Recommendation: To increase transparency and obtain information to better inform decisions on whether to investigate potentially unfair or deceptive practices in the air ambulance industry, the Secretary of Transportation should assess available federal and industry data and determine what further information could assist in the evaluation of future complaints or concerns regarding unfair or deceptive practices.

Agency: Department of Transportation
Status: Open
Priority recommendation

Comments: The FAA Reauthorization Act of 2018 (the Act), signed into law on October 5, 2018, directed the establishment of an Air Ambulance and Patient Billing (AAPB) Advisory Committee. The Act also required the committee to make recommendations on a variety of topics, including what additional data from air ambulance providers and other sources should be collected by DOT to improve its understanding of the industry. On September 12, 2019, DOT announced the formation of the AAPB Advisory Committee, including the appointment of 13 members. The first meeting of the AAPB Advisory Committee was held in January 2020. Soon after this meeting, three subcommittees were established, including one on Disclosure and Distinction of Charges and Coverage for Air Ambulance Services and another on Prevention of Balance Billing. Subcommittee meetings began in March 2020, although given the impact of COVID-19, the subcommittee meets scheduled for April and May 2020 were postponed. Pursuant to the Act, the AAPB Advisory Committee is to submit a report containing its recommendations not later than 180 days after the date of its first meeting. GAO will continue to monitor the work of the AAPB Advisory Committee related to this recommendation.

Recommendation: To increase transparency and obtain information to better inform decisions on whether to investigate potentially unfair or deceptive practices in the air ambulance industry, the Secretary of Transportation should consider consumer disclosure requirements for air ambulance providers, which could include information such as established prices charged, business model and entity that establishes prices, and extent of contracting with insurance.

Agency: Department of Transportation
Status: Open

Comments: The FAA Reauthorization Act of 2018 (the Act), signed into law on October 5, 2018, directed the establishment of an Air Ambulance and Patient Billing (AAPB) Advisory Committee. The Act also required the committee to make recommendations on a variety of topics, including the recommendations from this GAO report. On September 12, 2019, DOT announced the formation of the AAPB Advisory Committee, including the appointment of 13 members. The first meeting of the AAPB Advisory Committee was held in January 2020. Soon after this meeting, three subcommittees were established, including one on Disclosure and Distinction of Charges and Coverage for Air Ambulance Services and another on Prevention of Balance Billing. Subcommittee meetings began in March 2020, although given the impact of COVID-19, the subcommittee meets scheduled for April and May 2020 were postponed. Pursuant to the Act, the AAPB Advisory Committee is to submit a report containing its recommendations not later than 180 days after the date of its first meeting. GAO will continue to monitor the work of the AAPB Advisory Committee related to this recommendation.

Recommendation: To preserve the balance between the importance of repaying federal student loan debt and protecting a minimum level of Social Security benefits put in place by the Debt Collection Improvement Act of 1996, Congress should consider modifying Social Security administrative offset provisions, such as by authorizing the Department of the Treasury to annually index the amount of Social Security benefits exempted from administrative offset to reflect changes in the cost of living over time.

Agency: Congress
Status: Open

Comments: As of December 2018, Congress has not yet taken action on this matter.

Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should inform affected borrowers of the suspension of offset and potential consequences if the borrower does not take action to apply for a TPD discharge. Such information could include notification that interest continues to accrue and that offsets may resume once their disability benefits are converted to retirement benefits.

Agency: Department of Education
Status: Open

Comments: The Department of Education does not currently notify borrowers of the suspension of offset, but plans to implement a process to do so in the future using a new mailing sent to affected borrowers by their default servicer. The current budget situation does not allow for this type of enhancement, and it is not clear when that will change. In the interim, the agency is exploring alternative notification approaches that could be put in place prior to the implementation of an automated solution. Although Education reported in December 2018 that it has implemented this recommendation, we will consider closing it when we receive documentation that this effort has been completed. As of October 2020, Education's website includes information about the suspension of offset. However, affected borrowers may not know to check the website and the agency has not provided documentation that it has directly alerted affected borrowers.

Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should revise forms sent to borrowers already approved for a TPD discharge to clearly and prominently state that failure to provide annual income verification documentation during the 3-year monitoring period will result in loan reinstatement.

Agency: Department of Education
Status: Open

Comments: The FUTURE Act (H.R. 5363), signed into law on Dec. 19, 2019, requires the Department of Education (Education) to automate the income monitoring process for borrowers whose loans are discharged for total and permanent disability. As a result of automating the process, borrowers will no longer need to receive Education's forms requesting the borrower to individually provide their income verification documentation during the 3-year monitoring period.

Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should inform borrowers about the financial hardship exemption option and application process on the agency's website, as well as the notice of offset sent to borrowers.

Agency: Department of Education
Status: Open

Comments: The Department of Education agrees with the recommendation and said that they will include this change in upcoming revisions to the agency's web content. The agency reported that the Notice of Offset to borrowers is sent by Treasury and that they will share this recommendation with Treasury and discuss possible changes to the notice. As of October 2020, Education's website notes that borrowers can request a review of their offset , but it does not specifically note that they may do so because of a financial hardship. Although Education reported in December 2018 that it has implemented this recommendation, we will consider closing it when we receive documentation that the agency has notified borrowers about the financial hardship exemption process on its website and the notice of offset sent to borrowers.

Recommendation: To improve program design for Social Security offsets and related relief options, the Secretary of Education should implement an annual review process to ensure that only eligible borrowers are exempted from offset for financial hardship on an ongoing basis.

Agency: Department of Education
Status: Open

Comments: The Department of Education reported that it plans to fully automate their process for tracking hardships and other exceptions from offset. However, due to competing priorities and funding limitations, full implementation of these improvements have not been scheduled. As they fully implement this process, they will review complementary strategies to assist borrowers in complying with annual reporting requirements. As of December 2018, Education reported that it is in the process of re-designing the student loan financial services environment, which will lead to major improvements such as offset exceptions. They are conducting market research on the new environment, then plan to develop requirements and timelines in support of a procurement with a projected completion in September 2020. We will consider closing this recommendation when we receive documentation that the agency has implemented an annual review process.