Passengers with Disabilities: Airport Accessibility Barriers and Practices and DOT’s Oversight of Airlines’ Disability-Related Training

What GAO Found

Passengers with disabilities face infrastructure, information, and customer service barriers at U.S. airports, according to representatives of selected airports, disability advocacy organizations, as well as a review of relevant literature.

  • Infrastructure barriers can include complex terminal layouts and long distances between gates and can be difficult for some to navigate.
  • Essential travel information is not always available in a format accessible to all. For example, a person with hearing loss could miss crucial gate information that is solely provided over a loudspeaker.
  • A passenger might not receive appropriately sensitive service, such as wheelchair assistance, at the airport, although the service provided is required by the Air Carrier Access Act of 1986 (ACAA) regulations.

According to stakeholders, while no solution meets all needs, a number of practices can help reduce or eliminate some of these barriers to equal access at airports. For example, some selected airports use external disability community and passenger groups to proactively engage in identifying barriers and develop solutions. Other airports have implemented technology-based solutions, such as mobile phone applications to make airport navigation easier.

Examples of Stakeholder-Identified Features to Assist Airport Passengers with Disabilities

The Office of Aviation Consumer Protection within the Department of Transportation (DOT) is responsible for oversight of airlines’ compliance with the ACAA. In 2008, DOT updated its entire ACAA regulation, including adding new training requirements for airline personnel, such as requiring training to be recurrent. Following this update, DOT conducted outreach to domestic and foreign airlines on the changes and reviewed airlines’ disability training sessions and materials. Agency officials said that in recent years, DOT has conducted reviews of airlines’ training only when passengers’ complaints indicate a possible problem, as officials’ analyses have not shown training generally to be a significant cause of service violations. DOT officials and stakeholders said other factors, such as limited availability of staff to assist passengers with disabilities, at times may affect the service passengers with disabilities receive. DOT is assessing some of these factors through the statutorily mandated ACAA Advisory Committee, formed in late 2019 to make recommendations to improve accessibility to air travel. The committee met in 2020, established three subcommittees, and plans to reconvene by summer 2021.

Why GAO Did This Study

Approximately 43 million people in the United States have some type of disability, which may affect mobility, vision, hearing, and cognition. Without accessible airport facilities and accommodations—such as appropriate assistance from the check-in counter to the gate, or effective communication of flight information—air travel for people with disabilities can be extremely challenging.

The FAA Reauthorization Act of 2018 includes provisions for GAO to review leading airport accessibility practices for passengers with disabilities, as well as required training for airline and contract service personnel who assist these passengers within the airport. This report examines, among other objectives: stakeholder-identified barriers that passengers with disabilities face when accessing airport facilities, accessibility practices to assist passengers with disabilities, as well as how DOT has overseen airlines’ disability-related training.

GAO reviewed relevant federal laws, regulations, DOT documents, literature, as well as information describing disability training provided by selected airlines and contractors. GAO interviewed a non-generalizable sample of stakeholders, including those at 16 U.S. airports selected based on size and geography, eight large and low-cost domestic airlines selected based on the greatest number of disability-related passenger complaints and enplanements, and six aviation service contractors working for those airlines. GAO also conducted interviews with DOT officials and 10 disability advocacy organizations, among others.

For more information, contact Heather Krause at (202) 512-2834 or krauseh@gao.gov.

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    As of June 2020, the Federal Communications Commission (FCC) required consumers nationwide to use the Lifeline National Verifier (Verifier), a centralized process and data system, to check their eligibility for Lifeline. Because consumers who participate in certain federal benefits programs qualify for discounted phone and internet service through Lifeline, the Verifier checks state and federal benefits databases to verify consumers' eligibility. The Verifier also includes a manual review process for consumers to submit documents proving their eligibility if they cannot be found in a database. As of November 2020, the Verifier had connections with databases in 20 states and 2 federal agencies. GAO found that although consumers in states without state database connections had the same likelihood of actually meeting eligibility requirements as consumers in states with such connections, they were less likely to be found eligible for Lifeline through the Verifier (see figure). Average Eligibility Determination for New Lifeline Applicants in States with and without State Database Connections to the Lifeline National Verifier, June 2018 through June 2020 FCC coordinated with state and federal stakeholders to implement the Verifier. However, stakeholders told GAO that many eligible consumers are not aware of the Verifier or Lifeline. Consumers may lack this awareness because FCC's consumer education planning did not always align with key practices, such as developing consistent, clear messages and researching target audiences. As a result, eligible consumers may not apply for Lifeline. Moreover, while FCC originally envisioned tribal governments and organizations assisting residents of tribal lands with the Verifier, it has not provided them with quality information to effectively do so. Although FCC reported that the Verifier is meeting its goal of improving the consumer experience, GAO found that the manual review process, which FCC used to determine the eligibility of more than half of applicants in many states, is challenging for consumers. However, FCC does not collect complete information on consumers' experience with this process, and thus is limited in its ability to identify and address the challenges consumers face. Such challenges likely contributed to eligible consumers giving up on their applications. For example, we found that more than two-thirds of applicants who underwent manual review between June 2018 and June 2020 did not complete their applications. FCC's Lifeline program discounts phone and internet service for eligible low-income consumers. In 2019, FCC authorized $982 million in support for 6.9 million eligible consumers. FCC created the Verifier with the stated goals of reducing fraud and costs and improving the consumer experience. The Verifier includes an online application, connections to state and federal benefits databases, and a standardized manual review process. GAO was asked to review FCC's implementation of the Verifier. This report examines: (1) the status of the Verifier; (2) FCC's coordination with stakeholders and efforts to educate consumers and facilitate tribal stakeholders' involvement; and (3) the extent to which the Verifier is meeting its goals. GAO reviewed FCC orders and documentation; analyzed Verifier performance and Lifeline subscriber data; interviewed FCC and other agency officials, and selected industry, state, tribal, and consumer stakeholders; and surveyed state officials. Stakeholders were selected to obtain a variety of non-generalizable viewpoints. GAO is making six recommendations, including that FCC develop a consumer education plan, provide quality information to tribal organizations, and collect information on consumers' experience with the manual review process. FCC agreed to take steps to address all of GAO's recommendations. For more information, contact Andrew Von Ah at (202)-512-2834 or vonaha@gao.gov.
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  • Offshore Wind Energy: Planned Projects May Lead to Construction of New Vessels in the U.S., but Industry Has Made Few Decisions amid Uncertainties
    In U.S GAO News
    Under the Jones Act, vessels carrying merchandise between two points in the U.S. must be built and registered in the United States. Developers are planning a number of offshore wind projects along the U.S. east coast, where many states have set targets for offshore wind energy production. Stakeholders described two approaches to using vessels to install offshore wind energy projects in the U.S. Either approach may lead to the construction of new vessels that comply with the Jones Act. Under one approach, a Jones Act-compliant wind turbine installation vessel (WTIV) would carry components from a U.S. port to the site and also install the turbines. WTIVs have a large deck, legs that allow the vessel to lift out of the water, and a tall crane to lift and place turbines. Stakeholders told GAO there are currently no Jones Act-compliant vessels capable of serving as a WTIV. One company, however, has announced a plan to build one. Under the second approach, a foreign-flag WTIV would install the turbines with components carried to the site from U.S. ports by Jones Act-compliant feeder vessels (see figure). While some potential feeder vessels exist, stakeholders said larger ones would probably need to be built to handle the large turbines developers would likely use. Example of an Offshore Wind Installation in U.S. Waters Using a Foreign-Flag Installation Vessel and Jones Act-Compliant Feeder Vessels Stakeholders identified multiple challenges—which some federal programs address—associated with constructing and using Jones Act-compliant vessels for offshore wind installations. For example, stakeholders said that obtaining investments in Jones Act-compliant WTIVs—which may cost up to $500 million—has been challenging, in part due to uncertainty about the timing of federal approval for projects. According to officials at the Department of the Interior, which is responsible for approving offshore wind projects, the Department plans to issue a decision on the nation's first large-scale offshore wind project in December 2020. Some stakeholders said that if this project is approved, investors may be more willing to move forward with vessel investments. While stakeholders also said port infrastructure limitations could pose challenges to using Jones Act-compliant vessels for offshore wind, offshore wind developers and state agencies have committed to make port investments. Offshore wind, a significant potential source of energy in the United States, requires a number of oceangoing vessels for installation and other tasks. Depending on the use, these vessels may need to comply with the Jones Act. Because Jones Act-compliant vessels are generally more expensive to build and operate than foreign-flag vessels, using such vessels may increase the costs of offshore wind projects. Building such vessels may also lead to some economic benefits for the maritime industry. A provision was included in statute for GAO to review offshore wind vessels. This report examines (1) approaches to use of vessels that developers are considering for offshore wind, consistent with Jones Act requirements, and the extent to which such vessels exist, and (2) the challenges industry stakeholders have identified associated with constructing and using such vessels to support U.S. offshore wind, and the actions federal agencies have taken to address these challenges. GAO analyzed information on vessels that could support offshore wind, reviewed relevant laws and studies, and interviewed officials from federal agencies and industry stakeholders selected based on their involvement in ongoing projects and recommendations from others. For more information, contact Andrew Von Ah at (202) 512-2834 or vonaha@gao.gov.
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  • Unaccompanied Children: Actions Needed to Improve Grant Application Reviews and Oversight of Care Facilities
    In U.S GAO News
    The Office of Refugee Resettlement's (ORR) grant announcements soliciting care providers for unaccompanied children—those without lawful immigration status and without a parent or guardian in the U.S. available to provide care and physical custody for them—lack clarity about what state licensing information is required. Further, ORR does not systematically confirm the information submitted by applicants or document a review of their past performance on ORR grants, when applicable, according to GAO's analysis of ORR documents and interviews with ORR officials. The grant announcements do not specify how applicants without a state license should show license eligibility—a criterion for receiving an ORR grant—or specify what past licensing allegations and concerns they must report. In addition, the extent to which ORR staff verify applicants' licensing information is unclear. In fiscal years 2018 and 2019, ORR awarded grants to approximately 14 facilities that were unable to serve children for 12 or more months because they remained unlicensed. In addition, ORR did not provide any documentation that staff conducted a review of past performance for the nearly 70 percent of applicants that previously held ORR grants. Without addressing these issues, ORR risks awarding grants to organizations that cannot obtain a state license or that have a history of poor performance. State licensing agencies regularly monitor ORR-funded facilities, but according to GAO's survey of these agencies, their information sharing with ORR is limited (see figure). State licensing agencies and ORR staff both said that improved information sharing would benefit their monitoring of facilities. Without such improvements, ORR may lack information about ongoing issues at its facilities. Key Survey Responses on Information-Sharing with the Office of Refugee Resettlement (ORR) by the 23 State Agencies That Licensed ORR-Funded Facilities in Fall 2019 ORR requires grantees to take corrective action to address noncompliance it identifies through monitoring, but ORR has not met some of its monitoring goals or notified grantees of the need for corrective actions in a timely manner. For example, under ORR regulations, each facility is to be audited for compliance with standards to prevent and respond to sexual abuse and harassment of children by February 22, 2019, but by April 2020, only 67 of 133 facilities had been audited. In fiscal years 2018 and 2019, ORR also did not meet its policy goals to visit each facility at least every 2 years, or to submit a report to facilities on any corrective actions identified within 30 days of a visit. Without further action, ORR will continue to not meet its own monitoring goals, which are designed to ensure the safety and well-being of children in its care. ORR is responsible for the care and placement of unaccompanied children in its custody, which it provides through grants to state-licensed care provider facilities. ORR was appropriated $1.3 billion for this program in fiscal year 2020. GAO was asked to review ORR's grant making process and oversight of its grantees. This report examines (1) how ORR considers state licensing issues and past performance in its review of grant applications; (2) state licensing agencies' oversight of ORR grantees, and how ORR and states share information; and (3) how ORR addresses grantee noncompliance. GAO reviewed ORR grant announcements and applications for fiscal years 2018 and 2019. GAO conducted a survey of 29 state licensing agencies in states with ORR facilities, and reviewed ORR monitoring documentation and corrective action reports. GAO also reviewed ORR guidance and policies, as well as relevant federal laws and regulations, and interviewed ORR officials. GAO is making eight recommendations to ORR on improving clarity in its grant announcements, communication with state licensing agencies, and monitoring of its grantees. ORR agreed with all eight recommendations. For more information, contact Kathryn A. Larin at (202) 512-7215 or larink@gao.gov.
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  • Opioid Use Disorder: Treatment with Injectable and Implantable Buprenorphine
    In U.S GAO News
    Of the medications used to treat opioid use disorder (OUD), only buprenorphine is both a controlled substance and available as an injection or implant. Buprenorphine is used to treat patients with OUD because it reduces or eliminates opioid withdrawal symptoms and blunts the euphoria or dangerous side effects of other opioids, such as heroin. When used to treat OUD, buprenorphine, in any form, is subject to additional laws and regulations that are overseen by the Drug Enforcement Administration (DEA), within the Department of Justice (DOJ) and the Substance Abuse and Mental Health Services Administration (SAMHSA), within the Department of Health and Human Services (HHS). To ensure patient safety when injectable and implantable buprenorphine is used, the Food and Drug Administration (FDA), within HHS has also required drug companies to establish risk evaluation and mitigation strategies to help ensure the benefits of these medications outweigh their risks. Providers and pharmacies must follow a number of specific steps based on federal requirements when providing treatment with injectable and implantable buprenorphine. Providers are responsible for prescribing, storing, and administering injectable and implantable buprenorphine, while pharmacies are responsible for dispensing these medications (see figure). Representatives GAO interviewed from provider groups and pharmacies said they did not find the steps involved in treating patients to be difficult overall. However, they stated that careful and timely coordination with each other and patients is needed at key steps of the process to ensure that the patient receives treatment. Representatives from provider groups and pharmacies reported that the risk of diversion of injectable and implantable buprenorphine is low. For example, all of the provider groups GAO spoke with said that diversion of injectable or implantable buprenorphine is unlikely, and representatives from three of the six provider groups said that the design of these formulations reduces opportunities for diversion due to how they are administered. Process for Treating Opioid Use Disorder with Injectable and Implantable Buprenorphine The use of injectable and implantable buprenorphine to treat OUD is relatively low compared to oral forms of buprenorphine. HHS has reported that about 7,250 prescriptions were issued for injectable and implantable buprenorphine in fiscal year 2019, compared to over 700,000 patients who received buprenorphine prescriptions for oral formulations to treat OUD or pain in that year. In 2018, SAMHSA estimated that about one-quarter of the estimated 2 million people with OUD had received some form of substance use treatment in the prior year. One form of treatment—medication-assisted treatment (MAT)— combines behavioral therapy with the use of certain medications. HHS has identified expanding access to treatment for OUD as an important strategy for reducing opioid morbidity and mortality, which includes increasing the number of injectable and implantable buprenorphine prescriptions. Congress included a provision in the SUPPORT Act for GAO to review access to and the potential for the diversion of controlled substances administered by injection or implantation. This report focuses on injectable and implantable controlled substances that can be used to treat OUD and specifically, describes the process for treating OUD with injectable and implantable buprenorphine and what is known about their use. GAO reviewed laws, regulations, and documentation from DEA, FDA, and SAMHSA governing the process of providing treatment with buprenorphine and interviewed officials from those agencies. GAO also interviewed representatives from stakeholder groups representing MAT providers; drug companies that manufacture injectable or implantable buprenorphine; and pharmacies that dispense these medications. HHS and DOJ reviewed a draft of this report, and GAO incorporated their technical comments, as appropriate. For more information, contact James Cosgrove at (202) 512-7114 or cosgrovej@gao.gov.
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