DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS FOR 2018 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED FIFTEENTH CONGRESS FIRST SESSION SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES TOM COLE, Oklahoma, Chairman MICHAEL K. SIMPSON, Idaho ROSA L. DELAURO, Connecticut STEVE WOMACK, Arkansas LUCILLE ROYBAL-ALLARD, California CHARLES J. FLEISCHMANN, Tennessee BARBARA LEE, California ANDY HARRIS, Maryland MARK POCAN, Wisconsin MARTHA ROBY, Alabama KATHERINE CLARK, Massachusetts JAIME HERRERA BEUTLER, Washington JOHN R. MOOLENAAR, Michigan NOTE: Under committee rules, Mr. Frelinghuysen, as chairman of the full committee, and Mrs. Lowey, as ranking minority member of the full committee, are authorized to sit as members of all subcommittees. SUSAN ROSS, JENNIFER CAMA, JUSTIN GIBBONS, KATHRYN SALMON, and LORI BIAS Subcommittee Staff PART 5 Page Management Challenges at Depts. of Labor, Health and Human Services, Education, and Social Security Administration .................. 1 Early Childhood Education Programs at Dept. of Health and Human Services ............................................................................................................ 127 Corporation for Public Broadcasting ........................................................... 181 Department of Health and Human Services .............................................. 225 Examining Federal Support for Job Training Programs ....................... 337 ( Printed for the use of the Committee on Appropriations U.S. GOVERNMENT PUBLISHING OFFICE 27–208 WASHINGTON: 2017 COMMITTEE ON APPROPRIATIONS RODNEY P. FRELINGHUYSEN, New Jersey, Chairman HAROLD ROGERS, Kentucky 1 NITA M. LOWEY, New York ROBERT B. ADERHOLT, Alabama MARCY KAPTUR, Ohio KAY GRANGER, Texas PETER J. VISCLOSKY, Indiana MICHAEL K. SIMPSON, Idaho JOSE´ E. SERRANO, New York JOHN ABNEY CULBERSON, Texas ROSA L. DELAURO, Connecticut JOHN R. CARTER, Texas DAVID E. PRICE, North Carolina KEN CALVERT, California LUCILLE ROYBAL-ALLARD, California TOM COLE, Oklahoma SANFORD D. BISHOP, JR., Georgia MARIO DIAZ-BALART, Florida BARBARA LEE, California CHARLES W. DENT, Pennsylvania BETTY MCCOLLUM, Minnesota TOM GRAVES, Georgia TIM RYAN, Ohio KEVIN YODER, Kansas C. A. DUTCH RUPPERSBERGER, Maryland STEVE WOMACK, Arkansas DEBBIE WASSERMAN SCHULTZ, Florida JEFF FORTENBERRY, Nebraska HENRY CUELLAR, Texas THOMAS J. ROONEY, Florida CHELLIE PINGREE, Maine CHARLES J. FLEISCHMANN, Tennessee MIKE QUIGLEY, Illinois JAIME HERRERA BEUTLER, Washington DEREK KILMER, Washington DAVID P. JOYCE, Ohio MATT CARTWRIGHT, Pennsylvania DAVID G. VALADAO, California GRACE MENG, New York ANDY HARRIS, Maryland MARK POCAN, Wisconsin MARTHA ROBY, Alabama KATHERINE M. CLARK, Massachusetts MARK E. AMODEI, Nevada PETE AGUILAR, California CHRIS STEWART, Utah DAVID YOUNG, Iowa EVAN H. JENKINS, West Virginia STEVEN M. PALAZZO, Mississippi DAN NEWHOUSE, Washington JOHN R. MOOLENAAR, Michigan SCOTT TAYLOR, Virginia ————— 1 Chairman Emeritus NANCY FOX, Clerk and Staff Director (II) DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RE- LATED AGENCIES APPROPRIATIONS FOR 2018 THURSDAY, MARCH 9, 2017. MANAGEMENT CHALLENGES AT THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDU- CATION AND THE SOCIAL SECURITY ADMINISTRA- TION: VIEWS FROM THE INSPECTORS GENERAL WITNESSES SCOTT S. DAHL, INSPECTOR GENERAL, U.S. DEPARTMENT OF LABOR DANIEL R. LEVINSON, INSPECTOR GENERAL, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES KATHLEEN TIGHE, INSPECTOR GENERAL, U.S. DEPARTMENT OF EDU- CATION GALE STALLWORTH STONE, ACTING INSPECTOR GENERAL, SOCIAL SECURITY ADMINISTRATION Mr. COLE. I open the hearing, and good morning. It is my pleas- ure to welcome everybody to the Subcommittee on Labor, Health and Human Services, and Education for a hearing this sub- committee has not had for a few years, and that is to hear from our inspectors general about some of the most pressing manage- ment and fiscal challenges facing the agencies under our purview. Programs administered by these three Cabinet agencies as well as the Social Security Administration touch the lives of every American. Many people rely on programs they oversee to see them through tough times in the case of unemployment insurance, to go to school in the case of Pell Grants, and to obtain medical care in the case of the Indian Health Services and Medicare, and to do something as simple as legally changing their name on their Social Security card. It is, therefore, crucially important that these agencies maintain strict security over personally identifiable information, that they ensure payments are made properly, in the correct amounts, and to the person to whom they are intended. It is critical that the agencies modernize their internal system to keep one step ahead of criminals and cyber terrorists, and to maintain the trust the public places in them both in terms of finances as well as informa- tion, and, in some cases, people’s very lives. The inspectors general have each outlined some of the most pressing challenges confronting each agency, and I look forward to hearing their testimony. (1) 2 Before we begin, though, I would like to turn to my ranking member, my good friend, the gentlelady from Connecticut, for any remarks that she would care to make. And, please, the gentlelady is recognized. Ms. DELAURO. Thank you very much, Mr. Chairman. Let me say thank you to our four inspectors general who have joined us today: Department of Education, Department of Health and Human Serv- ices, Social Security Administration, Department of Labor. Today both trust in government and confidence in public institu- tions are at record lows, and to restore that trust, we need to insist on a strong ethical framework and invest in robust oversight of our Federal Government. The work that is carried out every day by the OIG agencies is fundamental for maintaining the integrity and the efficiency of our government programs. At a time when resources are limited, there are significant man- agement challenges that require the IGs to identify and address the most pressing issues facing our agencies. So, it is imperative that our public resources are used effectively, and that fraud, waste, and abuse are addressed or eliminated. I want to focus specifically on the ways in which the taxpayers are victims of fraud and abuse. As inspector general reports high- light, we have problems with the skyrocketing cost of prescription drugs, the predatory practices of low-quality, for-profit education institutions targeting vulnerable students, and we need to uphold our obligation to ensure that American workers have a safe and healthy workplace, and to protect the Social Security Program, the most successful social program in our Nation’s history. With regard to the Department of Health and Human Services— thank you—I am concerned about funding for program integrity ac- tivities. In 2016, the Budget Control Act allowed for a cap adjust- ment of $395,000,000 for healthcare, fraud, and abuse control, which acts as a deterrent against fraud and overbilling in our Medicare system. It saves billions of taxpayers’ dollars and ensures that our seniors receive the benefits that they have earned. Unfor- tunately, the majority did not allow for full funding of this pro- gram, leaving us $25,000,000 short. HICVAC has returned $18,000,000,0000 to the Medicare Trust Fund since 2009. That is an average of more than $2,000,000,000 per year in 2016, and I quote, ‘‘Over $3,300,000,000 was deposited with the Departments of Treasury, CMS, transferred to other Fed- eral agencies administering healthcare programs, or paid to private individuals.’’ If we are truly concerned about stopping healthcare fraud and reducing the deficit, we need to fund the programs that work to do so. And I hope together with my colleagues we can com- mit to fully funding this program this year. The pattern repeats itself when we looked at the Social Security Administration’s cap adjustment. The Budget Control Act allowed for $1,170,000,000. We fell $13,000,000 short. We should talk about curtailing waste, fraud, and abuse, but we need to fully fund the prevention efforts in order to make this happen. Fraud, waste, and abuse do not just manifest itself in one form. We have the obligation to root it out when it is carried out by large corporations just as we do with individuals. We cannot pick and choose where we want to apply program integrity. 3 I would note that in 2017, the Budget Control Act allows a cap adjustment of $725,000,000 for healthcare, fraud, and abuse con- trol. However, it allows a cap adjustment of more than $1,500,000,000 for efforts to identify fraud and disability in SSI benefits. While I fully support ensuring that disability and SSI are reserved for their intended recipients, I cannot help but notice that we spend twice as much locking predominantly low-income Ameri- cans from receiving modest benefits than we spend investigating fraud and overbilling by large healthcare providers. Education. We have an obligation to protect students at risk from low-quality, high-debt for-profit programs that hurt students and veterans. These programs prey on vulnerable students and men and women who serve our country. This is unacceptable. Students at for-profit colleges represent only 10 percent of the total higher education population, yet they represent 35 percent of all Federal student loan defaults. Over the past few years,