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(2)

Question: What is the background and experience of your chief
Financial Officer and what authority does this individual hold?

Suggested Response: All Chief Financial Officers should
possess demonstrated ability in general management and
knowledge of and extensive practical experience in financial
management in large governmental or business entities.
Section 902 (a) of title 31 prescribes the authority and
functions of the agency CFO. They include:
A. Report directly to the head of the agency regarding

financial management matters;
B. Oversee all financial management activities relating to

the programs and operations of the agency:
C. Develop and maintain an integrated accounting and

financial management system, including financial

reporting and internal controls;
D. Recommend to the head of the agency individuals to be

selected as the Deputy CFO;
E. Direct, manage, and provide policy guidance and oversight

of agency financial management personnel, activities and operations in the areas of implementing the five-year financial management plan prepared by the OMB Director, recruitment of financial management personnel, systems

design, and asset management systems;
F. Prepare and transmit an annual report to the agency head

and the Director of OMB, which includes an analysis of
the status of financial management in the agency,
including any annual financial statement and audit
report, and a summary of the report on internal
accounting and control systems;
Monitor the financial execution of the budget of the
agency in relation to actual expenditures and prepare
timely performance reports; and
Review, on a biennial basis, the fees, royalties, rents
and other charges imposed by the agency for services and
things of value it provides and make recommendations on
revising those charges to reflect costs incurred by the
agency in providing the services.

G.

H.

(3)

Question: What steps have been taken to prepare the
department's financial statements?

Suggested Response: Section 303(a) of the Act amends Subchapter II of chapter 35 of title 31, U.S. Code, by adding a new section 3515. Section 3515 (a) requires agencies to prepare financial statements by March 31, 1992 and each year thereafter, for agency revolving and trust funds and for agency offices, bureaus, and activities which performed substantial commercial functions during the preceding fiscal year.

Section 3515(b) requires that financial statements reflect the
overall financial position of the agency revolving funds,
trust funds, and offices, bureaus and activities covered by
the statement, results of operations, cash flows or changes in
financial position, and a reconciliation to the budget of the
agency.

The standards necessary for consistent development of
departmental financial statements are still being prepared by
the Office of Management and Budget and the Federal Government
Accounting Standards Advisory Committee. Agency heads should
note their responsibilities in this area and discuss the
detail of guidance received from OMB and the agencies
timetable to prepare such statements.

(4)

Question: What level of funding and personnel (FTE) has been identified to fulfill the CFO function?

The

Suggested Response: The Financial Executives Institute does not recommend a level of funding or personnel necessary to perform this function in each department or agency. subcommittee should ensure, however, that the agency head has thoroughly considered the enormous undertaking required to establish appropriate financial systems and controls and to prepare annual rinancial statements. The key responsibilities of these offices will include:

A.

B.
C.

D.

E.

Implementing government-wide, uniform accounting
standards;
Issuing annual financial statements;
Planning long range for financial accounting and
reporting systems;
Establishing federal financial management policies,
practices, and internal controls;
Providing guidance to and assisting federal program
managers in implementing integrated accounting systems
and procedures;
Reviewing financial audit reports and responses and
reporting material weaknesses to the agency head and
Congress;
Providing guidance and consent on the appointment and
evaluation of financial managers within the department;
and
Establishing training standards for financial
professionals throughout the department.

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Again, let me restate our view that enactment of the Chief Financial Officers Act of 1990 was not meant to simply codify "business as usual." Framers of the CFO Act called for fundamental reform of the federal government's financial management practices. These reforms included: (1) appointment of senior financial executives named by the President and confirmed by the Senate, but selected on solid experience in the financial management arena; (2) departmental CFOs supported by deputies with years of proven financial experience in government entities; (3) adequate funding and manpower to perform enhanced financial responsibilities; (4) preparation of financial statements; and (5) audit of agency financial practices by the General Accounting office and Inspector Generals.

The corporate financial executive community calls upon the Appropriation Subcommittees of the House and Senate Appropriation Committees to ensure that the provisions of the CFO Act are carried out to the fullest intent of the law. If you require further information, please contact Kevin Sabo, FEI's Manager of Government Relations, at 202-659-3700.

STATEMENT OF MARILYN PRICE SPIVACK, PRESIDENT, MPS

ASSOCIATES, INC.

Dear Mr. Hall:

I want to thank Senator Harkin and the Subcommittee for the opportunity to submit this statement on behalf of survivors of traumatic brain injury (TBI) and their families as well as for the caring professionals who treat them. Injury in America is a major public health epidemic still not recognized by actions in proportion to its significance by the Administra. tion, Congress or by the American public. Injury is the major cause of death and disability for all Americans under 35 - greater than all other disease combined. TBI is the most devastating and costly of these injuries, and occurs to 200 out of 100,000 persons. Since the mid-80's, this Subcommittee has recognized expressed interest and concern regarding people who have sustained traumatic brain injury. The Congress and the Federal Agencies have either directed or funded agencies, particularly Rehabilitation Services Administration (RSA), to document incidence, causes, effects and costs of TBI on the individual, their family and society. The documentation gathered over the past few years has corroborated the past testimony of the National Head Injury Foundation. I would like to particularly mention the information gathered from the Senate Subcommittee Hearing on Head Injury in 1988 chaired by Senator Tom Harkin. In 1988, the Department of Education and NIDRA sponsored an international conference to define and assess needs in the areas of research, clinical services and community reentry. The proceedings were published in 1989. It is still a valid report. In 1987, the House Subcommittee on Appropriations with this Committee's support, encouraged the establishment of an Interagency Head Injury Task Force which would identify the issues and gaps in research, prevention, trauma systems and clinical treatment, community services, and financial barriers. This Committee was formed in 1988 under the Chairmanship of Dr. Murray Goldstein, Director of NINDS. The report was submitted to the Secretary of HHS in 1989.

Last fall-1990, the Secretary assigned CDC as the lead agency to begin to coordinate and implement the major recommendations of the report. The report indicates the impact of head injury in this country has been substantial. This past year's report, Disability in America-1990, and the report of Costs of Injury in America-1989, both sponsored by the National Academy of Science, the National Institute of Medicine and the Department of Health & Human Services, all claim that Injury is indeed the major cause of death and disability to those under age 35. The costs to this country are well over 125 billion dollars annually. Traumatic brain injury estimated costs are over $25 billion. TBI is the major cause of those injury deaths and accounts for 100,000 a year. There are an estimated 500,000-700,000 hospitalizations annually, with 70,000 left severely disabled, 70,000 to 90,000 left with moderate disability, and 10's of thousands left with residual impairments of short- to long-term duration. We now know that individuals can benefit from rehabilitation and that disability can be minimized by prompt trauma care and appropriate medical treatment. It is now time to ask this Subcommittee and Congress how long, how man more years in the decade will pass into and beyond the year 2000 before the Congress and Administration will take a leadership role resolving some of these key issues which could control the numbers of young people who die or who are left with significant disability caused by traumatic brain injury.

All of these issues (prevention, clinical care, research, surveillance, financial and reentry to community) have been well identified in the Interagency Task Force Report. Since this report was requested by the House Subcommittee and encouraged by this Committee, we ask you now to do no less for this population than you have done with others afflicted with major disease epidemics such as cancer, heart, AIDS and Alzheimer's Disease. The disease of injury is as great in numbers, costs and human suffering as all diseases and health epidemics that we as a society have chosen to take action against. As Founder of the head injury movement and a leader over the past ecade, I implore you again to request action of Secretary of Health & Human Services to implement the programs and services as recommended by the Interagency Task Force starting now, with $ 100 million to be appropriated in 1992.

Task this Subcommittee, after 10 years of advocating and educating, how long must the victims and the survivors wait? How long must families bear the tremendous emotional and financial burden - as they crumble under the weight – before the Congress and Administration recognize their pain and suffering as no less than the victims of disease and war TBL injury is a societal disease caught in a war with motor vehicles injury, violence, guns, child and spousal abuse drugs, alcohol, falls and recreational injury. This is a war we can win with many of the skills and services we already possess - but we need the commitment and resources that only this prestigious body can provide to make a ditter. ence in prevention care and rehabilitation to maximize function and promote quality of lite There has been much accomplished The 515 million appropriated last year to ASA has been put to work in four regions the country By this time next year, an impact should be made, but 515 million is just a beginning with the current prevalence and annual incidence of TBI

We ask for 100 million dollars to allow for implementation across agencies in Health & Human Services Department of Education Department of Labor, Department of Transportation Department of Justice Department of Housing and inrough the veterans Administration, to attend to the recommendations addressed in that Task Force Report We would ask you to inquire that if the Centers for Disease Control has been appointed lead agency for this Task Force Report by the Secretary of HHS why that request has not been funded accordingly 10 support the eton what can be accomplished without fiscal resources and designated statt to coordinate a massive effort? It funds were not requested by administrators, why not? Why is there not a public educational campaign developed and launched across the United States to educate the American public as to the long term disabilities caused by traumatic brain injuries and how injury can be prevented? What size budget and what specific plan will the administrators of HHS put forth to develop and disseminate such public education not dissimilar to that of AIDS and Substance Abuse Prevention Campaigns? We know that the members of this Subcommittee have expressed interest in the pasi We need you to continue that interest to move this enort forward We cannot let the recommendations of the Federal interagency Task Force on Head Injury die for the lack of such interest The rhetoric must be turned into action

Thank you for this opportunity I will be available, along with others within the head injury movemeni to answer any questions and assist you in any way possible I have enclosed the major recommendations of the Task Force Report for your consideration

STATEMENT OF THE HEALTH INSURANCE ASSOCIATION

OF AMERICA

For the past several years, the budget proposals submitted to Congress by the Administration have refused to recognize the cost of administering the Medicare program in an efficient manner. Despite the fact that Medicare carriers and intermediaries have a record of constantly improving performance, the President's proposed budgets for contractor operations have been inadequate to keep up with the rising number of claims received each year. For FY 1992, the President's budget is $200 to $250 million below the minimum needed to assure that carriers and intermediaries can adequately perform their responsibilities.

Background

For FY 1990, the Administration's budget slashed funding for Medicare payment safeguards, i.e., audits, medical review of claims and the Medicare Secondary Payer program. This resulted in the waste of hundreds of millions of dollars on inappropriate benefit payments.

For FY 1991, the proposed underfunding of program safeguards continued, and the Administration's budgeteers devised another way to further reduce the contractor operations budget. In deciding how much to budget for the processing of claims, they ignored a ten year pattern of annual growth in the number of claims submitted and assumed that the number of claims received in FY 1991 would be no higher than in FY 1990. Once the current fiscal year got underway, it quickly became clear that, due to this deliberate underfunding, carriers and intermediaries were

going to accumulate mountains of unprocessed and unpaid Medicare claims, triggering millions of complaints from beneficiaries and providers of care and costing the government millions of dollars in interest required on late payments. OMB reluctantly released enough of the FY 1991 contingency fund it controls to permit the program to barely meet the statutory requirements for prompt payment of claims.

FY 1992 President's Budget

The Budget Enforcement Act of 1990 directs that the budget for the administration of Medicare be adjusted each year to take into account both inflation and increases in the beneficiary population. This adjustment should have resulted in the FY 1992 Medicare administrative budget being increased about 6%. The Administration calculated the increase, but then, in its proposed budget, used those dollars for other federal programs instead of Medicare. Rather than provide its intermediaries and carriers with the funds needed to cope with inflation and a growing Medicare population, the President's FY 1992 budget proposes to reduce funding for contractor operations by 2.5%.

Having learned in FY 1991 that the number of Medicare claims will rise each year even though the people who formulate the budget pretend otherwise, for FY 1992 the Administration proposes to increase funding for claims processing, but slashes all other necessary contractor activities. The most dramatic reduction is a 63% cut in funding for the handling of beneficiary and provider appeals and requests for reconsideration of claims payments. As the Administrator of the Health Care Financing Administration testified before the Senate Labor and HHS Appropriations Subcommittee on March 7, this cut will result in a 9 month delay in hearings and a backlog of 7 million unprocessed appeals by the end of FY 1992.

Much of the furor that this will create among beneficiaries, doctors and hospitals will be directed at Congressional offices this is particularly likely since the intermediaries and carriers to whom complaints would normally be directed will not have the staff to answer them.

While the Administration professes concern over the growing cost of the Medicare program, the FY 1992 President's budget contains no increase for audits, medical review of claims or Medicare Secondary Payer activities. These payment safeguard activities were cut in FY 1990 and inadequately funded again in FY 1991 despite the fact that, year after year, they save Medicare an average of more than $10 for every dollar spent on them. The Administration's proposal also does not take into account the likelihood that Congress will enact changes in Medicare benefits and procedures that may cost as much as $50 million dollars in administrative expense for carriers and intermediaries to implement.

In order to process the 670_million claims that will be received in FY 1992, maintain an acceptable level of response to beneficiary and provider inguiries and appeals, and prevent the waste of $1 billion in inappropriate payments that will result at the level of funding proposed by the Administration, we urge the Committee to increase the appropriation for the operations of Medicare carriers and intermediaries by $227 million above the amount requested in the President's budget.

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