual reports may not identify deficiencies with states’ HCBS waiver programs that may affect the health and welfare of beneficiaries  States may determine that issues or problems they identified through monitoring do not represent reportable deficiencies and therefore may not report those deficiencies to CMS, increasing the risk that problems are not elevated to CMS’s attention  In the case of one of the selected states we reviewed, no problems were included on the annual reports submitted to CMS between 2011 and 2015  However, when CMS completed its review in the fourth year of the state’s waiver— for purpose of renewing the waiver—it determined the state was not assuring beneficiary health and welfare  CMS found that the information the state submitted for purpose of renewal suggested a “pervasive failure” by the state to assure the health and welfare of beneficiaries receiving services, including assisted living services  In particular, CMS noted the state provided insufficient information regarding the number of unexpected or suspicious beneficiary deaths  CMS concluded that the state failed to demonstrate that it has effective systems and processes for ensuring the health and welfare of beneficiaries  Lack of requirements on states to annually provide CMS information on critical incidents  Despite the importance of state critical incident management and reporting systems to protecting the health and welfare of beneficiaries, CMS lacks written requirements that states provide information needed for the agency oversight of state monitoring of critical incidents  According to CMS, a critical element of effective state oversight is the operation of data systems that support the identification of trends and patterns in the occurrence of critical incidents to identify needed improvements  Such a system is also consistent with federal internal controls standards which specify, in particular, the need for federal agencies to have processes that identify information needed to achieve objectives and address risk  CMS requires states to operate a critical incident reporting system  On their waiver applications states must check a box indicating they operate a system and also describe their system—including who must report and when, and what must be reported  Despite this requirement for states to have critical incident reporting systems, CMS does not require states to report to CMS any data from these systems on critical incidents as part of their required annual reports  Specifically, states are not required to include, in their annual reports, the number of critical incidents reported or substantiated that involve Medicaid beneficiaries  As a result, CMS does not have a method to confirm what states describe about critical incident management systems, which is a required component of states’ waiver applications or to assess the capabilities of states’ systems  For example, CMS cannot confirm whether the state systems can report incidents by location or type of residential provider, such as assisted living facilities; the type and severity of critical incidents that occurred; and the number of incidents that involved Medicaid beneficiaries  Without annual critical incident reporting, CMS may be at risk of (1) not having adequate evidence that states are meeting CMS requirements to have an effective critical incident management and reporting system and of (2) being unaware of problems with states’ abilities to identify, track, and address critical incidents involving Medicaid beneficiaries  Our prior work has shown that the lack of explicit reporting requirements on critical incidents not only impacts HCBS waiver programs but also impacts other types of Medicaid long-term services programs as well  Specifically, In a November 2016 report, we found that CMS requirements for states to report on their critical incident monitoring systems for the HCBS waiver program were more stringent than those for other types of HCBS programs, potentially leaving those other programs at even greater risk  We recommended that CMS take steps to harmonize requirements across different types of HCBS programs  HHS concurred with the recommendation stating it would seek input from states, stakeholders, and the public regarding harmonizing requirements across programs  In an August 2017 report we found similar issues in critical incident reporting requirements for other types of long term services programs, particularly those used to provide HCBS and other long term services under managed care  We found that CMS was not always requiring states that contracted with managed care organizations to provide long term services and supports to report to CMS sufficient information on critical incidents and other key areas needed to monitor beneficiary access and quality  We recommended that CMS take steps to identify and obtain key information needed to better oversee states’ efforts to monitor beneficiary access to quality services in their managed long-term services and supports programs  HHS concurred with this recommendation and stated that the agency would take this recommendation into account as part of an ongoing review of its 2016 Medicaid managed care rule  We continue to believe that the implementation of our prior recommendations is needed to help improve CMS oversight of states monitoring of beneficiary safety  CMS’s inconsistent enforcement of the requirement that states submit annual reports  States must prepare and submit an annual report for each HCBS waiver as a condition of waiver approval  According to CMS guidance, the agency’s review of the annual report is part of the ongoing oversight of HCBS waiver programs and not submitting an annual report jeopardizes the states renewal of HCBS waiver programs  However, some states have not been timely in submitting the required annual reports for their HCBS waivers  A review of 2013 HCBS annual reports by a CMS contractor, published in 2016, found that annual reports were missing for 29 HCBS waivers and multiple years’ of annual reports were missing for 8 waivers  In 2014, CMS adopted new strategies to ensure compliance with HCBS waiver requirements, including the requirement that states submit annual reports on a timely basis  These strategies include withholding federal funding, placing a moratorium on enrollment in the waiver, or other actions the agency determines necessary  CMS officials reported that the agency had not used these new strategies with states that were delinquent in submitting their annual reports  Officials said they were in the process of reviewing how to implement these new strategies in the case of one state; however, as of August 2017 officials had not finalized a decision  CMS’s ability to provide effective oversight of state programs and protect beneficiary health and welfare is undermined by the lack of enforcement and receipt of required annual waiver reports  Effective state and federal oversight is necessary to ensure that the health and welfare of Medicaid beneficiaries receiving assisted living services are protected, especially given the particular vulnerability of many of these beneficiaries to abuse, neglect, or exploitation  CMS has taken steps to strengthen beneficiary health and welfare protections in states’ HCBS waiver programs, the most common type of program that covers assisted living services and one that serves the most vulnerable beneficiaries  In particular, CMS now has multiple requirements for states to safeguard beneficiaries’ health and welfare, including requirements to operate an effective critical incident management and reporting system to identify, investigate, and address incidents of beneficiary abuse, neglect, exploitation, and unexplained death  However, CMS’s ability to effectively monitor how well states are assuring beneficiary health and welfare is limited by gaps in state reporting to CMS  CMS has not provided clear guidance to states on what information to include in annual reports on deficiencies they identify  As a result, CMS lacks assurance that it is receiving consistent, complete, and relevant information on deficiencies that is needed to oversee beneficiary health and welfare  Lacking clear guidance on the reporting of deficiencies may result in a delayed recognition of problems that may affect beneficiary health and welfare  Further, for years, states have been required to check a box attesting that they operate a critical incident management system, but have not always been required to report information on incidents of potential or actual harm to beneficiaries  Given the increasing prevalence of assisted living facilities as a provider of services to Medicaid beneficiaries, it is unclear why more than half of states responding to our survey could not provide us information on the number of critical incidents that occurred in these facilities in their states  Reporting data from their critical incident systems, such as the number of incidents, the type and severity of the incidents, or the location or type of facility in which the incident occurred would provide evidence that an effective system is in place, provide information on the extent beneficiaries are subject to actual or potential harm, and allow for tracking trends over time  Finally, CMS has not ensured that all states submit annual reports on their HCBS waiver programs as required  Without improvements to state reporting, CMS cannot ensure states are meeting their commitments to protect the health and welfare of Medicaid beneficiaries receiving assisted living services, potentially jeopardizing their care  We are making the following three recommendations to CMS: The Administrator of CMS should provide guidance and clarify requirements regarding the monitoring and reporting of deficiencies that states using HCBS waivers are required to report on their annual reports  (Recommendation 1) The Administrator of CMS should establish standard Medicaid reporting requirements for all states to annually report key information on critical incidents, considering, at a minimum, the type of critical incidents involving Medicaid beneficiaries, and the type of residential facilities, including assisted living facilities, where critical incidents occurred  (Recommendation 2) The Administrator of CMS should ensure that all states submit annual reports for HCBS waivers on time as required  (Recommendation 3) We provided a draft of this report to HHS for review and comment  HHS provided written comments, which are reproduced in Appendix V  The department also provided technical comments, which we incorporated as appropriate  In its written comments, the department concurred with two of our three recommendations, specifically, that CMS will clarify requirements for state reporting of program deficiencies and ensure that all states submit required annual reports on time  HHS did not explicitly agree or disagree with our third recommendation to require all states to report information on critical incidents to CMS annually  The department noted it has established a workgroup to learn more about states’ health and welfare systems and that it will use the results of this workgroup to determine which additional reporting requirements would be beneficial  The workgroup’s review will continue through calendar year 2018  In technical comments, HHS indicated that after the workgroup’s review is complete it will consider annual reporting of critical incidents  We believe establishing the workgroup is a positive first step towards improving oversight and state reporting and encourage HHS to require annual reporting on critical incidents when developing additional reporting requirements  As agreed with your offices, unless you publicly announce the contents of this report earlier, we plan no further distribution until 30 days from the report date  At that time, we will send copies to the Secretary of Health and Human Services, the Administrator of CMS, the Administrator of the Administration for Community Living, appropriate congressional committees, and other interested parties  In addition, the report will be available at no charge on the GAO website at http://www gao gov  If you or your staff members have any questions about this report, please contact me at (202) 512-7114 or at iritanik@gao gov  Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report  GAO staff that made key contributions to this report are listed in appendix VI  Our survey of state Medicaid agencies regarding coverage, spending, enrollment, and oversight of assisted living services in 2014, obtained information on challenges for Medicaid beneficiaries to access assisted living services in their states  States provided information related to factors that create challenges for Medicaid beneficiaries’ ability to access and receive assisted living services and the extent states had policies to help beneficiaries with the cost of room and board  A number of states in our survey cited common factors as creating the greatest challenges to a beneficiary’s ability to access assisted living services, including the number of assisted living facilities willing to accept Medicaid beneficiaries (13 states or 27 percent of the 48 states) program enrollment caps (9 states or 19 percent of the 48 states) beneficiaries’ inability to pay for assisted living facility room and board (9 states or 19 percent of the 48 states), which Medicaid typically does not cover low rates the state Medicaid program paid assisted living facilities (8 states or 17 percent of the 48 states)  A number of states reported that they had policies to assist Medicaid beneficiaries with the costs of room and board charged by assisted living facilities, which Medicaid does not typically cover  Two common policies, cited by at least half of the states, were aimed at limiting how much assisted living facilities could charge Medicaid beneficiaries for room and board  For example, 30 of 48 states, limited the amount facilities could charge for room and board to the amount of income certain beneficiaries receive as Supplemental Security Income  The other commonly cited policies focused on providing financial assistance to the beneficiaries to defray the room and board costs  (See table 9 ) In addition to the contact named above, Tim Bushfield and Christine Brudevold (Assistant Directors), Jennie Apter, Shirin Hormozi, Anne Hopewell, Kelsey Kreider, Perry Parsons, Vikki Porter, and Jennifer Whitworth made key contributions to this report 


Report 2: The inventories of the selected Air Force and Navy fixed-wing aircraft in our review totaled 2,823 aircraft and required approximately $20 billion to operate and support in fiscal year 2016  The inventory, aircraft status, initial operational capability, and service life forecast for each of the 12 selected fixed-wing aircraft are shown in figure 1  Sustainment of fixed-wing aircraft and other weapon systems comprises the logistics and personnel services required to maintain and prolong operations, and DOD policy provides direction to service components on sustainment planning across the life cycle of the weapon system  Specifically, DOD policy requires the services to develop and implement a sustainment strategy, such as a Life-cycle Sustainment Plan, for sustaining its weapon systems  According to DOD’s policy, this strategy should be the basis for all sustainment efforts, including sustainment metrics mapped to key performance parameters and key system attributes, such as aircraft availability, to manage sustainment performance  The policy states that, after initial operating capability, programs should update the sustainment plan whenever there are major changes to its strategy for sustaining the weapon system, or every 5 years, whichever occurs first  The Air Force and the Navy also have guidance that implements the requirements of the DOD guidance  These services’ guidance include sustainment-planning requirements for life-cycle sustainment and assurance of affordability  There are a variety of DOD offices that have roles and responsibilities related to sustaining fixed-wing aircraft  For instance, the Under Secretary of Defense for Acquisition and Sustainment (USD ), is the principal staff assistant and advisor to the Secretary of Defense for all matters concerning acquisition and sustainment  Specifically, USD (A&S) is responsible for establishing policies for logistics, maintenance, and sustainment support for all elements of DOD, including fixed-wing aircraft  The Assistant Secretary of Defense for Logistics and Materiel Readiness (ASD ) serves as the principal staff assistant and advisor to the USD (A&S) on logistics and materiel readiness within DOD  Specifically, the ASD (L&MR) is responsible for (1) establishing DOD policies and procedures for logistics, maintenance, materiel readiness, strategic mobility, and sustainment support; (2) providing related guidance to the Secretaries of the military departments, including developing the Life- cycle Sustainment Plan outline; and (3) monitoring and reviewing programs associated with these areas, among other duties and responsibilities  For the Air Force, the Air Force Materiel Command develops, acquires, and sustains weapon systems through research, development, testing, evaluation, acquisition, maintenance, and program management of the systems and their components  This command provides acquisition and life-cycle management services and logistics support, among other things  The Air Force Life Cycle Management Center within the Air Force Materiel Command is responsible for the life-cycle management of weapon systems from inception to retirement  A Program Executive Officer—responsible for managing a specific portfolio of weapon systems—is responsible for each of the selected fixed-wing aircraft  The Program Executive Officer oversees the program office that manages each weapon system  For the Navy and Marine Corps, the Naval Air Systems Command is responsible for providing the full life-cycle support of naval aviation aircraft, weapons, and systems  This support includes research, design, development and systems engineering; acquisition; test and evaluation; training facilities and equipment; repair and modification; and in-service engineering and logistics support  As with the Air Force, Program Executive Officers oversee their assigned program managers  DOD relies on program managers to lead the development, delivery, and sustainment of individual weapon systems through their life cycles  The program managers are the designated individuals with responsibility for and authority to accomplish the program’s sustainment objectives to meet the users’ operational needs  Product support managers, who work within the program offices, are responsible for developing and implementing support strategies for weapon systems that maintain readiness and control life-cycle costs  Weapon systems are sustained under various arrangements that may include contractors, DOD organic facilities, or some combination of the two  For example, the Air Force Sustainment Center provides depot maintenance through its Air Logistics Complexes for weapon systems  Naval Air Systems Command is responsible for the Navy Fleet Readiness Centers, which provide depot-level maintenance for Navy and Marine Corps fixed-wing aircraft  Additionally, the Air Force Sustainment Center and the Navy Supply Systems Command, as well as the Defense Logistics Agency, manage inventories of repair parts, and individual weapon systems programs are typically supported by a complex supplier network that includes a prime contractor, subcontractors, and various tiers of parts suppliers  On the other hand, sustainment responsibilities—in their entirety or particular elements—may be contracted out as part of a public-private partnership or a performance-based logistics agreement, such as with the F-22 Raptor  The Air Force and Navy monitor the readiness status of selected fixed- wing aircraft through numerous performance metrics  Specifically, the Air Force measures how well a fleet is performing by calculating the availability of the fleets’ aircraft, which is the number of aircraft that are available for flight operations  The Navy measures its aircraft availability through two metrics: (1) Ready-Basic-Aircraft (RBA)—the number of aircraft that are able to safely fly—and (2) Ready-for-Tasking (RFT)—the number of aircraft that are able to conduct specific missions  Both the Air Force and Navy have established goals associated with aircraft availability  In addition to measuring the availability of the aircraft against the associated goals, the Air Force and Navy track the reasons for aircraft not being available or able to conduct missions  Specifically, the Air Force and Navy track the following: Aircraft in depot: Aircraft unavailable to conduct missions because of scheduled or unscheduled depot maintenance or modification  Not mission capable maintenance: Aircraft that are not in depot and not capable of performing any of their assigned missions because of maintenance  Not mission capable supply: Aircraft that are not in depot and not capable of performing any of their assigned missions because of the lack of a repair part  In addition to these three metrics, the Air Force also tracks the following: Not mission capable for both supply and maintenance: Aircraft that are not in depot and not capable of performing any of their assigned missions because of both maintenance and the lack of a repair part  Units possessed not reported: Aircraft that are not available for use for reasons other than depot and not mission capable status, but possessed by the squadron  There are various costs associated with operating and supporting weapon systems  DOD’s Operating and Support Cost-Estimating Guide provides direction to the service components on developing estimates to support various analyses and reviews throughout the program life cycle  According to the guide, as a program matures, it remains necessary to continue to track and assess O&S costs and trends to ensure that the program remains sustainable, affordable, and properly funded  Each military department maintains a database that collects historical data on the O&S costs for major fielded weapon systems  DOD’s Office of Cost Assessment and Program Evaluation provides policy guidance on this requirement, known as the Visibility and Management of Operating and Support Costs program; specifies the common format in which the data are to be reported; and monitors its implementation by each of the military departments  O&S costs are categorized using the following six overarching elements: unit level manpower—cost of operators, maintainers, and other support manpower assigned to operating units; unit operations—cost of unit operating materiel such as fuel, and training material, unit support services, and unit travel; maintenance—cost of system maintenance including depot- and sustaining support—cost of system support activities that are provided by organizations other than the system’s operating units; continuing system improvements—cost of system hardware and software modifications; and indirect support—cost of activities that provide general services that lack the visibility of actual support to specific force units or systems  For the selected Air Force and Navy fixed-wing aircraft in our review, aircraft availability and O&S cost trends varied over the 6-year period between fiscal years 2011 and 2016, and the aircraft generally did not meet availability goals  We found that 6 of 12 fixed-wing aircraft—3 from each service—experienced decreased aircraft availability between fiscal years 2011 and 2016  One aircraft met availability goals each year between fiscal year 2011 and 2016  Conversely, six aircraft met the goals in some years but not others, and five aircraft did not meet the goals in any year  In the latest year included in our review—fiscal year 2016—9 of 12 of the fixed-wing aircraft did not meet their associated availability goals  With respect to O&S costs, the overall O&S total for all 12 aircraft was about $20 billion annually over the 6-year period; some aircraft experienced increases while the costs to operate and support others decreased  The reasons for changes in costs included increases in maintenance costs for 8 of 12 fixed-wing aircraft  Below we summarize these trends, and the “Sustainment Quick Looks” in appendices II–XIII provide detailed information on the trends associated with each of the 12 fixed-wing aircraft and appendix XV provides additional information on operating and support cost per aircraft  Our analysis found that: between fiscal years 2011 and 2016, aircraft availability for two of five selected Air Force fixed-wing aircraft fluctuated and for three decreased; between fiscal 2011 and 2016, two aircraft met availability goals in some years, and three aircraft did not meet availability goals in any of the years; and in fiscal year 2016, four of the five aircraft did not meet availability goals  Specific details regarding aircraft availability and not mission capable status for maintenance, supply, and both maintenance and supply were omitted because DOD deemed this information as sensitive (i e , For Official Use Only)  According to officials, when aircraft availability goals are not met, training and operational missions may not be fulfilled as timely as needed  For example, F-22 squadron officials explained that the lack of available aircraft creates a shortage of trained pilots  F-22 pilots need extensive training to fulfill their air-superiority role  Further, command officials explained that when aircraft availability goals are not met, there may not be enough aircraft to respond to contingency requirements  Officials expressed concern that, given the capability and expectation of the F-22 to be available to create air superiority in any operation, missions may not be met  Additionally, E-8C program office officials stated that missions are often limited to top priority, which means supported combatant commands may not obtain all needed capabilities, such as the E-8C not being able to provide surveillance capability to particular combatant commands  From fiscal years 2011 through 2016, O&S costs for the Air Force aircraft in our review totaled about $13 billion annually  These costs decreased for the C-17, F-16, and the F-22, but increased for the B-52 and E-8C, as shown in figure 2  For example, the F-16’s total annual O&S costs decreased by about $943 million (or about 19 percent) because of decreases in all cost elements—the largest decrease being unit operations—except sustaining support  According to officials, the decrease in unit operations can be attributed to the retiring of aircraft and the consolidation of squadrons  The C-17’s and F-22’s O&S costs decreased mainly because of decreases in two cost elements: continuing system improvements and unit operations  In contrast, the B-52’s and the E-8C’s O&S costs increased, by $76 million (or about 6 percent) and $41 million (or about 6 percent), respectively  The increases occurred because two of the cost elements—continuing system improvements and maintenance costs—increased more than the other costs elements decreased  Based on our analysis of the O&S cost elements, maintenance cost generally is one of the largest portions—on average about 36 percent—of total O&S costs for each aircraft  As shown in figure 3, maintenance costs for four of the five aircraft generally have increased from fiscal years 2011 through 2016  Specifically, maintenance costs for the C-17, E-8C, and F- 22 increased because of additional depot maintenance needs  B-52 maintenance costs fluctuated year to year, but increased overall during this period  The overall maintenance costs for the F-16 decreased by approximately $140 million  According to our analysis, even though there was an increase in some of the F-16 maintenance cost elements, the fleet’s executed flying hours decreased  Therefore, the flying hour depot- level reparable costs decreased by approximately $123 million and engine repair decreased by $115 million, causing the overall maintenance cost to decrease  Our analysis found that: between fiscal years 2011 and 2016, aircraft availability increased for three of the seven Navy fixed-wing aircraft, fluctuated for one, and decreased for the remaining three aircraft; between fiscal 2011 and 2016, one aircraft met aircraft availability goals in each year, and four aircraft met goals in some years, while two aircraft did not meet goals in any of the years; and in fiscal year 2016, the Navy did not meet aircraft availability goals for five of the seven aircraft  Specific details regarding aircraft availability and not mission capable status for maintenance and supply were omitted because DOD deemed this information as sensitive (i e , For Official Use Only)  To address decreases in aircraft availability, the Navy has moved available aircraft between squadrons to help ensure deploying squadrons are fully equipped for their assigned missions  In November 2017, the Commander of Naval Air Forces testified before the House Armed Services Committee that to equip the air wings with the required number of mission capable aircraft for the deployment of three aircraft carriers in 2017, the Navy had to transfer 94 strike fighters to and from the maintenance depots or between squadrons  This transfer included pulling aircraft from fleet replacement squadrons, where the focus should be on training new aviators  The Commander of Naval Air Forces, in his November 2017 testimony, summarized the issue: “That strike fighter inventory management, or shell game, leaves non-deployed squadrons well below the number of jets required to keep aviators proficient and progressing toward their career qualifications and milestones, with detrimental impacts to both retention and future experience levels ” Furthermore, based on our analysis, F/A- 18A-D squadrons have underexecuted their flight hours by an average of 4 percent from fiscal years 2011 through 2016  According to officials, this is largely due to low aircraft availability  Additionally, placing further strain on aircraft availability, the F/A-18A-D inventory has decreased from 581 aircraft in fiscal year 2011 to 537 aircraft in fiscal year 2016  From fiscal years 2011 through 2016, O&S costs for the Navy’s seven selected fixed-wing aircraft totaled about $7 billion annually  Also, the Navy has experienced varying O&S and maintenance costs since fiscal year 2011 for these aircraft  Specifically, annual O&S costs decreased for the AV-8B, C-2A, E-2C, and F/A-18A-D, and increased for the E-2D, EA- 18G, and F/A-18E-F, as shown in figure 4  We found that O&S costs for the F/A-18A-D decreased by about 22 percent from about $3 1 billion in fiscal year 2011 to about $2 4 billion in fiscal year 2016  According to officials, this decrease can be attributed to the decrease in inventory as aircraft are retired and squadrons transition to the F-35 Joint Strike Fighter  In another example, O&S costs for the E- 2D increased from about $1 6 million in fiscal year 2012 to about $125 million in fiscal year 2016  The size of the fleet has increased by 17 aircraft—from 3 to 20 since fiscal year 2011  According to officials, this aircraft remains in production with a projected fleet size of 75; as inventory increases, so will O&S costs  Based on our analysis of the O&S cost elements, maintenance cost generally is one of the largest portions—about 42 percent—of total O&S costs for the seven aircraft in our review  Annual maintenance costs have increased for the C-2A, E-2D, EA-18G, and F/A-18E-F, and decreased for the AV-8B, E-2C, and F/A-18A-D, as shown in figure 5  We found that maintenance cost for the C-2A increased by about 7 percent from about $89 million in fiscal year 2011 to about $95 million in fiscal year 2016  According to officials, the increase in maintenance cost can be attributed to increased demand for outer wing panels, which resulted in a $16 million increase in depot-level repair costs and a more than 10 percent increase in executed flight hours, among other things  In another example, maintenance cost for the AV-8B decreased by about 9 percent from about $375 million in fiscal year 2011 to about $341 million in fiscal year 2016  According to officials, these decreases can be attributed to the AV-8B no longer being used in Operation Enduring Freedom in 2012, the loss of six aircraft, and the transition of AV-8B squadrons to the F-35 Joint Strike Fighter  The Air Force and Navy face similar sustainment challenges that relate to aging, maintenance, and supply support that affect aircraft availability and O&S costs for the 12 aircraft selected in our review, as shown in figure 6  Specifically, 10 of 12 aircraft are experiencing sustainment challenges related to aging; all 12 are experiencing challenges related to maintenance; and all 12 are also experiencing challenges related to supply support  Below is a brief overview of these challenges: Aging: A number of these aircraft are aging and operating beyond their planned service life, partly because of delays in replacement aircraft  Specifically, the Air Force and Navy plan to replace the F-16, AV-8B, and F/A-18A-D with the F-35 Joint Strike Fighter  The Navy is expected to transition the F/A-18A-D through 2030 and the Marine Corps is planning to use the F/A-18A-D beyond 2030 (although these time frames have been extended several times already)  The Navy plans to retire the AV-8B in 2026  On the other hand, the Air Force is not expected to retire the F-16 until at least 2040  Because of aging, according to officials, there are parts on some aircraft that need to be repaired and replaced that were not accounted for during initial sustainment analysis  To mitigate some challenges associated with the age of the fixed-wing aircraft, the Air Force and Navy program officials have decided to extend the service life of some aircraft by repairing and overhauling airframes and components, as well as developing the engineering specifications for parts that were never planned to be repaired or replaced  Maintenance: Delays in getting aircraft into and through depot maintenance, as well as shortages of skilled maintainers, are contributing to some aircraft missing their availability goals  Both services reported losing experienced maintainers, either to retirement or to other programs such as the F-35 Joint Strike Fighter  To address maintenance challenges, program offices for the selected aircraft have improved the efficiency and speed of depot maintenance, as well as are working to ensure there are sufficient numbers of trained maintainers  Supply Support: Some aircraft are encountering supply shortages as a result of parts not being available, in some cases due to obsolescence issues or diminishing manufacturer sources  Overcoming part shortages through either searching for replacement parts or reengineering parts takes time, which can contribute to aircraft being unavailable for longer periods  To mitigate supply challenges, officials have proactively upgraded aircraft before obsolescence occurs or located available parts and reengineered parts that are no longer in production, as well as identified suitable manufacturers in advance, among other things  For more specific information on sustainment challenges related to aging aircraft, maintenance, and supply support for each of the fixed-wing aircraft, see the “Sustainment Quick Looks” in appendixes II–XIII  The Air Force has documented sustainment strategies for its five selected aircraft in our review, but the Navy has not documented sustainment strategies or updated the strategies for four of seven of its aircraft in our review  The Air Force and Navy also regularly reviewed sustainment metrics and have implemented plans to improve aircraft availability  The Air Force has documented sustainment strategies for the five selected fixed-wing aircraft and updated them in accordance with Air Force guidance  However, the Navy has not documented a sustainment strategy or updated the strategies for four of the seven aircraft in our review since 2012  See figure 7 for the year of the most recent update to the sustainment strategy for the aircraft in our review  While sustainment strategies do not guarantee successful outcomes, they serve as a tool to guide operations as well as support planning and implementation of activities through the life-cycle of the aircraft  Specifically, at a high-level the strategy is aimed at integrating requirements, product support elements, funding, and risk management to provide oversight of the aircraft  For example, these sustainment strategies can be documented in a life-cycle sustainment plan, postproduction support plan, or an in-service support plan, among other types of documented strategies  Additionally, program officials stated that an aircraft’s sustainment strategy is an important management tool for the sustainment of the aircraft by documenting requirements that are known by all stakeholders, including good practices identified in sustaining each aircraft  For example: The strategy for the Air Force B-52 has been updated several times in recent years because of several major modifications  For example, in 2014 the Air Force issued an updated sustainment plan within the life- cycle management plan to update the combat network communications technology program because the B-52’s communications system is still the original from the 1950s and has limitations related to making mission or target changes in flight  The plan addresses the testing, resource management, and numerous program performance indicators and requirements of the system  The strategy for the Air Force F-16 outlines plans for the aircraft’s service life extension and includes proactive measures and data forecasting to bundle depot modifications in order to minimize fleet- wide effects on aircraft availability  The service life extension for the F- 16 is designed to extend the service life of 300 F-16 aircraft from 8,000 to 13,856 flight hours at an estimated cost of $740 million (as of June 2016)  The strategy for the Navy E-2D provides a systematic approach to ensure that a comprehensive support package is in place to support the sustainment of the aircraft  Also, it describes the overall plan for the management and execution of the product support package by communicating the sustainment strategy to stakeholders in the acquisition, engineering, and logistics communities  However, the Navy had not documented a sustainment strategy for the C- 2A because a strategy was not required when the aircraft, now a legacy system, was going through the acquisition process prior to 1965  According to Navy officials, while they have not documented a strategy for the C-2A, they are undertaking efforts, such as updating technical publications, performing maintenance analysis on the landing gear, and evaluating depot tasks to decrease turnaround time, among other efforts, to sustain the aircraft  However, a documented sustainment strategy for the C-2A would help guide the planning and implementation of these efforts, as well as serve as a management tool by documenting these requirements that are known by all stakeholders  In addition, the Navy’s sustainment strategies for the E-2C (2011), EA- 18G (2006), and F/A-18A-D (2001) were developed prior to 2012 and thus have not been updated in over 5 years  With respect to the EA-18G, Navy officials told us that the sustainment strategy should be updated in accordance with DOD’s acquisition policy—DOD Instruction 5000 02— since the EA-18G is still in the acquisition process, as it continues to be produced  For the E-2C and F/A-18A-D, Naval Air Systems Command officials and program office officials told us that they were not required to document sustainment strategies because these aircraft were legacy systems at the time the requirement to develop and maintain a sustainment strategy was implemented  Therefore, according to these officials, the DOD requirements to document and update sustainment strategies every 5 years in DOD Instruction 5000 02 were not applicable  DOD Instruction 5000 02 requires weapon systems to have some form of a sustainment strategy that is not older than 5 years; however, it is unclear whether this policy is applicable to legacy weapon systems  Specifically, the policy states that program managers for all programs are responsible for developing and maintaining a sustainment strategy, such as a Life-cycle Sustainment Plan, beginning at the risk-reduction decision point (i e , Milestone A of the acquisition process)  However, based on our discussions with Navy program officials for our selected aircraft and our review of the policy, it is unclear whether the policy—as currently written—is applicable to legacy systems that were no longer in production and thus had completed the risk-reduction decision point (or Milestone A) prior to the requirement to update a sustainment strategy every 5 years  According to DOD officials, the intent of the policy is for all programs, including legacy weapon systems, to develop and maintain a sustainment strategy; however, the policy does not explicitly state that legacy systems are expected to fulfill this requirement  In May 2017, the Air Force updated its sustainment guidance to require sustainment strategies for legacy systems and for those strategies to be updated every 5 years  Air Force officials told us that they did this because the DOD policy was unclear whether it was applicable to legacy systems and it was a good practice to ensure the guidance was explicit for all weapon systems to document and update a sustainment strategy  This instruction explicitly states that the requirement to document a sustainment strategy and update it every 5 years is applicable to all weapon systems, including legacy systems that are in the O&S phase of their life cycles  Additionally, the Air Force Instruction states that these legacy systems are not required to retroactively meet requirements identified for previous phases of the acquisition life-cycle, but should meet the requirements needed for continued operations of the system  However, the Navy has not made the requirement explicit for legacy systems in its guidance  Specifically, Navy guidance does not explicitly state that documenting a sustainment strategy and updating that strategy every 5 years is a requirement for legacy systems  While Navy guidance requires the development and use of sustainment metrics for legacy systems and requires the Naval Air Systems Command be responsible for aviation weapon systems in sustainment, the Navy does not address any requirement for sustainment strategies for legacy systems  The lack of clarity in DOD Instruction 5000 02 and the Navy guidance regarding whether legacy systems are required to document a sustainment strategy and update that strategy every 5 years has resulted in confusion regarding sustainment planning requirements among Navy program offices and could cause confusion with other weapon system program offices across DOD  Standards for Internal Control in the Federal Government state that management should define objectives in specific terms so they are understood at all levels of the entity  The standards also state that guidance should clearly define what is to be achieved, who is to achieve it, how it will be achieved, and the time frames for achievement  As indicated by the Air Force’s 2017 update to its sustainment guidance, clarifying DOD and Navy guidance and the applicability of sustainment strategy requirements to legacy systems could be done through very small additions and clarifications to the applicable guidance documents  Until DOD and the Navy update or issue new guidance clarifying the requirements for documenting sustainment strategies for legacy systems, weapon system program offices, such as those for fixed-wing aircraft, as well as Naval Air Systems Command and DOD may not have full visibility of necessary requirements to achieve program objectives or any related risks associated with the sustainment of these weapon systems  While the DOD policy and Navy guidance is unclear, Naval Air Systems Command and Navy program offices for the four aircraft—C-2A, E-2C, EA-18G, and F/A-18A-D—that either do not have a sustainment strategy or have not updated the strategy within the last 5 years are taking actions to document or update the sustainment strategies for these aircraft  According to Naval Air Systems Command officials, once it was brought to their attention that the intent of DOD Instruction 5000 02 was for legacy systems to have an updated documented sustainment strategy, they began to take action to develop or update the respective sustainment strategies  Specifically, according to C-2A, E-2C, and E-2D program officials, they are currently updating the E-2D strategy for its 5-year update, which is due in fiscal year 2018, and it will include updates for the C-2A and E-2C since the airframe for all three aircraft are very similar  Also, program officials for the EA-18G and F/A-18A-D told us that they are currently updating the strategies for these aircraft and are expected to complete the process in fiscal year 2018  Given that the Navy is already taking action to update its sustainment strategies and has established timelines for these updates, we are not making any recommendations to the Navy regarding updating the respective sustainment strategies  The Air Force and the Navy have (1) regularly reviewed sustainment metrics for fixed-wing aircraft and (2) implemented improvement plans to address aircraft availability  The Air Force and Navy have regularly monitored the condition of their fixed-wing aircraft, which includes measuring aircraft availability against planned goals as well as monitoring other sustainment metrics  Specifically, the Air Force Materiel Command monitors aircraft availability and other sustainment metrics through quarterly Weapon System Enterprise Review (WSER) briefings  The program office in conjunction with the Air Force Life Cycle Management Center generates the WSER, which is briefed through Air Force Materiel Command and the Program Executive Offices to the Air Force Chief of Staff  The WSER delivers insight into the comprehensive health of a system by flagging gaps in performance and identifying mitigating actions, which is used to conduct crosscutting enterprise analysis and provide input into readiness reviews  In addition to the WSER, the program offices manage their performance through their Health of the Fleet briefs  These briefs—conducted monthly or quarterly depending upon the aircraft—include readiness assessments that provide insight on maintenance and management practices  The assessment is delivered by the program’s maintenance group, and includes aircraft performance metrics, issues, actions, and schedules to inform program leadership on fleet status and to help prioritize and make decisions concerning the issues  The Navy monitors aircraft availability through its aircraft status dashboard for each aircraft, which provides specific information, such as goals, actual availability, and gaps between the two  More specifically, the Navy tracks the status of each of its aircraft through the dashboard, including those aircraft that are available (i e , Ready-Basic-Aircraft ), are in depot maintenance, or are not mission capable due to maintenance or supply, among other metrics  The dashboard is updated monthly, and there are weekly meetings with key stakeholders, including Naval Air Systems Command officials, industry partners, and depot officials, to monitor the performance of each aircraft and make adjustments to improve aircraft availability  Additionally, all program offices have processes in place to manage the fleet within their portfolios, including semiannual or annual program reviews such as Program Management Reviews and Executive Steering Reviews  These reviews focus on readiness, cost drivers, and initiatives to address program risk and ways to resolve issues affecting each aircraft  Further, the Marine Corps Commandant for Aviation leads biannual Executive Steering Summits to assess readiness issues affecting Marine Corps aircraft  The Air Force and Navy have implemented improvement plans to address aircraft availability for each of the selected fixed-wing aircraft  Air Force program offices for the fixed-wing aircraft in our review have plans for improving availability  Since 2005, the Air Force Materiel Command has had an annual process to improve aircraft availability, which is known as the Aircraft Availability Improvement Program  The process enables the program offices to assess and limit risk, incorporate available support funding, and specifically address where there are effects on availability, such as aircraft in depot  This process also incorporates projecting historical and goal rates in order to leverage scheduled and modernization maintenance  Program offices create plans, known as aircraft availability improvement plans, based on these projections to forecast improvements that can facilitate increased availability and reduction of costs, among other things  The Air Force provides guidance in the form of a template to ensure consistency amongst the plans, which typically must include improvement initiatives with milestone goals  This information includes projected aircraft availability rates for mission capable, units possessed not reported, not mission capable for supply, not mission capable for maintenance, and depot possession  Officials noted that the program office creates an improvement plan each year, regardless of whether it is short of its availability goal, since the plan serves as a forecasting measure  The program is designed to ensure the program offices have plans in place to meet target goals, and the information and milestones laid out in the plans feed into the WSER briefings to senior management  For example: The B-52 plan for fiscal year 2017 discusses the process and milestones for replacing actuator seals for the fleet, the costs of the repair, and the expected benefit to B-52 availability—1 05 percent improvement to the not mission capable supply metric  The C-17 plan for fiscal year 2017 identifies the current and future modifications, timelines for beginning and completion, and the effect on availability  For example, the future replacement of a legacy computer system with a modernized system and display is set to begin in fiscal year 2019 with an estimated completion date of 2026  This replacement is planned to be done concurrently with other maintenance, and to prevent future declines in the C-17’s availability  The F-22 plan for fiscal year 2017 identifies several projects taking place between 2016 and 2021 that are expected to improve availability by almost 2 percent  Further, officials said they are currently working with the Assistant Secretary of the Air Force (Acquisition) to develop an Air Force manual that would make developing an Aircraft Availability Improvement Plan a requirement  This manual will become a supplement to Air Force Instruction 63-101/20-101, according to the officials  Navy program offices for all seven fixed-wing aircraft in our review also have plans for improving availability  According to Navy officials, they started preparing “summary playbooks,” which is the Navy’s term for improvement plans, in late 2015 and started implementing these plans in early 2016 to increase aircraft availability  Officials told us that there was a limitation in funding because of sequestration prior to fiscal year 2017, which hampered their ability to fully implement the playbooks  At a broad level, the Navy’s playbooks include efforts such as maintenance planning, supply support, aircraft material condition and management, and technical data, among other things  These efforts are linked to specific initiatives such as working with the manufacturer and contractors to provide maintenance support, identifying obsolete parts, conducting aircraft fatigue analysis, and updating technical publications, among other things, which have been identified by the program office as ways to improve aircraft availability  Additionally, these playbooks include the extent to which these initiatives are funded, underfunded, or partially funded and the appropriation account that would fund each initiative  The playbooks include the status of each initiative, and some of the playbooks also provide an approximate time frame for implementing each initiative  For example: The playbook for the C-2A has a fatigue analysis initiative focused on analyzing the landing gear to update its design, provide a depot repair manual, and increase its service life, among other things  This initiative is considered funded, is expected to improve aircraft availability, and has an estimated time frame for implementation between fiscal years 2017 and 2021  The playbook for the E-2D contains a maintenance initiative focused on improving the maintenance planning process of the C-2A, E-2C, and E-2D aircraft by completing elements of the product support package, such as training, publications, support equipment, and tools, among others  This initiative is considered partially funded, is expected to improve aircraft availability by decreasing the not mission- capable rates related to maintenance and supply and decreasing maintenance down time, and has an estimated time frame for implementation between fiscal years 2017 through 2019  The playbook for the F/A-18A-D includes a product improvement initiative to conduct a case study to assess the condition of the wiring of the aircraft in the fleet  This initiative is considered funded and is expected to help to sustain aircraft availability  However, there is no time frame for implementing this initiative  The playbook for the F/A-18E-F contains a service life modification initiative focused on extending the service life of the aircraft through modifications  According to officials, this initiative is considered partially funded, is expected to help to sustain aircraft availability, and is expected to help the fleet realize an 80 percent cost avoidance because the Navy will not have to pay the cost to replace these aircraft  Also, this initiative has an estimated time frame for implementation between fiscal years 2018 through 2040  The Departments of the Air Force and Navy spend tens of billions of dollars each year to sustain their fixed-wing aircraft, which need expensive logistics support, including maintenance and repair, to meet goals for availability  The departments spent at least $20 billion annually since 2011 to sustain the 12 aircraft that we examined  The Air Force and Navy share a variety of sustainment challenges, including the age of their aircraft as well as maintenance and supply support issues  These challenges have led to half (6 of 12) of the aircraft in our review experiencing decreasing availability and to the aircraft in general not being able to meet aircraft availability goals  For example, 9 of 12 aircraft did not meet availability goals in fiscal year 2016  These trends are occurring even though the Air Force and Navy regularly review sustainment metrics for the aircraft and are implementing plans for improving aircraft availability  However, DOD’s policy and the Navy’s guidance are not clear on whether the services should have a current sustainment strategy for legacy weapon systems, including fixed-wing aircraft, and on whether the strategies are required to be updated every 5 years  Without clarity about whether the DOD instruction and the Navy guidance apply to legacy systems, program officials will not know whether they are required to have a sustainment strategy or are required to update the plan for their respective fixed-wing aircraft  Furthermore, the program offices, the services, and DOD may not have full visibility of necessary requirements to document program objectives, related risks, and the effectiveness of the program, ultimately jeopardizing the sustainability and affordability of each of the programs  We are making the following two recommendations to DOD: The Secretary of Defense should ensure that the Under Secretary of Defense for Acquisition and Sustainment updates or issues new policy clarifying the requirements for documenting sustainment strategies for legacy weapon systems, including fixed-wing aircraft  (Recommendation 1) The Secretary of the Navy should update or issue new guidance clarifying the requirements for documenting sustainment strategies for legacy weapon systems, including fixed-wing aircraft  (Recommendation 2) We provided a draft of the sensitive report to DOD for review and comment  In written comments that are reproduced in appendix XVI, DOD concurred with our recommendations and noted planned actions to address each recommendation  The Air Force and Navy also provided technical comments, which we incorporated as appropriate  We are sending copies of this report to the appropriate congressional committees; the Secretary of Defense; the Secretaries of the Navy and Air Force; the Commandant of the Marine Corps; the Under Secretary of Defense for Acquisition and Sustainment; and the Director, Defense Logistics Agency  In addition, the report is available at no charge on the GAO website at http://www gao gov  If you or your staff have questions about this report, please contact me at merrittz@gao gov or (202) 512-5257  GAO staff who made key contributions to this report are listed in appendix XVII  Over the past several years, we have conducted work on a number of issues that affect the ability of the Department of Defense (DOD) to sustain its weapon systems  In September 2017, we found that several factors were important to the success of Product Support Managers  These factors included teamwork and collaboration, early implementation of the Product Support Manager position, and organizational support and emphasis on sustainment  We also found that in response to our 2014 recommendations regarding the implementation of the Product Support Manager position, DOD had developed a comprehensive career path and associated guidance to develop, train, and support future Product Support Managers  Additionally, DOD revised guidance to define roles, responsibilities, and reporting relationships between support staff and Product Support Managers  However, DOD was still in the process of implementing our other three recommendations, such as issuing clear, comprehensive, centralized guidance regarding the roles and responsibilities of PSMs and collecting and evaluating information on the effects, if any, that Product Support Managers are having on life-cycle sustainment decisions for their assigned weapon systems  In September 2017, we also found that DOD does not have complete information to identify and manage single-source-of-supply risks  Specifically, some parts are provided by a single source of supply (e g , one manufacturing facility), and if that single source were no longer able to provide the part, DOD could face challenges in maintaining weapon systems  DOD concurred with our six recommendations focused on improving the completeness of information for single-source-of-supply risks, including issuing department-wide policy that clearly defines requirements of Diminishing Manufacturing Sources and Material Shortages management, and details responsibilities and procedures to be followed to implement the policy  DOD is in the process of taking action to implement these recommendations  In June 2016, we found that the Defense Logistics Agency and the military services have not adopted metrics to measure the accuracy of planning factors, such as the accuracy of part lists, or the costs created by backorders  As a result, depot maintenance may not be efficient or cost-effective, resulting in unnecessary delays in the repair of weapon systems  DOD concurred with our six recommendations to develop metrics to monitor the accuracy of demand planning factors and disruption costs created by the lack of parts at depot maintenance sites and is in the process of taking action to implement these recommendations  For a listing of relevant past GAO work, see the Related GAO Products list at the end of this report  Sustainment: Depot maintenance conducted organically at the designated air logistics complex and contractually for some depot- level repairs at contractor facilities  The B-52 is a long-range, heavy bomber that can perform a variety of missions, including strategic attack, close air support, air interdiction, maritime operations, and offensive counter-air missions  It can carry nuclear or precision-guided conventional ordnance with worldwide precision navigation capability  However, the B-52s are some of the oldest aircraft in the Air Force’s fleet, and will continue to operate until at least 2040 (see fig  8)  Operating and support (O&S) costs for the B-52s have remained relatively steady, generally fluctuating around $1 2 billion–$1 3 billion per year  As a predominantly military-maintained system, most of that O&S cost is related to maintenance and manpower, with depot maintenance and depot-level reparables—direct labor and materials for item repairs, transportation, and storage, among other things—accounting for most of the maintenance cost  Technology Program (2014) is focused on upgrading outdated communications technology  The communications modification requires 7,000 hours of work and is estimated to be complete by 2020  The fleet has active sustainment plans for other components of the aircraft, such as the B-52 Anti-skid Replacement Life Cycle Sustainment Plan (2015), which is estimated to cost over $40 million and be completed by 2019  The B-52 faces sustainment challenges related to its age and, according to officials, replacement parts are difficult to obtain  Several modernization efforts are under way (communications, engines, etc ), and is working with vendors and its own service engineers to identify problem areas and plan ahead so that replacement parts will be available  Depot maintenance on the B-52 is managed by the program office and conducted at Oklahoma City Air Logistics Complex depot  This report is a public version of a sensitive report that we issued on April 25, 2018  DOD deemed some of the information, such as aircraft availability, not mission capable rates, number of aircraft in depots, and budgeted and executed flight hours to be sensitive (i e , For Official Use Only)  This public report omits the information that DOD deemed to be sensitive  The C-17 is a long-range, heavy logistic transport aircraft powered by four F-117 turbofan engines with air-refueling capability that was first manufactured in 1987 (see fig  10)  It is capable of rapid strategic delivery of troops and all types of cargo to main operating bases or to bases in any forward deployment area  The C-17 can perform tactical airlift and airdrop missions and can transport ambulatory patients during aeromedical evacuations, when required  The C-17 can carry virtually all air-transportable equipment  Total operating and support (O&S) costs for the C-17 have decreased from about $5 3 billion in fiscal 2011 to about $4 0 billion in fiscal year 2016  Specifically, unit operations decreased, while maintenance costs have generally increased during this period due to contractor logistics support because the C-17 is a predominantly contractor-managed aircraft  The C-17 Enterprise Life Cycle Management Plan and Life Cycle Sustainment Plan (2014) documents current and future acquisition, sustainment, and integration efforts of the aircraft  It also addresses contractual arrangements and partnership support agreements between Air Force, Boeing, and other service providers for aircraft sustainment  Boeing provides continued sole-source life-cycle support for the C-17 under the terms of the Globemaster Integrated Sustainment Program (2013)  Under this program, Boeing is responsible for sustainment, to include material management and depot maintenance support  The C-17 participates in a virtual fleet arrangement, a global network of 43 additional C-17 aircraft, which allows participants total aircraft parts access from any fleet participant worldwide  The C-17 is an aircraft being modified to meet its requirements as well as to address maintenance and supply issues  The Air Force’s actions to mitigate these challenges include processes to increase the service life of the aircraft, allowing managers to quickly hire skilled workers for critical positions, and locating other vendor source for parts  Logistics Complex, and at its facility in San Antonio; landing gear overhaul occurs at Ogden Air Logistics Complex, and engine overhaul occurs at Oklahoma City Air Logistics Complex in partnership with Pratt & Whitney, the original equipment manufacturer on the F-117 turbofan engine  This report is a public version of a sensitive report that we issued on April 25, 2018  DOD deemed some of the information, such as aircraft availability, not mission capable rates, number of aircraft in depots, and budgeted and executed flight hours to be sensitive (i e , For Official Use Only)  This public report omits the information that DOD deemed to be sensitive  Sustainment: Depot maintenance conducted by Northrop Grumman, and field maintenance conducted organically, by the National Guard  The E-8C Joint Surveillance Target Attack Radar System (E-8C) was first manufactured in 1967 (see fig  12)  Its primary mission is to provide theater ground and air commanders with ground surveillance to support attack operations and targeting that contributes to the delay, disruption, and destruction of enemy forces  Total operating and support (O&S) costs for the E-8C have generally increased from about $686 million in fiscal year 2011 to about $734 million in fiscal year 2016  Specifically, maintenance cost has increased partly because of increases in contractor logistics support since the E-8C is maintained by Northrop Grumman  E-8C aircraft were formerly used as commercial airliners and purchased by the Air Force  Therefore, the exact usage of the aircraft was unknown with any degree of specificity  The program office has utilized new analysis conducted by Boeing to develop an improved method of determining and tracking service life for the E-8C aircraft  The new method uses a quantitative analysis capability to identify safety of flight structural concerns, allowing for planning and execution of risk mitigation  The E-8C is an aircraft with significant maintenance and supply issues according to Air Force officials  The Air Force’s actions to mitigate these challenges include updating the Maintenance Plan and the Corrosion Plan for the E-8C (formerly a commercial airframe) to bring them in line with military standards  This report is a public version of a sensitive report that we issued on April 25, 2018  DOD deemed some of the information, such as aircraft availability, not mission capable rates, number of aircraft in depots, and budgeted and executed flight hours to be sensitive (i e , For Official Use Only)  This public report omits the information that DOD deemed to be sensitive  Sustainment: Depot maintenance conducted organically at the designated air logistics complex, and field maintenance conducted organically and by contractors  The F-16 Fighting Falcon is a compact, single-engine, multirole fighter aircraft first manufactured in 1978 (see figure 14)  It is highly maneuverable and participates in air-to-air combat and air-to-surface attack  There are four versions of the F-16: A, single-seat model; B, two-seat model with tandem cockpits; C and D, single- and two-seat models, respectively, incorporating newer capabilities  Total operating and support (O&S) cost for the F-16 decreased from about $5 billion in fiscal year 2011 to about $4 billion in fiscal year 2016 because of a 6 percent reduction of inventory  Specifically, maintenance cost has generally decreased during this same period as a result of a decrease in cost of depot maintenance  Sustainment: Performance-based logistics contract with depot maintenance subcontracted to Ogden Air Logistics Complex, Utah, and field maintenance performed organically  and is designed to project air dominance, rapidly and at great distances, and defeat threats  Overall operating and support costs (O&S) for the F-22 have decreased about $248 million overall since fiscal year 2011  Maintenance issues continue to be an area of concern for the aircraft, and these costs increased approximately $255 million from fiscal years 2011 to 2016, due to increases in contractor logistics costs  maintaining a comprehensive diminishing manufacturing sources program and proactively supporting the continued sustainment of component parts of the aircraft through various replacement programs, such as the F-22 Reliability and Maintainability Maturation  This initiative is an ongoing effort to drive continuous improvement in availability  The F-22 faces issues with its low- observable coating and supply funding  Actions to mitigate these challenges include contracting a repair facility to conduct coating reversion repair and securing additional spares funding  This report is a public version of a sensitive report that we issued on April 25, 2018  DOD deemed some of the information, such as aircraft availability, not mission capable rates, number of aircraft in depots, and budgeted and executed flight hours to be sensitive (i e , For Official Use Only)  This public report omits the information that DOD deemed to be sensitive  The AV-8B Harrier (AV-8B) is a Vertical/Short Take-off and Landing attack aircraft first manufactured in 1984 (see fig  18)  The AV-8B has the capability of conducting close air support using conventional weapons for intermediate range intercept and attack missions  The AV-8B is capable of deploying and operating on aircraft carriers and other suitable seagoing platforms, advanced bases, expeditionary airfields, and remote tactical landing sites  Total operating and support (O&S) costs for the AV-8B have decreased from about $815 million in fiscal year 2011 to about $646 million in fiscal year 2016  Specifically, unit-level manpower and operations as well as maintenance costs have decreased partly because the inventory is decreasing as AV-8B squadrons transition to the F-35 Joint Strike Fighter  Average number of flying hours: 4,711 hours per aircraft Operating and support cost: $646 million Depot maintenance activity and squadron locations: AV-8B Program Strategic Sustainment and Warfighting Relevance Plan (2013) addresses strategic sustainment and warfighting requirements to ensure relevance, reliability, safety, and sustainability through five pillars: recruit and retain high-quality people, develop a comprehensive readiness and sustainment plan, meet combatant commander requirements, retain and sustain government and industry agencies to support engineering and logistics requirements, and integrate capabilities to remain tactically relevant and operationally effective  AV-8B is maintained organically at Navy Fleet Readiness Centers under planned maintenance intervals occurring every 1,500 flight hours; supply support is provided organically by Naval Supply Systems Command and Defense Logistics Agency; contractor support services are provided by Boeing  This report is a public version of a sensitive report that we issued on April 25, 2018  DOD deemed some of the information, such as aircraft availability, not mission capable rates, number of aircraft in depots, and budgeted and executed flight hours to be sensitive (i e , For Official Use Only)  This public report omits the information that DOD deemed to be sensitive  Manufacturer: Grumman Corporation (acquired by Northrop Grumman) The C-2A Greyhound Logistics Aircraft (C-2A) is a high-wing, twin-engine monoplane cargo aircraft first manufactured in 1965 (see fig  20)  It is designed to land on aircraft carriers, with a primary mission of providing critical logistics support to Carrier Strike Groups by transporting high-priority cargo, mail, and passengers between carriers and shore bases  The original C-2A aircraft were overhauled to extend their operational life in 1973 and again from 2004 through 2011  Total operating and support (O&S) costs for the C-2A have generally decreased from about $233 million in fiscal year 2011 to about $207 million in fiscal year 2016  Specifically, unit-level manpower, unit operations, and continuing system improvements have decreased, while maintenance costs have increased  landing gear, and avionics system, among others  The Navy will include an appendix for the C-2A when it updates the sustainment strategy for the E 2D for its 5-year update  C-2A completed a service life extension program from 2004 through 2011 to increase flight hours from 10,000 to 15,000 and landings from 16,020 to 36,000, among other things  Aircraft are maintained organically by field maintainers and at Navy Fleet Readiness Centers under a planned maintenance interval cycle with three planned maintenance interval events occurring consecutively every 24 months, and supply support is provided organically by the Naval Supply Systems Command and Defense Logistics Agency  This report is a public version of a sensitive report that we issued on April 25, 2018  DOD deemed some of the information, such as aircraft availability, not mission capable rates, number of aircraft in depots, and budgeted and executed flight hours to be sensitive (i e , For Official Use Only)  This public report omits the information that DOD deemed to be sensitive  The E-2 Hawkeye (E-2C) is the Navy’s all-weather, carrier-based tactical battle management, surface surveillance coordination and airborne early warning, command and control aircraft, with a planned sunset in 2026 when the last E-2D is delivered (see fig  22)  The E-2 is a twin-engine, five- crewmember, high-wing turboprop aircraft with a 24-foot diameter radar rotodome attached to the upper fuselage  Total operating and support (O&S) costs for the E-2 have decreased from about $536 million in fiscal year 2011 to about $345 million in fiscal year 2016  Specifically, unit manpower and maintenance costs have decreased, partly because E-2C inventory is decreasing as E-2C squadrons transition to the E-2D fleet  comprehensive sustainment logistics, engineering programs, and financial resources necessary to ensure continued platform sustainment and attainment of readiness and safety operations  The Navy will include an appendix for the E-2C when it updates the sustainment strategy for the E-2D for its 5-year update  E-2C is maintained organically by field maintainers and at Navy Fleet Readiness Centers under a planned maintenance interval cycle: initial planned maintenance interval is performed by field maintainers at 42 months and the second cycle is performed at a Fleet Readiness Center 46 months after the initial planned maintenance interval  Supply support is provided organically by the Naval Supply Systems Command and Defense Logistics Agency; contractor support services are provided by General Dynamics and Wyle Labs  This report is a public version of a sensitive report that we issued on April 25, 2018  DOD deemed some of the information, such as aircraft availability, not mission capable rates, number of aircraft in depots, and budgeted and executed flight hours to be sensitive (i e , For Official Use Only)  This public report omits the information that DOD deemed to be sensitive  The E-2 Advanced Hawkeye (E-2D) is the newest variant of the E-2 aircraft platform, expecting to reach full operational capability by 2027 (see fig  24)  Using the same configuration as the E-2C, the E-2D aircraft is used for surface-surveillance coordination and airborne early warning, and command control  Its mission is to provide advanced warning of approaching enemy surface units, and cruise missiles and aircraft, among other things  Total operating and support (O&S) costs for the E-2D have increased consistently since fiscal year 2011 to about $125 million in fiscal year 2016  This increase is driven by the addition of aircraft to the inventory as the Navy continues to produce E-2D aircraft through 2026  This report is a public version of a sensitive report that we issued on April 25, 2018  DOD deemed some of the information, such as aircraft availability, not mission capable rates, number of aircraft in depots, and budgeted and executed flight hours to be sensitive (i e , For Official Use Only)  This public report omits the information that DOD deemed to be sensitive  The EA-18G Growler is the fourth major variant of the F/A-18 family of aircraft manufactured in 2007 to replace the EA-6B Prowler (see fig  26)  The EA-18G is the first newly designed electronic warfare aircraft produced in more than 35 years and combines the proven F/A-18 Super Hornet platform with a sophisticated electronic warfare suite  Total O&S costs for the EA-18G have consistently increased from about $334 million in fiscal year 2011 to about $868 million in fiscal year 2016  Specifically, unit manpower and maintenance costs have increased partly because the inventory is increasing, as EA-18Gs are still in production  design, development, and fielding of the aircraft  Some of the key support program elements include developing support equipment and technical data, testing requirements for avionics, and facilities requirements, among others  The Navy is updating this plan and expects to finalize it in 2018  The aircraft are maintained organically at Navy Fleet Readiness Centers under planned maintenance intervals, which typically occur every 72 months  Also, the Navy partners with Boeing to provide wholesale supply and depot repair support for major components, such as the engine  This report is a public version of a sensitive report that we issued on April 25, 2018  DOD deemed some of the information, such as aircraft availability, not mission capable rates, number of aircraft in depots, and budgeted and executed flight hours to be sensitive (i e , For Official Use Only)  This public report omits the information that DOD deemed to be sensitive  The F/A-18A-D Hornet Strike Fighter is a twin-engine, mid-wing, multimission tactical aircraft initially fielded in the 1980s (see fig  28)  In its fighter mode, it is used primarily as a fighter escort and for air defense; in its attack mode, it is used for force projection, interdiction, and air support  Total operating and support (O&S) costs for the F/A-18A-D have decreased consistently from about $3 1 billion in fiscal year 2011 to about $2 4 billion in fiscal year 2016  Specifically, unit manpower, operations, and maintenance costs have decreased, partly because the F/A-18A-Ds are being permanently transitioned out of service to be replaced by the F-35 Joint Strike Fighter   and financial resources necessary to ensure continued readiness and supportability for the remainder of the aircraft’s service life  The Navy is currently updating this plan and expects to finalize it in 2018  The aircraft are maintained organically at Navy Fleet Readiness Centers under planned maintenance intervals, which typically occur every 48 months for carrier-deploying aircraft, and every 72 months for land-based aircraft  The Navy implemented the High-Flight-Hour program in 2006 to extend the service life from 8,000 to 10,000 flight hours by inspecting and repairing airframes, and replacing major components and parts  The High-Flight-Hour program, along with other factors, has led to maintenance carryover (i e , into the next fiscal year) due to maintenance events taking longer than planned  In 1999, the Navy entered into a contract with Boeing for engineering support to leverage resources within the technology and industrial base to improve efficiency of the maintenance process and address the maintenance backlog  The F/A-18A-D is operating beyond its planned service life with maintenance and supply issues  The Navy’s actions to mitigate these challenges include extending the service life of the aircraft, allowing maintainers to work overtime to reduce backlog, and cannibalizing parts—moving parts from one aircraft to another  This report is a public version of a sensitive report that we issued on April 25, 2018  DOD deemed some of the information, such as aircraft availability, not mission capable rates, number of aircraft in depots, and budgeted and executed flight hours to be sensitive (i e , For Official Use Only)  This public report omits the information that DOD deemed to be sensitive  The F/A-18E-F Super Hornet was first manufactured in 1998 (see fig  30)  The F/A-18E-F is highly capable across the full mission spectrum: air superiority, fighter escort, reconnaissance, aerial refueling, close air support, air defense suppression, and day/night precision strike  The F/A-18E-F provides aircrew the capability and performance necessary to face 21st century threats  Total operating and support (O&S) costs for the F/A-18E-4 have increased from about $2 2 billion in fiscal year 2011 to about $3 1 billion in fiscal year 2016  Specifically, unit manpower, maintenance, and continuing system support have increased, partly because the inventory is increasing, as the F/A-18E-F is still in production  the Navy is conducting an assessment to determine the number of flight hours the aircraft can safely continue to fly, and then extend the service life of the program through inspections, repairs, and modifications, among other things  The Navy contracted with Boeing to potentially begin these efforts by fiscal year 2018  The F/A-18E-F is a high operational tempo aircraft supporting contingency operations with maintenance and supply issues  The Navy’s actions to mitigate these challenges include plans to extend the service life of the aircraft, training maintainers to transition to vacated positions, and cannibalizing parts—removing parts from one aircraft to another  This report is a public version of a sensitive report that we issued on April 25, 2018  DOD deemed some of the information, such as aircraft availability, not mission capable rates, number of aircraft in depots, and budgeted and executed flight hours to be sensitive (i e , For Official Use Only)  This public report omits the information that DOD deemed to be sensitive  To examine the trends in aircraft availability and operating and support (O&S) costs for selected Air Force and Navy fixed-wing aircraft, including whether the aircraft met availability goals, we selected a nongeneralizable sample of 12 fixed-wing aircraft managed by the Departments of the Air Force and the Navy  These included two Marine Corps aircraft that are managed by the Department of the Navy  This nongeneralizable sample was selected to ensure a mix of aircraft, including type of aircraft (fighter, bomber, cargo, etc ), age of the aircraft, and size of inventory, and whether the aircraft were sustained organically by the Department of Defense (DOD) or through contract arrangements, such as public-private partnerships or performance-based logistics, among other factors  For the Air Force, we selected five fixed-wing aircraft—the B-52 Stratofortress, C-17 Globemaster III, E-8C Joint Surveillance and Target Attack Radar System (JSTARS), F-16 Fighting Falcon, and F-22 Raptor  For the Navy, including the Marine Corps, we selected seven fixed-wing aircraft—the AV-8B Harrier, C-2A Greyhound Logistics Aircraft, E-2 Hawkeye Early Warning and Control Aircraft, E-2 Advanced Hawkeye Early Warning and Control Aircraft, EA-18G Growler, F/A-18 Hornet Strike Fighter A-D, and F/A-18 Super Hornet E-F  The Marine Corps uses the AV-8B Harrier and also uses a variant of the F/A-18A-D  For the selected aircraft, we obtained and reviewed the aircraft availability, sustainment, and O&S data for accuracy and completeness, interviewed officials regarding their data-collection processes, and reviewed available related policies and procedures associated with the collection of the data  As a result, we found the information to be sufficiently reliable for the purposes of presenting sustainment metrics, such as aircraft availability and O&S costs  status due to maintenance, supply, and both  With respect to O&S costs, we collected and analyzed data from fiscal years 2011 through 2016  We conducted data-reliability assessments for the data provided by the Air Force and the Navy  To do this, we sent data-reliability questionnaires to both departments requesting information on the sources that generated the data  For the Air Force, we conducted data-reliability assessments on the Air Force Total Ownership Cost system and the Logistics Installation and Mission Support system  For the Navy, we conducted data-reliability assessments on the Aviation Management Supply and Readiness Reporting—Type Model Series Integrated Database, the Decision Knowledge Programming for Logistics Analysis and Technical Evaluation system, the Flying Hour Projection System / Cost Adjustment and Visibility Tracking System, and the Visibility and Management of Operating and Support Costs system  We reviewed responses from both departments on these sources as well as documentation—such as guidance, user manuals, and data dictionaries—provided to corroborate questionnaire responses, and interviewed knowledgeable officials to discuss the data  We concluded that the data provided by the Air Force and the Navy were sufficiently reliable for the purposes of reporting condition metrics such as aircraft availability; not mission capable status due to maintenance, supply, and both; depot inductions; budgeted and executed flight hours; and O&S costs for the selected fixed-wing aircraft in our review  To identify the sustainment challenges and mitigation actions for the selected aircraft, we reviewed sustainment metrics data, performance briefings, and other relevant documentation to identify specific challenges for each of the 12 aircraft in our review  We also reviewed ongoing and planned actions to address those challenges  Additionally, we interviewed program officials, depot officials, field maintainers, and squadron personnel to obtain their views on the challenges they face in sustaining the aircraft and the actions they take to mitigate those challenges  In some instances, we visited depots and squadrons to observe aircraft undergoing maintenance, discuss the respective maintenance processes, and discuss challenges and mitigation actions with officials  We then grouped the identified challenges into categories and represented them in a table to demonstrate which aircraft are experiencing specific challenges  To assess the extent to which the Air Force and the Navy have sustainment strategies, regularly review sustainment metrics, and have plans to improve aircraft availability for the selected fixed-wing aircraft, we obtained and analyzed sustainment strategies, performance management frameworks (i e , sustainment metrics collected and monitored as well as the levels of management review), and improvement plans for each of the selected 12 fixed-wing aircraft  We also identified and reviewed DOD, Air Force, and Navy guidance to analyze the departments’ efforts in sustaining these aircraft and to determine whether these were consistent with federal standards for internal control that deal with management defining objectives in specific terms  Specifically, we reviewed DOD Instruction 5000 02, Operation of the Defense Acquisition System, which provides management principles and mandatory policies for defense acquisition systems such as fixed- wing aircraft  These policies incorporate decision processes and assessing of readiness, which includes the creation of and requirements for a Life-cycle Sustainment Plan  We also reviewed Air Force Instruction 63-101/20-101, Integrated Life Cycle Management, which implements various Air Force and DOD policy directives, including DOD Instruction 5000 02  It establishes the integrated life-cycle management guidelines and procedures for Air Force personnel who develop, review, approve, or manage the systems, subsystems, end-items, services, and activities procured by the Air Force  For the Navy, we reviewed Secretary of the Navy M-5000 2, Department of the Navy Acquisition and Capabilities Guidebook, which provides guidance for the operation of the defense acquisition system and the joint capabilities integration and development system  It also implements DOD Instruction 5000 02 for the Navy and Marine Corps, including guidance on the management and execution of a sustainment strategy  and service guidance  We also reviewed the Air Force’s and the Navy’s performance metric briefings and improvement plans to determine whether the departments regularly reviewed sustainment metrics and had plans aimed at improving aircraft availability  We interviewed DOD, Air Force, and Navy officials knowledgeable about sustainment of these selected fixed-wing aircraft to discuss DOD’s and the departments’ efforts in sustaining these aircraft, including historical information on each aircraft, applicability of policy and guidance for legacy aircraft, and overviews of performance management frameworks identified by the departments to monitor and improve aircraft availability  To develop the fixed-wing aircraft sustainment summary documents (i e , “Sustainment Quick Looks”) in appendixes II–XIII we obtained historical and current information including background on aircraft capabilities, manufacturer, sustainment strategy, depot maintenance and squadron locations, and key dates in the life cycle of each aircraft (i e , first manufactured, initial and full operational capability, last production, and planned sunset year)  We collected and analyzed the following metrics: aircraft availability, not mission capable maintenance, not mission capable supply, and not mission capable aircraft from fiscal year 2011 through March 2017; the number of aircraft in depots for fiscal years 2011 through 2016; budgeted and executed flight hours from fiscal years 2011 through overall O&S and maintenance costs for fiscal years 2011 through 2016  We compared availability actuals to goals, aircraft in depots to availability trends, and budgeted and executed flight hours to availability trends  We analyzed O&S cost by reviewing its six elements and compared them to availability trends  We also analyzed the subcategories of the maintenance costs element  Through interviews with knowledgeable officials and reviewing documentation, we identified sustainment challenges (i e , aging, maintenance and supply support) and mitigation actions to address these challenges for each selected fixed-wing aircraft  DOD deemed some of the information, such as aircraft availability, not mission capable status, number of aircraft in depots, and budgeted and executed flight hours, to be sensitive (i e , For Official Use Only), which must be protected from public disclosure  This public report omits the information that DOD deemed to be sensitive  Additionally, to support our work for each objective we conducted site visits and interviewed officials to discuss data trends and identify specific sustainment challenges such as aging, maintenance, and supply support, among other challenges affecting aircraft availability, and mitigation actions to address these challenges  For the Air Force, we met with the following entities: Headquarters—Secretary of the Air Force, Logistics and Product Support and Deputy Assistant Secretary for Cost and Economics, Air Force Cost Analysis Agency; Materiel Commands—Air Force Materiel Command and Air Force Life Cycle Management Center; Program Offices—B-52 Program Office, C-17 Program Office, E-8C Program Office, F-16 Program Office, and F-22 Program Office; Depots—Tinker Air Force Base at Oklahoma City, Oklahoma (B-52); Robins Air Force Base at Warner Robbins, Georgia (C-17); Northrop Grumman facility at Lake Charles, Louisiana (E-8C); Ogden Air Logistics Center / Hill Air Force Base at Ogden, Utah (F-16 and F-22); and Squadrons—437th Maintenance Group, Joint Base Charleston, South Carolina (C-17); 461st Air Control Wing, Robins Air Force Base Georgia (E-8C); 20th Fighter Wing, Shaw Air Force Base, South Carolina (F-16); and 325th Maintenance Group, Tyndall Air Force Base, Florida (F-22)  For the Navy, we met with the following entities: Headquarters—Deputy Assistant Secretary of the Navy— Expeditionary Programs and Logistics Management, Marine Corps Aviation Plans and Policy Branch, and Air Warfare Division; Materiel Commands—Commander, Fleet Readiness Center; Naval Air Systems Command; and Naval Supply Systems Command; Program Offices—Program Manager–Air (PMA)-231 (C-2A, E-2C, and E-2D); PMA- 257 (AV-8B); and PMA-265 (F/A-18A-F, and EA- 18G); Depots—Fleet Readiness Center–East at Cherry Point, North Carolina; Fleet Readiness Center–Mid Atlantic at Naval Air Station Norfolk, Virginia, and Naval Air Station Oceana, Virginia; Squadrons—Marine Corps Air Station Cherry Point, North Carolina; Marine Corps Air Station Miramar, California; Naval Air Station Norfolk, Virginia; and Naval Air Station Oceana, Virginia; and Other—Naval Center for Cost Analysis  The performance audit upon which this report is based was conducted from September 2016 to April 2018 in accordance with generally accepted government auditing standards  Those standards require that we plan and perform the audit to obtain sufficient, appropriate, evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives  We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives  We subsequently worked with DOD from April 2018 to September 2018 to prepare this unclassified version of the original sensitive report for public release  This public version was also prepared in accordance with these standards  For fiscal year 2016, total operating and support (O&S) costs for the five Air Force fixed-wing aircraft selected in our review were about $12 billion, and the average O&S cost per aircraft across all five fleets was about $96 million, as shown in figure 32  Each of the C-17 and F-16 fleets accounted for about 33 percent of the total O&S cost, and the E-8C’s average cost per aircraft accounted for about 48 percent of the total average cost per aircraft  For fiscal year 2016, total O&S costs for the seven Navy fixed-wing aircraft selected in our review were about $7 7 billion, and the average O&S cost per aircraft across all seven fleets was about $44 million, as shown in figure 33  The F/A-18E-F fleet accounted for about 40 percent of the total O&S cost, and the E-2C’s average cost per aircraft accounted for about 19 percent of the total average cost per aircraft  In addition to the contact named above, John Bumgarner (Assistant Director), Clarine Allen, Ron Aribo, Vincent Buquicchio, Amie Lesser, Richard Powelson, Steven Putansu, Matt Spiers, and Natasha Wilder made key contributions to this report  Defense Supply Chain: DOD Needs Complete Information on Single Sources of Supply to Proactively Manage the Risks  GAO-17-768  Washington, D C : September 27, 2017  Weapon Systems Management: Product Support Managers’ Perspectives on Factors Critical to Influencing Sustainment-Related Decisions  GAO-17-744R  Washington, D C : September 12, 2017  Defense Acquisitions: Assessments of Selected Weapon Programs  GAO-17-333SP  Washington, D C : March 30, 2017  Depot Maintenance: Executed Workload and Maintenance Operations at DOD Depots  GAO-17-82R  Washington, D C : February 3, 2017  Defense Inventory: Further Analysis and Enhanced Metrics Could Improve Service Supply and Depot Operations  GAO-16-450  Washington, D C : June 9, 2016  Weapon Systems Management: DOD Has Taken Steps to Implement Product Support Managers but Needs to Evaluate Their Effects  GAO-14-326  Washington, D C : April 29, 2014 

ground_truth: DOD spends billions of dollars annually to sustain its weapon systems to support current and future operations. The Air Force and Navy are operating many of their fixed-wing aircraft well beyond their original designed service lives and therefore are confronted with sustainment challenges. House Report 114-537 included a provision for GAO to evaluate the sustainment of major weapon systems. This report, among other things, (1) examines the trends in availability and O&S costs for selected Air Force and Navy fixed-wing aircraft since fiscal year 2011, including whether they met availability goals, and (2) assesses the extent that the departments documented sustainment strategies, reviewed sustainment metrics, and implemented plans to improve aircraft availability. GAO selected a nongeneralizable sample of 12 fixed-wing aircraft by considering a variety of factors, such as the type, age, and manufacturer of the aircraft, among other factors, and analyzed condition and availability data, O&S costs, and sustainment challenges from fiscal year 2011 through March 2017 for each aircraft in a “Sustainment Quick Look.” GAO also analyzed policies, strategies, and plans, and interviewed Navy and Air Force officials in program offices, squadrons, and maintenance depots. Between fiscal years 2011 and 2016, the Air Force and Navy generally did not meet aircraft availability goals, and operating and support (O&S) cost trends for GAO's selected fixed-wing aircraft varied. Specifically, GAO found that availability declined for 6 of 12 aircraft—3 from each service—between fiscal years 2011 and 2016; availability fell short of goals for 9 of 12 aircraft in fiscal year 2016; and O&S costs increased for 5 of the aircraft, and maintenance costs—the largest share—increased for 8 of 12 aircraft. GAO found, and officials agreed, that these aircraft face similar challenges. a Obsolescence means a part is unavailable due to its lack of usefulness or it is no longer current or available for production. b Diminishing manufacturing sources is a loss or impending loss of manufacturers or suppliers. The Air Force and Navy have documented sustainment strategies for some aircraft, regularly reviewed sustainment metrics, and implemented improvement plans. The Air Force has documented sustainment strategies for all aircraft GAO reviewed; however, the Navy has not documented or updated its sustainment strategies for four aircraft. Specifically, the Navy does not have a documented sustainment strategy for the C-2A, and has not updated the strategies for the E2C, EA-18G, and F/A-18A-D since before 2012. The Navy is in the process of documenting its strategies, but Department of Defense (DOD) policy is unclear on whether a sustainment strategy is required and has to be updated every 5 years for weapon systems that are in the operations and support phase of their life cycle (i.e., legacy systems). Also, Navy guidance does not specify a requirement for legacy systems, although Air Force guidance does. Clarifying the requirements to document sustainment strategies for legacy systems, and documenting those strategies, would add additional visibility over the availability and O&S costs of DOD aircraft and any associated sustainment risks. This is a public version of a sensitive report issued in April 2018. Information on aircraft availability and other related information was deemed to be sensitive and has been omitted from this report. GAO is recommending that DOD and the Navy update or issue new policy and guidance clarifying the requirements for documenting sustainment strategies for legacy weapon systems. DOD concurred with the recommendations.