HRSA’s New Access Point Grant Process

HRSA uses a competitive process to award Health Center Program grants. HRSA’s Training and TA Cooperative Agreements

For fiscal year 2007, HRSA funded 60 training and TA cooperative  agreements with various national, regional, and state organizations to  support the Health Center Program, in part, by providing training and  technical assistance to health center grant applicants. Almost Half of MUAs Nationwide Lacked Health Center Sites in 2006, and the Percentage of MUAs Lacking Sites Varied Widely by Census Region and State

Based on our analysis of HRSA data, we found that 47 percent of MUAs  nationwide—1,600 of 3,421—lacked a health center site in 2006. 2.) The minimal impact of the 2007 awards on regional variation is due, in  large part, to the fact that more than two-thirds of the nationwide decline  in the number of MUAs that lacked a health center site—77 out of the 113  MUAs—occurred in the South census region. HRSA Oversees Cooperative Agreement Recipients but Oversight Is Limited in Key Respects, and Its Feedback to Unsuccessful Applicants Is Not Always Clear

HRSA oversees cooperative agreement recipients, but the agency’s  oversight is limited because it does not have standardized performance  measures to assess the performance of the cooperative agreement  recipients in assisting new access point applicants and the agency is  unlikely to meet its policy timeline for conducting comprehensive on-site  reviews. Moreover, more than a third  of the summary statements sent to unsuccessful applicants for new access  point competitions held in fiscal years 2005 and 2007 contained unclear  feedback. HRSA’s stated purpose in providing summary statements to  unsuccessful applicants is to improve the quality of future grant  applications. However, if the feedback HRSA provides in these statements  is unclear, it may undermine the usefulness of the feedback for applicants  and their ability to successfully compete for new access point grants. However, in 2007, 43 percent of MUAs continue to lack a health  center site, and the new access point awards made in 2007 had little  impact on the wide variation among census regions and states in the  percentage of MUAs lacking a health center site. However, HRSA’s ability to  target these awards and place new health center sites in locations where  they are most needed is limited because HRSA does not collect and  maintain readily available information on the services provided at  individual health center sites. Because HRSA  does not have standardized performance measures for these recipients— either for their work plan activities or for the comprehensive on-site  reviews—the agency cannot assess recipients’ performance using  comparable measures and determine the extent to which they support the  overall goals of the Health Center Program. These standardized performance measures should include a  measure of the number of successful applicants a recipient assisted. Reevaluate its policy of requiring comprehensive on-site reviews of Health  Center Program training and TA cooperative agreement recipients every   3 to 5 years and consider targeting its available resources at  comprehensive on-site reviews for cooperative agreement recipients that  would benefit most from such oversight.
Why GAO Did This Study

Health centers funded through grants under the Health Center Program--managed by the Health Resources and Services Administration (HRSA), an agency in the U.S. Department of Health and Human Services (HHS)--provide comprehensive primary care services for the medically underserved. HRSA provides funding for training and technical assistance (TA) cooperative agreement recipients to assist grant applicants. GAO was asked to examine (1) to what extent medically underserved areas (MUA) lacked health center sites in 2006 and 2007 and (2) HRSA's oversight of training and TA cooperative agreement recipients' assistance to grant applicants and its provision of written feedback provided to unsuccessful applicants. To do this, GAO obtained and analyzed HRSA data, grant applications, and the written feedback provided to unsuccessful grant applicants and interviewed HRSA officials.

What GAO Found

Grant awards for new health center sites in 2007 reduced the overall percentage of MUAs lacking a health center site from 47 percent in 2006 to 43 percent in 2007. In addition, GAO found wide geographic variation in the percentage of MUAs that lacked a health center site in both years. Most of the 2007 nationwide decline in the number of MUAs that lacked a site occurred in the South census region, in large part, because half of all awards made in 2007 for new health center sites were granted to the South census region. GAO also found that HRSA lacks readily available data on the services provided at individual health center sites. HRSA oversees training and TA cooperative agreement recipients, but its oversight is limited in key respects and it does not always provide clear feedback to unsuccessful grant applicants. HRSA oversees recipients using a number of methods, including regular communications, review of cooperative agreement applications, and comprehensive on-site reviews. However, the agency's oversight is limited because it lacks standardized performance measures to assess the performance of the cooperative agreement recipients and it is unlikely to meet its policy goal of conducting comprehensive on-site reviews of these recipients every 3 to 5 years. The lack of standardized performance measures limits HRSA's ability to effectively evaluate cooperative agreement recipients' activities that support the Health Center Program's goals with comparable measures. In addition, without timely comprehensive on-site reviews, HRSA does not have up-to-date comprehensive information on the performance of these recipients in supporting the Health Center Program. HRSA officials stated that they are in the process of developing standardized performance measures. Moreover, more than a third of the written feedback HRSA sent to unsuccessful Health Center Program grant applicants in fiscal years 2005 and 2007 contained unclear statements. The lack of clarity in this written feedback may undermine its usefulness rather than enhance the ability of applicants to successfully compete for grants in the future.