Energy got off to a slow start in processing cases but  had taken some steps to reduce the backlog of cases waiting for review by  a physician panel. Further,  insufficient strategic planning and systems limitations made it difficult to  assess Energy’s achievement of goals relative to case processing and  program objectives, such as the quality of the assistance provided to  claimants in filing for state workers’ compensation. Specifically, we recommended that Energy take additional steps to  expedite the processing of claims through its physician panels, enhance  the quality of its communications with claimants, and develop cost- effective methods for improving the quality of case management data and  its capabilities to aggregate these data to address program issues. Our May 2004 report also identified structural problems that could lead to  inconsistent benefit outcomes for claimants whose illness was determined  by a physician panel to be caused by exposure to toxic substances while  employed at an Energy facility. Congress subsequently  enacted legislation that dramatically restructured the program, transferred  it from Energy to Labor, and incorporated features of some of the options  we identified. Labor told us it has taken actions to address each of the  recommendations we made to the Secretary of Energy in our report. NIOSH learned from its  initial implementation experience that completing site profiles is a critical  element for efficiently processing claims requiring dose reconstructions. To enhance program management and promote greater transparency with  regard to timeliness, we recommended that the Secretary of HHS direct  agency officials to establish time frames for completing the remaining site  profiles, which HHS has done. GAO’s Prior Work Also Highlighted Issues of Advisory Board Independence and Oversight of the Contractor Supporting the Board

Our February 2006 report discussed the roles of certain federal agency  officials involved in the advisory board’s review of NIOSH’s dose  reconstructions and site profiles that raised concerns about the  independence of this review. The project officer who was initially assigned  responsibility for reviewing the monthly progress reports and monitoring  the technical performance of the contractor reviewing NIOSH’s dose  reconstruction activities for the advisory board was also a manager of the  NIOSH dose reconstruction program. In response  to concerns about the appearance of conflicting roles, the director of  NIOSH replaced both of these officials in December 2004 with a senior  NIOSH official not involved in the program. Since credibility is essential to the work of  the advisory board and the contractor assisting the board, we concluded  that continued diligence by HHS is required to prevent such problems  from recurring when new candidates are considered for these roles. We found that  this review presented a steep learning curve for the various parties  involved. First, we recommended that HHS provide the board with more integrated  and comprehensive data on contractor spending levels compared with  work actually completed, which HHS has done. Third,  we recommended that the Director of NIOSH establish a system to track  actions taken by the agency in response to the board and contractor’s  findings and recommendations. NIOSH now tracks agency actions to  resolve the board and contractor’s comments. GAO’s Ongoing Work Includes Focus on Labor’s Involvement in Certain Subtitle B Program Activities

As part of our ongoing work, we are examining to what extent, if any,  Labor is involved in certain Subtitle B activities. While the director of  Labor’s Office of Workers’ Compensation Programs stated that Labor has  not taken any actions to implement the options outlined in the OMB  memorandum, Labor’s internal correspondence reflects major concerns  about the potential for rapidly expanding costs in Subtitle B benefits  resulting from adding new classes of workers to the special exposure  cohort. One aspect of our ongoing work is determining whether Labor is  involved in activities that have been tasked to NIOSH, the advisory board,  or the contractor assisting the board, and if so, whether these activities  reflect an effort to constrain the costs of benefits. For example, NIOSH has shared draft special exposure cohort petition  evaluations with Labor. Labor has  provided comments on some of these draft documents. Labor officials  added that their reviews of these documents focus on changes needed to  promote clarity and consistency in the adjudication of claims. As our review proceeds,  we plan to obtain more information on key issues such as the timing,  nature, and basis of Labor’s activities in light of the program’s design and  assignment of responsibilities.
Why GAO Did This Study

The Energy Employees Occupational Illness Compensation Program Act (EEOICPA) was enacted in 2000 to compensate Department of Energy employees and contractors who developed work-related illnesses such as cancer and lung disease. Energy administered Subtitle D of the program. Subtitle B of the program is administered by the Department of Labor, which uses estimates of workers' likely radiation exposure to make compensation decisions. The estimates, known as dose reconstructions, are performed by the National Institute for Occupational Safety and Health (NIOSH) under the Department of Health and Human Services (HHS). The act specified that the President establish an Advisory Board on Radiation and Worker Health to review the scientific validity of NIOSH's dose reconstructions and recommend whether workers should be part of special exposure cohorts whose claimants can be compensated without dose reconstructions. A recent memorandum from the Office of Management and Budget (OMB) to Labor has raised concern about potential efforts to unduly contain the cost of benefits paid to claimants. This testimony presents GAO's past work on program performance and the work of the advisory board. It also highlights GAO's ongoing work relevant to issues raised by the OMB memorandum. GAO interviewed key officials and reviewed contract and other agency documents.

What GAO Found

GAO issued two reports in 2004 that focused on claims processing and program structure. The first report found that Energy got off to a slow start in processing Subtitle D claims and faced a backlog of cases. In addition, limitations in data systems made it difficult to assess Energy's performance. GAO recommended that Energy take actions to expedite claims processing, enhance communication with claimants, and improve case management data. The report also highlighted problems with program structure that could lead to inconsistent benefit outcomes and GAO presented various options for restructuring the program. Congress subsequently incorporated features of some of these options in enacting new legislation that dramatically restructured the program and transferred it from Energy to Labor. Labor has taken action to address the recommendations GAO made to Energy. The second report found that Labor and NIOSH faced a large backlog of claims awaiting dose reconstruction. To enhance program management and transparency, HHS implemented GAO's recommendation to establish time frames for completing profiles of Energy work sites, which are a critical element in efficiently processing claims that require dose reconstruction. GAO's February 2006 report found that the roles of two key NIOSH officials involved with the work of the advisory board may not have been sufficiently independent because these officials also represented the dose reconstruction program under review. In response, NIOSH replaced them with a senior official not involved in the program. Since credibility is essential to the advisory board's work, GAO concluded that ongoing diligence by HHS is required to avoid actual or perceived conflicts of roles when new candidates are considered for these roles. GAO also found that the board's work presented a steep learning curve, prompting adjustments to the work done by the contractor assisting the board. GAO recommended actions to provide the board with more comprehensive data on contractor spending levels compared to work actually completed, assist the board in reexamining its long-term plan for reviewing NIOSH's work, and better track agency actions taken in response to board and contractor findings. HHS has implemented these recommendations. One aspect of GAO's ongoing work especially relevant to the OMB memorandum is the extent to which Labor's concerns over potentially escalating benefit costs may have led the agency to be involved in activities tasked to NIOSH, the advisory board, or the contractor assisting the board. NIOSH agreed to provide Labor with draft versions of some of its evaluations of special exposure cohort petitions and other NIOSH technical documents before sending them for board review. Labor has commented on some of these draft documents. Labor officials told us that their reviews focus on changes needed to promote clarity and consistency in the adjudication of claims. As the review proceeds, GAO plans to obtain more information on key issues such as the timing, nature, and basis of Labor's activities in light of the program's design and assignment of responsibilities.