A letter report issued by the Government Accountability Office with an abstract that begins "Under the Department of Defense's (DOD) TRICARE health program, hospitals that treat primarily children--designated by DOD as children's hospitals--are paid differently from other types of civilian hospitals through a children's hospital differential payment. Representatives of children's hospitals state that payments for children's hospital services do not fully recognize the higher complexity of children's hospital patients. Acknowledging concerns over payments for children's hospital services, the National Defense Authorization Act for Fiscal Year 2006 directed GAO to study DOD's current system of payments to children's hospitals. This report examines (1) the effect of the differential on TRICARE's base payments to children's hospitals, (2) differences in diagnosis and complexity between TRICARE pediatric patients at children's hospitals and those at other hospitals, (3) the extent to which TRICARE payment differences across hospitals reflect differences in patient complexity, and (4) recent trends in TRICARE pediatric patients' use of children's hospital services. To do this, GAO analyzed pertinent TRICARE claims data for fiscal years 2003 through 2006 and interviewed relevant DOD officials and representatives of children's hospitals."

A letter report issued by the Government Accountability Office with an abstract that begins "Under section 319 of the Clean Water Act, state-selected projects to reduce nonpoint source pollution have helped restore more than 350 impaired water bodies since 2000, but other projects have encountered significant challenges. According to GAO survey results, 28 percent of projects did not achieve all objectives originally identified in the project proposal (e.g., implementing the desired number of pollution reduction practices), while many that did so still faced considerable challenges. About half such challenges were beyond staff control (e.g., bad weather or staff turnover), but the other half were challenges that generally could have been identified and mitigated before projects were proposed and selected for funding, such as gaining access to desired properties. In one state, for example, $285,000 in section 319 funds was to subsidize the cost to homeowners of repairing damaged septic systems. Once the grant was awarded, however, one homeowner signed up to participate."

A letter report issued by the Government Accountability Office with an abstract that begins "Cyber analysis and warning capabilities are critical to thwarting computer-based (cyber) threats and attacks. The Department of Homeland Security (DHS) established the United States Computer Emergency Readiness Team (US-CERT) to, among other things, coordinate the nation's efforts to prepare for, prevent, and respond to cyber threats to systems and communications networks. GAO's objectives were to (1) identify key attributes of cyber analysis and warning capabilities, (2) compare these attributes with US-CERT's current capabilities to identify whether there are gaps, and (3) identify US-CERT's challenges to developing and implementing key attributes and a successful national cyber analysis and warning capability. To address these objectives, GAO identified and analyzed related documents, observed operations at numerous entities, and interviewed responsible officials and experts."

A letter report issued by the Government Accountability Office with an abstract that begins "The 2004 Summer Olympics in Athens, Greece, were held against the backdrop of growing concerns about international terrorism. Despite widespread fears of a potential terrorist attack on the Olympics, Greece hosted a safe and secure event with no terrorist incidents. To assist Greece in securing the 2004 Games, U.S. government agencies provided training and other support in the four years leading up to the Games. In addition, the U.S. government provided some security and other assistance to American athletes, spectators, and commercial investors, and expects to continue such support for future Olympics, including the upcoming 2006 Winter Olympics in Turin, Italy. GAO was asked to (1) determine the U.S. approach and coordination efforts for providing security assistance to the 2004 Summer Olympics; (2) examine the roles of U.S. agencies in Athens Olympics security and their financial outlays; and (3) review lessons learned in providing security assistance in support of the Olympics and how they are being incorporated into preparations for future Olympics. The Departments of State, Homeland Security, Defense, and Justice concurred with the report or had no comments."

A letter report issued by the Government Accountability Office with an abstract that begins "The Federal Deposit Insurance Corporation (FDIC) has a demanding responsibility enforcing banking laws, regulating financial institutions, and protecting depositors. The corporation relies extensively on computerized systems to support and carry out its financial and mission-related operations. As part of the audit of the calendar year 2005 financial statements, GAO assessed (1) the progress FDIC has made in correcting or mitigating information security weaknesses previously reported and (2) the effectiveness of the corporation's information system controls to protect the confidentiality, integrity, and availability of its key financial information and information systems."

A letter report issued by the Government Accountability Office with an abstract that begins "In 2004, several high-profile drug safety cases raised concerns about the Food and Drug Administration's (FDA) ability to manage postmarket drug safety issues. In some cases there have been disagreements within FDA about how to address safety issues. In this report GAO (1) describes FDA's organizational structure and process for postmarket drug safety decision making, (2) assesses the effectiveness of FDA's postmarket drug safety decision-making process, and (3) assesses the steps FDA is taking to improve postmarket drug safety decision making. GAO conducted an organizational review and case studies of four drugs with safety issues: Arava, Baycol, Bextra, and Propulsid."

A letter report issued by the Government Accountability Office with an abstract that begins "Methamphetamine (meth) lab incidents--seizures of labs, dumpsites, chemicals, and glassware--declined following state and federal sales restrictions on pseudoephedrine (PSE), an ingredient commonly found in over-the-counter cold and allergy medications, but they rose again after changes to methods in acquiring PSE and in the methods to produce meth. According to Drug Enforcement Administration (DEA) data, the number of lab incidents nationwide declined through 2007 after the implementation of state and federal regulations on PSE product sales, which started in 2004. The number of meth lab incidents reported nationally increased after 2007, a trend primarily attributed to (1) the emergence of a new technique for smaller-scale production and (2) a new method called smurfing--a technique used to obtain large quantities of PSE by recruiting groups of individuals to purchase the legally allowable amount of PSE products at multiple stores that are then aggregated for meth production."

A letter report issued by the Government Accountability Office with an abstract that begins "In fiscal year 2005, the Trans-Sahara Counterterrorism Partnership (TSCTP) was established to eliminate terrorist safe havens in northwest Africa by strengthening countries' counterterrorism capabilities and inhibiting the spread of extremist ideology. Funds obligated for TSCTP in fiscal years 2005 through 2007 and committed for fiscal year 2008 by the Department of State (State), the U.S. Agency for International Development (USAID), and the Department of Defense (DOD) have amounted to about $353 million for activities in nine partner countries. In this report, GAO examines (1) the distribution of funds for TSCTP and the types of activities supported and (2) the program's implementation, including the extent to which it is guided by a comprehensive, integrated strategy. GAO has reported previously on the need for a strategy that includes priorities and milestones that can help agencies collaborate in combating terrorism. GAO analyzed TSCTP-related documents and conducted work in Mali, Morocco, and Mauritania."

A letter report issued by the Government Accountability Office with an abstract that begins "As a result of the terrorist attacks of September 11, 2001, the Federal Bureau of Investigation (FBI) has committed to a transformation to increase its focus on national security. The FBI has shifted agent resources to its top priorities of counterterrorism, counterintelligence, and cyber crime. Some of these agent resources were shifted away from drug, white-collar, and violent crime enforcement programs. The FBI's drug program has sustained, by far, the largest reduction in FBI agent workforce--about 550 positions, or more than 80 percent of the nonsupervisory field agents who were permanently reprogrammed. In addition, the FBI has had a continuing need to temporarily redirect agents from drug, white-collar, and violent crime enforcement to address counterterrorism-related workload demands. While GAO and other organizations have focused considerable attention on the progress of the FBI's transformation, this report addresses questions about the extent to which the shift in resources has affected federal efforts to combat drug, white-collar, and violent crime and whether other agencies, including the Drug Enforcement Administration (DEA) in the drug enforcement area, are filling gaps created by FBI resource shifts."

A letter report issued by the Government Accountability Office with an abstract that begins "Since the Global War on Terrorism, the Department of Defense (DOD) has taken steps to expand the role of the United States Special Operations Command (Command) and its forces. In response, the Command has transformed its headquarters to coordinate counterterrorism activities, and DOD has increased funding and the number of special operations forces positions. Given the expanded mission, it is critical that the Command has personnel with the right knowledge and skill sets. GAO was asked to assess: (1) whether the Command has determined all of the personnel requirements needed to meet its expanded role; (2) the progress and challenges in meeting growth goals; and (3) any effect of deployments on the Command's ability to provide trained forces, and the progress made in managing deployments. GAO performed its work at the Special Operations Command and its service components, analyzed personnel data against requirements, and examined policies and directives."

A letter report issued by the Government Accountability Office with an abstract that begins "Although transit service is generally safe, recent high-profile accidents on several large rail transit systems--notably the June 2009 collision in Washington, D.C., that resulted in nine fatalities and 52 injuries--have raised concerns. The Federal Transit Administration (FTA) oversees state agencies that directly oversee rail transit agencies' safety practices. FTA also provides assistance to transit agencies, such as funding and training, to enhance safety. GAO was asked to determine (1) the challenges the largest rail transit systems face in ensuring safety and (2) the extent to which assistance provided by FTA addresses these challenges. GAO visited eight large rail transit systems and their respective state oversight agencies, reviewed pertinent documents, and interviewed rail transit safety experts and officials from FTA and the National Transportation Safety Board (NTSB)."

A letter report issued by the Government Accountability Office with an abstract that begins "Media reports on elevated lead in the District of Columbia's drinking water raised concern about how local and federal agencies are carrying out their responsibilities. The Lead and Copper Rule requires water systems to protect drinking water from lead. The U.S. Army Corps of Engineers' Washington Aqueduct treats and sells water to the District Water and Sewer Authority (WASA), which delivers it to District residents. The Environmental Protection Agency's (EPA) Region III Office oversees these agencies. GAO examined (1) what agencies implementing the rule in the District are doing to improve their coordination and reduce lead levels, (2) the extent to which WASA and other agencies are identifying populations at greatest risk of exposure to lead in drinking water and reducing their exposure, (3) how other drinking water systems that exceed EPA's action level for lead conduct public education, and (4) the state of research on lead exposure and how it applies to drinking water."

A letter report issued by the Government Accountability Office with an abstract that begins "The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created a prescription drug benefit for beneficiaries, called Medicare Part D, beginning in January 2006. The MMA resulted in options for sponsors of employment-based prescription drug benefits, such as a federal subsidy payment--the retiree drug subsidy (RDS)--when sponsors provide benefits meeting certain MMA requirements to Medicare-eligible retirees. The MMA required GAO to conduct two studies on trends in employment-based retiree health coverage and the MMA options available to sponsors. The first study, Retiree Health Benefits: Options for Employment-Based Prescription Drug Benefits under the Medicare Modernization Act (GAO-05-205), was published February 14, 2005. In this second study, GAO determined which MMA prescription drug coverage options sponsors selected, the factors they considered in selecting these options, and the effect these decisions may have on the provision of employment-based health benefits for retirees. GAO identified options that sponsors selected using data from employer benefit surveys and the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare. To obtain sponsors' views about the factors they considered and the effects of their decisions, GAO also interviewed …

A letter report issued by the Government Accountability Office with an abstract that begins "To help alleviate the psychological distress caused by the September 11, 2001, attacks the Federal Emergency Management Agency (FEMA) awarded the state of New York two grants totaling $154.9 million to provide crisis counseling and public education. Because of questions about whether the program, called Project Liberty, had spent all the funds it received from the federal government, GAO was asked to determine (1) the extent to which the program expended the funds awarded from the federal government, (2) whether the federal government had an effective process in place to determine the amount of funds to provide the program, (3) whether the federal government had adequate financial oversight of the program, and (4) steps taken by the federal government and New York State to assess the program's effectiveness."

A letter report issued by the Government Accountability Office with an abstract that begins "The Small Business Administration (SBA) played a key role in assisting small businesses affected by the September 11, 2001 terrorist attacks by providing over $1 billion in disaster loans to businesses that sustained physical damage or economic injury. Small businesses in the immediate areas of the attacks and others nationwide that suffered related economic injury were eligible to apply for disaster loans. SBA declined or withdrew about half of these loan applications. SBA's disaster loans are direct federal government loans provided at a subsidized interest rate. In response to concerns that more small businesses impacted by September 11 could have benefited from SBA's disaster loans, GAO conducted a review of its Disaster Loan Program. Specifically, GAO addressed the following questions: (1) Are the disaster program policies consistent with the law and the overall mission of SBA's Disaster Loan Program? (2) What were SBA's underwriting policies and criteria for September 11 Economic Injury Disaster Loans (EIDL) and how did they compare with those applied by nonprofit lenders that were active in New York City after September 11? (3) Did SBA correctly apply its policies and procedures in …

A letter report issued by the Government Accountability Office with an abstract that begins "Established in 1994, the Department of the Treasury's Bank Enterprise Award (BEA) program provides cash awards to banks that increase their investments in community development financial institutions (CDFI) and lending in economically distressed communities. CDFIs are specialized institutions that provide financial services to areas and populations underserved by conventional lenders and investors. In 2005, Treasury provided nearly $10 million in BEA awards. The BEA program has faced longstanding questions about its effectiveness and experienced significant declines in funding in recent years. This report (1) examines the extent to which the BEA program may have provided banks with financial incentives and (2) assesses the BEA program's performance measures and internal controls. To complete this study, GAO reviewed relevant award data; interviewed Treasury, bank, and CDFI officials; and assessed the BEA program's performance measures and internal controls against GAO's standards for effective measures and controls."

A letter report issued by the Government Accountability Office with an abstract that begins "Medicare's physician fees may not always reflect efficiencies that occur when a physician performs multiple services for the same patient on the same day, and some resources required for these services do not need to be duplicated. In response to a request from Congress, GAO examined (1) the Centers for Medicare & Medicaid Services' (CMS) efforts to set appropriate fees for services furnished together and (2) additional opportunities for CMS to avoid excessive payments when services are furnished together. GAO examined relevant policies, laws, and regulations; interviewed CMS officials and others; and analyzed claims data to identify opportunities for further savings."

A letter report issued by the Government Accountability Office with an abstract that begins "Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which created a Part D outpatient prescription drug benefit that enables Medicare beneficiaries to enroll in competing private drug coverage plans. The benefit also offers a subsidy administered by the Social Security Administration (SSA) to assist certain low-income Medicare beneficiaries with out-of-pocket costs. GAO was asked to review (1) SSA's progress in identifying and soliciting applications from individuals potentially eligible for the subsidy; (2) SSA's processes for making eligibility determinations, resolving appeals, and redetermining beneficiaries' eligibility; and (3) how the subsidy has affected SSA's workload and operations. To conduct this study, GAO reviewed the law, assessed subsidy data, and interviewed SSA and other officials."

A letter report issued by the Government Accountability Office with an abstract that begins "Concerns have been raised about the Department of Education's (Education) role in overseeing the lenders and schools that participate in the largest of the federal government's student loan programs, the Federal Family Education Loan Program (FFELP). GAO was asked to analyze Education's use of its oversight, guidance, and enforcement authorities under FFELP. To do this, GAO reviewed departmental documents and federal laws, regulations, and cases and interviewed officials from Education and the student loan industry."

A letter report issued by the Government Accountability Office with an abstract that begins "Until destroyed, Russia's stockpile of chemical weapons remains a proliferation threat, vulnerable to theft and diversion. Since 1992, Congress has authorized the Department of Defense (DOD) to provide more than $1 billion for the Cooperative Threat Reduction (CTR) program to help the Russian Federation construct a chemical weapons destruction facility (CWDF) at Shchuch'ye to eliminate about 14 percent of its stockpile. Over the past several years, DOD has faced numerous challenges that have increased the estimated cost of the facility from about $750 million to more than $1 billion and delayed the facility's operation from 2006 until 2009. DOD has attributed the increase cost and schedule to a variety of factors. In this report, we (1) assess the facility's progress, schedule, and cost and (2) review the status of Russia's efforts to destroy all of its chemical weapons."

A letter report issued by the Government Accountability Office with an abstract that begins "Little is known nationally about the extent to which workers laid off as a result of international trade use the variety of federally funded reemployment services available to them. GAO was asked to study the experiences of workers affected by a small number of trade-related layoffs. GAO examined (1) the extent to which workers accessed federally funded reemployment services and the mix of services received, (2) the employment outcomes these workers achieved, and (3) the extent to which workers used the new health insurance and wage insurance benefits under the Trade Adjustment Assistance (TAA) program, and the factors affecting their participation."

A letter report issued by the Government Accountability Office with an abstract that begins "Our review identified articles that used varying approaches to estimate the savings associated with generic drug use in the United States. One group of studies estimated the savings in reduced drug costs that have accrued from the use of generics. For example, a series of studies estimated the total savings that have accrued to the U.S. health care system from substituting generic drugs for their brand-name counterparts, and found that from 1999 through 2010 doing so saved more than $1 trillion. A second group of studies estimated the potential to save more on drugs through greater use of generics. For example, one study assessed the potential for additional savings within the Medicare Part D program—which provides outpatient prescription drug coverage for Medicare—and found that if generic drugs had always been substituted for the brand-name drugs studied, about $900 million would have been saved in 2007. A third group of studies estimated the effect on health care costs of using generic versions of certain types of drugs where questions had generally been raised about whether substituting generic drugs for brand-name drugs was medically appropriate. Unlike the other …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) and other federal agencies face challenges to maintain suppliers capable of meeting current and future mission requirements. Changing security threats, rapidly evolving science and technology, and budget imbalances have created an uncertain acquisition environment. As DOD, Department of Homeland Security, and others seek to fundamentally transform operations, they are giving contractors increased program management responsibilities to develop requirements, design products, and select major system and subsystem contractors. At the same time, the government workforce that manages and oversees these purchases has decreased. An increasingly global and interconnected defense and commercial supplier base also poses significant acquisition challenges. To identify and discuss key supplier issues, GAO sponsored a 1-day forum in October 2005 where defense policy experts from federal agencies, defense industry, nonprofit organizations, and academia shared insights into the current supplier base environment. As agreed with the participants, GAO's goal was to engage in a dialog on a non-attribution basis to reach consensus on the top challenges facing agencies as they seek to manage the supplier base. This report provides highlights of the forum."

A letter report issued by the Government Accountability Office with an abstract that begins "The Medicare Modernization Act of 2003 directed that hospitals lose 0.4 percent of their Medicare payment update if they do not submit clinical data for both Medicare and non-Medicare patients needed to calculate hospital performance on 10 quality measures. The Centers for Medicare & Medicaid Services (CMS) instituted the Annual Payment Update (APU) program to collect these data from hospitals and report their rates on the measures on its Hospital Compare Web site. For hospital quality data to be useful to patients and other users, they need to be reliable, that is, accurate and complete. GAO was asked to (1) describe the processes CMS uses to ensure the accuracy and completeness of data submitted for the APU program, (2) analyze the results of CMS's audit of the accuracy of data from the program's first two calendar quarters, and (3) describe processes used by seven other organizations that assess the accuracy and completeness of clinical performance data."