Returned Peace Corps Volunteers: Labor and Peace Corps Need Joint Approach to Monitor Access to and Quality of Health Care Benefits
Released: 2012-11-19T00:00:00


Highlights: section_title: Why GAO Did This Study
paragraphs: Peace Corps volunteers who suffer a service-connected illness or injury are eligible to receive certain health care and other benefits under FECA--a workers' compensation program administered by DOL. FECA provides health care benefits--reimbursements for medical expenses--to federal employees and volunteers for illnesses or injuries that DOL determines are service-connected.

GAO was mandated to report on the access and quality of health care benefits for Peace Corps volunteers. This report (1) identifies the health care and other benefits provided to volunteers from 2009 through 2011 under the FECA program, and (2) examines the extent to which DOL and the Peace Corps use available agency information to monitor the accessibility and quality of FECA health care benefits provided to volunteers. GAO reviewed agency documents, interviewed agency officials, and analyzed DOL data. GAO developed a framework with four areas to define access and quality and examined available information in these areas that could be used for monitoring.

section_title: What GAO Found
paragraphs: From 2009 through 2011, the Department of Labor (DOL) provided a total of about $36 million in Federal Employees' Compensation Act (FECA) benefits--health and other benefits--for Peace Corps volunteers who have returned from service abroad (volunteers). Specifically, DOL provided about $22 million in health care benefits for these volunteers in the form of reimbursements for medical expenses related to service-connected injuries and illnesses, and $13.8 million in other benefits, such as reimbursement for travel expenses incurred when seeking medical care. During this period, approximately 1,400 volunteers each year received these health care benefits under the FECA program. The most common types of medical conditions for which DOL provided reimbursements were mental, emotional, and nervous conditions; dental; other/nonclassified diseases; and infectious or parasitic diseases. These four medical conditions accounted for more than a quarter of all medical reimbursements for volunteers under FECA from 2009 through 2011.

In general, neither DOL nor the Peace Corps use all available information in the four areas GAO reviewed to monitor access and quality of FECA benefits for volunteers. GAO found that the Peace Corps uses information in just one of the areas--volunteers' awareness of the FECA program; however, in general, neither agency uses information in the remaining three areas. These areas are (1) information on volunteers' knowledge of FECA program and application requirements, such as required medical documentation; (2) information on DOL's timeliness in reviewing FECA applications and reimbursing medical expenses, and on the level of customer satisfaction; and (3) availability of FECA-registered medical providers. By not using information available to the agencies, DOL and the Peace Corps are missing an opportunity to determine whether, or to what extent, volunteers face access and quality issues in the FECA program. For example, DOL and the Peace Corps may not be able to determine the extent to which there are limitations in the availability of FECA-registered providers for certain medical specialties.

DOL and the Peace Corps each have certain responsibilities related to the provision of FECA benefits for eligible volunteers, and each has information that could be used for monitoring. From DOL's perspective, volunteers do not represent a large proportion of the overall FECA population. However, FECA is a relatively larger issue from the Peace Corps' perspective. The volunteers are a unique population compared to others who receive benefits under FECA, and the FECA costs associated with volunteers represent a growing portion of the Peace Corps' annual budget. Neither agency has all the information GAO reviewed, and the agencies generally do not work together to use available information to monitor the accessibility and quality of FECA benefits for volunteers. As a result, DOL and the Peace Corps are missing an opportunity to make use of the available information to help ensure the accessibility and quality of FECA benefits for volunteers. GAO recommends that the Secretary of Labor and the Director of the Peace Corps jointly develop and implement an approach for working together to use available agency information to monitor the access to and quality of FECA benefits provided to volunteers. Neither DOL nor the Peace Corps indicated whether or not they agreed with GAO's recommendation. Instead, the agencies provided additional context related to the provision of FECA benefits.

section_title: What GAO Recommends
paragraphs: GAO recommends that the Secretary of Labor and the Director of the Peace Corps jointly develop and implement an approach for working together to use available agency information to monitor the access to and quality of FECA benefits provided to volunteers.

Neither DOL nor the Peace Corps indicated whether or not they agreed with GAO’s recommendation. Instead, the agencies provided additional context related to the provision of FECA benefits.

section_title: Letter
paragraphs: Founded in 1961, the Peace Corps’ mission is to help host countries meet  their needs for trained personnel while promoting mutual understanding  between Americans and other peoples. Peace Corps volunteers commit  to 2-year assignments in host communities in various countries, where  they work on projects such as teaching English, strengthening farmer  cooperatives, or building sanitation systems. As of July 2012, over  200,000 Peace Corps volunteers have served in 139 countries. After  completing their service with the Peace Corps, volunteers typically return   In this report, we generally refer to returned Peace  to the United States.Corps volunteers as volunteers.

Returned volunteers who suffer a service-connected illness or injury are  eligible to receive compensation for certain medical expenses as well as  other benefits under the Federal Employees’ Compensation Act (FECA). The FECA program is a federal workers’ compensation program  administered by Department of Labor’s (DOL) Office of Workers’  Compensation Programs (OWCP). The FECA program provides health  care benefits—in the form of reimbursement for medical expenses—to  federal employees and Peace Corps volunteers for illnesses or injuries  that DOL determines were sustained while in the performance of an  employee’s duty. In addition to these health care benefits, the FECA  program provides other benefits for federal employees, including Peace  Corps volunteers, who are injured or become ill while performing their  duties. These benefits include reimbursement for travel expenses related  to obtaining medical treatment and wage-loss compensation—that is,  disability payments—for those who are temporarily unable to perform  their duties.

5 U.S.C. §§ 8101 et seq.

The Peace Corps and DOL each have certain responsibilities related to  the provision of FECA benefits for eligible volunteers who return from  service abroad. Specifically, the Peace Corps is responsible for informing  volunteers that they may be eligible for FECA benefits, assisting in the  application process, and paying DOL back annually for FECA benefits  provided to volunteers. DOL is responsible for administering the program  by reviewing and approving applications for FECA benefits and for  providing reimbursements for the costs of medical care and other  expenses for service-connected injuries or illnesses. Given their  responsibilities, it is important that DOL and the Peace Corps periodically  monitor the accessibility and quality of the program for the volunteers.

Peace Corps volunteer advocates have raised several questions  regarding whether volunteers have access to timely, high-quality health  care and other benefits under FECA for service-connected injuries and  illnesses. For example, these advocates have asked whether volunteers  are made aware of FECA benefits, whether they report injuries or  illnesses, Advocates also raised questions about whether volunteers face  challenges during the FECA application process, such as dealing with  multiple agencies—the Peace Corps and DOL.   and whether they can locate or access medical providers.

According to a Peace Corps volunteer advocate, some volunteers who are victims of  sexual or other assaults may not report illnesses or injuries to the Peace Corps staff in- country or at close-of-service because the volunteer is ashamed or fearful of filing a  report. As a result, the volunteer may be unable to gather the required medical evidence  while in-country to support their FECA application and thereby establish a service  connection.

In response to the questions raised by advocates, the House Committee  on Foreign Affairs convened a hearing in May 2011. Subsequently, the  Kate Puzey Peace Corps Volunteer Protection Act of 2011 was enacted  in November 2011. Among other things, the law requires that GAO  examine the accessibility and quality of the health care services provided  through DOL to volunteers who return from service abroad in the Peace  Corps.1.  identify the health care and other benefits provided by DOL to  returned Peace Corps volunteers from 2009 through 2011 under the  FECA program, and  2.  examine the extent to which DOL and the Peace Corps use available  agency information to monitor the accessibility and quality of FECA  health care benefits provided to returned Peace Corps volunteers.

To identify the health care and other benefits provided to volunteers by  DOL under the FECA program from 2009 through 2011, we reviewed  agency documents, such as those that describe FECA benefits provided  to volunteers. We also conducted an analysis of DOL’s claims data from  the FECA chargeback database on the reimbursements for medical  expenses that DOL, under the FECA program, made on behalf of federal  agencies from 2009 through 2011. We analyzed these data to identify  (1) the number of volunteers receiving FECA benefits each year, (2) the  total amount of reimbursements DOL made for medical expenses, (3) the  types of injuries and illnesses for which volunteers received health care  benefits—reimbursements for medical expenses—and (4) the other  benefits provided under FECA. We also identified the total amount of  wage-loss compensation and reimbursements DOL made to volunteers  for travel expenses from 2009 through 2011. We compared the types of  injuries and illnesses for which volunteers received health care benefits  and the demographic and other characteristics of volunteers to other  recipients of FECA benefits. In addition, we interviewed DOL and Peace  Corps agency officials about the benefits provided to volunteers under  FECA and the types of injuries or illnesses reported by volunteers.

To assess the reliability of DOL’s FECA data, we reviewed prior GAO  work using DOL’s FECA chargeback database—which is used to track  FECA costs for employing agencies, such as the Peace Corps—and  obtained information from agency officials knowledgeable about the  database. We performed data quality checks to assess the reliability of  the FECA chargeback database received from DOL. These data quality  checks involved an assessment to identify missing or incorrect entries or  outliers. On the basis of the information we obtained and analyses we  conducted, we determined that the data we used were sufficiently reliable  for the purposes of this report.

To identify the extent to which DOL and the Peace Corps use available  agency information to monitor the accessibility and quality of FECA health  care benefits provided to volunteers, we developed a framework with four  key areas to define accessibility and quality and that could be used to  monitor the accessibility and quality of FECA benefits. Because the FECA  program is a workers’ compensation program and not a health care  delivery program, DOL does not deliver or actively manage the health  care services received by returned volunteers. Therefore, we did not  assess the quality of health care services delivered by medical providers  to volunteers. Rather, we examined volunteers’ access to FECA benefits  and the quality of the FECA workers’ compensation program using the  following four areas: (1) volunteers’ awareness of the FECA program,  including their general awareness of the FECA program and knowledge  of the specific health care benefits available under FECA; (2) volunteers’  knowledge of FECA program and application requirements, including  knowledge of the FECA eligibility requirements and the documentation  that is typically required by DOL to make a FECA application decision; (3)  DOL’s timeliness in reviewing FECA applications and providing  reimbursement for health and other benefits, including average time to  review and approve or deny a FECA application, average time to provide  reimbursement for submitted medical claims, and the level of customer  satisfaction with the FECA program; and (4) availability of FECA- registered medical providers, including the ability of volunteers to access  these providers.

We interviewed officials and reviewed documentation about the  information available to DOL and the Peace Corps for monitoring access  and quality of the FECA program, including information related to our four  key areas. For example, we examined: (1) the Peace Corps’ policies on  informing volunteers of their rights to FECA benefits to determine what  information is available on volunteers’ awareness of the FECA program,  and (2) letters sent by DOL to volunteers whose FECA applications were   We synthesized the information provided by agency officials to  denied. determine the extent to which the two agencies use information in the four  areas to monitor the accessibility and quality of FECA benefits for  volunteers. Because the Peace Corps and DOL both have certain  responsibilities related to the provision of FECA benefits for eligible  volunteers who return from service abroad, we also looked at the extent  to which the Peace Corps and DOL work together by sharing this  information.

We conducted this performance audit from March 2012 to November  2012, in accordance with generally accepted government auditing  standards. Those standards require that we plan and perform the audit to  obtain sufficient, appropriate evidence to provide a reasonable basis for  our findings and conclusions based on our audit objectives. We believe  that the evidence obtained provides a reasonable basis for our findings  and conclusions based on our audit objectives.
subsections: section_title: Background
paragraphs: After volunteers separate from the Peace Corps they typically return to  the United States, and may transition into new employment. As they  make this employment transition, the Peace Corps offers various health  care services and benefits to returned volunteers. First, each volunteer  receives a close-of-service medical evaluation that assesses their health  status as they complete their service. The Peace Corps also has a  contract with an insurance company to make a health insurance policy— AfterCorps—available for volunteers to purchase. This policy covers  non-service-connected illnesses or injuries. The Peace Corps also pays  for certain health examinations for 6 months after a volunteer’s service is  completed. Finally, volunteers may also be eligible for reimbursements  under the FECA program for medical expenses associated with service- connected illnesses or injuries, such as those identified during the  physical conducted at the close-of-service medical evaluation.
subsections: section_title: FECA Eligibility
paragraphs: The FECA program provides health benefits—reimbursement for medical  expenses related to illnesses or injuries that DOL determines are service  connected—as well as other benefits, such as wage-loss (death and  disability) compensation. To receive benefits through FECA, a volunteer  must establish that, among other things, he or she was in the  performance of duty at the time the illness or injury occurred. Under the  FECA program, volunteers are considered to be in the performance of  duty 24 hours a day while abroad during the period of their Peace Corps  service. DOL requires that if an illness or injury is first discovered after a  volunteer has returned from service, then the medical evidence must  show that the injury or illness was sustained while overseas or in the  performance of duty. In order to be eligible for FECA health care  benefits for preexisting illnesses or injuries—a condition that existed prior  to service—the volunteer’s medical evidence must demonstrate that the  volunteer’s service was the proximate cause of or aggravated,  accelerated, or precipitated the illness or injury. Further, volunteers  must apply for FECA benefits within 3 years of the date of injury or illness,  or within 3 years after they recognize that a health condition is service- connected. In 2010, the FECA program provided about $2.8 billion in  health and other benefits to about 251,000 federal and postal  employees—including volunteers—who suffered a service related illness  or injury.

section_title: Application Process for FECA Program Benefits for Volunteers
paragraphs: Volunteers who apply for FECA benefits typically go through the following  steps:  1.  Each volunteer is informed of the availability of FECA benefits at the  close-of-service medical evaluation.  a.  Each volunteer is expected to receive a close-of-service medical  evaluation that assesses his or her health status prior to leaving  service to document any service-connected illnesses or injuries.  Should a volunteer terminate service early—before completing his  or her assignment—the volunteer will also undergo a complete  medical and dental exam to identify any unmet health care needs  and potential medical issues.  2.  Volunteers complete a FECA application and submit it to DOL through  the Peace Corps’ Post-Service Unit.a.  The Peace Corps—through its Post-Service Unit—assists  volunteers applying for benefits by helping them to complete the  appropriate forms and providing the appropriate medical evidence  from volunteers’ Peace Corps medical records.  b.   The Peace Corps’ Post-Service Unit sends all FECA  applications—which includes information on the injury or illness  reported by the volunteer—to DOL for review and eligibility  determination.  3.  FECA applications submitted for volunteers are reviewed by DOL, and  the agency then makes an eligibility determination.  a.   For those applications that do not include sufficient information  and require further development, volunteers are given  approximately 30 days to submit additional information to support  their request for FECA benefits. If the additional information  submitted is sufficient, the application is approved. If the additional  information is not sufficient, the FECA application is denied and  medical treatment is not authorized.  b.   For those applications that are approved, DOL assigns a medical  diagnosis on the basis of medical evidence submitted in the FECA  application. This assigned medical diagnosis defines the medical  treatment and services for which the volunteer is eligible for FECA  reimbursement.  4.  Typically, after benefits are approved by DOL, a volunteer obtains  health care services through a medical provider. After receiving these  services, the volunteer or the volunteer’s medical provider submits a  bill to DOL for reimbursement. DOL provides reimbursement for  medical expenses.  5.  On an annual basis, DOL requires the Peace Corps to pay DOL back  for these reimbursements.

section_title: From 2009 through 2011, DOL Provided about $36 Million in Health Care and Other Benefits for Volunteers
paragraphs: From 2009 through 2011, DOL provided a total of about $36 million in  FECA benefits for volunteers, providing about $22 million in health care  benefits—reimbursements for medical expenses to treat service- connected injuries and illnesses for Peace Corps volunteers—and   $13.8 million in other benefits. During this period, almost 1,400 volunteers  each year received health care benefits. The average reimbursement  for medical expenses per volunteer was about $5,000 in 2009, and about  $5,600 in 2011. The most-common medical conditions for which DOL  provided health care benefits—reimbursements for medical services— were mental, emotional, and nervous conditions; dental;  other/nonclassified diseases; and infectious or parasitic diseases.These four medical conditions represented about 40 percent of all  medical conditions and accounted for about $5.9 million—or more than a  quarter—of all medical reimbursements for volunteers under FECA  between 2009 and 2011. See table 1 for the medical conditions for which  DOL provided reimbursements for volunteers under FECA.

In addition to health care benefits, volunteers also received other  benefits—such as wage-loss compensation and reimbursement for travel  to receive medical treatment. Specifically, from 2009 through 2011, these  other benefits received by volunteers totaled about $13.8 million. In  2011, the total reimbursements for both health care and other benefits  were about $12 million, which represents about 3.3 percent of the Peace  Corps’ 2012 appropriation of $375 million. According to Peace Corps  officials, these health care and other expenses represent a growing  portion of its annual budget. These officials explained that from 2009  through 2011 these expenses have increased a total of approximately   7.2 percent.

Volunteers who received FECA benefits from 2009 through 2011 are  unique in several ways when compared to other recipients of these  benefits. Specifically, our analysis of DOL’s FECA program claims data  found that the volunteers were generally younger and more likely to be  female when compared to others who received benefits under the FECA  program. Volunteers were, on average, 12 years younger than others  who received FECA benefits. About two-thirds of volunteers receiving  FECA benefits were female, whereas less than half of others receiving  FECA benefits were female. These differences in age and gender are  consistent with the overall demographics of these two populations—the  volunteers and federal workers.

In addition, the medical conditions for which volunteers received FECA  benefits were different than those for others who received FECA benefits.  For example, volunteers were more likely than others to receive FECA  benefits for mental, emotional, or nervous conditions; dental conditions;  other/nonclassified diseases; and infectious or parasitic diseases. While  these four medical conditions represented 40 percent of the conditions for  volunteers, they represented less than 2 percent for the others receiving  FECA benefits.

section_title: The Peace Corps Uses Information on Volunteers’ Awareness of FECA, but Neither DOL Nor the Peace Corps Use Other Available Information to Monitor Access and Quality
paragraphs: The Peace Corps uses information it has to monitor volunteers’  awareness of the FECA program; however, in general, neither DOL nor  the Peace Corps use information in the remaining three areas in our  review to monitor the accessibility and quality of FECA benefits for  volunteers. These areas are (1) information on volunteers’ knowledge of  FECA program and application requirements, such as medical  documentation that is required to be submitted with an application;   (2) information on DOL’s timeliness in reviewing FECA applications and  reimbursing medical expenses, and on the level of customer satisfaction  with the FECA program; and (3) information on the availability of FECA-  Table 2 summarizes the extent to which  registered medical providers.DOL and the Peace Corps use information available in the four key areas  to monitor the accessibility and quality of FECA benefits for volunteers.

As shown in table 2, the Peace Corps uses information related to  volunteers’ awareness of the FECA program. Specifically, to monitor  volunteers’ awareness, the Peace Corps currently documents that  volunteers have acknowledged that they have been informed of their  potential eligibility for FECA during their close-of-service evaluation.  Peace Corps officials told us the agency uses this information to help  ensure all volunteers are made aware of their possible eligibility for FECA  benefits.

While the Peace Corps uses information on volunteer awareness, neither  DOL nor the Peace Corps use available information related to the  remaining three areas of our review to monitor the accessibility and  quality of FECA benefits for volunteers.

Volunteers’ knowledge of FECA program and application requirements.  As table 2 shows, neither DOL nor the Peace Corps use available  information, such as data on FECA application denial rates, and  information on reasons for denials, in order to monitor the accessibility  and quality of FECA benefits for volunteers. DOL officials told us that it  is not their responsibility to use this information for this type of monitoring.  However, by not using this available information to review volunteers’  level of knowledge of the FECA requirements, DOL and the Peace Corps  may be unaware, for example, of the extent to which volunteers  experience difficulties accessing FECA benefits because of limited  understanding of certain application requirements, such as in (a)  providing appropriate and sufficient medical evidence and (b) establishing  a service connection for the illness or injury for which the volunteer is  seeking FECA benefits.

According to volunteer advocates, volunteers and their physicians may  lack knowledge of certain FECA documentation requirements, such as  the need to include a medical diagnosis rather than just the symptoms of  an injury or illness in the FECA application. Furthermore, our examination  of a limited number of FECA denial letters confirms that these difficulties  are often a contributing factor in the FECA applications that were not  approved from 2009 through 2011. For example, our review of denial  letters showed that the most-common reasons for denial were lack of  sufficient medical documentation and inability to establish a service  connection. Further, DOL and the Peace Corps also do not work together  to use the information available to them on volunteers’ knowledge of  program and application requirements.

DOL maintains metrics for measuring performance for the overall FECA program,  including those that are part of the Protecting Our Workers and Ensuring Reemployment  (POWER) Initiative, the Government Performance and Results Act of 1993 (GPRA), as  amended, and measures outlined in DOL’s Operational Plan. The POWER Initiative  established goals related to FECA—such as the timeliness of filing a FECA application.  Under GPRA, DOL established customer satisfaction measures for the FECA program.  Under its Operational Plan, DOL established additional timeliness and customer  satisfaction measures, such as those to monitor the timeliness of the FECA application  review process. of the overall FECA population. Instead, DOL’s focus has been on using  the data in order to monitor FECA program timeliness and customer  satisfaction for all individuals who receive FECA benefits. While it is  reasonable that DOL focus on the entire FECA program, DOL and the  Peace Corps also do not work together to use the timeliness and  customer satisfaction information to help the Peace Corps gauge whether  volunteers are receiving FECA benefits in a timely and satisfactory  manner. For example, Peace Corps officials told us that a survey of  former volunteers specifically about access and satisfaction issues would  be useful. According to Peace Corps officials, the results of such a survey  could help clarify whether volunteers have access to the care they need  and what the volunteers think about the quality of the care they receive.  Without this information, DOL and the Peace Corps may be unable to  determine volunteers’ level of satisfaction with the FECA program.

Our review of DOL timeliness data suggests that between 2009 and  2011, the agency met its timeliness benchmarks related to review of  FECA applications for volunteers. these data to determine the timeliness in reviewing volunteers’ FECA  applications, DOL may not be able to determine whether or to what extent  its performance on timeliness is sustained in the future. Furthermore, a  lack of ongoing examinations of timeliness may make it difficult for DOL to  identify problems if they should arise in the future or to provide  information to alleviate the concerns of advocates and Peace Corps  officials regarding the timeliness of the review of FECA applications.

For example, our review of information showed that DOL reviewed about 97 percent of  all volunteers’ applications related to traumatic cases within 45 days of receiving the  application—meeting its benchmark to review 90 percent within that time frame. geographic areas and for certain medical specialties.information DOL has on the geographic location and medical specialty of  FECA-registered providers, DOL and the Peace Corps cannot determine  the extent to which there are limitations in the availability of FECA- registered providers in certain geographic areas and for certain medical  specialties.

DOL’s available information on FECA-registered providers suggests that  volunteers may face some challenges accessing registered providers.  Officials stated that although it is the responsibility of the volunteer to find  a FECA-registered provider, DOL publishes an online search tool that  contains a partial listing of the available FECA-registered providers as a  service to FECA beneficiaries, including volunteers, to help locate  providers. Officials also noted the agency does not actively manage or   Although the online search tool is recognized by DOL as  update the list. incomplete, it does provide some partial information about the availability  of FECA-registered providers. We reviewed this online search tool and  found, for example, that as of June 2012 there were no FECA-registered  providers in the online search tool listed as mental health specialists in   Peace  any of the 10 states with the largest population of volunteers.Corps officials and volunteer advocates also noted there are a limited  number of FECA-registered providers in some geographic locations and  medical specialties. In addition, Peace Corps officials told us that they  have assisted volunteers in finding and enrolling providers, and have had  difficulty in doing so. Although the information on FECA-registered  providers in the online search tool that DOL provides as a resource to  volunteers may be incomplete, it includes information that could be used  to help identify potential access issues and areas for monitoring the  accessibility of FECA benefits for volunteers.

section_title: Conclusions
paragraphs: The Peace Corps and DOL both have certain responsibilities related to  the provision of FECA benefits for eligible volunteers who return from  service abroad. Specifically, DOL administers the FECA program and the  Peace Corps pays for the expenses incurred by volunteers in the  program. From DOL’s perspective, volunteers do not represent a large  proportion of the overall FECA population. However, FECA is a relatively  larger issue from the Peace Corps’ perspective. The volunteers are a  unique population compared to others who receive benefits under  FECA—for example, they are more likely to have mental, emotional, or  nervous conditions that are service-connected—and, according to Peace  Corps officials, the amount the Peace Corps pays DOL for FECA  reimbursements represents an increasing portion of the Peace Corps’  annual budget. Because both of the agencies have certain responsibilities  related to the provision of FECA benefits for eligible volunteers who return  from service abroad, it is especially important that the Peace Corps and  DOL jointly monitor the accessibility and quality of the FECA program to  ensure that the FECA program is achieving its intended objectives— including ensuring that eligible volunteers receive needed FECA health  care benefits.

The Peace Corps and DOL have information available to them in the four  key areas we reviewed that could be used to monitor the accessibility and  quality of FECA benefits for volunteers: (1) volunteers’ awareness of  FECA; (2) volunteers’ knowledge of program and application  requirements; (3) DOL’s timeliness in reviewing FECA applications and  reimbursing medical expenses, and the level of customer satisfaction with  the FECA program; and (4) availability of FECA-registered medical  providers. However, in general, the two agencies are not using this  information for such monitoring. For example, the agencies do not use the  information they have to determine whether there is a gap in the number  and geographic location of FECA-registered providers, such as the  potential gap we identified in the number and geographic location of  FECA-registered providers who treat mental health conditions—the most  common medical condition for which volunteers received reimbursement.

While information is available to DOL and the Peace Corps that could be  used for monitoring, the agencies are generally not working together to  use the available information to monitor the accessibility and quality of  FECA benefits for volunteers. Working together is important because  neither agency has all the information to monitor the program on its own.  Finally, because the information we identified under the four areas is not  a comprehensive list of all the information the agencies could use to  monitor FECA benefits for volunteers, the Peace Corps and DOL may be  able to identify other information that could be used for this purpose.  Unless the two agencies work together on monitoring, they will miss the  opportunity to make use of the available information to help ensure the  accessibility and quality of FECA benefits for volunteers.

section_title: Recommendation for Executive Action
paragraphs: We recommend that the Secretary of Labor and the Director of the Peace  Corps jointly develop and implement an approach for working together to  use available information to monitor the access to and quality of FECA  benefits provided to returned volunteers.

section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to the Department of Labor (DOL) and  the Peace Corps for review. Peace Corps provided written comments  (reprinted in app. I), and both provided technical comments, which we  incorporated as appropriate. Neither DOL nor the Peace Corps indicated  whether or not they agreed with our recommendation. Instead, among  other things, DOL’s technical comments identified examples of the  agency’s collaboration with the Peace Corps to provide benefits under the  FECA program. For example, DOL noted that officials from both agencies  have met multiple times over the last 2 years to try to improve the  handling of volunteers’ claims, and that DOL officials are available to work  with the Peace Corps to improve the process of providing benefits to  volunteers. In contrast, the Peace Corps noted specific improvements  that it believes could assist returned volunteers, but stated that it cannot  make these reforms on its own and needs action from DOL. DOL’s and  the Peace Corps’ comments further underscore that the two agencies do  not have a joint approach for monitoring the quality and accessibility of  benefits for returned volunteers under the FECA program. As a result, we  are concerned that the two agencies are missing opportunities to  collaborate. We also remain convinced that DOL and the Peace Corps  should, as we recommended, work together and develop an approach for  using available agency information to monitor the accessibility and quality  of FECA benefits for returned volunteers.

We are sending copies of this report to the Secretary of Labor, the  Director of the Peace Corps, and other interested parties. In addition, the  report will be available at no charge on GAO’s website at  http://www.gao.gov.

If you or your staff have any questions about this report, please contact  me at (202) 512-7114 or at kohnl@gao.gov. Contact points for our Office  of Congressional Relations and Office of Public Affairs can be found on  the last page of this report. Other major contributors to this report are  listed in appendix II.

section_title: Appendix I: Comments from the Peace Corps

section_title: Appendix II: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact

section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, Will Simerl and Cynthia Grant,  Assistant Directors; N. Rotimi Adebonojo; Melinda Cordero;   Carolyn Fitzgerald; Krister Friday; Marina Klimenko; Amy Leone; and  Jennifer Whitworth made key contributions to this report.


Question-summary annotations: questions: question: How did the DOL support Peace Corps volunteers from 2009 through 2011?
answer: From 2009 through 2011, the Department of Labor (DOL) provided a total of about $36 million in Federal Employees' Compensation Act (FECA) benefits--health and other benefits--for Peace Corps volunteers who have returned from service abroad (volunteers).
child_questions: question: How was this money allocated to various types of benefits?
answer: Specifically, DOL provided about $22 million in health care benefits for these volunteers in the form of reimbursements for medical expenses related to service-connected injuries and illnesses, and $13.8 million in other benefits, such as reimbursement for travel expenses incurred when seeking medical care.

question: What was the scale of the volunteer population during this period?
answer: During this period, approximately 1,400 volunteers each year received these health care benefits under the FECA program.

question: What were the most common health conditions treated under DOL reimbursements?
answer: The most common types of medical conditions for which DOL provided reimbursements were mental, emotional, and nervous conditions; dental; other/nonclassified diseases; and infectious or parasitic diseases.
child_questions: question: How did these health issues compare to other medical conditions treated under FECA?
answer: These four medical conditions accounted for more than a quarter of all medical reimbursements for volunteers under FECA from 2009 through 2011.

questions: question: How is available information used by DOL and Peace Corps to monitor FECA benefits?
answer: In general, neither DOL nor the Peace Corps use all available information in the four areas GAO reviewed to monitor access and quality of FECA benefits for volunteers.
child_questions: question: How does the Peace Corps use information from the four identified areas?
answer: GAO found that the Peace Corps uses information in just one of the areas--volunteers' awareness of the FECA program; however, in general, neither agency uses information in the remaining three areas.
child_questions: question: What are the three ignored areas reviewed by GAO in this report?
answer: These areas are (1) information on volunteers' knowledge of FECA program and application requirements, such as required medical documentation; (2) information on DOL's timeliness in reviewing FECA applications and reimbursing medical expenses, and on the level of customer satisfaction; and (3) availability of FECA-registered medical providers.

question: How does not using all available information affect DOL and the Peace Corps?
answer: By not using information available to the agencies, DOL and the Peace Corps are missing an opportunity to determine whether, or to what extent, volunteers face access and quality issues in the FECA program. For example, DOL and the Peace Corps may not be able to determine the extent to which there are limitations in the availability of FECA-registered providers for certain medical specialties.

questions: question: Why did GAO conduct this report?
answer: GAO was mandated to report on the access and quality of health care benefits for Peace Corps volunteers.
child_questions: question: What topics are examined in this report?
answer: This report (1) identifies the health care and other benefits provided to volunteers from 2009 through 2011 under the FECA program, and (2) examines the extent to which DOL and the Peace Corps use available agency information to monitor the accessibility and quality of FECA health care benefits provided to volunteers.

question: How did GAO collect information for this report?
answer: GAO reviewed agency documents, interviewed agency officials, and analyzed DOL data.

question: Why did GAO develop the four-area framework?
answer: GAO developed a framework with four areas to define access and quality and examined available information in these areas that could be used for monitoring.