A letter report issued by the Government Accountability Office with an abstract that begins "Thirteen states reported that in fiscal year 2012 they paid a total of about $5.6 billion to limited benefit plans to provide mental health services to about 4.4 million adult Medicaid beneficiaries. States can enroll different populations--such as adults who are blind, disabled, or have developmental disabilities--in limited benefit plans, which could contribute to the variation in the number of adults enrolled and level of capitated payments made across the 13 states."

A letter report issued by the Government Accountability Office with an abstract that begins "Since 2008, the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) has awarded five contracts to research organizations to update national workforce projections, but HRSA has failed to publish any new reports containing projections. As a result, the most recent projections from HRSA available to Congress and others to inform health care workforce policy decisions are from the agency's 2008 report, which is based on data that are more than a decade old. While HRSA created a timeline for publishing new workforce projection reports in 2012, the agency missed its goal to publish a clinician specialty report by December 2012 projecting the supply of and demand for health care professionals through 2025. HRSA officials attributed the delay in publishing this report to data challenges and modeling limitations. HRSA has also revised its timeline to postpone publication of two other health care workforce reports, as shown in the table below. HRSA officials said that the agency does not have standard written procedures for preparing a report for publication after final reports are delivered from contractors, which may impede its ability …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Homeland Security (DHS) has made considerable progress toward obtaining a clean opinion on its financial statements but limited progress in obtaining a clean opinion on its internal control over financial reporting. DHS continues to rely on compensating controls and complex manual work-arounds rather than sound internal control over financial reporting and effective financial management systems. DHS is working to resolve the deficiencies that caused its auditors to issue a qualified opinion on its fiscal year 2012 financial statements and has a goal of achieving a clean opinion in fiscal year 2013. In addition, DHS has plans to resolve the remaining five material internal control weaknesses, with a goal of achieving a clean opinion on internal control over financial reporting for fiscal year 2016. However, DHS's auditors stated that they may have identified additional material weaknesses in fiscal year 2012 had they been able to perform sufficient work to enable them to express an opinion on the effectiveness of DHS's internal control over financial reporting. DHS will continue to face challenges in obtaining and sustaining a clean opinion on its financial statements and attaining …

A letter report issued by the Government Accountability Office with an abstract that begins "Internal Revenue Service (IRS) data are not sufficient for identifying who claims a tax expenditure and how much they claim for $492 billion or almost half the dollar value of all tax expenditures that GAO examined. Such basic data are not available at IRS for tax expenditures because they do not have their own line item on a tax form. This included $102 billion of tax expenditures that were not on tax forms, such as the exclusion of interest on life insurance savings, and $390 billion of tax expenditures that were on tax forms but did not have their own line items, such as the credit for holding clean renewable energy bonds which is aggregated with other credits on a single line item."

A letter report issued by the Government Accountability Office with an abstract that begins "Federal agencies need to exercise strong oversight to promote effectiveness and efficiency and prevent waste, fraud, and abuse--especially in a federal procurement program such as this, which is exempt from full and open competition requirements. However, although the AbilityOne Commission is ultimately responsible for overseeing the program, the Commission cannot control how CNAs (1) spend their funds, (2) set and manage their performance goals, or (3) set and implement governance policies and other internal controls. The Commission's authority to direct CNA budget priorities--including how much they compensate their executives and the level and growth of their reserves--is limited. As independent entities, the CNAs are responsible for determining their spending. Most of their money comes from fees they charge their affiliates as a percent of revenue earned from AbilityOne contracts. Moreover, the Commission does not have sufficient authority to set CNA performance and governance standards, so it depends on the CNAs to set and enforce such standards. Although the CNAs have instituted their own internal controls, the Commission does not have procedures to monitor alleged CNA control violations, nor is there an inspector general to provide independent …

A letter report issued by the Government Accountability Office with an abstract that begins "The Center for Consumer Information and Insurance Oversight (CCIIO) discontinued enrollment in the Early Retiree Reinsurance Program (ERRP) in early 2011 and stopped most program reimbursements the following year to keep spending within the $5 billion ERRP appropriation. Specifically, anticipating exhaustion of funds, CCIIO stopped ERRP enrollment in May 2011. According to CCIIO officials, CCIIO suspended making reimbursements to plan sponsors in September 2012, as reimbursements had reached the $4.7 billion cap established for paying claims under the original appropriation, and the remainder was reserved for administrative expenses. When the cap was reached, significant demand for the program remained with 5,699 ERRP reimbursement requests left outstanding that accounted for about $2.5 billion in unpaid claims. CCIIO officials told GAO that they planned to pay some of the outstanding reimbursement requests by redistributing any overpayments recovered from plan sponsors--when, for example a plan receives a rebate that lowers the total cost of a prior claim--as well as money recovered from program audits. As of January 2013, officials told GAO that CCIIO had recovered a total of $54 million and redistributed $20.7 million of this amount."

A letter report issued by the Government Accountability Office with an abstract that begins "The DC Children and Youth Investment Trust Corporation (the Trust) provides information to prospective and current families of children participating in the District of Columbia (the District) Opportunity Scholarship Program (OSP) through a variety of outreach activities. To reach prospective OSP families, the Trust advertises through print, radio, and bus ads, as well as in newspapers and flyers posted in neighborhood libraries, recreation centers, and local government service centers. However, the Trust provides incomplete and untimely information about participating schools to OSP families. The participating school directory, which is published by the Trust, lacks key information about tuition, fees, and accreditation. The Trust published the directory 9 months after the start of the 2012-13 school year, too late to assist families in selecting a school for that year. Without such information, parents cannot make fully informed school choices. Additionally, the Trust awarded scholarships to students several months after many schools completed their admissions and enrollment processes, limiting the amount of time and choice in selecting schools. Most families GAO spoke with were generally happy with OSP but some were concerned about the availability of program information."

A letter report issued by the Government Accountability Office with an abstract that begins "The four states GAO selected used funds provided under Title IV-B of the Social Security Act for a variety of child welfare services and other activities, and had different strategies for spending these funds. For instance, in fiscal year 2011 Virginia provided funding to all local child welfare agencies to spend on their own priorities, such as parenting classes. New Mexico targeted certain counties for services, such as intensive in-home services for families at risk of foster care."

A letter report issued by the Government Accountability Office with an abstract that begins "According to the Department of Health and Human Services (HHS), about 60 percent of the chemical, biological, radiological, and nuclear (CBRN) medical countermeasures in the Strategic National Stockpile (SNS) have been approved for children, but in many instances approval is limited to specific age groups. In addition, about 40 percent of the CBRN countermeasures have not been approved for any pediatric use. Furthermore, some of the countermeasures have not been approved to treat individuals for the specific indications for which they have been stockpiled. For example, ciprofloxacin is stockpiled in the SNS for the treatment of anthrax, plague, and tularemia, but is not approved for these indications. Countermeasures may be used to treat unapproved age groups or indications under an emergency use authorization (EUA) or an Investigational New Drug (IND) application submitted to the Food and Drug Administration (FDA)."

Correspondence issued by the Government Accountability Office with an abstract that begins "CDC has administered and provided oversight of the CPPW program, which includes the monitoring of award recipients. CDC required recipients to use their CPPW funds to support efforts to improve nutrition, increase physical activity, or reduce tobacco use and exposure to secondhand smoke. In addition, CDC suggested possible strategies for achieving these results, such as working to establish smoke-free zones or to implement zoning changes that promote physical activity. CDC policy prohibited CPPW award recipients from using funds for specific types of activities, including lobbying, which generally meant certain activities designed to influence action in regard to a particular piece of pending legislation."

Correspondence issued by the Government Accountability Office with an abstract that begins "Because data were not readily available to identify how the Department of Veterans Affairs (VA) uses consulting services and what is known about their costs, this report discusses the limitations on data concerning consulting services and provides information on some of the uses of consultant contracts. Two primary factors limited GAO's ability to identify a list of consulting contracts that was sufficiently accurate and complete for identifying the types and costs of consulting services used by VA. First, there is no consistently used definition for consultant or consulting services across VA that GAO could apply for our intended purposes. Second, there are data limitations associated with identifying consulting services at VA. Since there is no means for contracting officers to track obligations for consulting services in the Federal Procurement Data System-New Generation, GAO used North American Industrial Classification Codes (NAICS) to identify contracts that could be for consulting. However, GAO could not use the NAICS codes to consistently identify consulting contracts because a single NAICS code can be used to classify both consulting and nonconsulting services and VA contracting officers sometimes reported that they had applied the wrong …

A letter report issued by the Government Accountability Office with an abstract that begins "In fiscal year 2012, the Department of Health and Human Services (HHS), HHS Office of Inspector General (HHS-OIG), and the Department of Justice (DOJ) obligated approximately $583.6 million to fund Health Care Fraud and Abuse Control (HCFAC) program activities. About 78 percent of obligated funds were from mandatory HCFAC appropriations (budgetary resources provided in laws other than appropriation acts), 11 percent of obligated funds were from discretionary HCFAC appropriations (budgetary resources provided in appropriation acts), and 12 percent were obligated funds from other appropriations that HHS, HHS-OIG, and DOJ used to support HCFAC activities. HCFAC funds were obligated to support a variety of activities, including interagency Medicare Fraud Strike Force Teams--which provide additional investigative and prosecutorial resources in geographic areas with high rates of health care fraud--located in 9 cities nationwide."

A letter report issued by the Government Accountability Office with an abstract that begins "According to Transportation Security Administration (TSA) employee misconduct data that GAO analyzed, TSA investigated and adjudicated approximately 9,600 cases of employee misconduct from fiscal years 2010 through 2012. From fiscal years 2010 through 2012, the annual number of TSA misconduct cases increased from 2,691 to 3,408. In that same period, TSA's workforce of Office of Security Operations employees at the airport level grew by about 3,200 employees. Two offense categories accounted for about half of all cases--(1) attendance and leave, which accounted for 32 percent, and (2) screening and security, which accounted for 20 percent. Charges for screening and security related incidents pertain to violating standard operating procedures, including not conducting security or equipment checks, and allowing patrons or baggage to bypass screening. TSA's guidance delineates common employee charges, along with a suggested range of penalties. Forty-seven percent of the cases that GAO analyzed resulted in letters of reprimand, which describe unacceptable conduct that is the basis for a disciplinary action; 31 percent resulted in suspensions of a definite duration; and 17 percent resulted in the employee's removal from TSA. The remaining cases covered a variety …

A letter report issued by the Government Accountability Office with an abstract that begins "GAO identified six key fee design decisions related to how fees are set, used, and reviewed that, in the aggregate, enable Congress to design fees that strike the desired balance between agency flexibility and congressional control. For example, narrowly limiting the activities for which fees may be used heightens congressional control over the funds; however, doing so can also reduce an agency's flexibility to reallocate resources as needs change and may increase administrative costs. Design decisions also have program management implications. For example, the frequency of fee reviews and adjustments affects the alignment between collections and costs. Failing to review fees regularly has sometimes resulted in large increases when fees are eventually updated, creating costly challenges. Understanding the implications of fee design is important to avoid such unintended consequences."

Testimony issued by the Government Accountability Office with an abstract that begins "In 2010, GAO reported that industry stakeholders and experts believed that the Federal Aviation Administration's (FAA) certification and approval processes contribute positively to the safety of the national airspace system. However, stakeholders and experts also noted that negative certification and approval experiences--such as duplication of approvals--although infrequent, can result in delays that industry says are costly. GAO made two recommendations requiring, among other things, that FAA develop a continuous evaluative process and a method to track submission approvals. FAA addressed one recommendation and partially addressed the other. An FAA-industry committee established in response to the FAA Modernization and Reform Act of 2012 (the Act) made six recommendations to improve the certification and approval processes, including establishing a performance measurement process. In response to recommendations from the certification process committee, FAA developed an implementation plan with 14 initiatives, but the initiatives do not contain some elements essential to a performance measurement process, such as performance measures. Without performance measures, FAA will be unable to evaluate current and future programs."

A letter report issued by the Government Accountability Office with an abstract that begins "Effective tax rates (ETR) differ from statutory tax rates in that they attempt to measure taxes paid as a proportion of economic income, while statutory rates indicate the amount of tax liability (before any credits) relative to taxable income, which is defined by tax law and reflects tax benefits and subsidies built into the law. Lacking access to detailed data from tax returns, most researchers have estimated ETRs based on data from financial statements. A common measure of tax liability used in past estimates has been the current tax expense--either federal only or worldwide (which comprises federal, foreign, and U.S. state and local income taxes). The most common measure of income for these estimates has been some variant of pretax net book income. GAO was able to compare book tax expenses to tax liabilities actually reported on corporate income tax returns."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) used various methods to identify needed changes to requirements for its upcoming pharmacy services contract. During acquisition planning for the upcoming TRICARE pharmacy services contract, DOD solicited feedback from industry through its market research process to align the contract requirements with industry best practices and promote competition. For example, DOD issued requests for information (RFI) in which DOD asked questions about specific market trends, such as ensuring that certain categories of drugs are distributed through the most cost-effective mechanism. DOD also issued an RFI to obtain information on promoting competition, asking industry for opinions on the length of the contract period. DOD officials told us that responses indicated that potential offerors would prefer a longer contract period because it would allow a new contractor more time to recover any capital investment made in implementing the contract. The request for proposals for the upcoming contract, issued in June 2013, included a contract period of 1 base year and 7 option years. DOD also identified changes to contract requirements in response to legislative changes to the TRICARE pharmacy benefit. For example, the National …

Correspondence issued by the Government Accountability Office with an abstract that begins "USDA’s Food Safety Inspection Service (FSIS) completed most of the key activities outlined in the Food, Conservation, and Energy Act of 2008 (the 2008 Farm Bill), which authorized a new meat and poultry inspection program to support interstate shipment of meat and poultry products from establishments with 25 or fewer employees, inspected by state agencies. Specifically, FSIS issued program regulations in May 2011for the new inspection program, called the Cooperative Interstate Shipment (CIS) program,and it provided additional guidance in October 2011 instructing states on what they needed to demonstrate to be approved for the CIS program.As of January 31, 2013, three states—Ohio, North Dakota, and Wisconsin—and eight establishments in two of those states had been selected to participate in the program. However, although FSIS established a technical assistance division, that division has not coordinated with other USDA agencies on initiatives to provide outreach, education, and training to establishments and grants to states for those initiatives and also for technical assistance to small establishments,as required by the 2008 Farm Bill. Also, FSIS gave funds to four states to assess the changes they would have to make to their inspection …

A letter report issued by the Government Accountability Office with an abstract that begins "Many emergency managers from the 27 major cities responding to GAO's questionnaire, although not all, reported that their city had assessed the risks of a terrorist attack using a radiological dispersal device (RDD) or improvised nuclear device (IND) and had ranked the risk of these attacks as lower than the risk of other hazards they face. Also, 11 of the 27 reported that they had completed RDD response plans, and 8 of the 27 reported that they had completed IND response plans. Some emergency managers for cities without specific RDD and IND response plans reported that they would rely on their city's all hazards emergency operations plan or hazard management plan if attacked. Most cities that had RDD and IND response plans reported conducting exercises to validate the plans based on federal guidance."

A letter report issued by the Government Accountability Office with an abstract that begins "The scope of the Nuclear Regulatory Commission's (NRC) license renewal process focuses on managing the effects of aging on a reactor and its associated systems, structures, and components (i.e. safety) and assessing certain potential environmental impacts of extending a reactor's operating-life. As a result, reviews done as part of this process are not required to address as many topics as reviews for initial licensing, which include security and emergency planning."

Testimony issued by the Government Accountability Office with an abstract that begins "The Federal Protective Service (FPS) faces challenges ensuring that contract guards have been properly trained and certified before being deployed to federal facilities around the country. In a September 2013 report, GAO found that providing active-shooter-response and screener training is a challenge for FPS. For example, according to officials at five guard companies, their contract guards have not received training on how to respond during incidents involving an active-shooter. Without ensuring that all guards receive this training, FPS has limited assurance that its guards are prepared for such a threat. Similarly, officials from one of FPS's contract guard companies stated that 133 (about 38 percent) of its approximately 350 guards have never received screener training. As a result, those guards may be using x-ray and magnetometer equipment at federal facilities that they are not qualified to use, raising questions about their ability to properly screen access control points at federal facilities--one of their primary responsibilities. We were unable to determine the extent to which FPS's guards have received active-shooter-response and screener training. FPS agreed with GAO's 2013 recommendation that they take steps to identify guards that have not …

A letter report issued by the Government Accountability Office with an abstract that begins "DOD and the International Security Assistance Force (ISAF) have defined the mission and broad goals for Security Force Assistance (SFA) advisor teams; however, teams varied in the extent to which their approaches for developing their Afghan National Security Force (ANSF) units identified activities based on specific objectives or end states that were clearly linked with established goals. SFA guidance states that to be successful, advisors must have an end or goal in mind, and establish objectives that support higher-command plans. Theater commanders have outlined goals aimed at strengthening specific capabilities such as logistics, and it is largely left to the teams to then develop their approach for working with their counterparts. GAO found some advisor teams had developed structured advising approaches drawing from these goals, such as identifying monthly objectives and milestones for their team. Other teams GAO met with used less structured approaches, such as relying on interactions with ANSF counterparts to identify priorities and using this input to develop activities on an ad hoc basis, rather than as part of a longer-term, more structured approach to achieve broad goals. Officials from several teams stated …

A letter report issued by the Government Accountability Office with an abstract that begins "Carryover balances in fiscal year 2012 were $2.2 trillion, of which about $800 billion had not yet been obligated. Answering key questions during review of carryover balances provides insights into why a balance exists, what size balance is appropriate, and what opportunities (if any) for savings exist. Given that a single account may support a single program or multiple programs--or that multiple accounts may support a single program--these questions can be applied when evaluating balances at either the account or program level. Examination of balances may assist decision makers in identifying opportunities to achieve budgetary savings or redirecting resources to other priorities. However, the complexity of the federal budget is such that a case-by-case analysis is needed to understand how best to achieve these financial benefits."

A letter report issued by the Government Accountability Office with an abstract that begins ""