A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) provides health care through its TRICARE program. Under TRICARE, beneficiaries may obtain care through a managed care option that requires enrollment and the use of civilian provider networks, which are developed and managed by contractors. Beneficiaries who do not enroll may receive care through TRICARE Standard, a fee-for-service option, using nonnetwork civilian providers or through TRICARE Extra, a preferred provider organization option, using network civilian providers. Nonenrolled beneficiaries in some locations have reported difficulties finding civilian providers who will accept them as patients. The National Defense Authorization Act (NDAA) for fiscal year 2004 directed GAO to provide information on access to care for nonenrolled TRICARE beneficiaries. This report describes (1) how DOD and its contractors evaluate nonenrolled beneficiaries' access to care and the results of these evaluations; (2) impediments to civilian provider acceptance of nonenrolled beneficiaries, and how they are being addressed; and (3) how DOD has implemented the NDAA fiscal year 2004 requirements to take actions to ensure nonenrolled beneficiaries' access to care. To address these objectives, GAO examined DOD's survey results and DOD and contractor documents and interviewed DOD …

A letter report issued by the Government Accountability Office with an abstract that begins "Average health insurance premiums for plans participating in the Federal Employees Health Benefits Program (FEHBP) have risen each year since 1997. These growing premiums result in higher costs to the federal government and plan enrollees. The Office of Personnel Management (OPM) oversees FEHBP, negotiating benefits and premiums and administering reserve accounts that may be used to cover plans' unanticipated spending increases. GAO was asked to evaluate the nature and extent of premium increases. To do this, GAO examined (1) FEHBP premium trends compared with those of other purchasers, (2) factors contributing to average premium growth across all FEHBP plans, and (3) factors contributing to differing trends among selected FEHBP plans. GAO reviewed data provided by OPM relating to FEHBP premiums and factors contributing to premium growth. For comparison purposes, GAO also examined premium data from the California Public Employees' Retirement System (CalPERS) and surveys of other public and private employers. GAO also interviewed officials from OPM and eight FEHBP plans with premium growth that was higher than average, and six FEHBP plans with premium growth that was lower than average to discuss premium growth trends and …

A letter report issued by the Government Accountability Office with an abstract that begins "A key provision of the Cash Management Improvement Act (CMIA) of 1990 (P.L. 101-453), as amended, requires the federal government and the states to minimize the time between transfer of federal funds and payments made by states for federal grant program purposes. Concerns were expressed by representatives of local government subgrantees that more flexibility was needed in the receipt of federal funding for first responders. Congress exempted certain first responder grants from this CMIA provision in the Department of Homeland Security's (DHS) fiscal years 2005 and 2006 appropriations acts. Under the exemption, grantees can receive cash advance funding and hold such funds for extended periods of time prior to payment. GAO was asked to (1) assess whether this CMIA provision, prior to its exemption in fiscal year 2005, had prevented DHS grant recipients from receiving first responder grant funds when such funds were needed; and (2) identify any key fiscal and accountability implications of the exemption."

Correspondence issued by the Government Accountability Office with an abstract that begins "Spending on outpatient prescription drugs in Medicaid--the joint federal-state program that finances medical services for certain low-income adults and children--has accounted for a substantial and growing share of Medicaid expenditures. Medicaid's total spending on outpatient prescription drugs grew from $4.6 billion in fiscal year 1990 to $40 billion in fiscal year 2004--or from 7.0 to 14.2 percent of Medicaid's total expenditures for medical care. State Medicaid programs do not directly purchase prescription drugs; instead, they reimburse retail pharmacies for covered outpatient prescription drugs dispensed to Medicaid beneficiaries. For some outpatient multiple-source prescription drugs, state Medicaid programs may only receive federal matching funds for reimbursements up to a maximum amount known as a federal upper limit (FUL). Required by law as a cost-containment strategy, FULs are calculated as 150 percent of the lowest price for a drug, from among the prices published nationally in three drug pricing compendia. State Medicaid programs have the authority to determine their own reimbursements to retail pharmacies6 for covered outpatient multiple-source prescription drugs, as long as those reimbursements do not exceed established FULs in the aggregate. The Deficit Reduction Act of 2005 (DRA) included …

A letter report issued by the Government Accountability Office with an abstract that begins "During the evacuation of New Orleans in response to Hurricane Katrina in 2005, many of those who did not own a vehicle and could not evacuate were among the over 1,300 people who died. This raised questions about how well state and local governments, primarily responsible for disaster planning, integrate transportation-disadvantaged populations into such planning. GAO assessed the challenges and barriers state and local officials face; how prepared these governments are and steps they are taking to address challenges and barriers; and federal efforts to provide evacuation assistance. GAO reviewed evacuation plans; Department of Homeland Security (DHS), Department of Transportation (DOT), and other studies; and interviewed officials in five major city and four state governments."

A letter report issued by the Government Accountability Office with an abstract that begins "The Workforce Investment Act of 1998 (WIA) required that many federal workforce employment and training programs for low-income individuals, the unemployed, and other job seekers provide their services through a streamlined delivery system. WIA also promoted greater employer engagement in this delivery system by, among other things, calling for it to help meet employers' workforce needs with services provided through one-stop centers. In 2005, we found that about half of employers were aware of their local one-stop centers. However, questions remained about how employers use them. In this report, GAO addressed (1) the extent to which employers, both large and small, hire their employees through one-stops; (2) the extent to which these employers view one-stop services as useful; and (3) factors that may affect one-stop service to employers. To answer these questions we surveyed employers who had used the one-stop system, visited eight one-stops, and talked to one-stop and Labor officials."

A letter report issued by the Government Accountability Office with an abstract that begins "The National Transportation Safety Board (NTSB) plays a vital role in advancing transportation safety by investigating accidents, determining their causes, and issuing safety recommendations. To support its mission, NTSB's training center, which opened in 2003, provides training to NTSB investigators and others. It is important that NTSB use its resources efficiently to carry out its mission. GAO was asked to examine the extent to which NTSB follows leading management practices, how NTSB carries out its transportation safety function, and the extent to which NTSB's training center is cost-effective, including potential options for improving the center's cost-effectiveness. GAO reviewed NTSB documents and data concerning management practices and accident investigations, interviewed relevant NTSB and other federal officials, and evaluated NTSB's management practices based on leading practices identified in prior work."

A letter report issued by the Government Accountability Office with an abstract that begins "The Environmental Quality Incentives Program (EQIP) assists agricultural producers who install conservation practices, such as planting vegetation along streams and installing waste storage facilities, to address impairments to water, air, and soil caused by agriculture or to conserve water. EQIP is a voluntary program managed by the U.S. Department of Agriculture's (USDA) Natural Resources Conservation Service (NRCS). NRCS allocates about $1 billion in financial and technical assistance funds to states annually. About $650 million of the funds are allocated through a general financial assistance formula. As requested, GAO reviewed whether USDA's process for allocating EQIP funds to states is consistent with the program's purposes and whether USDA has developed outcome-based measures to monitor program performance. To address these issues, GAO, in part, examined the factors and weights in the general financial assistance formula"

A letter report issued by the Government Accountability Office with an abstract that begins "The marine transportation system is a critical part of the nation's infrastructure. To facilitate the safety and efficiency of this system, the Coast Guard maintains aids-to-navigation (ATON), such as buoys and beacons, and conducts domestic icebreaking in the Great Lakes, St. Lawrence Seaway, and northeast coast. To conduct these missions, the Coast Guard has a fleet of more than 200 vessels, ranging from 225-foot seagoing buoy tenders and 140-foot domestic icebreakers to 21-foot boats. After the terrorist attacks of September 11, 2001, many of these assets took on additional responsibilities for security patrols and other homeland security duties. Although some assets have been recently acquired, many others are reaching or have exceeded their design service lives, raising concerns about how well and for how much longer these older assets may be able to carry out their missions. In response, GAO examined (1) recent trends in the amount of time these assets have spent performing missions; (2) asset condition and its effect on mission performance; and (3) the actions taken by the Coast Guard to continue to achieve the missions of these assets. To conduct this work, …

A letter report issued by the Government Accountability Office with an abstract that begins "The Air Force has turned to service contracts for the F-15C, F-16, Airborne Warning and Control System, and F-15E, and the Army has done the same for helicopter simulator training at its Flight School XXI. The contractors own, operate, and maintain the simulator hardware and software. The military services rely on industry to capitalize the required up-front investment, with the understanding that the contractors will amortize this investment by selling training services by the hour. GAO was asked to address (1) the factors that led the Air Force and Army to acquire simulator training as a service and whether the decision to use this approach was adequately supported; (2) whether implementation of the approach has resulted in the planned number of simulator training sites being activated; and (3) whether the Air Force and Army are effectively tracking the return on their expenditure of taxpayer dollars. GAO makes recommendations to the Secretary of Defense intended to improve management and oversight of these service contracts to help ensure that the best approach is used to provide the war-fighter with needed training. In written comments on a draft of …

A letter report issued by the Government Accountability Office with an abstract that begins "The Empowerment Zone/Enterprise Community (EZ/EC) program is one of the most recent large-scale federal effort intended to revitalize impoverished urban and rural communities. There have been three rounds of EZs and two rounds of ECs, all of which are scheduled to end no later than December 2009. The Community Renewal Tax Relief Act of 2000 mandated that GAO audit and report in 2004, 2007, and 2010 on the EZ/EC program and its effect on poverty, unemployment, and economic growth. This report, which focuses on the first round of the program starting in 1994, discusses program implementation; program oversight; data available on the use of program tax benefits; and the program's effect on poverty, unemployment, and economic growth. In conducting this work, GAO made site visits to all Round I EZs, conducted an e-mail survey of 60 Round I ECs, and used several statistical methods to analyze program effects."

Other written product issued by the Government Accountability Office with an abstract that begins "This document presents the results of GAO's survey of federal Enterprise Communities (EC) that were designated in the first round of the Empowerment Zone and Enterprise Community program in 1994. Round I ECs received $2.95 million in program grants and businesses in the ECs could use a program tax-exempt bond. The purpose of our survey was to collect data describing how Round I ECs implemented the program. Questionnaire items covered the types of governance structures ECs established, number of programs they implemented, usage of the program tax-exempt bond, and perceptions of factors influencing changes observed in poverty, unemployment, and economic growth in the ECs. We administered an e-mail survey to officials from the 60 Round I ECs--33 urban and 27 rural--that were still in operation as of June 2005 and did not receive additional designations under the Empowerment Zone or Renewal Community programs. We chose to exclude ECs that received subsequent designations, because we did not want their responses to be influenced by the benefits received under the additional designations. We created two versions of the questionnaire, one for urban ECs and another for rural ECs, …

Correspondence issued by the Government Accountability Office with an abstract that begins "The U.S. military has long relied on contractors to provide a variety of goods and services to U.S. forces around the world, including those located in Iraq and Afghanistan. These services range from maintaining advanced weapon systems and setting up and operating communications networks to providing gate and perimeter security, interpreting foreign languages, preparing meals and doing laundry for the troops. The U.S. Department of Defense (DOD) uses contractors for a variety of reasons, including a lack of skilled and qualified military personnel and the need to conserve scarce skills to ensure that they will be available for future deployments. DOD estimates that it has more than 50,000 contractor employees in support of operations in Afghanistan and Iraq. Depending on the types of services being offered, contractor employees may be U.S. citizens, or third country nationals, and contractors are often encouraged to hire host country nationals to help rebuild local economies and get local nationals back to work. While contractor employees can provide significant benefits to U.S. forces, contractor employees can also pose a risk to U.S. troops. For example, the terrorists who attacked the U.S.S. Cole were …

A letter report issued by the Government Accountability Office with an abstract that begins "Almost 6,000 servicemembers died from October 2001 through September 2005. The Department of Defense (DOD), the Department of Veterans Affairs (VA), and the Social Security Administration (SSA) provide assistance to survivors of servicemembers who die on active duty. This assistance includes but is not limited to making funeral arrangements, applying for federal benefits, providing relocation assistance, and coordinating with other agencies. The National Defense Authorization Act for Fiscal Year 2006 required GAO to assess casualty assistance provided to survivors of servicemembers. For this report, GAO reviewed the extent to which DOD has (1) an oversight framework and standards to monitor the assistance it provides to survivors of these deceased servicemembers and (2) visibility over the costs of its casualty assistance programs. GAO also reviewed the roles of VA and SSA in providing casualty assistance. In conducting this review, GAO analyzed agency documents and interviewed program officials, limiting its scope to federal programs."

A letter report issued by the Government Accountability Office with an abstract that begins "In recent years, Congress has expressed concerns about the federal land management agencies' ability to provide quality recreational opportunities and reduce visitor confusion over the variety of user fees. In December 2004, Congress passed the Federal Lands Recreation Enhancement Act (REA) to standardize recreation fee collection and use at federal lands and waters. GAO was asked to determine (1) what the agencies have done to coordinate implementation of REA, (2) what agencies have done to implement REA, (3) the extent to which agencies have controls and accounting procedures for collected fees, (4) how projects and activities are selected to receive funding from fees, and (5) the extent of unobligated fund balances. To answer these objectives, GAO reviewed agency guidance, analyzed fee data, interviewed officials, visited 26 fee-collecting units, and administered a nationwide survey to 900 fee-collecting units."

Correspondence issued by the Government Accountability Office with an abstract that begins "In 2004, President Bush announced what was described as the most comprehensive restructuring of U.S. military forces overseas since the end of the Korean War. Soon thereafter, the Department of Defense (DOD) issued a report titled Strengthening U.S. Global Defense Posture. This report defined the key tenets of the integrated global presence and basing strategy, which outlines troop and basing adjustments overseas. Although the strategy is intended to make the overseas posture of the United States more flexible and efficient, it will require new facilities costing billions of dollars, some of the cost to be borne by the United States and some by other nations. As plans for overseas basing began to emerge, the Senate Appropriations Committee expressed concern about the use of military construction funds for projects at overseas bases that may soon be obsolete or closed because of changes being considered by DOD and the military services. Accordingly, the Senate report accompanying the fiscal year 2004 military construction appropriation bill directed DOD to prepare detailed, comprehensive master plans for changing infrastructure requirements at U.S. military facilities in each of the overseas regional commands. The Senate report …

A letter report issued by the Government Accountability Office with an abstract that begins "The increasing threat of improvised explosive devices (IED) in Iraq has led to widespread interest by Congress and the public regarding the availability of critical force protection equipment. GAO initiated a series of engagements under the Comptroller General's authority to address these concerns. In March 2006, GAO reported on factors that affected the production and installation of armor for the Army's medium and heavy trucks. This engagement examines issues affecting the production and installation of armor for the Marine Corps' medium and heavy trucks. The objectives were to (1) determine the extent to which truck armor was produced and installed to meet identified requirements, (2) identify what factors affected the time to provide truck armor, and (3) identify what actions the Marine Corps and DOD have taken to improve the timely availability of truck armor."

Testimony issued by the Government Accountability Office with an abstract that begins "The judiciary pays over $900 million in rent annually to GSA for court-related space, representing a growing proportion of the judiciary's budget. The judiciary's rent payments are deposited into GSA's Federal Buildings Fund (FBF), a revolving fund used to finance GSA's real property services, including the construction and repair of federal facilities under GSA control. In December 2004, the judiciary requested a $483 million dollar permanent, annual rent exemption which GSA denied, saying that it undermined the intent of FBF and that GSA was unlikely to obtain appropriations to replace lost FBF income. GAO reviewed (1) recent trends in the judiciary's rent and space occupied and (2) challenges that the judiciary faces in managing its rent costs."

A letter report issued by the Government Accountability Office with an abstract that begins "The H-1B visa program assists U.S. employers in temporarily filling certain occupations with highly-skilled foreign workers. There is considerable interest regarding how Labor, along with Homeland Security and Justice, is enforcing the requirements of the program. This report describes: (1) how Labor carries out its H-1B program responsibilities; and (2) how Labor works with other agencies involved in the H-1B program. We interviewed officials and analyzed data from all three agencies."

Testimony issued by the Government Accountability Office with an abstract that begins "The H-1B visa program assists U.S. employers in temporarily filling certain occupations with highly-skilled foreign workers. There is considerable interest regarding how Labor, along with Homeland Security and Justice, is enforcing the requirements of the program. This testimony summarizes our report, GAO-06-720, that describes how Labor carries out its H-1B program responsibilities and how Labor works with other agencies involved in the H-1B program."

A letter report issued by the Government Accountability Office with an abstract that begins "Critical to the success of the federal government's transformation are its people--human capital. Yet, the government has not transformed, in many cases, how it classifies, compensates, develops, and motivates its employees to achieve maximum results within available resources and existing authorities. GAO has reported that the federal government as a whole may face challenges in offering competitive compensation to its senior leaders who have reached a statutory pay cap. As requested, GAO (1) provided trend data for basic pay rates of selected federal executive and judicial pay plans from 1970 to 2006, (2) identified elements of total compensation for the selected pay plans in 2006, and (3) identified principles for any possible restructuring of these pay plans. We selected 1970 as a baseline because salary increases went into effect in 1969 for executive-level positions as recommended by the Commission on Executive, Legislative, and Judicial Salaries. The pay plans cover the following--career Senior Executive Service (SES), administrative law judges (ALJ), senior-level (SL), Executive Schedule (EX), scientific or professional (ST), and members of Boards of Contract Appeals (BCA), as well as federal justices and judges--the Chief Justice, associate …

Testimony issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) is engaged in an ongoing effort to share electronic medical information with the Department of Defense (DOD), which is important in helping to ensure high-quality health care for active duty military personnel and veterans. Also important, in the face of current military responses to national and foreign crises, is ensuring effective and efficient delivery of veterans' benefits, which is the focus of VA's development of the Veterans Service Network (VETSNET), a modernized system to support benefits payment processes. GAO is testifying on (1) VA's efforts to exchange medical information with DOD, including both near-term initiatives involving existing systems and the longer term program to exchange data between the departments' new health information systems, and (2) VA's ongoing project to develop VETSNET. To develop this testimony, GAO relied on its previous work and followed up on agency actions to respond to GAO recommendations."

A letter report issued by the Government Accountability Office with an abstract that begins "Medicaid--the federal-state health care financing program--covered over 56 million people at a cost of $295 billion in fiscal year 2004, the latest fiscal year for which complete data are available. The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for overseeing states' Medicaid programs and ensuring the propriety of expenditures reported by states for federal reimbursement. In 2002, GAO reported on weaknesses in CMS's oversight of Medicaid financial management and made recommendations to CMS to strengthen its oversight process. In fiscal year 2003, CMS started receiving funds from the Health Care Fraud and Abuse Control (HCFAC) program to help improve Medicaid financial management. GAO was asked to evaluate CMS's financial management activities, including following up on prior recommendations. In this report, GAO examined (1) the extent to which CMS has improved its ability to identify and address emerging issues that put federal Medicaid dollars at risk and (2) how CMS used funds for Medicaid from the HCFAC account."

Correspondence issued by the Government Accountability Office with an abstract that begins "The fiscal year 2005 Department of Homeland Security (DHS) appropriation set aside $25 million, of the $885 million appropriated for the Urban Areas Security Initiative (UASI), for grants to eligible nonprofit organizations that the Secretary of Homeland Security determined to be at high risk of international terrorist attack. This letter responds to the conference report that directed GAO to review the validity of the threat and risk factors used by DHS to allocate discretionary grants to nonprofit organizations in fiscal years 2003, 2004, and 2005. Based on our review of DHS's risk methodology for fiscal year 2006, the criteria in the fiscal year 2005 grant application kit, and conversations with Congressional staff about the conference report, we addressed the following objectives: (1) DHS's methodology for determining risk for urban areas and the nonprofit grant program, and DHS implementation of the program; (2) states' efforts to implement the nonprofit grant program in fiscal year 2005, and (3) whether subgrants were made to nonprofits in fiscal years 2003 and 2004, when funds were not specifically set aside for nonprofits."