oversight

Health, Education, Employment, Social Security, Welfare, and Veterans Reports

Published by the Government Accountability Office on 1997-01-01.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                 United States General Accounting Offlce
GAO              Health, Education, and Human
                 Services Division Reports



January   1997
                 Health
                 Education
                 Employment
                 Social Security
                 Welfare
                 Veterans




                                                           / (1 “/
GAO/HEHS-97S6W
c

Preface


This monthlybibliographylists theU.S. GeneralAccountingO ffice’s recentlyreleased
productson health,education,e m p loyment,socialsecurity,disability,welfare,and
veteransissues.

To learnaboutpreviousreports,pleasecall (202)512-6000for a customizedkeyword
searchor do your own searchvia the Internet.You canalsolearnaboutnew reportsas
they areissuedthroughoutthe monthby visiting our World W ide W e bsite at


                               http#wmv.gaogov


New releasesarehighlightedthereandmay be downloaded
                                                  or orderedin printedform.

Orderingproductsis easy.Simply call thenumberaboveor fax theform in the backof
thisbookletto (301)258-4066.




Jan&. Shikles
AssistantComptrollerGeneral
Health,Education,andHumanServicesDivision
(202)512-6806




                                                             GAO/HEHS-97.56W
?.I - j j,
 / ,a        A,/.
                    Page 2   GAO/HEHB-97-66W
New Releases


Health


Forebn Phvsicians: Exchange Visitor Propram Becoming Major Route to
Practicing in U.S. Underserved Areas (Report, GAOA-TEHS-97-26, Dec. 30,1996).
Contact: Frank C. Pasquier, (206) 287-4861

U.S. communitiesthat needphysiciansare increasinglytappingan exchangevisitor
programcreatedto train doctorsfrom othercountries.Ratherthan returninghome after
completingtheir training, thesephysicianscan receivewaiversat the requestof
federalagenciesand statesif they agreeto practicein underservedareas.The growing
use of thesewaivers is not beingmanagedas a program,federalefforts to address
physicianshortagesare not coordinatedamongfederalagenciesor with the states,
monitoringto ensurephysiciansfulfill their agreementsremainsspotty,and thereis
limited accountabilityin termsof whetherthe physicianstargettheir efforts to that part
of the populationthat is underservedor serveothersin their areasinstead.If the
Congresswants medical underservicein this country to continueto be addressed
throughthe useof thesewaivers, it shouldconsiderrequiring the use of waivers be
managedas a program.

Skilled Nursing Facilities: ADDroval Process for Certain Services Mav Result in
Higher Medicare Costs (Report, GAO/HEHS-97-18, Dec. 20,1996). Contact:
Thomas Dowdal, (202) 512-6588; Sandra K. Isaacson, (202) 512-7174

Medicarelimits the amountsit will pay for the room, board,and generalnursingcare
skilled nursmgfacilities (SNF) provideto beneficiaries.But SNFsthat incur higher
costs becausethey provided atypical services(such as ventilator care) to Medicare
patientscan requestexceptionsto theselimits. The processfor reviewing these
waiver requests,however,doesnot ensurethat SNFs actually provide atypical
services. In effect, SNFs only needto show that their averageroutine costs are above
the Medicarelimits; the review processdoesnot determinewhetherthesehigher costs
result from beneficiariesneedingmoreexpensivecareor simply from inefficiency. In
the four statesGAO studied,SNFs with and without exceptionswere found to be
caring for similar Medicarepatientsandproviding similar services.




                             Page 6                               GAO/HEHS-97-66W
                                                                      To otrfer reports,
                                                                    call (202) 512-6000




A&w Issues: Related GAO Weaorts and A&Me-s in Fiscal Year 19% (Rep~fi
GAO/HENS-M-41,Dec. 31,1996), Coaatacd:Diana S. Eisenstat, (202) 562-5562

This reportsummarizesall of GAO’s fiscal year 1996productsandall ongoingwork on
programsandissuesaffectingolderAmericansandtheir families, including
employment,healthcare,housing,incomesecurity,and veterans*Issues.


SSA Disabilitv Redesh: Focus Needed on Initiatives Most Crucial to Reduciq
Costs and Time(Report, GAUHEHS-97-20, Dec. 20,1996). Contact: Michael T.
Blair, Js., (404) 679-1944

The SocialSecurityAdministration’s(SSA) planto redesignits disability claims
processis a valid attemptto addressfundamentalproblems,but as of July, SSA had
not completedany of the initiatives in its plan and had not begunthe testingfor 14 of
19 of the initiatives to determinewhetherproposedchangeswill achievethe desired
results.Someinitiatives haveexpandedin scopeandtheir time frameshave
lengthened,delayingimplementationandincreasingthe risk of disruptionfrom
turnoveramongseniorexecutives.Meanwhile,stakeholdersupporthaseroded.To
increasethe redesign’slikelihood of success,the Commissionerof SSA shouldselect
the initiatives most crucial to cutting claims-processing
                                                        time and costsand combine
them into an integratedprocessto be testedat a few sitesand evaluatedbeforefull-
scaleimplementationbegins.




                             Page 4                               GAO/HEHS-97-66W
                                                                    To om’er revorts,
                                                                  call (202) 512:6OOi!I
Chid SUDDOI-~Enforcement: Earlv Results on Comaarabiiitv of Privatized and Public
Offices (Report, GAO/HEHS-97-4, Dec. 16,1996). Contact: David R Bixler,
(202) 512-7201

To meetgrowing demandswith constrainedresources,many statesarecontracting
with privatefirms to providechild supportenforcementservices;15 states,in fact,
havefully privatizedselectedlocal child supportenforcementoffices. In three
comparisons,fully privatizedoffices performedat leastas well as or, in someinstances,
betterthan government-staffed offices in locating noncustodialparents,establishing
paternityand supportorders,and collecting supportowed.Cost-effectivenessvaried,
however.Becausefull-serviceprivatizationis relativelynew in child support
enforcement,additionalevaluationof performanceandcost-effectiveness      will be
neededover the long term.               e


SSA Benefit Statements: Well Received bp the Public but Dicult to Comprehend
(Report, GAO/HEHS-97-19, Dec. 5,1996). Contact: Cynthia Fagnoni,
(202) 512-7202

SSA is requiredto provideyearly PersonalEarningsandBenefit EstimateStatements
to workerswho havereachedage60; beginningin the year2000,the statementmust
go to every US. worker aged25 andolder.The statement’design
                                                       s     makesit difficult for
the readerto locateandunderstandimportantinformation,and feedbackfrom the
public indicatesthat readersareconfusedby the statement’sexplanationsof several
importantpoints. SSA is consideringredesigningthe statementto cut printing costs
but also needsto improvethe statement’sdesignand simplify explanations.SSA
shouldalso evaluateand test alternativeformats.




                            Page 6                              GAO/HEHS-97-66W
                                                                  To order reports,




Resourcea(Report, GACMHEHIS-977-27,
                               Dec.2O,B996).Contact: GeorgeE
Poindexter,(202)512-7213

The Departmentof VeteransAffairs (VA) providesnursinghomecarethroughstate
andcommunityfacilities as well as its own nursinghomes.VA’s reportedcost for
providing care in its own nursinghomesis considerablyhigherthan its cost for care
providedthroughstateand community facilities, thoughprecisecost differences
cannotbe determinedbecauseof weaknesses     in VA’s cost data.Differenceshavealso
beennotedin the quality of care veteransreceivein the varioushinds of nursing
homeswith VA facilities appearingto providemorecomprehensive     care.To meet
expectedincreasesin demandwith limited resources,VA needsaccurateandcomplete
information on the costsof nursinghomeservicesit providesor purchases,better
informationon the availability of communitynursinghomebeds,andinformationon
the competitivenessof its reimbursementrates.
September-December1996


Want to check more than just the last 4 months? Call (202) 512-6000for a
customizedkeyword searchw to orderproducts. Or, to conductyour own search
via the Internet, seethe instructions on page 16.

Health

ForeignPhvsicians:Exchawe Visitor ProwamBecomiw Maior Routeto Practiciw in
U.S. Underserved
               Areas(Report,GAO/HEHS-97-26,Dec. 30,1996).

Skilled Nursirw Facilities: Anoroval Processfor CertainServicesMav Resultin Higher
MedicareCosts(Report,GAO/HEHS-97-18,Dec.20,1996).
Children’sHealthInsuranceProuram.1996(Letter,GAO/I-lEHS-97-40R.
                                                             Dec.3,1996).
PrivateHealthInsurance:Millions Relvinn on Individual Market FaceCost and
CoverageTrade-Offs(Report,GAO/HEHS-97-8,Nov. 25,1996).
Rural HealthClinics: Risine ProPramExnendituresNot Focusedon ImprovingCarein
ZsolatedAreas(Report,GAO/HEHS-97-24,Nov. 22,1996).
Public Health: A Health StatusIndicatorfor TareetineFederalAid to States(Report,
GAO/HEHS-97-13,   Nov. 13,1996).

FederalTort ClaimsAct Coverage(Letter,GAO/HEHS-97-32R,
                                                     Nov. 51996).

Medicare:HCFA ShouldReleaseDatato Aid Consumers.PromntBetterHMQ
Performance
          (Report,GAO/HEHS-97-23,Oct. 22,1996).

MedicareDrw andNutrientPrices(Letter,GAOiHEHS-97-22R,Oct. 11,1996).

Drug and Alcohol Abuse:Billions Spe t A nually for Treatmentand Prevention
Activities (Report,GAO/HEHS-97-12,&t. 8?1996).

Lone-TermCare:SomeStatesADD~Y Criminal BackwoundChecksto HomeCare
Workers(Report,GAO/PEMD-96-5,Sept.27,1996).




                            Page 7
                       (Letter9GAO/HEM&96153R, Sept.25,1996).


(Report,GAO/PEMD-9616,Sept.19,1996).
Medicare: Private-Sectorand FederalEfforts to AssessHealth CareOuality
(Testimony,GAO/T-HEM-96-215,Sept.19.19%).

PrescrintionDrue Pricine: Imnlicationsfor RetailPharmacies(‘Iestimony,
                                                                    GAO/T-
HEHS-96-216,Sept.19,1996).

GAOkIEHS-96 184,Sept.17,1996).
PrescriptionDrues:Imolications of Drug Labeling andOff-Label Drur! Use(Testimony,
GAO/I’-HEHS-96-212,Sept.12.1996).

(Report,GAO/HEHS-96-207,Sept.11.1996).
                                                 . .
Medinap Insurance:Alternativesfor MedicareBeneficiartesto A void lkledicaI
Underwiting(Report,GAO/HEHS-96-180,Sept.10,1996).

Nledicaid: Oversight of Institutions for the Mentallv RetardedShould Be -thened
(Report,GAOkIEHS-96 131,Sept.6,1996).

Blue CrossandBlue Shield: Changein PharmacvBenefitsAffects FederalEmployees!
(Testimony,GAOA’-HEHS-96-206,Sept.5,1996).
                                          . .                 *.    .
F aud and Abuse:ProvidersExcludedFro Med crudContinueto Part~~pW
F&era1HealthProerams(Testimony,GAO~4IEI-k96-205, Sept.$1996).




                            Page 8                              GAOmHS-97-66W
Education

IntercollegiateAthletics: Statusof Efforts to PromoteGenderEauitv (Report,GAO/
HEHS-97-10,  Oct.25,1996).

States’
      AverageCollegeTuition(Letter,GAO/HEHS-96213R,Sept.19,1996).
EducationandLabor:Informationon theDeDartments’
                                             Field Offices (Report,GAO/
HEHS-96178,Sept.16,1996).



Employment


OSHA’sInspectionDatabase
                       (Letter,GAO/HEHS-97-43RDec.30,1996).

Informationon theDavis-BaconAct (Letter,GAO/HEHS-97-30R,
                                                       Oct. 30.1996).
EducationandLabor Informationon theDeoartments’
                                              Field Offices(Report,GAO/
HEHS-96-178,Sept.16,1996).

FederalLaborRelations:Official Time Usedfor Union Activities (Testimony,GAO/T-
GGD-96191,Sept. 11,1996).
PeouleWith Disabilities.FederalProgramsCouldWork ToPetherMore Efficientlv to
PromoteEmployment(Report,GAO/HEHS-96-126,   Sept.3,1996).




                           Page 9                             GAO/HBHS-97.66W
AginP Issues:RelatedGAO ReDortsandActivities in Fiscal Year 1996(Report,GAO/
HEHS-974l,Dec.31,1996).

SSA Disability Redesipn:FocusNeededon Initiatives Most Crucial to Reducing
CostsandTime (Report,GAO/HEHS-97-20,Dec.20,1996).
Child SupportEnforcement:Early Resultson Comparabilitvof PrivatizedandPublic
Qftices (Report,GAOL-IEHS-97-4,Dec. 16,1996).
SSA Benefit Statements:Well Receivedbv the Public but Difficult to Comorehend
(Report,GAO/HEHS-97-19,Dec. 5,1996). Testimonyon sametopic (GAO/T-HEHS-96
210,Sept.12,1996).

AppealedDisabilitv Claims: DespiteSSA.‘sEfforts. It Will Not ReachBacklog
ReductionGoal (Report,GAO/HEHS-97-28,Nov. 21,1996).
SupplementalSecurityIncome:SSA Is Taking Stepsto Review Recipients’Disability
m    (Report,GAO/HEHS-97-17,Oct. 30,1996).
Child SupportEnforcement:ReorientirmManagementTowardAchieving Better
ProgramResults(Report,GAO/HEHS/GGD-97-14,Oct.25,1996).
Child SupportEnforcement:States’ExDerienceWith PrivateApencies’Collection of
SupportPayments(Report,GAO/HEHS-97-11,Oct. 23,1996).
                                                                             . .
Social Securitv Disabilitv: AlternativesWould Boost CoSt-Effectivenessof Contrnumg
Disability Reviews(Report,GAO/HEHS-97-2,Oct. 16,1996).

Social SecuritvDisabilitv: ImorovementsNeededto ContinuinpDisabilitv Review
Process(Report,GAO/HEHS-97-1,Oct. 16,1996).

Private Pensions:Most EmuloversThat Offer PensionsUse Defined Contribution
w(Report,GAO/GGD-97-1,Oct. 3,1996).




                            Page 10                           GAO/HBHS-97-66811
Social Securitv:Union Activitv at the Social SecuritvAdministration (Report,GAO/
HEHS-97-3,Oct.2,1996).
                                                             . ..
SSA Disabilitv Rede ‘en: MO e Te t’ Q Neededto Assess easlbtlltv of New Claim
ManagerPosition(Re’krt, GA&I&&-96 170,Sept.27,19:6).
                    . .    .
Soc’al Secu ‘t?Ad n st at on: Effective LeadershioNeededto Meet Dau ting
ChatlienFes
          ~eportmG&$I~HS-96- 196,Sept.12,1996). Testimonyon s;e topic
(GAO/r-OCG-96-7,July25,1996).

SSA Disabilitv Reengineerinp:ProiectMagnitudeandComolexity Imnede
Implementation(Testimony,GAOfT-HEHS-96-211,Sept.12,1996).
PeooleWith Disabilities:FederalProgramsCould Work TogetherMore Efficientlv to
PromoteEmplovment(Report,GAOA-IEHS-96-126,   Sept.3,1996).




                            Page 11                             GAO/HEHS-97-66W
VA HealthCare:BetterData Neededto Effectivelv UseLimited Nursing Home
Resources(Report,GAO/HEHS-97-27,Dec.20,1996).

SubstanceAbuse Treatment:VA ProgramsServePsvcholoeicallvand Economically
DisadvantagedVeterans(Report,GAOkJEHS-97-6,Nov. 5.1996).

VA Health Care:Improving Veterans’AccessPosesFinancial and Mission-Related
Challenfres(Report,GAO/I-lEHS-97-7,Oct.25,1996).

VBA InformationTechnologyInvestment(Letter,GAO/AIMD-97- IOR,Oct. 18.1996).

VA Health Care: Opportunitiesto Sianificantlv ReduceOutoatientPharmacvCosts
(Report,GAO/HEHS-97-15,Oct. 11,1996).

WartimeMedical Care:DOD Is AddressingCaDabilitvShortfalls.but Challenges
Remain(Report,GAO/NSIAD-96-224,Sept.25,1996).
VA HealthCare:IssuesAffectinPEligibilitv ReformEfforts (Report,GAO/HEHS-96-
160,Sept.11,1996).
       .
VA Health Care*Travis Hosoital ConstructionProiectIs Not Justified (Report,GAO/
HEHS-96-198,Sept.3,1996).

VocationalRehabilitation*VA Continuesto PlaceFew DisabledVeteransin Jobs
(Report,GAO/HEHS-96 155,Sept.3,1996).




                            Page 12                           GAO/XEHS-I)?-66W
GAo/HEHS-97-66W
Edusatfoan and Empbyment        Hssna~
CarlottaC. Joyner,Director,(202)5 12-7002
ComeliaM. Blanchette,AssociateDirector,(202)512-8403
  * Early ChildhoodDevelopment
  Q ElementaryandSecondaryEducation
  a HigherEducation
  m Training andEmploymentAssistance
  0 WorkplaceQuality



Wealth Fhamcing and systems Issue5
William J. Scanlon,Director,(202)5 124561
LeslieG. Aronovitz,AssociateDirector,(3 12)220-7767
JonathanRatner,AssociateDirector,(202)5 12-7107
  0   EmployeeandRetireeHealthBenefits
  0   Long-TermCareandAging
  0   IMedicaid
  0   Ivledicare
  0   HealthCareInsuranceReform




                           Page 14                     GAQ/KEHS-97-66W
Health ServicesQuality and Public Health Issues
BemiceSteinhardt,Director,(202)512-7119
MarshaLillie-Blanton,AssociateDirector,(202)512-7119

  l   HHS Public HealthServiceAgencies
  l   Public HealthandEducation
  l   SubstanceAbuse and Drug Treatment
  l   PrescriptionDrugs
  l   Quality andPracticeStandards



Income Security Issues
JaneL. Ross,Director,(202)5 12-7215
DianaS. Eisenstat,AssociateDirector,(202)512-5562
Mark V. Nadel,AssociateDirector,(202)5 12-7215

  l   PensionFundingand Benefits
  l   SocialSecurityandDisability
  l   Welfare,Child Support,andChild Care
  l   Child AbuseandFosterCare



Veterans’Affairs and Military Health Care Issues
DavidP.Baine,Director,(202)5 12-7101
StephenP.Backhus,AssociateDirector,(202)5 12-7111
  l   Military HealthCare
  l   Veterans’ Benefits
  l   Veterans*HealthCare




                            Page 16                    GAO/HEHS-97.66W
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                                     Page 17                                  GAO/HEHS-97.66W
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