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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 activities—which include HHS programs and initiatives—were administered by HHS’s 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 fund’s 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.

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.

For more information, contact Katherine Iritani at (202) 512-7114 or

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