Fiscal Year 2022 Budget Request: U.S. Government Accountability Office

In fiscal year (FY) 2020, GAO’s work yielded $77.6 billion in financial benefits, a return of about $114 for every dollar invested in GAO. We also identified 1,332 other benefits that led to improved services to the American people, strengthened public safety, and spurred program and operational improvements across the government. In addition, GAO reported on 35 areas designated as high risk due to their vulnerabilities to fraud, waste, abuse, and mismanagement or because they face economy, efficiency, or effectiveness challenges. In FY 2020 GAO’s High Risk Series products resulted in 168 reports, 26 testimonies, $54.2 billion in financial benefits, and 606 other benefits.

In this year of GAO’s centennial, GAO’s FY 2022 budget request seeks to lay the foundation for the next 100 years to help Congress improve the performance of government, ensure transparency, and save taxpayer dollars. GAO’s fiscal year (FY) 2022 budget requests $744.3 million in appropriated funds and uses $50.0 million in offsets and supplemental appropriations. These resources will support 3,400 full-time equivalents (FTEs). We will continue our hiring focus on boosting our Science and Technology and appropriations law capacity. GAO will also maintain entry-level and intern positions to address succession planning and to fill other skill gaps. These efforts will help ensure that GAO recruits and retains a talented and diverse workforce to meet the priority needs of the Congress.

In FY 2022, we will continue to support Congressional oversight across the wide array of government programs and operations. In particular, our science and technology experts will continue to expand our focus on rapidly evolving issues. Hallmarks of GAO’s work include: (1) conducting technology assessments at the request of the Congress; (2) providing technical assistance to Congress on science and technology matters; (3) continuing the development and use of technical guides to assess major federal acquisitions and technology programs in areas such as technology readiness, cost estimating, and schedule planning; and (4) supporting Congressional oversight of federal science programs.

With our requested funding, GAO will also bolster capacity to review the challenges of complex and growing cyber security developments. In addition, GAO will continue robust analyses of factors behind rising health care costs, including costs associated with the ongoing COVID-19 Pandemic.

Internally, the funding requested will make possible priority investments in our information technology that include the ability to execute transformative plans to protect data and systems. In FY 2022 GAO will continue to implement efforts to increase our flexibility to evolve IT services as our mission needs change, strengthen information security, increase IT agility, and maintain compliance. We will increase speed and scalability to deliver capabilities and services to the agency.

This request will also help address building infrastructure, security requirements, as well as tackle long deferred maintenance, including installing equipment to help protect occupants from dangerous bacteria, viruses, and mold. As reported in our FY 2020 financial statements, GAO’s backlog of deferred maintenance on its Headquarters Building had grown to over $82 million as of fiscal year-end.

Background

GAO’s mission is to support Congress in meeting its constitutional responsibilities and to help improve the performance and ensure the accountability of the federal government for the benefit of the American people. We provide nonpartisan, objective, and reliable information to Congress, federal agencies, and to the public, and recommend improvements across the full breadth and scope of the federal government’s responsibilities.

In fiscal year 2020. GAO issued 691 products, and 1,459 new recommendations. Congress used our work extensively to inform its decisions on key fiscal year 2020 and 2021 legislation. Since fiscal year 2000, GAO’s work has resulted in over:

  • $1.2 trillion dollars in financial benefits; and
  • 25,328 program and operational benefits that helped to change laws, improve public services, and promote sound management throughout government.

As GAO recognizes 100 years of non-partisan, fact-based service, we remain committed to providing program and technical expertise to support Congress in overseeing the executive branch; evaluating government programs, operations and spending priorities; and assessing information from outside parties.

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  • K-12 Education: Observations on States’ School Improvement Efforts
    In U.S GAO News
    Many states use flexibilities in the Elementary and Secondary Education Act (ESEA), as amended, in identifying low-performing schools and student subgroups (e.g., students from major racial and ethnic groups and low-income students) that need support and improvement. For example, states must identify all public high schools failing to graduate at least one-third of their students. According to GAO's state plan analysis, four states used ESEA's flexibilities to set higher graduation rates (i.e., 70-86 percent) for purposes of state accountability. Similarly, while ESEA requires states to identify schools in which students in certain subgroups are consistently underperforming, 12 states assess the performance of additional student subgroups. Although states are generally required to set aside a portion of their federal education funding for school improvement activities (see figure), states have some discretion in how they allocate these funds to school districts. According to GAO's survey, 27 states use a formula to allocate funds. GAO also found that in at least 34 states, all school districts that applied for federal funds received them in school year 2018-2019, but states had discretion regarding which schools within those districts to fund and at what level. Funding for School Improvement through the Elementary and Secondary Education Act (ESEA) Title I, Part A Note: For more details, see figure 2 in GAO-21-199. A majority of the 50 states and the District of Columbia responding to our survey reported having at least moderate capacity to support school districts' school improvement activities. Education provides various types of technical assistance to build local and state capacity such as webinars, in-person training, guidance, and peer networks. About one-half of states responding to GAO's survey sought at least one type of technical assistance from Education's program office and various initiatives, and almost all of those found it helpful. For example, Education's Regional Educational Laboratories (REL) help states use data and evidence, access high-quality research to inform decisions, identify opportunities to conduct original research, and track progress over time using high-quality data and methods. Several states most commonly reported finding the following assistance by RELs to be helpful: in-person training (26), webinars (28), and reviews of existing research studies to help select interventions (24). The Elementary and Secondary Education Act (ESEA) requires states to have statewide accountability systems to help provide all children significant opportunity to receive a fair, equitable, and high-quality education, and to close educational achievement gaps high-quality education. These systems must meet certain federal requirements, but states have some discretion in how they design them. For example, ESEA requires states to identify low-performing schools and student subgroups for support and improvement. Senate Report 115-289 accompanying the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2019, includes a provision for GAO to review states' school improvement activities. This report addresses (1) how states identify and allocate funds for schools identified for support and improvement; and (2) the extent to which states have capacity to support districts' school improvement activities and how helpful states find Education's technical assistance. GAO analyzed the most current approved state accountability plans from all 50 states and the District of Columbia as of September 2020. The information in these plans predates the COVID-19 pandemic and represents a baseline from which to compare school improvement activities going forward. GAO also surveyed and received responses from all 50 states and the District of Columbia. GAO also conducted follow-up interviews with officials in three states selected based on variation in reported capacity and geographic diversity. For more information, contact Jacqueline M. Nowicki at (617) 788-0580 or nowickij@gao.gov.
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  • Indian Health Service: Actions Needed to Improve Oversight of Federal Facilities’ Decision-Making About the Use of Funds
    In U.S GAO News
    The Indian Health Service's (IHS) oversight of federally operated health care facilities' decision-making process about the use of funds has been limited and inconsistent. Funds include those from appropriations, as well as payments from federal programs, such as Medicaid and from private insurance, for care provided by IHS to American Indians and Alaska Natives (AI/AN). While some oversight functions are performed at IHS headquarters, the agency has delegated primary responsibility for the oversight of health care facilities' decision-making about the use of funds to its area offices. Area office officials said the oversight they provide has generally included (1) reviewing facilities' scope of services, and (2) reviewing facilities' proposed expenditures. However, GAO's review found that this oversight was limited and inconsistent across IHS area offices, in part, due to a lack of consistent agency-wide processes. While IHS officials from all nine area offices GAO interviewed said they reviewed facilities' scope of services and coordinated with tribes when doing so, none reported systematically reviewing the extent to which their facilities' services were meeting local health needs, such as by incorporating the results of community health assessments. Such assessments can involve the collection and assessment of data, as well as the input of local community members and leaders to identify and prioritize community needs. These assessments can be used by facilities to assess their resources and identify priorities for facility investment. While IHS has identified such assessments as a priority, the agency does not require federally operated facilities to conduct such assessments or require the area offices to use them as they review facilities' scope of services. To ensure that facilities are effectively managing their resources, IHS has a process to guide its review of facilities' proposed construction projects that cost at least $25,000. However, IHS does not have a similar process to guide its oversight of other key proposed expenditures, such as those involving the purchase of major medical equipment, the hiring of providers, or the expansion of services. Specifically, GAO found limitations and inconsistencies with respect to requiring a documented justification for proposed expenditures; documenting the review and approval of decisions; and conducting an impact assessment on patient access, cost, and quality of care. The limitations and inconsistencies that GAO found in IHS's oversight are driven by the lack of consistent oversight processes across the area offices. Without establishing a systematic oversight process to compare federally operated facilities' current services to population needs, and to guide the review of facilities' proposed expenditures, IHS cannot ensure that its facilities are identifying and investing in projects to meet the greatest community needs, and therefore that federal resources are being maximized to best serve the AI/AN population. IHS, an agency of the Department of Health and Human Services, provides care to AI/AN populations through a system of federally operated and tribally operated health care facilities. AI/AN have experienced long standing problems accessing needed health care services. GAO has previously reported that IHS has not been able to pay for all eligible health care services; however, the resources available to federally operated facilities have recently grown. This report assesses IHS oversight of federal health care facilities' decision-making about the use of funds. GAO reviewed IHS policies and documents; and interviewed IHS officials from headquarters, nine area offices, and three federally operated facilities (two hospitals and one health clinic). GAO recommends that IHS develop processes to guide area offices in (1) systematically assessing how federally operated facilities will effectively meet the needs of their patient populations, and (2) reviewing federal facilities' spending proposals. HHS concurred with these recommendations. For more information, contact Jessica Farb at (202) 512-7114 or farbj@gao.gov.
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  • Rural Hospital Closures: Affected Residents Had Reduced Access to Health Care Services
    In U.S GAO News
    GAO found that when rural hospitals closed, residents living in the closed hospitals' service areas would have to travel substantially farther to access certain health care services. Specifically, for residents living in these service areas, GAO's analysis shows that the median distance to access some of the more common health care services increased about 20 miles from 2012 to 2018. For example, the median distance to access general inpatient services was 3.4 miles in 2012, compared to 23.9 miles in 2018—an increase of 20.5 miles. For some of the less common services that were offered by a few of the hospitals that closed, this median distance increased much more. For example, among residents in the service areas of the 11 closed hospitals that offered treatment services for alcohol or drug abuse, the median distance was 5.5 miles in 2012, compared to 44.6 miles in 2018—an increase of 39.1 miles to access these services (see figure). Median Distance in Miles from Service Areas with Rural Hospital Closures to the Nearest Open Hospital that Offered Certain Health Care Services, 2012 and 2018 Notes: GAO focused its analysis on the health care services offered in 2012 by the 64 rural hospitals that closed during the years 2013 through 2017 and for which data were available. For example, in 2012, 64 closed hospitals offered general inpatient services, 62 offered emergency department services, 11 offered treatment services for alcohol or drug abuse, and 11 offered services in a coronary care unit. To examine distance, GAO calculated “crow-fly miles” (the distance measured in a straight line) from the geographic center of each closed rural hospital's service area to the geographic center of the ZIP Code with the nearest open rural or urban hospital that offered a given service. GAO also found that the availability of health care providers in counties with rural hospital closures generally was lower and declined more over time, compared to those without closures. Specifically, counties with closures generally had fewer health care professionals per 100,000 residents in 2012 than did counties without closures. The disparities in the availability of health care professionals in these counties grew from 2012 to 2017. For example, over this time period, the availability of physicians declined more among counties with closures—dropping from a median of 71.2 to 59.7 per 100,000 residents—compared to counties without closures—which dropped from 87.5 to 86.3 per 100,000 residents. Rural hospitals face many challenges in providing essential access to health care services to rural communities. From January 2013 through February 2020, 101 rural hospitals closed. GAO was asked to examine the effects of rural hospital closures on residents living in the areas of the hospitals that closed. This report examines, among other objectives, how closures affected the distance for residents to access health care services, as well as changes in the availability of health care providers in counties with and without closures. GAO analyzed data from the Department of Health and Human Services (HHS) and the North Carolina Rural Health Research Program (NC RHRP) for rural hospitals (1) that closed and those that were open during the years 2013 through 2017, and (2) for which complete data generally were available at the time of GAO's review. GAO also interviewed HHS and NC RHRP officials and reviewed relevant literature. GAO defined hospitals as rural according to data from the Federal Office of Rural Health Policy. GAO defined hospital closure as a cessation of inpatient services, the same definition used by NC RHRP. GAO defined service areas with closures as the collection of ZIP Codes that were served by closed rural hospitals and service areas without closures as the collection of ZIP Codes served only by rural hospitals that were open. GAO provided a draft of this report to HHS for comment. The Department provided technical comments, which GAO incorporated as appropriate. For more information, contact James Cosgrove at (202) 512-7114 or cosgrovej@gao.gov.
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