A letter report issued by the General Accounting Office with an abstract that begins "To make buses a more reliable and effective high-speed transit alternative, a new concept-- Bus Rapid Transit--proposes (1) running buses on highways exclusively for them or on HOV lanes or (2) improving service on busier routes on city streets. Federal support for Bus Rapid Transit projects may come from several different sources, including the Federal Transit Administration's New Starts, Bus Capital, and Urbanized Area Formula Grants programs, but its use is constrained. Two Bus Rapid Transit projects have received about $831 million in funding commitments from the current New Starts Program. Few additional Bus Rapid Transit projects will likely receive funding commitments under the current New Starts Program, which expires in 2003, because few Bus Rapid Transit projects are ready to compete for funding; many projects are eligible to compete for the $462 million that is projected to remain available for fiscal year 2003; and some types of Bus Rapid Transit projects are ineligible for New Starts funding because projects are required to operate on separate right-of-ways for the exclusive use of mass transit and high-occupancy vehicles. The Bus Rapid Transit systems generally had lower capital …

Testimony issued by the General Accounting Office with an abstract that begins "In recent years, the Washington Metropolitan Area Transit Authority's (WMATA) public transit system has experienced safety and reliability problems, including equipment breakdowns, delays in scheduled service, unprecedented crowding on trains, and accidents and tunnel fires. WMATA is examining ways to ease crowding on the systems rail cars and determining whether and how to expand Metrorail maintenance and repair shop capacity as WMATA acquires nearly 200 new rail cars. WMATA has also undertaken a comprehensive program for infrastructure renewal, and it is now studying improvements or modifications to accommodate the goal of doubling ridership by the year 2025. WMATA's safety program has evolved since the mid-1990s, when a series of accidents and incidents led to several independent reviews citing the need for program improvements. WMATA monitors safety and crime statistics and has several ongoing targeted efforts to reduce safety incidents and deter crime on its transit systems. WMATA has adopted several of the best capital investment practices used by leading public and private sector organizations, but it could benefit by establishing a more formal, disciplined framework for its capital decision-making process. WMATA has used a wide variety of innovative …

A letter report issued by the General Accounting Office with an abstract that begins "States provide health care coverage to low-income uninsured children largely through two federal-state programs--Medicaid and the State Children's Health Insurance Program (SCHIP). Medicaid was established in 1965 to provide health care coverage to low-income adults and children. Medicaid expenditures for health services to 22.3 million children totaled $32.4 billion in 1998. Congress established SCHIP in 1997 to provide health care coverage to children living in poor families whose incomes exceed the eligibility requirements for Medicaid. SCHIP expenditures for health services to nearly 2 million children totaled $2 billion in 1999. In implementing SCHIP, states could opt to expand their Medicaid programs or establish a separate child health program distinct from Medicaid that uses specified public or private insurance plans offering a minimum benefit package. Thirty-five states have chosen SCHIP approaches that are, to varying degrees, separate from their Medicaid programs. Because eligibility for Medicaid and SCHIP can vary with a child's age, children may, at different ages, need to move from one program to the other. Access to care, therefore, is affected by the extent to which health plans and providers are available and participate in …

Testimony issued by the General Accounting Office with an abstract that begins "Complete, accurate, and timely communication of program information is necessary to help Medicare providers comply with program requirements and appropriately bill for their services. Information provided to physicians about billing and payment policies is often incomplete, confusing, out of date, or even incorrect. GAO found that the rules governing Centers for Medicare and Medicaid Services (CMS) contracts with its claims processors lack incentives for efficient operations. Medicare contractors are chosen without full and open competition from among health insurance companies, rather from a broad universe of potential qualified entities, and CMS almost always uses cost-only contracts, which pay contractors for costs incurred but generally do not offer any type of performance incentives. To improve Medicare contractors' provider communications, CMS must develop a more centralized and coordinated approach consistent with the provisions of the Medicare Regulatory and Contracting Reform Act (MRCRA) of 2001. MRCRA would require that CMS (1) centrally coordinate contractors' provider education activities, (2) establish communications performance standards, (3) appoint a Medicare Provider Ombudsman, and (4) create a demonstration program to offer technical assistance to small providers. MRCRA would also broaden CMS authority so that various types …

A letter report issued by the General Accounting Office with an abstract that begins "Congress has questioned whether the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration, adequately implemented new payment methods, effectively safeguarded program payments, and adequately oversaw the quality of care provided to beneficiaries. CMS depends on hundreds of information technology (IT) systems to help manage the Medicare program. With year 2000 systems renovations successfully completed, CMS has focused on modernizing its IT systems. The agency's information systems are crucial to carrying out Medicare's core missions of claims processing and payment, program oversight, and administration of participating health plans. Medicare's major systems are aged, however, and many are incompatible with one another. To address these problems, CMS intends to modify, replace, or redesign systems on which key Medicare missions depend. CMS plans to make incremental system improvements while maintaining current functions and accommodating changes mandated by legislation. The agency's IT planning and management processes--intended to increase the likelihood that new systems will be successful and cost-effective--have shortcomings. The agency's blueprint documenting its existing and planned IT environments, also known as its enterprise architecture, is missing essential detail in critical parts, including well-documented business …

Testimony issued by the General Accounting Office with an abstract that begins "The pricing of Medicare's part B-covered prescription drugs--largely drugs that cannot be administered by patients themselves--has been under scrutiny for years. Most of the part B drugs with the highest Medicare payments and billing volume fall into three categories: those that are billed for by physicians and typically provided in a physician office setting, those that are billed for by pharmacy suppliers and administered through a durable medical equipment (DME) item, and those that are also billed by pharmacy suppliers but are patient-administered and covered explicitly by statute. Studies show that Medicare sometimes pays physicians and other providers significantly more than their actual costs for the drugs. In September 2000, the Health Care Financing Administration's (HCFA)--now the Centers for Medicare and Medicaid Services--took steps to reduce Medicare's payment for part B-covered drugs by authorizing Medicare carriers, the contractors that pay part B claims, to use prices obtained in the Justice Department investigations of providers' drug acquisition costs. HFCA retracted this authority in November 2000 after providers raised concerns. GAO found that Medicare's method for establishing drug payments is flawed. Medicare pays 95 percent of the average wholesale price …

A letter report issued by the General Accounting Office with an abstract that begins "Although physicians and other health care providers acknowledge that they can buy drugs for prices lower than Medicare payments, they contend that they need drug payments in excess of their actual costs to compensate for inadequate or nonexistent Medicare payments for administrating the drugs. Physicians are able to obtain Medicare-covered drugs at prices significantly below current Medicare payments, which are set at 95 percent of average wholesale prices (AWP). The prices paid by wholesalers and group purchasing organizations that would be generally available to physicians were considerably less than AWPs used to establish the Medicare payment for these drugs. The difference between these prices and AWP for physician-administered drugs in GAO's sample varied by drug. For most physician-administered drugs, the average discount from AWP ranged from 13 percent to 34 percent; two physician-administered drugs had discounts of 65 percent and 86 percent. Other suppliers are also able to buy drugs at prices that are considerably less than the AWP used to establish the applicable Medicare payment. Pharmacy suppliers were predominant billers for 10 of the high-expenditure and high-volume Medicare-covered drugs GAO analyzed. These suppliers generally provide …

A letter report issued by the General Accounting Office with an abstract that begins "The Balanced Budget Act of 1997 (BBA) established the Medicare+Choice (M+C) program to expand health plan choices. BBA permitted Medicare participation by preferred provider organizations, provider-sponsored organizations, and insurers offering private fee-for-service plans or medical savings accounts. It also encouraged the wider availability of health maintenance organizations, which have long been an option for many beneficiaries. To help beneficiaries understand and consider all of their Medicare options, the National Medicare Education Program offers a toll-free help line, informational mailings to beneficiaries, an Internet site, and educational and publicity campaigns. During fiscal years 1998 through 2000, the Health Care Financing Administration (HCFA) spent an average of $107.8 million on the program annually. Most of the money came from user fees collected from M+C plans. Reaction to the program has generally been positive among beneficiaries and beneficiary advocacy groups, but representatives of M+C plans offered a mixed assessment. Program activities have increased the information available to beneficiaries on Medicare, the M+C program, and specific health plans. However, the extent to which the program has motivated beneficiaries to actively weigh their health plan options is unknown."

A letter report issued by the General Accounting Office with an abstract that begins "The Department of Energy (DOE) created the Laboratory Directed Research and Development (LDRD) program in fiscal year 1992. This program formalized a long-standing policy of giving its multi-program national laboratories discretion to conduct self-initiated, independent research and development (R&D). Since then, DOE's multi-program national laboratories have spent more than $2 billion on LDRD projects. DOE's three largest multi-program national laboratories account for nearly three-quarters of laboratory-wide LDRD spending. All LDRD projects GAO reviewed at the five laboratories met DOE's guidelines for selection. In addition, each of the five laboratories created the internal controls necessary to reasonably ensure compliance with DOE's guidelines. Each laboratory issues annual LDRD reports that contain performance indicators, such as the numbers of patents obtained, publications, copyrights, awards, and relevance of the research to DOE's missions. The reports present performance information in various formats, making it difficult to focus on the most relevant performance information."

A letter report issued by the General Accounting Office with an abstract that begins "The Intergovernmental Personnel Act's (IPA) mobility program authorizes the temporary assignment of employees between federal agencies and state and local governments, universities, Indian tribal governments, and other nonfederal groups. These assignments, which may last up to four years, are intended to increase cooperation between the federal government and the non-federal entity. The National Science Foundation (NSF) temporarily assigned 45 of its employees to nonfederal organizations between 1995 and 2000, making NSF one of the most active users of the IPA program among federal agencies. NSF assigned 29 participants to universities, one to a local government, and 15 to other nonfederal organizations, such as research institutions or professional associations. NSF's implementation of the IPA program conformed to applicable laws and regulations. Although the partnering institutions nearly always made some financial contribution to these assignments, NSF paid about 78 percent of the total costs associated with the 45 assignments that GAO reviewed. The estimated total cost of these assignments to NSF was about $7.2 million for the six-year period GAO covered. NSF's external IPA assignments benefit not only the assignees but also the partnering institutions and NSF, according …

A letter report issued by the General Accounting Office with an abstract that begins "The National Transportation Safety Board (NTSB) promotes transportation safety through accident investigations, special studies, and recommendations intended to prevent accidents. Separate reviews at NTSB by PricewaterhouseCoopers, LLP (PwC) and GAO found significant shortcomings in the design and operation of NTSB's internal controls during 1999 and 2000. These deficiencies indicated insufficient or ineffective management attention to establishing and maintaining an effective system of internal control over financial management operations. The resulting weaknesses exposed the agency to waste, fraud, and mismanagement. Some basic controls were not always clearly and consistently incorporated into NTSB policies and procedures, and, in some cases, the written policies were ambiguous and contributed to possible improper transactions. Furthermore, NTSB's payment review and approval process--the last and best opportunity to detect and address inadequate documentation and other policy violations prior to payment--was often ineffective. Separate reviews of different aspects of NTSB's 1999 and 2000 financial activities and related internal controls, done by PwC at NTSB's request, documented various internal control weaknesses, including problems with the completeness and clarity of policies, the recording and review of transactions, and the tracking and reporting its use of funds."

A letter report issued by the General Accounting Office with an abstract that begins "Pediatric patients in need of an organ transplant face a shortage of donated organs. The number of pediatric organ donors has remained relatively constant from 1991 to 2000, despite a drop in potential donors. The number of adult donors rose 45 percent during the same period, in large part because donor eligibility criteria have been expanded to include older donors and donors with diseases that have been prohibited in the past. Organ waiting lists for pediatric patients have more than doubled. Compared to adults, however, children account for a small number of transplant candidates. The degree to which pediatric organs are transplanted into adults varies by organ. Pediatric patients appear to be faring as well as or better than adult patients, both while on the waiting list and after transplantation. Allocation policies for kidneys, livers, and hearts provide several protections for children awaiting transplants. The priority a child receives takes into account differences between children and adults in the progression and treatment of end stage organ disease, with the policies differing for each organ."

Correspondence issued by the General Accounting Office with an abstract that begins "The current federal peanut program, administered by the U.S. Department of Agriculture, is designed to support producers' incomes while ensuring an ample supply of domestically produced peanuts. To achieve these goals, the program controls the domestic supply of peanuts and guarantees producers a minimum price for their crops. This price substantially exceeds the price for peanuts in world markets. The program uses two mechanisms to control the domestic supply of peanuts--a national quota on the number of pounds that can be sold for edible consumption domestically and import restrictions. Only producers holding quota, either through ownership or rental of farmland, may sell their peanuts domestically as "quota" peanuts. Generally, all other production, referred to as "additional" peanuts, must be exported or crushed for oil or meal. The program protects producers' incomes through a two-tiered system that sets minimum support prices for quota and for additional peanuts. GAO and others have criticized the program because it provides substantial benefits to a relatively small number of producers who hold most of the quota, generally restricts nonquota holders from producing peanuts for the U.S. domestic market, and increases consumers' cost. In …

A letter report issued by the General Accounting Office with an abstract that begins "The Treasury Department, on behalf of the Customs Service, requested Office of Personnel Management (OPM) approval for Schedule A appointment authority for 10 positions for oversight policy and direction of sensitive law enforcement activities. Treasury's request stated that "due to the sensitive nature of the operations, these positions require a unique blend of special characteristics, skills and abilities that cannot be announced to the general public, and for which it is not practical to examine." According to OPM officials, no detailed criteria are applied when OPM considers such requests. OPM approved the request primarily because Treasury argued that the positions were sensitive in nature, involved law enforcement activities, and were impracticable to advertise and examine for. In using the Schedule A authority between September 1998 and January 2001, Customs made nine appointments to various positions. GAO found that circumstances surrounding five of the nine appointments can give the appearance of inconsistency in the application of the Schedule A appointment authority or possible favoritism toward former political employees. OPM reviews agencies' use of appointment authorities, including Schedule A and other excepted appointments, every four to five years. …

Correspondence issued by the General Accounting Office with an abstract that begins "The federal government runs an incentive awards program, consisting of monetary and nonmonetary awards, to recognize individual employees or teams for outstanding contributions that enhance government operations. Congress has placed prohibitions on cash awards to political appointees. Overall, 32 of the 46 agencies reported that 297 political appointees received 373 monetary awards from September 1999 through April 2001. The remaining 14 agencies reported that they did not provide any awards to political appointees during that period. Political appointees in each of the government's pay groups received both monetary and time-off awards less frequently than did regular federal employees, but at a larger mean dollar value. The mean dollar value of all monetary awards to political appointees exceeded that of awards to regular federal employees. The number, rates, and mean dollar value of awards to political and regular federal employees also varied by type of award. Individual political appointees and regular federal employees often received more than one award. Agencies reported that 46 political appointees, or about 17 percent of the appointees who received monetary awards, received multiple awards from September 1999, through May 2000. Six departments--the Departments of …

A letter report issued by the General Accounting Office with an abstract that begins "In a May 2000 report on the performance of the Department of Transportation's Office of Pipeline Safety (OPS), GAO found that the number of pipeline accidents rose four percent annually from 1989 to 1998--from 190 in 1989 to 280 in 1998. GAO also found that OPS did not implement 22 statutory requirements and 39 recommendations made by the National Transportation Safety Board. Since GAO's May report, OPS has fully implemented six of the 22 statutory requirements. However, 11 other requirements--including some that are significant and long-standing--have not been fully implemented. The agency does not plan to report on abandoned underwater pipeline facilities--a remaining open requirement--because it believes that insufficient data exists to conduct the study. The Safety Board is encouraged by OPS' recent efforts to improve its responsiveness, but the Board remains concerned about the amount of time OPS has taken to implement recommendations. OPS has the lowest rate of any transportation agency in implementing the Board's recommendations."

A letter report issued by the General Accounting Office with an abstract that begins "Proposals to expand pension coverage and promote pension savings have recently received much attention. In the Economic Growth and Tax Relief Reconciliation Act of 2001, for example, Congress raised statutory limits on tax-deferred pension contributions and benefits and made other changes to the law governing qualified pension plans. Some believe that increasing these limits will encourage employers to start new plans and improve existing plan coverage, especially for employees of small businesses. Others contend that these measures will primarily benefit higher-paid individuals and may not improve pension coverage for low-or moderate-income workers. Forty-seven percent of all workers participated in a pension plan, and 36 percent of all workers participated in a defined contribution (DC) plan. Most pension plan participants had low or moderate earnings (less than $40,000 per year) and were men. About eight percent of all DC participants, or 3.1 million people, were likely direct beneficiaries of a simultaneous increase in all the statutory contribution limits GAO analyzed. Higher earners were more likely than low and moderate earners, and men were more likely than women, to benefit directly from such an increase; this was also …

A letter report issued by the General Accounting Office with an abstract that begins "Public assistance programs make millions of dollars in improper payments every year. Some of these improper payments occur because state and local agencies that run the programs lack adequate, timely information to determine recipients' eligibility for assistance. This inability to share information can result in both federal and state tax dollars being needlessly spent on benefits for the same individuals and families in more than one state. In 1997, the Department of Health and Human Services (HHS) began a project to help states share eligibility information with one another. The public assistance reporting information system (PARIS) interstate match helps states share information on public assistance programs, such as Temporary Assistance for Needy Families (TANF) and Food Stamps, to identify individuals or families who may be receiving benefit payments in more than one state simultaneously. Officials in almost all of the 16 states and the District of Columbia that participated in PARIS said that the project has helped identify improper TANF, Medicaid, or Food Stamp payments. Despite its successes, the project has several limitations. First, the opportunity to detect improper duplicate payments is not as great as …

A letter report issued by the General Accounting Office with an abstract that begins "From 1945 through 1962, the United States conducted a series of aboveground atomic weapons tests. Many people exposed to radiation from this nuclear weapons testing program later developed serious diseases, including cancer. To begin the process of making partial restitution to these victims, the President signed into law the Radiation Exposure Compensation Act (RECA) in 1990. RECA established the Radiation Exposure Compensation Trust Fund (Trust Fund), criteria for determining claimant eligibility for compensation, and a program (administered by the Attorney General) to process and adjudicate claims under the act. The Department of Justice (DOJ) established the Radiation Exposure Compensation Program (RECP) within its Civil Division to administer its responsibilities under the act. Through the end of fiscal year 2000, RECP received 7,819 applications for compensation. Roughly equal numbers of applications have been approved and denied, awarding compensation to about 46 percent of the claimants and denying compensation to about 46 percent. RECA claims are most often denied because the victim's disease is not eligible for compensation under the RECA program. The costs for administering RECP have fluctuated from the first full year of program implementation, fiscal …

A letter report issued by the General Accounting Office with an abstract that begins "Apprenticeship, which combines supervised on-the-job training with formal instruction, benefits both employers and employees by providing the skills and knowledge necessary for a specific job and a credential recognized throughout an industry. The use of apprenticeship is standard practice in some industries, but expansion beyond traditional occupations has been limited. The Department of Labor has not systematically identified new occupations suitable for apprenticeship programs, nor has it successfully alleviated the concerns of some employers about apprenticeship requirements, which has slowed the expansion of apprenticeship to new occupations. Labor has approved 19 new occupations for apprenticeships in the last five years, and many of these have been in less traditional occupations, such as internetworking technicians. Employers are often wary of apprenticeship programs. For example, some employers are reluctant to commit to incremental increases in wages as required by apprenticeship regulations. GAO identified several apprenticeship programs in which apprenticeship training helped to develop workers with sought-after skills. The key to the establishment of the several programs GAO reviewed was the close interaction between employers and federal or state apprenticeship officials to ensure that employers understood the value of …

A letter report issued by the General Accounting Office with an abstract that begins "The U.S. Securities and Exchange Commission's (SEC) human capital management practices have been shaped largely by a growing staffing crisis that threatens to undermine the agency's ability to carry out its mission. GAO surveyed current and former SEC attorneys, accountants, and examiners to determine what factors influenced turnover, satisfaction, and morale among SEC staff. GAO found that inadequate compensation is the primary reason that employees leave the agency. But staff raised other issues that warrant attention, including limited opportunities for advancement, the amount of uncompensated overtime, and the quality of administrative support services. In response to the high turnover rates, SEC has placed greater emphasis on compensation-based human capital programs, including compensation-based flexibilities and performance awards. Although SEC uses compensation-based flexibilities to a greater extent than do other government agencies, the Office of Personnel Management believes it could do more. SEC has taken several steps to focus more attention on strategic human capital management but faces continuing challenges. In April 2001, SEC integrated its human capital strategies with it's core business practices by adding a human capital goal to its 2002 Annual Performance Plan. SEC has …

Testimony issued by the General Accounting Office with an abstract that begins "In August 2000, the National Aeronautics and Space Administration's (NASA) space shuttle program was at a critical juncture. Its workforce had declined significantly since 1995, its flight rate was to double to support the assembly of the International Space Station, and costly safety upgrades were planned to enhance the space shuttle's operation until at least 2012. Workforce reductions were jeopardizing NASA's ability to safely support the shuttle's planned flight rate. Recognizing the need to revitalize the shuttle's workforce, NASA ended its downsizing plans for the shuttle program and began to develop and equip the shuttle fleet with various safety and supportability upgrades. NASA is making progress in revitalizing the shuttle program's workforce. NASA's current budget request projects an increase of more than 200 full-time equivalent staff through fiscal year 2002. NASA has also focused more attention on human capital management in its annual performance plan. However, considerable challenges still lie ahead. Because many of the additional staff are new hires, they will need considerable training and will need to be integrated into the shuttle program. Also, NASA still needs to fully staff areas critical to shuttle safety; deal …

Correspondence issued by the General Accounting Office with an abstract that begins "The National Aeronautics and Space Administration's (NASA) procedures and guidelines require that program and project managers review and apply lessons learned from the past throughout a program's or project's life cycle. Managers must also document and submit any significant lessons learned in a timely manner. NASA's principal mechanism for collecting and sharing lessons learned from programs, projects, and missions agency wide is the Lessons Learned Information System. The goal of the system is to prevent NASA from having to "relearn" the lessons of the past. NASA also shares lessons learned through revisions to its policies and guidance. Furthermore, lessons learned from a mishap or operational event are captured in procedure and process documents. GAO surveyed all of NASA's program and project managers to obtain their perspectives on NASA's mechanisms to ensure that past lessons learned from mission failures are being applied. GAO found fundamental weaknesses in the collection and sharing of lessons learned in NASA by program and project managers as well as in the system. Although some lessons learning does take place, lessons are not routinely identified, collected, or shared by program and project managers. In addition, …

Testimony issued by the General Accounting Office with an abstract that begins "Telecommuting refers to work that is done at an employee's home or at a job site other than a traditional business office. Perhaps the biggest challenge to establishing and expanding telecommuting programs in both the public and private sectors is management's concerns about the types of positions and employees suitable for telecommuting, protecting proprietary and sensitive data, and establishing cost-effective telecommuting programs. Some federal and state laws and regulations, including those governing taxes, workplace safety, workforce recordkeeping, and liability for home workplace injuries, are also potential obstacles to telecommuting. Overall, the application of state tax laws to telecommuting arrangements, as well as other laws and regulations enacted before the transition to a more technological and information based economy, is evolving and their ultimate impact remains unclear."