A letter report issued by the Government Accountability Office with an abstract that begins "Providers and stakeholders GAO interviewed in four states with ongoing electronic health information exchange efforts cited key challenges to exchange, in particular, issues related to insufficient standards, concerns about how privacy rules can vary among states, difficulties in matching patients to their records, and costs associated with exchange. Officials from the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC)—agencies within the Department of Health and Human Services (HHS)—noted that they have several ongoing programs and initiatives to help address some aspects of these key challenges, but concerns in these areas continue to exist. For example, several providers GAO interviewed said that they have difficulty exchanging certain types of health information due to insufficient health data standards. Although HHS has begun to address insufficiencies in standards through its Medicare and Medicaid Electronic Health Record (EHR) programs, such as through the introduction of new 2014 standards for certified EHR technology, it is unclear whether its efforts will lead to widespread improvements in electronic health information exchange. In addition, providers GAO interviewed reported challenges covering costs associated with …

Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the status of the Small Business Administration's (SBA) efforts to complete the mandated planning actions for the development of its loan monitoring system."

Testimony issued by the Government Accountability Office with an abstract that begins "As discussed in our report, OMB and key federal agencies have made progress on selected action items identified in the IT Reform Plan, but there are several areas where more remains to be done. Of the 10 key action items we reviewed, 3 were completed and the other 7 were partially completed by December 2011. The action items that are behind schedule share a common reason for the delays: the complexity of the initiatives. In all seven of the cases, OMB and the federal agencies are still working on the initiatives. However, OMB and federal agencies have established time frames for completing only two of these initiatives."

A letter report issued by the Government Accountability Office with an abstract that begins "In addition to providing health care to veterans, the Department of Veterans Affairs (VA) funds research that focuses on health conditions veterans may experience. According to VA, experts estimate that up to 20 percent of Operation Enduring Freedom and Operation Iraqi Freedom veterans have experienced post-traumatic stress disorder (PTSD) and demand for PTSD treatment is increasing. Because of the importance of research in improving the services that veterans receive, GAO was asked to report on VA's funding of PTSD research, and its processes for funding PTSD research proposals, reviewing and incorporating research outcomes into clinical practice guidelines (CPG)--tools that offer clinicians recommendations for clinical services but do not require clinicians to provide one service over another--and determining which PTSD services are required to be made available at VA facilities. To do this work, GAO obtained and summarized VA data on the funding of PTSD research from its medical and prosthetic research appropriation through its intramural research program. GAO also reviewed relevant VA documents, such as those for developing CPGs and those related to VA's 2008 Uniform Mental Health Services in VA Medical Centers and Clinics handbook …

A letter report issued by the Government Accountability Office with an abstract that begins "Pending legislation to the Federal Housing Administration's (FHA) Title I Manufactured Home Loan program would increase loan limits, insure each loan, incorporate stricter underwriting requirements, and set up-front premiums. GAO was asked to review (1) selected characteristics of manufactured housing and the demographics of the owners; (2) federal and state consumer protections for owners of manufactured homes; and (3) the potential benefits and costs of the proposed changes for borrowers and the federal government. In addressing these objectives, GAO analyzed select Census data; researched federal laws and laws in eight states; interviewed local, state, and federal officials; and analyzed various scenarios that might affect Title I program costs."

A letter report issued by the General Accounting Office with an abstract that begins "Clean Water Act regulations generally prohibit boats from discharging untreated sewage but allow the discharge of treated sewage using certified marine sanitation devices. The act allows states to designate "no-discharge zones"--areas in which vessels are prohibited from discharging any sewage--if the Environmental Protection Agency (EPA) finds that adequate facilities exist in such zones for the removal and treatment of sewage from vessels. In some cases, such as for drinking water intake zones, EPA makes the designation. As requested, this report assesses (1) EPA's process for determining the adequacy of facilities to remove and treat sewage in proposed no-discharge zones; (2) the extent to which EPA and the states ensure that adequate facilities remain available after designation; (3) the extent to which the Coast Guard and the states enforce discharge prohibitions; and (4) various effects of no-discharge zones, as identified by EPA, states, and localities."

Correspondence issued by the Government Accountability Office with an abstract that begins "Science establishes research priorities within and across its six core interdisciplinary research programs, which include a wide variety of research ranging from biology to particle physics. However, Science does not explicitly rank these programs in terms of priority. The office currently prioritizes research that aligns with the Secretary of Energy’s interest in fostering the development of clean energy technologies. For example, Science supports research in materials sciences, which informs technology development of batteries and fuels cells. According to Science’s Deputy Director for Science Programs, the office remains committed to all of its research programs and, in the case of stable or declining budgets, does not intend to limit funding reductions to certain programs. Science formalizes priorities annually through the budget formulation process."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) relies on a network of DOD and non-DOD infrastructure assets in the United States and abroad so critical that its unavailability could hinder DOD's ability to project, support, and sustain its forces and operations worldwide. DOD established the Defense Critical Infrastructure Program (DCIP) to identify and assure the availability of mission-critical infrastructure. GAO was asked to evaluate the extent to which DOD has (1) developed a comprehensive management plan to implement DCIP and (2) identified, prioritized, and assessed its critical infrastructure. GAO analyzed relevant DCIP documents and guidance and met with officials from more than 30 DOD organizations that have DCIP responsibilities, and with Department of Homeland Security (DHS) officials involved in protecting critical infrastructure."

Correspondence issued by the General Accounting Office with an abstract that begins "A new convention center is being constructed in accordance with the Washington Convention Center Authority Act of 1994, which authorizes the Washington Convention Center Authority (WCCA) to construct, maintain, and operate a new convention center while continuing to maintain and operate the existing convention center. GAO reviewed (1) issues related to the Revised Guaranteed Maximum Price agreement (RGMP) set in January 2002; (2) the status of construction and significant construction issues that could delay completion of the project; (3) whether the January 2002 estimated total project cost of $799.5 million has changed, and if so, the causes and nature of the changes; and (4) whether WCCA's funding appears to be sufficient to cover the current estimated total project cost. GAO found that on January 31, 2002, the RGMP was set by the construction manager and WCCA at $590.7 million. As of June 30, 2002, the RGMP has increased by $7 million to $597.7 million. The project construction schedule established by the RGMP includes deadlines for (1) substantial completion of convention-ready areas by March 31, 2002; (2) substantial completion of all remaining areas by June 30, 2003; and (3) …

A letter report issued by the Government Accountability Office with an abstract that begins "After studying the Joint Capabilities Integration and Development System (JCIDS) process since September 2010, the Joint Staff began initiating actions in October 2011 to better prioritize capability needs and align those needs with available budgetary resources. Specifically, according to Joint Staff officials, the Joint Requirements Oversight Council (JROC) has begun to consider the benefits and affordability of new capabilities within the context of joint capability areas and to evaluate possible duplication before validating new capability requirements. The Joint Staff has begun to implement a new approach to support JROC prioritization of capability needs, but the new approach is still evolving and has not been fully developed and clearly documented. New guidance does not clearly outline goals of the new approach, develop and communicate the analytic approach envisioned to support JROC decision making, or set out criteria and accompanying measures of progress. GAO previously reported that JCIDS’s ability to prioritize needs could be improved if it had an analytic approach to reviewing and validating proposals that would help ensure that the most important capability needs of the department are addressed. Until the Joint Staff takes steps to …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs' (VA) performance pay policy has gaps in information needed to appropriately administer this type of pay. The performance pay policy gives VA's 152 medical centers and 21 networks discretion in setting the goals providers must achieve to receive this pay, but does not specify an overarching purpose the goals are to support. VA officials responsible for writing the policy told us that the purpose of performance pay is to improve health care outcomes and quality, but this is not specified in the policy. Moreover, the Veterans Health Administration (VHA) has not reviewed the goals set by medical centers and networks and therefore does not have reasonable assurance that the goals make a clear link between performance pay and providers' performance. Among the four medical centers GAO visited, performance pay goals covered a range of areas, including clinical, research, teaching, patient satisfaction, and administration. At these medical centers, all providers GAO reviewed who were eligible for performance pay received it, including all five providers who had an action taken against them related to clinical performance in the same year the pay was …

A statement of record issued by the General Accounting Office with an abstract that begins "The United States is bound by five international environmental agreements related to climate change (Framework Convention), desertification (Desertification Convention), the earth's ozone layer (Montreal Protocol), endangered species (CITES), and North American environmental cooperation (North American Agreement). However, the United States fell short of meeting a commitment or pledge in two areas--providing financial assistance to other nations and timely reporting. Agencies use informal means, such as meetings and informal communications, to track their actions to fulfill commitments under the five agreements. GAO found few studies that evaluated the effectiveness of the U.S. actions. These few studies generally concluded that the actions examined had positive effects."

A statement of record issued by the General Accounting Office with an abstract that begins "GAO, the Institute of Medicine, and others have cited weaknesses in the Defense Department's (DOD) medical surveillance during the Gulf War and Operation Joint Endeavor. DOD was unable to collect, maintain, and transfer accurate data on the movement of troops, potential exposures to health risks, and medical incidents during deployment in the Gulf war. DOD improved its medical surveillance system under Operation Joint Endeavor, providing useful information to military commanders and medical personnel. However, GAO found several problems with this system. For example, incomplete or inaccurate information related to service members' health and deployment status. DOD's has not established a single, comprehensive electronic system to document, archive, and access medical surveillance data. DOD has begun several initiatives to improve the reliability of deployment information and to enhance its information technology capabilities, but some initiatives are several years away from full implementation. Nonetheless, these efforts reflect a commitment by DOD to establish a comprehensive medical surveillance system. The ability of the Department of Veterans Affairs to fulfill its role in serving veterans and providing backup to DOD in times of war will be enhanced as DOD …

A letter report issued by the General Accounting Office with an abstract that begins "As the second largest source of foreign direct investment in China, U.S. companies continue their keen interest in China's implementation of its World Trade Organization (WTO) commitments. China's 2001 WTO commitments include specific pledges to increase market access, liberalize foreign investment, continue fundamental market reforms, and improve the rule of law. In 2002, GAO reported on selected U.S. companies' views, finding that many commitment areas, particularly those related to rule of law, were important to U.S. companies. GAO also found that company representatives expected China's reforms would have a positive impact on their business operations but expected some difficulties during implementation. In 2003, GAO continued to analyze companies' views about (1) the extent to which China has implemented its WTO commitments and (2) the impact of China's implementation of its WTO commitments on U.S. companies' business operations. GAO collected the views of representatives from 82 U.S. companies with a presence in China. GAO focused on companies in the agriculture, banking, machinery, and pharmaceutical industries. Results reflect a response rate of 60 percent of the study population. These responses may not reflect the views of all U.S. …

A letter report issued by the Government Accountability Office with an abstract that begins "Federal agencies have used time-and-materials (T&M) contracts to purchase billions of dollars in services. These contracts are risky because the government bears the risk of cost overruns. Effective February 2007, the Federal Acquisition Regulation (FAR) was revised, pursuant to a statutory change, to allow T&M contracts to be used to acquire commercial services under FAR Part 12, which uses a streamlined procurement process. Certain safeguards were included in FAR Part 12, including a requirement that contracting officers prepare a detailed determination and findings (D&F) that no other contract type is suitable. Based on a mandate to review the use of T&M contracts for commercial services, we assessed (1) agencies' reported use of such contracts and what they acquired, (2) the degree to which agencies complied with the new safeguards, and (3) the applicability of the safeguards to General Services Administration (GSA) schedule contracts. GAO reviewed contracts and orders at DOD and civilian agencies and spoke with contracting officials."

A letter report issued by the Government Accountability Office with an abstract that begins "In 2005, U.S. agriculture faced potentially devastating losses from Asian Soybean Rust (ASR), a fungal disease that spreads airborne spores. Fungicides approved by the Environmental Protection Agency (EPA) can protect against ASR. In 2005, growers in 31 states planted about 72.2 million soybean acres worth about $17 billion. While favorable weather conditions limited losses due to ASR, it still threatens the soybean industry. In May 2005, GAO described the U.S. Department of Agriculture's (USDA) efforts to prepare for ASR's entry, (Agriculture Production: USDA's Preparation for Asian Soybean Rust, GAO-05-668R). This report examines (1) USDA's strategy to minimize ASR's effects in 2005 and the lessons learned to improve future efforts and (2) USDA, EPA, and others' efforts to develop, test, and license fungicides for ASR and to identify and breed soybeans that tolerate it."

A letter report issued by the Government Accountability Office with an abstract that begins "Wildland fires have become increasingly damaging and costly. To deal with fire's threats, the five federal wildland fire agencies--the Forest Service in the Department of Agriculture and four agencies in the Department of the Interior (Interior)--rely on thousands of firefighters, fire engines, and other assets. To ensure acquisition of the best mix of these assets, the agencies in 2002 began developing a new interagency budget tool known as fire program analysis (FPA). FPA underwent major changes in 2006, raising questions about its ability to meet its original objectives. GAO was asked to examine (1) FPA's development to date, including the 2006 changes, and (2) the extent to which FPA will meet its objectives. To do so, GAO reviewed agency policies and FPA documentation and interviewed agency officials."

Correspondence issued by the Government Accountability Office with an abstract that begins "In 2005, the most recent year for which complete data were available, occupants of older manufactured homes paid over twice as much on average per square foot for energy---$1.75 per square foot as compared with $0.87---as was paid by occupants of detached homes. Annual energy expenditures for older manufactured homes--about 906 square feet on average--were about $1,369, compared with detached homes--about 2,919 square feet on average--were about $2,060. Energy expenditures--both per square foot and annually--varied significantly by region reflecting regional differences in the types and costs of fuels commonly used to heat and cool homes, income levels, and climate, among other things. In 2005, LIHEAP provided more assistance on a per square foot basis--about $0.33 per square foot--to occupants of older manufactured homes than to those of detached homes--about $0.20 per square foot. However, this assistance covers slightly less of the annual energy expenditures of occupants of older manufactured homes than occupants of detached homes--15 and 17 percent, respectively. Based on our analysis of EIA's RECS data, we estimate that about 3 percent of LIHEAP funds--about $57 million--spent in 2005 were used to assist occupants of older manufactured …

A letter report issued by the Government Accountability Office with an abstract that begins "Concerns about transfer pricing abuse have led researchers to compare the tax liabilities of foreign- and U.S.-controlled corporations. (Transfer prices are the prices related companies charge on intercompany transactions.) However, such comparisons are complicated because other factors may explain the differences in reported tax liabilities. In three prior reports, GAO found differences in the percentages of foreign-controlled and U.S.-controlled corporations reporting no tax liability. GAO was asked to update the previous reports by comparing: (1) the tax liabilities of foreign-controlled domestic corporations (FCDC) and U.S.-controlled corporations (USCC)-including those reporting zero tax liabilities for 1998 through 2005 (the latest available data) and (2) characteristics of FCDCs and USCCs such as age, size, and industry. GAO analyzed data from the Internal Revenue Service's Statistics of Income samples of corporate tax returns. GAO does not make any recommendations in this report. In commenting on a draft of this report, IRS provided comments on technical issues, which we incorporated into this report where appropriate."

A letter report issued by the Government Accountability Office with an abstract that begins "Since 2002, Congress has directed GAO to assess the Missile Defense Agency's (MDA) annual fiscal year cost, schedule, testing, and performance progress in developing the Ballistic Missile Defense System (BMDS). This year's report specifically assesses MDA's progress in (1) delivering missile defense assets as scheduled (2) improving accountability and transparency over the past year (3) implementing the European Phased Adaptive Approach (4) implementing changes to the Ground-based Midcourse Defense program (5) implementing the targets revised acquisition strategy identified in 2009, and (6) testing the BMDS and developing its modeling and simulations to assess performance. To accomplish this, GAO reviewed MDA's progress reports to the Congress, pertinent Department of Defense (DOD) policies and reports including a DOD assessment and plan related to the Ground-based Midcourse Defense system."

A letter report issued by the Government Accountability Office with an abstract that begins "State and local retiree benefits are not subject, for the most part, to federal laws governing private sector retiree benefits. Nevertheless, there is a federal interest in ensuring that all Americans have a secure retirement, as reflected in the special tax treatment provided for both private and public pension funds. In 2004, new government accounting standards were issued, calling for the reporting of liabilities for future retiree health costs. As these standards are implemented and the extent of the related liabilities become known, questions have been raised about whether the public sector can continue to provide the current level of benefits to its retirees. GAO was asked to provide an overview of state and local government retiree benefits, including the following: (1) the types of benefits provided and how they are structured, (2) how retiree benefits are protected and managed, and (3) the fiscal outlook for retiree benefits and what governments are doing to ensure they can meet their future commitments. For this overview, GAO obtained data from various organizations, used our model that simulates the fiscal outlook for the state and local sector, and conducted …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Labor's Occupational Safety and Health Administration (OSHA) provides more frequent monitoring and more consistent guidance for its federal enforcement activities than for state enforcement activities. More specifically, OSHA regional officials review performance reports on federal activities at least every other week but review reports on state-run program activities quarterly. In addition, OSHA's guidance for audits of its regional and area offices is more consistent than the guidance for its audits of state-run programs. Guidance for audits of its offices requires that regional offices conduct a comprehensive audit with on-site review of inspection case files at least once every 4 years and other audits focused on more specific activities in all other years. In contrast, guidance for regional office audits of state-run programs changes from year to year and does not include a regular schedule for comprehensive audits with on-site case file reviews. While the frequency of OSHA's monitoring of state-run programs is necessarily different because of the independent enforcement authority of participating states, OSHA's lack of consistent guidance for audits of these state-run programs may allow enforcement deficiencies to go undetected, increasing the …

Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO responded to congressional concerns regarding the Department of Veterans Affairs' (VA) efforts to address the year 2000 computer problem, focusing on: (1) VA's ability to achieve year 2000 compliance; (2) VA's work to date on the year 2000 challenge; (3) what areas VA should concentrate on over the next six months to ensure that its highest risks areas are addressed prior to January 1, 2000; (4) identifying any areas where VA has misdirected its efforts; and (5) VA's greatest strengths in the effort to surmount the year 2000 challenge."

Correspondence issued by the General Accounting Office with an abstract that begins "Between fiscal years 1996 and 2001, the United States provided $3.45 billion in direct contributions and $24.2 billion in voluntary or indirect contributions to 33 U.N. peacekeeping operations in such areas as the Congo, Sierra Leone, Kosovo, Bosnia, and, most recently, Afghanistan. The prospects for implementing peace agreements are enhanced if all major parties to the conflict participate in negotiating the agreements and if these agreements include specific authority and mechanisms for their enforcement. Peace operations are more likely to succeed if the military forces carrying out the operations have clear objectives, sufficient resources, and the authority to carry out their tasks. Military forces can help create a secure environment for civilian work to proceed. Moreover, the slow or late deployment of a peace operation's civil administrators might impede efforts to establish good governance. Finally, peace operations tend to be more successful when locals participate at every reasonable opportunity."