Correspondence issued by the Government Accountability Office with an abstract that begins "This report presents the results of our review of the expenses paid from the Department of Justice (DOJ) permanent, indefinite appropriation covering the 7- month period ending September 30, 2009. The expenses we reviewed were those paid out of the permanent, indefinite appropriation by DOJ between March 1, 2009, and September 30, 2009, to cover Independent and Special Counsel administrative activities. With the October 2009 repeal of the requirement for a GAO review and report on such expenses, this represents our final report."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) provides health care and mental health care through its TRICARE program. Under TRICARE, beneficiaries may obtain care through TRICARE Prime, an option that includes the use of civilian provider networks and requires enrollment. TRICARE beneficiaries who do not enroll in this option may obtain care from nonnetwork providers through TRICARE Standard, or from network providers through TRICARE Extra. In addition, qualified National Guard and Reserve servicemembers may purchase TRICARE Reserve Select, a plan whose care options are similar to those of TRICARE Standard and TRICARE Extra. We refer to servicemembers who use TRICARE Standard, TRICARE Extra, or TRICARE Reserve Select as nonenrolled beneficiaries. The National Defense Authorization Act for Fiscal Year 2008 directed GAO to analyze the adequacy of DOD's surveys of TRICARE beneficiaries and providers and report what the surveys' results indicate about access to care for nonenrolled beneficiaries. To do so, GAO evaluated the surveys' methodology by interviewing DOD officials and reviewing relevant documentation, including the Office of Management and Budget's (OMB) survey standards. GAO also assessed the surveys' results by interviewing DOD officials, obtaining relevant documentation, and analyzing …

A letter report issued by the Government Accountability Office with an abstract that begins "In response to the most recent U.S. recession, from December 2007 to June 2009, Congress passed the American Recovery and Reinvestment Act of 2009 (Recovery Act). To help states maintain their Medicaid programs and provide states with general fiscal relief, the Recovery Act temporarily increased the federal share of Medicaid funding for states. The federal funding states receive for Medicaid is determined by a statutory formula--the Federal Medical Assistance Percentage (FMAP). The Recovery Act also required GAO to study options for providing a temporary increased FMAP in response to future recessions. GAO reviewed how past recessions affected states' ability to fund Medicaid, examined the responsiveness of past increased FMAP assistance to state needs, and identified options for adjusting the increased FMAP formula for use during future recessions. To conduct this work, GAO reviewed its previous reports on recessions and the increased FMAP and similar work from other organizations. GAO analyzed federal Medicaid data and enrollment data provided by state Medicaid directors. GAO also analyzed labor market data from the Bureau of Labor Statistics, state revenue data from the Census Bureau, and the Federal Reserve Bank of …

Correspondence issued by the Government Accountability Office with an abstract that begins "On November 16, 2009, we issued our opinion on the U.S. Securities and Exchange Commission's (SEC) fiscal years 2009 and 2008 financial statements. We also issued our opinion on the effectiveness of SEC's internal controls over financial reporting as of September 30, 2009, and our evaluation of SEC's compliance with selected provisions of laws and regulations during fiscal year 2009. The purpose of this report is to present (1) our recommendations related to the significant deficiencies we reported and discussed in our opinion report; (2) less significant internal control issues we identified during our fiscal year 2009 audit of SEC's internal controls and accounting procedures, along with our related recommended corrective actions; (3) the status of the recommendations reported as open in our April 2, 2009, management report (see enclosure I), and (4) the status of the security weaknesses in information systems controls at SEC that we identified in public and "Limited Official Use Only" reports issued in 2005, 2007, 2008, and 2009, that were unresolved at the time of our March 16, 2009, information security reports."

A statement of record issued by the Government Accountability Office with an abstract that begins "This testimony comments on the H-1B program. Congress created the current H-1B program in 1990 to enable U.S. employers to hire temporary, foreign workers in specialty occupations. The law capped the number of H-1B visas issued per fiscal year at 65,000, although the cap has fluctuated over time with legislative changes. The H-1B cap and the program itself have been a subject of continued controversy. Proponents of the program argue that it allows companies to fill important and growing gaps in the supply of U.S. workers, especially in the science and technology fields. Opponents of the program argue that there is no skill shortage and that the H-1B program displaces U.S. workers and undercuts their pay. Others argue that the eligibility criteria for the H-1B visa should be revised to better target foreign nationals whose skills are undersupplied in the domestic workforce. Our comments in this statement for the record are based on the results of our recent examination of the H-1B program, highlighting the key challenges it presents for H-1B employers, H-1B and U.S. workers, and federal agencies. Specifically, this statement presents information on …

A letter report issued by the Government Accountability Office with an abstract that begins "Federal officials, Congress, and the public have long voiced concerns about safety at the nation's nuclear weapons laboratories: Lawrence Livermore, Los Alamos, and Sandia. The laboratories are overseen by the National Nuclear Security Administration (NNSA), while contractors carry out the majority of the work. A recent change to oversight policy would result in NNSA's relying more on contractors' own management controls, including those for assuring safety. This report discusses (1) the recent history of safety problems at the laboratories and contributing factors, (2) steps taken to improve safety, and (3) challenges that remain to effective management and oversight of safety. To address these objectives, GAO reviewed almost 100 reports and investigations and interviewed key federal and laboratory officials."

A letter report issued by the Government Accountability Office with an abstract that begins "The Indian Health Service (IHS), located within the Department of Health and Human Services, is responsible for arranging health care services for Native Americans (American Indians and Alaska Natives). IHS services include primary care (medical, dental, and vision); ancillary services, such as laboratory and pharmacy; and specialty care, including services provided by physician specialists. IHS provides some services through direct care at hospitals, health centers, and health stations, which may be federally or tribally operated. When services are not available--that is, both offered and accessible--on site, IHS offers them, as funds permit, through contract care furnished by outside providers. Concerns persist that some Native Americans are experiencing gaps in necessary health care. GAO was asked to examine the availability of (1) primary care services and (2) ancillary and specialty services for Native Americans. Additionally, GAO examined the underlying factors associated with variations in the availability of services and strategies used by facilities to increase service availability. GAO conducted site visits to 13 facilities and interviewed IHS officials from all 12 IHS areas, which cover all or part of 35 states. GAO received written comments from IHS. …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Health and Human Services (HHS) has a structured process for awarding Patient Protection and Affordable Care Act (PPACA) exchange and rate review grants to states. These grants are designed to help states establish exchanges--new health insurance marketplaces through which individuals and small businesses can obtain insurance--and review issuers' proposed rate increases. The grant award process consists of a series of steps during which the agency solicits, screens, and evaluates grant applications, and then makes funding awards. Once HHS deems that applications meet program eligibility criteria, applications go through various reviews, including a review by independent experts and HHS officials. On the basis of these reviews, HHS determines whether states' proposed activities are allowable, and if so, whether the associated requests for grant funding are reasonable. Based on recommendations from the reviews, HHS determines whether to award grants to states, and if so, the amounts of any grants to be awarded."

A letter report issued by the Government Accountability Office with an abstract that begins "Currently in Iraq, there are thousands of private security contractor (PSC) personnel supporting DOD and State, many of whom are foreign nationals. Congressional concerns about the selection, training, equipping, and conduct of personnel performing private security functions in Iraq are reflected in a provision in the fiscal year 2008 National Defense Authorization Act (NDAA) that directs DOD to develop guidance on PSCs. This report examines the extent (1) that DOD and State have developed and implemented policies and procedures to ensure that the backgrounds of PSC employees have been screened and (2) that DOD has developed guidance to implement the provisions of the NDAA and (3) that DOD and State have addressed measures on other issues related to PSC employees in Iraq. To address these objectives, GAO reviewed DOD and State guidance, policies, and contract oversight documentation and interviewed agency and private security industry officials."

A letter report issued by the General Accounting Office with an abstract that begins "The LOCAL TV Act required that GAO perform an annual audit of the (1) administration of the provisions of the Act, and (2) financial position of each applicant who receives a loan guarantee under the Act, including the nature, amount, and purpose of investments made by the applicant. In fiscal year 2002, the LOCAL TV Program was funded; however, because it was not fully implemented in that year, there were no loan guarantee applicants for GAO to audit. Therefore, this report primarily addresses whether program administration during fiscal year 2002 satisfied the provisions of the Act."

A chapter report issued by the General Accounting Office with an abstract that begins "The federal government has been a key participant in the efforts to provide aid to the New York City area to help it respond to and recover from the September 11 terrorist attacks. The President pledged, and the Congress subsequently authorized, about $20 billion in federal aid. This federal aid was provided primarily through four sources: the Federal Emergency Management Agency (FEMA), the Department of Housing and Urban Development (HUD), the Department of Transportation (DOT), and the Liberty Zone tax benefits--a set of tax benefits targeted to lower Manhattan. These sources provided 96 percent, or $19.63 billion, of the committed federal aid to the New York City area. It has been over 2 years since the attacks occurred, and many efforts have been undertaken to aid the New York City area to cope with the disaster and its many impacts. GAO was asked to describe how much and what type of federal assistance was provided to the New York City area through these four sources and how the federal government's response to this disaster differed from previous disasters. We provided a draft of this report to …

Testimony issued by the Government Accountability Office with an abstract that begins "The U.S. Navy is about to begin construction of the first Zumwalt-class destroyer (DDG 1000) amid considerable uncertainties and a high likelihood of cost and schedule growth. Significant cost growth and schedule delays are persistent problems that continue to compromise the Navy's shipbuilding goals. This testimony focuses on (1) the challenges faced by the DDG 1000 program and (2) the strain such challenges portend for long term shipbuilding plans."

Other written product issued by the Government Accountability Office with an abstract that begins "The unified budget deficit--sometimes called the "cash deficit"--and the net operating cost-- sometimes called the "accrual deficit"--are two key measures of the government's annual fiscal position. The cash deficit provides information on the government's current cash flow and borrowing needs. The accrual deficit provides information on the current cost of government-- the amount of resources used to produce goods or deliver services during the fiscal year-- regardless of when cash is used."

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a legislative requirement, GAO presented the results of its audits of expenditures reported by seven offices of independent counsel for the 6 months ended September 30, 1998, focusing on whether the statements of expenditures complied with the financial reporting requirements of the law."

A letter report issued by the General Accounting Office with an abstract that begins "Many small employers--those with 50 or fewer workers--do not offer health benefits to their employees. This is particularly true for employers with fewer than 10 workers. The families of workers employed by small employers are about twice as likely to be uninsured as households with a worker at a large employer. Despite efforts by Congress and the states to help small employers buy coverage, many small employers continue to cite cost as a major obstacle to providing coverage. Small and large employers purchasing health insurance generally had comparable premiums in 1998, but this comparison does not fully reflect the challenges facing small employers in providing health insurance for their employees. Although the premiums were similar, the health plans offered by small employers were slightly less generous on average--they had slightly higher average cost-sharing requirements for their employees and were somewhat less likely to offer some benefits, excluding, for example, mental health services and chiropractic care. Also, insurers' costs to administer employer-based health insurance and protect against potentially large health care costs result in a larger share of small employers' premium dollars being spent on these nonbenefit …

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a legislative requirement, GAO provided information on the Department of Defense's (DOD) efforts to develop future warfighting capability, focusing on the: (1) status of DOD's efforts to implement its joint experimentation program; (2) factors that GAO believes contribute to the success of a joint experimentation program; and (3) extent of DOD's support for future warfighting."

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO reviewed the Small Business Administration's (SBA) management of information technology (IT), focusing on the five key IT process areas--investment management, architecture, information security, software development and acquisition, and human capital management."

Other written product issued by the Government Accountability Office with an abstract that begins "The United States and the international community have stressed that a coordinated response is required to address the global threat from transnational terrorism. Multilateral engagements provide opportunities to foster relationships with traditional and nontraditional partner countries. Partnerships also can raise common awareness of the threat and build the trust necessary to share information that could prevent and detect terrorist acts. GAO convened a forum on April 22, 2008, to advance the dialogue on how partnerships can mitigate the conditions that foster transnational terrorism and to identify potential strategies for overcoming challenges faced in engaging in such partnerships. Participants included representatives from U.S. government agencies, foreign embassies, nongovernmental and multilateral organizations, policy institutes, the private sector, and academia. The forum focused on (1) the partnership efforts and key practices of the U.S. government and its partners, (2) challenges to these efforts and practices, and (3) strategies to overcome the challenges. Comments expressed during the proceedings do not necessarily represent the views of all participants, the organizations they represent, or GAO. Participants reviewed a draft of this summary, and their comments were incorporated, as appropriate."

A letter report issued by the General Accounting Office with an abstract that begins "GAO was asked to review the Centers for Medicare & Medicaid Services (CMS) initiative to publicly report additional information on its "Nursing Home Compare" Web site intended to help consumers choose a nursing home. GAO examined CMS's development of the new nursing home quality indicators and efforts to verify the underlying data used to calculate them. GAO also reviewed the assistance CMS offered the public in interpreting and comparing indicators available in its six-state pilot program, launched in April 2002, and its own evaluation of the pilot. The new indicators are scheduled to be used nationally beginning in November 2002."

A letter report issued by the General Accounting Office with an abstract that begins "Industrial facilities that operate under permits regulating some emissions and discharges have been the subject of complaints from community groups and environmental activists who charge that the facilities expose the surrounding communities to greater environmental risk than the general population. In response, the facilities point out that they contribute to the economic growth of the surrounding communities by employing residents and supporting other community needs, such as schools and infrastructure. In a survey of selected facilities, GAO found that the number of jobs in some decreased over time. According to facility officials, these jobs included unskilled, trade, technical, administrative, and professional positions with salaries ranging from $15,000 to $80,000 per year. Most of the facilities identified other contributions that they had made or planned to make in the local communities. These included volunteer work such as organizing cleanups; infrastructure improvements such as installing a new water drainage system; and financial assistance to schools, universities, community groups, and other organizations. Property values in a community are affected by many factors, including the condition of the land and houses, the proximity of the property to natural or man-made …

A letter report issued by the General Accounting Office with an abstract that begins "Federal employees' health insurance premiums have increased at double-digit rates for 3 consecutive years. GAO was asked to examine how the Federal Employees Health Benefits Program's (FEHBP) premium trends compared to those of other large purchasers of employer-sponsored health insurance, factors contributing to FEHBP's premium growth, and steps the Office of Personnel Management (OPM) takes to help contain premium increases compared to those of other large purchasers. GAO compared FEHBP to the California Public Employees' Retirement System (CalPERS), General Motors, and a large private-employer purchasing coalition in California as well as data from employee benefit surveys."

A letter report issued by the General Accounting Office with an abstract that begins "This report addresses (1) the relationship between Medicare skilled nursing facility (SNF) payments and the costs of treating Medicare patients in freestanding SNFs, as well as the effect of Medicare SNF payments on the financial condition of these facilities, and (2) the relationship between Medicare SNF payments and the costs of treating patients in hospital-based SNFs, as well as the factors that may account for cost differences between hospital-based and freestanding SNFs."

A letter report issued by the Government Accountability Office with an abstract that begins "Over 100,000 chemicals, pollutants, and toxic substances are used in the United States and regulated by the Environmental Protection Agency (EPA). EPA uses risk assessment to determine the health risk from exposure to these substances, collectively referred to as contaminants. In the last 12 years, independent reviewers have examined this process and made recommendations for how it could be improved. GAO was asked to (1) identify the significant recommendations that have been made to improve human health risk assessment; (2) describe what EPA has done to modify its human health risk assessment process; (3) determine the effects these past modifications have had on the preparation of risk assessments; and (4) identify any additional actions experts believe EPA could take to improve its process, and the barriers it would face in doing so."

A letter report issued by the Government Accountability Office with an abstract that begins "Several information security threats exist that can exploit vulnerabilities in active implantable medical devices, but experts caution that efforts to mitigate information security risks may adversely affect device performance. Threats to active devices—that is, devices that rely on a power source to operate—that also have wireless capability can be unintentional, such as interference from electromagnetic energy in the environment, or intentional, such as the unauthorized accessing of a device. Several experts consider certain threats to be of greater concern than others; for example, experts noted less concern about interference from electromagnetic energy than other threats. Incidents resulting from unintentional threats have occurred, such as a malfunction resulting from electromagnetic interference, but have since been addressed. Although researchers have recently demonstrated the potential for incidents resulting from intentional threats in two devices—an implantable cardioverter defibrillator and an insulin pump—no such actual incidents are known to have occurred, according to the Food and Drug Administration (FDA). Medical devices may have several such vulnerabilities that make them susceptible to unintentional and intentional threats, including untested software and firmware and limited battery life. Information security risks resulting from certain threats …