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 Most recent GAO publications are on line as full text ASCII and PDF (portable document format) files through the GPO Access system. MbrPd Wide Web via GAG Home Page 1. Go to http://www.gao.gov 2. From the home page,select“GAO Reportsand Testimony,”then “Search for GAO Reportsand Testimony,”and then “Directly Through GPCIAccess”. 3. Enter report title or report number.If enteringa report number,place quote marks before and after the numberand leave off the GAG/ prefix (for example,enterGAOIPIEHS-96- 195W as “HEHS-96-195W”). 4. Download or mail the file to yourself. Via Telneb 1. Telnet to swais.access.gpo.gov 2. Log in as > guesta (must be lowercase)and selectGAO databases. 3. Enter report title or report number.If enteringa report number,place quote marks before and after the numberand leave off the GAO/ prefix (for example,enterGAO/HEWS-96- 195W as “HEHS-96-195W”). 4. Download or mail the file to yourself. Via Dial-in Use modemsettingsVT-100 emulation(8,N.l) and dial (202) 512-1661. :: Qpe “SWAB”. 3. Log in as > guest< (must be lowercase)and selectGAG databases. 4. Enter report title or report number.If enteringa report number,place quote marks before and after the numberand leaveoff the GAO/ prefix (for example,enterGAO/HEWS-96 195W as ‘HEHS-96195W”). 5. To downloadfiles, follow your modemsoftwareguidelines. For More Information 0 See“Helpful Hints” and “WAIS Manual”files on line for more information on search techniques. 0 Contactthe GovernmentPrinting Office at firstname.lastname@example.org or (202) 512-1530for additional accessoptions or other information about the GPO Accesssystem. 0 Retrieve GAO’s FAQ (FrequentlyAsked Questions)by sendinge-mail with “info” in the messagebody to email@example.com Note: PDF files are availableonly throughthe World Wide Web or a Wide Area Information Server(WAIS) client. Paga 16 GAO/HEH5-97-56W Mailing List Request Form To receive this booklet each month, check here: 0 Organization: Address Which of the following best describesyour organization? q Congress (2) 0 University (6) c3 State/Local Government (9) 0 Press (3) 0 Private Industry (7) 0 Trade/Interest Group (10) cl Library 0 Other Federal Cl Law Firm (11) (Non-Umverslty) (5) Government (8) 0 All Others (99) To receive future reports and testimonies,check your area(s)of interest. Health Education 3 AccessAnfrastmcture(78) 0 Departmentof Education(27) 1 Employee/RetireeBenefits(77) 0 Early ChddhoodDevelopment(70) 1 Rnancmg(64) 0 ArmedForces(35) 3 HealthCareReform(85) 0 Elementary/Secondary(02) 1 HHS PubhcHealthService(8) 0 HigherEducation(39) Long-TermCardAgIng(73) 0 School-to-WorkTransitlon(01) ; Malpracbce(79) ManagedCare(SO) Employment : Medlcare/Medlcald(11) 0 EqualOpportumnes(00) PrescrlptlonDrugs(81) q High Performance Work(38) : ProviderIssues(82) 0 Labor/Management Relations(57) II PubhcHealth/E&canon(83) 0 TrammglEmploymentAssistance(60) ; Qualny/PracnceStandards(25) 0 WorkplaceQuahty(07) SubstanceAbuse/Treatment (84) 0 OtherEmploymentIssues(47) 3 OtherHealthIssues(86) Social Security, Disability, and Welfare Veterans Affairs and Military Health 0 Chddren’sIssues(59) 0 Mlhtary Health(05) 0 PensIons(61) 0 Veterans’Benefits(74) 0 SocialSecuntyand Dlsatnhty(58) 0 Veterans’HealthCare(10) 0 Welfare(75) Fax. Janet Shikles, Assistant Comptroller General, U S General Accounting Office at (202) 512-5806 Page 17 GAO/HEHS-97.66W Fold on dotted line, tape closed, and affix stamp. JanetShikles AssistantComptroller General us0 Geweral Accounting Office n-nEHS,NGB/ACG 441 G Street, NW Washington,DC 20548-0001 Orders & Address Changes U.S. General Accounting Office P.O. Box 6015 For ordering singlecopiesonly. Galthersburg, MD 20884-6015 (Nocoverpagerequired) Fax. (301) 258-4066 Telephone* (202) 512-6000 I-Digit Customer ID # (top of mruhng label) 1111111 Changeof address? Yes0 No 0 or your full mailing address below Name II I I I I I II II I Ill l l I I I I I l I Organization I I I I I I I I I I I I I I II I I I I I I I I Address II I WI I I I I I I I 11 I I I I l I I I Irlllllrllllllllllll Ill I Ctty. State, and ZIP I I I I I I I I I I I I I I I I I I I I I Sample Order (to order GAOIHEHS-96.83W) lti-awm-l-m-I-I Ic;ilAlol/lmnn-m-mnn ia-iwmnn-m-inn-n lGlA-a/ml-T-Tl-1-m-T-m IElnlolilllrlll-m-rnnn IclAlol/llll-m-n-m-n wwmnn-m-n-m77 iclAldl/lmnn-m-mnn Page 19 GAO/HEHS-97-66W Fold on dotted line, tape closed, and affix stamp. Ordering Information The first copy of each GAO report and testimony is free. Additional copies are $2 each. Orders should be sent to the following address, accompanied by a check or money order made out to the Superintendent of Documents, when necessary. Visa and MasterCard credit cards are accepted, also. Orders for 100 or more copies to be mailed to a single address are discounted 25 percent. Orders by mail: U.S. General Accounting Office P.O. Box 6015 Gaithersburg, MD 20884-6015 or visit: Room 1100 700 4th Street, NW (corner of 4th and G Streets, NW) U.S. General Accounting Office Washington, DC Orders may also be placed by calling (202) 512-6000 or by using fax number (301) 258-4066, or TDD (301) 413-0006. Each day, GAO issues a list of newly available reports and testimony. To receive facsimile copies of the daily list or any list from the past 30 days, please call (202) 512-6000 using a touchtone phone. A recorded menu will provide information on how to obtain these lists. For information on how to access GAO reports on the INTERNET, send an e-mail message with “info” in the body to: info%wvw.gao.gov or visit GAO’s World Wide Web Home Page at: http;//www.gao.gov PRINTED ON 0 RECYCLED PAPER United States GeneraI Amounting Office Washington, DC 20548-0001 Official Business Penalty for Private Use $300 Address Correction Requested
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)