A publication issued by the Government Accountability Office with an abstract that begins "In fiscal year 2010, the Department of Veterans Affairs (VA) provided health care to about 5.2 million veterans. Recent legislation has increased many Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) veterans' priority for accessing VA's health care, and concerns have been raised about the extent to which VA is providing mental health care to eligible veterans of all eras. There also are concerns that barriers may hinder some veterans from accessing needed mental health care. GAO was asked to provide information on veterans who receive mental health care from VA. In this report, GAO provides information on (1) how many veterans received mental health care from VA from fiscal years 2006 through 2010, (2) key barriers that may hinder veterans from accessing mental health care from VA, and (3) VA efforts to increase veterans' access to VA mental health care. GAO obtained data from VA's Northeast Program Evaluation Center (NEPEC) on the number of veterans who received mental health care from VA. The number of veterans represents a unique count of veterans; veterans were counted only once, even if they received care multiple times during a …

A publication issued by the Government Accountability Office with an abstract that begins "This testimony discusses our recent work on the Coast Guard's Deepwater acquisition, which represents the majority of the Coast Guard's efforts to recapitalize its fleet of vessels and aircraft. This statement is based on our July 28, 2011, report, Coast Guard: Action Needed as Approved Deepwater Program Remains Unachievable. This report discusses areas in which the Coast Guard has strengthened its acquisition management capabilities but also emphasizes actions the Coast Guard needs to take to address the cost growth, schedule delays, and capability shortfalls that have made the approved Deepwater Program unachievable. Today's climate of rapidly building fiscal pressures underscores the importance of assessing priorities--from a Coast Guard-wide perspective--so that more realistic budgets can be submitted to Congress. Such a step would help alleviate what has become a pattern of churn in revising program baselines when unrealistic planned funding does not materialize, which contributes to schedule delays and can lead to other issues such as unhealthy competition for funding. We also recognize several steps that the Coast Guard has taken to improve the management of the Deepwater Program. For example, the Coast Guard has updated its Major …

A publication issued by the Government Accountability Office with an abstract that begins "The Justice Department has reported that Indians are at least twice as likely to be raped or sexually assaulted as all other races in the United States. Indians living in remote areas may be days away from health care facilities providing medical forensic exams, which collect evidence related to an assault for use in criminal prosecution. The principal health care provider for Indians, which operates or funds tribes to operate 45 hospitals, is the Department of Health and Human Services' Indian Health Service (IHS). In response to a Tribal Law and Order Act of 2010 mandate, GAO examined (1) the ability of IHS and tribally operated hospitals to collect and preserve medical forensic evidence involving cases of sexual assault and domestic violence, as needed for criminal prosecution; (2) what challenges, if any, these hospitals face in collecting and preserving such evidence; and (3) what factors besides medical forensic evidence contribute to a decision to prosecute such cases. GAO surveyed all 45 IHS and tribally operated hospitals and interviewed IHS and law enforcement officials and prosecutors.."

A publication issued by the Government Accountability Office with an abstract that begins "This testimony discusses the effects of the recent recession on older adults. While the recession officially ended in June 2009, our economy has experienced a weak recovery, with unemployment still above 9 percent. Older adults--particularly those close to or in retirement--may not have the same opportunities as younger adults to recover from the recession's effects. For example, older adults--generally those 55 and older--may have insufficient time to rebuild their depleted retirement savings due to sharp declines in financial markets and home equity, and increased medical costs. Further, while older workers are less likely to be unemployed than workers in younger age groups, when older workers lose a job they are less likely to find other employment. These changes have intensified older adults' concerns about having sufficient savings now and adequate income throughout retirement. Social Security forms the foundation of income for nearly all retiree households, providing 36 percent of aggregate income for households with a member aged 65 and older; however, it provides a much greater portion of income for low and middle income households. Pensions and assets together provide 31 percent of aggregate income. However, many …

A publication issued by the Government Accountability Office with an abstract that begins "Since 1992, GAO has published long-term fiscal simulations showing federal deficits and debt under different sets of assumptions. GAO developed its long-term model in response to a bipartisan request from members of Congress concerned about the long-term effects of fiscal policy. GAO's simulations provide context for consideration of policy options. They are not intended to suggest particular policy choices but rather to help facilitate a dialogue on this important issue. GAO regularly updates its simulations as new data become available from the Congressional Budget Office (CBO) and the Social Security and Medicare Trustees (Trustees). This update incorporates provisions of the Budget Control Act. As in the past, GAO shows two simulations: The Baseline Extended simulation follows CBO's August 2011 baseline for the first 10 years and then holds revenue and spending other than interest on the debt and large entitlement programs (Social Security, Medicare, and Medicaid) constant as a share of gross domestic product (GDP). Revenue as a share of GDP over the entire period is higher than the historical averages; discretionary spending is below average. In the Alternative simulation, expiring tax provisions other than the temporary …

A publication issued by the Government Accountability Office with an abstract that begins "After the Army canceled the Future Combat System in June of 2009, it began developing modernization plans, including developing a new Ground Combat Vehicle (GCV) and additional network capability. At the same time, the Army was considering options on how to improve its light tactical vehicles. This statement addresses potential issues related to developing (1) the new GCV, (2) a common information network, and (3) the Joint Light Tactical Vehicle (JLTV) in a constrained budget environment. The statement is based largely on previous GAO work conducted over the last year in response to congressional requests and results of other reviews of Army modernization. To conduct this work, GAO analyzed program documentation, strategies, and test results; interviewed independent experts and Army and Department of Defense (DOD) officials; and witnessed demonstrations of current and emerging network technologies. DOD reviewed the facts contained in this statement and provided technical comments, which were incorporated as appropriate."

A publication issued by the Government Accountability Office with an abstract that begins "This testimony discusses the results of our investigation of fraud and prescription drug abuse in Medicare Part D. Prescription drug abuse is a serious and growing public health problem. According to the Centers for Disease Control and Prevention, drug overdoses, including those from prescription drugs, are the second leading cause of deaths from unintentional injuries in the United States, exceeded only by motor vehicle fatalities. Unlike addiction to heroin and other drugs that have no accepted medical use, addiction to some controlled substances can be unknowingly financed by insurance companies and public programs, such as Medicare Part D. This statement today summarizes our report, describing indications of doctor shopping in the Medicare Part D program for 14 categories of frequently abused prescription drugs. The objectives of the forensic audit and related investigation were to (1) determine the extent to which Medicare beneficiaries obtained frequently abused drugs from multiple prescribers, (2) identify examples of doctor shopping activity, and (3) determine the actions taken by the Centers for Medicaid & Medicare Services (CMS) to limit access to drugs for known abusers."

Correspondence issued by the Government Accountability Office with an abstract that begins "Realistic training ranges are one of the most valued assets the military has in preparing its personnel for their missions. Realistic training requires access to areas and environments that closely match the locations where the military may face combat or complex situations. International events, changes in strategy, force structure, base closures, and population growth are increasing the challenges the military faces in training its personnel to be prepared to defend the nation. Moreover, the military services report that they have increasingly lost training range capabilities because of factors such as encroachment. To respond to these challenges and increase the sustainability of military ranges, the Department of Defense (DOD) has launched a number of efforts aimed at preserving training ranges while also minimizing adverse environmental effects of training activities. As required by section 366(a) of the Bob Stump National Defense Authorization Act for Fiscal Year 2003 (as amended), DOD was to submit a comprehensive plan for using existing authorities available to the department to address training constraints caused by limitations on the use of worldwide military lands, marine areas, and airspace to Congress at the same time as the …

Correspondence issued by the Government Accountability Office with an abstract that begins "In November 1988, the Capitol Preservation Commission (Commission) was established for the purpose of providing for improvements in, preservation of, and acquisitions for the United States Capitol. At the same time, the Capitol Preservation Fund (Fund) was established within the U.S. Treasury (Treasury) and was made available to the Commission to provide financing for the Commission to carry out its purpose. The Library of Congress (Library) provides financial management services and support to the Commission. GAO is required to audit the transactions of the Commission and report the results to the Congress. This report presents the results of our audit of the Commission's transactions as recorded in the Fund during fiscal years 2008 through 2010. Our audit objectives were to determine whether (1) the Fund's recorded transactions for fiscal years 2008 through 2010 were authorized in advance, supported by documentation, accurately accounted for, and in compliance with applicable laws: and (2) operating, reporting, and oversight practices were documented and in place at the Commission and the Library to help ensure that Fund transactions were properly executed and Fund assets were adequately safeguarded."

Testimony issued by the Government Accountability Office with an abstract that begins "The Social Security Administration's (SSA) Supplemental Security Income (SSI) program provides cash benefits to eligible low-income disabled individuals, including children, as well as certain others. Children may generally qualify for SSI benefits if they meet certain financial requirements and are deemed to have a qualifying medically determinable physical or mental impairment of a specified duration or severity that results in a functional limitation. In 2010, SSA paid more than $9 billion to about 1.2 million disabled children. Over the past decade, the overall number of children receiving SSI benefits has continued to rise. In this statement, GAO discusses initial observations from its ongoing review and examines (1) the trends in the rate of children receiving SSI benefits due to mental impairments over the past decade; (2) the role that medical and nonmedical information, such as medication and school records, play in the initial determination of a child's medical eligibility; and (3) the steps SSA has taken to monitor the continued medical eligibility of these children. To examine these issues, GAO analyzed program data, interviewed SSA officials, conducted site visits to SSA field offices and state disability determination services …

A statement of record issued by the Government Accountability Office with an abstract that begins "A breakdown in information sharing was a major factor contributing to the failure to prevent the September 11, 2001, terrorist attacks. Since then, federal, state, and local governments have taken steps to improve sharing. This statement focuses on government efforts to (1) establish the Information Sharing Environment (ISE), a government-wide approach that facilitates the sharing of terrorism-related information; (2) support fusion centers, where states collaborate with federal agencies to improve sharing; (3) provide other support to state and local agencies to enhance sharing; and (4) strengthen use of the terrorist watchlist. GAO's comments are based on products issued from September 2010 through July 2011 and selected updates in September 2011. For the updates, GAO reviewed reports on the status of Department of Homeland Security (DHS) efforts to support fusion centers, and interviewed DHS officials regarding these efforts. This statement also includes preliminary observations based on GAO's ongoing watchlist work. For this work, GAO is analyzing the guidance used by agencies to nominate individuals to the watchlist and agency procedures for screening individuals against the list, and is interviewing relevant officials from law enforcement and intelligence …

A publication issued by the Government Accountability Office with an abstract that begins "This testimony discusses the Federal government's use of suspensions and debarments. In 2010, spending on contracted goods and services was more than $535 billion. To protect the government's interests, federal agencies are required to award contracts only to responsible sources--those that are determined to be reliable, dependable, and capable of performing required work. One way to do so is through the use of suspensions and debarments, which are actions taken to exclude firms or individuals from receiving contracts or assistance based on various types of misconduct. The Federal Acquisition Regulation (FAR) prescribes overall policies and procedures governing the suspension and debarment of contractors by agencies and directs agencies to establish appropriate procedures to implement them. This flexibility enables each agency to establish a suspension and debarment program suitable to its mission and structure. Even though the FAR specifies numerous causes for suspensions and debarments, including fraud, theft, bribery, tax evasion, or lack of business integrity, the existence of one of these does not necessarily require that the party be suspended or debarred. Agencies are to establish procedures for prompt reporting, investigation, and referral to the agency suspension …

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 …

A publication issued by the Government Accountability Office with an abstract that begins "The Office of Personnel Management (OPM) is responsible for administering the Civil Service Retirement System (CSRS), including the United States Postal Service (USPS) CSRS benefits. Two independent agencies--USPS Office of Inspector General (OIG) and Postal Regulatory Commission (PRC)--have issued reports stating that OPM's current method of allocating responsibility for CSRS benefits allocates a disproportionately large share to USPS. The USPS OIG and the PRC proposed alternate methodologies that they estimate would shift responsibility for from $56 billion to $85 billion in CSRS benefits from USPS to the federal government. GAO's objectives were to comment on (1) whether OPM's current methodology for allocating responsibility for CSRS benefits between USPS and the federal government is consistent with the law, (2) the analysis used by the USPS OIG and PRC to conclude that OPM should refund the CSRS contributions in question, (3) the potential impacts such a refund would have on the CSRS fund and CSRS stakeholders, and (4) the potential impacts that such a refund would have on USPS's financial outlook. GAO reviewed legislation regarding the allocation of responsibility for CSRS benefits and methodologies used in all three reports. …

A publication issued by the Government Accountability Office with an abstract that begins "In fiscal year 2010, the Department of Defense (DOD) spent billions of dollars to move troops and materiel into Afghanistan, a mountainous, land-locked country with poorly developed infrastructure. The increase of 30,000 U.S. troops in Afghanistan as of August 2010, along with thousands of civilians and contractors supporting U.S. efforts, have required further development of DOD's already-complex distribution network to support and sustain U.S. military presence in Afghanistan. GAO conducted this review to assess distribution issues in Afghanistan, including (1) DOD's oversight of distribution operations; (2) DOD's performance in providing supplies and equipment; and (3) challenges that have affected DOD's ability to provide supplies and equipment. GAO reviewed joint doctrine and DOD policies on distribution, analyzed DOD delivery data, and interviewed DOD officials in the United States and in the U.S. Central Command area of responsibility, including Afghanistan, Pakistan, Kuwait, Qatar, and Bahrain."

A publication issued by the Government Accountability Office with an abstract that begins "Over the last 10 fiscal years, federal agencies have increased their spending on construction contracts, leading to obligations of almost $54 billion in fiscal year 2010. When awarding contracts, the Federal Acquisition Regulation (FAR) requires agencies to consider firms' performance records to help ensure that taxpayer dollars go to capable contractors. The FAR also provides agencies with broad discretion in deciding how they will consider firms' prior experience, which refers to whether the firms have done similar work before, and past performance, which describes how well they have done that work. As construction firms without prior federal contracting experience seek to gain entry into the federal marketplace, some may regard the consideration of these factors as an impediment. In response to your request for information on the consideration of prior experience and past performance, we reviewed (1) how selected agencies consider prior experience and past performance in awarding construction contracts and (2) the resources available to assist firms in gaining entry to the federal marketplace."

Correspondence issued by the Government Accountability Office with an abstract that begins "This report is in response to a request from congressional subcommittees to evaluate the design of the Department of Veterans Affairs (VA) fraud prevention controls within the Service-Disabled Veteran-Owned Small Business (SDVOSB) verification program instituted in response to Public Law 111-275. This work is part of our ongoing audit of the SDVOSB program governmentwide, which, in part, assesses the design of the three areas of a fraud prevention framework including preventive controls, detection and monitoring controls, and investigations and prosecutions. We will report the results of the larger audit at a later date.."

A publication issued by the Government Accountability Office with an abstract that begins "The Internal Revenue Service's (IRS) Business Systems Modernization (BSM) program is a multi-billion dollar, high-risk, highly complex effort that involves the development and delivery of a number of modernized systems that are intended to replace the agency's aging business and tax processing systems. As required, IRS submitted its fiscal year 2011 expenditure plan in May 2011 to the House and Senate appropriations committees, requesting approximately $352 million from the BSM account. In response to a mandate, GAO's objectives in reviewing the expenditure plan were to (1) determine whether it satisfies the applicable statutory conditions, (2) determine IRS's progress in implementing prior expenditure plan review recommendations, and (3) provide additional observations about the plan and the BSM program. To accomplish the objectives, GAO analyzed the plan, reviewed related documentation, and interviewed IRS officials."

A publication issued by the Government Accountability Office with an abstract that begins "This testimony discusses our prior work on the Environmental Protection Agency's (EPA) Integrated Risk Information System (IRIS) program and database. IRIS is one of the most significant tools that EPA has developed to support its mission to protect people and the environment from harmful chemical exposures. The IRIS database contains EPA's scientific position on the potential human health effects that may result from exposure to more than 550 chemicals in the environment and is a critical component of EPA's capacity to support its mission. IRIS assessments provide the scientific input to risk management decisions, such as whether EPA should establish air and water quality standards to protect the public from exposure to toxic chemicals or set cleanup standards for hazardous waste sites. Consequently, IRIS assessments are a critical component of EPA's capacity to support scientifically sound decisions, policies, and regulations. EPA created IRIS in 1985 to help the agency develop consensus opinions within the agency about the health effects from chronic exposure to chemicals. Over time, the importance of the program has increased as EPA program offices, state and local environmental programs, and some international regulatory bodies …

Correspondence issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) operates a regional office in the Republic of the Philippines--the only one of its 57 regional offices that is located in a foreign country. Over the last two decades, Congress has periodically reauthorized the office for an average of 3 years each time. The Philippines was a U.S. territory prior to World War II and was granted independence in 1946. Congress authorized limited benefits for Filipino veterans who served under the command of the United States during the war, and authorized VA to operate a regional office to administer these benefits. In 1958, the office expanded to include an outpatient health clinic. VA estimates that about 18,000 Filipino WWII veterans were alive as of 2010, down from an estimated 452,000 in 1977. In light of this declining population eligible for benefits, maintaining the office may no longer be warranted at some point. Public Law 111-275 extended the authority for VA to operate this office until December 31, 2011, and directed GAO to submit this report. Our objectives are to (1) describe the primary activities undertaken by the VA regional office in the …

A publication issued by the Government Accountability Office with an abstract that begins "Traumatic brain injury (TBI) has emerged as a serious concern among U.S. forces serving in military operations in Afghanistan and Iraq. The widespread use of improvised explosive devices in these conflicts increases the likelihood that servicemembers will sustain a TBI, which the Department of Defense (DOD) defines as a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force. TBI cases within DOD are generally classified as mild, moderate, severe, or penetrating. From 2000 to March 2011 there were a total of 212,742 TBI cases reported by the Defense and Veterans Brain Injury Center within DOD. A majority of these cases, 163,181, were classified as mild traumatic brain injuries (mTBI)--commonly referred to as concussions. Early detection of injury is critical in TBI patient management. Diagnosis of moderate and severe TBI usually occurs in a timely manner due to the obvious and visible nature of the head injury. Identification of mTBI presents a challenge due to its less obvious nature. With mTBI, there may be no observable head injury. In addition, in the combat theater, an mTBI may not be identified …

Correspondence issued by the Government Accountability Office with an abstract that begins "On June 28, 2009, Honduran President Manuel Zelaya was detained by his country's military and flown to Costa Rica. Zelaya's removal from Honduras followed several months of political polarization within Honduras in response to a number of controversial actions taken by Zelaya, including efforts to hold a national poll on June 28, 2009. Zelaya's stated purpose for the poll was to ask Hondurans if there should be a referendum on whether the country should convoke a national constituent assembly to approve a new constitution. However, Honduran officials from other government institutions stated that they believed Zelaya would use the results of the poll to suspend the Honduran constitution. Immediately following the removal of Zelaya, the Honduran National Congress voted in Roberto Micheletti, President of the National Congress at the time, to replace Zelaya as President of Honduras. U.S. policy toward Honduras in the months preceding Zelaya's removal was to support the rule of law and the Honduran constitution, and to encourage Honduras' political actors to resolve their differences consensually and within Honduran law. In response to Zelaya's removal, U.S. officials characterized the events of June 28, 2009, as …

A publication issued by the Government Accountability Office with an abstract that begins "The United States Postal Service (USPS) is in a serious financial crisis and has not generated sufficient revenue to cover its expenses and financial obligations as mail volume continues to decline. Congress requested that we examine how much additional revenue could result from the increased use of voting by mail--that is, more registered voters receiving and casting ballots through the mail. Currently, all states use voting by mail to some degree, most commonly in the form of absentee ballots mailed to registered voters who cannot, or choose not to, vote in person on Election Day. However, Oregon and Washington now administer elections solely through mail voting. According to a 2009 U.S. Election Assistance Commission (EAC) study, about 23.7 million ballots, or 17.7 percent of all votes, were cast by mail in the 2008 presidential election. This report documents information on the revenue potential of increased use of voting by mail that we presented to your office on August 17, 2011."

A publication issued by the Government Accountability Office with an abstract that begins "This testimony discusses the current progress toward implementing the Next Generation Air Transportation System (NextGen). NextGen will impact nearly every aspect of air transportation and will transform the way in which the air transportation system operates today. It will do so, in part, by (1) using satellite-based surveillance as opposed to ground-based radars, (2) using performance-based navigation instead of cumbersome step-by-step procedures, (3) replacing routine voice communications with data transmissions, and (4) organizing and merging the disjointed data that pilots, controllers, airports, airlines, and others currently rely on to operate the system. The Federal Aviation Administration (FAA) has been planning and developing NextGen since 2003, and is now implementing near-term (through 2012) and mid-term (through 2018) capabilities. Over the years, concerns have been raised by the Congress and other stakeholders that despite years of effort and billions of dollars spent, FAA has not made sufficient progress in deploying systems and producing benefits. In past reports, we have made a number of recommendations to FAA to address delays in development and acquisitions, improve its processes, and focus on accountability and performance. Others have also made recommendations to FAA …