A letter report issued by the Government Accountability Office with an abstract that begins "Providers and stakeholders GAO interviewed in four states with ongoing electronic health information exchange efforts cited key challenges to exchange, in particular, issues related to insufficient standards, concerns about how privacy rules can vary among states, difficulties in matching patients to their records, and costs associated with exchange. Officials from the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC)—agencies within the Department of Health and Human Services (HHS)—noted that they have several ongoing programs and initiatives to help address some aspects of these key challenges, but concerns in these areas continue to exist. For example, several providers GAO interviewed said that they have difficulty exchanging certain types of health information due to insufficient health data standards. Although HHS has begun to address insufficiencies in standards through its Medicare and Medicaid Electronic Health Record (EHR) programs, such as through the introduction of new 2014 standards for certified EHR technology, it is unclear whether its efforts will lead to widespread improvements in electronic health information exchange. In addition, providers GAO interviewed reported challenges covering costs associated with …

A letter report issued by the Government Accountability Office with an abstract that begins "The Navy's 2013 report to Congress on the Port Royal 's material condition partially addressed congressional reporting requirements but has likely overstated modernization costs should the ship be retained in service. While the Navy acknowledges that it did not obtain an independent structural assessment as required by one of the mandates, the Navy found the condition of the ship to be comparable to other cruisers when its own technical experts assessed the ship. For example, in addressing the congressional requirements, the Navy assessed the Port Royal 's structure and found the condition of the superstructure and interior hull to be typical of other cruisers in the class, indicating its suitability for continued use. The mandate also required that the Navy's assessments be reviewed by experts. GAO found that the Navy's assessment was reviewed by the Naval Sea Systems Command Engineering Directorate, the Navy's technical authority, and by independent boards of subject-matter experts from the Department of Defense and industry—the Board of Inspection and Survey and the American Bureau of Shipping, respectively. All three reviewers generally concurred with the assessment. Finally, the Navy's report to Congress included …

A letter report issued by the Government Accountability Office with an abstract that begins "The Small Business Administration (SBA) has established lending standards to protect against default and has measured program performance, but lacks guidance on determining the number of jobs supported by 504 program-funded projects. SBA's guidance for certified development companies (CDC)—nonprofits that provide funding to small businesses to promote local economic development in their communities and are certified by SBA—includes credit underwriting standards for determining ability to repay. SBA also has established performance indicators—such as the number of small businesses assisted and jobs supported—for the 504 loan program. However, SBA does not describe how CDCs should calculate jobs created and retained by 504 projects, a key program requirement. Federal internal control standards require control activities that help participants report information accurately. Without specific guidance, SBA cannot ensure that CDCs are calculating this information consistently or accurately. GAO's analysis of SBA data showed that 504 loans approved in fiscal years 2006 through 2008 had the highest 18-month default rates, which correlated with trends in the private sector for commercial real estate loans."

A letter report issued by the Government Accountability Office with an abstract that begins "Clinicians at the four Department of Veterans Affairs Medical Centers (VAMC) GAO visited said that patient need and their clinical expertise were the main factors influencing their decisions of which surgical implants to use. Also, clinicians in certain specialties said they typically used one of the implants available on VA-negotiated national committed-use contracts, which generally establish a fixed price for several models of nine types of surgical implants that the Veterans Health Administration (VHA) commits to using nationally. VHA recognizes the need for expanding items covered under these contracts to fully leverage its purchasing power but, as of October 2013, had not identified additional implants to include on such contracts or established timelines for doing so. GAO also found that the availability of implants on VA-negotiated federal supply schedule (FSS) contracts rarely influenced clinicians' decisions on which implant to use. Clinicians were often not aware of the availability of surgical implants on FSS contracts, which are negotiated by one of VA's contracting offices, but for which VHA clinicians have little or no input. Clinicians told GAO that in some cases they may avoid implants on FSS …

A letter report issued by the Government Accountability Office with an abstract that begins "About half of the almost 17,000 veterans who entered the Department of Veterans Affairs' (VA) Vocational Rehabilitation and Employment (VR&E) program in fiscal year 2003 and received employment-related services were placed in suitable jobs, one-third left the program, and most of the others are still participating. It often took veterans 6 years or more to achieve success, due in part to veterans often leaving the program temporarily. Interviews with VR&E staff and participants and administrative data GAO reviewed suggest veterans face numerous challenges that affect their ability to obtain employment, especially related to mental health conditions, working with multiple VR&E counselors over time, and civilian employers' limited understanding of military work experience."

Testimony issued by the Government Accountability Office with an abstract that begins "In managing its Chemical Facility Anti-Terrorism Standards (CFATS) program, the Department of Homeland Security (DHS) has a number of efforts underway to identify facilities that are covered by the program, assess risk and prioritize facilities, review and approve facility security plans, and inspect facilities to ensure compliance with security regulations."

A letter report issued by the Government Accountability Office with an abstract that begins "The KC-46 program has made good progress over the past year—acquisition costs have remained relatively stable, the critical design review was successfully completed, the program is on track to meet performance parameters, and the contractor started building development aircraft. As shown, total program acquisition costs—which include development, production, and military construction costs—and unit costs have changed less than 1 percent since February 2011."

A statement of record issued by the Government Accountability Office with an abstract that begins "Limitations in the intelligence community's (IC) inventory of contract personnel hinder the ability to determine the extent to which the eight civilian IC elements—the Central Intelligence Agency (CIA), Office of the Director of National Intelligence (ODNI), and six components within the Departments of Energy, Homeland Security, Justice, State, and the Treasury—use these personnel. The IC Chief Human Capital Officer (CHCO) conducts an annual inventory of core contract personnel that includes information on the number and costs of these personnel. However, GAO identified a number of limitations in the inventory that collectively limit the comparability, accuracy, and consistency of the information reported by the civilian IC elements as a whole. For example, changes to the definition of core contract personnel limit the comparability of the information over time. In addition, the civilian IC elements used various methods to calculate the number of contract personnel and did not maintain documentation to validate the number of personnel reported for 37 percent of the records GAO reviewed. GAO also found that the civilian IC elements either under- or over-reported the amount of contract obligations by more than 10 percent …

A letter report issued by the Government Accountability Office with an abstract that begins "From 2009 through 2012, certified registered nurse anesthetists (CRNA)—a type of advanced-practice nurse specializing in anesthesia care—billed Medicare fee-for-service (FFS) for a minimal share of selected chronic pain procedures, less than ½ of 1 percent of these procedures in each year. Physicians without board certification in pain medicine billed for the majority of selected procedures each year, while pain physicians consistently billed for roughly 40 percent of selected procedures. Furthermore, although the number of chronic pain procedures billed by all rural providers increased from 2009 through 2012, the number of procedures billed by rural CRNAs declined over the period. Of all CRNA claims for selected procedures, the share billed by CRNAs in rural areas fell from 66 percent in 2009 to 39 percent in 2012."

A letter report issued by the Government Accountability Office with an abstract that begins "Total Direct Loan administrative costs grew from $314 million to $864 million from fiscal years 2007 to 2012, but federal costs per borrower have generally remained steady or fallen. The increase in total administrative costs largely results from an increase of over 300 percent in the number of Direct Loans during that same time period. One key factor contributing to this loan volume increase was a law that ended student loan originations under a federally guaranteed loan program resulting in new originations being made under the Direct Loan program. Loan servicing--which includes activities like counseling borrowers on selecting repayment plans, processing payments, and collecting on loans in delinquent status--is the largest category of administrative costs, comprising 63 percent of total Direct Loan administrative costs in fiscal year 2012. While total administrative costs have increased, costs per borrower and other unit costs have remained steady or declined. For example, the servicing cost per borrower has remained roughly $25 over the six-year period we examined. However, a number of factors, including a new payment structure for loan servicing contracts to reward servicers for keeping more borrowers in repayment …

Testimony issued by the Government Accountability Office with an abstract that begins "GAO's work at four VAMCs found that these VAMCs did not always follow VHA requirements for documenting open-market purchases of surgical implants. Specifically:"

A letter report issued by the Government Accountability Office with an abstract that begins "The Office of Management and Budget (OMB), the General Services Administration (GSA), and selected agencies have taken steps to consider small businesses, including small disadvantaged businesses, in their strategic sourcing efforts. (Small disadvantaged businesses are those unconditionally owned and controlled by socially and economically disadvantaged individuals.) OMB and GSA have developed guidance on strategic sourcing that stresses the importance of including small businesses. GAO's review of documentation for three ongoing government-wide strategic sourcing initiatives showed that GSA considered the inclusion of small businesses in the strategic sourcing process. For example, when developing strategic sourcing initiatives for office supplies and print management, GSA identified the current market share of small businesses with these products and also set aside specific contracts for various categories of small businesses, such as service-disabled veteran-owned small businesses. In addition, GAO's review of agency-wide strategic sourcing initiatives at each of five agencies--Departments of Defense (DOD), specifically Army and the Defense Logistics Agency; Homeland Security (DHS); Housing and Urban Development (HUD); and the Interior and the National Aeronautics and Space Administration (NASA)--showed that the agencies generally considered the inclusion of small businesses."

Correspondence issued by the Government Accountability Office with an abstract that begins "GAO's review found that DOD's July 2013 report addressed the four elements specified in the House Committee on Armed Services' report. Specifically, the report by the Director of DOD's Corrosion Office addressed the following elements related to corrosion of facilities and infrastructure: (1) identification of key drivers of corrosion costs and recommended strategies for reducing their effect; (2) review of a sampling of facilities that are representative of facility type, military department, and facility age; (3) assessment of at least one planned facility construction program; and (4) inclusion of information from 30 locations (15 site visits and 15 teleconferences) and the examination of program documentation from all the locations, including maintenance and facility engineering processes."

A letter report issued by the Government Accountability Office with an abstract that begins "American Samoa employment and earnings have decreased since 2007, but employment increased slightly from 2011 to 2012. Since 2005, the American Samoa economy has had a flat or declining real gross domestic product (GDP)."

Correspondence issued by the Government Accountability Office with an abstract that begins "To encourage private-sector employers to sponsor new pension plans and U.S. workers to save for retirement, federal law authorizes a variety of tax incentives, such as the ability to defer taxes on contributions to qualified plans until the funds are distributed, up to certain limits. Since 2000, the dollar amount of these limits has increased over time. However, from 2009 through 2011, the number of new pension plans formed each year in the private sector remained relatively flat, and was below the levels reported previously for 2003 through 2007. Specifically, from 2009 through 2011, private-sector employers sponsored about 81,000 new pension plans, including 75,000 defined contribution (DC) plans and 6,000 defined benefit (DB) plans. DC plans with fewer than 100 participants accounted for about 90 percent of all new plan growth over this period. Moreover, the net change in the number of pension plans over this period was negative, with the number of terminated plans more than offsetting new plan formation by nearly 34,000 plans. Over the 3-year span from 2009 through 2011, private-sector employers terminated about 106,000 DC and 9,000 DB plans. Overall, there were about 52,000 …

A letter report issued by the Government Accountability Office with an abstract that begins "To help prevent the sexual abuse of students in public K-12 schools, 46 of the 50 states and the District of Columbia surveyed by GAO required background checks of applicants--such as teachers or bus drivers--seeking public school employment; however, the methods and sources varied widely. Forty-two states established professional standards or codes of conduct for school personnel, and 22 of those included information on appropriate boundaries between personnel and students. Although experts view awareness and prevention training on sexual abuse and misconduct as another key prevention tool, only 18 states reported in the survey that they require school districts to provide this training. However, two of six districts GAO visited provided training to school personnel, volunteers, and students in response to prior allegations of sexual misconduct by school personnel. These trainings covered a variety of topics, including recognizing the signs of abuse and misconduct."

Correspondence issued by the Government Accountability Office with an abstract that begins "GAO provided an in-depth classified briefing to committee staff on the results of this review in January 2014. GAO briefed on the status of several on-going nuclear command, control, and communications (NC3) modernization efforts within the Department of Defense (DOD), including progress made and remaining challenges to completing those efforts. GAO also reported on DOD's efforts to plan and develop the National Leadership Command Capability, a large initiative to integrate nuclear, senior leader, and continuity of government command, control, and communications capabilities and systems. Further details remain classified."

Correspondence issued by the Government Accountability Office with an abstract that begins "Among the 9 states and 35 services examined, GAO found that all states varied Medicaid payments for at least some services. However, the states differed in the number of services for which they varied payments, in the factors that accounted for variation, and in the magnitude of the variation. Many of the states varied payment rates by at least one of the factors GAO was able to explore in detail: provider type, service setting, and/or patient age. Some states also varied their payment rates for other reasons, such as by geographic region or by physician specialty. GAO also found that most of the median Medicaid payment rates calculated from claims data generally confirmed payment rates published in studies of fee schedules conducted by the American Academy of Pediatrics and the Urban Institute; however, some of the published fee schedule rates were rarely used in practice. Collectively, GAO's findings demonstrate that Medicaid fee-for-service claims data can be a useful source of information for analyzing provider payments. These data have the potential to provide a more complete representation of provider payment than do fee schedules, as claims data can capture …

A letter report issued by the Government Accountability Office with an abstract that begins "The number of servicemembers with mortgages eligible for Servicemembers Civil Relief Act (SCRA) mortgage protections is unknown because servicers have not collected this information in a comprehensive manner. Based on the limited and nongeneralizeable information that GAO obtained from the three mortgage servicers and the credit union, a small percentage of the total loan portfolios were identified as eligible for SCRA protections. Two large servicers had loan-level data on delinquency rates. For those identified as SCRA-eligible, rates ranged from 16 to 20 percent and from 4 to 8 percent for their other military borrowers. Delinquencies at the credit union were under 1 percent. Some servicemembers appeared to have benefitted from the SCRA interest rate cap of 6 percent, but many eligible borrowers had apparently not taken advantage of this protection. For example, at one institution 82 percent of those who could benefit from the interest rate caps still had mortgage rates above 6 percent. The data also were insufficient to assess the impact of SCRA protections after servicemembers left active duty, although one institution's limited data indicated that military borrowers had a higher risk of delinquency …

A letter report issued by the Government Accountability Office with an abstract that begins "Based on the number of providers awarded incentive payments, participation in the Department of Health and Human Services' (HHS) Medicare and Medicaid Electronic Health Record (EHR) programs increased substantially from their first year in 2011 to 2012. For hospitals, participation increased from 45 percent of those eligible for 2011 to 64 percent of those eligible for 2012. For professionals, such as physicians, participation increased from 21 percent of those eligible for 2011 to 48 percent of those eligible for 2012. While increases occurred, a substantial percentage of providers that participated in 2011 did not participate in 2012. Officials who oversee the programs at the Centers for Medicare & Medicaid Services (CMS) noted there could be several reasons for this, such as challenges in demonstrating meaningful use, and are monitoring the issue. Various program changes make future participation difficult to estimate. For example, increased stringency of requirements for the programs' second phase beginning in 2014—Stage 2—may slow participation, while the introduction of penalties in 2015 for some providers may motivate participation."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of State (State) and U.S. Agency for International Development (USAID) identified a number of changes needed to improve contract support in overseas contingency operations, but have not completed implementation efforts. As required by the Fiscal Year 2013 National Defense Authorization Act (NDAA), both agencies determined that their organizational structures were effective, though State created a new regional Contract Management Office to better support contracting efforts in Iraq. In October 2013, State approved a number of actions to improve policies and procedures, including specific initiatives in acquisition planning and risk management, among others, and intends to institutionalize these changes in its Foreign Affairs Manual in 2014. State generally has not, however, developed plans to assess the impact of these initiatives. Federal internal control standards highlight the importance of managers comparing actual performance to expected results. Accordingly, continued management attention is needed to ensure that these efforts achieve their intended objectives. USAID focused its efforts on areas such as improving contractor performance evaluations and risk management. GAO found that some USAID missions and offices that operate in contingency environments have developed procedures and practices, but USAID …

A letter report issued by the Government Accountability Office with an abstract that begins "The Departments of Defense (DOD), Labor (DOL), and Veterans Affairs (VA) have implemented most of the key components of the Transition Assistance Program (TAP), a gateway to information and services available to servicemembers transitioning to civilian life. However, the agencies are still in the process of implementing other key components of TAP. While originally planned for October 2013, agencies now plan to implement virtually all components by the end of March 2014, with full implementation expected by June 2014."

Correspondence issued by the Government Accountability Office with an abstract that begins "To operate as effectively and efficiently as possible and to make difficult decisions to address the federal government's fiscal challenges, Congress, the administration, and federal managers must have ready access to reliable and complete financial and performance information--both for individual federal entities and for the federal government as a whole. Overall, significant progress has been made since the enactment of key federal financial management reforms in the 1990s; however, GAO's report on the U.S. government's consolidated financial statements underscores that much work remains to improve federal financial management, and these improvements are urgently needed."

A letter report issued by the Government Accountability Office with an abstract that begins "GAO has identified five additional risks since its November 2010 report ( GAO-11-103 ) associated with using new technologies in the National Nuclear Security Administration's (NNSA) Uranium Processing Facility (UPF), which is to be built in three interrelated phases. These risks and the steps that NNSA is taking to address them include the following:"