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Highlights

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.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Health Resources and Services Administration 1. To improve the Health Center Program, the Administrator of HRSA should collect and maintain readily available data on the types of services provided at each health center site to improve the agency's ability to measure access to comprehensive primary care services in MUAs.
Closed - Not Implemented
HRSA has consistently disagreed with this recommendation. It has informed GAO as recently as 2014 that is has no intention of implementing it.
Health Resources and Services Administration 2. To improve the Health Center Program, the Administrator of HRSA should develop and implement standardized performance measures for training and TA cooperative recipients that assist applicants to improve HRSA's ability to evaluate the performance of its training and TA cooperative agreements. These standardized performance measures should include a measure of the number of successful applicants a recipient assisted.
Closed - Implemented
As part of our review of the Health Resources and Services Administration's (HRSA) oversight of assistance provided to health center grant applicants through training and technical assistance (TA) cooperative agreements, we found that the agency's oversight was limited because it lacked standardized performance measures to assess the performance of the cooperative agreement recipients. As a result, we recommended that the Administrator of HRSA develop and implement standardized performance measures to enhance its ability to assess the performance of its training and TA cooperative agreement recipients. Consistent with our recommendation, beginning in fiscal year 2009, HRSA included standardized performance measures for training and TA cooperative agreement recipients as part of its program guidance. Specifically, the guidance instructed cooperative agreement applicants to establish goals for three required performance measures as part of their application. The three required performance measures focused on health center satisfaction, program requirements, and performance improvement. HRSA has continued to require applicants to address specific performance measures in their applications. In fiscal year 2011, applicants were required to address four specific performance measures, including the same three goals from fiscal year 2009, and one additional measure that focused on program development/analysis. Developing and implementing standardized performance measures for training and TA cooperative agreement recipients improves HRSA's ability to assess recipients' performance and can help inform the agency in determining where to focus its limited resources.
Health Resources and Services Administration 3. To improve the Health Center Program, the Administrator of HRSA should 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.
Closed - Implemented
HRSA provided documentation that it conducted its onsite reviews and TA visits in a way that targeted health centers with the greatest need for monitoring and/or assistance.
Health Resources and Services Administration 4. To improve the Health Center Program, the Administrator of HRSA should identify and take appropriate action to ensure that the discussion of an applicant's strengths and weaknesses in all summary statements is clear.
Closed - Implemented
HRSA provided documentation that it took action to ensure a clear discussion of an applicant's strengths and weaknesses in summary statements such as by including this information in pre-review orientation scripts.

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