HEALTH 

RESOURCES AND 

SERVICES 

ADMINISTRATION

Review of Internal 

Communication 

Mechanisms, Staffing, 

and Use of Contracts

Report to Congressional Requesters

December 2013

GAO-14-52

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-14-52, a report to 

congressional requesters

December 2013

HEALTH RESOURCES AND SERVICES 

ADMINISTRATION 

Review of Internal Communication Mechanisms, 

Staffing, and Use of Contracts 

Why GAO Did This Study

HRSA is charged with improving 

access to health care services for 

people who are uninsured, isolated, or 

medically vulnerable. HRSA carries out 

its mission by providing funding and 

support to a wide variety of programs, 

which have grown in number and size 

since the agency was established in 

1982. To manage these programs, 

HRSA has a staff of nearly 1,900 

employees, supplemented by contract 

staff who perform a variety of tasks to 

support HRSA’s programs and 

operations. HRSA’s staff are organized 

into seven programmatic bureaus that 

are responsible for overseeing HRSA’s 

programs and nine cross-cutting 

operational support offices—each of 

which reports to the Office of the 

Administrator. In recent years, GAO 

reported on weaknesses in HRSA’s 

oversight and monitoring of certain 

programs.

Given GAO’s past findings and the 

expansion of the agency’s programs, 

GAO was asked to review HRSA’s 

management and operations. This 

report examines (1) HRSA’s internal 

communication mechanisms and how 

they are used to support the agency’s 

mission; (2) HRSA’s staffing and how 

the agency plans for attrition; and 

(3) HRSA’s use of contracts to support 

its operations. GAO reviewed and 

analyzed HRSA’s communication 

methods and organizational structure; 

analyzed data on HRSA personnel and 

contracts for fiscal years 2008 through 

2012; interviewed HRSA officials 

knowledgeable about the agency’s 

organization, staffing, and use of 

contracts; and reviewed relevant 

documentation.

What GAO Found

The Department of Health and Human Services’ (HHS) Health Resources and 

Services Administration (HRSA) has mechanisms in place to share information 

important for supporting the agency’s mission across its various organizational 

components and levels of staff—a practice that is consistent with internal control 

standards for the federal government. These communication methods include an 

annual operational planning process for allocating agency resources, workgroups 

that involve staff from across the agency to work on issues of a cross-cutting 

nature, and regular meetings between the Office of the Administrator and leaders 

of the agency’s various organizational components.

HRSA’s staff grew by more than 30 percent from fiscal years 2008 to 2012. The 

number of HRSA employees grew from 1,418 in fiscal year 2008 to 1,857 in 

fiscal year 2012. According to agency officials, the most common job function 

within HRSA is a project officer—an employee responsible for the oversight of 

grantees funded by the agency’s programs; and HRSA has over 400 project 

officers. From fiscal years 2008 through 2012, HRSA lost an average of 

9 percent of its staff annually to attrition. Of those who left HRSA in fiscal year 

2012, approximately 59 percent resigned and 35 percent retired. Agency-wide, 

over 30 percent of HRSA’s permanent employees will be eligible to retire by the 

end of fiscal year 2017. An even larger portion of HRSA’s leadership, nearly 

50 percent, will be eligible to retire by 2017. If a large portion of the agency’s 

leadership were to actually retire during this time period, HRSA runs the risk of 

having gaps in leadership and potential loss of important institutional knowledge. 

HRSA periodically tracks attrition and retirement eligibility. To respond to 

retirements and other attrition, HRSA has instituted succession planning efforts 

which generally focus on leadership development for agency staff. For example, 

HRSA has instituted two leadership development programs, has two other 

programs under development, and has established mentoring and coaching 

programs.

In fiscal year 2012, HRSA obligated over $240 million, or about 3 percent of its 

appropriations, to contracts to acquire goods and services necessary to support 

its operations, an amount that has generally remained steady over the past few 

years. Over half of the fiscal year 2012 contract obligations were for two 

categories of services—information technology and telecommunications 

services, and professional support services, which includes providing technical 

assistance to grantees. According to HRSA officials, the agency uses contracts 

to support its operations for a variety of reasons; these include supplementing 

HRSA staff or fulfilling short-term needs and performing functions that require 

specialized skills for which HRSA staff do not have the appropriate expertise,

such as clinical or financial expertise.

We provided a draft of this report to HHS for its review. In its written comments, 

HHS noted that the report recognized the mechanisms HRSA has in place to 

ensure the coordinated flow of communication and plan for succession.

View GAO-14-52. For more information, 

contact Debra A.Draper at (202) 512-7114 or 

draperd@gao.gov.
Page i GAO-14-52 Health Resources and Services Administration

Letter 1 

Background 6

HRSA Has Mechanisms in Place for Multi-Directional 

Communication Throughout the Agency 14

HRSA’s Staff Has Grown in Recent Years; About Half of Its 

Leadership Will Be Eligible to Retire by 2017 17

HRSA Obligated Over $240 Million for Contracts in Fiscal Year 

2012, the Majority of Which Were for Information Technology 

and Program Support 29

Agency Comments 33

Appendix I Health Resources and Services Administration’s (HRSA) 

Programs by Programmatic Bureau, Fiscal Year 2013 35

Appendix II HRSA Contracts with the Highest Total Amount of 

Obligations by Organizational Component, Fiscal Year 2012 41

Appendix III Top Three Products or Services Obtained through 

Contracts by Organizational Component, Fiscal Year 2012 42

Appendix IV Comments from the Department of Health and Human 

Services 43

Appendix V GAO Contact and Staff Acknowledgments 45

Tables

Table 1: Overview of HRSA’s Programmatic Bureaus and 

Operational Support Offices, as of September 2013 12

Table 2: HRSA Contract Obligations by Category, Fiscal Year 2012 30

Table 3: Amount of HRSA Contract Obligations by Organizational 

Component, Fiscal Year 2012 31

Contents 
Page ii GAO-14-52 Health Resources and Services Administration

Figures

Figure 1: HRSA’s Appropriations, Fiscal Years 1982 through 2012 7

Figure 2: Locations of HRSA Employees as of September 2013 9

Figure 3: HRSA’s Organizational Chart as of September 2013 11

Figure 4: Number of HRSA Staff by Location, Fiscal Years 2008 

through 2012 18

Figure 5: Number of HRSA Employees by Organizational 

Component and Location, Fiscal Year 2012 19

Figure 6: Percent of HRSA Staff by Pay Plan, Fiscal Year 2012 21

Figure 7: HRSA Attrition Rates by Organizational Component, 

Fiscal Year 2012 23

Figure 8: Percent of HRSA Employees Eligible to Retire by Fiscal 

Year 2017, by Organizational Component 25

Figure 9: Amount of HRSA Contract Obligations, Fiscal Years 2008 

through 2012 29

Abbreviations

ARRA American Recovery and Reinvestment Act of 2009

FPDS-NG Federal Procurement Data System-Next Generation

GS General Schedule 

HHS Department of Health and Human Services

HIV/AIDS human immunodeficiency virus and acquired 

 immunodeficiency syndrome

HPSA health professional shortage area

HRSA Health Resources and Services Administration

PPACA Patient Protection and Affordable Care Act

SES Senior Executive Service

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Page 1 GAO-14-52 Health Resources and Services Administration

441 G St. N.W.

Washington, DC 20548

December 3, 2013 

Congressional Requesters,

The Health Resources and Services Administration (HRSA), an agency 

within the Department of Health and Human Services (HHS), is charged 

with improving access to health care services for people who are 

uninsured, isolated, or medically vulnerable. HRSA’s scope of work has 

evolved since it was established in 1982 and its programs have grown in 

number and size. According to information provided by HRSA, in the last 

decade, the agency’s appropriation has also increased in nominal dollars 

from approximately $7.2 billion in fiscal year 2003 to about $8.1 billion in 

fiscal year 2013. Some of the agency’s recent growth is due to additional 

authority, responsibilities, and funding for HRSA programs provided 

through the American Recovery and Reinvestment Act of 2009 (ARRA)1

and the Patient Protection and Affordable Care Act (PPACA).2 According 

to HRSA, ARRA provided an additional $2.5 billion from fiscal years 2009 

through 2011 and PPACA authorized an additional $8.2 billion for the 

agency’s programs from fiscal years 2010 through 2014.3 While HRSA’s 

programs and responsibilities have expanded, the agency is also facing 

new challenges as a result of sequestration,4

To carry out its mission “to improve health and achieve health equity 

through access to quality services, a skilled health workforce, and 

innovative programs,” HRSA provides leadership and financial support to 

which led the agency to 

implement a hiring freeze in January 2013.

 

1

Pub. L. No.111-5, 123 Stat. 115 (2009).

2

Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and 

Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010). In this 

report, references to PPACA include amendments made by the Health Care and 

Education Reconciliation Act.

3

While ARRA and PPACA provided additional funding to HRSA, the annual appropriation 

made to the agency was reduced during some of these years.

4

Sequestration refers to mandated budget caps for federal agencies established by the 

Budget Control Act of 2011, Pub. Law No. 112-25, 125 Stat. 240 (2011), which amended 

the Balanced Budget and Emergency Deficit Control Act of 1985, Pub. L. No. 99-177, 

99 Stat. 1037 (1985), and reinstated caps on discretionary budget authority. These caps 

subsequently were amended by the American Taxpayer Relief Act of 2012, Pub. L. 

No. 112-240, 126 Stat. 2313 (2013). 

 
 

Page 2 GAO-14-52 Health Resources and Services Administration

more than 3,000 grantees, including organizations in every state. These 

grantees serve millions of people each year through a variety of HRSAsponsored programs. For example, through its Health Center Program, 

HRSA awards grants to nonprofit community-based or public 

organizations that provide comprehensive primary care services to 

millions of people regardless of their ability to pay for care. HRSA also 

provides funding for poison control centers; programs for organ, bone 

marrow, and cord blood donation; and scholarships to students and loan 

repayment to health care providers who agree to work in underserved 

areas. HRSA also has programs that award grants to organizations that 

provide health care to people living with human immunodeficiency virus 

and acquired immunodeficiency syndrome (HIV/AIDS); pregnant women, 

mothers, and children; and people living in rural communities.

To manage its diverse array of programs, HRSA has a staff of almost 

1,900 employees, supplemented by contract staff who perform a variety 

of tasks to support HRSA’s programs and operations. HRSA staff are 

organized into the Office of the Administrator and 16 other organizational 

components—7 programmatic bureaus that are responsible for 

overseeing HRSA’s programs, and 9 cross-cutting operational support 

offices—each of which reports to the Office of the Administrator. Staff 

must communicate across these bureaus and offices to accomplish 

certain tasks such as planning for the agency’s budget, allocating staff, 

implementing the HRSA-related provisions in PPACA, and overseeing 

grantees.

In recent years, we reported on weaknesses in HRSA’s oversight and 

monitoring of certain programs. For example, in 2011, we reported that 

HRSA’s oversight of the 340B Drug Pricing Program—a program through 

which drug manufacturers give certain covered entities access to 

discounted prices on outpatient drugs—was inadequate to ensure that 

covered entities were in compliance with program requirements.5 In 

addition, in 2012, we reported that HRSA did not consistently follow HHS 

regulations and guidance in its oversight of grantees under the Ryan 

White Comprehensive AIDS Resources Emergency Act of 1990.6

 

5

See GAO, Drug Pricing: Manufacturer Discounts in the 340B Program Offer Benefits, but 

Federal Oversight Needs Improvement, 

We 

GAO-11-836 (Washington, D.C.: Sept. 23, 2011).

6

See GAO, Ryan White CARE Act: Improvements Needed in Oversight of Grantees, 

GAO-12-610 (Washington, D.C.: June 11, 2012).
 

Page 3 GAO-14-52 Health Resources and Services Administration

also reported in 2012 that HRSA’s oversight of its Health Center Program 

grantees was insufficient to ensure that the agency consistently identified 

all instances of grantee noncompliance with Health Center Program 

requirements.7

Given our past findings of weaknesses in HRSA’s oversight of certain 

programs, the importance of the agency’s programs to low-income and 

underserved populations, and the expansion of the agency’s programs, 

you asked us to review HRSA’s management and operations, including 

how the agency uses contracts to support its operations. In this report, we 

examine (1) HRSA’s internal communication mechanisms and how they 

are used to support the agency’s mission; (2) HRSA’s staffing and how 

the agency plans for attrition; and (3) how HRSA uses contracts to 

support its operations.8

To examine HRSA’s internal communication mechanisms and how they 

are used to support the agency’s mission, we reviewed and analyzed 

HRSA’s methods of communication, organizational structure, and 

reporting arrangements overall and at the bureau and office level. In 

addition, we interviewed the leaders of each bureau and selected 

operational support offices, as well as agency-level officials about a range 

of management practices related to communication among agency, 

bureau, and office leaders. We reviewed relevant documents such as 

organizational charts, meeting minutes, and agency reports and memos. 

As part of our review, we assessed whether HRSA’s communication 

mechanisms and practices were consistent with internal controls related 

to communication.9

To examine HRSA’s staffing and how the agency plans for attrition, we 

analyzed trends in HRSA personnel data for the most recent five-year 

period, fiscal years 2008 through 2012, from the Office of Personnel 

Management’s Enterprise Human Resources Integration-Statistical Data 

Mart (formerly the Central Personnel Data File) for civilian employees and 

 

7

See GAO, Health Center Program: Improved Oversight Needed to Ensure Grantee 

Compliance with Requirements, GAO-12-546 (Washington, D.C.: May 29, 2012).

8

We have additional work underway to review HRSA’s management of the staff and 

contractors who have responsibility for overseeing grantees.

9

See GAO, Standards for Internal Control in the Federal Government, 

GAO/AMID-00-21.3.1 (Washington, D.C.: Nov. 1, 1999).
 

Page 4 GAO-14-52 Health Resources and Services Administration

HHS’s Commissioned Corps Personnel and Payroll System for 

employees in the U.S. Public Health Service Commissioned Corps.10

• the number of staff overall and by location, organizational component, 

and pay plan;

For 

our analysis we combined data from both systems to create a complete 

picture of HRSA’s staff. We analyzed data from these two systems to 

determine

11

• attrition rates and the reasons for attrition, which include resignation, 

retirement, termination, and death;12

• retirement eligibility for HRSA staff from fiscal years 2012 through 

2017, by using birth date and service computation date, as well as 

retirement eligibility requirements for civilian employees and 

Commissioned Corps officers.

and,

13

To determine the reliability of data obtained from the Office of Personnel 

Management’s Enterprise Human Resources Integration-Statistical Data 

Mart, we reviewed the data system’s technical documentation and 

compared output from our analysis to information provided by HRSA to 

ensure the information was consistent across sources. To determine the 

reliability of data obtained from the Commissioned Corps Personnel and 

 

10HRSA has employees who are members of the U.S. Public Health Service 

Commissioned Corps (referred to in this report as Commissioned Corps), which is a part 

of HHS and fills essential public health leadership and service roles in federal government 

agencies and programs. Commissioned Corps officers are paid through a different pay 

plan than employees under the civilian pay plans.

11We excluded student interns and staff with intermittent temporary schedules from our 

analysis due to the transient nature of their employment. Headquarters staff were those in 

the DC-Metro locality pay area; employees in all other locality pay areas were designated 

as regional staff. Organizational component codes were used to identify the bureau or 

office an employee was assigned to within HRSA.

12We used the 2-year “onboard” average as the base population of “onboard” staff in a 

particular year to calculate attrition. These calculations include anyone who left HRSA, 

including those who left HRSA for jobs with other agencies within HHS. To identify 

individuals who left HRSA to go to another HHS agency, we tracked HRSA staff over the 

time period of our review and counted individuals whose agency changed from HRSA to 

another HHS agency as a departure due to resignation.

13Our analysis of retirement eligibility is limited to career permanent employees. To 

calculate retirement eligibility, we computed the date at which the employee would be 

eligible for voluntary retirement at an unreduced annuity using age at hire, years of 

service, birth date, and retirement plan coverage.
 

Page 5 GAO-14-52 Health Resources and Services Administration

Payroll System, we conducted interviews with officials knowledgeable 

about the system to understand the actions taken to ensure the data’s 

consistency, accuracy, and completeness. We also conducted electronic 

data testing for data reliability for both systems. We determined that the 

data obtained from both systems were sufficiently reliable for our 

purposes. In addition to analyzing data on HRSA staffing, we interviewed 

HRSA officials including the leaders of each programmatic bureau 

regarding staffing allocation decisions, practices, and challenges, as well 

as the agency’s tracking and planning for staff attrition and retirements. 

We also reviewed relevant documentation, such as strategic plans to 

identify HRSA’s approach to staff planning, including for allocation, 

attrition, and retirements. Finally, we assessed HRSA’s practices against 

best practices for human capital management and planning.14

To examine how HRSA uses contracts to support its operations, we 

analyzed data on HRSA’s contracts from the Federal Procurement Data 

System-Next Generation (FPDS-NG), the primary government-wide 

contracting database which provides information on government 

contracting actions and procurement trends. We focused our review on 

contracts with obligations in fiscal year 2012 to determine dollar amounts 

of contract obligations agency-wide and by organizational component, as 

well as key characteristics of contracts used to support the agency’s 

operations. To assess whether HRSA’s use of contracts has changed 

significantly over time, we also reviewed data on the agency’s contracts 

with obligations in fiscal years 2008 through 2011. To assess the 

reliability of the HRSA data we obtained from FPDS-NG, we reviewed 

recent audits and certifications of HRSA’s contract data, compared the 

data we obtained with data provided by HRSA, and conducted electronic 

data testing to look for obvious data errors. Based on this, we determined 

that the data were sufficiently reliable for our purposes. To supplement 

the data from FPDS-NG, we obtained information manually compiled by 

HRSA on the organizational component supported by each contract with 

obligations in fiscal year 2012. We also interviewed HRSA officials 

knowledgeable about the agency’s contracts, contracting data, and 

approach to determining when and how to use contractors, and leaders of 

HRSA’s programmatic bureaus about how the bureaus use contracts to 

support their programs. In addition, we reviewed relevant documentation 

 

14See GAO, A Model of Strategic Human Capital Management, GAO-02-373SP

(Washington, D.C.: Mar. 15, 2002).
 

Page 6 GAO-14-52 Health Resources and Services Administration

about HRSA’s process for requesting and approving the need for contract 

support such as procurement plan, operating plan, and decision memo 

documentation.

We conducted this performance audit from January 2013 to December 

2013 in accordance with generally accepted government auditing 

standards. Those standards require that we plan and perform the audit to 

obtain sufficient, appropriate evidence to provide a reasonable basis for 

our findings and conclusions based on our audit objectives. We believe 

that the evidence obtained provides a reasonable basis for our findings 

and conclusions based on our audit objectives.

HRSA was established in 1982, and its mission is to improve health and 

achieve health equity through access to quality services, a skilled health 

workforce, and innovative programs. HRSA’s strategic plan contains four 

main goals: (1) improve access to quality health care and services, 

(2) strengthen the health workforce, (3) build healthy communities, and 

(4) improve health equity. HRSA also has a human capital strategic plan 

meant to ensure that the agency has the workforce it needs to carry out 

its mission. That plan contains five main goals: (1) plan for and align the 

workforce to ensure employees have the right experience and skills to fit 

the job, (2) support continuous learning, (3) build leadership bench 

strength,15 (4) strengthen the performance culture, and (5) improve 

employee satisfaction. As of September 2013, HRSA was in the process 

of updating its human capital strategic plan for the 2013 through 2015 

timeframe.

According to information from HRSA, the agency had appropriations of 

about $8.1 billion in fiscal year 2013. Since its inception in 1982, HRSA’s 

appropriations have generally increased in real terms. (See fig.1.) 

Increases to HRSA’s appropriations since fiscal year 2009 can partially 

be attributed to ARRA and PPACA. According to HRSA, ARRA provided 

an additional $2.5 billion to the agency from fiscal years 2009 through 

2011. HRSA received approximately $7.8 billion through PPACA from 

 

15HRSA defines this goal as ensuring leadership continuity and instilling leadership skills 

to support the agency’s mission.

Background 

Overview of HRSA 

Operations 
 

Page 7 GAO-14-52 Health Resources and Services Administration

fiscal years 2010 through 2013, and is expecting another $400 million in 

fiscal year 2014, for a total of about $8.2 billion over the 5 years.

Figure 1: HRSA’s Appropriations, Fiscal Years 1982 through 2012

a

According to HRSA, in fiscal year 2012 the agency used over 90 percent 

of its budget on funding for its programs through grants, cooperative 

agreements, scholarships and loan repayments, and other forms of 

programmatic funding.

Appropriation amounts are adjusted using the U.S. Department of Commerce, Bureau of Economic 

Analysis, Gross Domestic Product Price Index.

16

 

16Grants constitute one form of federal assistance consisting of payments in cash or in 

kind to a state or local government or a nongovernmental recipient for a specified 

purpose. Cooperative agreements are another form of financial assistance similar to 

grants, but where the federal agency is more involved with the recipient during the 

performance of the project. HRSA also has programs that offer scholarships to students 

and educational loan repayment to health care providers in exchange for a commitment to 

provide care in underserved areas or for underserved populations.

In addition to these funding mechanisms, HRSA 

uses contracts—award mechanisms used to acquire services or property 

from a non-federal party for the benefit or use of HRSA—to support its 

operations and programs.
 

Page 8 GAO-14-52 Health Resources and Services Administration

Through these mechanisms, HRSA provides funding and support for a 

wide variety of programs. HRSA’s programs include a block grant to fund 

services for maternal and child health across the country, compensation 

for people injured by vaccines, grants to a national network of health 

centers to provide primary health care, loan repayment and scholarships 

for recruiting and training health care providers who practice in 

underserved communities, and grants to organizations providing services 

for people living with HIV/AIDS.17 As a result of ARRA and PPACA, 

HRSA has expanded some of its programs, and started new programs in 

recent years. For example, HRSA expanded its Health Center Program 

and established a Home Visiting Program to improve coordination of 

services and outcomes for families living in at-risk communities.18

HRSA’s staff of nearly 1,900 provides oversight, technical assistance, and 

operational support for the agency’s programs. Its workforce consists of 

permanent civilian staff, including those within the General Schedule (GS) 

employment system, the Senior Executive Service (SES), and other 

government pay plans.19

 

17A block grant is a type of grant where funding recipients have substantial discretion over 

the type of activities to support, with minimal federal administrative requirements or 

restrictions.

HRSA also employs staff from the 

Commissioned Corps. In addition to permanent civilian and

Commissioned Corps staff, HRSA also employs some nonpermanent 

staff. For example, for its grant review panels, advisory committees, and 

certain other activities, HRSA may hire individuals for discrete, timelimited activities for which a particular expertise is needed. HRSA has 

headquarters staff who are assigned to the agency’s headquarters in 

Rockville, Maryland, and “regional staff” who work in 1 of the agency’s 10 

regional offices or 1 of 2 field locations across the United States and 

Puerto Rico (see fig. 2).

18Under the Home Visiting Program, at-risk communities are communities with 

concentrations of (1) premature birth, low-birth weight infants, and infant mortality, or other 

indicators of at-risk prenatal, maternal, newborn or child health; (2) poverty; (3) crime; 

(4) domestic violence; (5) high-school drop outs; (6) substance abuse; (7) unemployment; 

or (8) child maltreatment. 

19The GS system is a classification and pay system for the majority of civilian federal 

employees. The GS system has 15 grades—GS-1 (lowest) to GS-15 (highest). SES 

positions are federal employee positions that are classified above GS-15. Other 

government pay plans for which HRSA has staff include the federal wage system for 

hourly, blue collar employees and a pay plan for physicians and dentists.
 

Page 9 GAO-14-52 Health Resources and Services Administration

Figure 2: Locations of HRSA Employees as of September 2013
 

Page 10 GAO-14-52 Health Resources and Services Administration

HRSA’s organization consists of the Office of the Administrator and 16 

other organizational components—7 programmatic bureaus and 9 crosscutting operational support offices (see fig. 3).20

 

20Throughout this report, we use the term “bureaus” to refer to the seven organizational 

components that carry out the agency’s programmatic work: Bureau of Clinician 

Recruitment and Service, Bureau of Health Professions, Bureau of Primary Health Care, 

Healthcare Systems Bureau, HIV/AIDS Bureau, Maternal and Child Health Bureau, and 

the Office of Rural Health Policy. HRSA considers the Office of Rural Health Policy to be 

similar in function and organizational structure to the six units with “bureau” in their titles.

HRSA’s Organizational 

Structure 
 

Page 11 GAO-14-52 Health Resources and Services Administration

Figure 3: HRSA’s Organizational Chart as of September 2013

Note: HRSA considers the Office of Rural Health Policy to be a programmatic bureau as it is similar in 

function and organizational structure to the six units with “bureau” in their titles.

HRSA’s Office of the Administrator provides broad leadership and 

direction to HRSA staff and plans, directs, and interprets major policies, 

programs, and initiatives for the agency. The Office of the Administrator 

also makes final decisions about HRSA’s organization, staff allocation, 

budget, and contracts. The office includes HRSA’s Administrator, Deputy 

Administrator, and Senior Advisors. HRSA’s seven programmatic bureaus 

each manage a portfolio of activities dealing with a specific area of health 

care services, systems, or workforce. Each of HRSA’s bureaus is led by 

an Associate Administrator and Deputy Associate Administrator, who are 
 

Page 12 GAO-14-52 Health Resources and Services Administration

generally members of the SES. The bureaus are organized into smaller 

components called divisions or offices that are led by a director, generally 

a GS-15, who reports to the bureau’s Associate Administrator. Some of 

these divisions and offices are further broken down into subcomponents 

called branches which are led by chiefs who report to the division or office 

directors. HRSA’s nine operational support offices provide assistance for 

the agency’s programmatic work and coordination for cross-cutting or 

agency-wide issues, such as human resources, acquisitions 

management, and grants administration. (See table 1 for an overview of 

HRSA’s bureaus and offices and app. I for a list of HRSA programs by 

bureau.)

Table 1: Overview of HRSA’s Programmatic Bureaus and Operational Support Offices, as of September 2013 

Organizational Component Intended Purpose

Programmatic Bureau

Bureau of Clinician Recruitment and 

Service 

Helps underserved communities and facilities experiencing critical shortages of health 

care providers recruit and retain clinicians through scholarship and educational loan 

repayment programs in exchange for services.

Bureau of Health Professions Increases access to health care by developing, distributing, and retaining a diverse, 

culturally competent health workforce.

Bureau of Primary Health Care Oversees, funds, and supports a national network of health centers that provide access 

to high quality, family oriented, comprehensive primary and preventive health care for 

people who are low income, uninsured, or living where health care is scarce.

Healthcare Systems Bureau Provides infrastructure to protect, improve, and enhance public health including organ, 

bone marrow, and cord blood donation.

HIV/AIDS Bureau Administers the Ryan White HIV/AIDS CARE Act Program, which is the largest federal 

program focused exclusively on HIV/AIDS care, and is for those who do not have 

sufficient health care coverage or financial resources for coping with HIV/AIDS.

Maternal and Child Health Bureau Administers the Maternal and Child Health Block Grant to states, as well as discretionary 

grants to ensure that the nation’s women, infants, children, adolescents, and their 

families, including fathers and children with special health care needs, have access to 

quality health care.

Office of Rural Health Policy

a

Promotes better health care services in rural areas. The office works both within 

government at federal, state, and local levels, and with the private sector—with 

associations, foundations, providers, and community leaders—to seek solutions to rural 

health care problems.

b

Operational Support Office

Office of Communications Develops and implements national communication initiatives to inform and educate the 

public, health care professionals, policy makers, and the media; coordinates, 

researches, writes, and prepares speeches and audiovisual presentations for the 

agency; maintains the agency’s social media presence; and coordinates with the 

Department of Health and Human Services’ (HHS) Public Affairs staff.

Office of Equal Opportunity, Civil Rights, 

and Diversity Management

Provides advice, counsel, and recommendations to HRSA personnel, including regional 

divisions, on equal opportunity and civil rights.
 

Page 13 GAO-14-52 Health Resources and Services Administration

Organizational Component Intended Purpose

Office of Federal Assistance Management Serves as a central office for pre-award, award, administration and management, and 

close-out of the agency’s grants and cooperative agreements in partnership with HRSA’s 

programmatic bureaus.

Office of Health Equity Serves as the principal advisor and coordinator to the agency for the special needs of 

minority and disadvantaged populations.

Office of Legislation Provides advice on legislative affairs, including preparing analytic papers and reports on 

proposed legislation; conducting legislative research, monitoring hearings and 

congressional activities; and coordinating with HHS legislative staff on information 

requested by Congress.

Office of Operations Serves as a central office for managing the agency’s operations related to information 

technology, budgets, financial policy and controls, human resources functions, and 

acquisitions.

Office of Planning, Analysis and Evaluation Serves as an agency resource for policy analysis, data synthesis, organizational 

planning, external liaison activities, research, evaluation, and performance and quality 

measurement.

Office of Regional Operations Provides leadership on collaborative efforts between state health care leaders, agency 

managers, and program resources in each state to improve public health and health 

care systems.

Office of Women’s Health Provides leadership on women’s health and sex/gender-specific issues and policy for the

agency and other HHS agencies.

Source: HRSA.

a

A block grant is a type of grant where funding recipients have substantial discretion over the type of 

activities to support, with minimal federal administrative requirements or restrictions.

b

HRSA’s underlying organizational structure of bureaus and offices has 

been in place for some time; however, since 2010, the agency has made 

several organizational changes. These included creating new 

organizational components, expanding or otherwise changing the 

functions of some components, and consolidating functions in order to 

eliminate a component. In addition, HRSA has made minor organizational 

changes within bureaus, such as realigning branches or shifting oversight 

responsibility of certain programs, and the staff responsible for them, 

between or within bureaus. HRSA officials reported that organizational 

changes were generally made to improve agency efficiency. For example, 

in 2010, HRSA established the Office of Operations to consolidate three 

previously separate offices: (1) the Office of Information Technology; 

(2) the Office of Management; and (3) the Office of Financial 

Management, which consisted of procurement, budget, policy, and control 

functions. These offices had formerly each reported directly to the Office 

of the Administrator. With this restructuring, the Chief Operating Officer—

a position created in 2010—gained responsibility for oversight of these 

functions. In at least one instance, HRSA made a change as a result of a 

HRSA considers the Office of Rural Health Policy to be a programmatic bureau as it is similar in 

function and organizational structure to the six units with “bureau” in their titles.
 

Page 14 GAO-14-52 Health Resources and Services Administration

legislative requirement, namely, in October 2011 HRSA made its Office of 

Women’s Health, which was previously located within its Maternal and 

Child Health Bureau, a separate office in response to a requirement in 

PPACA that the office be established within the Office of the 

Administrator.21 Most recently, as a result of fiscal circumstances, 

including the sequester which went into effect in March 2013, and an 

ongoing hiring freeze in effect since January 2013, HRSA eliminated its 

Office of Special Health Affairs and distributed most of its functions to 

other existing bureaus and offices.22 According to HRSA, the elimination 

of the Office of Special Health Affairs was made to reduce overhead costs 

and better utilize staff.

HRSA has mechanisms in place to share information important for 

supporting the agency’s mission across various levels of staff in the 

agency, including among agency leaders, programmatic bureau and 

operational support office leaders, and staff. These communication 

mechanisms include the agency’s operational planning process; crosscutting workgroups and meetings; and regular communications among 

the Office of the Administrator, leaders in the bureaus and offices, and 

agency staff. The mechanisms HRSA has in place are consistent with 

internal control standards for the federal government, which state that 

effective communications within organizations should occur in a broad 

sense with a flow of information down, across, and up the organization.23

HRSA officials have established an annual operational planning process 

to facilitate the exchange of information across the agency to plan its 

budget and allocation of other resources. According to HRSA officials, 

each bureau and office develops a proposal to request contracts, budget, 

and other resources for the coming fiscal year. Next, these proposals are 

shared and discussed among all bureau and office leaders to allow for 

 

21Pub. L. No. 111-148, § 3509(a), 124 Stat. 119, 535-536 (codifed at 42 U.S.C. § 914).

22As part of this process, the Office of Health Equity, which was previously within the 

Office of Special Health Affairs, began reporting directly to the Office of the Administrator.

23Internal control is a component of an organization’s management that provides 

reasonable assurance that it is, among other things, operating effectively and efficiently. 

While the standards for internal control provide a general framework, it is up to 

management in each agency to implement the standards and to create practices to 

ensure that they are built into and are an integral part of operations. See 

GAO/AMID-00-21.3.1.

HRSA Has 

Mechanisms in Place 

for Multi-Directional 

Communication 

Throughout the 

Agency 
 

Page 15 GAO-14-52 Health Resources and Services Administration

coordination and to reduce the risk of duplication or overlap of resources. 

Finally, HRSA’s Administrator makes a determination about resource 

allocation—such as budgets and contracts for the coming fiscal year—

which is documented in a decision memo for each bureau and office.24

In addition, HRSA has established 20 active workgroups to coordinate 

across the agency’s bureaus and offices on cross-cutting topics. For 

example, according to agency officials, HRSA established a workgroup in 

April 2010— following the passage of PPACA—to coordinate 

communications and activities related to the implementation of provisions 

in the act pertaining to HRSA. The workgroup includes senior leaders 

from across the agency or their designees. In November 2012, HRSA 

established a Standard Operating Procedures Workgroup to monitor the 

implementation of standard operating procedures related to grantee 

oversight across bureaus, discuss the status of implementation, and to 

share successful practices regarding their use. Members include 

individuals who are tasked with leading the implementation of standard 

operating procedures within each bureau. Another workgroup—the HRSA 

Program Integrity Initiative Workgroup, launched in June 2010—is tasked 

with identifying risks to the agency’s management of programs and 

working to reduce those risks by initiating new or improved oversight 

efforts. The workgroup is comprised of representatives from all bureaus 

and offices. Other established workgroups focus on issues such as 

providing technical assistance to potential grantees who may be new to 

the application process, analyzing requests for information technology 

capital projects, and monitoring performance of the agency’s ongoing 

technology investments. In addition to the formal workgroups, officials in 

all the bureaus told us they regularly work with colleagues from other 

bureaus and offices as needed to coordinate on program areas where 

topics and issues overlap.

Agency officials told us that this process improves efficiency and reduces 

the chance for duplication of effort among the bureaus and offices.

HRSA also has mechanisms in place to ensure the flow of information up 

and down the organizational hierarchy, such as from the Office of the 

Administrator down to individual bureaus and offices. The Office of the 

Administrator uses a variety of standing meetings and reporting tools to 

 

24HRSA also has a process for considering requests for additional resources as needs 

arise outside of the operational planning process.
 

Page 16 GAO-14-52 Health Resources and Services Administration

communicate and exchange information with bureau and office leadership 

on a broad range of policy, program, and management matters. For 

example, HRSA’s Administrator holds a weekly senior staff meeting with 

the leaders of all of HRSA’s bureaus and offices. Topics for discussion 

include HRSA’s budget, operations, and implementation of PPACA. 

During these meetings, bureau and office leaders have the opportunity to 

share their concerns and discuss issues that they think may be of interest 

to the other organizational components of the agency. In addition, officials 

told us that HRSA’s Administrator, Deputy Administrator, and a Senior 

Advisor hold a meeting every other week with each of the bureaus’ 

Associate Administrators to discuss any problems that arise concerning 

grantees, plans for upcoming grant awards, program integrity issues, and 

any other bureau news or updates. Officials indicated that HRSA’s 

Administrator meets monthly with the directors from all nine operational 

support offices; officials from the Office of the Administrator also meet 

weekly for one-on-one discussions with the directors from most of these 

offices. In addition, the leaders of each of the bureaus told us they hold 

regular meetings with their staff such as one-on-one meetings with 

division directors, weekly senior staff meetings within the bureau where 

participants can raise issues of concern or topics for discussion, and “allhands” meetings used to inform all bureau staff.

In addition to participating in these standing meetings, bureau leaders 

make use of routine reports and other written communication to convey 

key programmatic information from the bureau to the Office of the 

Administrator. For example, bureau leaders provide monthly written 

updates on their programs and activities for inclusion in an agency-level 

report for the Secretary of HHS. These reports include information about 

HRSA collaboration with other agencies, programmatic updates, status of 

efforts related to PPACA, areas of concern, and completed congressional 

testimonies. HRSA officials also prepare decision papers to outline policy 

options for the Administrator’s consideration. For example, officials sent 

decision papers to the Administrator to outline proposals for 

organizational changes, such as the disbanding of the Office of Special 

Health Affairs. These papers outlined the rationale for the change, budget 

and staffing implications, and specific recommendations for the 

Administrator.
 

Page 17 GAO-14-52 Health Resources and Services Administration

HRSA’s staff has grown approximately 30 percent over the last 5 years. 

While the number of staff has grown, HRSA experienced attrition 

averaging 9 percent per year over the past five years. Looking forward, 

almost half of HRSA’s leadership will be eligible to retire by fiscal year 

2017. HRSA periodically tracks attrition and retirement eligibility and has 

focused its succession planning efforts on leadership development.

HRSA’s staff grew by more than 30 percent from fiscal years 2008 to 

2012; the number of HRSA employees at the end of each fiscal year grew 

from 1,418 in fiscal year 2008 to 1,857 in fiscal year 2012.25

 

25Throughout this report, the data on HRSA staffing represents staff on board as of 

September 30, which is the end of the federal fiscal year. Our analysis of HRSA staff 

levels excludes two categories of HRSA employees who serve on a temporary basis—1) 

students, interns, and similarly classified individuals, and 2) intermittent employees who 

HRSA officials told us primarily include special government employees who generally 

serve a few days a year on HRSA advisory committees. At the end of fiscal year 2012, 

there were 213 such employees (41 students, interns, and similarly classified individuals 

and 172 intermittent employees). 

(See fig. 4.) 

HRSA officials indicated that the staffing increases correspond in part 

with HRSA’s increased responsibilities and funding due to ARRA and 

PPACA. The majority of HRSA’s staff, about 86 percent in fiscal year 

2012, were stationed in HRSA’s Rockville, Maryland headquarters. The 

remaining employees were regional staff who were located in one of 

HRSA’s 10 regional offices or 2 field locations in the United States and 

Puerto Rico. While the overall number of staff grew, the total number of 

regional staff declined by about 14 percent—from 311 in fiscal year 2008 

to 269 in fiscal year 2012.

HRSA’s Staff Has 

Grown in Recent 

Years; About Half of 

Its Leadership Will Be 

Eligible to Retire by 

2017 

HRSA’s Staff Has Grown in 

Recent Years with the 

Largest Segment of Staff 

Concentrated at the GS-13 

Level
 

Page 18 GAO-14-52 Health Resources and Services Administration

Figure 4: Number of HRSA Staff by Location, Fiscal Years 2008 through 2012

Note: HRSA’s headquarters is located in Rockville, Maryland. HRSA also has “regional staff” who 

work in 1 of the agency’s 10 regional offices or 1 of 2 field locations across the United States and 

Puerto Rico.

HRSA’s organizational components vary in size and how staff are

distributed across headquarters and regions. As of the end of fiscal year 

2012, the organizational component with the greatest number of staff was 

the Bureau of Primary Health Care (308 employees) and the one with the 

fewest staff, with 4 employees, was the Office of Women’s Health. Eight 

of HRSA’s organizational components—five programmatic bureaus and 

three operational support offices—had regional staff. The Office of 

Regional Operations had the largest number and proportion of regional 

staff–70 of 84 staff (83 percent), followed by the Healthcare Systems 

Bureau (40 percent) and the Bureau of Clinician Recruitment and Service 

(25 percent). (See fig. 5.)
 

Page 19 GAO-14-52 Health Resources and Services Administration

Figure 5: Number of HRSA Employees by Organizational Component and Location, Fiscal Year 2012

a

The Office of Special Health Affairs was disbanded in June 2013 and most of its functions and staff 

were distributed to other Bureaus and Offices. As part of this process, an Office of Health Equity, 

which was previously within the Office of Special Health Affairs, began reporting directly to the Office 

of the Administrator.
 

Page 20 GAO-14-52 Health Resources and Services Administration

As of the end of fiscal year 2012, HRSA’s staff were employed in one of 

76 job occupations.26 The 5 most common occupations were: Public 

Health Program Specialist (635 employees), Management and Program 

Analysis (336 employees), General Health Science (165 employees), 

Grant Management (92 employees), and Miscellaneous Administration 

and Program (70 employees). Officials indicated that within HRSA, the 

most common job function is a project officer. HRSA has over 400 project 

officers who are responsible for the ongoing oversight of an assigned 

portion of program funding recipients, such as grantees. Individuals from 

different occupations may serve as project officers, as the project officer 

function is not a distinct occupation.27

The majority of HRSA’s staff, 1601 individuals or 86 percent of the staff in 

fiscal year 2012, were civilians within the GS pay plan, with GS-13s 

representing the largest number of employees—651 staff members 

(35 percent of HRSA employees). The remaining HRSA staff were SES, 

Commissioned Corps officers, or employees paid under one of several 

additional civilian pay plans. (See fig. 6 for the distribution of HRSA staff 

by pay plan.) Within HRSA, 510 staff members (27 percent) were GS-14s 

or above (including individuals in the SES)—individuals who are generally 

supervisors, according to HRSA officials.

 

26The occupations are defined by occupational series which consist of positions that are 

similar in terms of their specialized line of work and qualification requirements.

27The most common occupation for a HRSA project officer is the Public Health Program 

Specialist.
 

Page 21 GAO-14-52 Health Resources and Services Administration

Figure 6: Percent of HRSA Staff by Pay Plan, Fiscal Year 2012

Notes: Due to rounding, percentages do not add to 100.

a

Other refers to employees in other federal pay plans, such as the federal wage system for hourly, 

blue collar employees and a pay plan for physicians and dentists. About 1 percent of HRSA’s staff—

18 individuals—were in other pay plans, and 11 percent of the agency’s employees—211 

individuals—were in the U.S. Public Health Service Commissioned Corps, which is part of the United 

States Uniformed Services.

From fiscal years 2008 through 2012, HRSA lost an average of about 

9 percent of its staff per year to attrition.28 HRSA’s annual attrition rates 

from fiscal years 2008 through 2012 ranged from a low of 7.6 percent in 

fiscal year 2009 to a high of 9.9 percent in fiscal year 2008.29 In fiscal 

year 2012, HRSA had an attrition rate of 8.8 percent. Of those who left 

HRSA in that year, approximately 59 percent resigned, 35 percent retired, 

and 4 percent were terminated or removed.30

 

28We define attrition as any departure from HRSA, including retirements, resignations, 

terminations, and deaths. Individuals who left HRSA for jobs with other agencies within 

HHS are counted as resignations.

29HRSA’s attrition rates for fiscal years 2008 through 2012 were 9.9 percent (2008), 

7.6 percent (2009), 9.3 percent (2010), 8.9 percent (2011), and 8.8 percent (2012).

30The remaining two percent of departures were due to death.

HRSA’s Attrition Averaged 

About 9 Percent Over the 

Past 5 Years; Almost Half 

of Its Leadership Will Be 

Eligible to Retire by Fiscal 

Year 2017
 

Page 22 GAO-14-52 Health Resources and Services Administration

Attrition rates varied by pay plan and organizational component. In fiscal 

year 2012, attrition ranged from a high of 16.1 percent among GS-1s 

through GS-8s to a low of 3.9 percent for SES employees. While three 

organizational components, including the Office of the Administrator, had 

no attrition in fiscal year 2012, the Office of Planning, Analysis, and 

Evaluation had an attrition rate over 21 percent. Across HRSA’s 

programmatic bureaus, attrition rates ranged from 6.1 percent in the 

Office of Rural Health Policy to 13.4 percent in the Bureau of Health 

Professions. (See fig. 7.)
 

Page 23 GAO-14-52 Health Resources and Services Administration

Figure 7: HRSA Attrition Rates by Organizational Component, Fiscal Year 2012

Notes: In this report, attrition includes anyone who left HRSA, including those who left HRSA for jobs 

with other agencies within HHS.

a

The Office of Special Health Affairs was disbanded in June 2013 and most of its functions and staff 

were distributed to other bureaus and offices. As part of this process, the Office of Health Equity, 

which was previously within the Office of Special Health Affairs, began reporting directly to the Office 

of the Administrator.
 

Page 24 GAO-14-52 Health Resources and Services Administration

Agency-wide, 31.3 percent of HRSA’s permanent employees will be 

eligible to retire by the end of fiscal year 2017; a rate similar to that for the 

entire federal government.31 However, a larger portion of HRSA’s 

leadership, nearly 50 percent, is eligible to retire in the next few years. 

Specifically, over 55 percent of HRSA’s SES employees, who serve as 

the leaders of HRSA’s bureaus and offices, and almost 50 percent of 

GS-15s, which include Division Directors, will be eligible to retire by the 

end of fiscal year 2017.32

Within HRSA, retirement eligibility rates also vary by organizational 

component. By fiscal year 2017, over 40 percent of the employees in 

HRSA’s Office of the Administrator, the Healthcare Systems Bureau, the 

Maternal and Child Health Bureau, and several of HRSA’s operational 

support offices, will be eligible to retire. (See fig. 8.)

Although eligibility to retire does not necessarily 

mean that employees will do so at the time they become eligible, if there 

were a large number of retirements among the agency’s leadership 

during this time period, HRSA runs the risk of having gaps in leadership 

and potential loss of important institutional knowledge.

 

31In 2012, we reported that around 30 percent of federal employees onboard at the end of 

fiscal year 2011 would become eligible to retire by 2016. See GAO, Human Capital 

Management: Effectively Implementing Reforms and Closing Critical Skills Gaps Are Key 

to Addressing Federal Workforce Challenges, GAO-12-1023T (Washington, D.C.: 

Sept. 19, 2012).

32The HRSA retirement eligibility rates we report for GS-15s and SES employees are 

similar to the fiscal year 2011 government-wide retirement eligibility rates for the same 

groups (about 45 percent of GS-15s and 58 percent of SES employees). See 

GAO-12-1023T. 
 

Page 25 GAO-14-52 Health Resources and Services Administration

Figure 8: Percent of HRSA Employees Eligible to Retire by Fiscal Year 2017, by Organizational Component

Notes: This analysis of retirement eligibility is limited to career permanent employees onboard as of 

the end of fiscal year 2012.

a

The Office of Special Health Affairs was disbanded in June 2013 and most of its functions and staff 

were distributed to other bureaus and offices. As part of this process, an Office of Health Equity, 

which was previously within the Office of Special Health Affairs, began reporting directly to the Office 

of the Administrator.
 

Page 26 GAO-14-52 Health Resources and Services Administration

HRSA periodically tracks attrition and retirement eligibility data. Collecting 

and analyzing data on attrition rates and retirement eligibility are 

considered a fundamental element for measuring the effectiveness of 

human capital approaches in support of an agency’s mission and goals.33

In addition to reviewing attrition data, officials from several bureaus 

reported that they use information from exit interviews to help them 

understand the reasons for attrition. According to officials, a common 

reason why staff leave the agency is limited promotion potential, 

particularly from the GS-12 or GS-13 levels into more senior positions. 

Another reason officials reported for attrition is that some employees have 

expertise or skill sets that are easily transferrable and in demand 

elsewhere, including within other HHS and federal agencies. In particular, 

officials noted that the skill sets of project officers and those with 

information technology backgrounds are highly sought elsewhere in the 

government. While exit interviews provide insight into why staff are 

leaving the agency, officials also reported that they use information from 

the Federal Employee Viewpoint Survey to get a sense of the number of 

staff considering leaving the agency in the next year.

HRSA receives a quarterly report from HHS that provides agency-wide

attrition data by reason for departure. Additionally, HRSA officials stated 

that staff in the Office of Operations track employee attrition data as 

needed for making agency-wide hiring and budget decisions. According 

to these officials, staff attrition data is shared with leaders of the 

programmatic bureaus and operational support offices as requested, or 

when high rates of attrition occur.

34

 

33See GAO-02-373SP. 

34The Federal Employee Viewpoint Survey is a tool that measures employees’ 

perceptions of whether, and to what extent, conditions characterizing successful 

organizations are present in their agencies. Survey results are intended to provide insight 

into the challenges agency leaders face in ensuring the federal government has an 

effective civilian workforce and how well they are responding. The Office of Personnel 

Management administers this survey and provides reports to participating agencies that 

include the results of their respondents, including comparisons to results at the agency, 

department, and government-wide levels. One question asks “are you considering leaving 

your organization within the next year, and if so, why?” Respondents can indicate: No; 

Yes, to retire; Yes, to take another federal job; Yes, to take another job outside the federal 

government; or, Yes, other. Officials also noted that they use results from this survey to 

gauge employee satisfaction and identify areas for improvement to prevent further 

attrition.

HRSA Periodically Tracks 

Attrition and Retirement 

Eligibility; Agency 

Succession Planning 

Efforts Focus on 

Leadership Development
 

Page 27 GAO-14-52 Health Resources and Services Administration

HRSA also tracks retirement eligibility at the agency, bureau, and office 

levels. Quarterly, HRSA receives agency-wide data from HHS on the 

proportion of staff, including supervisory staff, eligible to retire in the next 

5 years. Additionally, in early 2013, HRSA officials began providing 

leaders in each bureau and office with the names and retirement eligibility 

dates of their staff who are eligible to retire within the next 5 years. HRSA 

officials indicated they plan to provide these data on an annual basis 

going forward; however, officials indicated that the retirement eligibility 

reports are of limited use to them because eligibility to retire does not 

mean that an employee actually plans to retire.

To respond to retirements and other types of attrition, HRSA has 

instituted succession planning efforts which generally focus on providing 

leadership development to agency staff. In 2011, HRSA launched two 

agency-wide leadership development programs to help prepare staff to 

take on leadership roles when such opportunities arise. One of these 

programs, the Mid-Level Leadership Development Program, is for staff at 

the GS-12 and GS-13 levels and focuses on leadership skills 

development, interdepartmental project experience, exposure to HRSA 

leaders, and an understanding of HRSA’s mission, challenges, and 

opportunities. The other program, the Administrative Management 

Development Program, focuses on individuals who are interested in 

careers handling the administrative management functions of the agency.

HRSA officials indicated that, as of September 2013, 59 staff had 

completed one of these two programs. According to HRSA officials, as of 

July 2013, the agency was in the process of developing two additional 

leadership development programs—one targeted to staff at the GS-11 

level and below and another for staff at the GS-14 and GS-15 levels. 

Officials estimated these additional programs would become operational 

in fiscal year 2014.

In addition to leadership development programs, HRSA officials said that 

there are several other opportunities for staff to gain leadership 

experience and professional development. For example, HRSA has 

established a mentoring program, which focuses on leadership 

development for both the participating mentor and mentee, and a 

coaching program, which provides participating supervisors and 

managers with opportunities to focus on specific areas for further 

development. Officials across the agency also promote opportunities for 

employees to be assigned to acting roles in more senior positions when 

there is a vacant position or when a supervisor is on leave. For example, 

if a branch chief were to retire or be out of the office for an extended 

period, a senior level employee in the branch may be asked to act as the 
 

Page 28 GAO-14-52 Health Resources and Services Administration

branch chief until the position can officially be filled or the branch chief 

returns. HRSA officials indicated that they work to train individuals to 

enhance their capabilities, which may better position staff to be 

successful candidates when leadership positions open up in the agency. 

In addition, opportunities to serve in an acting capacity in a role more 

senior to their own allows employees to smoothly transition into a position 

should they be selected for it on a permanent basis. For example, HRSA 

officials we spoke with told us that when the Associate Administrator of 

one of the bureaus was recently promoted—leaving a key vacancy—the 

Deputy Associate Administrator served as Acting Associate Administrator 

until promoted into the position permanently. Leaders from some bureaus 

also noted additional bureau-specific succession planning efforts. For 

example, the HIV/AIDS Bureau created its Organizational Development 

Unit in fiscal year 2012 to help deal with staff attrition issues within the 

bureau by providing training, helping staff create individual development 

plans, and providing mentoring opportunities to encourage staff to stay 

and continue to grow professionally.

HRSA officials told us they also promote cross-training opportunities 

among staff, where employees work on multiple programs to assure a 

broader range of knowledge so that they are able to take over for each 

other should someone leave the bureau or agency. For example, Office of 

Rural Health Policy leaders said that they have their staff work on multiple 

programs to ensure they obtain a broader range of skills than they would 

acquire by working on just one program. Similarly, they assign their policy 

staff to a lead and backup role on key regulations so that if one person 

leaves the organization or is out of the office for an extended period of 

time, another is also familiar with the topic and able to complete the 

review. HRSA officials noted that some of these succession planning 

efforts, such as leadership training, also help with staff retention. In 

addition, officials noted that they have other efforts in place to promote 

staff retention, such as employee recognition and morale boosting 

opportunities.35

 

35For example, HRSA officials noted that one bureau has an online recognition system 

that allows employees at all levels to acknowledge the accomplishments and contributions 

of one another by generating a recognition email that goes to the recipient, as well as their 

supervisor.
 

Page 29 GAO-14-52 Health Resources and Services Administration

In fiscal year 2012, HRSA obligated over $240 million, or about 3 percent 

of its appropriations, to contracts to acquire goods or services necessary 

to support its operations.36

Figure 9: Amount of HRSA Contract Obligations, Fiscal Years 2008 through 2012

With the exception of fiscal year 2008, when 

HRSA had approximately $167 million in contract obligations, the amount 

of HRSA’s contract obligations generally remained steady over the past 

5 years. (See fig. 9.)

The vast majority of HRSA’s fiscal year 2012 contract obligations 

(approximately 97 percent) were used to obtain services, while the 

remaining 3 percent of obligations went toward goods, such as computer 

software. Nearly 60 percent of HRSA’s fiscal year 2012 contract 

obligations were for two categories of services:37

 

36When an agency awards a contract, it incurs an obligation, which is a definite legal 

commitment that will result in payment at some point in the future. The amount of 

obligations we report accounts for any funds that were deobligated within the fiscal year; 

funds may be deobligated, for example, due to a reduction in costs or a correction to 

recorded amounts. In fiscal year 2012, HRSA had just over $2 million in deobligations.

(1) information 

37A contract may include more than one product or service, but agencies can only record 

one product or service per contract in FPDS-NG. Our analysis presents the product or 

service category that HRSA recorded for the contract.

HRSA Obligated Over 

$240 Million for 

Contracts in Fiscal 

Year 2012, the 

Majority of Which 

Were for Information 

Technology and 

Program Support
 

Page 30 GAO-14-52 Health Resources and Services Administration

technology and telecommunications services, which includes HRSA’s 

contract to support the operation and management of the agency’s online 

system for documenting its grantee oversight activities, called the 

Electronic Handbook; and (2) professional support services, which 

includes HRSA’s contracts for the provision of technical assistance, such 

as site visits, to grantees. (See table 2.)

Table 2: HRSA Contract Obligations by Category, Fiscal Year 2012

Category Description

Amount of 

obligations

Percent of 

obligations a

Information Technology and 

Telecommunications

b

Covers contracts for the provision of information technology, 

including systems development, operations, and 

maintenance such as for HRSA’s Electronic Handbook and 

the Vaccine Injury Compensation System.

$79,180,379 32.9%

Professional Support Covers contracts that provide temporary support services, 

technical assistance for grantees, expert witnesses, 

evaluations, studies, and accounting assistance.

$62,031,355 25.8%

Medical, Dental, and Surgical 

Services 

Covers contracts that provide critical medical functions such 

as care for individuals with leprosy through the National 

Hansen’s Disease Program.

$34,170,271 14.2%

Management Support Covers contracts that provide advertising, data collection, 

accounting, logistics, public relations, and procurement 

support.

$25,092,122 10.4%

Special Studies and Analysis Covers contracts for analysis and studies to all of HRSA’s 

programmatic bureaus for purposes other than research and 

development.

$12,586,780 5.2%

Education and Training Covers contracts that provide curriculum development and 

training for HRSA employees, including grants management 

and other professional training.

$5,934,606 2.5%

Automatic Data Processing 

Equipment, Software, Supplies 

and Support Equipment

Covers the provision of information technology and 

telecommunication goods and services, such as scanners 

and records management services.

$5,869,453 2.4%

Other Covers all other HRSA contract obligations for goods and 

services.

$16,068,292 6.7%

Source: GAO analysis of information from HRSA and the Federal Procurement Data System-Next Generation.

a

The amount of obligations we report accounts for any funds that were deobligated within the fiscal 

year; funds may be deobligated, for example, due to a reduction in costs or a correction to recorded 

amounts.

b

In fiscal year 2012, nearly 40 percent, or $95,697,751, of HRSA’s contract 

obligations provided cross-cutting support, meaning that they were 

utilized by more than one HRSA organizational component. The 

remaining 60 percent of HRSA’s obligations were for programs and 

activities specific to a single programmatic bureau, though the amount of 

Due to rounding, percentages do not add to 100.
 

Page 31 GAO-14-52 Health Resources and Services Administration

obligations varied by bureau. (See table 3 for a summary of the amount of 

contract obligations by organizational component and app. II for 

information on the contract with the highest obligation for each 

component.)

Table 3: Amount of HRSA Contract Obligations by Organizational Component, 

Fiscal Year 2012

Organizational component

Amount of 

obligations

Percent of HRSA’s 

obligations a

Bureau of Clinician Recruitment 

and Service $8,955,736 3.7%

Bureau of Health Professions $24,974,157 10.4%

Bureau of Primary Health Care $27,114,951 11.3%

Healthcare Systems Bureau $63,633,813 b 26.4%

HIV/AIDS Bureau $7,770,125 3.2%

Maternal and Child Health Bureau $7,221,337 3.0%

Office of Rural Health Policy $5,565,386 2.3%

Cross-cutting $95,697,751 c 39.7%

HRSA Total $240,933,256 100%

Source: GAO analysis of information from HRSA and the Federal Procurement Data System-Next Generation.

a

The amount of obligations we report accounts for any funds that were deobligated within the fiscal 

year; funds may be deobligated, for example, due to a reduction in costs or a correction to recorded 

amounts.

b

We have included contract obligations for the National Hansen’s Disease Program—a program that 

provides care and treatment for individuals with leprosy and related conditions—with the data for the 

Healthcare Systems Bureau, since this bureau took oversight responsibility for this program in August 

2012. Prior to that, the program was under the auspices of the Bureau of Primary Health Care.

c

HRSA’s bureaus utilized contracts for different purposes. For example, 

nearly 78 percent of the Bureau of Health Profession’s fiscal year 2012 

obligations were for information technology and telecommunications 

services, primarily for the National Practitioner Data Bank, while the 

Maternal and Child Health Bureau did not have any obligations for that 

Cross-cutting refers to contracts that were utilized by more than one HRSA organizational 

component.
 

Page 32 GAO-14-52 Health Resources and Services Administration

purpose.38

According to HRSA officials, the agency uses contracts to support its 

operations for a variety of reasons, including to supplement HRSA staff 

because of time constraints, or to fulfill short-term needs. In addition, 

HRSA uses contracts to perform functions that require specialized skills 

for which HRSA staff do not have the appropriate expertise, such as 

clinical or financial expertise. For example, the Office of Rural Health 

Policy uses contract staff with special expertise in areas such as oral and 

primary health care to provide technical assistance to its broad range of 

grantees, while the Bureau of Primary Health Care uses contract staff 

with financial expertise to conduct site-visits to health center grantees, 

assist HRSA staff with understanding grantees’ financial audits, and help 

grantees develop plans to improve their financial stability. Furthermore, 

according to HRSA officials, the agency uses contracts to support its 

operations when contract staff can perform the functions more efficiently 

and at a lower cost than HRSA staff. For instance, the Maternal and Child 

Health Bureau obtains logistical support services, such as supporting 

large advisory committee meetings, from a contractor because it is more 

efficient and cost effective than having bureau staff manage these 

functions. Finally, HRSA uses contracts for other reasons including when 

the agency is legislatively required to do so. For example, HRSA is 

required by law to contract with one or more entities to carry out certain 

aspects of its C.W. Bill Young Cell Transplantation Program, a program 

overseen by the Healthcare Systems Bureau related to cord blood, bone 

marrow, and transplantation.

Conversely, 69 percent of the Maternal and Child Health 

Bureau’s obligations in fiscal year 2012 were for professional services 

such as for a newborn hearing, screening, and intervention programs 

study, while about 12 percent of the Bureau of Health Professions’ 

obligations were for professional services. See appendix III for 

information on the top categories of contracted services or goods by 

organizational component.

39

 

38HRSA’s Bureau of Health Professions administers the National Practitioner Data Bank, 

which serves as a flagging system intended to prompt a comprehensive review of health 

care practitioners’ licensure activity, medical malpractice payment history, and record of 

clinical privileges. Used in conjunction with information from other sources, the National 

Practitioner Data Bank assists in promoting quality health care, and deterring fraud and 

abuse in the health care delivery system.

3942 U.S.C. § 274k.
 

Page 33 GAO-14-52 Health Resources and Services Administration

We provided a draft of this report to HHS for its review. In its written 

comments, HHS noted that the report recognized the mechanisms HRSA 

has in place to ensure the coordinated flow of communication and plan for 

succession. (HHS comments are reprinted in app. IV.)

As agreed with your offices, unless you publicly announce the contents of 

this report earlier, we plan no further distribution until 30 days from the 

report date. At that time, we will send copies of this report to the 

Secretary of Health and Human Services and the Administrator of HRSA. 

In addition, the report will be available on the GAO website at 

http://www.gao.gov. 

If you or your staff have any questions about this report, please contact 

me at (202) 512-7114 or draperd@gao.gov. Contact points for our Offices 

of Congressional Relations and Public Affairs may be found on the last 

page of this report. GAO staff who made major contributions to this report 

are listed in appendix V.

Debra A. Draper

Director, Health Care

Agency Comments
Page 34 GAO-14-52 Health Resources and Services Administration

List of Requestors

The Honorable Lamar Alexander

Ranking Member

Committee on Health, Education, Labor, and Pensions

United States Senate

The Honorable Tom Coburn

Ranking Member

Committee on Homeland Security and Governmental Affairs

United States Senate

The Honorable Michael B. Enzi

Ranking Member

Subcommittee on Children and Families

Committee on Health, Education, Labor, and Pensions

United States Senate

The Honorable Richard Burr

Ranking Member

Subcommittee on Primary Health and Aging

Committee on Health, Education, Labor, and Pensions

United States Senate
Appendix I: Health Resources and Services 

Administration’s (HRSA) Programs by 

Programmatic Bureau, Fiscal Year 2013

Page 35 GAO-14-52 Health Resources and Services Administration

Programs Description

Bureau of Clinician Recruitment and Service

Faculty Loan Repayment Program Provides individuals from disadvantaged backgrounds with an eligible health professions 

degree (e.g., dentistry, physician assistant) opportunities to serve as faculty members in 

an accredited and eligible health professions school for a minimum of two years. For each 

year of service, participants are awarded up to $30,000 for their educational loans.

Health Professional Shortage Areas 

(HPSAs) 

Designates federal HPSAs (areas in which there may be a shortage of primary medical 

care, dental, or mental health providers), Medically Underserved Areas (areas in which 

residents have a shortage of personal health services), and Medically Underserved 

Populations (which may include groups of persons who face economic, cultural, or 

linguistic barriers to health care). Shortage designations are used to prioritize HRSA’s 

health professional scholarship and loan repayment programs and other federal and state 

programs.

National Health Service Corps Offers assistance to HPSAs in every U.S. state and territory to recruit and retain qualified 

primary care providers by providing scholarships or loan repayments to individuals who 

agree to provide services in shortage areas.

Native Hawaiian Health Scholarship 

Program 

Supports the demand for more health care professionals to deliver primary health 

services to Native Hawaiians in the State of Hawaii by providing scholarships in return for 

a commitment to serve in designated areas for a specified time period.

NURSE Corps Alleviates the shortage of nurses and economic barriers that may be associated with 

pursuing a career in nursing or teaching as nurse faculty by offering loan repayment 

assistance to registered nurses in return for a commitment to serve as a nurse in a critical 

shortage facility (in designated HPSAs) or as nurse faculty at an accredited eligible school 

of nursing, and offering scholarships to nursing students in return for service in a critical 

shortage facility.

Primary Care Offices In partnership with HRSA’s Bureau of Primary Health Care, this program supports 

cooperative agreements with 54 State Primary Care Offices and territorial agencies to 

facilitate the coordination of activities such as needs assessments and technical 

assistance within a state that relate to the delivery of primary care services, and the 

recruitment and retention of critical health providers.

Bureau of Health Professions

Advanced Nursing Education Program Provides infrastructure grants to schools to build and enhance advanced nursing 

education programs, and two traineeships—the Advanced Education in Nursing 

Traineeship and the Nurse Anesthetist Traineeship. In addition, the Advanced Nursing 

Education Expansion Program provides grants to schools of nursing to accelerate the 

production of primary care advanced practice nurses.

Area Health Education Centers Promotes a national role in addressing health care workforce shortages, particularly in the 

areas of health career awareness and interdisciplinary and interprofessional communitybased primary care training.

Centers of Excellence Supports activities to enhance the academic performance of underrepresented minority 

students, support underrepresented minority faculty development, and facilitate research 

on minority health issues.

Children’s Hospitals Graduate Medical 

Education Payment Program

Supports graduate medical education and training of residents and fellows in freestanding 

children’s teaching hospitals and enhances the supply of primary care and pediatric 

medical and surgical subspecialties.

Appendix I: Health Resources and Services 

Administration’s (HRSA) Programs by 

Programmatic Bureau, Fiscal Year 2013
Appendix I: Health Resources and Services 

Administration’s (HRSA) Programs by 

Programmatic Bureau, Fiscal Year 2013

Page 36 GAO-14-52 Health Resources and Services Administration

Programs Description

Comprehensive Geriatric Education Provides support to train and educate individuals who provide geriatric care for the 

elderly.

Geriatric Programs Improves access to quality health care to the elderly through a range of programs that 

focus on increasing the number of geriatric specialists and increasing geriatrics 

competencies in the generalist workforce through education and training to improve care.

Health Care Workforce Assessment Collects and analyzes health workforce data and information through the National Center 

for Health Workforce Analysis (National Center) in order to provide national and state 

policy makers and the private sector with information on health workforce supply, 

demand, and needs. The National Center also evaluates workforce policies and programs 

as to their effectiveness in addressing workforce issues.

Health Careers Opportunity Program Supports activities for kindergarten through 12th grade, baccalaureate, postbaccalaureate, and graduate students to improve the recruitment and enhance the 

academic preparation of students from disadvantaged backgrounds into the health 

professions.

Mental and Behavioral Health Education 

and Training

Works to close the gap in access to mental and behavioral health care services by 

increasing the number of adequately prepared mental and behavioral health and 

substance abuse providers.

National Practitioner Data Bank Serves as a flagging system intended to prompt a comprehensive review of health care 

practitioners’ licensure activity, medical malpractice payment history and record of clinical 

privileges. Used in conjunction with information from other sources, the National 

Practitioner Data Bank assists in promoting quality health care, and deterring fraud and 

abuse in the health care delivery system.

Nurse Education, Practice, Quality and 

Retention Program

Supports initiatives to expand the nursing pipeline, promote career mobility, enhance 

nursing practice, provide continuing education, and support retention.

Nurse Faculty Loan Program Supports the establishment and operation of a loan fund within participating schools of 

nursing to assist nurses in completing their graduate education to become qualified nurse 

faculty.

Nursing Workforce Diversity Increases nursing education opportunities for individuals from disadvantaged 

backgrounds, including racial and ethnic minorities underrepresented among registered 

nurses, by providing student stipends and scholarships.

Oral Health Training Programs Includes a range of programs designed to increase access to culturally competent, high 

quality dental health services to rural and other underserved communities by increasing 

the number of oral health care providers and improving the training programs for oral 

health care providers.

Primary Care Training and Enhancement Supports and develops primary care physician and physician assistant training programs.

Public Health and Preventative Medicine 

Program 

Supports activities that train public health and preventive medicine students, residents, 

and professionals to enhance the supply and expertise of the public health workforce.

Scholarships for Disadvantaged Students Increases diversity in the health professions and nursing workforce by providing grants to 

eligible professions and nursing schools for use in awarding scholarships to students from 

disadvantaged backgrounds with financial need, many of whom are underrepresented 

minorities.

Teaching Health Centers Graduate 

Medical Education Payment Program

Provides Graduate Medical Education payments to support community-based training by 

covering the costs of resident training in community-based ambulatory primary care 

settings, such as health centers, and bolstering the primary care workforce.
Appendix I: Health Resources and Services 

Administration’s (HRSA) Programs by 

Programmatic Bureau, Fiscal Year 2013

Page 37 GAO-14-52 Health Resources and Services Administration

Programs Description

Bureau of Primary Health Care

Free Clinics Medical Malpractice Provides medical malpractice protection at sponsoring health clinics to encourage health 

care providers to volunteer their time at free clinics, thus expanding the capacity of the 

health care safety net.

Health Center Capital Development 

Program 

Supports the construction and renovation of health centers.

Health Center Federal Tort Claims 

Program 

The Health Center Program administers the Federal Tort Claims Act program, under 

which employees of eligible health centers may be deemed to be federal employees 

qualified for malpractice coverage under the Federal Tort Claims Act.

Health Center Program Provides grants to eligible health centers to deliver comprehensive, high-quality, costeffective primary health care to patients regardless of their ability to pay.

School-Based Health Center Facilities Provides grants for the establishment of school-based health centers; grant funds can be 

used for expenditures for facilities, equipment, or similar expenditures.

Healthcare Systems Bureaua

340B Drug Pricing Program Requires drug manufacturers to provide discounts or rebates to a specified set of HHSassisted programs and hospitals that meet the criteria in the Public Health Service Act 

and the Social Security Act for serving a disproportionate share of low-income patients.

Countermeasures Injury Compensation 

Program 

Provides compensation to individuals for serious physical injuries or deaths from 

pandemic, epidemic, or security countermeasures.

C.W. Bill Young Cell Transplantation 

Program 

Attempts to increase the number of transplants for recipients suitably matched to 

biologically unrelated donors of bone marrow and cord blood.

National Hansen’s Disease Program Provides care and treatment for Hansen’s Disease (leprosy) and related conditions to any 

patient living in the United States or Puerto Rico through direct patient care at its facilities 

in Louisiana, through grants to an inpatient program in Hawaii, by contracting with 11 

regional outpatient clinics, and providing payments to the State of Hawaii for hospital and 

clinic facilities at Kalaupapa, Molokai, and Honolulu. Also provides for the renovation and 

modernization of the Louisiana facilities to eliminate structural deficiencies and keep with 

accepted standards of safety, comfort, human dignity, efficiency, and effectiveness.

b 

National Cord Blood Inventory Works on building a genetically and ethnically diverse inventory of high-quality umbilical 

cord blood for transplantation.

National Vaccine Injury Compensation 

Program 

Provides compensation to people found to be injured by certain vaccines given routinely 

to children and adults, such as seasonal flu vaccine, measles, mumps, rubella, or polio.

Organ Transplantation Attempts to extend and enhance the lives of individuals with end-stage organ failure for 

whom an organ transplant is the most appropriate therapeutic treatment by providing a 

national system to allocate and distribute donor organs to individuals waiting for an organ 

transplant.

Poison Control Program Funds poison centers; maintains a single, national toll-free number to ensure universal 

access to poison center services and connect callers to the poison center serving their 

area; and implements a nationwide media campaign to educate the public and health 

care providers about poison prevention, poison center services, and the toll-free number.

HIV/AIDS Bureau

Ryan White HIV/AIDS CARE Act Program 

Part A-Emergency Relief

Provides grants to metropolitan areas experiencing the greatest burdens of the country’s 

human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) 

epidemic, and provide those communities with resources they need to confront the highly 

concentrated epidemic within the jurisdiction.
Appendix I: Health Resources and Services 

Administration’s (HRSA) Programs by 

Programmatic Bureau, Fiscal Year 2013

Page 38 GAO-14-52 Health Resources and Services Administration

Programs Description

Ryan White HIV/AIDS CARE Act Program 

Part B-Comprehensive Care: HIV Care 

Grants to States and the AIDS Drug 

Assistance Program

Provides grants to all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin 

Islands, Guam and 5 U.S. Pacific Territories or Associated Jurisdictions to provide 

services for people living with HIV/AIDS. The AIDS Drug Assistance Program supports 

the provision of HIV medications and related services.

Ryan White HIV/AIDS CARE Act Program 

Part C-Early Intervention Services

Provides grants to 344 community and faith-based primary health clinics and public health 

providers in 49 states, Puerto Rico, the District of Columbia, and the U.S. Virgin Islands 

for targeting HIV medical services to underserved and uninsured people living with 

HIV/AIDS in specific geographic communities, including rural and frontier communities.

Ryan White HIV/AIDS CARE Act Program 

Part D-Women, Infants, Children, and 

Youth

Provides grants to public or private nonprofit entities that provide or arrange for primary 

care and support services for HIV-positive women, infants, children, and youth.

Ryan White HIV/AIDS CARE Act Program 

Part F-AIDS Education and Training 

Centers

Funds the AIDS Education and Training Centers—a network of 11 regional centers with

more than 130 local performance sites and five national centers—that offers specialized 

clinical education and consultation on HIV/AIDS transmission, treatment, and prevention 

to front-line health care providers.

Ryan White HIV/AIDS CARE Act Program 

Part F-Dental Reimbursement Program

Provides access to oral health care for people living with HIV/AIDS by reimbursing dental 

education programs for the unreimbursed costs associated with providing care to people 

with HIV and by working with partners to provide education and clinical training for dental 

care providers, especially those in community-based settings.

President’s Emergency Plan for AIDS 

Relief

Although overseen by multiple federal agencies, the HIV/AIDS Bureau manages HRSA’s 

contributions to this program whose mission is to deliver HIV/AIDS care and treatment 

and helps build sustainable health systems so that host countries can confront their 

epidemics in the future.

Special Projects of National Significance Supports the development of innovative models of HIV care to quickly respond to the 

emerging needs of clients served by the Ryan White HIV/AIDS CARE Act Program by 

evaluating the effectiveness of the models’ design, implementation, utilization, cost, and 

health-related outcomes, and promoting the dissemination and replication of successful 

models.

Maternal and Child Health Bureau

Autism and Other Developmental 

Disorders 

Under the auspices of the Combating Autism Act of 2006, this program supports activities 

to provide information and education to increase public awareness, promote research into 

the development and validation of screening tools and interventions, promote early 

learning of individuals at higher risk, increase the number of individuals who are able to 

confirm or rule out a diagnosis, and increase the number of individuals able to provide 

evidence-based interventions for autism spectrum disorders or other developmental 

disabilities.

Emergency Medical Services for Children Focuses on generating evidence on best practices regarding pediatric emergency care as 

well as direct outreach to the states, territories, and the District of Columbia to implement 

these best practices.

Family to Family Health Information 

Centers

Provides grants funded by the Patient Protection and Affordable Care Act to familystaffed, family-run organizations to ensure families have access to adequate information 

about health care, community resources, and support in order to make informed decisions 

around their children’s health care. 

Healthy Start Provides grants to communities with exceptionally high rates of infant mortality to reduce 

disparities in access to and utilization of health services, improve the quality of the local 

health care system, empower women and their families, and increase consumer and 

community voices and participation in health care decisions.
Appendix I: Health Resources and Services 

Administration’s (HRSA) Programs by 

Programmatic Bureau, Fiscal Year 2013

Page 39 GAO-14-52 Health Resources and Services Administration

Programs Description

Heritable Disorders Works to improve the ability of states to provide newborn and child screening for heritable 

(genetic) disorders.

James T. Walsh Universal Newborn 

Hearing Screening

Provides grants to support the physiologic testing of newborn infants prior to their hospital 

discharge; audiologic evaluation by three months of age; and entry into a program of early 

intervention by six months of age with linkages to a medical home and family-to-family 

support.

Maternal and Child Health Block Grant Aims to improve the health of all mothers, children, and their families to reduce health 

disparities, improve access to health care, and improve the quality of health care. The 

program has three components: (1) block grant funds to states distributed by formula; 

(2) Special Projects of Regional and National Significance which supports a variety of 

projects in research, training, screening, and other services; and (3) Community 

Integrated Service Systems which supports projects that seek to increase the capacity for 

service delivery at the local level and to foster formation of comprehensive, integrated, 

community level service systems for mothers and children.

Maternal, Infant, and Early Childhood 

Home Visiting Program

c

Collaborates with the Administration for Children and Families to improve coordination of 

services for at-risk communities, to identify and provide comprehensive services to 

improve outcomes for families who reside in at-risk communities, and to strengthen and 

improve the programs and activities carried out under the Maternal and Child Health 

Block Grant program.

Sickle Cell Service Demonstrations

d

Develops systemic mechanisms for the treatment of sickle cell disease and the 

prevention of morbidity and mortality associated with the condition.

Traumatic Brain Injury Provides grants to (1) fund the development and implementation of statewide systems 

that ensure access to comprehensive and coordinated traumatic brain injury services 

including: transitional service, rehabilitation, education and employment, and long-term 

community support; and (2) provide services such as referrals, advice, and legal 

representation to individuals with traumatic brain injury.

Office of Rural Health Policy

Black Lung Provides grants to public and private entities, including faith-based and community-based 

organizations, to establish and operate clinics that provide for the outreach and 

education, diagnosis, treatment, rehabilitation, and benefits counseling of active and 

retired coal miners and others with occupation-related respiratory and pulmonary 

impairments.

Radiation Exposure Screening and 

Education Program

Provides grants to states, local governments, and appropriate health care organizations 

to support programs for cancer screening for individuals adversely affected by the mining, 

transport, and processing of uranium, and the testing of nuclear weapons for the nation’s 

weapons arsenal.

Rural and Community Access to 

Emergency Devices

Provides funds to community partnerships, which then purchase and distribute automatic 

external defibrillators to be placed in rural communities and train emergency first

responders to use the devices.

Rural Health Care Services, Outreach, 

Network, and Quality Improvement Grants

Provides grants to improve access to care, coordination of care, integration of services, 

and focus on quality improvement in rural communities.

Rural Health Policy Development Supports a range of policy analysis, research, and information dissemination for the

Office of Rural Health Policy.

Rural Hospital Flexibility Grants Supports a range of activities focusing primarily on Critical Access Hospitals through 

three grant programs: (1) the Medicare Rural Hospital Flexibility (Flex) Grant Program; 

(2) Small Hospital Improvement Program; and (3) the Flex Rural Veterans Health Access 

Program.

State Offices of Rural Health

e

Provides grants to states to establish and maintain State Offices of Rural Health.
Appendix I: Health Resources and Services 

Administration’s (HRSA) Programs by 

Programmatic Bureau, Fiscal Year 2013

Page 40 GAO-14-52 Health Resources and Services Administration

Programs Description

Telehealth Provides grants that support telehealth technologies through the following three 

programs: (1) Telehealth Network Grant Program, which provides funding for pilot 

projects to examine the cost impact and value-added from telehome care and telemonitoring services and activities such as chronic disease management and distance 

learning; (2) Telehealth Resource Center Grant Program, which provides technical 

assistance to communities wishing to establish telehealth services; and (3) Licensure 

Portability Grant Program, which assists states to improve clinical licensure coordination 

across state lines.

f

Source: GAO summary of information from HRSA.

a

As of April 2013, the Healthcare Systems Bureau managed two programs that no longer receive 

funding: (1) the Health Care and Other Facilities Program, which provided grants for new 

construction, renovation, design development and equipment to hospitals, community health centers, 

universities, and research centers; and (2) the Hill-Burton Loan Guarantee and Project Grant 

Program which provided loan guarantees and grants to facilities for construction. Although these 

programs were not funded in fiscal year 2012, HRSA officials told us that they continue to monitor 

recipients of prior years funding under these programs.

b

The Healthcare Systems Bureau took oversight responsibility for this program in August 2012. Prior 

to that, the program was under the auspices of the Bureau of Primary Health Care.

c

A block grant is a type of grant where funding recipients have substantial discretion over the type of 

activities to support, with minimal federal administrative requirements or restrictions.

d

At-risk communities are communities with concentrations of (1) premature birth, low-birth weight 

infants, and infant mortality, or other indicators of at-risk prenatal, maternal, newborn or child health; 

(2) poverty; (3) crime; (4) domestic violence; (5) high-school drop outs; (6) substance abuse; 

(7) unemployment; or (8) child maltreatment.

e

Critical Access Hospitals are small, rural hospitals. To be certified as a Critical Access Hospital a 

facility must meet certain criteria, including being located in a rural area, having no more than 25 

inpatient beds, and furnishing 24-hour emergency care services 7 days a week.

f

Telehealth is the use of electronic information and telecommunications technologies to support long 

distance health care, patient and professional health related education, public health, and health 

administration.
Appendix II: HRSA Contracts with the Highest 

Total Amount of Obligations by Organizational 

Component, Fiscal Year 2012

Page 41 GAO-14-52 Health Resources and Services Administration

Organizational component 

Purpose of contract with the highest total amount 

of obligations in fiscal year 2012

Amount of 

contract 

obligations

Percent of total 

HRSA contract 

obligations a 

Bureau of Clinician Recruitment 

and Service

Provides travel, relocation, and logistical support to 

relocate health care providers for the National Health 

Service Corps

$4,376,546 1.8%

Bureau of Health Professions Provides services to maintain, update, and enhance the 

National Practitioner Data Bank

$9,186,026 3.8%

Bureau of Primary Health Care Provides supplemental expert assistance and support to 

health center grantees and federal staff by providing 

technical and consultative assistance through site visits, 

documentation reviews, and consultations to new and 

existing grantees

$13,356,664 5.5%

Healthcare Systems Bureau Establishes and maintains the National Bone Marrow 

Coordinating Center

b $16,048,000 6.7%

HIV/AIDS Bureau Provides technical assistance for the Ryan White 

HIV/AIDS CARE Act Program

$2,480,090 1.0%

Maternal and Child Health 

Bureau

Operates the Maternal, Infant, and Early Childhood 

Home Visiting Program Technical Assistance 

Coordinating Center

$2,580,000 1.1%

Office of Rural Health Policy Provides technical assistance for grantee programs to 

expand access to, coordinate, restrain the cost of, and 

improve the quality of health care through the 

development of health care networks in rural areas and 

regions

$1,899,426 0.8%

Cross-Cutting Supports development, maintenance, and enhancement 

efforts for HRSA’s Electronic Handbook, the agency’s 

online system for documenting its grantee oversight 

activities, by integrating new business processes into the 

Electronic Handbook or integrating the Electronic 

Handbook with other existing systems

c $27,791,403 11.5%

Source: GAO analysis of information from HRSA and the Federal Procurement Data System-Next Generation.

a

The amount of obligations we report accounts for any funds that were deobligated within the fiscal 

year; funds may be deobligated, for example, due to a reduction in costs or a correction to recorded 

amounts.

b

We have included contract data for the National Hansen’s Disease Program with the data for the 

Healthcare Systems Bureau, as this bureau took oversight responsibility for this program in August 

2012. Prior to that, the program was under the auspices of the Bureau of Primary Health Care.

c

Cross-cutting refers to contracts that were utilized by more than one HRSA organizational 

component.

Appendix II: HRSA Contracts with the 

Highest Total Amount of Obligations by 

Organizational Component, Fiscal Year 2012
Appendix III: Top Three Products or Services 

Obtained through Contracts by Organizational 

Component, Fiscal Year 2012

Page 42 GAO-14-52 Health Resources and Services Administration

Organizational component Top products or services obtained through contracts

Percent of component’s 

contract obligations

Bureau of Clinician Recruitment and 

Service 

1. Management Support 48.9%

2. Education and Training 17.6%

3. Professional Support 17.4%

Bureau of Health Professions 1. Information Technology and Telecommunications 77.5%

2. Professional Support 12.2%

3. Special Studies and Analysis 4.5%

Bureau of Primary Health Care 1. Professional Support 72.4%

2. Special Studies and Analysis 22.4%

3. Information Technology and Telecommunications 3.4%

Healthcare Systems Bureau 1. Medical, Dental, and Surgical Services a 53.7%

2. Management Support 11.3%

3. Professional Support 10.7%

HIV/AIDS Bureau 1. Professional Support 48.6%

2. Information Technology and Telecommunications 28.5%

3. Management Support 12.7%

Maternal and Child Health Bureau 1. Professional Support 69.0%

2. Management Support 21.6%

3. Administrative Support Services 10.4%

Office of Rural Health Policy 1. Professional Support 95.1%

2. Management Support 4.7%

3. Administrative Support Services 0.1%

Cross-Cutting 1. Information Technology and Telecommunications b 54.1%

2. Professional Support 17.7%

3. Management Support 9.9%

Source: GAO Analysis of information from HRSA and the Federal Procurement Data System-Next Generation.

a

We have included contract data for the National Hansen’s Disease Program with the data for the 

Healthcare Systems Bureau, as this bureau took oversight responsibility for this program in August 

2012. Prior to that, the program was under the auspices of the Bureau of Primary Health Care.

b

Appendix III: Top Three Products or Services 

Obtained through Contracts by 

Organizational Component, Fiscal Year 2012 

Cross-cutting refers to contracts that were utilized by more than one HRSA organizational 

component.
Appendix IV: Comments from the Department 

of Health and Human Services

Page 43 GAO-14-52 Health Resources and Services Administration

Appendix IV: Comments from the 

Department of Health and Human Services
Appendix IV: Comments from the Department 

of Health and Human Services

Page 44 GAO-14-52 Health Resources and Services Administration
Appendix V: GAO Contact and Staff 

Acknowledgments

Page 45 GAO-14-52 Health Resources and Services Administration

Debra A. Draper, (202) 512-7114 or draperd@gao.gov

In addition to the contact named above, Michelle B. Rosenberg, Assistant 

Director; Jill K. Center; Kathleen Diamond; Cathleen J. Hamann; 

Julia Kennon; Emily Loriso; Rebecca Shea; and Jennifer M. Whitworth 

made key contributions to this report.

Appendix V: GAO Contact and Staff 

Acknowledgments 

GAO Contact

Staff 

Acknowledgments 

(291088)
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