A publication issued by the Government Accountability Office with an abstract that begins "In fiscal year 2010, the Department of Veterans Affairs (VA) provided health care to about 5.2 million veterans. Recent legislation has increased many Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) veterans' priority for accessing VA's health care, and concerns have been raised about the extent to which VA is providing mental health care to eligible veterans of all eras. There also are concerns that barriers may hinder some veterans from accessing needed mental health care. GAO was asked to provide information on veterans who receive mental health care from VA. In this report, GAO provides information on (1) how many veterans received mental health care from VA from fiscal years 2006 through 2010, (2) key barriers that may hinder veterans from accessing mental health care from VA, and (3) VA efforts to increase veterans' access to VA mental health care. GAO obtained data from VA's Northeast Program Evaluation Center (NEPEC) on the number of veterans who received mental health care from VA. The number of veterans represents a unique count of veterans; veterans were counted only once, even if they received care multiple times during a …

A publication issued by the Government Accountability Office with an abstract that begins "This testimony discusses our recent work on the Coast Guard's Deepwater acquisition, which represents the majority of the Coast Guard's efforts to recapitalize its fleet of vessels and aircraft. This statement is based on our July 28, 2011, report, Coast Guard: Action Needed as Approved Deepwater Program Remains Unachievable. This report discusses areas in which the Coast Guard has strengthened its acquisition management capabilities but also emphasizes actions the Coast Guard needs to take to address the cost growth, schedule delays, and capability shortfalls that have made the approved Deepwater Program unachievable. Today's climate of rapidly building fiscal pressures underscores the importance of assessing priorities--from a Coast Guard-wide perspective--so that more realistic budgets can be submitted to Congress. Such a step would help alleviate what has become a pattern of churn in revising program baselines when unrealistic planned funding does not materialize, which contributes to schedule delays and can lead to other issues such as unhealthy competition for funding. We also recognize several steps that the Coast Guard has taken to improve the management of the Deepwater Program. For example, the Coast Guard has updated its Major …

A publication issued by the Government Accountability Office with an abstract that begins "The Justice Department has reported that Indians are at least twice as likely to be raped or sexually assaulted as all other races in the United States. Indians living in remote areas may be days away from health care facilities providing medical forensic exams, which collect evidence related to an assault for use in criminal prosecution. The principal health care provider for Indians, which operates or funds tribes to operate 45 hospitals, is the Department of Health and Human Services' Indian Health Service (IHS). In response to a Tribal Law and Order Act of 2010 mandate, GAO examined (1) the ability of IHS and tribally operated hospitals to collect and preserve medical forensic evidence involving cases of sexual assault and domestic violence, as needed for criminal prosecution; (2) what challenges, if any, these hospitals face in collecting and preserving such evidence; and (3) what factors besides medical forensic evidence contribute to a decision to prosecute such cases. GAO surveyed all 45 IHS and tribally operated hospitals and interviewed IHS and law enforcement officials and prosecutors.."

Testimony issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) must get better outcomes from its weapon system investments, which in recent years have totaled around $1.5 trillion or more. Recently, there have been some improvements, owing in part to reforms. For example, cost growth declined between 2011 and 2012 and a number of programs also improved their buying power by finding efficiencies in development or production and requirements changes. Still, cost and schedule growth remain significant; 39 percent of fiscal 2012 programs have had unit cost growth of 25 percent or more."

A publication issued by the Government Accountability Office with an abstract that begins "This testimony discusses the effects of the recent recession on older adults. While the recession officially ended in June 2009, our economy has experienced a weak recovery, with unemployment still above 9 percent. Older adults--particularly those close to or in retirement--may not have the same opportunities as younger adults to recover from the recession's effects. For example, older adults--generally those 55 and older--may have insufficient time to rebuild their depleted retirement savings due to sharp declines in financial markets and home equity, and increased medical costs. Further, while older workers are less likely to be unemployed than workers in younger age groups, when older workers lose a job they are less likely to find other employment. These changes have intensified older adults' concerns about having sufficient savings now and adequate income throughout retirement. Social Security forms the foundation of income for nearly all retiree households, providing 36 percent of aggregate income for households with a member aged 65 and older; however, it provides a much greater portion of income for low and middle income households. Pensions and assets together provide 31 percent of aggregate income. However, many …

A publication issued by the Government Accountability Office with an abstract that begins "Since 1992, GAO has published long-term fiscal simulations showing federal deficits and debt under different sets of assumptions. GAO developed its long-term model in response to a bipartisan request from members of Congress concerned about the long-term effects of fiscal policy. GAO's simulations provide context for consideration of policy options. They are not intended to suggest particular policy choices but rather to help facilitate a dialogue on this important issue. GAO regularly updates its simulations as new data become available from the Congressional Budget Office (CBO) and the Social Security and Medicare Trustees (Trustees). This update incorporates provisions of the Budget Control Act. As in the past, GAO shows two simulations: The Baseline Extended simulation follows CBO's August 2011 baseline for the first 10 years and then holds revenue and spending other than interest on the debt and large entitlement programs (Social Security, Medicare, and Medicaid) constant as a share of gross domestic product (GDP). Revenue as a share of GDP over the entire period is higher than the historical averages; discretionary spending is below average. In the Alternative simulation, expiring tax provisions other than the temporary …

Correspondence issued by the Government Accountability Office with an abstract that begins "In 2010, the 55 highest-expenditure Part B drugs represented $16.9 billion in spending, or about 85 percent of all Medicare spending on Part B drugs, which totaled $19.5 billion. The number of Medicare beneficiaries who received each of these drugs varied from 15.2 million receiving the influenza vaccines to 660 hemophilia A patients receiving a group of biologicals known collectively as factor viii recombinant, which had the largest average annual cost per beneficiary--$217,000. Our analysis showed that most of the 55 drugs increased in expenditures, prices, and average annual cost per beneficiary from 2008 to 2010. The 5 drugs with the largest increase in Medicare expenditures over this time period also had the largest increase in the number of beneficiaries receiving each drug. Four of the 10 drugs which showed the greatest increase in expenditures were also among the 10 drugs showing the greatest price increases."

Other written product issued by the Government Accountability Office with an abstract that begins "The Rehabilitation Act of 1973 (Rehabilitation Act) requires agencies to take proactive steps to provide equal opportunity to qualified individuals with disabilities, but their rate of employment with the federal government remains low. GAO was asked to identify barriers to the employment of people with disabilities in the federal workforce and leading practices that could be used to overcome these barriers. On July 20, 2010, GAO convened a forum to identify leading practices that federal agencies could implement within the current legislative context. In preparation for the forum, GAO surveyed a wide range of knowledgeable individuals to identify barriers and leading practices. Forum participants were selected from among respondents (or their representatives) to reflect varying expertise and views concerning the employment of individuals with disabilities. The survey results formed the basis for the initial forum agenda, and were refined by participants to focus on actions they deemed most important. Comments in this report do not necessarily represent the views of any individual participant or the organizations that these participants represent or with which they are affiliated, including GAO."

A publication issued by the Government Accountability Office with an abstract that begins "After the Army canceled the Future Combat System in June of 2009, it began developing modernization plans, including developing a new Ground Combat Vehicle (GCV) and additional network capability. At the same time, the Army was considering options on how to improve its light tactical vehicles. This statement addresses potential issues related to developing (1) the new GCV, (2) a common information network, and (3) the Joint Light Tactical Vehicle (JLTV) in a constrained budget environment. The statement is based largely on previous GAO work conducted over the last year in response to congressional requests and results of other reviews of Army modernization. To conduct this work, GAO analyzed program documentation, strategies, and test results; interviewed independent experts and Army and Department of Defense (DOD) officials; and witnessed demonstrations of current and emerging network technologies. DOD reviewed the facts contained in this statement and provided technical comments, which were incorporated as appropriate."

Testimony issued by the Government Accountability Office with an abstract that begins "As of June 30, 2013, the U.S. Agency for International Development (USAID) had obligated $336 million (52 percent) and disbursed $229.5 million (35 percent) of $651 million in funding for Haiti earthquake reconstruction from the Supplemental Appropriations Act, 2010."

Correspondence issued by the Government Accountability Office with an abstract that begins "Many of our nation's children have difficulty accessing needed health care services. In 2008, the Robert Wood Johnson Foundation reported that about 25 percent of children with insurance and about 55 percent of uninsured children did not receive a recommended routine checkup within the previous year. According to the Department of Health and Human Services (HHS), children face growing risks from chronic physical conditions such as asthma and obesity and from mental health disorders such as depression, and yet, as we have reported, their access to services may be impeded by a number of barriers, including a lack of health insurance and a lack of convenient transportation to medical appointments. Access to mental health care services may also be impeded by concerns about stigma--negative attitudes and beliefs often associated with receiving such care--which can be a deterrent to seeking these services. To help increase children's access to primary health care and other health care services, states and communities have established school-based health centers (SBHC). SBHCs are located on school grounds, provide health care services regardless of ability to pay, and offer a broader range of services than a …

A publication issued by the Government Accountability Office with an abstract that begins "This testimony discusses the results of our investigation of fraud and prescription drug abuse in Medicare Part D. Prescription drug abuse is a serious and growing public health problem. According to the Centers for Disease Control and Prevention, drug overdoses, including those from prescription drugs, are the second leading cause of deaths from unintentional injuries in the United States, exceeded only by motor vehicle fatalities. Unlike addiction to heroin and other drugs that have no accepted medical use, addiction to some controlled substances can be unknowingly financed by insurance companies and public programs, such as Medicare Part D. This statement today summarizes our report, describing indications of doctor shopping in the Medicare Part D program for 14 categories of frequently abused prescription drugs. The objectives of the forensic audit and related investigation were to (1) determine the extent to which Medicare beneficiaries obtained frequently abused drugs from multiple prescribers, (2) identify examples of doctor shopping activity, and (3) determine the actions taken by the Centers for Medicaid & Medicare Services (CMS) to limit access to drugs for known abusers."

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."

Correspondence issued by the Government Accountability Office with an abstract that begins "On July 21, 2010, we testified to Congress on the Department of Homeland Security's (DHS) progress and challenges in key areas of port security. Members of the committee requested that we provide additional comments to a number of post hearing questions. The responses are based on work associated with previously issued GAO products and also include selected updates--conducted in September 2010--to the information provided in these products."

Correspondence issued by the Government Accountability Office with an abstract that begins "Realistic training ranges are one of the most valued assets the military has in preparing its personnel for their missions. Realistic training requires access to areas and environments that closely match the locations where the military may face combat or complex situations. International events, changes in strategy, force structure, base closures, and population growth are increasing the challenges the military faces in training its personnel to be prepared to defend the nation. Moreover, the military services report that they have increasingly lost training range capabilities because of factors such as encroachment. To respond to these challenges and increase the sustainability of military ranges, the Department of Defense (DOD) has launched a number of efforts aimed at preserving training ranges while also minimizing adverse environmental effects of training activities. As required by section 366(a) of the Bob Stump National Defense Authorization Act for Fiscal Year 2003 (as amended), DOD was to submit a comprehensive plan for using existing authorities available to the department to address training constraints caused by limitations on the use of worldwide military lands, marine areas, and airspace to Congress at the same time as the …

Correspondence issued by the Government Accountability Office with an abstract that begins "In November 1988, the Capitol Preservation Commission (Commission) was established for the purpose of providing for improvements in, preservation of, and acquisitions for the United States Capitol. At the same time, the Capitol Preservation Fund (Fund) was established within the U.S. Treasury (Treasury) and was made available to the Commission to provide financing for the Commission to carry out its purpose. The Library of Congress (Library) provides financial management services and support to the Commission. GAO is required to audit the transactions of the Commission and report the results to the Congress. This report presents the results of our audit of the Commission's transactions as recorded in the Fund during fiscal years 2008 through 2010. Our audit objectives were to determine whether (1) the Fund's recorded transactions for fiscal years 2008 through 2010 were authorized in advance, supported by documentation, accurately accounted for, and in compliance with applicable laws: and (2) operating, reporting, and oversight practices were documented and in place at the Commission and the Library to help ensure that Fund transactions were properly executed and Fund assets were adequately safeguarded."

Testimony issued by the Government Accountability Office with an abstract that begins "The Social Security Administration's (SSA) Supplemental Security Income (SSI) program provides cash benefits to eligible low-income disabled individuals, including children, as well as certain others. Children may generally qualify for SSI benefits if they meet certain financial requirements and are deemed to have a qualifying medically determinable physical or mental impairment of a specified duration or severity that results in a functional limitation. In 2010, SSA paid more than $9 billion to about 1.2 million disabled children. Over the past decade, the overall number of children receiving SSI benefits has continued to rise. In this statement, GAO discusses initial observations from its ongoing review and examines (1) the trends in the rate of children receiving SSI benefits due to mental impairments over the past decade; (2) the role that medical and nonmedical information, such as medication and school records, play in the initial determination of a child's medical eligibility; and (3) the steps SSA has taken to monitor the continued medical eligibility of these children. To examine these issues, GAO analyzed program data, interviewed SSA officials, conducted site visits to SSA field offices and state disability determination services …

A statement of record issued by the Government Accountability Office with an abstract that begins "A breakdown in information sharing was a major factor contributing to the failure to prevent the September 11, 2001, terrorist attacks. Since then, federal, state, and local governments have taken steps to improve sharing. This statement focuses on government efforts to (1) establish the Information Sharing Environment (ISE), a government-wide approach that facilitates the sharing of terrorism-related information; (2) support fusion centers, where states collaborate with federal agencies to improve sharing; (3) provide other support to state and local agencies to enhance sharing; and (4) strengthen use of the terrorist watchlist. GAO's comments are based on products issued from September 2010 through July 2011 and selected updates in September 2011. For the updates, GAO reviewed reports on the status of Department of Homeland Security (DHS) efforts to support fusion centers, and interviewed DHS officials regarding these efforts. This statement also includes preliminary observations based on GAO's ongoing watchlist work. For this work, GAO is analyzing the guidance used by agencies to nominate individuals to the watchlist and agency procedures for screening individuals against the list, and is interviewing relevant officials from law enforcement and intelligence …

A publication issued by the Government Accountability Office with an abstract that begins "This testimony discusses the Federal government's use of suspensions and debarments. In 2010, spending on contracted goods and services was more than $535 billion. To protect the government's interests, federal agencies are required to award contracts only to responsible sources--those that are determined to be reliable, dependable, and capable of performing required work. One way to do so is through the use of suspensions and debarments, which are actions taken to exclude firms or individuals from receiving contracts or assistance based on various types of misconduct. The Federal Acquisition Regulation (FAR) prescribes overall policies and procedures governing the suspension and debarment of contractors by agencies and directs agencies to establish appropriate procedures to implement them. This flexibility enables each agency to establish a suspension and debarment program suitable to its mission and structure. Even though the FAR specifies numerous causes for suspensions and debarments, including fraud, theft, bribery, tax evasion, or lack of business integrity, the existence of one of these does not necessarily require that the party be suspended or debarred. Agencies are to establish procedures for prompt reporting, investigation, and referral to the agency suspension …

Correspondence issued by the Government Accountability Office with an abstract that begins "To help ensure that millions of Americans who rely on private insurance for health care coverage receive value for their premium dollars, the Patient Protection and Affordable Care Act (PPACA) established minimum "medical loss ratio" (MLR) standards for insurers. The MLR is a basic financial indicator, traditionally referring to the percentage of insurance premium revenues health insurers spent on their enrollees' medical claims. The MLR definition specified in the PPACA provision-- referred to as the PPACA MLR in this report--differs from the traditional MLR definition. Key differences are that the PPACA MLR allows insurers to include in their expenses spending on activities to improve health care quality and to deduct from their revenues certain tax payments and fees, and these differences will generally increase insurers' MLRs. Beginning in 2011, PPACA required insurers to meet minimum PPACA MLR standards of 85 percent in the large group market and 80 percent in the small group and individual markets or pay rebates to their enrollees. In implementing these MLR requirements, the Department of Health and Human Services (HHS) includes an adjustment for certain insurers to help address the disproportionate impact of …

Testimony issued by the Government Accountability Office with an abstract that begins "Multiple executive branch agencies are responsible for different steps of the multi-phased personnel security clearance process that includes: determination of whether a position requires a clearance, application submission, investigation, and adjudication. Agency officials must first determine whether a federal civilian position requires access to classified information. The Director of National Intelligence (DNI) and the Office of Personnel Management (OPM) are in the process of issuing a joint revision to the regulations guiding this step in response to GAO's 2012 recommendation that the DNI issue policy and guidance for the determination, review, and validation of requirements. After an individual has been selected for a federal civilian position that requires a personnel security clearance and the individual submits an application for a clearance, investigators--often contractors--from OPM conduct background investigations for most executive branch agencies. Adjudicators from requesting agencies use the information from these investigations and consider federal adjudicative guidelines to determine whether an applicant is eligible for a clearance. Further, individuals are subject to reinvestigations at intervals that are dependent on the level of security clearance. For example, top secret and secret clearance holders are to be reinvestigated every 5 …

A publication issued by the Government Accountability Office with an abstract that begins "The Office of Personnel Management (OPM) is responsible for administering the Civil Service Retirement System (CSRS), including the United States Postal Service (USPS) CSRS benefits. Two independent agencies--USPS Office of Inspector General (OIG) and Postal Regulatory Commission (PRC)--have issued reports stating that OPM's current method of allocating responsibility for CSRS benefits allocates a disproportionately large share to USPS. The USPS OIG and the PRC proposed alternate methodologies that they estimate would shift responsibility for from $56 billion to $85 billion in CSRS benefits from USPS to the federal government. GAO's objectives were to comment on (1) whether OPM's current methodology for allocating responsibility for CSRS benefits between USPS and the federal government is consistent with the law, (2) the analysis used by the USPS OIG and PRC to conclude that OPM should refund the CSRS contributions in question, (3) the potential impacts such a refund would have on the CSRS fund and CSRS stakeholders, and (4) the potential impacts that such a refund would have on USPS's financial outlook. GAO reviewed legislation regarding the allocation of responsibility for CSRS benefits and methodologies used in all three reports. …

A publication issued by the Government Accountability Office with an abstract that begins "In fiscal year 2010, the Department of Defense (DOD) spent billions of dollars to move troops and materiel into Afghanistan, a mountainous, land-locked country with poorly developed infrastructure. The increase of 30,000 U.S. troops in Afghanistan as of August 2010, along with thousands of civilians and contractors supporting U.S. efforts, have required further development of DOD's already-complex distribution network to support and sustain U.S. military presence in Afghanistan. GAO conducted this review to assess distribution issues in Afghanistan, including (1) DOD's oversight of distribution operations; (2) DOD's performance in providing supplies and equipment; and (3) challenges that have affected DOD's ability to provide supplies and equipment. GAO reviewed joint doctrine and DOD policies on distribution, analyzed DOD delivery data, and interviewed DOD officials in the United States and in the U.S. Central Command area of responsibility, including Afghanistan, Pakistan, Kuwait, Qatar, and Bahrain."

A publication issued by the Government Accountability Office with an abstract that begins "Over the last 10 fiscal years, federal agencies have increased their spending on construction contracts, leading to obligations of almost $54 billion in fiscal year 2010. When awarding contracts, the Federal Acquisition Regulation (FAR) requires agencies to consider firms' performance records to help ensure that taxpayer dollars go to capable contractors. The FAR also provides agencies with broad discretion in deciding how they will consider firms' prior experience, which refers to whether the firms have done similar work before, and past performance, which describes how well they have done that work. As construction firms without prior federal contracting experience seek to gain entry into the federal marketplace, some may regard the consideration of these factors as an impediment. In response to your request for information on the consideration of prior experience and past performance, we reviewed (1) how selected agencies consider prior experience and past performance in awarding construction contracts and (2) the resources available to assist firms in gaining entry to the federal marketplace."