Add the ground beef and onions to the pan and cook until the beef is browned. Drain the grease if necessary.
For the next step, add the flour and mix into the ground beef mixture.
Pour the beef broth and milk into the pan.
Sprinkle the Italian seasonings, garlic salt, salt, and pepper into the pan and mix well.
Pour the tomato sauce into the skillet and mix well.
Add the macaroni noodles to the pan, as well as the hot water, and stir. Make sure the macaroni is covered with liquid.
Bring to a boil, place the lid on top, and turn the temperature down to low.
Cook for 15-20 minutes, stirring occasionally.
Once the noodles are done, add the cheese and stir until melted.