Correspondence issued by the Government Accountability Office with an abstract that begins "The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) added a prescription drug benefit to the Medicare program, to become effective January 1, 2006. To assist Medicare beneficiaries with their prescription drug costs until the new benefit becomes available, the MMA also required the establishment of a temporary program, the Medicare Prescription Drug Discount Card and Transitional Assistance Program, which began in June 2004. The drug card program is designed to offer Medicare beneficiaries access to discounts off the retail price of prescription drugs. All Medicare beneficiaries, except those receiving Medicaid drug coverage, are eligible to enroll in the drug card program. Certain low-income beneficiaries without other drug coverage qualify for an additional benefit, a transitional assistance (TA) subsidy, that can be applied toward the cost of drugs covered under the drug card program. The Centers for Medicare & Medicaid Services (CMS)--the agency within the Department of Health and Human Services that administers the Medicare and Medicaid programs--administers and oversees the drug card program. The drug cards themselves are offered and managed by private organizations, known as drug card sponsors. There are different types of drug …

Testimony issued by the Government Accountability Office with an abstract that begins "GAO was asked to provide testimony about the effectiveness and reliability of the State Department's Office of Inspector General (State IG). We focused on the independence of the State IG, the use of inspections instead of audits to provide oversight of the department, and the effectiveness of the IG's investigative function. The testimony is based primarily on our March 2007 report, Inspectors General: Activities of the Department of State Office of Inspector General (GAO-07-138)."

Testimony issued by the Government Accountability Office with an abstract that begins "The Transportation Security Administration (TSA) is developing the Transportation Worker Identification Credential (TWIC) to help ensure that only workers who are not known to pose a terrorist threat are allowed to enter secure areas of the nation's transportation facilities. This testimony is based primarily on GAO's September 2006 report on the TWIC program, and interviews with TSA and maritime industry officials conducted in September and October 2007 to obtain updates on the TWIC program. Specifically, this testimony addresses (1) the progress TSA has made since September 2006 in implementing the TWIC program and addressing GAO recommendations; and (2) some of the remaining challenges that TSA and the maritime industry must overcome to ensure the successful implementation of the program."

Correspondence issued by the Government Accountability Office with an abstract that begins "Rising pharmacy costs have been a long-standing issue for the Department of Defense (DOD). In 1998, we reported that DOD's fiscal year 1997 total pharmacy costs were $1.3 billion--a 13 percent increase from fiscal year 1995. In fiscal year 2006, DOD dispensed 115 million prescriptions to about 6.5 million beneficiaries at a cost of about $6 billion. One effort to control pharmacy costs is through the use of a uniform formulary, which is a list of preferred drugs that are generally available to beneficiaries. The National Defense Authorization Act for Fiscal Year 2000 directed DOD to establish a pharmacy benefits program that included a uniform formulary. DOD implemented the uniform formulary in 2005. Drugs on the uniform formulary are generally available at military treatment facilities (MTF), the TRICARE Mail Order Pharmacy (TMOP), and retail pharmacies. Each quarter, DOD reviews drugs for inclusion on the uniform formulary. DOD's decision to designate a drug as either formulary or nonformulary is based on the drug's clinical and cost-effectiveness relative to the other drugs in its therapeutic class. In its decision-making process, DOD considers information such as the drug's indications, clinical outcomes, …

Correspondence issued by the General Accounting Office with an abstract that begins "This report provides information on oil and gas activities in the National Wildlife Refuge System. GAO focuses on (1) how many units produced or had oil or gas activities on their lands in 2000, (2) why these activities took place in these units, (3) the number of these units for which the federal government owned the oil and gas mineral rights, (4) resources available to these units to manage oil and gas activities, and (5) the effects of the National Wildlife Refuge System Administration Act of 1966 on leases for oil and gas activities."

Correspondence issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) operates one of the largest health care systems in the nation. For fiscal year 2007, VA estimates that it will provide health care to more than 5 million veterans, either in its own facilities or through other health care providers. During the past decade, the numbers of VA patients and the costs for treating them have increased rapidly, due in part to an expansion in the number of veterans eligible to receive care. The Veterans Health Administration (VHA)--the VA entity responsible for the health care of veterans--spends about $35 billion a year providing health care to veterans, including more than $7 billion to acquire health care services and products. In its own health care facilities, VHA contracts for a broad range of medical services such as anesthesiology, for other services that support the delivery of medical care such as facility maintenance and laundry services, and for products such as medical equipment, food, and hospital linens. It also contracts for medical care for veterans provided in non-VA hospitals and community based clinics. Contracting for services at VHA represents a large and growing proportion …

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 …

Testimony issued by the Government Accountability Office with an abstract that begins "Multiple executive branch agencies are responsible for different steps of the multi-phased personnel security clearance process that includes: determination of whether a position requires a clearance, application submission, investigation, and adjudication. Agency officials must first determine whether a federal civilian position requires access to classified information. The Director of National Intelligence (DNI) and the Office of Personnel Management (OPM) are in the process of issuing a joint revision to the regulations guiding this step in response to GAO's 2012 recommendation that the DNI issue policy and guidance for the determination, review, and validation of requirements. After an individual has been selected for a federal civilian position that requires a personnel security clearance and the individual submits an application for a clearance, investigators--often contractors--from OPM conduct background investigations for most executive branch agencies. Adjudicators from requesting agencies use the information from these investigations and consider federal adjudicative guidelines to determine whether an applicant is eligible for a clearance. Further, individuals are subject to reinvestigations at intervals that are dependent on the level of security clearance. For example, top secret and secret clearance holders are to be reinvestigated every 5 …

Correspondence issued by the General Accounting Office with an abstract that begins "In a fiscal year 1999 accountability report to Congress, the Health Care Financing Administration (HCFA) made several clerical errors in the accounting of Medicare trust funds, which caused the Hospital Insurance (HI) Trust Fund to be overinvested by about $14 billion and the Supplementary Medical Insurance (SMI) Trust Fund to be underinvested by about $18 billion. Because of these errors, the HI Trust Fund earned excess interest and the SMI Trust Fund lost interest. GAO found that these errors went undetected for a year because of internal control weaknesses. Inadequate training and supervision and ineffective reconciliations were key factors that allowed the errors to go undetected. HCFA took corrective action, however, as soon as the errors were discovered."

Correspondence issued by the General Accounting Office with an abstract that begins "The United States/Canada Softwood Lumber Agreement expired in March 2001. As part of the preparation process for renegotiating the agreement, the United States Trade Representative requested public comment on softwood lumber trade issues between the United States and Canada and on Canadian softwood lumbering practices. The comments received included allegations that Canadian lumbering and forestry practices were affecting animal species with U.S./Canadian ranges that are listed as threatened or endangered in the United States. To consider these comments as well as provide useful information to the U.S. Trade Representative in the renegotiations, the Department of the Interior, with the Department's U.S. Fish and Wildlife Service's (FWS) assistance, prepared a conservation status report on selected species that may be affected by the new agreement. GAO reviewed the FWS' preliminary conclusions and found that, in compiling the information for the Department of the Interior's 2001 conservation report for the U.S. Trade Representative, FWS relied chiefly on previously published material and internal agency documents, such as individual species recovery plans, Federal Register listing information, other administrative records, and public comments received. The report underestimates the extent of cooperation between U.S. and …

Correspondence issued by the General Accounting Office with an abstract that begins "GAO worked with the Department of Defense (DOD) to develop and report a reliable estimate for the postemployment health care benefits due to military retirees, their dependents, and survivors. To accomplish this, the DOD Office of Actuary has contracted with a private sector firm of actuaries and consultants, Milliman & Robertson. This report provides a non-technical summary of the contractor's findings and includes GAO's recommendation that the changes discussed in the reports be implemented. GAO found that although the analysis prepared by the Office of Actuary does a good job of identifying the factors that affect the military postretirement health care benefits liability and of evaluating the possible impact of those factors, issues still need to be addressed. An additional break out of information is needed in some areas in order for the Office of Actuary to properly analyze their impact on liability. The methodology used was generally reasonable, but some deficiencies still remained."

Correspondence issued by the General Accounting Office with an abstract that begins "Section 1085 of the National Defense Authorization Act for Fiscal Year 2001 authorized the military department secretaries to (1) charge fees to persons requesting information from the primary military archives and (2) retain collected fees to help defray costs associated with providing the information. The military archives also have authority under the User Charge Statute and the Freedom of Information Act (FOIA) to charge for general information provided to the public. The Conference Report on the National Defense Authorization Act for Fiscal Year 2001 directs the Comptroller General to provide a report 1 year after implementation of the act on the fees collected and the associated costs of providing historical information. GAO found that Section 1085 authorizes but does not require action by the four primary military archives. Because of this, only the Army Military History Institute has implemented a fee schedule. Officials of the other three archives stated that the archives have no plans to implement a fee schedule under Section 1085. The Army Military History Institute first implemented a Section 1085 fee schedule in October 2001 and modified it in April 2002 to simplify some of …

Correspondence issued by the General Accounting Office with an abstract that begins "This report compares the drug prices paid by the Department of Defense (DOD) and the Department of Veterans Affairs (VA) with the prices paid by the Health Care Financing Administration (HCFA). On average, for the sample of drug prices analyzed by GAO, HCFA's prices were higher than those of either DOD or VA."

Correspondence issued by the Government Accountability Office with an abstract that begins "On July 25, 2005, the Centers for Medicare & Medicaid Services (CMS) in the Department of Health and Human Services (HHS) published its notice of proposed rulemaking (NPRM) entitled "Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates." As part of these changes, CMS is proposing Medicare payment rates for certain hospital outpatient drugs classified for payment purposes as specified covered outpatient drugs (SCOD). The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) defined a SCOD as a drug or radiopharmaceutical used in hospital outpatient departments, covered by Medicare, and paid for individually rather than as part of a payment group with other services. With regard to SCODs, the MMA directed CMS to set 2006 payment rates equal to hospitals' average acquisition costs--the cost to hospitals of acquiring a product, net of rebates. In several related requirements, the MMA directed us to provide information on SCOD costs and CMS's proposed rates. First, we were required to conduct a survey of hospitals to obtain data on their acquisition costs of SCODs and provide information based on these data to …

Correspondence issued by the Government Accountability Office with an abstract that begins "Spending on outpatient prescription drug coverage for Medicaid beneficiaries has accounted for a substantial and growing share of Medicaid program expenditures. All states and the District of Columbia have elected to include outpatient prescription drug coverage as a benefit of their Medicaid programs. Total Medicaid expenditures on outpatient prescription drugs grew from $4.6 billion (nearly 7 percent of Medicaid's total medical care expenditures) in fiscal year 1990 to $33.8 billion (13 percent of Medicaid's total medical care expenditures) in fiscal year 2003. This represented more than twice the rate of increase in total Medicaid spending from fiscal year 1990 through fiscal year 2003. Amid concerns about increasing Medicaid drug spending, focus has been drawn to the ways states pay for prescription drugs. State Medicaid programs pay pharmacies for covered outpatient prescription drugs dispensed to Medicaid beneficiaries. The Centers for Medicare & Medicaid Services (CMS)--the agency of the Department of Health and Human Services (HHS) that oversees states' Medicaid programs--sets maximum payment limits for certain drugs--federal upper limits (FUL)--and provides guidelines regarding drug payment, as defined by regulation. Within these parameters, states may determine their own drug payment methodologies. …

Correspondence issued by the General Accounting Office with an abstract that begins "Concerns have been raised about the Health Care Financing Administration's (HCFA) decision to extend a contract with an accounting firm that has been implicated in major fraud. KPMG's contract with HCFA included annual options to extend performance that could be exercised at HCFA's will. Although information on the fraud investigation was available to HCFA staff at various levels, the information was not used to make reasoned contracting decisions. If HCFA had considered the information and documented its decision to extend KPMG's contract, it could have minimized concerns over the appropriateness of its decision."

Correspondence issued by the Government Accountability Office with an abstract that begins "According to the U.S. Environmental Protection Agency, buildings in the United States account for 68 percent of the nation's total electricity consumption and 39 percent of its total energy consumption. In December 2007, Congress enacted the Energy Independence and Security Act of 2007 (EISA) to, among other things, increase energy efficiency and the availability of renewable energy in federal buildings. Specifically, the act established new energy-related requirements and standards for federal buildings and for the agencies that oversee them. For example, it required the General Services Administration (GSA) to establish an Office of Federal High-Performance Green Buildings to coordinate green building information and activities within GSA and with other federal agencies. The act also required GAO to report to Congress on the implementation of certain provisions contained in EISA by October 31, 2008, and October 31, 2009. As determined in consultation with Congressional offices, this report fulfills the 2008 requirement by addressing the status of GSA's implementation of selected EISA requirements related to high-performance federal green buildings. We selected GSA as the focus of our initial report because GSA is responsible for the design, construction, operation, and maintenance …

Other written product issued by the Government Accountability Office with an abstract that begins "A recent GAO report assessed the thoroughness of the process used by the Department of Housing and Urban Development (HUD) to resolve complaints of housing discrimination (GAO-06-79). As part of that study, GAO did a telephone survey, which is reproduced here, of a sample of complainants in housing discrimination cases that were investigated and closed by HUD's Office of Fair Housing and Equal Opportunity (FHEO) and state and local Fair Housing Assistance Program (FHAP) agencies from July 1 through December 31, 2004. A survey research firm under contract to GAO interviewed a random sample of 575 complainants to determine their levels of satisfaction with the thoroughness, fairness, timeliness, and outcomes of the complaint intake and investigation process. Using HUD records, GAO mailed advance letters to and subsequently called the complainants of record in 1,517 eligible cases. The response rate was 38 percent, resulting in the 575 complete interviews. The sample was allocated proportionally across three types of case closures (administrative, conciliation without determination of cause, or a determination of no cause) and responsible agency (FHEO or FHAP). Results were weighted, or statistically adjusted, to make them …

Testimony issued by the Government Accountability Office with an abstract that begins "More than 5.5 billion pounds of explosives are used each year in the United States by private sector companies and government entities. The Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) has authority to regulate explosives and to license privately owned explosives storage facilities. After the July 2004 theft of several hundred pounds of explosives from a local government storage facility, concerns arose about vulnerability to theft. This testimony provides information about (1) the extent of explosives thefts from state and local government facilities, (2) ATF's authority to regulate and oversee state and local government storage facilities, and (3) security measures in place at selected state and local government storage facilities. This information is based on a report GAO is releasing today on these issues."

Testimony issued by the Government Accountability Office with an abstract that begins "GAO has for many years warned that our nation is on an imprudent and unsustainable fiscal path. During the past 2 years, the Comptroller General has traveled to 24 states as part of the Fiscal Wake-Up Tour. Members of this diverse group of policy experts agree that finding solutions to the nation's long-term fiscal challenge will require bipartisan cooperation, a willingness to discuss all options, and the courage to make tough choices. Indeed, the members of the Fiscal Wake-Up Tour believe that fiscal responsibility and intergenerational equity must be a top priority for the new President. Several bills have been introduced that would establish a bipartisan group to develop proposals/policy options for addressing the longterm fiscal challenge. At the request of Chairman Conrad and Senator Gregg, the Comptroller General discussed GAO's views on their proposal to create a Bipartisan Task Force for Responsible Fiscal Action (S. 2063)."

Testimony issued by the Government Accountability Office with an abstract that begins "The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) protects the employment and reemployment rights of federal and nonfederal employees who leave their employment to perform military or other uniformed service. Under a demonstration project from February 8, 2005, through September 30, 2007, and subsequently extended through November 16, 2007, the Department of Labor (DOL) and the Office of Special Counsel (OSC) share responsibility for receiving and investigating USERRA claims and seeking corrective action for federal employees. In July 2007, GAO reported on its review of the operation of the demonstration project through September 2006. This testimony describes the findings of our work and actions taken to address our recommendations. In response to the request from Congress, GAO also presents views on (1) factors to consider in deciding whether to extend the demonstration project and the merits of conducting a follow-up review and (2) options available if the demonstration is not extended. In preparing this statement, GAO interviewed officials from DOL and OSC to update actions taken on recommendations from our July 2007 report and developments since we conducted that review."

Testimony issued by the Government Accountability Office with an abstract that begins "The nation's critical infrastructure sectors--such as banking and finance, information technology, and public health--rely on computerized information and systems to provide services to the public. To fulfill the requirement for a comprehensive plan, including cyber aspects, the Department of Homeland Security (DHS) issued a national plan in June 2006 for the sectors to use as a road map to enhance the protection of critical infrastructure. Lead federal agencies, referred to as sector-specific agencies, are responsible for coordinating critical infrastructure protection efforts such as the development of plans that are specific to each sector. GAO was asked to summarize a report being released today that identifies the extent to which the sector plans addressed key aspects of cyber security, including cyber assets, key vulnerabilities, vulnerability reduction efforts, and recovery plans. In the report, GAO analyzed each sector-specific plan against criteria that were developed on the basis of DHS guidance."

Testimony issued by the Government Accountability Office with an abstract that begins "This testimony discusses internal oversight and procurement in the United Nations (UN). The findings of the Independent Inquiry Committee into the UN's Oil for Food Program have rekindled long-standing concerns about internal oversight and procurement at the United Nations. In addition, the UN's 2005 World Summit called for a host of reforms, from human rights, terrorism, and peace-building to economic development and management reform. Specifically, this testimony conveys our preliminary observations on the UN's budgeting processes as it relates to the ability of the UN's Office of Internal Oversight Services (OIOS) to perform independent and effective oversight. We will also discuss some of the UN's efforts to address problems affecting the openness and professionalism of its procurement system. We would like to emphasize that our comments reflect the preliminary results of two ongoing GAO engagements examining the UN's internal oversight and procurement services. We will issue reports covering a wide range of issues in both areas early next year."

Testimony issued by the General Accounting Office with an abstract that begins "Because of the terrorist attacks against the World Trade Center and the Pentagon on September 11 and the subsequent appearance of letters containing anthrax, terrorism rose to the top of the national agenda. The Attorney General has indicated that the country needs to be prepared for still more terrorist incidents. The Department of Justice is working with state and local governments to complete risk management tools for the domestic preparedness program. However, the FBI told GAO that these will be limited to threat assessments only and will not include other aspects of risk management that GAO advocates. Despite these inconclusive results, the federal government can benefit from risk management. Risk management is a systematic and analytic process to consider the likelihood that a threat will endanger an asset and to identify actions that reduce the risk and mitigate the consequences of an attack. An effective risk management approach includes a threat assessment, a vulnerability assessment, and a criticality assessment. Such an approach could help the nation prepare against threats it faces and help better target finite resources to areas of highest priority."