Bøger af U S Government Accountability Office

" The federal government owns underutilized properties that are costly to operate, yet challenges exist to closing and disposing of them. To obtain value from these properties, some agencies have used EULs, which are generally long-term agreements to lease property from the federal government in exchange for cash or non-cash consideration. However, agencies also incur costs for EUL programs. We have previously reported that agencies should include all costs associated with programs' activities when assessing their values. This report addresses (1) the extent to which agencies attribute the full benefits and costs of their EULs in their assessments of their EUL programs and (2) the experiences of agencies in using their EUL authority. GAO reviewed property data and documents from the largest civilian federal real property agencies including four agencies that use EULs-VA, NASA, the Department of State, and the Department of Agriculture-and applicable laws, and regulations and guidance. GAO visited nine sites where agencies were using EULs. "

" Created in 1998, the TIFIA program is designed to fill market gaps and leverage substantial nonfederal investment by providing federal credit assistance to help finance surface transportation projects including highway, transit, rail, and intermodal projects. Since 2008, demand for the program has surged, annually exceeding budget resources for the program by a factor of more than 10 to 1. Given the increased demand and recent proposals to expand and modify the program, GAO was asked to review (1) the characteristics of TIFIA projects and how DOT tracks progress toward the program's goals, (2) the process DOT used to evaluate and select projects that submitted LOIs to apply for credit assistance in fiscal years 2010 and 2011, (3) the factors that affect project sponsors' decisions about whether to seek TIFIA credit assistance, and (4) the options proposed to modify the program. GAO reviewed laws and program guidance; interviewed DOT officials, project sponsors, and advisors involved in procuring credit assistance; and surveyed all state departments of transportation and other recent applicants about the TIFIA program. "

Drug compounding, FDA has taken steps to implement compounding law, but some states and stakeholders reported challenges: report to Congressional Committees.

"Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that employers who offer health insurance coverage for mental health conditions and substance use disorders (MH/SU) provide coverage that is no more restrictive than that offered for medical and surgical conditions. Employers were required to comply with the law for coverage that began on or after October 3, 2009. The Department of Labor (DOL), the Department of Health and Human Services (HHS), and the Department of the Treasury share oversight for MHPAEA. MHPAEA also requires GAO to examine trends in health insurance coverage of MH/SU. This report describes (1) the extent to which employers cover MH/SU through private health insurance plans, and how this coverage has changed since 2008; and (2) what is known about the effect of health insurance coverage for MH/SU on enrollees' health care expenditures; access to, or use of, MH/SU services; and health status. GAO surveyed a random sample of employers about their MH/SU coverage for the most current plan year and for 2008. GAO received usable responses from 168 employers-a 24 percent response rate. The survey results are not generalizable; rather, they provide information limited to responding employers' MH/SU coverage. GAO reviewed published national employer surveys on health insurance coverage and interviewed officials from DOL..."

"Fiscal sustainability presents a national challenge shared by all levels of government. Since 2007, GAO has published long-term fiscal simulations for the state and local government sector. These simulations show that, like the federal government, the state and local government sector faces persistent and long-term fiscal pressures. Using the Bureau of Economic Analysis's National Income and Product Accounts (NIPA) as the primary data source, GAO's model projects the level of receipts and expenditures for the sector until 2060 based on current and historical spending and revenue patterns. GAO assumes the current set of policies in place across federal, state, and local governments remains constant. This update incorporates NIPA data including increased federal grant funding made available to the sector through the American Recovery and Reinvestment Act of 2009. The model simulates the long-term fiscal outlook for the state and local sector as a whole and, while the model incorporates the Congressional Budget Office's economic projections, adjustments are made to capture the budgetary effects of near-term cyclical swings in the economy. Because the model covers the sector in the aggregate, the fiscal outcomes for individual states and localities cannot be..."

Standardized tests are often requiredto gain admission into postsecondaryschools or to obtain professionalcertifications. Federal disability laws, such as the Americans with DisabilitiesAct (ADA) require entities thatadminister these tests to provideaccommodations, such as extendedtime or changes in test format, tostudents with disabilities. GAOexamined (1) the types ofaccommodations individuals apply forand receive and how schools assistthem, (2) factors testing companiesconsider when making decisions aboutrequests for accommodations, (3)challenges individuals and testingcompanies experience in receiving andgranting accommodations, and (4) how federal agencies enforce compliancewith relevant disability laws andregulations. To conduct this work, GAOinterviewed disability experts;individuals with disabilities; officialsfrom high schools, postsecondaryschools, testing companies; andofficials from the Departments ofJustice (Justice), Education, andHealth and Human Services (HHS).GAO also reviewed testing companypolicies and data, federal complaintand case data for selected testingcompanies, and relevant laws andregulations

" On April 20, 2010, the Deepwater Horizon drilling rig exploded in the Gulf of Mexico resulting in 11 deaths, serious injuries, and the largest marine oil spill in U.S. history. Interior, which oversees offshore oil and gas activities, initiated a number of reforms following the incident to improve its oversight. This report assesses (1) Interior's reorganization of its oversight of offshore oil and gas activities; (2) how key policy changes Interior has implemented since this incident have affected Interior's environmental analyses, plan reviews, and drilling permit reviews; (3) the extent to which Interior's inspections of drilling rigs and production platforms in the Gulf identify violations or result in civil penalty assessments; (4) when stakeholders provided input to Interior on proposed oil and gas activities, and the extent which they believe Interior considered their concerns; and (5) key challenges, if any, Interior faces in overseeing offshore oil and gas activities in the Gulf. GAO analyzed data and documents and interviewed officials from Interior and the Department of Commerce's National Oceanic and Atmospheric Administration, Gulf of Mexico states, environmental groups, and industry. "

"The development of oil and natural gas resources on federal lands contributes to domestic energy production but also results in concerns over potential impacts on those lands. Numerous public protests about oil and gas lease sales have been filed with the Bureau of Land Management (BLM), which manages these federal resources. GAO was asked to examine (1) the extent to which BLM maintains and makes publicly available information related to protests, (2) the extent to which parcels were protested and the nature of protests, and (3) the effects of protests on BLM's lease sale decisions and on oil and gas development activities. To address these questions, GAO examined laws, regulations, and guidance; BLM's agencywide lease record-keeping system; lease sale records for the 53 lease sales held in the four BLM state offices of Colorado, New Mexico, Utah, and Wyoming during fiscal years 2007-2009; and protest data from a random sample of 12 of the 53 lease sales. GAO also interviewed BLM officials and industry and protester groups. "

the Energy Independence andSecurity Act of 2007, Congressmandated higher vehicle fueleconomy by model year 2020 andestablished the Advanced TechnologyVehicles Manufacturing (ATVM) loanprogram in the Department of Energy(DOE). ATVM is to provide up to $25billion in loans for more fuel-efficientvehicles and components. Congressalso provided $7.5 billion to pay therequired credit subsidy coststhegovernments estimated net long-termcost, in present value terms, of theloans. GAO was asked to review theATVM program and agreed to (1)identify the steps DOE has taken toimplement the program, (2) examinethe programs progress in awardingloans, (3) assess how the program isoverseeing the loans, and (4) evaluatethe extent to which DOE can assessprogress toward meeting its goals.GAO analyzed loan documents andrelevant laws and regulations andinterviewed DOE and ATVM officials.

" About 20 percent of U.S. electricity is generated by 104 nuclear reactors. NRC, which regulates reactors, requires their owners (licensees) to reduce radioactive contamination after reactors permanently shut down. This process, called decommissioning, costs hundreds of millions of dollars per reactor. NRC requires licensees to provide reasonable assurance that they will have adequate funds to decommission, in part, by accumulating funds that are greater than or equal to NRC's decommissioning funding formula. GAO and NRC's OIG have identified concerns about NRC's oversight of decommissioning funds. GAO was asked by Representative Markey in his former capacity as Chairman of the House Subcommittee on Energy and Environment to (1) describe how NRC ensures that licensees provide reasonable assurance of adequate decommissioning funds and (2) identify any improvements or weaknesses in NRC's oversight of this area. GAO analyzed NRC's formula and reviews of licensee information and interviewed NRC officials, licensees, and others. "

" The DHS OIG plays a critical role in strengthening accountability throughout DHS. The OIG received about $141 million in fiscal year 2013 appropriations to carry out this oversight. The joint explanatory statement to the Department of Homeland Security Appropriations Act, 2013, directed GAO to review the OIG and its organizational structure for meeting independence standards. This report examines (1) the coverage the OIG's audits and inspections provided of DHS's component agencies, management challenges, and high-risk areas; (2) the extent to which the OIG's organizational structure, roles, and responsibilities were consistent with the IG Act; and (3) the extent to which the design of the OIG's policies and procedures was consistent with applicable independence standards. To address these objectives, GAO obtained relevant documentation, such as selected reports and OIG policies and procedures, and compared this information to the IG Act and independence standards. GAO also interviewed officials from the OIG, DHS components, and the FBI. "

"The number of charter schools is growing, spurred by demand for innovation and federal incentives, such as the Race to the Top Fund, which favors states supportive of charter schools. However, states often define charter schools differently than traditional public schools. Some charter schools operate as a school district, while others are part of a school district and some are for-profit entities. These differences could complicate eligibility determination for federal administrators. GAO was asked: (1) To what extent do charter schools apply for federal discretionary grant programs and what challenges do they face, if any, in doing so? (2) What role has the U.S. Department of Education played in helping charter schools establish their eligibility for federal discretionary grant programs? GAO identified grant programs governmentwide for which charter schools are eligible to apply, surveyed a stratified random sample of charter school officials, and interviewed federal agency officials. We also visited charter schools, school districts, charter school associations, and state educational agencies in 3 states. "

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The Food and Drug Administration (FDA) oversees federal requirements to prohibit false or misleading food labels; the Federal Trade Commission enforces the prohibition against false or misleading advertising. By statute, health claims on food labels must have significant scientific agreement, but in 2002, in response to a court decision, FDA decided to allow qualified health claims with less scientific support. Structure/function claims refer to a foods effect on body structure or function and are also used on food. Congress directed GAO to study FDAs implementation of qualified health claims for food. GAO examined (1) the results of FDAs efforts to allow the use of qualified health claims and oversight of these claims and (2) consumers understanding of the claims. GAO also examined FDAs oversight of structure/function claims. GAO reviewed FDA documents and consumer studies and interviewed stakeholders from health, medical, industry, and consumer groups.

" The Emergency Economic Stabilization Act of 2008 authorized the Department of the Treasury (Treasury) to create the Troubled Asset Relief Program (TARP), a $700 billion program designed to restore the liquidity and stability of the financial system. The act also requires that GAO report every 60 days on TARP activities. This report examines (1) the condition and status of TARP programs; (2) Treasury's management of TARP operations, including staffing for the Office of Financial Stability (OFS) and oversight of contractors and financial agents; and (3) what is known about the direct and indirect costs of TARP. To do this work, GAO analyzed audited financial data for various TARP programs; reviewed documentation such as program terms and internal decision memos; analyzed TARP cost estimates from the Congressional Budget Office (CBO), the Office of Management and Budget, and Treasury; and interviewed CBO and OFS officials. "

" Ports, waterways, and vessels handle billions of dollars in cargo annually and an attack on this maritime transportation system could impact the global economy. November 2012 marks the 10-year anniversary of MTSA, which required a wide range of security improvements. DHS is the lead federal department responsible for implementing MTSA and it relies on its component agencies, such as the Coast Guard and CBP, to help implement the act. The Coast Guard is responsible for U.S. maritime security interests and CBP is responsible for screening arriving vessel crew and cargo. This testimony summarizes GAO's work on implementation of MTSA requirements over the last decade and addresses (1) progress the federal government has made in improving maritime security and (2) key challenges that DHS and its component agencies have encountered in implementing maritime security-related programs. GAO was unable to identify all related federal spending, but estimated funding for certain programs. For example, from 2004 through May 2012, CBP obligated over $390 million to fund its program to partner with companies to review the security of their supply chains. This statement is based on GAO products issued from August 2002 through July 2012, as well as updates on the status of recommendations made and budget data obtained in August 2012. "

Nuclear nonproliferation, additional actions needed to increase the security of U.S. industrial radiological sources: report to congressional requesters.

" As part of the nation's UI system, overseen by DOL, states provide benefits to eligible unemployed workers, with additional weeks of benefits sometimes provided by the federal government in times of economic stress. Since the 1960s, states have had maximum UI benefit durations of 26 weeks or longer. However, since 2011, nine states have reduced their maximum benefit durations: Arkansas, Florida, Georgia, Illinois, Kansas, Michigan, Missouri, North Carolina, and South Carolina. GAO was asked to review the states' reductions. GAO examined (1) the circumstances in which states reduced the maximum duration of UI benefits, (2) the implications of these reductions for individuals, (3) the effects on federal UI costs, and (4) their broader economic effects. GAO reviewed relevant federal and state laws; visited Georgia and Michigan, which had different approaches to reducing durations; analyzed UI program data from 2006 (before the recession) to 2014; and reviewed relevant economic research. "

" Agricultural imports-including imports of fruit, vegetables, seafood, and other commodities that directly compete with U.S. products-have more than doubled over the last decade, according to data from USDA. The department's TAA for Farmers program provides technical and financial assistance to producers of commodities certified by USDA as eligible for assistance. The Trade and Globalization Adjustment Assistance Act of 2009 reauthorized and amended the program and directed GAO to prepare and submit a report on the operation and effectiveness of the amendments. In particular, GAO examined (1) the commodities and producers USDA approved for assistance and the type and amount of assistance it provided, and (2) the approach USDA is taking to evaluate the program's effectiveness and limitations, if any, in this approach. GAO analyzed USDA data and documents; interviewed USDA officials, their academic partners, producer groups, and commodity experts; and conducted fieldwork in two states to meet with producer groups for certified commodities. "

Since the Department of Energys (DOE) loan guarantee program (LGP) for innovative energy projects was established in Title XVII of the Energy Policy Act of 2005, its scope has expanded both in the types of projects it can support and in the amount of loan guarantee authority available. DOE currently has loan guarantee authority estimated at about $77 billion and is seeking additional authority. As of April 2010, it had issued one loan guarantee for $535 million and made nine conditional commitments. In response to Congress mandate to review DOEs execution of the LGP, GAO assessed (1) the extent to which DOE has identified what it intends to achieve through the LGP and is positioned to evaluate progress and (2) how DOE has implemented the program for applicants. GAO analyzed relevant legislation, prior GAO work, and DOE guidance and regulations. GAO also interviewed DOE officials, LGP applicants, and trade association representatives.

Federal agencies depend on IT to support their missions and spent at least $76 billion on IT in fiscal year 2011. However, long-standing congressional interest has contributed to the identification of numerous examples of lengthy IT projects that incurred cost overruns and schedule delays while contributing little to mission-related outcomes. To reduce the risk of such problems, the Office of Management and Budget (OMB) recommends modular software delivery consistent with an approach known as Agile, which calls for producing software in small, short increments. Recently, several agencies have applied Agile practices to their software projects.Accordingly, GAO was asked to identify (1) effective practices in applying Agile for software development solutions and (2) federal challenges in implementing Agile development techniques. To do so, GAO identified and interviewed ten experienced users and officials from five federal projects that used Agile methods and analyzed and categorized their responses.

"Since 2002, DOD obligated at least $166.6 billion on contracts supporting reconstruction and stabilization efforts in Iraq and Afghanistan. Many of these contingency contracts, in particular those awarded in Iraq, need to be closed. Contract closeout is a key step to ensure the government receives the goods and services it purchased at the agreed upon price and, if done timely, provides opportunities to use unspent funds for other needs and reduces exposure to other financial risks. To assess DOD's efforts to close its Iraq contracts, GAO examined the (1) number of contracts that are eligible for closeout and the extent to which they will be closed within required time frames, (2) factors contributing to contracts not being closed within required time frames, (3) steps DOD took to manage the financial risks associated with not closing contracts within required time frames, and (4) extent to which DOD captured and implemented lessons learned from closing its Iraq contracts. GAO reviewed contingency contracting guidance, analyzed contract and closeout data for contracts awarded between fiscal years 2003 and 2010, and interviewed DOD officials from six organizations responsible for awarding or closing out these contracts. "

"Globalization has placed increasing demands on the Food and Drug Administration (FDA), an agency within the Department of Health and Human Services (HHS), in ensuring the safety and effectiveness of drugs marketed in the United States. Drugs manufactured in more than 100 countries were offered for entry into the United States in fiscal year 2009. FDA inspects drug manufacturing establishments in order to ensure that the safety and quality of drugs are not jeopardized by poor manufacturing practices. In 1998 GAO identified weaknesses in FDA's foreign drug inspection program. In 2008 GAO found, among other things, that from fiscal years 2002 through 2007, FDA inspected relatively few foreign establishments each year. GAO also determined that, because of inaccurate information in its databases, FDA did not know how many foreign drug establishments were subject to inspection. In 2008 GAO recommended that FDA increase inspections of foreign drug establishments and improve information it receives to manage the foreign drug inspection program. This report examines FDA's progress since 2008 in (1) conducting more foreign drug inspections, and (2) improving its information on foreign drug establishments. GAO analyzed information from FDA databases, reviewed documents related to FDA's efforts to both improve these..."

DOD financial management: improvements needed in Army's efforts to ensure the reliability of Its statement of budgetary resources: Report to Congressional committees.

The Department of Defense (DOD) leads detection and monitoring of aerial and maritime transit of illegal drugs into the United States in support of law enforcement agencies. DOD reported resources of more than $1.5 billion for fiscal year 2010 to support its counternarcotics activities.Congress mandated GAO report on DODs counternarcotics performance measurement system. Specifically, this report addresses the extent to which (1) DODs counternarcotics performance measurement system enables DOD to track progress and (2) DOD uses performance information from its counternarcotics performance measurement system to manage its activities. GAO analyzed relevant DOD performance and budget documents, and discussed these efforts with officials from DOD and the Office of National Drug Control Policy (ONDCP).

"Missing children who are not found quickly are at an increased risk of victimization. The National Child Search Assistance Act, as amended, requires that within 2 hours of receiving a missing child report, law enforcement agencies (LEAs) enter the report into the Department of Justice's (DOJ) National Crime Information Center (NCIC), a clearinghouse of information instantly available to LEAs nationwide. DOJ's Criminal Justice Information Services (CJIS), the CJIS Advisory Policy Board (the Board), and state criminal justice agencies share responsibility for overseeing this requirement. As requested, GAO examined (1) CJIS's and the Board's efforts to implement and monitor compliance with the requirement; and (2) selected LEA-reported challenges with timely entry and DOJ's actions to assist LEAs in addressing them. GAO reviewed documents, such as agency guidelines, and interviewed officials from DOJ, six state criminal justice agencies, and nine LEAs selected in part based on missing children rates. The results are not generalizable to all states and LEAs, but provided insights on this issue. GAO recommends that CJIS and the Board consider establishing minimum standards for states to use to monitor compliance with the"

" Since 1989 the National Guard has received hundreds of millions of dollars to help enhance the effectiveness of state-level counterdrug efforts by providing military support to assist interagency partners with their counterdrug activities. The program funds the drug interdiction priorities of each state Governor; counterdrug-related training to interagency partners at five counterdrug schools; and state-level counterthreat finance investigations, all of which are part of DOD's broader counterdrug efforts. Senate Report 113-176 included a provision for GAO to conduct an assessment of the state operations of the National Guard's counterdrug program. This report: (1) identifies the changes in funding for the program since fiscal year 2004, and (2) assesses the extent to which performance information is used to evaluate the program's activities. GAO analyzed the program's budgets and obligations data, performance measures, and program guidance, and interviewed knowledgeable officials. "

OSHA is generally responsible for setting and enforcing occupational safety and health standards in the nation's workplaces. OSHA carries out enforcement directly in 34 states and territories, while the remaining 22 have chosen to administer their own enforcement programs (state-run programs) under plans approved by OSHA. GAO was asked to review issues related to state-run programs. This report examines (1) what challenges states face in administering their safety and health programs, and (2) how OSHA responds to state-run programs with performance issues. GAO reviewed relevant federal laws, regulations and OSHA policies; conducted a survey of 22 state-run programs; and interviewed officials in OSHA's national office, all 10 OSHA regions, and from a nongeneralizable sample of 5 state-run programs; and interviewed labor and business associations and safety and health experts. State-run programs face several challenges that primarily relate to staffing, and include having constrained budgets, according to OSHA and state officials. States have difficulty filling vacant inspector positions, obtaining training for inspectors, and retaining qualified inspectors. Recruiting inspectors is difficult due to the shortage of qualified candidates, relatively low state salaries, and hiring freezes. Although OSHA has taken steps to make its courses more accessible to states, obtaining inspector training continues to be difficult. According to an agency official, OSHA's Training Institute faces several challenges in delivering training, including recruiting and retaining instructors, difficulty accommodating the demand for training, and limitations in taking some courses to the field due to the need for special equipment and facilities. These challenges are further exacerbated by states' lack of travel funds, which limit state inspectors' access to OSHA training. Retaining qualified inspectors is another challenge among states. Officials noted that, once state inspectors are trained, they often leave for higher paying positions in the private sector or federal government. GAO's survey of the 22 state-run programs that cover private and public sector workplaces showed that turnover was more prevalent among safety inspectors than health inspectors. Nearly half of these states reported that at least 40 percent of their safety inspectors had fewer than 5 years of service. In contrast, half of the states reported that at least 40 percent of their health inspectors had more than 10 years of service. These staffing challenges have limited the capacity of some state-run programs to meet their inspection goals. OSHA has responded in a variety of ways to state-run programs with performance issues. These include closely monitoring and assisting such states, such as accompanying state staff during inspections and providing additional training on how to document inspections. OSHA has also drawn attention to poor state performance by communicating its concerns to the governor and other high-level state officials. In addition, OSHA has shared enforcement responsibilities with struggling states or, as a last resort, has resumed sole responsibility for federal enforcement when a state has voluntarily withdrawn its program. Although OSHA evaluates state-run programs during its annual reviews, GAO found that OSHA does not hold states accountable for addressing issues in a timely manner or establish time frames for when to resume federal enforcement when necessary. In addition, the current statutory framework may not permit OSHA to quickly resume concurrent enforcement authority with the state when a state is struggling with performance issues. As a result, a state's performance problems can continue for years. OSHA officials acknowledged the need for a mechanism that allows them to intervene more quickly in such circumstances. GAO-13-320

" DOD spends billions of dollars each year to maintain key business operations intended to support the warfighter. In 2005, GAO identified DOD's approach to business transformation as high-risk because DOD had not established management responsibility, accountability, and control over business transformationrelated activities and resources, and it lacked a plan with specific goals, measures, and mechanisms to monitor progress. GAO previously reported that DOD has taken steps to develop a management approach. This report addresses DOD's progress in (1) incorporating key strategic planning elements into its transformation plan; and (2) developing and implementing an approach for assessing DOD-wide progress toward business goals. GAO analyzed relevant DOD documents, reviewed prior and ongoing GAO work; and interviewed DOD officials. "

"analyzed federal data on Medicaid expenditures for comprehensive risk-based managed care. GAO selected eight states because they used managed care for some portion of their Medicaid population and were geographically diverse. For these states, GAO reviewed state payment data and documentation, including contracts with MCOs, and interviewed state officials. GAO also reviewed federal laws to describe MLR minimums in Medicare and the private insurance market. The Department of Health and Human Services had no comments on this report. What GAO Found Federal spending for Medicaid managed care increased significantly from fiscal year 2004 through fiscal year 2014 (from $27 billion to $107 billion), and represented 38 percent of total federal Medicaid spending in fiscal year 2014. Consistent with this national trend, managed care as a proportion of total federal Medicaid spending was higher in seven of eight selected states in fiscal year 2014 compared with fiscal year 2004. Federal Expenditures for Medicaid Managed Care as a Percentage of Federal Medicaid Expenditures, in Eight States, Fiscal Years 2004 and 2014 Total and average per beneficiary payments by states to managed care organizations (MCOs) varied considerably across the eight selected states in state fiscal year 2014. For example, total payments ranged from $1.3 billion in one state to $18.2 billion in another, and average payments per beneficiary ranged from about $2,800 to about $5,200. While not required by federal policy to do so, five of the eight selected states required MCOs to annually meet minimum medical loss ratio (MLR) percentages-standards that ensure a certain proportion of payments are for medical care and, in effect, limit the amount that can be used for administrative cost and profit. These state minimums generally ranged from 83 to 85 percent, similar to the 85 percent minimums established in the Patient Protection and Affordable Care Act (PPACA) for other sources of health coverage. All MCOs in the five states had MLRs in state fiscal year 2014 that were above the state-required minimums. GAO also found that all eight selected states focused on beneficiary factors, such as assigning a beneficiary to the same managed care plan in which a family member is enrolled, when the state selects a plan for the beneficiary in the absence of the beneficiary choosing a plan-referred to as auto assignment. States also considered plan performance, for example, on quality measures and program goals, such as achieving a certain distribution of enrollment across plans. Auto assignments of beneficiaries ranged from 23 to 61 percent of managed care enrollees across the seven selected states that tracked such data. View GAO-16-77. For more information, contact Carolyn L. Yocom at (202) 512-7114 or yocomc@gao.gov. Letter"