Health, Education, Employment, Social Security, Welfare, and Veterans
Reports (Letter Report, 11/01/95, GAO/HEHS-96-58W).

This booklet lists GAO documents on government programs related to
health, education, employment, social security, welfare, and veterans
issues, which are primarily run by the Departments of Health and Human
Services, Labor, Education, and Veterans Affairs. One section identifies
reports and testimony issued during the past month and summarizes key
products. Another section lists all documents published during the past
year, organized chronologically by subject. Order forms are included.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-96-58W
     TITLE:  Health, Education, Employment, Social Security, Welfare, 
             and Veterans Reports
      DATE:  11/01/95
   SUBJECT:  Managed health care
             Social security benefits
             Welfare benefits
             Veterans benefits
             Health care services
             Employment or training programs
             Educational programs
             Veterans employment programs
             Student financial aid
IDENTIFIER:  Arizona Medicaid Managed Care Program
             Federal Employees Retirement System
             Federal Thrift Savings Plan
             Social Security Program
             Bibliographies
             Medicaid Program
             
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Cover
================================================================ COVER


Health, Education, and Human
Services Division Reports

November 1995

HEALTH
EDUCATION
EMPLOYMENT
SOCIAL SECURITY
WELFARE
VETERANS

GAO/HEHS-96-58W



Abbreviations
=============================================================== ABBREV

  HMO - health maintenance organization
  HPSA - Health Professional Shortage Area
  HRD - Human Resources Division, GAO
  JOBS - Job Opportunities and Basic Skills program
  MCO - managed care organization
  MUA - Medically Underserved Area
  NAFTA - North American Free Trade Agreement
  NASA - National Aeronautics and Space Administration
  NCI - National Cancer Institute, National Institutes of Health
  NIH - National Institutes of Health
  NLRA - National Labor Relations Act
  NPR - National Performance Review
  NRC - Nuclear Regulatory Commission
  OFCCP - Office of Federal Contract Compliance Programs, DOL
  OHA - Office of Hearings and Appeals, Social Security
     Administration
  PBGC - Pension Benefit Guarantee Corporation
  SAA - state approved agencies
  SSA - Social Security Administration
  SSI - Supplemental Security Income
  T&A - time and attendance
  TRICARE - DOD nationwide managed health care program
  TSP - Thrift Savings Plan
  VA - Department of Veterans Affairs

PREFACE
============================================================ Chapter 0

The General Accounting Office (GAO), an arm of the Congress, was
established to independently audit government agencies.  GAO's
Health, Education, and Human Services (HEHS) Division reviews the
government's health, education, employment, social security,
disability, welfare, and veterans programs administered in the
Departments of Health and Human Services, Labor, Education, Veterans
Affairs, and some other agencies. 

This booklet lists the GAO products issued on these programs.  It is
divided into two major sections: 

  -- Most Recent GAO Products:  This section identifies reports and
     testimonies issued during the past month and provides summaries
     for selected key products.

  -- Comprehensive 1-Year Listings:  This section lists all products
     published in the last year, organized chronologically by subject
     as shown in the table of contents.  When appropriate, products
     may be included in more than one subject area. 

You may obtain single copies of the products free of charge, by
telephoning your request to (202) 512-6000 or faxing it to (301)
258-4066.  Additional ordering details appear at the end of this
booklet.  Instructions for getting on GAO's mailing list appear on
page 37 of this booklet. 

You may access the Most Recent GAO Products section of this booklet
on Internet.  Instructions appear on the last two pages of this
booklet.





Janet L.  Shikles
Assistant Comptroller General


MOST RECENT GAO PRODUCTS
(OCTOBER 1995)
============================================================ Chapter 1


   HEALTH
---------------------------------------------------------- Chapter 1:1


      SELECTED SUMMARIES
-------------------------------------------------------- Chapter 1:1.1

Mammography Services:  Initial Impact of New Federal Law Has Been
Positive (Report, 10/27/95, GAO/HEHS-96-17). 

Early indications are that the Mammography Quality Standards Act of
1992 has had a positive effect on the quality of mammography
services.  A set of uniform standards, substantially the same as
those advocated by the American College of Radiology (ACR), a
private, nonprofit professional association of radiologists, is now
required in all states.  When the act was passed, the Congress was
concerned that access to mammography services might be limited
because many providers would choose to drop mammography services
rather than upgrade operations to comply with the standards.  GAO's
work suggests that this does not appear to be the case.  While some
facilities have chosen to cease mammography services, the number that
have done so is relatively small compared with the total number of
facilities available to provide services.  Those facilities that
chose to stop delivering such services were generally small-volume
providers located within 25 miles of another certified facility. 
FDA's gradual approach to implementing the act's requirements appears
to have been a factor in minimizing adverse effects on access.  FDA
has not closed many facilities that have not met certification or
inspection requirements.  Instead, it has given facilities time and
repeated opportunities to meet new quality assurance requirements and
to correct problems found during inspections. 

For more information, contact Frank Pasquier at (206) 287-4861. 

Arizona Medicaid:  Competition Among Managed Care Plans Lowers
Program Costs (Report, 10/4/95, GAO/HEHS-96-2). 

As many states are converting their traditional fee-for-service
Medicaid programs to managed care delivery systems, Arizona's
Medicaid program offers valuable insights--especially in fostering
competition and monitoring plan performance.  Arizona's recent cost
containment record is noteworthy.  According to one estimate,
Arizona's Medicaid program saved the federal government $37 million
and the state $15 million in acute care costs during fiscal year
1991.  Arizona's program contained costs by developing a competitive
Medicaid health care market.  These cost control efforts do not
appear to have hindered beneficiaries' access to appropriate care. 
GAO's work suggests that key conditions for containing Medicaid costs
without compromising beneficiaries' access to appropriate medical
care include (1) freedom from certain federal managed care
regulations, (2) development and use of market forces, (3) controls
to protect beneficiaries from inadequate care, and (4) investment in
data collection and analysis capabilities. 

For more information, contact James Cosgrove at (202) 512-7029. 


      OTHER HEALTH PRODUCTS
-------------------------------------------------------- Chapter 1:1.2

Medicaid and Children's Insurance (Letter, 10/20/95, GAO/HEHS-
96-50R). 

Medicare Managed Care Growth (Letter, 10/18/95, GAO/HEHS-96- 47R). 

Community Health Center Grants (Letter, 10/11/95, GAO/HEHS-96- 13R). 

Fraud and Abuse Provisions in H.R.  2425 (Letter, 10/7/95,
GAO/HEHS-96-37R). 

Montana's Medical Assistance Facilities (Letter, 10/2/95,
GAO/HEHS-96-12R). 

Medigrant:  Florida (Letter, 10/2/95, GAO/HEHS-96-11R). 


   EDUCATION
---------------------------------------------------------- Chapter 1:2


      EDUCATION PRODUCTS
-------------------------------------------------------- Chapter 1:2.1

Land-Grant College Revenues (Letter, 10/20/95, GAO/HEHS-96-10R). 


   EMPLOYMENT
---------------------------------------------------------- Chapter 1:3


      SELECTED SUMMARIES
-------------------------------------------------------- Chapter 1:3.1

Worker Protection:  Federal Contractors and Violations of Labor Law
(Report, 10/24/95, GAO/HEHS-96-8). 

Federal contracts have been awarded to employers who have violated
the National Labor Relations Act (NLRA).  GAO found that 80 firms had
violated the act and received over $23 billion, about 13 percent of
the $182 billion in federal contracts awarded in fiscal year 1993. 
However, these contracts were concentrated among only a few
violators; six violators received almost 90 percent of the more than
$23 billion in contracts.  The cases that GAO examined indicate a
range of violations.  The cases also show that the National Labor
Relations Board (NLRB) had ordered various remedies relating to the
unlawful activities by firms that discouraged workers from exercising
their right to bargain collectively.  Fifteen of the violators
(almost 20 percent of the 80 firms) might be considered more serious
violators.  NLRB's enforcement of the act could be enhanced by
collecting judgments against violators from federal contract awards. 
Coordination with the General Services Administration (GSA) would be
necessary to collect judgments in this fashion. 

For more information, contact Charles A.  Jeszeck at (202) 512- 7036. 


   SOCIAL SECURITY, DISABILITY,
   AND WELFARE
---------------------------------------------------------- Chapter 1:4


      SELECTED SUMMARIES
-------------------------------------------------------- Chapter 1:4.1

Federal Pensions:  Thrift Savings Plan Has Key Role in Retirement
Benefits (Report, 10/19/95, GAO/HEHS-96-1). 

As of September 1994, some 942,000 Federal Employees Retirement
System (FERS)-covered employees (about 76 percent) were voluntarily
contributing an average of 5.7 percent of their salaries to the
Thrift Savings Plan (TSP).  Most of the remaining 300,000
FERS-covered employees (24 percent) who were not contributing were in
the lower pay ranges.  Although lower-paid workers are deferring at
lower rates, GAO found that it may be less necessary for them to
contribute to TSP than it is for workers with higher earnings. 
Lower-paid workers may achieve retirement income levels even with low
deferral rates, because Social Security benefits are proportionately
greater for them.  Educating FERS workers can play a central role in
their making wise preretirement investment decisions.  GAO found that
TSP's educational materials are not explicit in discussing how TSP
can enable FERS- covered employees to achieve their retirement income
goals.  A full range of TSP fund options can also facilitate sound
pretirement investment decisions. 

For more information, contact Donald Snyder at (202) 512-7204. 


      OTHER SOCIAL SECURITY,
      DISABILITY, AND WELFARE
      PRODUCTS
-------------------------------------------------------- Chapter 1:4.2

Proposed Pension Reversion (Letter, 10/24/95, GAO/HEHS-96-54R). 


   VETERANS AFFAIRS AND MILITARY
   HEALTH
---------------------------------------------------------- Chapter 1:5


      SELECTED SUMMARIES
-------------------------------------------------------- Chapter 1:5.1

VA Student Financial Aid:  Opportunity to Reduce Overlap in Approving
Education and Training Programs (Report, 10/30/95, GAO/HEHS-96-22). 

In fiscal year 1994, VA paid more than $1 billion in education
assistance benefits to more than 450,000 beneficiaries and spent
about $12 billion for state approved agencies' (SAA) gatekeeping
services.  GAO estimates that $10.5 million of the $12 million paid
to SAAs in 1994 was spent to conduct assessments that overlapped with
those of the Department of Education.  These assessments involved
reviews of academic and vocational schools that were already
accredited by Education-approved agencies.  The continued use of SAAs
to conduct assessments that overlap other assessments does not appear
to be a useful investment of scarce federal dollars.  The overlap may
not amount to out-and-out duplication, because SAAs use standards and
methods that may differ somewhat from those of other reviewing
bodies.  However, a comparison of VA's key standards with those used
by Education's gatekeepers shows that the standards are similar. 
Given this similarity, and the significant amount of SAA work (about
87 percent) that overlapped Education assessments, reducing SAA
activity to apply only to those schools and programs not subject to
Education gatekeeping appears advisable. 

For more information, contact Joseph Eglin, Jr., at (202) 512- 7009. 


MAJOR CONTRIBUTORS
============================================================ Chapter 2

Jessie L.  Battle
David W.  Bieritz
Susan Y.  Higgins
James L.  Kirkman
Stephen F.  Palincsar



MAILING LIST REQUEST FORM
============================================================ Chapter 3


         ADDRESS INFORMATION
------------------------------------------------------ Chapter 3:0.0.1

To receive this booklet each month, check here:  .

Name: 
Organization: 
Address: 

Which of the following best describes your organization? 

Congress (2) Other Federal Government (8)
Press (3) State/Local Government (9)
Library (Non-University) (5) Trade/Interest Group (10)
University (6) Law Firm (11)
Private Industry (7) All Others (99)


         AREAS OF INTEREST
------------------------------------------------------ Chapter 3:0.0.2

To receive future reports and testimonies, check your area(s) of
interest. 

HEALTH EMPLOYMENT
Access/Infrastructure (78) Equal Opportunities (00)
Employee/Retiree Benefits (77) High Performance Work (38)
Financing (64) Labor/Mgt.Relations (57)
Health Care Reform (85) Training/Employment
HHS Public Health Service (8) Assistance (60)
Long-Term Care/Aging (73) Workplace Quality (07)
Malpractice (79) Other Employment Issues (47)
Managed Care (80)
Medicare/Medicaid (11) SOCIAL SECURITY, DISABILITY,
Prescription Drugs (81) & WELFARE
Provider Issues (82) Children's Issues (59)
Public Health/Education (83) Pensions (61)
Quality/Practice Standards (25) Social Security & Disability (58)
Substance Abuse/Treatment (84) Welfare (75)
Other Health Issues (86) Other Social Security, Disability
& Welfare Issues (96)
EDUCATION
Department of Education (27)
Early Childhood Develop.  (70) VETERANS AFFAIRS & MILITARY
Armed Forces (35) HEALTH
Elementary/Secondary (02) Military Health (05)
Higher Education (39) Veterans' Benefits (74)
School-to-Work Transition (01) Veterans' Health Care (10)


         FAX OR MAIL TO: 
------------------------------------------------------ Chapter 3:0.0.3

Janet Shikles, Assistant Comptroller General
Health, Education, and Human Services Division, NGB/ACG
U.S.  General Accounting Office
441 G Street, N.W., Washington, D.C., 20548


         (11/95)
------------------------------------------------------ Chapter 3:0.0.4

Fax (202) 512-5806



CHANGE OF ADDRESS NOTIFICATION
FORM
============================================================ Chapter 4


         REQUESTING CHANGES
------------------------------------------------------ Chapter 4:0.0.1

Please complete the following information. 

To change name, organization, or address, enter appropriate changes
below. 

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(Customer Number on Mailing Label above Name)
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         FAX OR MAIL TO: 
------------------------------------------------------ Chapter 4:0.0.2

Janet Shikles, Assistant Comptroller General
Health, Education, and Human Services Division, NGB/ACG
U.S.  General Accounting Office
441 G Street, N.W., Washington, D.C., 20548


         (11/95)
------------------------------------------------------ Chapter 4:0.0.3

Fax (202) 512-5806



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============================================================ Chapter 5

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