Correspondence issued by the Government Accountability Office with an abstract that begins "Medicaid--the joint federal-state program that finances medical services for certain low-income adults and children--spent $15.0 billion on outpatient prescription drugs in fiscal year 2007. Instead of directly purchasing drugs, state Medicaid programs reimburse retail pharmacies for dispensing them to Medicaid beneficiaries. The federal government provides matching funds to states to help cover the costs of their Medicaid programs, and states must pay the remaining costs to qualify for these federal funds. For certain outpatient 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). Designed to control drug spending, FULs are currently calculated as 150 percent of a drug's lowest published price in three national drug pricing compendia. State Medicaid programs can determine reimbursements to retail pharmacies for each drug, but the federal government will only provide matching funds to the extent that reimbursements for all drugs subject to FULs do not exceed established FULs in the aggregate. A 2005 report by the Department of Health and Human Services' (HHS) Office of Inspector General (OIG) found that FULs were ineffective at controlling outpatient …

Correspondence issued by the Government Accountability Office with an abstract that begins "The American Recovery and Reinvestment Act of 2009 (Recovery Act) was enacted on February 17, 2009, to help stimulate the United States economy by creating new jobs, as well as saving existing ones, and investing in projects that will provide long-term economic benefits. Estimates show that the Recovery Act's combined spending and tax provisions will cost $787 billion over 10 years--about $207 billion in tax reductions plus about $580 billion in additional federal spending. These funds are being provided directly to federal agencies and also distributed to states, localities, other entities, and individuals through a combination of formula and competitive grants and direct assistance. About $280 billion of the funds will be administered through state and local governments. The Recovery Act delineates an important set of responsibilities for the accountability community. The inspectors general across government are expected to audit the programs, grants, and projects funded under the Recovery Act, both within their particular agency or department and collectively. To address the collective oversight at the federal level, the Recovery Act established the Recovery Accountability and Transparency Board to help prevent waste, fraud, and abuse. In addition, the …

Correspondence issued by the Government Accountability Office with an abstract that begins "Growing congestion on our nation's roads results in wasted time and fuel, which adversely affects the economy and the environment. State and local government agencies and private companies disseminate real-time traffic information to help travelers decide whether to use alternative, less congested routes. Legislation enacted in 2005 required the U.S. Department of Transportation (DOT) to establish the Real-Time System Management Information Program, in order to provide states the capability to monitor traffic and travel conditions on major highways and share that information. As requested, this GAO report addresses, among other things, (1) how the public and private sectors disseminate real-time traffic information to the public, (2) actions DOT has taken to establish the Real-Time System Management Information Program, and (3) experts' views on the need for a nationwide real-time traffic information system and its potential characteristics. To conduct this study, GAO visited sites in California and Florida, which have well-developed traffic information systems; reviewed and analyzed DOT reports and data; and interviewed transportation officials, experts, and other stakeholders. GAO is not making any recommendations at this time because DOT has not finalized the proposed rule it issued in …

Document issued by the Office of the Attorney General of Texas in Austin, Texas, providing an interpretation of Texas law. It provides the opinion of the Texas Attorney General, Greg Abbott, regarding a legal question submitted for clarification; Application of Education Code section 11.063 to former school district trustee placed in his district by a school staffing company (RQ-0806-GA)

Correspondence issued by the Government Accountability Office with an abstract that begins "The Fair Treatment for Experienced Pilots Act (the act) extended the federal age standard for pilots of large commercial aircraft from 60 to 65 years of age. The act also requires us to report--no later than 24 months after its enactment--on the effect, if any, of this change on aviation safety. This report responds to that requirement."

Correspondence issued by the Government Accountability Office with an abstract that begins "On December 22, 2008, a breach in a surface impoundment (or storage pond) dike at the Tennessee Valley Authority (TVA) Kingston Fossil Plant in Tennessee resulted in the release of 5.4 million cubic yards of coal ash--also referred to as coal combustion residue (CCR)--into the nearby Emory River. The spill covered more than 300 acres and made 3 homes uninhabitable; it damaged 23 other homes, plus roads, rail lines, and utilities. TVA estimated the cleanup will cost between $933 million and $1.2 billion and take 2 to 3 years to complete. In light of the spill in Kingston, Congress asked us to identify: (1) the number of surface impoundments for storing CCR in the United States and their location; (2) problems, if any, with the storage of coal ash, and how those problems are being addressed; and (3) the type of federal oversight that exists for CCR and what, if any, issues need to be resolved. We briefed your staffs on October 1, 2009, and September 28, 2009, respectively, on the results of this work. This report summarizes and transmits that briefing. The full briefing is reprinted in …

Correspondence issued by the Government Accountability Office with an abstract that begins "The Civil Rights Division (Division) of the Department of Justice (DOJ) is the primary federal entity charged with enforcing federal statutes prohibiting discrimination on the basis of race, sex, disability, religion, and national origin in such areas as voting, employment, housing, public accommodations, the rights of institutionalized persons, and education. Each year, the Division initiates thousands of matters, which may consist of the investigation of an allegation of discrimination, and participates in hundreds of cases to carry out its broad enforcement responsibilities. Over the past 20 years, the Division has used various case management systems to manage its workload. In October 2000, the Division implemented the Interactive Case Management System (ICM) as its official system to track, count, and capture performance measurement information for all matters and cases from their inception to their conclusion and to assist staff in their casework. According to Division documentation, ICM was also designed to serve as a tool for senior management to oversee the work of the Division and to assist senior managers in reporting accurate matter and case data at all levels of the organization, improving accountability, analyzing the Division's performance, …

Testimony issued by the Government Accountability Office with an abstract that begins "A comprehensive system to alert the American people in times of hazard allows people to take action to save lives. The Federal Emergency Management Agency (FEMA) is the agency within the Department of Homeland Security (DHS) responsible for the current Emergency Alert System (EAS) and the development of the new Integrated Public Alert and Warning System (IPAWS). In this testimony, based on its report released today, GAO discusses (1) the current status of EAS, (2) the progress made by FEMA in implementing an integrated alert and warning system, and (3) coordination issues involved in implementing an integrated alert and warning system. GAO conducted a survey of states, reviewed FEMA and other documentation, and interviewed industry stakeholders and officials from federal agencies responsible for public alerting."

A statement of record issued by the Government Accountability Office with an abstract that begins "Biennially, the Judicial Conference, the federal judiciary's principal policymaking body, assesses the need for additional judges. The assessment is based on a variety of factors, but begins with quantitative case-related workload measures. This statement focuses on (1) whether the judiciary's quantitative case-related workload measures from 1993 were reasonably accurate; and (2) the reasonableness of any proposed methodologies to update the 1993 workload measures. This statement is based on work completed and reported in 2003 and discussed in testimony on June 17, 2008."

Correspondence issued by the Government Accountability Office with an abstract that begins "This letter formally transmits the briefing slides in response to section 1119 of Pub. L. No. 110-315, the Higher Education Opportunity Act. This act mandated GAO study the financial and compliance audits and reviews required or conducted for the Federal Family Education Loan and Federal Direct Loan Programs. On August 6 and 7, 2009, we briefed the staff of congressional committees on the types of audits, reviews, agreed-upon procedures, and reconciliations that are required or conducted for these programs. At congressional request, we have incorporated additional information on the agreed-upon procedures engagements required by the Ensuring Continued Access to Student Loans Act and the reconciliations performed by the Department of Education's Office of Federal Student Aid. In a forthcoming report, we will provide an assessment of whether these audits and reviews as designed provide comparable coverage of the two loan programs. That report will also discuss how the Department of Education ensures that these audits and reviews comply with statutory and regulatory requirements and how the Department uses them to oversee these loan programs."

Testimony issued by the Government Accountability Office with an abstract that begins "This testimony discusses (1) continuing indications of fraud and abuse related to controlled substances paid for by Medicaid; (2) specific case study examples of fraudulent, improper, or abusive controlled substance activity; and (3) the effectiveness of internal controls that the federal government and selected states have in place to prevent and detect fraud and abuse related to controlled substances. To identify whether there are continuing indications of fraud and abuse related to controlled substances paid for by Medicaid, we obtained and analyzed Medicaid claims paid in fiscal years 2006 and 2007 from five states: California, Illinois, New York, North Carolina, and Texas. To identify indications of fraud and abuse related to controlled substances paid for by Medicaid, we obtained and analyzed Medicaid prescription claims data for these five states from the Centers for Medicare & Medicaid Services (CMS). To identify other potential fraud and improper payments, we compared the beneficiary and prescriber shown on the Medicaid claims to the Death Master Files (DMF) from the Social Security Administration (SSA) to identify deceased beneficiaries and prescribers. To identify claims that were improperly processed and paid by the Medicaid program …

Correspondence issued by the Government Accountability Office with an abstract that begins "The Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for administering the Medicare program for nearly 45 million beneficiaries, including beneficiaries with limited English proficiency (LEP)--meaning they may not be proficient or are limited in their ability to communicate in the English language. Medicare beneficiaries face a complex set of health care choices that require them to obtain information about the comparative benefits, costs, and quality of available options. CMS is responsible for providing clear, accurate, and timely information about this program and making the information accessible to beneficiaries. Under section 601 of Title VI of the Civil Rights Act of 1964, entities that receive federal financial assistance are prohibited from discriminating against or otherwise excluding individuals from their programs or activities on the basis of race, color, or national origin. In 1964, as directed under section 602 of Title VI, HHS first published regulations applying these prohibitions to entities receiving federal financial assistance from HHS, including health care organizations. In 2000, Executive Order 13166 was published, requiring federal agencies to take certain step to clarify Title …

Testimony issued by the Government Accountability Office with an abstract that begins "The U.S. Postal Service's (USPS) financial condition has worsened this year, with the recession and changing mail use causing declines in mail volume and revenues despite postal rate increases. GAO testified in May to this subcommittee that USPS expects these declines to lead to a record net loss and an unprecedented cash shortfall even if ambitious cost cutting is achieved. GAO reported that maintaining USPS's financial viability as the provider of affordable, high-quality universal postal service will require actions in a number of areas, such as (1) rightsizing its retail and mail processing networks by consolidating operations and closing unnecessary facilities and (2) reducing the cost and size of its workforce, which generates about 80 percent of its costs. Today GAO is releasing its report on USPS efforts to improve the efficiency of delivery. Delivery accounts for nearly half of USPS salary and benefit costs. This testimony (1) updates USPS's financial condition and outlook and explains GAO's decision to place USPS's financial condition on the High-Risk List and (2) discusses the need for USPS to restructure its mail processing, retail, and delivery networks and its efforts to improve …

Correspondence issued by the Government Accountability Office with an abstract that begins "In 2008, the United Nations (UN) began construction associated with its Capital Master Plan (CMP) to renovate its headquarters complex in New York City. As the UN's host country and largest contributor, the United States has a substantial interest in the success of the CMP. In this requested update, GAO reviewed the following key areas: schedule, cost, funding, risk management, procurement, and oversight. To perform this work, GAO reviewed UN documents and met with officials from the CMP office and other UN departments. GAO also reviewed select CMP schedules to assess the extent to which they met best practices for scheduling contained in GAO's Cost Estimating and Assessment Guide. To assess oversight and monitoring, GAO reviewed UN documents and oversight reports and interviewed officials from the UN's Office of Internal Oversight Services and officials from the U.S. Department of State (State)."

Correspondence issued by the Government Accountability Office with an abstract that begins "This letter responds to congressional request that GAO address additional questions arising from the May 19, 2009, hearing on federal information security held by the Subcommittee on Government Management, Organization, and Procurement. In that hearing, we discussed the current state of information security throughout the federal government and agency efforts to comply with the requirements of the Federal Information Security Management Act of 2002 (FISMA). Congress had the following two questions: (1) Please comment on the need for improved cyber security relating to S.773, the proposed Cybersecurity Act of 2009; and (2) Please provide recommendations to improve the Federal Information Security Management Act."

Correspondence issued by the Government Accountability Office with an abstract that begins "The Highway Trust Fund (HTF) was created in 1956 to finance the construction of the Interstate Highway System. This system, built in partnership with state and local governments for over 50 years, has become central to transportation in the United States. Over these 50 years, the federal role in surface transportation has expanded to include broader goals and more programs. Although most surface transportation funds remain dedicated to highway infrastructure, federal surface transportation programs now serve additional transportation, environmental, and societal purposes such as construction of pedestrian walkways and safety enforcement facilities along border regions. The 2005 Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU) authorized $244.1 billion over 5 years for highways, highway safety, and public transportation, with the HTF serving as the funding source for most of the act's programs. In addition to authorizing funds for construction and maintenance of highways and bridges, the act specifies other purposes for which funding must or may be used, including, but not limited to, safety; metropolitan planning; transit; and transportation enhancement activities, such as trails for transportation purposes, pedestrian walkways, bicycle lanes and parking, and …

Correspondence issued by the Government Accountability Office with an abstract that begins "The five largest insular areas of the United States--American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico, and the U.S. Virgin Islands--receive federal funding through Medicaid and the State Children's Health Insurance Program (CHIP), joint federal-state programs that finance health care for certain low-income individuals. These programs are administered and funded differently in the insular areas when compared to the states. For example, while states must extend Medicaid eligibility to certain individuals whose incomes are at or below a percentage of the federal poverty level (FPL), the insular areas are not required to cover this population. In addition, under both Medicaid and CHIP, the federal government matches state or local government spending. However, federal law establishes the federal matching rate for expenditures by the insular areas at the lowest rate available to states, while matching rates for the states are determined each year based on a formula that takes into account variations in per capita income in each state. Furthermore, federal Medicaid spending in the insular areas is subject to an annual limit that does not apply to the states. Finally, while CHIP funding …

Correspondence issued by the Government Accountability Office with an abstract that begins "The Recovery Act established relatively few requirements for the design of the TIGER grant program. In addition to the requirements outlined in the opening paragraph of this report, the act requires that the department (1) award grants of no less than $20 million and no more than $300 million with no more than $300 million awarded for projects in any one state; (2) give priority to projects that are expected to be completed by February 17, 2012; (3) give priority to projects that require a contribution of federal funds in order to complete an overall financing package, although the federal share of the costs for which expenditure is made may be 100 percent; and (4) ensure a balance in addressing the needs of rural and urban communities and an equitable geographic distribution of funds. In its May 18 interim notice, the department created two tiers of selection criteria--primary and secondary. The primary selection criteria are (1) long-term outcomes (state of good repair, economic competitiveness, livability, sustainability, and safety) and (2) jobs creation and economic stimulus. The secondary criteria are innovation and partnership. Within each criterion, the department has …

Correspondence issued by the Government Accountability Office with an abstract that begins "Over the past 25 years, farmers have received a decreasing share of the consumer food dollar. Some analysts and farm interest groups are concerned that this decline can be attributed, in part, to increasing concentration in agriculture. They believe that firms in highly concentrated markets may be able to exert market power by raising retail food prices while also depressing prices farmers receive for agricultural commodities. Others have argued that concentration has facilitated changes, such as technological innovations, that have improved productivity and served to lower food prices while increasing some farm incomes. The influence of any one factor, such as concentration, in determining agricultural commodity and retail food prices (commodity and food prices) varies and is difficult to isolate. Our prior work has noted that concentration may be one of a number of factors that can influence prices along the food marketing chain from farms to food processors, retail stores, and finally, consumers. To better understand the impact of concentration on commodity and food prices, economists have used a variety of analytical techniques and data sets. However, their work has been complicated by various issues, such as …

Correspondence issued by the Government Accountability Office with an abstract that begins "On May 13, 2008, the President submitted to Congress a proposed Agreement Between the Government of the United States of America and the Government of the Russian Federation for Cooperation in the Field of Peaceful Uses of Nuclear Energy (henceforth referred to as the U.S.-Russia 123 agreement) in accordance with the review requirements established under Section 123 of the Atomic Energy Act of 1954 (AEA), as amended. The United States has agreements for peaceful nuclear cooperation governing nuclear exports to nearly 50 countries, Taiwan, and the International Atomic Energy Agency (IAEA). Such agreements provide the framework and authorization for civilian nuclear cooperation, but do not guarantee that cooperation will take place or that nuclear material or technology transfers will occur. The proposed agreement with Russia would, among other things, establish the legal basis for the Department of Energy (DOE) to work with Russia on large-scale development of nuclear energy. However, owing to Russia's status as a nuclear weapons state, the size of its nuclear complex, and past proliferation concerns, including weaknesses in the Russian export control system, an agreement for peaceful nuclear cooperation between the United States and …

Testimony issued by the Government Accountability Office with an abstract that begins "Since 1990, GAO has designated the Department of Defense's (DOD) management of its major weapon acquisitions as a high-risk area; however DOD's problems delivering weapon systems on time, at the estimated cost, in the planned amounts, and with the promised performance go back decades. Congress and DOD have continually explored ways to improve acquisition outcomes, yet problems persist. The committee asked GAO to testify on measures needed to reform the acquisition of major weapon systems and related legislative proposals. Specifically, this statement will describe the poor outcomes on weapon system investments that make reform imperative; attributes of the requirements, funding, and acquisition processes that will need to change for reform to be effective; and positive steps that Congress and DOD have taken to improve weapon program outcomes. The statement will also examine other factors that should be considered as the committee moves forward with its reform efforts. The testimony is drawn from GAO's body of work on DOD's requirements, funding, and acquisition processes. GAO has made numerous recommendations aimed at improving DOD's management of its major weapon acquisitions, but it is not making any new recommendations in this …

Correspondence issued by the Government Accountability Office with an abstract that begins "Recent increases in prescription drug costs have been fueled in part by the high and rising cost of specialty prescription drugs. Specialty prescription drugs are typically used to treat chronic or life-threatening conditions, such as multiple sclerosis and cancer, for which few other treatment options exist. The drugs typically have few competitors or generic alternatives and may require frequent dosage adjustment, special storage, patient education, or special methods of administration, such as by injection. Costs for specialty prescription drugs are usually high, typically ranging from $1,200 to $40,000 for a 30-day supply. Health plans--including those participating in the Federal Employees Health Benefits Program (FEHBP), which covers nearly 8 million federal employees, dependents, and retirees-- provide coverage for many specialty drugs. Enrollees may be required to pay a portion of specialty drug costs through a copayment--a flat dollar amount--or coinsurance--a percentage share of the drug's actual costs. To manage the high and rising costs of these drugs, some health plans have begun to require enrollees to contribute a greater share of their costs, such as by increasing the use of coinsurance. Congress asked us to examine the costs that …

Testimony issued by the Government Accountability Office with an abstract that begins "Health centers funded through grants under the Health Center Program--managed by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS)--provide comprehensive primary care services for the medically underserved. The statement GAO is issuing today summarizes an August 2008 report, Health Resources and Services Administration: Many Underserved Areas Lack a Health Center Site, and the Health Center Program Needs More Oversight (GAO-08-723). In that report, GAO examined to what extent medically underserved areas (MUA) lacked health center sites in 2006 and 2007. To do this, GAO obtained and analyzed HRSA data and grant application"

Other written product issued by the Government Accountability Office with an abstract that begins "This is an e-supplement to GAO-09-347. This document presents a bibliography of a literature review conducted as part of our work on emergency department crowding (GAO-09-347). As part of our work to analyze and report on information made available since 2003 about (1) three indicators of emergency department crowding--ambulance diversion, wait times, and patient boarding, and (2) factors that contribute to emergency department crowding, we conducted a literature review of 197 articles, including articles published in peer-reviewed and other periodicals, publications from professional, research, and other organizations, and reports issued by federal and state agencies. In examining the information made available since 2003 about indicators of crowding during our literature review, we also analyzed articles for what was reported on the effect of crowding on patient quality of care and proposed strategies to address crowding. In order to obtain these articles, we conducted structured searches of 16 research databases and obtained articles identified as a result of interviews with federal officials, professional and research organizations, and subject-matter experts, and through searches of related Web sites. We reviewed 197 articles, publications, and reports (which we call articles) …