Fiscal Year 1993 GAO Reports on Issues Housing Issues Assisted Housing: Evening 1993) Homelessness: McKinney 1992) they use. This fact sheet provides information on (1) the size and ownership of UROS, (2) the professional qualifications of the staff involved in utilization review decisions, (3) the complexity of decisions made by various types of staff, (4) appeal procedures, (5) clinical review criteria used by UROS, and (6) quality assurance procedures implemented to ensure adherence to company directives. In short, GAO discovered the following: that UROS often employ physicians on a part-time basis or as consultants; registered nurses are heavily involved in first-level review decisions but doctors become more involved during the second-level review and appeals process; UROS generally use commercially developed review criteria when making their recommendations; most UROS have established appeal procedures; of the few utilization decisions that are appealed, many are successful; and UROS have implemented quality assurance procedures to ensure adherence to company directives. Housing subsidies provided under the government's Section 8 program This report provides a legislative history of the McKinney Act; a Fiscal Year 1993 GAO Reports on Issues Public and Assisted 1993) Public Housing: Low-Income Housing Tax 1993) programs to help the homeless; 95 percent of the money went for food, shelter, and health care; the rest went for education and job training. The government's family self-sufficiency program was created in 1990 to Under the National Affordable Housing Act of 1990, GAO is required to review different ways of developing public housing units. This report compares the approaches taken by public housing authorities in developing housing under the Public Housing Development Program and the Low-Income Housing Tax Credit Program. The former provides direct federal grants, while the latter allows public housing authorities to raise development funds by forming public-private partnerships with investors. The public housing authorities GAO reviewed used the tax credit program to serve kinds of tenants and to develop kinds of programs that differed from those in the public housing program. For example, the tax credit projects served smaller households and were more likely to be located in predominantly low-income households than were the public housing projects. Furthermore, if the cost inefficiencies suggested by GAO's case study in Montgomery County, Maryland, exist in other tax credit projects, the federal government may find the tax credit program to be the more costly alternative for helping very poor households. Nevertheless, the public housing authorities GAO reviewed found the tax credit program a valuable resource for developing public housing in this period of shrinking federal budgets. Fiscal Year 1993 GAO Reports on Issues Affecting Older Americans and Others Rural Housing: FmHA's 1993) The Farmers Home Administration (FMHA), part of the Agriculture Department, makes home loans to rural residents who cannot afford homes through private financing. GAO found that although rural areas have the worst housing conditions, they receive a smaller percentage of housing assistance than areas close to urban centers. Program funds lent under FmHA's single-family housing program are concentrated in and around metropolitan areas and are disproportionately higher than the demand for housing in these areas warrants. Remote rural areas, on the other hand, receive a disproportionately low amount of funds in relation to housing needs. Congress has acted to ensure that remote rural areas are better served by the program, but these actions have not yet been implemented. FMHA has identified factors contributing to the low demand for program funds in remote areas, including low income limits difficult for remote rural families to meet and subjective application of criteria used to approve housing for the program. This report includes color photos of houses rejected for the program because of slight violations, such as having a fireplace or too many windows. Income Security Legal Services In response to congressional interest in congressional funds spent on programs involved, directly or indirectly, in political, cultural, institutional, ideological, and/or economic advocacy, this report provides information on the Legal Services Corporation (LSC). GAO presents data on the activities of the 16 grantees, referred to as national support centers, that received funds from LSC in 1990. GAO discusses (1) the amount and the sources of the centers' funding, (2) their principal activities, (3) the estimate of funds spent on lobbying activities, and (4) the makeup of their boards of directors. GAO also discusses recent findings of monitoring reviews done by LSC on each center's funded activities. Long-Term Care Forum: 1993) Public dissatisfaction with the existing long-term care system is mounting. Long-term care is seen widely as both expensive and failing to meet the needs of the disabled of all ages. In particular, many people take issue with long-term care's bias in favor of institutional rather than home- and community-based services. This discussion paper was prepared for a GAO forum on long-term care issues. The views presented, although not Fiscal Year 1993 GAO Reports on Issues Massachusetts Long-Term Social Security Disability: 1993) necessarily the official position of GAO, are an attempt to pull together a wide variety of evidence and expert opinion on the key issues in long-term reform. GAO touches on the key elements of innovative long-term care programs in the United States and abroad that have developed a wider range of home- and community-based services for the elderly as well as younger disabled persons. These key elements include (1) service flexibility to meet the unique needs of individuals, (2) high standards of organizational accountability to taxpayers for money spent and the quality of services delivered, and (3) effective cost controls to stay within the budgets decided upon by elected officials. GAO reviewed Massachusetts' long-term care programs for elderly and The Social Security Administration (SSA) has not met the legal requirements for conducting continuing disability reviews, which ensure that individuals receiving government disability benefits are eligible for them. Significant operational problems due to unprecedented increases in initial claims for social security benefits have prompted SSA to shift resources from conducting the reviews to processing these claims. Since fiscal year 1987, SSA has done only about half of the more than 2 million required reviews. Consequently, SSA will pay more than a billion dollars to beneficiaries who have improved enough to return to work. Further, the integrity of the trust funds is affected because thousands of ineligible Fiscal Year 1993 GAO Reports on Issues Veterans Issues Defense Civilian beneficiaries remain on the disability rolls. In 1991, SSA streamlined its continuing disability review process by being more selective about which beneficiaries are reviewed. SSA is evaluating ways to further refine its process. GAO believes that SSA should (1) continue to examine ways to better target reviews for beneficiaries who may have medically improved and (2) increase the number of reviews beyond those planned. GAO has been monitoring the Pentagon's management of civilian force reductions since 1991. This report (1) updates the status of the Defense Department's (DOD) civilian work force reductions; (2) updates some of the problems and consequences arising from DOD's approach to civilian downsizing, including the difference in how white-collar and blue-collar employees have been affected so far; and (3) provides a preliminary assessment of DOD'S initial use of financial separation incentives. GAO also discusses some important constraints on DOD's planning for future force reductions. Defense Force Management: Challenges Continues to Downsize Its GAO testified last year that although the Defense Department (DOD) provided significant transition assistance and financial separation incentives to military personnel, it provided much less assistance to facilitate civilian downsizing. At another congressional hearing, GAO said that some Defense managers were concerned that DOD's reliance on hiring freezes to reduce its civilian work force was making it hard to respond to fluctuations in work load and creating the potential for imbalances in worker skills. This report builds on these testimonies by (1) reporting on the status of DOD's civilian work force reductions, (2) contrasting DOD'S strategy for reducing the military work force with the strategy for reducing the civilian work force, and (3) providing information on DOD'S implementation of the new authorizations for separation incentive programs. |