A letter report issued by the Government Accountability Office with an abstract that begins "Changes in the air ambulance industry's size and structure have led to differences of opinion about the implications for air ambulance use, safety, and services. Some industry stakeholders believe that greater state regulation would be good for consumers. While states can regulate the medical aspects of air ambulances, the Airline Deregulation Act (ADA) preempts states from economic regulation--i.e., regulating rates, routes, and services--of air ambulances. Other stakeholders view the industry changes as having been beneficial to consumers and see no need for a regulatory change. Asked to review the U.S. air ambulance industry, GAO examined (1) changes in the industry in the last decade and the implications of these changes on the availability of air ambulances and patient services and (2) the relationship between federal and state oversight and regulation of the industry. GAO analyzed available data about the industry; synthesized empirically based literature on the industry; visited four air ambulance providers with differing views on the industry changes; and interviewed federal and industry officials."

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 "U.S. Northern Command (NORTHCOM) and U.S. Pacific Command (PACOM) are updating their existing civil support plans to include a complex catastrophe scenario, as directed by the Secretary of Defense and the Joint Staff. However, the commands are delaying the identification of capabilities that could be provided to execute the plans until the Federal Emergency Management Agency (FEMA), the lead federal response agency, completes its regional planning efforts in 2018. NORTHCOM officials told us that the command's civil support plan would describe some general force requirements, such as types of military units, but that it will not identify specific capabilities that could be provided to civil authorities during a complex catastrophe. Similarly, according to PACOM officials, PACOM's plan also will not identify such capabilities. Still, defense coordinating officers--senior military officers who work closely with federal, state, and local officials in FEMA's regional offices--have taken some initial steps to coordinate with FEMA during its regional planning process to identify capabilities that the Department of Defense (DOD) may be required to provide in some regions. For example, a defense coordinating officer has helped one of the FEMA regions that …

A letter report issued by the Government Accountability Office with an abstract that begins "The Census Bureau (Bureau) and U.S. Postal Service (USPS) collaborated on aspects of the 2010 Census and prior decennials, and those efforts generally went well in such areas as address list development. But both agencies face challenges: the Bureau needs to control the escalating cost of the decennial census and maintain its accuracy, while USPS must improve its financial condition. As requested, GAO examined opportunities to enhance collaboration in such areas as technology, personnel, and facilities that could improve the cost-effectiveness of the 2020 Census and generate revenue for USPS. GAO analyzed Bureau and USPS data and documents, compared the agencies' existing collaborative efforts with prior GAO work, and interviewed agency officials."

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 "The Department of Defense (DOD) positions equipment and supplies at strategic locations around the world to enable it to field combat-ready forces in days rather than the weeks it would take if equipment had to be moved from the United States to the location of a military conflict. However, sustained operations have taken a toll on the condition and readiness of military equipment. Over the last few years, we have identified a number of ongoing and long-term challenges regarding DOD's prepositioned stocks. The services have estimated the cost and time frame to replenish their stocks in DOD's annual report to Congress, and they review their prepositioning programs to address new requirements to meet future needs. DOD has reported to Congress that the services are committed to reconstituting prepositioned materiel but must balance these efforts with the department's other priorities, such as restructuring capabilities within its prepositioned stocks and changes in its overseas military presence. In 2011, we reported that DOD has limited departmentwide guidance that would help ensure that its prepositioning programs accurately reflect national military objectives and recommended that DOD develop overarching guidance related to prepositioned stocks.2 …

A letter report issued by the Government Accountability Office with an abstract that begins "Rich in minerals, the eastern Democratic Republic of the Congo (DRC) has long been the site of one of the world's worst humanitarian crises. Since 1998, an estimated 5 million have died as a result of the conflict. GAO was asked to examine the connection between minerals trade and human rights abuses, and the efforts to help control the trade. This report assesses (1) how the key minerals are mined, transported, and processed; (2) the links between the minerals trade, armed conflicts, and human rights abuses; (3) measures the United States and the international community have taken to control the trade and; (4) challenges faced in controlling the trade. GAO reviewed and analyzed reports, memorandums, and other documents and interviewed officials from the Department of State (State), other United States agencies, the United Nations (UN), and foreign governments as well as representatives from nongovernmental organizations and industry."

Testimony issued by the Government Accountability Office with an abstract that begins "Since 2003, GAO has designated implementing and transforming the Department of Homeland Security (DHS) as high risk because DHS had to transform 22 agencies--several with significant management challenges--into one department, and failure to effectively address its mission and management risks could have serious consequences for national and economic security. This high-risk area includes challenges in management functional areas, including acquisition, information technology, financial, and human capital management; the impact of those challenges on mission implementation; and management integration. GAO has reported that DHS's transformation is a significant effort that will take years to achieve. This testimony discusses DHS's progress and actions remaining in (1) implementing its management functions; (2) integrating those functions and strengthening performance measurement; and (3) addressing GAO's high-risk designation. This testimony is based on GAO's prior reports on DHS transformation and management issues and updated information on these issues obtained from December 2009 through September 2010."

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 "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 "Globalization has placed increasing demands on the Food and Drug Administration (FDA), an agency within the Department of Health and Human Services (HHS), in ensuring the safety and effectiveness of drugs marketed in the United States. Drugs manufactured in more than 100 countries were offered for entry into the United States in fiscal year 2009. FDA inspects drug manufacturing establishments in order to ensure that the safety and quality of drugs are not jeopardized by poor manufacturing practices. In 1998 GAO identified weaknesses in FDA's foreign drug inspection program. In 2008 GAO found, among other things, that from fiscal years 2002 through 2007, FDA inspected relatively few foreign establishments each year. GAO also determined that, because of inaccurate information in its databases, FDA did not know how many foreign drug establishments were subject to inspection. In 2008 GAO recommended that FDA increase inspections of foreign drug establishments and improve information it receives to manage the foreign drug inspection program. This report examines FDA's progress since 2008 in (1) conducting more foreign drug inspections, and (2) improving its information on foreign drug establishments. GAO analyzed information from …

A publication issued by the Government Accountability Office with an abstract that begins "American consumers, businesses, utilities, and federal and state agencies rely on the Energy Star product labeling program to identify more efficient products that lower their energy costs. Even with the program's successes, several reports by GAO and others have identified weaknesses in the Energy Star program. The program, which began in 1992 and was reauthorized in 2005, has been jointly administered by the Environmental Protection Agency (EPA) and the Department of Energy (DOE). In 2009, the agencies signed a memorandum of understanding (MOU) that outlined changes to address these weaknesses. The changes included identifying EPA as the lead agency, clarifying the roles and responsibilities of each agency, as well as instituting third-party testing of products. GAO was asked to examine (1) the status of EPA's and DOE's implementation of changes to the Energy Star program under the MOU and (2) program partners' views of the Energy Star program and changes that are under way. To examine the status of the changes, GAO reviewed guidance and eligibility criteria and interviewed various program partners to gather their views. The results of these interviews are not generalizable, but provided insights …

A letter report issued by the Government Accountability Office with an abstract that begins "The Environmental Protection Agency's (EPA) library network provides agency staff and the public with access to environmental information. A 2006 attempt by EPA to reorganize its network by consolidating libraries and making more materials and services available online caused concern among users, and in 2007, EPA put a moratorium on its reorganization plans. Congress requested that GAO report on the reorganization and has again requested a follow-up on these issues. Accordingly, GAO reviewed (1) the status of EPA's overall strategy for its library network, (2) the status of EPA's plan to reopen the libraries it closed and other actions planned or taken, (3) EPA's efforts to digitize printed documents to make them electronically available, and (4) EPA's efforts to communicate with staff and other stakeholders about its library network. GAO reviewed regulations and agency funding and inventory documents and interviewed EPA staff and contractors, as well as independent library professionals. GAO also assessed the reliability of EPA's data on library holdings and from EPA's staff survey on library use and needs."

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."

A letter report issued by the Government Accountability Office with an abstract that begins "In September 2008, the Board of Governors of the Federal Reserve System (Federal Reserve Board) approved emergency lending to American International Group, Inc. (AIG)--the first in a series of actions that, together with the Department of the Treasury, authorized $182.3 billion in federal aid to assist the company. Federal Reserve System officials said that their goal was to avert a disorderly failure of AIG, which they believed would have posed systemic risk to the financial system. But these actions were controversial, raising questions about government intervention in the private marketplace. This report discusses (1) key decisions to provide aid to AIG; (2) decisions involving the Maiden Lane III (ML III) special purpose vehicle (SPV), which was a central part of providing assistance to the company; (3) the extent to which actions were consistent with relevant law or policy; and (4) lessons learned from the AIG assistance. To address these issues, GAO focused on the initial assistance to AIG and subsequent creation of ML III. GAO examined a large volume of AIG-related documents, primarily from the Federal Reserve System--the Federal Reserve Board and the Federal Reserve Bank …

A letter report issued by the Government Accountability Office with an abstract that begins "An increasing volume of food and medical products marketed in the United States are produced in foreign countries. This globalization has challenged the Food and Drug Administration (FDA), which is responsible for ensuring the safety of these products. In late 2008 and early 2009, FDA established overseas offices comprised of 42 total staff covering particular countries or regions--China, Europe, India, Latin America, and the Middle East. The offices are to engage with foreign stakeholders to develop information that FDA officials can use to make better decisions about products manufactured in foreign countries, among other activities. GAO examined (1) the steps overseas offices have taken to help ensure the safety of imported products and (2) the extent to which FDA has engaged in long-term strategic and workforce planning for the overseas offices. GAO reviewed documentation of overseas office activities and planning. GAO also visited offices in China, India, and Latin America to interview FDA officials, officials from other U.S. agencies overseas, and foreign regulators and other stakeholders."

A letter report issued by the Government Accountability Office with an abstract that begins "As individuals age, some become incapable of managing their personal and financial affairs. To protect these individuals, state laws provide for court appointment of guardians, who may be professionals or family members, to protect the incapacitated person's personal and/or financial welfare. State and local courts are responsible for overseeing guardians. In addition, federal agencies may appoint a representative payee, in some cases, the guardian, to manage federal benefits on behalf of incapacitated adults. Previous GAO reports have found that poor communication between state courts and federal agencies may allow guardians to continue abusing their victims. GAO was asked to (1) verify whether allegations of abuse by guardians are widespread; (2) examine the facts in selected closed cases; and (3) proactively test state guardian certification processes. To verify whether allegations are widespread, GAO interviewed advocates for seniors and reviewed court documents. To examine closed criminal, civil or administrative cases with a finding of guilt or liability in the past 15 years, GAO reviewed court records, interviewed court officials, attorneys and victims, and reviewed records from federal agencies. To test state guardian certification, GAO used fictitious identities to …

A letter report issued by the Government Accountability Office with an abstract that begins "The H-2B visa program assists U.S. employers anticipating a shortage of domestic nonagricultural workers by permitting them to hire nonimmigrant foreign workers temporarily. The program is overseen by several agencies, including the Department of Labor (Labor), the Department of Homeland Security's United States Citizenship and Immigration Services (USCIS), and the Department of State. Employers often hire labor recruiters or other intermediaries to assist with the process of obtaining labor certifications and finding foreign workers. GAO was asked to determine if there were examples of recruiters and employers engaging in illegal or fraudulent activity within the H-2B visa program. GAO reviewed recent closed civil and criminal court cases involving H-2B workers, obtained data from Labor and USCIS on H-2B visas issued in fiscal years 2008 and 2009 and in first 6 months of fiscal year 2010, and interviewed advocacy groups that represent H-2B workers in litigation. In addition, GAO made undercover calls and site visits to recruiters, posing as H-2B employers and foreign H-2B workers and asked a series of questions related to legal requirements of the program. GAO also visited several H-2B housing and work site …

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 "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 "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."

Correspondence issued by the Government Accountability Office with an abstract that begins "In section 3 of the National Guard and Reservists Debt Relief Act of 2008 (Pub. L. No 110-438 (2008)), Congress mandated that we provide information on the use and the effects of the provisions of law amended (and as amended) by the act. Specifically, the act amended the existing bankruptcy code to exempt qualifying members of the National Guard and Reserve Components from the means test process when they file a petition for Chapter 7 bankruptcy relief. We are fulfilling the act's requirement by transmitting the this briefing to the President Pro Tempore of the Senate and the Speaker of the House of Representatives."

A letter report issued by the Government Accountability Office with an abstract that begins "The North Atlantic Treaty Organization (NATO) established the Partnership for Peace (PfP) to increase cooperation with former Warsaw Pact members and provide many of these countries with a path to NATO membership. As NATO confronts new security challenges, including the war in Afghanistan, its relationships with partner countries have grown in scope and importance. Additionally, NATO is developing a new Strategic Concept to clarify its mission and activities, including its relationship with PfP countries and other partners. The Department of Defense (DOD)-funded Warsaw Initiative Fund (WIF) supports the goals of the PfP program. GAO was asked to review (1) how the PfP program has evolved since GAO last reported on it in 2001; (2) options NATO is considering for the future of the PfP and other partnership programs; and (3) support to PfP countries through the U.S. WIF program. GAO analyzed NATO, DOD, and State Department (State) documents; and WIF funding data. GAO also interviewed DOD, State, NATO, and selected country officials."

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."