Testimony issued by the General Accounting Office with an abstract that begins "The Balanced Budget Act of 1997 required Medicare to change its payment system for ambulance services. In response, the Health Care Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), proposed a fee schedule to standardize payments across provider types on the basis of national rates for particular services. Under the act, the fee schedule was to have applied to ambulance services furnished on or after January 1, 2000. HCFA published a proposed rule in September 2000 and has received public comment, but it has not yet issued a final rule. This testimony discusses the unique concerns of rural ambulance providers and the likely effects of the proposed fee schedule on these providers. Many rural ambulance providers face a set of unique challenges in implementing an appropriate payment policy. Rural providers--particularly those serving large geographic areas with low population density--tend to have high per-trip costs compared with urban and suburban providers. The proposed Medicare fee schedule does not sufficiently distinguish the providers serving beneficiaries in the most isolated rural areas and may not appropriately account for the higher costs of low-volume providers."

A statement of record issued by the General Accounting Office with an abstract that begins "Federal research and preparedness activities related to bioterrorism center on detection; the development of vaccines, antibiotics, and antivirals; and the development of performance standards for emergency response equipment. Preparedness activities include (1) increasing federal, state, and local response capabilities; (2) developing response teams; (3) increasing the availability of medical treatments; (4) participating in and sponsoring exercises; (5) aiding victims; and (6) providing support at special events, such as presidential inaugurations and Olympic games. To coordinate their efforts to combat terrorism, federal agencies are developing interagency response plans, participating in various interagency work groups, and entering into formal agreements with other agencies to share resources and capabilities. However, coordination of federal terrorism research, preparedness, and response programs is fragmented, raising concerns about the ability of states and localities to respond to a bioterrorist attack. These concerns include insufficient state and local planning and a lack of hospital participation in training on terrorism and emergency response planning. This testimony summarizes a September 2001 report (GAO-01-915)."

Other written product issued by the General Accounting Office with an abstract that begins "One of the priorities of the U.S. Chief Financial Officers (CFO) Council is to improve financial performance through better financial management systems. The Bush administration has identified several management reform initiatives, including strategic management of human capital, improving financial performance and expanding e-government. Under the auspices of the Financial Systems Committee and Human Resources Committee of the CFO Council and the Joint Financial Management Improvement Program, an interagency team was established to develop strategies to build the work force capacity for financial system implementation projects."

A letter report issued by the General Accounting Office with an abstract that begins "As a result of events surrounding the November 2000 presidential election, public officials and various interest groups have proposed reforms to address perceived shortcomings of various election systems. The complexity and intricacy of the American electoral system suggests that the success of an election system depends on the appropriate integration of people, processes, and technology. This report presents an analytical framework that Congress could use as it weighs the merits of various reform proposals."

A chapter report issued by the General Accounting Office with an abstract that begins "Events surrounding the 2000 presidential election raised concerns about the reliability of various types of voting equipment, the role of election officials, the disqualification of absentee ballots, and the accuracy of vote counts and recounts. As a result, public officials and various interest groups have proposed reforms to address perceived shortcomings. This report discusses: (1) voter registration; (2) absentee and early voting; (3) election day administration; and (4) vote counts, certification, and recounts."

A letter report issued by the General Accounting Office with an abstract that begins "Following the 2000 presidential election, concerns were raised about the election process, including the ability of some voting equipment to render a complete and accurate vote count. Furthermore, minorities and disadvantaged voters were seen as more likely to have their votes not counted because they may have used less reliable voting equipment than affluent white voters. GAO found that although the state in which counties are located had more of an effect on the number of uncounted presidential votes than did counties' demographic characteristics or voting equipment, there were statistically significant effects on uncounted presidential votes. State differences accounted for 26 percent of the total variation in uncounted presidential votes across counties. State differences may have included such factors as statewide voter education efforts, state standards for determining what is a valid vote, the use of straight party ballots, the number of candidates on the ballot, the use of provisional ballots, and the extent to which absentee or early voting occurred."

A letter report issued by the General Accounting Office with an abstract that begins "Events surrounding the last presidential election raised concerns about the people, processes, and technology used to administer elections. GAO has already reported on the scope of congressional authority in election administration and voting assistance to military and overseas citizens. This report focuses on the status and use of federal voting equipment standards, which define minimum functional and performance requirements for voting equipment. The standards define minimum life-cycle management processes for voting equipment developers to follow, such as quality assurance. No federal agency has been assigned explicit statutory responsibility for developing voting equipment standards; however, the Federal Election Commission (FEC) developed voluntary standards for computer-based systems in 1990, and Congress has provided funding for this effort. No federal agency is responsible for testing voting equipment against the federal standards. Instead, the National Association of State Election Directors accredits independent test authorities who test voting equipment against the standards."

Testimony issued by the General Accounting Office with an abstract that begins "In the event of a domestic terrorist attack or other major disasters, the Department of Veterans Affairs (VA) is to provide backup medical resources to the military health system and local communities. VA now assists other federal agencies that have lead responsibility for responding to disasters, including terrorism. Its areas of responsibility include disaster simulation exercises and maintaining medical stockpiles. VA's efforts in these areas have enhanced national emergency preparedness by improving medical response procedures and by strengthening the security of federal pharmaceutical stockpiles to ensure rapid response to local authorities. VA also has resources that could play a role in future federal homeland security efforts. Its assets include the bricks, mortar, and human capital components of its health care system; graduate medical education programs; and expertise involving emergency backup and support activities. In managing large-scale medical emergencies arising from terrorist attacks, VA's emergency response capabilities have strengths and weaknesses. Determining how VA can best contribute to homeland security is especially timely given the extraordinary level of federal activity underway to manage large-scale disasters."

A letter report issued by the General Accounting Office with an abstract that begins "Information sharing and coordination are key elements in any defense against cyber attacks. The organizations GAO reviewed identified factors they considered critical to their success in building successful information-sharing relationships with and among their members. All of the organizations identified trust as essential to successful relationships. They said that trust could only be built over time and through personal relationships. One of the most difficult challenges identified was the initial reluctance of new members to share information. Other challenges included (1) developing agreements on the use and protection of shared information, (2) obtaining adequate funding for websites and meetings while avoiding contributions intended primarily to promote the interests of an individual organization, (3) maintaining a focus on emerging issues of interest to members, and (4) maintaining appropriately skilled professional and administrative staff."

A letter report issued by the General Accounting Office with an abstract that begins "The U.S. Department of Agriculture's Graduate School provides extensive training opportunities to government employees and others. As a nonappropriated fund instrumentality, the Graduate School relies solely on income from the training it offers. During fiscal year 1999, the federal agencies GAO reviewed had 20 interagency agreements with the Graduate School totaling about $5.7 million. The agencies also had 531 contracts, totaling $29 million, with private companies for training and related services. The Graduate School's financial statements for fiscal year 1999 incorrectly identified the portion of revenue that was earned through interagency agreements. This misclassification occurred primarily because of the Graduate School's reporting policies."

A letter report issued by the General Accounting Office with an abstract that begins "Federal law requires that disabled persons have access to polling places on election day. State political subdivisions must ensure that polling places used in federal elections are accessible. Exceptions are allowed if all potential polling places have been surveyed, no accessible place is available, and the political subdivision cannot make one temporarily accessible. In these cases, disabled voters must either be reassigned to an accessible polling place or provided another means for voting on election day. All states have provisions that address voting by people with disabilities, but these provisions vary greatly. All states provide for one or more alternative voting methods or accommodations that may facilitate voting by people with disabilities. States and localities have made several efforts to improve voting accessibility for the disabled, such as modifying poling places, acquiring new voting equipment, and expanding voting options. Nevertheless, state and county election officials GAO surveyed cited various challenges to improving access."

A letter report issued by the General Accounting Office with an abstract that begins "Defense operations involve about $1 trillion in assets, $310 billion in annual budgetary authority, $24 billion in monthly disbursements, and three million military and civilian employees. Moreover, execution of DOD's operations spans a wide range of defense organizations, including the military services and their respective major commands and numerous defense agencies. Effectively managing DOD's finance and accounting operations across this complex array of organizations is both a formidable challenge and a prerequisite for effective and efficient departmental performance and accountability. Without reliable financial management information, DOD cannot make informed decisions among competing spending priorities and cannot effectively identify opportunities for reducing costs and reallocating resources to pressing needs. Because of congressional concern with DOD's financial management difficulties, Section 1008 of the National Defense Authorization Act for Fiscal Year 1998 directed the Secretary of Defense to submit to Congress a biennial strategic plan for the improvement of financial management. The National Defense Authorization Act for Fiscal Year 2000 established additional reporting requirements that were to be addressed in DOD's Financial Management Improvement Plan. This report reviews whether the plan (1) represents an effective tool for helping resolve …

A letter report issued by the General Accounting Office with an abstract that begins "This report assesses the compliance by the Office of Management and Budget (OMB) and the Congressional Budget Office (CBO) with the requirements of the Balanced Budget and Emergency Deficit Control Act of 1985. Overall, GAO found that OMB and CBO substantially complied with the act, although some of the required OMB and CBO reports were issued late. GAO's work was done in accordance with generally accepted government auditing standards."

A letter report issued by the General Accounting Office with an abstract that begins "Liquefied petroleum gas (propane) has thousands of uses in homes, farms, and workplaces and is widely available in the United States. Although propane can be stored and handled safely, serious propane-related accidents have resulted in death and the destruction of property. At times, the efforts of local emergency personnel to respond to such accidents have been impeded by lack of hazard and safety information. This report describes (1) relevant revisions to the 1998 version of the code that were published in the 2001 version, as well as the process used to revise the code, (2) the views of key stakeholders about whether the 2001 version of the code provides local emergency response personnel with enough information to prepare for and respond to emergencies involving propane, and (3) the status of state and local government adoption of the 2001 code. The 2001 version of the NFPA code strengthens provisions of previous versions regarding information on the off-site effects of accidental propane releases. According to the nine key stakeholders interviewed by GAO, the 2001 version of the code would make more information available to local emergency response personnel. …

A letter report issued by the General Accounting Office with an abstract that begins "Each year the United States produces about 7 billion gallons of fluid drinking milk that generate $22 billion in retail sales. Farmers, cooperatives, wholesale milk processors, and retailers all work to move milk from the dairy farm to the consumer. Each of these entities performs a distinct function in the production, processing, distribution, and sale of milk, and each receives a portion of the retail price of a gallon of milk. Fluid milk prices at the farm-level have fallen sharply, prompting Congress to authorize almost a billion dollars in emergency assistance to dairy farmers in the last three years. Fluid milk prices at the retail level, however, have not experienced a similar decline. Concerns have been raised about this growing price spread between farm and retail milk prices. This report examines (1) factors that influence the price of milk as it moves from the farm to the consumer, (2) the proportionate breakdown of the retail price of a gallon of milk received by farmers, cooperatives, wholesale milk processors, and retailers, (3) how changes in farm and retail milk prices affect the farm-to-retail milk price spread, (4) …

A letter report issued by the General Accounting Office with an abstract that begins "This report reviews the Department of Commerce's fiscal year 2000 performance report and fiscal year 2002 performance plan required by the Government Performance and Results Act to assess Commerce's progress on achieving selected key outcomes. Commerce's combined performance report and performance plan is a significant improvement over its fiscal year 1999 performance report and fiscal year 2001 performance plan and addresses the recommendations made in GAO's June 2000 report. Furthermore, the report indicates that Commerce has made progress toward achieving two of the selected key outcomes. However, progress toward achieving the remaining two outcomes is unclear largely because of weaknesses related to measuring performance. Specifically, some of the measures are output-oriented, rather than outcome oriented; some measures have known limitations, which Commerce acknowledges; many of the measures used to assess performance in the past are being discontinued for the future; and Commerce plans to rely on one, narrowly focused measure to demonstrate progress for each performance goal related to these key outcomes. Furthermore, other data exist within the International Trade Administration (ITA) that could support additional measures related to these performance goals."

A letter report issued by the General Accounting Office with an abstract that begins "This report reviews the Department of Labor's fiscal year 2000 performance report and fiscal year 2002 performance plan required by the Government Performance and Results Act. GAO found that Labor appears to be making progress in achieving the key outcomes in its strategic plan. Labor has increased its target levels for some goals for fiscal year 2002 and generally provided sound strategies for achieving these new targets. GAO continues to have concerns about some of the measures Labor uses. GAO is most concerned about the way in which Labor addresses two of its management challenges--information technology and strategic human capital management. Given the breadth of these goals, goal achievement cannot be fully assessed with the performance indicators Labor proposes. Without better indicators that more accurately and comprehensively measure performance toward the goal, Labor will be unable to fully assess its progress in these areas."

A letter report issued by the General Accounting Office with an abstract that begins "This report reviews the Department of the Interior's fiscal year 2000 performance report and fiscal year 2002 performance report plan required by the Government Performance and Results Act. Specifically, GAO discusses Interior's progress in achieving the following four outcomes: (1) maintaining the health of federally managed land, water, and renewable resources; (2) ensuring visitors' satisfaction with the availability, accessibility, diversity, and quality of national parks; (3) meeting the federal government's responsibility to preserve and protect Indian trust lands and resources; and (4) ensuring the safe and environmentally sound development of mineral resources. GAO could not judge the agency's progress in promoting the health of federally managed land, water, and renewable resources because the goals Interior has reported do not foster a broad or departmentwide approach to measuring progress. Although the Park Service's strategies for continuing to meet and exceed its visitor satisfaction and visitor education goals appear clear and reasonable, the agency's fiscal year 2002 performance plan lacks information on the strategic human capital management strategies to achieve this outcome. GAO cannot judge the Bureau of Indian Affairs' progress in protecting Indian trust lands and resources …

A letter report issued by the General Accounting Office with an abstract that begins "This report reviews the Department of the Treasury's fiscal year 2000 performance report and fiscal year 2002 performance report plan required by the Government Performance and Results Act. Specifically, GAO discusses Treasury's progress in addressing several key outcomes that are important to Treasury's mission. In general, GAO could not adequately determine Treasury's progress on five key outcomes because the fiscal year 2000 performance report lacked at least some measures needed to directly assess each of the outcomes. However, other information that GAO reviewed and GAO's past work suggest that Treasury may be at risk of not achieving these outcomes. In assessing Treasury's strategies, GAO identified shortcomings in its plans for each of the outcomes it reviewed. Chief among the limitations common to both the Treasury's fiscal year 1999 and 2000 performance reports was that the performance goals and measures of Treasury's agencies were not always directly reflected in the broader departmental goals, limiting the reports' usefulness in determining whether these agencies are making progress in meeting their strategic goals in general and the outcomes GAO reviewed in particular. Treasury improved the fiscal year 2000 report by …

A letter report issued by the General Accounting Office with an abstract that begins "This report reviews the Environmental Protection Agency's (EPA) fiscal year 2000 performance report and fiscal year 2002 performance plan required by the Government Performance and Results Act of 1993 (GPRA) to assess the agency's progress in achieving selected key outcomes that are important to EPA's mission. EPA reported reasonable progress in achieving its key outcomes. Specifically, EPA reported (1) attaining air quality standards in more areas of the country and reducing emissions of toxic pollutants, (2) making strides in achieving its goal of safe and clean drinking water, (3) making progress in cleaning up hazardous waste sites, and (4) making progress in ensuring that food is free from unsafe pesticide residues. Although EPA made several improvements to its fiscal year 2000 performance report, it still falls short in providing information on crosscutting goals and measures. EPA's 2002 performance plan's goals and performance measures address some, but not all, major management challenges."

A letter report issued by the General Accounting Office with an abstract that begins "Payments to farmers under federal farm programs have reached an historic high--over $20 billion in fiscal year 2000. Nearly half of U.S. farms are receiving payments for income or price support purposes and/or for engaging in activities such as land conservation. These payments, in total, made up almost one-half of net farm income in fiscal year 2000. Despite the annual influx of billions of federal dollars to the farm sector, the U.S. Department of Agriculture (USDA) reports that the number of farms has been declining about one percent per year, with the most notable declines in small family farms and young farmers. GAO reviewed USDA's annual surveys of U.S. farm operations--called the Agricultural Resource Management Study--and state and crop information from its Program Payments Reporting System to (1) determine the distribution of farm payments over the past decade by farm size, operators' age, state, and crop and (2) identify the major barriers that make it difficult for young people to enter farming. GAO found that in recent years, over 80 percent of farm payments have been made to large- and medium-sized farms, while small farms have …

A letter report issued by the General Accounting Office with an abstract that begins "This report reviews the Department of Health and Human Service's (HHS) fiscal year 2000 performance report and fiscal year 2002 performance plan required by the Government Performance and Results Act of 1993 to assess HHS' progress in achieving selected key outcomes that are important to its mission. It is difficult to fully assess the HHS' progress in fiscal year 2000 toward achieving the outcomes GAO reviewed because lags in reporting performance data are common for many of its components such as the Administration for Children and Families (ACF), Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration, and the Food and Drug Administration. In some cases, the delays are associated with the need to obtain performance data from states and local organizations. Some HHS components are working to improve the timeliness of data submitted by others and, in some instances, have reported trend data to show that progress is being made. For example, both ACF and CDC supplied fiscal year 1999 performance data in their current performance reports--data that were not available until this year. It is likely that ACF's …

A letter report issued by the General Accounting Office with an abstract that begins "This report reviews the challenges facing U.S. agricultural biotechnology products in international trade. GAO found that new regulations and guidelines that may restrict U.S. exports of crops with a large biotech component are being enacted or considered by some U.S. trading partners and are also under discussion in various international organizations. These actions address approval, labeling, and traceability of agricultural biotech products. U.S. corn and soybean exports are most threatened by new foreign regulatory measures because of their biotech content. Although U.S. soybean exports have not yet experienced disruptions, U.S. corn exports have been largely shut out of the European Union (EU) market because U.S. farmers are producing some biotech varieties that have not been approved for marketing in the EU. U.S. agricultural biotech exports face several significant challenges in international markets. First, as the single major producer of biotech products, the United States has been relatively isolated in its efforts to maintain access to markets for these products. Second, in many parts of the world, consumer concerns are growing about the safety of biotech foods, which have led key market countries to implement or consider …

A letter report issued by the General Accounting Office with an abstract that begins "This report reviews the National Science Foundation's (NSF) fiscal year 2000 performance report and fiscal year 2002 performance report plan required by the Government Performance and Results Act. Specifically, GAO discusses NSF's progress in addressing several key outcomes that are important to NSF's mission. NSF reported that it made substantial progress in achieving its key outcomes. Although the planned strategies for achieving these key outcomes generally are clear and reasonable, some are vague and do not identify the specific steps for achieving the goals. NSF's fiscal year 2000 performance report and fiscal year 2002 performance plan reflect continued improvement compared with the prior year's report and plan. Although the 2002 performance plan does not substantially address NSF's human capital management, NSF is developing a five-year workforce strategic plan to address strategic human capital management issues that must be submitted to the Office of Management and Budget by July 20, 2001. NSF's performance report did not explain its progress in resolving information security challenges, but NSF indicated that it has internal management controls that continually monitor data security."