A letter report issued by the General Accounting Office with an abstract that begins "For the past 50 years, the federal government has had a metropolitan area program designed to provide a nationally consistent set of standards for collecting, tabulating, and publishing federal statistics for geographic areas in the United States and Puerto Rico. Before each decennial census, the Office of Management and Budget (OMB) reviews the standards to ensure their continued usefulness and relevance and, if warranted, revises them. While designed only for statistical purposes, various federal programs use the statistical areas to determine eligibility and to allocate federal funds. OMB advises agencies to carefully review program goals to ensure that appropriate geographic entities are used in making these decisions. GAO was asked to examine the process used for developing the OMB standards issued in 2000 and their effects on certain federal programs. Specifically, GAO agreed to report on (1) the process used to develop the 2000 standards, (2) how the 2000 standards differed from the 1990 standards, (3) how the application of the standards affected the geographic distribution of counties into statistical areas, and (4) the effect of standards on the eligibility and funding allocations for four federal …

A letter report issued by the Government Accountability Office with an abstract that begins "Congress is concerned about the health care spending burden facing the Federal Employees Health Benefits Program (FEHBP), the largest private health insurance program in the country. Health care spending per person varies geographically, and the underlying causes for the spending variation have not been fully explored. Understanding market forces and other factors that may influence health care spending may contribute to efforts to moderate health care spending. Health care spending varies across the country due to differences in its components, the utilization and price of health care services. A wide body of research describes extensive geographic variation in utilization. However, less is known about private sector geographic variation in prices. This report examined prices and spending in FEHBP Preferred Provider Organizations (PPOs) to determine (1) the extent to which hospital and physician prices varied geographically, (2) which factors were associated with geographic variation in hospital and physician prices, and (3) the extent to which hospital and physician price variation contributed to geographic variation in spending. We analyzed claims data from several large national PPOs participating in FEHBP. We used 2001 data, the most current data available …

A letter report issued by the General Accounting Office with an abstract that begins "Breast cancer is the second leading cause of cancer deaths among American women. In 2001, 192,200 new cases of breast cancer were diagnosed and 40,200 women died from the disease. The probability of survival increases significantly, however, when breast cancer is discovered in its early stages. Currently, the most effective technique for early detection of breast cancer is screening mammography, an X-ray procedure that can detect small tumors and breast abnormalities up to two years before they can be detected by touch. Nationwide data indicate that mammography services are generally adequate to meet the growing demand. Between 1998 and 2000, both the population of women 40 and older and the extent to which they were screened increased by 15 percent. Although mammography services are generally available, women in some locations have problems obtaining timely mammography services in some metropolitan areas. However, the greatest losses in capacity have come in rural counties. In all, 121 counties, most of them rural, have experienced a drop of more than 25 percent in the number of mammography machines in the last three years. Officials from 37 of these counties reported …

A letter report issued by the General Accounting Office with an abstract that begins "This interim report reviews the implementation of the Department of Defense (DOD) Medicare Subvention Demonstration. GAO found that the demonstration sites were successful in operating Medicare managed care plans. Officials put substantial effort into meeting Medicare managed care requirements and, according to Health Care Financing Administration reviewers, were generally as successful as other new Medicare managed care plans in this regard. Most sites reached the enrollment limits they had established for retirees already covered by Medicare. DOD officials indicated that the demonstration's effect was positive. Enrollees received a broader range of services from DOD than in the past, when they got care only when space was available in DOD facilities. Officials also noted that providing more comprehensive care to seniors helped sharpen the skills of military clinical staff, which contributed to their readiness for supporting combat or other military missions. Some challenges encountered in the demonstration reflect larger DOD managed care issues and may have implications for DOD managed care generally. Although access to care was generally good, the demonstration experienced some problems in maintaining adequate clinical staff."

A letter report issued by the General Accounting Office with an abstract that begins "The Department of Defense's (DOD) Medicare subvention demonstration tested alternate approaches to health care coverage for military retirees. Retirees could enroll in new DOD-run Medicare managed care plans, known as TRICARE Senior Prime, at six sites. The demonstration plan offered enrollees the full range of Medicare-covered services as well as additional TRICARE services, with minimal copayments. During the demonstration period, the program parameters were changed, allowing military retirees age 65 and older to become eligible for TRICARE coverage as of October 1, 2001, and Senior Prime was extended for one year. The demonstration showed that retirees were interested in enrolling in low-cost military health plans and that DOD was able to satisfy its Senior Prime enrollees. By the close of the initial demonstration period, about 33,000 retirees were enrolled in Senior Prime, and more were on waiting lists. When nonenrollees were asked why they did not join Senior Prime, more than 60 percent said that they were satisfied with their existing health coverage; few said that they disliked military care. Although the demonstration had positive results for enrollees, it also highlighted three challenges confronting the military …

A letter report issued by the General Accounting Office with an abstract that begins "Most major U.S. airlines began realizing net operating losses early in the 2001, and all of the major U.S. passenger carriers except Southwest Airlines reported losses for the year. Travelers throughout the nation shared in the difficulties. In October 2000, the typical or median small community that GAO analyzed had service from two airlines, with a total of nine daily departing flights. Forty-one percent of the communities were served by only one airline with size being the most obvious factor for service limitations. However, the level of service also varied by the level of local economic activity. The total number of daily departures from these small communities declined by 19 percent between October 2000 and October 2001. Although carriers had reduced total departure levels at small communities before September 11th, airlines made even more reductions after that date. Because profitability is so critical to airline decisions about what markets to serve and how to serve them, the changes in service levels in small communities can be traced to economic factors. Two such factors--the economic decline that began in early 2001 and the collapse of airline passenger …

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the impact of electronic commerce (e-commerce) growth on state and local government sales tax collections, focusing on: (1) how taxes associated with the sale of goods and services over the Internet differ from taxes associated with sales by other remote sellers and in-store sellers; (2) the extent to which each state relies on sales and use tax revenues to fund the services they provide; (3) how much revenue state and local governments are losing this year by not being able to collect sales and use taxes on sales made by all remote sellers and, particularly, by Internet sellers; and (4) how much revenue state and local governments would likely lose in 2003 under various growth scenarios for all remote and Internet sales."

A letter report issued by the Government Accountability Office with an abstract that begins "Congress, policy analysts, and groups representing physicians have raised questions about beneficiary access to Medicare physician services. At the same time, high levels of spending for health care in some parts of the country, and rapid increases in spending for physician services, have been identified as factors that threaten the long-term fiscal sustainability of the Medicare program. GAO was asked to assess beneficiary access to physician services and to identify indicators of potential overutilization of physician services. In this report, GAO (1) examines whether, from 2000 through 2008, beneficiaries had problems accessing physician services; (2) identifies areas of the country in which Medicare beneficiaries are potentially overserved by physicians; and (3) describes characteristics that distinguish the potentially overserved areas from other areas in the nation. GAO analyzed the most recent data available from several sources, including an annual Centers for Medicare & Medicaid Services (CMS) survey of fee-for-service (FFS) Medicare beneficiaries, Medicare physician claims for services provided in April of each year from 2000 through 2008, the Health Resources and Services Administration's Area Resource File, and the U.S. Census Bureau."

A letter report issued by the General Accounting Office with an abstract that begins "Identity theft or identity fraud generally involves "stealing" another person's personal identifying information--such as Social Security Number (SSN), date of birth, and mother's maiden name--and then using the information to fraudulently establish credit, run up debt, or take away existing financial accounts. The Identity Theft and Assumption Deterrence Act of 1998 made identity theft a separate crime against the person whose identity was stolen, broadened the scope of the offense to include the misuse of information as well as documents and provided punishment--generally a fine or imprisonment or both. GAO found no comprehensive or centralized data on enforcement results under the federal Identity Theft Act. However, according to a Deputy Assistant Attorney General, federal prosecutors are using the 1998 federal law. As with the federal act, GAO found no centralized or comprehensive data on enforcement results under state identity theft statutes. However, officials in the 10 states selected for study provided examples of actual investigations or prosecutions under these statutes. Generally, the prevalence of identity theft and the frequently multi- or cross-jurisdictional nature of such a crime underscore the importance of promoting cooperation or coordination among …

A chapter report issued by the General Accounting Office with an abstract that begins "This report discusses the Drug Enforcement Administration's (DEA) Mobile Enforcement Team Program. GAO found that since the program was established in 1995, DEA has enhanced its management of the program and provided for greater headquarters oversight and monitoring. In implementing the program and carrying out deployments, the field division METs generally complied with some of the pertinent requirements and guidelines that GAO reviewed. However, some DEA headquarters files did not contain adequate documentation, GAO could not determine whether the METs consistently and adequately assessed the requesting local law enforcement agencies' abilities to address, on their own, the drug and related violence problems for which DEA's program assistance was requested. DEA expects the program to focus on specific, targeted gangs in the areas in which the METs are deployed and that deployments will generally continue until the targeted individuals are arrested and the targeted drug gangs have been disrupted or dismantled. Consistent with the nature and objectives of the program, investigators focused primarily on street-level drug dealers and were mostly local and regional in scope. DEA collects data on various performance measures to assess the results of …

A letter report issued by the General Accounting Office with an abstract that begins "In the Balanced Budget Act of 1997, Congress established a three-year demonstration, called Medicare subvention, to improve the access of Medicare-eligible military retirees to care at military treatment facilities (MTF). The demonstration allowed Medicare-eligible retirees to get their health care largely at MTFs by enrolling in a Department of Defense (DOD) Medicare managed care organization known as TRICARE Senior Prime. During the subvention demonstration, access to health care for many retirees who enrolled in Senior Prime improved, while access to MTF care for some of those who did not enroll declined. Many enrollees in Senior Prime said they were better able to get care when they needed it. They also reported better access to doctors in general as well as care at MTFs. Enrollees generally were more satisfied with their care than before the demonstration. However, the demonstration did not improve enrollees' self-reported health status. In addition, compared to nonenrollees, enrollees did not have better health outcomes, as measured by their mortality rates and rates of "preventable" hospitalizations. Moreover, DOD's costs were high, reflecting enrollees' heavy use of hospitals and doctors."

A letter report issued by the General Accounting Office with an abstract that begins "The Railroad Revitalization and Regulatory Reform Act of 1976 and the Staggers Rail Act of 1980 gave freight railroads increased freedom to price their services according to market conditions. A number of shippers are concerned that freight railroads have used these pricing freedoms to unreasonably exercise their market power in setting rates for shippers with fewer alternatives to rail transportation. This report updates the rate information in GAO's 1999 report (RCED-99-93) using selected commodities and with effective competitive transportation alternatives. From 1997 through 2000, rail rates generally decreased, both nationwide and for many of the specific commodities and markets that GAO examined. However, rail rates for some commodities and distance categories--such as wheat moving long distances and coal moving short distances--have stayed about the same or increased. In other instances, such as wheat moving medium distances, rail rates stayed about the same or decreased. Overall, the proportion of rail shipments above the Surface Transportation Board's statutory jurisdictional threshold for considering rate relief actions--where railroad revenues for the shipment exceed 180 percent of variable costs--stayed relatively constant at 30 percent from 1997 through 2000. However, the proportion …

A letter report issued by the Government Accountability Office with an abstract that begins "Major changes in the mailing industry have reinforced the need for the U.S. Postal Service (USPS) to reduce costs and increase efficiency. In its 2002 Transformation Plan, USPS proposed doing so by realigning its mail processing network. The objectives of this requested report are to (1) describe the status of the initiatives USPS has developed for realignment; (2) evaluate how the planning, impacts, and results of these initiatives align with realignment goals; and (3) evaluate USPS's communication practices with stakeholders in making realignment decisions."

Testimony issued by the Government Accountability Office with an abstract that begins "GAO has issued reports on the U.S. Postal Service's (USPS) strategy for realigning its mail processing network and improving delivery performance information. These reports recommended that the Postmaster General (1) strengthen planning and the overall integration of its realignment efforts, and enhance accountability by establishing measurable targets and evaluating results, (2) improve delivery service standards and performance measures, and (3) improve communication with stakeholders by revising its Area Mail Processing (AMP) Communication Plan to improve public notice, engagement, and transparency. The 2006 postal reform act required USPS to develop a network plan by June 2008 that described its vision and strategy for realigning its network; the anticipated costs, cost savings, and other benefits of its realignment initiatives; performance measures for its delivery service standards, and its communication procedures for consolidating AMP operations. This testimony discusses USPS's actions toward addressing GAO recommendations to (1) strengthen network realignment planning and accountability, (2) improve delivery performance information, and (3) improve communication with stakeholders. This testimony is based on prior GAO work, a review of USPS's 2008 Network Plan and revised AMP Communication Plan, and updated information from USPS officials. USPS did …

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the Department of Veterans Affairs' (VA) and Department of Defense's (DOD) shared health care resources, focusing on: (1) the benefits gained from sharing; (2) the extent to which VA and DOD are sharing health care resources; and (3) barriers and challenges VA and DOD face in their efforts to share health resources."

A letter report issued by the Government Accountability Office with an abstract that begins "In 2008, GAO reported that 1,088 oil industry mergers occurred between 2000 and 2007. Given the potential for price effects, GAO recommended that the Federal Trade Commission (FTC), the agency with the authority to maintain petroleum industry competition, undertake more regular retrospective reviews of past petroleum industry mergers, and FTC said it would consider this recommendation. GAO was asked to conduct such a review of its own to determine how mergers and market concentration--a measure of the number and market shares of firms in a market--affected wholesale gasoline prices since 2000. GAO examined the effects of mergers and market concentration using an economic model that ruled out the effects of many other factors. GAO consulted with a number of experts and used both public and private data in developing the model. GAO tested the model under a variety of assumptions to address some of its limitations. GAO also interviewed petroleum market participants."

Testimony issued by the Government Accountability Office with an abstract that begins "GAO reported in 2005 on major changes in the mailing industry that have reinforced the need for the U.S. Postal Service (USPS) to reduce costs and increase efficiency. To address these changes and become more efficient, USPS is implementing initiatives aimed at realigning its mail processing network. In a follow-up review, GAO recently reported that USPS has made progress in implementing these initiatives, yet challenges such as maintaining delivery standards and addressing stakeholder and community resistance remain. In July 2006, GAO also reported on USPS's progress in improving delivery performance information. This testimony describes (1) the changes that have affected USPS's processing network, (2) GAO's concerns related to USPS's strategy for realigning its mail processing network and implementing its area mail processing consolidations, and (3) GAO's concerns related to USPS's progress in improving delivery performance information. This testimony is based on prior GAO reports."

Other written product issued by the General Accounting Office with an abstract that begins "The Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001 (the Act) required that the Comptroller General of the United States convene a panel of experts to study the policies and procedures governing the transfer of commercial activities for the federal government from government personnel to a federal contractor. The Panel held a total of 11 meetings over the period of May 2001 to March 2002, including three public hearings in Washington, D.C., Indianapolis, Indiana, and San Antonio, Texas. In these hearings, panelists heard first-hand both about the current process, primarily the cost comparison process conducted under Office of Management and Budget Circular A-76, as well as alternatives to that process. Panel staff conducted an extensive amount of additional research, review, and analysis in order to supplement and evaluate the public testimony. This report includes the findings of the Panel as a whole, as well as a written statement from each Panel member as the Panel's report and recommendations."

A letter report issued by the General Accounting Office with an abstract that begins "The federal government has many vacant and underutilized properties that are no longer needed. Retaining unneeded real properties presents federal agencies with significant potential risks for (1) lost dollars because such properties are costly to maintain; and (2) lost opportunities because the properties could be put to more cost-beneficial uses, exchanged for other needed property, or sold to generate revenue for the government. The General Services Administration (GSA), the Department of Veterans Affairs (VA), and the U.S. Postal Service (USPS) hold a significant number of real property assets. GAO was asked to provide information on how these agencies identify vacant and underutilized real properties and the numbers, types, and locations of these properties."

A letter report issued by the General Accounting Office with an abstract that begins "Over the past 12 years, federal disaster assistance costs have totaled more than $39 billion (in fiscal year 2001 dollars)--a nearly fivefold increase over the previous 12-year period--as a result of a series of unusually large and frequent disasters and an increasing federal role in assisting communities and individuals affected by disasters. The Federal Emergency Management Agency (FEMA), the lead agency for providing federal disaster relief, has provided the bulk of the assistance to help those in need respond to and recover from disasters. As the costs for disaster assistance have risen, FEMA has made disaster mitigation a primary goal in its efforts to reduce the long-term cost of disasters and has developed mitigation programs designed to minimize risk to property or individuals from natural or man-made hazards. FEMA's multihazard mitigation programs differ substantially in how they have sought to reduce the risks from hazards but each has features that the state emergency management community believes has been successful for mitigation. The Hazard Mitigation Grant Program (HMGP), FEMA's oldest multihazard mitigation programs, is a post disaster program that has provided the bulk of mitigation assistance to …

A letter report issued by the General Accounting Office with an abstract that begins "In exchange for the possibility of dismissed charges or reduced sentences, defendants with substance abuse problems agree to be assigned to drug court programs. In drug courts, judges generally preside over the proceedings; monitor the progress of defendants; and prescribe sanctions and rewards in collaboration with prosecutors, defense attorneys, and treatment providers. Most decisions about drug court operations are left to local jurisdictions. Although programs funded by the Drug Court Program Office (DCPO) must collect and provide performance measurement and outcome data, the Department of Justice (DOJ) has not effectively managed this effort because of (1) its inability to readily identify the universe of DCPO-funded drug court programs, including those subject to DCPO's data collection reporting requirements; (2) its inability to accurately determine the number of drug court programs responding to DCPO's semiannual data collection survey; (3) inefficiencies in the administration of DCPO's semiannual data collection effort; (4) the elimination of post-program impact questions from the data collection survey effort; and (5) the lack of use of the Drug Court Clearinghouse. Various administrative and research factors have also hampered DOJ's ability to complete the two-phase National …

A letter report issued by the Government Accountability Office with an abstract that begins "To better assist veterans with service-connected disabilities seeking employment, in 2005, the Departments of Labor (Labor) and Veterans Affairs (VA) signed an agreement to coordinate employment services for disabled veterans. Around the same time, VA rolled out a redesigned employment program for these veterans, known as the Five-Track program, which also established an employment coordinator position and job resource labs. To help Congress understand the status of these initiatives, GAO was asked to provide information on (1) the progress in implementing the 2005 agreement and challenges to implementation, (2) the status of implementation of VA's Five-Track program and challenges posed by recently returning veterans, and (3) the role of employment coordinators and job resource labs in serving veterans. To obtain this information, GAO interviewed Labor and VA officials and national veterans' service organizations, and conducted site visits in five states."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) operates one of the nation's largest health care systems. In 1999, GAO reported on VA's aged, obsolete capital assets, noting that better management of these assets could significantly reduce VA's operating costs. GAO further noted that VA could reinvest the savings to enhance veterans' health care services. In response, VA initiated its Capital Asset Realignment for Enhanced Services (CARES) process. Through CARES, VA identified what health care services it should provide and in which locations through 2022. The CARES process included assessing alternative ways to align inpatient services by closing or adding services at existing VA medical facilities or establishing new facilities. In May 2004, VA published its CARES decisions, but did not provide a national comprehensive summary of all its decisions about the alignment of inpatient services. GAO was asked to provide additional information about the inpatient service assessments and decisions made by VA. To provide a national, comprehensive summary, GAO summarized the locations where VA (1) identified a need to evaluate alternative ways to align inpatient health care service to improve quality, efficiency, or access and (2) made …

A letter report issued by the General Accounting Office with an abstract that begins "Experts disagree about the best methods to teach student who speak little English. Even though different approaches to English language instruction may be effective, many variables may influence a given school's program choices. Moreover, there is no clear time line for acquiring English proficiency. Local decisions about the amount of time needed to attain proficiency and the amount of language support that should be provided may differ. Of the two main instructional approaches, English-based instruction is more common than instruction in a student's native language. Most students spent four or less years in these programs. School districts are required to ensure that English-language instruction is adequate and to provide these children with equal educational opportunities. The Office of Civil Rights (OCR) has adopted procedural requirements for criteria for judging the adequacy of local English-language instruction programs in meeting those needs. In three policy documents, OCR set forth requirements that school districts must meet to pass a three-pronged test established by the courts. When the adequacy of local English-language instruction programs is questioned, OCR investigates and, if problems are found, enters into agreement with the district specifying …