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Highlights

The Department of Health and Human Services (HHS) has initiated and supported grant programs aimed at increasing primary health care capacity in medically underserved areas (MUA), preventing and treating substance abuse, and providing services to deal with mental illness. Each of these programs requires that an assessment of the need for the proposed services be made. GAO reviewed the needs assessment processes used to justify funding grantees under the rural and urban health initiatives and several other health programs administered by HHS.

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Recommendations

Matter for Congressional Consideration

Matter Status Comments
Congress should incorporate a requirement in the community health center legislation that grant applicants be required to perform a demand analysis in conjunction with a needs assessment.
Closed
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Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services 1. The Secretary of HHS should establish mechanisms for verifying the information contained in all grant applications.
Closed
Please call 202/512-6100 for additional information.
Department of Health and Human Services 2. The Secretary of HHS should clearly define what constitutes need or eligibility for purposes of Federal funding.
Closed
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Department of Health and Human Services 3. The Secretary of HHS should develop a definition of "medical underservice" specifically for the rural and urban community health center program.
Closed
Please call 202/512-6100 for additional information.
Department of Health and Human Services 4. The Secretary of HHS should give HHS reviewers direction on how need and demand information should be used in the grant review process.
Closed
Please call 202/512-6100 for additional information.
Department of Health and Human Services 5. The Secretary of HHS should establish a specific timetable for updating future MUA lists that would consider current data as they become available.
Closed
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Department of Health and Human Services 6. The Secretary of HHS should reevaluate the eligibility of existing grantees in light of the these recommendations and phase out those that cannot meet the revised requirements.
Closed
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Department of Health and Human Services 7. The Secretary of HHS should revise the grant application review and approval procedures to ensure that future applications comply with all legislative and program requirements.
Closed
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Department of Health and Human Services 8. The Secretary of HHS should update the MUA list and, to the extent practical, consider the other weaknesses discussed in this report relating to the MUA criteria, recognizing they should be used only as a rough indicator of the adequacy of medical service in an area.
Closed
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Department of Health and Human Services 9. The Secretary of HHS should develop rough need indicators, similar to the MUA concept, which would serve as screens to identify geographic areas that would be candidates for Federal funding under the various health service programs.
Closed
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Department of Health and Human Services 10. The Secretary of HHS should develop and provide to prospective grantees guidance on how to perform and what should be included in needs and demand assessments for the program. As a minimum, the guidance should require that (1) rational service areas be established; (2) all health care services in the proposed target area and in contiguous areas be addressed in terms of availability and accessibility; (3) asserted health care problems be documented, and (4) opposition views be addressed in grant applications.
Closed
Please call 202/512-6100 for additional information.
Department of Health and Human Services 11. The Secretary of HHS should develop needs assessment guidance for the use of grant applicants that would address the need for services as well as a realistic analysis of the potential demand for services. As was recommended for the community health center program, such guidance should require that (1) rational service areas be established, (2) health care services in the proposed target areas and in contiguous areas be addressed in terms of availability and accessibility, (3) asserted health care problems be documented, and (4) opposition views be addressed in grant applications.
Closed
Please call 202/512-6100 for additional information.
Department of Health and Human Services 12. The Secretary of HHS should use the MUA designation process only as a rough indicator of the adequacy of medical service for determining areas of the Nation warranting more detailed assessment of need for purposes of Federal funding.
Closed
Please call 202/512-6100 for additional information.

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