	Background

PPACA established the PPHF to provide for expanded and sustained  national investment in prevention and public health programs to improve  health and help restrain the rate of growth in private and public sector  health care costs. For this purpose, the Secretary of Health and Human  Services is required to transfer amounts from the PPHF to HHS accounts  to increase funding, over the fiscal year 2008 level, for programs  authorized by the Public Health Service Act, “for prevention, wellness,  and public health activities including prevention research, health  screenings, and initiatives, such as the Community Transformation grant  program, the Education and Outreach Campaign Regarding Preventive  Benefits, and immunization programs.” Within HHS, agencies including  the Agency for Healthcare Research and Quality (AHRQ), the Centers for  Disease Control and Prevention (CDC), the Health Resources and  Services Administration (HRSA), the Substance Abuse and Mental Health  Services Administration (SAMHSA), and the OS administer programs  authorized by the Public Health Service Act. HHS Agencies and Activities for Which PPHF Funds Were Allocated and Entities That Received PPHF Funding, Fiscal Years 2010 and 2011

HHS allocated PPHF funds for 43 activities in five HHS agencies— AHRQ, CDC, HRSA, OS, and SAMHSA—in the first 2 years of the fund.The majority of the $500 million in PPHF funding available for fiscal year  2010 was allocated for activities administered by HRSA, while the  majority of the $750 million in PPHF funding available for fiscal year 2011  was allocated for activities administered by CDC (see fig. Process and Criteria for Allocating and Awarding PPHF Funds for Fiscal Years 2010 and 2011

HHS implemented an abbreviated process to allocate PPHF funds for  fiscal years 2010 and 2011 because of the timing when PPACA was  enacted, according to HHS. In its abbreviated process, HHS requested proposals for PPHF funding  from agencies. HHS did not develop HHS-wide criteria for fiscal years  2010 and 2011; instead HHS instructed agencies to use activities cited in  the PPACA provisions establishing the PPHF as guidance for developing  proposals for activities for which HHS could allocate PPHF funding. According to HHS, the proposed activities were also aligned with existing  departmental priorities. HHS Reporting of Performance Measures, Targets, and Outcomes of Activities and Projects Receiving PPHF Funding

HHS has relied on its agencies to establish performance measures and  targets and to track outcomes of PPHF activities. HHS agency officials told us that it is too early to report outcomes for  many activities for which PPHF funding was allocated because many  projects receiving PPHF funding in fiscal year 2010, 2011, or both are  multiyear projects or have not yet completed project evaluations, and  outcomes have not been measured or reported. Collectively, HHS allocated a total of   $198.1 million for fiscal year 2010 and $246.3 million for fiscal year 2011  for these three activities. Agency Comments

HHS reviewed a draft of this report and provided technical comments,  which we incorporated as appropriate. For each HRSA activity  that received PPHF funding, tables 63 through 70 summarize information  on awards made with those funds through grants and contracts for each  fiscal year.
Why GAO Did This Study

In March 2010, PPACA established the PPHF to provide for expanded and sustained national investment in prevention and public health programs, including prevention research, health screenings, and immunization programs. PPACA appropriated $500 million for fiscal year 2010, $750 million for fiscal year 2011, and additional amounts for future fiscal years to operationalize the PPHF.
HHS allocates funding from the PPHF for specific prevention and public health activities administered by HHS agencies. The agencies, once funds are transferred to them, use the PPHF funds to support individual projects through, for example, grants and contracts. GAO was asked to provide information on how PPHF funds were allocated for fiscal years 2010 and 2011. This report describes, for those fiscal years, (1) the HHS agencies and activities for which PPHF allocations were made, (2) the process and criteria HHS used to allocate PPHF funds, and (3) HHS reporting of the outcomes of activities receiving PPHF funding. GAO reviewed agency documents, including budget justifications, funding announcements, data on PPHF allocations and awards of PPHF-funded grants, contracts, and interagency agreements; examined agency websites; and interviewed HHS officials.
HHS provided technical comments on a draft of this report, which were incorporated as appropriate.

What GAO Found

For fiscal years 2010 and 2011, the Department of Health and Human Services (HHS) allocated funds from the Prevention and Public Health Fund (PPHF) for 43 activities in five agencies. These activitieswhich include HHS programs and initiativeswere administered by HHSs Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), and the Office of the Secretary (OS). Most of the $500 million available for fiscal year 2010 was allocated for activities administered by HRSA, and most of the $750 million available for fiscal year 2011 was allocated for activities administered by CDC (see fig.). HHS agencies funded individual projects with PPHF funds through grants, contracts, and interagency agreements.
Because the PPHF was established midway through fiscal year 2010 and after the President had submitted the fiscal year 2011 budget request, for the funds first 2 years HHS used an abbreviated process to allocate PPHF funds. Instead of developing HHS-wide written criteria, HHS requested that its agencies propose activities for PPHF funding based on language in the Patient Protection and Affordable Care Act (PPACA) provision establishing the PPHF. According to HHS, the proposed activities were also aligned with existing departmental priorities.
HHS has relied on its agencies to establish performance measures and targets and to track outcomes (the results) of the PPHF-funded activities. Agency officials reported that for many activities, it is too early to report outcomes because many projects receiving PPHF funding in fiscal years 2010 and 2011 are multiyear projects or have not yet completed evaluations.