A letter report issued by the General Accounting Office with an abstract that begins "The Centers for Medicare & Medicaid Services (CMS) recently implemented a Medicare ambulance fee schedule in which providers are paid a base payment per trip plus a mileage payment. An adjustment is made to the mileage rate for rural trips to account for higher costs. CMS has stated that this rural adjustment may not sufficiently target providers serving sparsely populated rural areas. The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) directed GAO to examine rural ambulance costs. GAO identified factors that affect ambulance costs per trip, examined how these factors varied across geographic areas, and analyzed whether Medicare payments account for geographic cost differences. GAO used survey data on ambulance providers and Medicare claims data."

Testimony issued by the General Accounting Office with an abstract that begins "One of the primary functions of any security system is the control of people moving into or out of protected areas, such as physical buildings, information systems, and our national border. Technologies called biometrics can automate the identification of people by one or more of their distinct physical or behavioral characteristics. The term biometrics covers a wide range of technologies that can be used to verify identity by measuring and analyzing human characteristics--relying on attributes of the individual instead of things the individual may have or know. Since the September 11, 2001, terrorist attacks, laws have been passed that require a more extensive use of biometric technologies in the federal government. In 2002, GAO conducted a technology assessment on the use of biometrics for border security. GAO was asked to testify about the issues that it raised in the report, the current state of the technology, and the application of biometrics to aviation security."

A letter report issued by the General Accounting Office with an abstract that begins "To help strengthen aviation security after the September 11, 2001, terrorist attacks, the Congress expanded the size and mission of the Federal Air Marshal Service (the Service) and located the Service within the newly created Transportation Security Administration (TSA). Between November 2001 and July 1, 2002, the Service grew from fewer than 50 air marshals to thousands, and its mission expanded to include the protection of domestic as well as international flights. In March 2003, the Service, with TSA, merged into the new Department of Homeland Security (DHS); and in November 2003, it was transferred from TSA and merged into DHS's Bureau of Immigration and Customs Enforcement (ICE). GAO looked at operational and management control issues that emerged during the rapid expansion of the Service, specifically addressing its (1) background check procedures and training; (2) management information, policies, and procedures; and (3) challenges likely to result from its mergers into DHS and ICE."

A statement of record issued by the General Accounting Office with an abstract that begins "When the President created the Department of Homeland Security, he included U.S. agriculture and food industries in the list of critical infrastructures needing protection. The Secretaries of Agriculture and of Health and Human Services have publicly declared that the U.S. food supply is susceptible to deliberate contamination. GAO was asked to provide an overview of the potential vulnerabilities of the food supply and agriculture sector to deliberate contamination and to summarize four recent GAO reports that identified problems with federal oversight that could leave the nation's agriculture and food supply vulnerable to deliberate contamination."

A letter report issued by the General Accounting Office with an abstract that begins "For several decades, debate over how to balance timber sales with resource protection and recreational use on federally managed lands has been at the heart of controversy surrounding federal land management. The Department of the Interior's Bureau of Land Management (BLM) is one of the federal agencies that manages some of the nation's forests--about 53 million acres--under its public domain forestry management program and offers timber for sale from these lands. With regard to BLM's offerings of timber for sale, congressional requesters asked GAO to determine (1) the statutory framework for BLM timber sales, (2) the trend in BLM timber volume offered for sale, and (3) factors contributing to any observed trends. GAO reviewed laws, regulations, and BLM policy governing BLM timber sales. GAO obtained and reviewed data on the volumes and composition of BLM timber sale offerings from fiscal years 1990 through 2002 and met with agency officials and others to identify factors affecting timber sale offering trends and their importance."

Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed the impact of crime and corruption on the implementation of the Dayton Peace Agreement, focusing on: (1) how organized crime and public sector corruption have affected implementation of the agreement in Bosnia; (2) what the international community has done to improve Bosnia's law enforcement and judicial system and reduce corruption; and (3) how international assistance resources are being safeguarded and whether such assistance is being used by Bosnia in place of domestic revenues lost due to crime and corruption."

Testimony issued by the General Accounting Office with an abstract that begins "This testimony discusses the budget process established by the Budget Enforcement Act, which will expire in fiscal year 2002. Because the goal of achieving zero deficits has been achieved, the focus of the budget process has shifted to to the allocation of surpluses among debt reduction, spending increases, and tax cuts. The budget process should be designed to avoid what has been described as the year-end "train wreck." A year-end "train wreck" results from a failure to reach agreement--or at least a compromise acceptable to all parties--earlier in the year. Although it is possible that early agreement on some broad parameters could facilitate a smoother process, it is not clear that such an agreement will always prevent gridlock--it may just come earlier. Two ideas that have been proposed to avert the year-end disruption caused by an inability to reach agreement on funding the government include joint budget resolutions and biennial budgeting. In discussing alternatives for improving the budget process, there is a broad consensus among observers and budget analysts that the spending constraints established by the act are necessary even with the advent of actual and projected surpluses. …

A letter report issued by the General Accounting Office with an abstract that begins "Public assessments by Department of Defense (DOD) officials have emphasized the seriousness of the military threat from chemical and biological (CB) weapons. However, neither DOD nor the services have systematically examined the adequacy of the current specialty mix of medical personnel for CB defense. Although some of the services have begun to review the adequacy of staffing of deployable medical units that would manage the consequences of chemical warfare scenarios, they have not done so for biological warfare scenarios. Joint protocols for treating CB casualties have recently been completed, but the services have not yet agreed on which health care providers should provide treatment. Relatively few military health care providers are trained to a standard of proficiency in providing care to CB casualties. The service surgeons general have begun integrating chemical and a few biological scenarios into their medical exercises, but no realistic field exercise of medical support for CB warfare had been concluded. DOD and the services have not fully addressed weaknesses and gaps in modeling, planning, training, tracking, or proficiency testing for the treatment of CB casualties. The resulting medical structure has not been …

A letter report issued by the General Accounting Office with an abstract that begins "Congress established the child support enforcement program in 1975 to ensure that parents financially supported their children. State agencies administer the program and the Office of Child Support Enforcement (OCSE) in the Department of Health and Human Services oversees it. In 2002, state agencies collected over $20 billion in child support, but $657 million in collections from 2002 and previous years were undistributed--funds that were delayed or never reached families. One method used to collect child support, intercepting federal tax refunds, involves all state agencies, OCSE, and two Department of the Treasury agencies--the Internal Revenue Service (IRS) and the Financial Management Service (FMS). GAO was asked to address (1) how the total amount of undistributed collections changed over the years, (2) the causes of undistributed collections, (3) states' efforts to reduce these funds, and (4) OCSE's efforts to assist states. GAO analyzed OCSE data, administered a survey, visited 6 state agencies and interviewed officials."

Testimony issued by the General Accounting Office with an abstract that begins "To better monitor children and families served by state child welfare agencies, Congress authorized matching funds for the development of statewide automated child welfare information systems (SACWIS) and required that the Department of Health and Human Services (HHS) compile information on the children served by state agencies. This testimony is based on our July 2003 report and addresses the following: (1) states' experiences in developing child welfare information systems and HHS's role in assisting in their development, (2) factors that affect the reliability of data that states collect and report on children served by their child welfare agencies and HHS's role in ensuring the reliability of those data, and (3) practices that child welfare agencies use to overcome challenges associated with SACWIS development and data reliability. For the July 2003 report, we surveyed all 50 states and the District of Columbia regarding their experiences developing and using information systems and their ability to report data to HHS. We also reviewed a variety of HHS documents and visited five states to obtain firsthand information. Finally, we interviewed HHS officials and child welfare and data experts and reviewed relevant literature."

Testimony issued by the General Accounting Office with an abstract that begins "Like many federal agencies, the Coast Guard's priorities were dramatically altered by the events of September 11. The Coast Guard has requested $7.3 billion for fiscal year 2003--a 36 percent increase from the previous year. The events of September 11 caused a substantial shift of effort toward homeland security and away from other missions. As resources were shifted to meet these needs, the law enforcement mission area, which consists mainly of drug and migrant interdiction and fisheries enforcement, saw a dramatic drop in mission capability. The Coast Guard's fiscal year 2003 budget request reflects an attempt to maintain and enhance heightened levels of funding for homeland security while also increasing funding for all other Coast Guard missions beyond fiscal year 2002 levels. The Coast Guard faces substantial management challenges in translating its requested funding increases into increased service levels in its key mission areas. For example, workforce issues present a daunting challenge. If the budget request for fiscal year 2003 is approved, the Coast Guard will add 2,200 full-time positions, retain and build on the expertise and skills of its current workforce, and deal with already high attrition …

A letter report issued by the General Accounting Office with an abstract that begins "Scientists at the Plum Island Animal Disease Center are responsible for protecting the nation against animal diseases that could be accidentally or deliberately introduced into the country. Questions about the security of Plum Island arose after the 2001 terrorist attacks and when employees of the contractor hired to operate and maintain the Plum Island facilities went on strike in August 2002. GAO reviewed (1) the adequacy of security at Plum Island and (2) how well the contractor performed during the strike. The Department of Homeland Security (DHS) assumed the administration of Plum Island from the Department of Agriculture (USDA) on June 1, 2003. While DHS is now responsible for Plum Island, USDA is continuing its research and diagnostic programs."

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO evaluated the Department of Defense's (DOD) efforts to protect U.S. forces stationed overseas from terrorist attacks, focusing on: (1) the extent to which DOD has made improvements to its antiterrorism/force protection program overseas; (2) changes in DOD's process for assessing and reporting vulnerability at overseas installations; and (3) the adequacy of antiterrorism/force protection funding and staff."

A chapter report issued by the General Accounting Office with an abstract that begins "As concerns about terrorism have grown, Executive Branch responsibilities and authorities have received greater attention, which led to the 1998 appointment of a national coordinator in the National Security Council. Both Congress and the President have recognized the need to review and clarify the structure for overall leadership and coordination. The President recently requested that the Vice President oversee a coordinated national effort to improve national preparedness, including efforts to combat terrorism. Federal efforts to develop a national strategy to combat terrorism and related guidance have progressed, but key efforts remain incomplete. The first step toward developing a national strategy is to conduct a national threat and risk assessment. The Department of Justice and the Federal Bureau of Investigation have collaborated on such an assessment, but they have not formally coordinated with other departments and agencies on this task. Under current policy, the federal government also has improved its capabilities to respond to a domestic terrorist incident. The Federal Bureau of Investigation and the Federal Emergency Management Agency are tasked with leading federal efforts in their respective roles for managing a terrorist crisis and the consequences …

Testimony issued by the General Accounting Office with an abstract that begins "Providing readily accessible health information on veterans and active duty military personnel is highly essential to ensuring that these individuals are given quality health care and assistance in adjudicating disability claims. Moreover, ready access to health information is consistent with the President's recently announced intention to provide electronic health records for most Americans within 10 years. In an attempt to improve the sharing of health information, the Departments of Veterans Affairs (VA) and Defense (DOD) have been working, since 1998, toward the ability to exchange electronic health records for use by veterans, military personnel, and their health care providers. In testimony before Congress last November and again this past March, GAO discussed the progress being made by the departments in this endeavor. While a measure of success has been achieved--the one-way transfer of health data from DOD to VA health care facilities--identifying the technical solution for a two-way exchange, as part of a longer term HealthePeople (Federal) initiative, has proven elusive. At Congress's request, GAO reported on its continuing review of the departments' progress toward this goal of an electronic two-way exchange of patient health records."

Testimony issued by the General Accounting Office with an abstract that begins "For the past 5 years, the Departments of Veterans Affairs and Defense have been working to exchange health care data and create electronic records for veterans and active duty personnel. Such exchange is seen as a means of reducing the billions of dollars that the departments spend annually on health care services and making such data more readily accessible to those treating our country's approximately 13 million veterans, military personnel, and dependents. This is especially critical when military personnel are engaged in conflicts all over the world, and their health records can reside at multiple locations. GAO has reported on these efforts several times, most recently in September 2002. At the request of the Subcommittee, GAO is updating its observations on the departments' efforts, focusing on (1) the reported status of the ongoing, one-way exchange of data, the Federal Health Information Exchange, and (2) progress toward achieving the longer term two-way exchange under the HealthePeople (Federal) initiative."

Testimony issued by the General Accounting Office with an abstract that begins "Protecting the computer systems that support our critical operations and infrastructures has never been more important because of the concern about attacks from individuals and groups with malicious intent, including terrorism. These concerns are well founded for a number of reasons, including the dramatic increases in reported computer security incidents, the ease of obtaining and using hacking tools, the steady advance in the sophistication and effectiveness of attack technology, and the dire warnings of new and more destructive attacks. As with other large organizations, federal agencies rely extensively on computerized systems and electronic data to support their missions. Accordingly, the security of these systems and data is essential to avoiding disruptions in critical operations, as well as to helping prevent data tampering, fraud, and inappropriate disclosure of sensitive information. At the subcommittee's request, GAO discussed its analysis of recent information security audits and evaluations at 24 major federal departments and agencies."

A letter report issued by the General Accounting Office with an abstract that begins "Congress authorized the Pilot Mentor Protege Program to boost the participation of small disadvantaged businesses as subcontractors and suppliers under Department of Defense (DOD) contracts. The program provides incentives for major defense contractors (mentors) to assist small disadvantaged businesses (proteges) in strengthening their ability to compete for work. However, DOD has been criticized for not establishing compelling evidence about the program's overall effectiveness. This report reviews (1) the relationship between the results of the Mentor-Protege Program and the statutory goal of awarding five percent of the total dollar amount contracted by DOD and subcontracted by DOD prime contractors to small disadvantaged businesses; (2) whether the Mentor-Protege Program enhanced the business competitiveness, financial independence, and business development of protege firms; and (3) whether program funds had been used as an effective incentive for mentor firms to participate in the program. GAO found that DOD lacks data integral to assessing the success of the Mentor-Protege Program. DOD lacks enough information to determine the relationship between the program and the goal of awarding five percent of the total dollar amount contracted to small disadvantaged businesses. Although DOD has consistently …

A letter report issued by the General Accounting Office with an abstract that begins "Since 1992, Congress has authorized more than $3 billion for the Cooperative Threat Reduction (CTR) program to help Russia, Belarus, Ukraine, Kazakhstan, Uzbekistan, Moldova, and Georgia secure and eliminate weapons of mass destruction. Concerned about proper oversight of equipment and services provided by the program, Congress required the Department of Defense (DOD) to report annually on whether the assistance was being used as intended. This report reviews (1) whether DOD's oversight procedures produce the necessary information to determine if the threat reduction assistance, including equipment provided and services furnished, is being used as intended and (2) whether DOD can improve its oversight. GAO found that DOD has procedures in place that reasonably ensure that at least 95 percent of the assistance is being used as intended and is adequately accounted for. Because of access restrictions imposed by the Russian government, a limited amount of equipment--less than five percent of the total value of assistance provided--is in locations where access by U.S. personnel is not permitted. DOD can enhance the quality of its program oversight by better targeting and expanding the scope of its formal audit and …

Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the: (1) extent to which the accuracy of the 1990 census address counts varied by geographic area; and (2) difficulties that the Bureau of the Census faces in building a quality address list."

A letter report issued by the General Accounting Office with an abstract that begins "Following the 1990-91 Persian Gulf War, many servicemembers experienced health problems that they attributed to their military service in the Persian Gulf. However, a lack of servicemember health and deployment data hampered subsequent investigations into the nature and causes of these illnesses. Public Law 105-85, enacted in November 1997, required the Department of Defense (DOD) to establish a system to assess the medical condition of service members before and after deployments. GAO was asked to determine whether (1) the military services met DOD's force health protection and surveillance requirements for servicemembers deploying in support of Operation Enduring Freedom (OEF) in Central Asia and Operation Joint Guardian (OJG) in Kosovo and (2) DOD has corrected problems related to the accuracy and completeness of databases reflecting which servicemembers were deployed to certain locations."

A letter report issued by the General Accounting Office with an abstract that begins "GAO prepared this report in response to its basic legislative responsibilities. Its objectives are threefold: (1) to examine the historical funding trends and their impact on the condition of the active forces' facilities, (2) to evaluate the consistency of the services' information on facility conditions, and (3) to assess the Department of Defense's (DOD) long-term strategic plan and objectives to improve facility conditions."

Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO examined the the Department of Defense's (DOD) initiatives to change export and procurement policies and procedures that relate to the transfer or sale of defense articles and services that may have national security implications."

Correspondence issued by the General Accounting Office with an abstract that begins "Section 127a, title 10 of the United States Code provides the Department of Defense (DOD) with two options for funding nontraining deployments and operations when Congress has not provided funds in advance. These options involve waiving reimbursements for support services and transferring amounts from other DOD accounts. Section 127a prescribes specific procedures to be followed by DOD when these funding options are used; requires DOD to notify Congress of and report on certain new contingency operations; and states that the Comptroller General of the United States shall from time to time, and when requested by a Committee of Congress, conduct a review to determine whether DOD is complying with the statutory requirements and limitations. GAO found that DOD has complied with the requirements contained in section 127a. Since the current notification and reporting requirements of section 127a were enacted in 1996, DOD has provided congressional notification for four operations, involving Bosnia, Kosovo, hurricane relief in Central America, and East Timor. DOD has rarely used the funding options provided in section 127a. It used the section 127a funding option allowing waiver of reimbursement for units providing support once, for …