Correspondence issued by the Government Accountability Office with an abstract that begins "In 2009, Medicare--a federal health insurance program that serves about 46.3 million beneficiaries--spent approximately $8.1 billion on durable medical equipment (DME), prosthetics, orthotics, and related supplies for 10.6 million beneficiaries. DME includes items such as wheelchairs, hospital beds, and walkers. Medicare beneficiaries typically obtain DME items from suppliers, who submit claims for payment for these items to Medicare on behalf of beneficiaries. The Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), has responsibility for administering the Medicare program. Both we and HHS's Office of Inspector General (OIG) have reported that Medicare and its beneficiaries--through their out-of-pocket costs--have sometimes paid higher than market rates for various medical equipment and supplies. To achieve Medicare savings for DME and to address DME fraud concerns, Congress, through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), required CMS to phase in a competitive bidding program (CBP) for DME suppliers in selected competitive bidding areas (CBA). In CBP, suppliers submit bid prices in the amounts they are willing to accept as payment to provide DME items to Medicare beneficiaries. CMS then …

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 …

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 "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 "To help ensure that millions of Americans who rely on private insurance for health care coverage receive value for their premium dollars, the Patient Protection and Affordable Care Act (PPACA) established minimum "medical loss ratio" (MLR) standards for insurers. The MLR is a basic financial indicator, traditionally referring to the percentage of insurance premium revenues health insurers spent on their enrollees' medical claims. The MLR definition specified in the PPACA provision-- referred to as the PPACA MLR in this report--differs from the traditional MLR definition. Key differences are that the PPACA MLR allows insurers to include in their expenses spending on activities to improve health care quality and to deduct from their revenues certain tax payments and fees, and these differences will generally increase insurers' MLRs. Beginning in 2011, PPACA required insurers to meet minimum PPACA MLR standards of 85 percent in the large group market and 80 percent in the small group and individual markets or pay rebates to their enrollees. In implementing these MLR requirements, the Department of Health and Human Services (HHS) includes an adjustment for certain insurers to help address the disproportionate impact of …

A statement of record issued by the Government Accountability Office with an abstract that begins "Millions of Americans rely on retirement savings plans for their financial well-being in retirement. Plan sponsors are increasingly investing in assets such as hedge funds (privately administered pooled investment vehicles that typically engage in active trading strategies) and private equity funds (privately managed investment pools that typically make long-term investments in private companies). Given ongoing market challenges, it is important that plan fiduciaries apply best practices, and choose wisely when investing plans assets to ensure that plans are adequately funded to meet future promised benefits. This statement addresses (1) what is known about the extent to which defined benefit plans have invested in hedge funds and private equity, (2) challenges that such plans face in investing in hedge funds and private equity, (3) steps that plan sponsors can take to address these challenges, and (4) the implications of these challenges for plan sponsors and the federal government."

Correspondence issued by the Government Accountability Office with an abstract that begins "In connection with fulfilling our requirement to audit the financial statements of the U.S. government, we audited and reported on the Schedules of Federal Debt Managed by the Bureau of the Public Debt (BPD) for the fiscal years ended September 30, 2010 and 2009. As part of these audits, we performed a review of information systems controls over key financial systems maintained and operated by the Federal Reserve Banks (FRB) on behalf of the Department of the Treasury's (Treasury) BPD relevant to the Schedule of Federal Debt. As we reported in connection with our audit of the Schedules of Federal Debt for the fiscal years ended September 30, 2010 and 2009, we concluded that BPD maintained, in all material respects, effective internal control over financial reporting relevant to the Schedule of Federal Debt as of September 30, 2010, that provided reasonable assurance that misstatements, losses, or noncompliance material in relation to the Schedule of Federal Debt would be prevented, or detected and corrected on a timely basis. However, we identified information systems deficiencies affecting internal control over financial reporting, which, while we do not consider them to be …

ADA-ES has completed an extensive sorbent screening program funded primarily through DOE NETL cooperative agreement DE-NT0005649 with support from EPRI and industry cost-share participants. Tests were completed on simulated and actual flue gas. The overall project objective is to address the viability and accelerate development of a solid-based postcombustion CO2 capture technology that can be retrofit to the existing fleet of coal-fired power plants. An important component of the viability assessment was to evaluate the state of development of sorbents and measure key performance characteristics under realistic operating conditions.

Minutes for the October 31st meeting of the Dallas Way including members of attendance and topics discussed.

The RACORO aerosol data (cloud condensation nuclei (CCN), condensation nuclei (CN) and aerosol size distributions) need further processing to be useful for model evaluation (e.g., GCM droplet nucleation parameterizations) and other investigations. These tasks include: (1) Identification and flagging of 'splash' contaminated Twin Otter aerosol data. (2) Calculation of actual supersaturation (SS) values in the two CCN columns flown on the Twin Otter. (3) Interpolation of CCN spectra from SGP and Twin Otter to 0.2% SS. (4) Process data for spatial variability studies. (5) Provide calculated light scattering from measured aerosol size distributions. Below we first briefly describe the measurements and then describe the results of several data processing tasks that which have been completed, paving the way for the scientific analyses for which the campaign was designed. The end result of this research will be several aerosol data sets which can be used to achieve some of the goals of the RACORO mission including the enhanced understanding of cloud-aerosol interactions and improved cloud simulations in climate models.

This was a university-based research project in support of distributed reforming production technologies for hydrogen. Our objective was to examine the steam reforming of bio-ethanol and other related bio-derived liquids over non-precious metal catalyst systems to enable small-scale distributed hydrogen production technologies from renewable sources. The study targeted development of a catalytic system that does not rely on precious metals and that can be active in the 350-550 C temperature range, with high selectivity and high stability. To this end, we adopted a multi-prong research strategy, that included catalyst formulation and synthesis, detailed catalyst characterization, reaction kinetics and reaction engineering, molecular modeling and economic analysis studies. Our approach was an iterative one, where the knowledge gained in one aspect of the study was utilized to modify and fine-tune catalyst development. The research addressed many fundamental and inter-related phenomena involved in the catalytic steam reforming of ethanol that may not be readily studied in an industrial development setting. The outcome of the project was a catalytic system that was able to meet the DOE targets in hydrogen production, with high H{sub 2} yield, high selectivity and stability that could perform efficiently in the 350-550 C temperature range. In addition, we were …

Energy Return On Investment (EROI) is an important figure of merit for assessing the viability of energy alternatives. For geothermal electric power generation, EROI is determined by the electricity delivered to the consumer compared to the energy consumed to construct, operate, and decommission the facility. Critical factors in determining the EROI of Engineered Geothermal Systems (EGS) are examined in this work. These include the input energy embodied into the system. The embodied energy includes the energy contained in the materials, as well as, that consumed in each stage of manufacturing from mining the raw materials to assembling the finished plant. Also critical are the system boundaries and value of the energy - heat is not as valuable as electrical energy.

Application materials submitted to the Texas Historical Commission requesting a historic marker for the Hill and Sara McClanahan House, in Cleveland, Texas. The materials include the inscription text of the marker, original application, narrative, floor plans, and photographs.

News release about DART being recognized at the Design-Build Institute of America's Design-Build Transportation Conference.