HRSA supplements its staff with contractors that perform grantee  monitoring activities such as conducting site visits to monitor compliance  with grant requirements, or financial audits and reviews. HRSA Has Developed Guidance for Staff on Grantee Monitoring, but Bureau-Level Guidance Did Not Address All of the Key Components of Monitoring

HRSA began systematically developing guidance for the key staff  responsible for grantee monitoring in 2012. Specifically, HRSA issued the first agency-wide guidance written primarily  for project officers in November 2012, and it required each of the bureaus  to develop more detailed guidance for project officers by the end of 2012. In addition, HRSA is in the process of developing new guidance and  revising existing guidance for grants management specialists and  financial integrity staff in OFAM. To assist the  bureaus in systematically developing their SOPs, HRSA provided the  bureaus with a template outlining the minimum components to be  included in their documents and established a workgroup to facilitate  implementation of the SOPs across the agency. In addition to SOPs, HRSA officials described other sources of guidance  developed by the bureaus, such as site visit guides, policy notices,  frequently asked questions, checklists, and templates.and supervisors we interviewed generally found the guidance on grantee   Project officers  monitoring to be helpful, and one project officer who had been with HRSA  for over 10 years stated that the level of guidance provided to project  officers has significantly improved in recent years. Guidance for OFAM staff. Bureau-Level Guidance Did Not Address All of the Key Components of Grantee Monitoring

While HRSA’s bureaus have developed bureau-level guidance for project  officers on monitoring of grantees, we found that the bureaus’ SOPs did  not address all of the key components of grantee monitoring identified by  HRSA. Because the SOPs do not include the  level of detail specified by HRSA in the template, there is an increased  possibility that project officers will not conduct, or appropriately document,  all of the required monitoring activities, which puts HRSA at greater risk  for having incomplete or ineffective grantee monitoring. HRSA Implemented Agency-Wide Training Programs for Grantee Monitoring Staff Beginning in 2013; Bureau-Level Training Varied

Since 2013, HRSA has implemented agency-wide training programs for  key staff responsible for monitoring grantees, including a project officer  certification program and a training program for grants management  specialists. Both the new and  experienced project officer training includes courses that cover material  related to grantee monitoring. In addition to agency-wide training programs, the bureaus provided their  own training—such as training on specific grant programs—to varying  degrees. HRSA Has Four Main Methods for Overseeing Its Staff’s Monitoring of Grantees

HRSA has four main methods for overseeing project officers, grants  management specialists, and financial integrity staff that are responsible  for monitoring its grantees—supervisors reviewing information in, and  reports from, EHB; participating in staff interactions with grantees;  communicating regularly with staff; and conducting performance  appraisals. HRSA also uses its annual  performance appraisal process to hold its staff accountable for their  grantee monitoring responsibilities. HRSA Has Several Mechanisms in Place Designed to Ensure Contractors That Monitor Grantees Are Qualified and to Oversee Their Work

HRSA has several mechanisms in place designed to ensure that HRSA  contractors that conduct grantee monitoring activities are qualified and to  oversee the work performed by these contractors. HRSA officials told us  that the agency’s process for awarding contracts is designed to ensure  the contractors that conduct grantee monitoring activities are qualified. For all 13 contracts that HRSA identified as  including grantee monitoring activities in fiscal year 2013, the personnel  proposed by contractors were a factor in HRSA’s evaluation and selection  of the contractors. For some contracts, HRSA identified specific qualifications required for  contractor staff. HRSA officials reported several mechanisms they use to oversee  contractors’ work, including regular communications with contractors, the  review of contractors’ deliverables, and the collection of feedback from  project officers and grantees on contractor performance. Conclusions

HRSA uses a large portion of its appropriations—over 80 percent in fiscal  year 2013—to award grants to external entities. Recommendation for Executive Action

To help ensure complete and effective monitoring of grantees, we  recommend that the Administrator of HRSA develop a process, either at  the agency or bureau level, to ensure that bureaus’ SOPs address all of  the key components of grantee monitoring as established by the agency. GAO staff who made key contributions to this  report are listed in appendix III.
Why GAO Did This Study

In fiscal year 2013, HRSA awarded over $6 billion in grants, which accounted for over 80 percent of the agency's appropriations. HRSA's workforce—its staff and contractors— is responsible for monitoring the agency's grantees to ensure they are financially sound, using federal funds appropriately, and in compliance with program requirements. In recent years, GAO has reported on weaknesses in HRSA's monitoring of certain grant programs and made recommendations for the agency to improve grantee monitoring.
GAO was asked to review HRSA's oversight mechanisms for its grantee monitoring workforce. This report examines (1) the extent to which HRSA has developed guidance for staff who monitor grantees; (2) the extent to which it implemented training for this staff; (3) HRSA's oversight of its staff; and (4) its practices to ensure contractors who conduct grantee monitoring activities are qualified and carry out their work as appropriate. GAO reviewed HRSA training documentation and guidance related to grantee monitoring and interviewed HRSA officials. GAO also reviewed the contracts that HRSA identified as including grantee monitoring activities in fiscal year 2013.

What GAO Found

In 2012, the Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA) began systematically developing guidance for the key staff involved in grantee monitoring—project officers in its programmatic bureaus and grants management specialists and financial integrity staff in its Office of Federal Assistance Management (OFAM). Specifically, HRSA issued the first agency-wide guidance written primarily for project officers in November 2012 and is in the process of developing new guidance and revising existing guidance for staff in OFAM. Additionally, HRSA required each of the bureaus to develop more detailed guidance for project officers by the end of 2012. To assist the bureaus in systematically developing this guidance, HRSA provided a template outlining the minimum components to be included in the documents. While all of HRSA's bureaus developed guidance for their project officers, GAO found that the bureaus' guidance did not address all of the key components of grantee monitoring identified by HRSA, such as components related to conducting site visits. Although HRSA conducted reviews of the bureaus' guidance, these reviews were not sufficient to ensure that the guidance addressed all required grantee monitoring components. Consequently, there is an increased possibility that project officers will not conduct, or document, all the monitoring activities required by HRSA, which puts the agency at risk for incomplete or insufficient grantee monitoring.
Since 2013, HRSA has implemented agency-wide training programs for key staff responsible for conducting monitoring of grantees—a project officer certification program, which the majority of project officers have completed, and a career development program for grants management specialists. Both programs include courses that cover material related to grantee monitoring. In addition to these training programs, the bureaus and OFAM offer formal and informal training related to grantee monitoring, such as training on specific grant program requirements.
HRSA has four main methods for overseeing its staff's monitoring of grantees. According to HRSA officials, supervisors
review information in, and reports from, HRSA's online system for documenting grantee monitoring activities, such as staff's assessments of grantee compliance;
regularly communicate with staff in one-on-one and other meetings; and
conduct annual performance appraisals to hold staff accountable for their monitoring responsibilities.
Additionally, HRSA has mechanisms in place to ensure that the contractors that conduct grantee monitoring activities are qualified, including reviewing staffing proposals prior to awarding the contract, requiring contractor staff to have specific qualifications, and requiring training for contractor staff. To oversee contractors' work, HRSA staff regularly communicate with the contractors, review their deliverables, and obtain feedback from project officers and grantees on contractor performance.

What GAO Recommends

GAO recommends that HRSA develop a process to ensure that the guidance developed by its bureaus addresses all of the key components of grantee monitoring as established by the agency. HHS agreed with GAO's recommendation and said HRSA has begun to take action to implement it.