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
                 Social Security

                                                           / (1 “/


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

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


New releasesarehighlightedthereandmay be downloaded
                                                  or orderedin printedform.

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

Jan&. Shikles

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


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
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-

                             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

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.

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.


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
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
          (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

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

Medicare: Private-Sectorand FederalEfforts to AssessHealth CareOuality

PrescrintionDrue Pricine: Imnlicationsfor RetailPharmacies(‘Iestimony,

GAOkIEHS-96 184,Sept.17,1996).
PrescriptionDrues:Imolications of Drug Labeling andOff-Label Drur! Use(Testimony,

                                                 . .
Medinap Insurance:Alternativesfor MedicareBeneficiartesto A void lkledicaI

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

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

                            Page 8                              GAOmHS-97-66W

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

EducationandLabor:Informationon theDeDartments’
                                             Field Offices (Report,GAO/



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

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/

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

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
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/
                                                             . ..
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
          ~eportmG&$I~HS-96- 196,Sept.12,1996). Testimonyon s;e topic

SSA Disabilitv Reengineerinp:ProiectMagnitudeandComolexity Imnede
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

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

VA Health Care:Improving Veterans’AccessPosesFinancial and Mission-Related

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
VA HealthCare:IssuesAffectinPEligibilitv ReformEfforts (Report,GAO/HEHS-96-
VA Health Care*Travis Hosoital ConstructionProiectIs Not Justified (Report,GAO/

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

                            Page 12                           GAO/XEHS-I)?-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

  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
0    Contactthe GovernmentPrinting Office at gpoaccess@gpo.gov   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 info@www.gao.gov

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


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
:    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)

                                     Page 17                                  GAO/HEHS-97.66W
Fold on dotted line, tape closed, and affix stamp.

AssistantComptroller General
us0 Geweral Accounting Office
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

                                     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:

or visit GAO’s World Wide Web Home Page at:


United States
GeneraI Amounting Office
Washington, DC 20548-0001
Official Business
Penalty for Private    Use $300
Address   Correction   Requested