A letter report issued by the Government Accountability Office with an abstract that begins "The Departments of Veterans Affairs (VA) and Defense (DOD) abandoned their plans to develop an integrated electronic health record (iEHR) system and are instead pursuing separate efforts to modernize or replace their existing systems in an attempt to create an interoperable electronic health record. Specifically, in February 2013, the secretaries cited challenges in the cost and schedule for developing the single, integrated system and announced that each department would focus instead on either building or acquiring similar core sets of electronic health record capabilities, then ensuring interoperability between them. However, VA and DOD have not substantiated their claims that the current approach will be less expensive and more timely than the single-system approach. Major investment decisions—including terminating or significantly restructuring an ongoing program—should be justified using analyses that compare the costs and schedules of alternative proposals. Yet, the departments have not developed revised cost and schedule estimates for their new modernization efforts and any additional efforts needed to achieve interoperability between the new systems, and compared them with the relevant estimates for their former approach. In the absence of such a comparison, VA and DOD lack …

A letter report issued by the Government Accountability Office with an abstract that begins "U.S. Immigration and Customs Enforcement (ICE), a component of the Department of Homeland Security (DHS), has not identified or assessed fraud or noncompliance risks posed by schools that recommend and foreign students approved for optional practical training (OPT), in accordance with DHS risk management guidance. ICE's Student and Exchange Visitor Program (SEVP) officials consider OPT to be a low-risk employment benefit for foreign students because, in part, they believe foreign students approved for OPT do not have an incentive to jeopardize their legal status in the United States. However, SEVP has not determined potential risks in OPT. Further, officials from the Counterterrorism and Criminal Exploitation Unit (CTCEU), ICE's investigative unit, and ICE field agents GAO interviewed have identified potential risks involving OPT based on prior and ongoing investigations. For example, ICE field agents identified cases where school officials recommended OPT for foreign students to work outside of their major areas of study, which is not allowed under ICE regulations. In response to a June 2012 GAO recommendation, ICE has taken initial actions to identify risks across SEVP-certified schools but has not identified and assessed OPT risks …

A letter report issued by the Government Accountability Office with an abstract that begins "The United States allocated $671 million for Lebanese security forces from fiscal year 2009 through fiscal year 2013. Of these total allocated funds, $477 million, or 71 percent, had been disbursed or committed by the end of fiscal year 2013. Nearly all of the allocations made in fiscal years 2009 through 2011 had been disbursed or committed. For the largest program, Foreign Military Financing, the Department of Defense (DOD) had committed about $352 million of the $481 million allocated in fiscal years 2009 through 2013."

A letter report issued by the Government Accountability Office with an abstract that begins "The Federal Communications Commission (FCC) has established buildout requirements—which require a licensee to build the necessary infrastructure and put the assigned spectrum to use within a set amount of time—for most wireless services, including cellular and personal communication services. FCC tailors the buildout requirements it sets for a wireless service based on the physical characteristics of the relevant spectrum and comments of stakeholders, among other factors. Therefore, buildout requirements vary across wireless services. For example, a buildout requirement can set the percentage of a license's population or geographic area that must be covered by service or can describe the required level of service in narrative terms rather than numeric benchmarks. Buildout requirements also vary by how much time a licensee has to meet a requirement and whether it has to meet one requirement or multiple requirements in stages."

A letter report issued by the Government Accountability Office with an abstract that begins "Trends associated with college affinity card agreements include fewer agreements and cardholders and declining payments, according to data GAO analyzed from the Board of Governors of the Federal Reserve System (Federal Reserve) and the Bureau of Consumer Financial Protection (CFPB). The number of affinity card agreements declined from 1,045 in 2009 to 617 in 2012 (41 percent). More than 70 percent of the agreements in 2012 were with institutions of higher education or alumni organizations, and one issuer—FIA Card Services, a subsidiary of Bank of America—had 67 percent of all agreements. Affinity card issuers paid $50.4 million to all organizations in 2012, 40 percent less than in 2009. In most cases, payments were based on numbers of cardholders and the amount spent on the cards. The card agreements covered contractual obligations related to such things as marketing practices, target populations, use of the organization's logo or trademark, terms of payment, and, in some cases, service standards."

A letter report issued by the Government Accountability Office with an abstract that begins "In fiscal year 2009, states spent nearly a third (31.6 percent) of all Medicaid expenditures on the most expensive Medicaid-only beneficiaries, who were 4.3 percent of total Medicaid beneficiaries. States spent another third (33.1 percent) on all other Medicaid-only beneficiaries, who represented 81.2 percent of total Medicaid beneficiaries. Among dual eligible beneficiaries, a similar pattern existed, with a small proportion of the population accounting for a disproportionate share of expenditures."

A letter report issued by the Government Accountability Office with an abstract that begins "For more than a decade, college prices have been rising consistently and have continued to rise at a gradual pace after the Stafford loan limit increases were enacted in 2008 and 2009. However, it is difficult to determine if a direct relationship exists between increases in college prices and the Stafford loan limit increases because of the confluence of many other factors that occurred around the time the loan limit increases took effect. Specifically, when the loan limit increases took effect, the nation was in a recession, which created one of the most tumultuous and complex economic environments in recent history. GAO's analysis found that the economic effects of the recession, which affected families' employment, income, and net worth make it difficult to isolate the impact the recession had on students' decisions to borrow money to finance college expenses versus the impact of the loan limit increases. Further, federal, state, and institutional aid available to students also increased significantly around the same time the loan limit increases went into effect. It is difficult to determine the extent to which the increased availability of this financial aid …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of State (State) and U.S. Agency for International Development (USAID) identified a number of changes needed to improve contract support in overseas contingency operations, but have not completed implementation efforts. As required by the Fiscal Year 2013 National Defense Authorization Act (NDAA), both agencies determined that their organizational structures were effective, though State created a new regional Contract Management Office to better support contracting efforts in Iraq. In October 2013, State approved a number of actions to improve policies and procedures, including specific initiatives in acquisition planning and risk management, among others, and intends to institutionalize these changes in its Foreign Affairs Manual in 2014. State generally has not, however, developed plans to assess the impact of these initiatives. Federal internal control standards highlight the importance of managers comparing actual performance to expected results. Accordingly, continued management attention is needed to ensure that these efforts achieve their intended objectives. USAID focused its efforts on areas such as improving contractor performance evaluations and risk management. GAO found that some USAID missions and offices that operate in contingency environments have developed procedures and practices, but USAID …

A letter report issued by the Government Accountability Office with an abstract that begins "The interagency groups GAO selected and expert practitioners—including those who received the Presidential Distinguished Rank Award—have used a range of approaches to address some of the key considerations for implementing interagency collaborative mechanisms, related to defining outcomes; measuring performance and ensuring accountability; establishing leadership approaches; and using resources, such as funding, staff, and technology."

A letter report issued by the Government Accountability Office with an abstract that begins "At least 852 schools, or 11 percent of U.S. colleges and universities, had agreements to provide debit or prepaid card services to their students as of July 2013, and most offered students the ability to receive federal student aid and other payments on a card. These schools were disproportionately large; their enrollments constituted about 40 percent of all postsecondary students. However, the percentage of students enrolled in their schools' college card programs was unknown. In the majority of agreements, the schools also outsourced to their card provider the process for paying financial aid and other funds via college cards and other methods. Some schools also used college cards as student identification. The dominant provider was Higher One, a nonbank financial firm that had a 57 percent market share in 2013, as measured by number of card agreements."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Energy's (DOE) National Nuclear Security Administration (NNSA) identified various drivers for the close to $3 billion increase in the estimated cost of the Plutonium Disposition program's two construction projects—the Mixed Oxide (MOX) Fuel Fabrication Facility and the Waste Solidification Building (WSB). These drivers included DOE's approval of the MOX facility's cost and schedule estimates before design was complete and schedule delays in construction of the WSB. According to NNSA, the cost of critical system components for the MOX facility averaged 60 percent higher than estimated as a result of approval of estimates before design was complete."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Housing and Urban Development's (HUD) fiscal year 2013 information technology (IT) expenditure plan satisfied the two sets of statutory conditions contained in the appropriations act. Regarding the first set of conditions, the plan identified for each project the functional and performance capabilities to be delivered, mission benefits, life-cycle costs, and key milestones. For example, for the Federal Housing Administration Transformation's Portfolio Evaluation Tool project, the plan identified functional capabilities such as the ability to produce on-demand reports to assess financial impacts and risks. The plan also satisfied the second set of conditions by demonstrating that each project was in compliance with HUD's enterprise architecture, was being managed in accordance with applicable life-cycle policies and guidance, conformed to capital planning and investment control requirements, and was supported by an adequately staffed project office. For instance, it included assessments demonstrating how projects conformed to requirements for planning and controlling investments. By satisfying these conditions, the plan should better inform the decision making of HUD's appropriations committees on current modernization projects."

A letter report issued by the Government Accountability Office with an abstract that begins "The Maritime Administration (MARAD) uses a two-step source selection process, first by qualifying contractors and then awarding contracts for ship recycling services based on best value, consistent with the Federal Acquisition Regulation (FAR). In the first step, MARAD qualifies contractors' ship recycling facilities. The qualification process involves evaluating ship recycling facilities' proposals based on multiple criteria, including how a facility plans to dismantle ships and the extent to which the contractor-including its ability to meet local, state, and federal regulations-supports that effort. For the second step, MARAD awards ship recycling contracts for specific ships using a best value source selection process. The best value source selection process allows the government to accept an offer other than the best-priced offer, considering both price and non-price factors, that provides the greatest overall benefit to the government. MARAD considers three evaluation criteria-price, schedule and capacity, and past performance."

A letter report issued by the Government Accountability Office with an abstract that begins "GAO identified 298 trade and investment commitments made by China in the U.S.-China Joint Commission on Commerce and Trade (JCCT)—184 since 2004—and the U.S.-China Strategic and Economic Dialogue (S&ED) and its predecessor—114 since 2007. The commitments range from affirmations of open trade principles to sector-specific actions. GAO identified 11 issue areas to characterize the content of each commitment. The prominence of issue areas, measured in number of commitments associated with an issue area, differs between the dialogues, reflecting differences in the dialogues' structure and focus. Intellectual property rights commitments are among those most common in the JCCT and investment commitments are among those most common in the S&ED. (For a detailed inventory of commitments and their categorization, see GAO-14-224SP .)"

A letter report issued by the Government Accountability Office with an abstract that begins "The number of drug shortages remains high. Although reports of new drug shortages declined in 2012, the total number of shortages active during a given year—including both new shortages reported and ongoing shortages that began in a prior year—has increased since 2007. Many shortages are of generic sterile injectable drugs. Provider association representatives reported that drug shortages may force providers to ration care or rely on less effective drugs."

A letter report issued by the Government Accountability Office with an abstract that begins "The Air Force's schedule that supported the February 2012 Milestone B decision for the Defense Enterprise Accounting and Management System (DEAMS) did not meet best practices. The cost estimate did meet best practices, but the issues associated with the schedule could negatively affect the cost estimate. GAO found that the schedule supporting the Air Force's decision to invest in DEAMS partially or minimally met the four characteristics for developing a high-quality and reliable schedule. For example, the schedule did not reflect all government and contractor activities, and resources were not assigned to specific activities. The schedule also lacked a valid critical path, preventing management from focusing on the activities most likely to cause critical program delays if they are not completed as planned. In addition, a schedule risk analysis was not conducted to predict a level of confidence in meeting the program's completion date."

A letter report issued by the Government Accountability Office with an abstract that begins "From 2009 through 2012, certified registered nurse anesthetists (CRNA)—a type of advanced-practice nurse specializing in anesthesia care—billed Medicare fee-for-service (FFS) for a minimal share of selected chronic pain procedures, less than ½ of 1 percent of these procedures in each year. Physicians without board certification in pain medicine billed for the majority of selected procedures each year, while pain physicians consistently billed for roughly 40 percent of selected procedures. Furthermore, although the number of chronic pain procedures billed by all rural providers increased from 2009 through 2012, the number of procedures billed by rural CRNAs declined over the period. Of all CRNA claims for selected procedures, the share billed by CRNAs in rural areas fell from 66 percent in 2009 to 39 percent in 2012."

A letter report issued by the Government Accountability Office with an abstract that begins "Federally funded programs to expand broadband access encompass but do not specifically target small businesses. These programs—the Broadband Initiatives Program (BIP), Broadband Technologies Opportunities Program, Community Connect Grants, Connect America Fund, Rural Broadband Access Loan and Loan Guarantee Program, and Telecommunications Infrastructure Loan Program—have eligibility requirements based on the need of an area, as well as deployment requirements that can maximize the number of businesses served. For example, the Community Connect grants require providers to serve all businesses and residences in deployment areas. Since these federal programs do not target deployment to small businesses, they do not measure the impact on small businesses. However, BIP has a specific goal to increase access to rural Americans and provide broadband speeds to businesses, and in August 2013, the United States Department of Agriculture reported BIP's funding had resulted in over 5,800 businesses' receiving new or improved broadband service since 2009. Other programs have broader goals and measures related to the program's purpose, such as serving schools and libraries."

A letter report issued by the Government Accountability Office with an abstract that begins "The Economic Development Administration (EDA) implemented a new procedure in fiscal year 2012 that requires its regional offices to complete a standard template to document the results of committee meetings in which proposed projects are discussed and potentially recommended for funding. However, GAO found that for the Public Works and Economic Development (Public Works) program and the Economic Adjustment Assistance (EAA) program—EDA's two largest grant assistance programs—EDA regional offices had not completed the template consistently. GAO estimated that only 46 percent of all projects recommended for funding in fiscal year 2012 under these programs were documented using the complete template. EDA has a history of inconsistent documentation: for example, in 2000 the Department of Commerce's Inspector General reported inconsistencies in how EDA's regional offices documented the project review process. Standards for internal control in the federal government require all transactions and significant events to be clearly documented and available for examination. Until EDA takes steps to ensure that all of its regional offices consistently and fully complete the standard template for all proposed projects considered for funding, EDA will not have adequate assurance that its funding …

A letter report issued by the Government Accountability Office with an abstract that begins "For the Spanish translation of the highlights page for this document, see GAO-14-457."

A letter report issued by the Government Accountability Office with an abstract that begins "Federal agencies use the test program for a relatively small portion of all commercial items and services bought. In fiscal year 2011, of the $90 billion agencies obligated on new awards for commercial items and services, federal agencies obligated $1.9 billion or about 2 percent using the test program, based on data reported in the Federal Procurement Data System-Next Generation (FPDS-NG). Within the largest reported users of the test program--the Departments of Defense (DOD), Homeland Security (DHS), and the Interior (DOI)--the five components GAO reviewed used the test program for about 9 percent of obligations, and 12 percent of the components' new commercial awards that fell within test program thresholds in fiscal year 2011. Agency officials cited the types of goods and services being acquired, the complexity of the acquisition, and the existence of other contracting approaches as factors affecting test program use. For example, the Coast Guard's Aviation Logistics Center used the test program for 139 of 370 new awards that fell within test program thresholds, whereas its Headquarters Contract Operations used the test program for only 3 of 164 new awards. Coast Guard officials …

A letter report issued by the Government Accountability Office with an abstract that begins "The Federal Motor Carrier Safety Administration's (FMCSA) Compliance, Safety, Accountability (CSA) program has helped the agency contact or investigate more motor carrier companies that own commercial trucks and buses and has provided a range of safety benefits to safety officials, law enforcement, and the industry than the previous approach, SafeStat. Specifically, from fiscal year 2007 to fiscal year 2012, FMCSA more than doubled its number of annual interventions, largely by sending warning letters to riskier carriers."

A letter report issued by the Government Accountability Office with an abstract that begins "According to assessments by the National Research Council (NRC) and the U.S. Global Change Research Program (USGCRP), U.S. energy infrastructure is increasingly vulnerable to a range of climate change impacts--particularly infrastructure in areas prone to severe weather and water shortages. Climate changes are projected to affect infrastructure throughout all major stages of the energy supply chain, thereby increasing the risk of disruptions. For example:"

A letter report issued by the Government Accountability Office with an abstract that begins "Total Direct Loan administrative costs grew from $314 million to $864 million from fiscal years 2007 to 2012, but federal costs per borrower have generally remained steady or fallen. The increase in total administrative costs largely results from an increase of over 300 percent in the number of Direct Loans during that same time period. One key factor contributing to this loan volume increase was a law that ended student loan originations under a federally guaranteed loan program resulting in new originations being made under the Direct Loan program. Loan servicing--which includes activities like counseling borrowers on selecting repayment plans, processing payments, and collecting on loans in delinquent status--is the largest category of administrative costs, comprising 63 percent of total Direct Loan administrative costs in fiscal year 2012. While total administrative costs have increased, costs per borrower and other unit costs have remained steady or declined. For example, the servicing cost per borrower has remained roughly $25 over the six-year period we examined. However, a number of factors, including a new payment structure for loan servicing contracts to reward servicers for keeping more borrowers in repayment …