The Africa Adaptation Programme (AAP) has been designed to support the long-term efforts of targeted countries to further develop their capability to successfully identify, design and implement holistic adaptation and disaster risk reduction programmes that are aligned with national development priorities. This report provides insight into the Africa Adaptation Programme (AAP) and its related country project profiles. The AAP has shifted into implementation, with Namibia and Tunisia as the first countries to complete national inception workshops. Eighteen out of the total twenty programme countries will complete national inception processes and start full-fledged implementation in the coming months.

Correspondence issued by the Government Accountability Office with an abstract that begins "Congress asked us to estimate the effect on Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) funding to urban areas if a certain stop-loss provision was enacted. The CARE Act, administered by the Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA), was enacted to address the needs of jurisdictions, health care providers, and people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In October 2009, the Ryan White HIV/AIDS Treatment Extension Act of 2009 (RWTEA) reauthorized CARE Act programs for fiscal years 2010 through 2013. The stop-loss provision that you asked us to address was contained in a draft consolidated appropriations bill for fiscal year 2011."

Correspondence issued by the Government Accountability Office with an abstract that begins "GAO's review of open sources published between October 1, 2012, and November 7, 2013, identified four foreign firms that were reported to have engaged in commercial activity in Iran's energy sector during this time period, including one previously-unidentified firm--China Oilfield Services Limited. In addition, since the last report issued in December 2012, GAO moved four firms--INA, ONGC Videsh Ltd., Petronet LNG, and Sasol--to the "Withdrawn" category. For eight additional firms that GAO previously identified as reported to have engaged in commercial activity in Iran's energy sector, GAO found insufficient information to indicate that they had either continued or ceased such activity during the specified time period."

Correspondence issued by the Government Accountability Office with an abstract that begins "We reported the number of 2008 tax returns by state for IRS's 2009 Offshore Voluntary Disclosure Program (OVDP) participants. OVPD offered incentives for taxpayers to disclose their offshore accounts and pay delinquent taxes, interest and penalties. Generally, the program offered somewhat reduced penalties and no risk of criminal prosecution, if eligible taxpayers fully disclosed their previously unreported offshore accounts, and paid taxes due plus interest. To safeguard taxpayer identifies, we suppressed the totals for any state with fewer than 10 OVDP participants."

Correspondence issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) relies on thousands of suppliers to ensure it has the weapons and supporting equipment needed to meet U.S. national security objectives. Congress has provided DOD with a variety of authorities to allow it to maintain information on its suppliers and to take actions to ensure that its suppliers can deliver needed items. In October 2008, we reported on our assessment of DOD's efforts to monitor the health of its supplier base and identify and address gaps and recommended that DOD develop a departmentwide framework and consistent approach, which DOD has begun to implement. In light of increased globalization in the defense industry and consolidation of the defense supplier base into a few prime contractors, Congress requested that we review DOD's efforts to assess supplier-base availability for future defense needs."

Correspondence issued by the Government Accountability Office with an abstract that begins "The Consolidated Appropriations Act, 2012, amended the Clean Air Act to transfer regulatory authority for air emissions on the outer continental shelf (OCS) off Alaska's north coast, including the Chukchi and Beaufort seas, from the Environmental Protection Agency (EPA) to the Department of the Interior. Since the act was passed on December 23, 2011, there has been limited activity subject to air emission regulations or permitting on the OCS off Alaska's north coast, according to officials at the EPA and Interior. EPA officials stated that, before the act was passed, EPA had issued to Shell Gulf of Mexico Inc. and Shell Offshore, Inc., collectively, three air emission permits for drilling and other activities on the OCS off Alaska's north coast. Interior's Bureau of Ocean Energy Management (BOEM) is responsible for reviewing and approving plans for exploration, development, and production activities; this process includes projections of air emissions. According to a BOEM official, after the act passed, Shell conducted exploratory drilling on the OCS off Alaska's north coast in 2012, but it did so under its existing air emissions permits from EPA. Ancillary activities, such as surveys of the …

Correspondence issued by the Government Accountability Office with an abstract that begins "On October 11, 2013, DOD submitted to the congressional defense committees the OPIR Technology report. Upon reviewing the report, we determined that the OPIR report was comprehensive and appropriately identified its limitations. In particular, DOD, in consultation with the IC, provided a description of (1) the plan and budget for current and next generation OPIR systems and (2) OPIR technology requirements. The report elaborated on current cooperative efforts between the DOD and IC communities and identified potential future opportunities for further cooperation. Further details remain classified."

Correspondence issued by the Government Accountability Office with an abstract that begins "Since the fall of 2010, State has sanctioned 13 foreign firms under the ISA—2 for investments in Iran’s energy sector and 11 for supplying refined petroleum products."

Correspondence issued by the Government Accountability Office with an abstract that begins "During fiscal years 2009 through 2011, four administrations within DOT obligated about $144 billion from the HTF. FHWA obligated the largest share--about 81 percent--of this total, specifically:"

Testimony issued by the Government Accountability Office with an abstract that begins "The Moving Ahead for Progress in the 21st Century Act (MAP-21) authorized $10.6 and $10.7 billion for fiscal years 2013 and 2014, respectively, for public transit, but did not address long-term funding. Federal funds available for FTA's transit programs come from the general fund of the U.S. Treasury and the Mass Transit Account of the Highway Trust Fund. The Highway Trust Fund supports surface transportation programs, including highways and transit, and is funded through motor fuel and other highway use taxes; however, revenues have eroded over time because federal fuel tax rate stagnation, fuel efficiency improvements, and the use of alternative fuel vehicles. In May 2013, the Congressional Budget Office estimated that to maintain current spending levels plus inflation between 2015 and 2022, the Fund will require over $132 billion more than it is expected to take in over that period. GAO reported that while Congress transferred over $50 billion in general revenues to the Fund since fiscal year 2008, this approach may not be sustainable given competing demands for funding. For these reasons funding surface transportation remains on GAO's High-Risk List."

Correspondence issued by the Government Accountability Office with an abstract that begins "Hospitals and other health care providers use purchasing intermediaries--group purchasing organizations (GPO)--as a way to control the cost of various medical products. Through GPO-negotiated contracts, hospitals and other health care providers can purchase everything from commodities, such as cotton balls and bandages, to high-technology medical devices, such as pacemakers and stents. By pooling the purchases of these products for their customers, GPOs are in a position to negotiate lower prices from manufacturers, distributors, and other suppliers, which may in turn benefit health care providers and, ultimately, consumers and payers of health care such as insurers and employers. Members of Congress and others have recently raised questions about the extent to which GPOs negotiate lower prices for health care providers. GPO and other trade associations have funded studies on the impact of GPOs. However, these studies have limitations. Congress asked us to review research on the impact of GPOs on pricing for hospitals and other health care providers. This report summarizes the peer-reviewed and nonpeer-reviewed literature on the impact of GPOs on pricing for hospitals and other health care providers that GAO identified in GAO's literature review."

Correspondence issued by the Government Accountability Office with an abstract that begins "GAO reported the range of base premiums prior to underwriting for individual market health insurance plans as displayed on the HealthCare.gov Plan Finder in January 2013. The base premiums were for individuals aged 19 and 64 in each of the 50 states and the District of Columbia. The base premiums reflected information from data submitted by insurers to the Center for Consumer Information and Insurance Oversight (CCIIO) within the Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS). They represented the lowest premium amounts that would have been available to different categories of individuals at that time; however, actual premium amounts paid by consumers could have been higher as they would have been determined after more complete underwriting for health conditions and other factors, and some individuals could have been denied coverage. GAO also reported on base premiums prior to underwriting for an urban and rural zip code in four select states, one from each census region. The states included: Illinois, Nevada, Pennsylvania, and Texas. This supplements data on base premiums in the individual market in January 2013 for other categories of individuals …

Correspondence issued by the Government Accountability Office with an abstract that begins "In its fiscal year 2012 report, the Army included information that responded to some of the statutory reporting requirements, but did not include required information on the risks associated with, and mitigation strategies for, any shortfalls in key enabler personnel and equipment and a schedule for meeting personnel and equipment needs. The report included, among other things, an assessment of the status of key enabler personnel and equipment and information on assessments of modular force capabilities. However, the Army did not present the information it included in a way that clearly demonstrated the extent of progress toward meeting modular force requirements. While not explicitly required by law, there were also a number of ways in which the Army could have presented the information to better demonstrate the extent of progress toward meeting modularity requirements. For example, the Army could have provided more explicit comparisons with prior years to demonstrate the trend toward meeting key enabler equipment and personnel requirements, but instead presented limited data for only one year. Army officials agreed that some of the required information was omitted and that some of the information could have been …

Correspondence issued by the Government Accountability Office with an abstract that begins ""

Correspondence issued by the Government Accountability Office with an abstract that begins "FEMA's NCRC officials are not assisting regional officials in (1) developing performance measures to better assess the implementation of their strategic plan and (2) identifying federal funding available to prioritize preparedness investments. They are not doing so because they view their role as that of acting as a coordinator for other federal agencies, although they agreed that they could do more to support regional efforts and are positioned to do so. The NCR Strategic Plan helps regional officials identify the capabilities needed to strengthen the region's homeland security efforts and defines the framework for achieving those capabilities. NCR preparedness officials said that they have been working to develop preparedness measures since 2003, but noted that these measures are difficult to link to a measured improvement in regional preparedness. For example, while the region identified more than $25 million in UASI grant projects invested in providing public alerts and warnings, regional officials have not developed a measure to determine the effectiveness of these activities. Without such measures, it is unclear to what extent the efforts will advance the region's goals."

Correspondence issued by the Government Accountability Office with an abstract that begins "As Congress requested, we conducted a review of challenges associated with enhancing safety on major rail transit systems. During the course of that review, we assessed the quality of data that the Federal Transit Administration (FTA) collects and maintains in its State Safety Oversight (SSO) Rail Accident Database. FTA, an agency within the Department of Transportation (DOT), collects these safety data, including data on types of accidents and causes, from SSO agencies and the rail transit agencies they oversee. FTA used the SSO Rail Accident Database to produce the agency's 2009 Rail Safety Statistics Report, which analyzed data from 2003 through 2008. Although we originally intended to report on safety trends using the SSO Rail Accident Database in the rail transit report, we determined that these data were not sufficiently reliable for such a purpose. As a result, in this review we further assess the SSO Rail Accident Database and FTA's processes for collecting and compiling the data. We determined that there are numerous inaccuracies in FTA's SSO Rail Accident Database and, consequently, the 2009 Rail Safety Statistics Report. FTA implemented changes to the data collection process over …

Correspondence issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) obligated more than $1 billion in imminent danger pay from fiscal years 2010 through 2013 in the U.S. Central Command's area of responsibility, excluding Afghanistan, according to data from the military services. In June 2011, the Office of the Under Secretary of Defense for Personnel and Readiness requested the geographic Combatant Commands to assess existing imminent danger pay areas. The last such review had been completed in 2007. In January 2013, the U.S. Central Command recommended terminating imminent danger pay designations in many locations within its area of responsibility. However, the Office of the Under Secretary of Defense for Personnel and Readiness had not completed its current review or made a decision as of December 20, 2013, when we transmitted a draft of our report to DOD. DOD's guidance on imminent danger pay requires a periodic review but neither specifies the frequency with which periodic reviews must be completed, nor stipulates a time frame by which the Office of the Under Secretary of Defense for Personnel and Readiness should render a final decision regarding the findings of the review. The Standards for Internal …

Correspondence issued by the Government Accountability Office with an abstract that begins "In summary, we identified three DOD joint publications and two guidance documents that call for the consideration of unintended consequences, moral hazards, or risk mitigation procedures in planning for security force assistance. For example, Joint Publication 5-0, Joint Operations Planning, explicitly advises commanders to consider undesired consequences when planning operations and to refine plans to mitigate any undesired effects. This joint publication also includes procedures, such as the mission analysis and course of action analysis, to mitigate risks, which could include unintended consequences. Further, the Security Force Assistance Handbook, a guidance document, explains that site surveys serve to determine the suitability of the foreign security force for training, which may include considerations for potential unintended consequences and moral hazards, according to DOD officials. In addition to DOD joint publications and guidance, we reviewed a DOD directive and an instruction that DOD identified as relevant for our review and found that neither document specifically calls for consideration of unintended consequences or similar risks. However, DOD officials noted that they may incorporate considerations for unintended consequences and similar risks in a subsequent update to DOD Directive 5132.03, DOD Policy and …

Correspondence issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) is the federal government's largest purchaser of contractor-provided services and relies on contractors to support its varied missions. DOD's contractors provide a range of services, such as consulting and administrative support, information technology services, and weapon system and base operations support. However, DOD contract management has been on our high-risk list since 1992, and our recent work continues to identify weaknesses in DOD's management and oversight of services contracts. In particular, we have reported on the need for reliable data on how service acquisition dollars are spent to make informed contract management decisions and achieve positive acquisition outcomes. Congress has enacted legislation in recent years to increase the availability of information on services acquisitions to improve DOD's ability to manage these purchases. As part of those efforts, the National Defense Authorization Act for Fiscal Year 2008 amended 10 U.S.C. 2330a to require DOD to submit an annual inventory of the activities performed pursuant to contracts for services for or on behalf of DOD during the preceding fiscal year. These inventories are to contain a number of different elements for the service contracts listed, …

Testimony issued by the Government Accountability Office with an abstract that begins "Numerous variables--some of which are under operators' control--influence the ability of transmission pipeline operators to respond to incidents. For example, the location of response personnel and the use of manual or automated valves can affect the amount of time it takes for operators to respond to incidents. However, because the advantages and disadvantages of installing an automated valve are closely related to the specifics of the valve's location, it is appropriate that operators decide whether to install automated valves on a case-by-case basis. Several operators we spoke with have developed approaches to evaluate the advantages and disadvantages of installing automated valves, such as using spill-modeling software to estimate the potential amount of product released and extent of damage that would occur in the event of an incident."

Testimony issued by the Government Accountability Office with an abstract that begins "GAO's work at four VAMCs found that these VAMCs did not always follow VHA requirements for documenting open-market purchases of surgical implants. Specifically:"

Correspondence issued by the Government Accountability Office with an abstract that begins "In recent years, we and other federal fiscal experts--including the Congressional Budget Office (CBO) and the Medicare Trustees--have noted the rise in Medicare spending and expressed concern that the program is unsustainable in its present form. Concerns about the rising cost of health care are particularly pressing in light of evidence that suggests that greater spending does not necessarily translate to better health outcomes or higher-quality care. Medicare's fee-for-service (FFS) payment system may contribute to spending growth because it rewards volume of services regardless of the appropriateness, cost, and quality of those services. Under FFS, a payment is made for each unit of service based on the expected costs of delivering that service. For example, Medicare makes multiple separate payments for the services associated with a complex medical procedure performed in a hospital. It pays the hospital for the initial admission and any related readmissions; each physician involved in the patient's care, such as the surgeon and the anesthesiologist; and the skilled nursing facility for any related care immediately after hospitalization. Payments made in isolation in this way may give providers little incentive to coordinate the provision of …

Correspondence issued by the Government Accountability Office with an abstract that begins "Political appointees in the federal government sometimes seek appointments to career competitive and other positions which, unlike political appointments, do not terminate at the end of an administration. Conversions of political appointees to career positions must conform to merit system principles requiring that selection be determined solely on the basis of merit after fair and open competition. Sometimes, however, circumstances surrounding conversions can raise questions as to whether the individuals received political favoritism or an unfair advantage in the merit system selection process, even the appearance of which could adversely compromise the integrity of the system. As requested, we are providing you with information on the number of conversions of political appointees to career positions as reported to us by 42 executive branch departments and agencies from May 1, 2005, through May 30, 2009. The types of positions this letter covers and a definition of each, along with the criteria we used to select the 42 departments and agencies, are listed in the scope and methodology section."

Correspondence issued by the Government Accountability Office with an abstract that begins "Among the 9 states and 35 services examined, GAO found that all states varied Medicaid payments for at least some services. However, the states differed in the number of services for which they varied payments, in the factors that accounted for variation, and in the magnitude of the variation. Many of the states varied payment rates by at least one of the factors GAO was able to explore in detail: provider type, service setting, and/or patient age. Some states also varied their payment rates for other reasons, such as by geographic region or by physician specialty. GAO also found that most of the median Medicaid payment rates calculated from claims data generally confirmed payment rates published in studies of fee schedules conducted by the American Academy of Pediatrics and the Urban Institute; however, some of the published fee schedule rates were rarely used in practice. Collectively, GAO's findings demonstrate that Medicaid fee-for-service claims data can be a useful source of information for analyzing provider payments. These data have the potential to provide a more complete representation of provider payment than do fee schedules, as claims data can capture …