A letter report issued by the General Accounting Office with an abstract that begins "The Centers for Medicare & Medicaid Services (CMS) recently implemented a Medicare ambulance fee schedule in which providers are paid a base payment per trip plus a mileage payment. An adjustment is made to the mileage rate for rural trips to account for higher costs. CMS has stated that this rural adjustment may not sufficiently target providers serving sparsely populated rural areas. The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) directed GAO to examine rural ambulance costs. GAO identified factors that affect ambulance costs per trip, examined how these factors varied across geographic areas, and analyzed whether Medicare payments account for geographic cost differences. GAO used survey data on ambulance providers and Medicare claims data."

A letter report issued by the General Accounting Office with an abstract that begins "The National Defense Authorization Act for Fiscal Year 2003 directed the Department of Defense (DOD) to develop an enterprise architecture and a transition plan that meets certain requirements. The act also directed DOD to have a process for controlling its system investments. As required by the act, GAO assessed DOD's actions to comply with the act's requirements and recently issued a report to congressional defense committees. This report provides further details of GAO's assessment results regarding (1) the extent to which DOD's actions complied with the requirements of the act and (2) DOD's plans for further development and implementation of its architecture."

A letter report issued by the General Accounting Office with an abstract that begins "The Department of Homeland Security (DHS) plans to establish a program to strengthen management of the pre-entry, entry, status, and exit of foreign nationals who travel to the United States. The goals of the program, known as the United States Visitor and Immigrant Status Indicator Technology (US-VISIT), are to facilitate legitimate trade and travel, enhance national security, and adhere to U.S. privacy laws and policies. By congressional mandate, DHS is to develop and submit for approval an expenditure plan for US-VISIT that satisfies certain conditions, including being reviewed by GAO. GAO was asked to determine, among other things, whether the plan satisfies these conditions and to provide observations about the plan and DHS's management of the program."

A letter report issued by the General Accounting Office with an abstract that begins "Each year federal agencies issue numerous proposed or final rules or take other regulatory actions that may potentially affect the use of private property. Some of these actions may result in the property owner being owed just compensation under the Fifth Amendment. In 1988 the President issued Executive Order 12630 on property rights to ensure that government actions affecting the use of private property are undertaken on a well-reasoned basis with due regard for the potential financial impacts imposed on the government. GAO was asked to provide information on the compliance of the Department of Justice and four agencies--the Department of Agriculture, the Army Corps of Engineers, the Environmental Protection Agency, and the Department of the Interior--with the executive order. Specifically, GAO examined the extent to which (1) Justice has updated its guidelines for the order to reflect changes in case law and issued supplemental guidelines for the four agencies, (2) the four agencies have complied with the specific provisions of the executive order, and (3) just compensation awards have been assessed against the four agencies in recent years. We provided the agencies with a draft …

A letter report issued by the General Accounting Office with an abstract that begins "Amid heightened awareness that many patients with cancer and other chronic diseases suffer from undertreated pain, the Food and Drug Administration (FDA) approved Purdue Pharma's controlled-release pain reliever OxyContin in 1995. Sales grew rapidly, and by 2001 OxyContin had become the most prescribed brandname narcotic medication for treating moderate-to-severe pain. In early 2000, reports began to surface about abuse and diversion for illicit use of OxyContin, which contains the opioid oxycodone. GAO was asked to examine concerns about these issues. Specifically, GAO reviewed (1) how OxyContin was marketed and promoted, (2) what factors contributed to the abuse and diversion of OxyContin, and (3) what actions have been taken to address OxyContin abuse and diversion."

A letter report issued by the General Accounting Office with an abstract that begins "The Congress has been seeking to increase federal agency purchases of equipment and services on line. The General Services Administration's (GSA) Advantage Internet-based ordering system is meant for conducting market research and ordering all types of products and services on line. About $84 million has already been invested in this endeavor. GAO was asked to assess how effectively GSA has managed this investment."

A letter report issued by the General Accounting Office with an abstract that begins "In 2001, 1.75 million workers lost jobs through extended mass layoffs. The Worker Adjustment and Retraining Notification (WARN) Act requires advance notice of plant closures and mass layoffs. The report discusses (1) the extent to which plant closures and mass layoffs were subject to WARN's requirements, (2) the extent to which employers with mass layoffs and plant closures provided notice, and (3) what issues employers and employees face when assessing the applicability of WARN to their circumstances."

A letter report issued by the General Accounting Office with an abstract that begins "Abusive tax avoidance schemes could threaten our tax system's integrity and fairness if honest taxpayers believe that significant numbers of individuals are not paying their fair share of taxes. Abusive schemes encompass such distortions of the tax system as falsely describing the law (saying, for example, that the income tax is unconstitutional), misrepresenting facts (for instance, promoting the deduction of personal expenses as business expenses), or using trusts or offshore bank accounts to hide income. As agreed, this report focuses on three objectives. They are to (1) describe the nature and scope of abusive tax avoidance schemes as determined by the Internal Revenue Service (IRS), (2) describe IRS's strategy to combat these schemes and the performance goals and measures IRS uses to track its major effort related to them, and (3) describe how IRS determined the amount and source of staff resources to be devoted to these schemes in the IRS operating division most directly affected."

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 15 million acres in the United States are suspected of being, or known to be, contaminated with military munitions. These sites include ranges on closing military installations, closed ranges on active installations, and formerly used defense sites. Under the Defense Environmental Restoration Program, established in 1986, the Department of Defense (DOD) must identify, assess, and clean up military munitions contamination at these sites. DOD estimates these activities will cost from $8 billion to $35 billion. Because of the magnitude of DOD's cleanup effort, both in terms of cost and affected acreage, as well as the significant public safety, health, and environmental risks that military munitions may pose, The Ranking Minority Member of the House Committee on Energy and Commerce asked us to evaluate (1) DOD's progress in implementing its program to identify, assess, and clean up military munitions sites and (2) DOD's plans to clean up remaining sites in the future."

A letter report issued by the General Accounting Office with an abstract that begins "Following the 1990-91 Persian Gulf War, many servicemembers experienced health problems that they attributed to their military service in the Persian Gulf. However, a lack of servicemember health and deployment data hampered subsequent investigations into the nature and causes of these illnesses. Public Law 105-85, enacted in November 1997, required the Department of Defense (DOD) to establish a system to assess the medical condition of service members before and after deployments. GAO was asked to determine whether (1) the military services met DOD's force health protection and surveillance requirements for servicemembers deploying in support of Operation Enduring Freedom (OEF) in Central Asia and Operation Joint Guardian (OJG) in Kosovo and (2) DOD has corrected problems related to the accuracy and completeness of databases reflecting which servicemembers were deployed to certain locations."

A letter report issued by the General Accounting Office with an abstract that begins "During the 1990s, the State Department lost more people than it hired. The resultant shortfalls in the number and skills of Foreign Service officers have endangered U.S. diplomatic readiness. Furthermore, recent studies, including several by GAO, have questioned whether State's recruitment system identifies people with the appropriate skills and whether State is assigning officers with specialized skills, such as the ability to speak a difficult language, to positions where they can be utilized. GAO was asked to review State's processes for determining the number and skills of junior officers the department needs and to determine whether it is hiring and assigning officers with the general skills to carry out foreign policy overseas. GAO was also asked to examine the challenges State still needs to address, especially regarding officers' foreign language skills."

A letter report issued by the General Accounting Office with an abstract that begins "Critical Access Hospitals (CAHs) are small rural hospitals that receive payment for their reasonable costs of providing inpatient and outpatient services to Medicare beneficiaries, rather than being paid fixed amounts under Medicare's prospective payment systems. Between fiscal years 1997 and 2002, 681 hospitals have become CAHs. In the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000, GAO was directed to examine requirements for CAH eligibility, including the ban on inpatient psychiatric or rehabilitation distinct part units (DPUs) and limit on patient census, and to make recommendations on related program changes."

A letter report issued by the General Accounting Office with an abstract that begins "The Department of Defense (DOD) must convince more than 200,000 people each year to join the military. To assist in recruiting, the military services advertise on television, on radio, and in print and participate in other promotional activities. In the late 1990s, some of the services missed their overall recruiting goals. In response, DOD added recruiting resources by increasing its advertising, number of recruiters, and financial incentives. By fiscal year 2003, DOD's total recruiting budget was approaching $4 billion annually. At the request of Congress, GAO determined the changes in DOD's advertising programs and funding trends since the late 1990s and assessed the adequacy of measures used by DOD to evaluate the effectiveness of its advertising. GAO recommends that DOD set clear, measurable advertising"

A letter report issued by the General Accounting Office with an abstract that begins "GAO prepared this report in response to its basic legislative responsibilities. Its objectives are threefold: (1) to examine the historical funding trends and their impact on the condition of the active forces' facilities, (2) to evaluate the consistency of the services' information on facility conditions, and (3) to assess the Department of Defense's (DOD) long-term strategic plan and objectives to improve facility conditions."

A letter report issued by the General Accounting Office with an abstract that begins "GAO was asked to assess the condition of key equipment items and to determine if the services have adequate plans for sustaining, modernizing, or replacing them. To address these questions, we selected 25 major equipment items, and determined (1) their current condition, (2) whether the services have mapped out a program strategy for these items, (3) whether current and projected funding is consistent with these strategies, and (4) whether these equipment items are capable of fulfilling their wartime missions."

A letter report issued by the General Accounting Office with an abstract that begins "The strong productivity gains in the U.S. economy have hinged in part on transportation networks working more efficiently. The nation's ports, which handle 95 percent of overseas freight tonnage, are a key link in this network, and efficient intermodal links between ship, rail, and highways are vital to continued productivity gains. GAO was asked to address (1) the challenges to freight mobility, (2) the limitations key stakeholders have encountered in addressing these challenges, and (3) strategies that may aid decision makers in enhancing freight mobility. GAO's work was based on a synthesis of previous studies and a review of conditions at 10 ports and surrounding areas that handle almost two-thirds of all containers moving in and out of the country."

A letter report issued by the General Accounting Office with an abstract that begins "To help strengthen aviation security after the September 11, 2001, terrorist attacks, the Congress expanded the size and mission of the Federal Air Marshal Service (the Service) and located the Service within the newly created Transportation Security Administration (TSA). Between November 2001 and July 1, 2002, the Service grew from fewer than 50 air marshals to thousands, and its mission expanded to include the protection of domestic as well as international flights. In March 2003, the Service, with TSA, merged into the new Department of Homeland Security (DHS); and in November 2003, it was transferred from TSA and merged into DHS's Bureau of Immigration and Customs Enforcement (ICE). GAO looked at operational and management control issues that emerged during the rapid expansion of the Service, specifically addressing its (1) background check procedures and training; (2) management information, policies, and procedures; and (3) challenges likely to result from its mergers into DHS and ICE."

In accordance with the Nuclear Waste Policy Amendments Act of 1987, Yucca Mountain was designated as the site to be investigated as a potential repository for the disposal of high-level radioactive waste. The Yucca Mountain site is an undeveloped area located on the southwestern edge of the Nevada Test Site (NTS), about 100 miles northwest of Las Vegas. The site currently lacks rail service or an existing right-of-way. If the Yucca Mountain site is found suitable for the repository, rail service is desirable to the Office of Civilian Waste Management (OCRWM) Program because of the potential of rail transportation to reduce costs and to reduce the number of shipments relative to highway transportation. A Preliminary Rail Access Study evaluated 13 potential rail spur options. Alternative routes within the major options were also developed. Each of these options was then evaluated for potential land use conflicts and access to regional rail carriers. Three potential routes having few land use conflicts and having access to regional carriers were recommended for further investigation. Figure 1-1 shows these three routes. The Jean route is estimated to be about 120 miles long, the Carlin route to be about 365 miles long, and Caliente route to …

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This report discusses the Supreme Court's decision in McConnell v. FEC. The court upheld against facial constitutional challenges key portions of the Bipartisan Campaign Reform Act of 2002 (BCRA), (P.L. 107-155, commonly known as the McCain-Feingold or Shays-Meehan campaign finance reform law).

The amending process is central to the consideration of legislation by the Senate. This report briefly describes the various types of amendments that take place in the Senate.