Health Resources and Services Administration:

Action Taken to Train and Oversee Grantee Monitoring Staff, but Certain Guidance Could Be Improved

GAO-14-800: Published: Sep 23, 2014. Publicly Released: Sep 23, 2014.

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Debra A. Draper
(202) 512-7114


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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;

participate in staff interactions with grantees, such as monitoring calls;

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.

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 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.

For more information, contact Debra A. Draper at (202) 512-7114 or

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: The Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA) concurred with our recommendation and has taken actions to address it. Specifically, HRSA required that each bureau complete a crosswalk in September 2014 in order to identify any potential inconsistencies. This crosswalk matched the key components of grantee monitoring, as described in the HRSA Grantee Oversight Manual, with sections of their bureau-specific policies. In addition, HRSA required each of the bureaus to certify by February 2015 that their bureaus were in alignment with HRSA grantee monitoring requirements.

    Recommendation: To help ensure complete and effective monitoring of grantees, the Administrator of HRSA should develop a process, either at the agency or bureau level, to ensure that bureaus' standard operating procedures address all of the key components of grantee monitoring as established by the agency.

    Agency Affected: Department of Health and Human Services: Public Health Service: Health Resources and Services Administration


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