The  guidance also notes that states and tribes that use the reassignment  authority will be directed to submit after-action reports to ASPR within 120  days of the termination of the authorization. ASPR’s Processes for the Reassignment Authority Were Not Well Communicated, and It Does Not Plan to Assess the Authority’s Impact on Emergency Response

HHS’s ASPR has developed processes for HHS agencies and offices to  review and approve states’ and tribes’ requests to temporarily reassign  federally funded personnel in public health emergencies and to review the  after-action reports these entities are required to submit on the effect of  the personnel reassignment. ASPR’s initial efforts to communicate  information about these processes to states, tribes, and HHS agencies  and offices were limited, though the office has begun to improve  communication efforts to state and tribal public health officials. While  these officials were generally aware of the reassignment authority  provided by PAHPRA, none of them were aware that the reassignment  guidance had been finalized in April 2016 until we shared this information  with them in summer 2016. Officials from three states we reviewed said that they  generally anticipated having enough personnel to respond to public health  emergencies and would likely not need to request further assistance. The federal internal control standard for information and  communication states that effective communication with internal parties is  necessary to achieve an entity’s objectives. However, the agency has not created a  roster of specific program officials: those grants management and other  staff responsible for day-to-day management of eligible funding programs  who would be charged with approving reassignment requests. However, without more  specific outreach on the part of ASPR about decision making for  reassignment requests, reporting requirements, and its process for  reviewing after-action reports, HHS officials that administer the funding  programs may be unaware of their expected roles in reviewing and  approving reassignment requests and reviewing after-action reports,  which may negatively affect states’ and tribes’ public health emergency  response. ASPR Does Not Plan to Evaluate the Impact of the Reassignment Authority on Public Health Emergency Response

ASPR will not be able to fully assess the impact of personnel  reassignment on public health emergency response because it does not  plan to conduct its own evaluations of states’ and tribes’ after-action  reports. Instead, according to ASPR officials, it plans to assign  responsibility for reviewing these reports to the HHS agencies and offices  that administer the programs from which personnel were reassigned,  because ASPR believes that these other HHS agencies and offices are  better able to identify the effect of the reassignment on their funding  programs and take corrective action as needed. However, ASPR is the federal office with primary responsibility for  overseeing medical and public health preparedness and response. Therefore, HHS and, specifically,  ASPR, would benefit from conducting targeted, timely outreach to other  HHS agencies and offices to provide information on HHS’s processes,  expectations, and requirements for using the authority prior to any further  federal public health emergency declarations. Recommendations

To help ensure that HHS agencies and offices fully understand the  requirements and processes for the temporary reassignment authority,  their responsibilities under the authority, and that ASPR is adequately and  comprehensively assessing the effect of the authority on public health  emergency response and medical surge, we recommend that the  Secretary of HHS direct ASPR to take the following two actions:
ASPR should conduct outreach to HHS agencies and offices that  administer programs eligible for the reassignment authority to inform  them of their responsibilities and ASPR’s expected time frames for  reviewing and approving states’ and tribes’ requests for personnel  reassignments, and inform them of their responsibilities and ASPR’s  expectations for reviewing states’ and tribes’ after-action reports. For the first recommendation that ASPR should  conduct outreach to HHS agencies and offices that administer the  programs eligible for reassignment, HHS told us that ASPR intends to  continue to provide information on reassignment procedures through the  information posted on its website and sharing language to describe the  applicability of the authority to specific grants with HHS agencies and  offices that administer the eligible programs. The Department of Health and  Human Services (HHS) provides funding through Hospital Preparedness  Program (HPP) and Public Health Emergency Preparedness (PHEP)  program cooperative agreements to assist state and local public health  agencies in building their public health emergency preparedness and  response capabilities, including for medical surge.
Why GAO Did This Study

HHS provides funding to state, local, and territorial entities to help them prepare for and respond to public health emergencies, such as influenza pandemics and other threats. However, states have reported not having sufficient personnel to assist in public health emergencies. The Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (PAHPRA) authorized HHS to allow states and tribes to temporarily reassign personnel funded, in whole or in part, by HHS programs to aid in public health emergency response.
PAHPRA included a provision for GAO to examine the impact of the reassignment authority. However, the authority has not yet been used. Therefore, this report examines the processes HHS has in place to review states' and tribes' requests for temporary reassignment and evaluate the after-action reports states and tribes are to submit after they have used the authority. GAO reviewed HHS guidance and interviewed officials from HHS and five states selected based on their increased risks for public health emergencies and levels of prior federal grant funding received.

What GAO Found

The Office of the Assistant Secretary for Preparedness and Response (ASPR), within the Department of Health and Human Services (HHS), has primary federal responsibility for overseeing medical and public health preparedness and response and coordinating the reassignment of personnel in a public health emergency. ASPR has developed processes to review and approve states' and tribes' requests for personnel reassignment. Should ASPR receive a request for personnel reassignment, it would convene relevant officials from the HHS agencies and offices from which states were requesting reassignment, with the goal of the agencies and offices considering requests and ASPR communicating reassignment decisions within four days. However, ASPR's efforts to communicate these processes to the HHS agencies and offices that administer programs eligible for personnel reassignment have been limited.
Program officials—personnel responsible for day-to-day administration of programs eligible for reassignment—from two HHS agencies told GAO that they were generally unaware of the reassignment authority, ASPR's processes and time frames for reviewing and approving requests, or the program officials' expected role in approving requests.
ASPR officials said that the office did not conduct targeted outreach to HHS agencies and offices to inform them of its processes, requirements, or expectations, noting that these entities should be aware of them through other channels, such as during the vetting of guidance on the use of the reassignment authority through HHS. However, officials from one agency said program officials are typically not directly involved in the vetting process.
Conducting outreach to HHS agencies and offices on ASPR's reassignment requests, review processes, and time frames would be consistent with federal internal control standards for information and communication, and would improve HHS agencies' and offices' awareness of expected roles, thereby preventing potential delays in decision making in the event of a public health emergency.
ASPR has assigned responsibility for reviewing after-action reports to HHS agencies and offices—an expectation program officials were also unaware of—and does not plan to conduct its own evaluations of the reports. HHS requires states and tribes that use the authority to submit after-action reports containing information on how the reassignment assisted their emergency response. In assigning report review responsibility to HHS agencies and offices, ASPR officials said that the HHS agencies and offices will be better able to identify the effect of the reassignments on their programs and take corrective actions as needed. However, ASPR's approach does not address the need to comprehensively assess the impact of reassignment on emergency response across HHS. Conducting its own evaluations of the after-action reports would be consistent with the federal internal control standard for monitoring, and would allow ASPR to determine whether the reassignment authority provides helpful resources for states' public health emergency response, as well as assess the effect of the authority across all participating HHS agencies and offices.

What GAO Recommends

GAO recommends that HHS direct ASPR to (1) conduct outreach to HHS agencies and offices to inform them of ASPR's processes, expectations, and requirements for the reassignment authority; and (2) develop a plan to evaluate after-action reports to assess the authority's impact on emergency response and medical surge. HHS agreed with both recommendations and provided information on how ASPR plans to implement them.