Correspondence issued by the Government Accountability Office with an abstract that begins "Congress asked us to estimate the effect on Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) funding to urban areas if a certain stop-loss provision was enacted. The CARE Act, administered by the Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA), was enacted to address the needs of jurisdictions, health care providers, and people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In October 2009, the Ryan White HIV/AIDS Treatment Extension Act of 2009 (RWTEA) reauthorized CARE Act programs for fiscal years 2010 through 2013. The stop-loss provision that you asked us to address was contained in a draft consolidated appropriations bill for fiscal year 2011."

A letter report issued by the Government Accountability Office with an abstract that begins "Federally funded employment and training programs play an important role in helping job seekers obtain employment. The Departments of Labor, Education, and Health and Human Services (HHS) largely administer these programs. GAO's objectives were to determine: (1) whether the number of federal employment and training programs and funding for them have changed since our 2003 report, (2) what kinds of outcome measures the programs use and what is known about program effectiveness, (3) the extent to which the programs provide similar services to similar populations, (4) the extent to which duplication may exist among selected large programs, and (5) what options exist for increasing efficiencies among these programs. To address these objectives, GAO searched federal program lists, surveyed federal agency officials, reviewed relevant reports and studies, and interviewed officials in selected states."

A letter report issued by the Government Accountability Office with an abstract that begins "Congress created the H-1B program in 1990 to enable U.S. employers to hire temporary, foreign workers in specialty occupations. The law capped the number of H-1B visas issued per fiscal year at 65,000. Since then, the cap has fluctuated with legislative changes. Congress asked GAO to assess the impact of the cap on the ability of domestic companies to innovate, while ensuring that U.S. workers are not disadvantaged. In response, GAO examined what is known about (1) employer demand for H-1B workers; (2) how the cap affects employer costs and decisions to move operations overseas; (3) H-1B worker characteristics and the potential impact of raising the cap; and (4) how well requirements of the H-1B program protect U.S. workers. GAO analyzed data from 4 federal agencies; interviewed agency officials, experts, and H-1B employers; and reviewed agency documents and literature."

A letter report issued by the Government Accountability Office with an abstract that begins "Road, rail, and waterway freight transportation is vital to the nation's economy. Government tax, regulatory, and infrastructure investment policies can affect the costs that shippers pass on to their customers. If government policy gives one mode a cost advantage over another, by, for example, not recouping all the costs of that mode's use of infrastructure, then shipping prices and customers' use of freight modes can be distorted, reducing the overall efficiency of the nation's economy. As requested, this report (1) describes how government policies can affect competition and efficiency within the surface freight transportation sector, (2) determines what is known about the extent to which all costs are borne by surface freight customers, and (3) discusses the use of the findings when making future surface freight transportation policy. GAO reviewed the transportation literature and analyzed financial and technical data from the Department of Transportation (DOT), the Army Corps of Engineers (Corps), and the Environmental Protection Agency to make cross-modal comparisons at a national level. Data limitations and assumptions inherent in an aggregate national comparison are noted in the report."

A letter report issued by the Government Accountability Office with an abstract that begins "Studies have found that Medicare payment rates for home oxygen exceeded other payers' rates. Congress has reduced home oxygen payment rates, capped rental payments after 36 months, and directed the Centers for Medicare & Medicaid Services (CMS), which administers Medicare, to use competitive bidding. GAO was asked to examine Medicare home oxygen payment policy. GAO describes how Medicare pays for home oxygen; the effect on Medicare's payments of using other methodologies and rates; and changes in beneficiary access. GAO reviewed federal laws and regulations, industry-reported costs, Medicare claims data and payment data from selected private insurers, the Department of Veterans Affairs (VA), and CMS's competitive bidding program."

A letter report issued by the Government Accountability Office with an abstract that begins "The unprecedented growth at 26 military installations across the country due to the implementation of several concurrent Department of Defense (DOD) initiatives is expected to stress transportation needs for surrounding communities. The Defense Access Roads program, while small when compared to other transportation funding sources, provides a means for DOD to pay a share of the cost of highway improvements due to unusual and sudden DOD-generated activities. In response to a congressional request to review the program, GAO (1) assessed the use of the program to mitigate transportation needs and (2) identified additional steps that may be necessary to address unmet transportation needs. GAO conducted extensive interviews with 26 growth installations and visited installations and state authorities in Maryland, Texas, and Virginia to discuss transportation issues."

A letter report issued by the Government Accountability Office with an abstract that begins "The State Department and two components of the Department of Homeland Security (DHS), Customs and Border Protection (CBP) and the Coast Guard, are responsible for preventing illegal immigration at U.S. seaports and identifying individuals who are potential security risks. The International Labor Organization (ILO) adopted the Seafarers' Identity Documents Convention (ILO 185) to establish an international framework of seafarer identification documents and reduce their vulnerability to fraud and exploitation. GAO was asked to examine (1) measures federal agencies take to address risks posed by foreign seafarers and the challenges, if any, DHS faces; (2) the challenges, if any, DHS faces in tracking illegal entries by foreign seafarers and how it enforces penalties; and (3) the implementation status of ILO 185. GAO reviewed relevant requirements and agency documents on maritime security, interviewed federal and industry officials, and visited seven seaports based on volume of seafarer arrivals. The visits provided insights, but were not projectable to all seaports."

A letter report issued by the Government Accountability Office with an abstract that begins "Because the U.S. Department of State (State) is the lead U.S. foreign affairs agency, its personnel require certain knowledge, skills, and abilities to address the global challenges and security threats facing the United States. State devoted about $255 million to personnel training in fiscal year 2010; the department's Foreign Service Institute (FSI) is the primary training provider for State's more than 66,000 Foreign Service, civil service, and locally employed staff (LE staff) worldwide. GAO was asked to examine (1) State's purpose and structure for training personnel and (2) the extent to which State's training incorporates elements for effective training programs. GAO reviewed and analyzed data and documentation related to the agency's training efforts; completed a training assessment using a tool developed based on prior GAO guidance; and interviewed officials in Washington, D.C., and at 12 overseas posts."

A letter report issued by the Government Accountability Office with an abstract that begins "The National Oceanic and Atmospheric Administration (NOAA) is a bureau within the Department of Commerce (Commerce). To help achieve NOAA's program goals, it relies on management and administration (M&A) services, such as legal support and information technology. In response to the fiscal year 2010 Consolidated Appropriations Act Conference Report, GAO (1) examined how NOAA's M&A services are funded, (2) assessed the extent to which NOAA's policies and procedures for M&A services conform to applicable standards, and (3) estimated salaries and expenses for NOAA's budget for fiscal year 2009. Among other things, GAO reviewed documents on M&A services and data on M&A costs from NOAA officials for its headquarters; line offices, which are responsible for executing NOAA's programs; and a subset of financial management centers (FMC) within the line offices, which manage specific programs and projects."

Correspondence issued by the Government Accountability Office with an abstract that begins "As Congress requested, we conducted a review of challenges associated with enhancing safety on major rail transit systems. During the course of that review, we assessed the quality of data that the Federal Transit Administration (FTA) collects and maintains in its State Safety Oversight (SSO) Rail Accident Database. FTA, an agency within the Department of Transportation (DOT), collects these safety data, including data on types of accidents and causes, from SSO agencies and the rail transit agencies they oversee. FTA used the SSO Rail Accident Database to produce the agency's 2009 Rail Safety Statistics Report, which analyzed data from 2003 through 2008. Although we originally intended to report on safety trends using the SSO Rail Accident Database in the rail transit report, we determined that these data were not sufficiently reliable for such a purpose. As a result, in this review we further assess the SSO Rail Accident Database and FTA's processes for collecting and compiling the data. We determined that there are numerous inaccuracies in FTA's SSO Rail Accident Database and, consequently, the 2009 Rail Safety Statistics Report. FTA implemented changes to the data collection process over …

A letter report issued by the Government Accountability Office with an abstract that begins "Although transit service is generally safe, recent high-profile accidents on several large rail transit systems--notably the June 2009 collision in Washington, D.C., that resulted in nine fatalities and 52 injuries--have raised concerns. The Federal Transit Administration (FTA) oversees state agencies that directly oversee rail transit agencies' safety practices. FTA also provides assistance to transit agencies, such as funding and training, to enhance safety. GAO was asked to determine (1) the challenges the largest rail transit systems face in ensuring safety and (2) the extent to which assistance provided by FTA addresses these challenges. GAO visited eight large rail transit systems and their respective state oversight agencies, reviewed pertinent documents, and interviewed rail transit safety experts and officials from FTA and the National Transportation Safety Board (NTSB)."

A letter report issued by the Government Accountability Office with an abstract that begins "Since 2001, the National Archives and Records Administration (NARA) has been working to develop an Electronic Records Archive (ERA) to preserve and provide access to massive volumes and all types of electronic records. However, in acquiring this system, NARA has repeatedly revised the program schedule and increased the estimated costs for completion from $317 million to $567 million. NARA is to manage this acquisition using, among other things, earned value management (EVM). EVM is a project management approach that, if implemented appropriately, provides objective reports of project status and unbiased estimates of anticipated costs at completion. GAO was asked to (1) assess whether NARA is adequately using EVM techniques to manage the acquisition and (2) evaluate the earned value data to determine ERA's cost and schedule performance. To do so, GAO compared agency and contractor documentation with best practices, evaluated earned value data to determine performance trends, and interviewed cognizant officials."

A letter report issued by the Government Accountability Office with an abstract that begins "In addition to providing health care to veterans, the Department of Veterans Affairs (VA) funds research that focuses on health conditions veterans may experience. According to VA, experts estimate that up to 20 percent of Operation Enduring Freedom and Operation Iraqi Freedom veterans have experienced post-traumatic stress disorder (PTSD) and demand for PTSD treatment is increasing. Because of the importance of research in improving the services that veterans receive, GAO was asked to report on VA's funding of PTSD research, and its processes for funding PTSD research proposals, reviewing and incorporating research outcomes into clinical practice guidelines (CPG)--tools that offer clinicians recommendations for clinical services but do not require clinicians to provide one service over another--and determining which PTSD services are required to be made available at VA facilities. To do this work, GAO obtained and summarized VA data on the funding of PTSD research from its medical and prosthetic research appropriation through its intramural research program. GAO also reviewed relevant VA documents, such as those for developing CPGs and those related to VA's 2008 Uniform Mental Health Services in VA Medical Centers and Clinics handbook …

A letter report issued by the Government Accountability Office with an abstract that begins "The Food and Drug Administration (FDA) oversees federal requirements to prohibit false or misleading food labels; the Federal Trade Commission enforces the prohibition against false or misleading advertising. By statute, health claims on food labels must have significant scientific agreement, but in 2002, in response to a court decision, FDA decided to allow qualified health claims with less scientific support. Structure/function claims refer to a food's effect on body structure or function and are also used on food. Congress directed GAO to study FDA's implementation of qualified health claims for food. GAO examined (1) the results of FDA's efforts to allow the use of qualified health claims and oversight of these claims and (2) consumers' understanding of the claims. GAO also examined FDA's oversight of structure/function claims. GAO reviewed FDA documents and consumer studies and interviewed stakeholders from health, medical, industry, and consumer groups."

A letter report issued by the Government Accountability Office with an abstract that begins "In September 2009, the President announced a revised approach for ballistic missile defense (BMD) in Europe. The European Phased Adaptive Approach (EPAA) is designed to defend against existing and near-term ballistic missile threats and build up defenses over four phases as threats mature and new BMD technologies become available. Although the approach will include capabilities such as radars and landand sea-based BMD assets, the Department of Defense (DOD) has not yet established EPAA life-cycle costs. EPAA is DOD's first implementation of its new, regional approach to BMD. GAO was asked to evaluate DOD's plans for implementing EPAA. GAO reviewed the extent to which: (1) DOD has developed guidance and addressed management of cost and schedule for EPAA, and (2) DOD planning for EPAA is informed by operational performance data. GAO reviewed key legislation, policy and guidance, and initial plans for implementation and asset allocation."

A letter report issued by the Government Accountability Office with an abstract that begins "For fiscal year 2010, Congress appropriated $14.5 billion for Title I, Part A of the Elementary and Secondary Education Act of 1965 (ESEA), which funds services to students in schools with high concentrations of students from low-income families. Title I, Part A includes several fiscal requirements, which are designed to prevent local school districts from using federal dollars to replace state and local education funding. One of these measures, Title I comparability, requires districts to provide services with state and local funds to Title I schools that are at least comparable to services provided in schools not served by Title I. State educational agencies monitor district compliance with Title I comparability requirements. Districts may comply with comparability requirements through one of several measures. Under Title I, districts are deemed to be in compliance with comparability requirements if they have established and implemented a districtwide salary schedule; a policy to ensure equivalence among schools in teachers, administrators, and other staff; and a policy to ensure equivalence among schools in the provision of curriculum materials and instructional supplies. Guidance from the U.S. Department of Education (Education) also allows …

Correspondence issued by the Government Accountability Office with an abstract that begins "In recent years, we and other federal fiscal experts--including the Congressional Budget Office (CBO) and the Medicare Trustees--have noted the rise in Medicare spending and expressed concern that the program is unsustainable in its present form. Concerns about the rising cost of health care are particularly pressing in light of evidence that suggests that greater spending does not necessarily translate to better health outcomes or higher-quality care. Medicare's fee-for-service (FFS) payment system may contribute to spending growth because it rewards volume of services regardless of the appropriateness, cost, and quality of those services. Under FFS, a payment is made for each unit of service based on the expected costs of delivering that service. For example, Medicare makes multiple separate payments for the services associated with a complex medical procedure performed in a hospital. It pays the hospital for the initial admission and any related readmissions; each physician involved in the patient's care, such as the surgeon and the anesthesiologist; and the skilled nursing facility for any related care immediately after hospitalization. Payments made in isolation in this way may give providers little incentive to coordinate the provision of …

A letter report issued by the Government Accountability Office with an abstract that begins "Developing capable Afghan National Army (ANA) forces is a key element of the U.S. and North Atlantic Treaty Organization (NATO)-led coalition effort to counter the insurgency and create sustainable security in Afghanistan. Since 2002, the United States, with assistance from NATO and other coalition nations, has worked to develop the ANA. The Department of Defense (DOD) leads U.S. efforts to train and equip the ANA. U.S. agencies have allocated about $20 billion in support of the ANA since 2002 and have requested $7.5 billion more for fiscal year 2011. GAO examined (1) the extent of progress made and challenges faced in expanding the size of the ANA, (2) the extent of progress made and challenges faced in developing ANA capability, and (3) how much estimated future funding will be needed to sustain and further grow the ANA. GAO reviewed DOD and NATO documents and met with officials in Washington, D.C.; Tampa, FL; Brussels, Belgium; and Kabul, Afghanistan."

A letter report issued by the Government Accountability Office with an abstract that begins "Since the Troubled Asset Relief Program (TARP) was implemented, GAO has issued more than 40 reports containing more than 60 recommendations to the Department of the Treasury (Treasury). This report assesses the status of Treasury's implementation of GAO's recommendations and current condition of TARP. Specifically, this 60-day report provides information on (1) the condition and status of active TARP programs; (2) Treasury's progress in implementing an effective management structure, including staffing for the Office of Financial Stability (OFS), overseeing contractors, and establishing a comprehensive system of internal control; and (3) trends in the status of key relevant economic indicators. GAO reviewed relevant documentation from various TARP programs and met with OFS officials and financial regulators. GAO also used information from existing reports and ongoing work."

A letter report issued by the Government Accountability Office with an abstract that begins "From fiscal years 1994 through 2009, the Department of Defense (DOD) separated over 13,000 active military servicemembers under its homosexual conduct policy. These separations represent about 0.37 percent of the 3.6 million members separated for all reasons, including expiration of terms of service and retirement. In 2005, GAO reported on the number of separated servicemembers under DOD's homosexual conduct policy who held critical skills and the costs associated with administering the policy from fiscal years 1994 through 2003. GAO was asked to examine data from fiscal years 2004 through 2009 to determine (1) the extent to which the policy has resulted in the separation of servicemembers with skills in critical occupations and important foreign languages and (2) the services' costs for certain activities associated with administering the policy. GAO obtained and analyzed DOD personnel and cost data; examined DOD regulations and policy documents; and conducted interviews with officials from the Office of the Under Secretary of Defense for Personnel and Readiness, the Defense Manpower Data Center, and each of the military services. GAO provided a draft of this report to DOD for review and comment. DOD …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) relies on contractors to perform myriad functions, which can offer benefits and flexibility for DOD. GAO's work has shown that reliance on contractors to support core missions, however, can place the government at risk of transferring government responsibilities to contractors. In April 2009, the Secretary of Defense announced his intent to reduce the department's reliance on contractors. In 2008, Congress required DOD to compile and review an annual inventory of the number of contractor employees working under service contracts and the functions and activities they performed. The fiscal year 2010 National Defense Authorization Act directed GAO to report annually on these inventories. GAO assessed (1) the approaches used to compile the fiscal year 2009 inventories and how the approaches have changed, and (2) how the inventories have been reviewed and used to inform workforce decisions. GAO reviewed guidance; compared the approaches used to develop the fiscal year 2008 and 2009 inventories; and interviewed acquisition and manpower officials from DOD, the military departments, and selected defense components."

A letter report issued by the Government Accountability Office with an abstract that begins "Funding for the Department of Veterans Affairs' (VA) health care is determined by Congress in the annual appropriations process. Prior to this process, VA develops a budget estimate of the resources needed to provide health care services to eligible veterans. The Veterans Health Care Budget Reform and Transparency Act of 2009 requires GAO to assess whether the funding requested for VA health care in the President's budget requests submitted to Congress in 2011, 2012, and 2013 is consistent with VA's estimates of the resources needed to provide health care services. In anticipation of these future studies, GAO was asked to obtain information on how VA prepares its health care budget estimate. In this report, GAO describes (1) how VA develops its health care budget estimate, and (2) how VA's health care budget estimate is used in the President's budget request to Congress. To conduct this work, GAO reviewed VA documents on the methods, data, and assumptions used to develop VA's health care budget estimate that informed the President's budget request for fiscal year 2011 and request for advance appropriations for fiscal year 2012. GAO also interviewed …

A letter report issued by the Government Accountability Office with an abstract that begins "In fiscal year 2009, the child support enforcement (CSE) program collected about $26 billion in child support payments from noncustodial parents on behalf of more than 17 million children. The CSE program is run by states and overseen by the Department of Health and Human Services (HHS). States receive federal performance incentive payments and a federal match on both state CSE funds and, except for fiscal year 2008, on the incentive payments, which must be reinvested into the program. The Deficit Reduction Act of 2005 (DRA) eliminated this incentive match beginning in 2008, but the American Recovery and Reinvestment Act of 2009 temporarily reinstated it for 2 years. DRA also gave states the option to give more child support collections to families receiving public assistance--the "family first" policy--rather than using it to reimburse government public assistance costs. GAO examined (1) how CSE collections and caseloads have changed in recent years, (2) how states have responded to federal funding changes, and (3) how states have responded to DRA's "family first" policy options. GAO reviewed laws, HHS policy documents, and CSE caseload, collections, and expenditure data and interviewed …

A letter report issued by the Government Accountability Office with an abstract that begins "To promote the adoption of appropriate default investments by retirement plans that automatically enroll workers, in 2007 the Department of Labor (DOL) identified three qualified default investment alternatives. One of these options--target date funds (TDF)--has emerged as by far the most popular default investment. TDFs are designed to provide an age-appropriate asset allocation for plan participants over time. Because of recent concerns about significant losses in and differences in the performance of some TDFs, GAO was asked address the following questions: (1) To what extent do the investment compositions of TDFs vary; (2) what is known about the performance of TDFs; (3) how do plan sponsors select and monitor TDFs that are chosen as the plan's default investment, and what steps do they take to communicate information on these funds to their participants; and (4) what steps have DOL and the Securities and Exchange Commission (SEC) taken to ensure that plan sponsors appropriately select and use TDFs? To answer these questions, GAO reviewed available reports and data, and interviewed TDF managers, plan sponsors, relevant federal officials, and others."