Prevention and Public Health Fund: Activities Funded in Fiscal Years 2010 and 2011
Published: 2012-09-13T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: In March 2010, PPACA established the PPHF to provide for expanded and sustained national investment in prevention and public health programs, including prevention research, health screenings, and immunization programs. PPACA appropriated $500 million for fiscal year 2010, $750 million for fiscal year 2011, and additional amounts for future fiscal years to operationalize the PPHF.
HHS allocates funding from the PPHF for specific prevention and public health activities administered by HHS agencies. The agencies, once funds are transferred to them, use the PPHF funds to support individual projects through, for example, grants and contracts. GAO was asked to provide information on how PPHF funds were allocated for fiscal years 2010 and 2011. This report describes, for those fiscal years, (1) the HHS agencies and activities for which PPHF allocations were made, (2) the process and criteria HHS used to allocate PPHF funds, and (3) HHS reporting of the outcomes of activities receiving PPHF funding. GAO reviewed agency documents, including budget justifications, funding announcements, data on PPHF allocations and awards of PPHF-funded grants, contracts, and interagency agreements; examined agency websites; and interviewed HHS officials.
HHS provided technical comments on a draft of this report, which were incorporated as appropriate.
section_title: What GAO Found
paragraphs: For fiscal years 2010 and 2011, the Department of Health and Human Services (HHS) allocated funds from the Prevention and Public Health Fund (PPHF) for 43 activities in five agencies. These activitieswhich include HHS programs and initiativeswere administered by HHSs Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), and the Office of the Secretary (OS). Most of the $500 million available for fiscal year 2010 was allocated for activities administered by HRSA, and most of the $750 million available for fiscal year 2011 was allocated for activities administered by CDC (see fig.). HHS agencies funded individual projects with PPHF funds through grants, contracts, and interagency agreements.
Because the PPHF was established midway through fiscal year 2010 and after the President had submitted the fiscal year 2011 budget request, for the funds first 2 years HHS used an abbreviated process to allocate PPHF funds. Instead of developing HHS-wide written criteria, HHS requested that its agencies propose activities for PPHF funding based on language in the Patient Protection and Affordable Care Act (PPACA) provision establishing the PPHF. According to HHS, the proposed activities were also aligned with existing departmental priorities.
HHS has relied on its agencies to establish performance measures and targets and to track outcomes (the results) of the PPHF-funded activities. Agency officials reported that for many activities, it is too early to report outcomes because many projects receiving PPHF funding in fiscal years 2010 and 2011 are multiyear projects or have not yet completed evaluations.

section_title: Letter
paragraphs: In March 2010, the Patient Protection and Affordable Care Act (PPACA)  established the Prevention and Public Health Fund (PPHF) to provide for  expanded and sustained national investment in prevention and public  health programs, such as prevention research, health screenings, and  immunization programs. PPACA appropriated $500 million to the fund for  fiscal year 2010, $750 million for fiscal year 2011, a total of $3.75 billion  for fiscal years 2012 through 2014, and $2 billion for fiscal year 2015 and  each subsequent fiscal year.
For each fiscal year since the passage of PPACA, the Department of  Health and Human Services (HHS) has allocated PPHF funds—that is,  established a plan for funding specific prevention and public health- related activities—for that year and then transferred funds from the PPHF  to the appropriation accounts for the HHS agencies that administer these  activities. Once HHS has allocated and transferred PPHF funds, HHS  agencies use PPHF funding for individual projects to carry out the  activities through, for example, grant and contract awards.
You asked us to provide detailed information on the allocation of PPHF  funding for fiscal years 2010 and 2011, including how decisions were  made to allocate PPHF funding for specific HHS activities, the entities  receiving PPHF funding, and the outcomes—that is, the results—of those  activities. This report describes (1) the HHS agencies and activities for  which PPHF funding was allocated for fiscal years 2010 and 2011 and the  entities receiving PPHF funding, (2) the process and criteria HHS used to  allocate and award PPHF funds for fiscal years 2010 and 2011, and   (3) HHS reporting of the performance measures, targets, and outcomes  of activities and projects receiving PPHF funding.
To describe the HHS agencies and activities for which PPHF funding was  allocated and for which awards were made for fiscal years 2010 and  2011, we reviewed documents, such as budget justifications, funding  opportunity announcements, and data on PPHF allocations and recipients  of PPHF-funded grants, contracts, and interagency agreements provided  by HHS agencies. We also interviewed officials from the Office of the  Assistant Secretary for Financial Resources (ASFR) within the HHS  Office of the Secretary (OS), which is involved in the allocation of PPHF  funds, and HHS agencies and the OS (hereafter collectively referred to as  HHS agencies) that administered activities that received PPHF funding in  fiscal years 2010 and 2011. We summarized funding data HHS reported  to us and did not independently verify the reported data. Through our  review of the relevant documentation, our discussions with HHS officials,  and quality control checks we performed on the data, we determined that  the data provided were sufficiently reliable for our purposes. To describe  the criteria and processes HHS used to allocate PPHF funds we  interviewed HHS and agency officials who were knowledgeable about the  decision-making process and reviewed available documentation,  including HHS websites. When documentation of the criteria and  processes was not available, we report HHS officials’ descriptions. To  describe how HHS and agencies reported the performance measures,  targets, and outcomes of activities and projects receiving PPHF funding,  we reviewed HHS’s websites, budget justifications, and other documents  and interviewed HHS and agency officials. We examined performance  measures that HHS established for PPHF-funded activities, the targets  set for those activities, and the available information from HHS on  outcomes. For all three objectives we also examined relevant laws and  other documents related to PPHF allocations and oversight.
We conducted this performance audit from December 2011 to September  2012 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.
subsections: section_title: Background
paragraphs: PPACA established the PPHF to provide for expanded and sustained  national investment in prevention and public health programs to improve  health and help restrain the rate of growth in private and public sector  health care costs. For this purpose, the Secretary of Health and Human  Services is required to transfer amounts from the PPHF to HHS accounts  to increase funding, over the fiscal year 2008 level, for programs  authorized by the Public Health Service Act, “for prevention, wellness,  and public health activities including prevention research, health  screenings, and initiatives, such as the Community Transformation grant  program, the Education and Outreach Campaign Regarding Preventive  Benefits, and immunization programs.” Within HHS, agencies including  the Agency for Healthcare Research and Quality (AHRQ), the Centers for  Disease Control and Prevention (CDC), the Health Resources and  Services Administration (HRSA), the Substance Abuse and Mental Health  Services Administration (SAMHSA), and the OS administer programs  authorized by the Public Health Service Act.
PPACA appropriated $5 billion to the PPHF for fiscal years 2010 through  2014, and $2 billion for each fiscal year thereafter. Middle Class Tax Relief and Job Creation Act of 2012reducing the amounts appropriated to the PPHF for fiscal years 2013  through 2021 by a total of $6.25 billion (see table 1).
Pub. L. No. 111-148, § 4002(b), 124 Stat. 541.
When appropriations are made available, an agency may obligate funds  through such actions as awarding discretionary grants, cooperative  agreements, or contracts, or through entering into interagency  agreements. For discretionary grants,availability of funds through a publicly available notice called a funding   agencies announce the  opportunity announcement.guidance on how to apply for available funding and often identify  restrictions on eligibility, such as limiting applicants to states, local  governments, tribal organizations, or academic institutions. Funding  opportunity announcements also indicate the type of grant award, such as  new, continuation, or supplemental. A new grant provides funding for a  project that is currently not receiving financial support, a continuation  grant provides additional funding for one or more budget periods to a  project that would otherwise end, and a supplemental grant increases  funding for an approved project during a current budget period.
An agency may also provide federal funding pursuant to a contract, a  legal instrument that establishes a binding relationship between the  agency and another entity for acquisition of property or services.Agencies can also enter into interagency agreements to carry out projects  when, for example, another agency has expertise in an area or has  additional capacity to do the work.
The Consolidated Appropriations Act, 2012 required HHS to establish a  website that provides information on the use of PPHF funds. Specifically,  it required HHS to post on a website specific information relating to use of  fiscal year 2012 PPHF funds.
section_title: HHS Agencies and Activities for Which PPHF Funds Were Allocated and Entities That Received PPHF Funding, Fiscal Years 2010 and 2011
paragraphs: HHS allocated PPHF funds for 43 activities in five HHS agencies— AHRQ, CDC, HRSA, OS, and SAMHSA—in the first 2 years of the fund.The majority of the $500 million in PPHF funding available for fiscal year  2010 was allocated for activities administered by HRSA, while the  majority of the $750 million in PPHF funding available for fiscal year 2011  was allocated for activities administered by CDC (see fig. 1).
According to information provided by HHS, of the 43 activities for which  PPHF allocations were made for fiscal years 2010 and 2011, about half  (23 activities accounting for 72 percent of total fiscal year 2010 and 2011  allocations) received funding from regular (that is, non-PPHF)  appropriations; the remainder (20 activities accounting for 28 percent of  total fiscal year 2010 and 2011 allocations) were funded solely from the  PPHF during those 2 fiscal years. In fiscal year 2010, the three activities  for which the largest PPHF allocations were made were:
HRSA’s Primary Care Training and Enhancement ($198.1 million),
CDC’s National Public Health Improvement Initiative ($50.0 million),
CDC’s ARRA: Communities Putting Prevention to Work ($36.4  million).
In fiscal year 2011, the three activities for which the largest PPHF  allocations were made were funded by CDC:
Community Transformation Grants program ($146.3 million),
Section 317 Immunization program ($100.0 million), and
Coordinated Chronic Disease Prevention program ($51.7 million).
Activities for which the largest allocations were made in the three other  HHS agencies during this 2-year period included AHRQ’s support of the  U.S. Preventive Services Task Force, SAMHSA’s Primary and Behavioral  Health Care Integration, and OS’s Obesity Media Activities (see table 2).
For the 43 activities for which HHS allocated PPHF funds for fiscal years  2010 and 2011, HHS agencies awarded grants and contracts, and  entered into interagency agreements, with the majority of funding  awarded through grants (see table 3). The number of award recipients  for each activity ranged from 1 contractor for the AHRQ Healthy Weight  Practice-Based Research Networks to 110 grantees receiving PPHF  funding under HRSA’s Primary Care Training and Enhancement activity.  Recipients of PPHF funds were located in all 50 states, the District of  Columbia, and 8 U.S. territories. (See apps. I-V for listings of recipients of  PPHF funds and their locations.)
PPHF-funded grants were awarded to state and local governments, tribal  organizations, academic institutions, as well as national organizations and  hospitals; eligibility for these awards was often limited to a certain type or  types of entity. Our review of 58 funding opportunity announcements for  PPHF-funded grants for fiscal years 2010 and 2011 found that state,  local, territory, or tribal governments were eligible for the most grant  opportunities in those years. While many funding opportunity  announcements limited eligibility to one type of entity, others—including  the funding opportunity announcement for the Community Transformation  Grants program—listed multiple types of entities as eligible to apply for  the PPHF-funded grants (see table 4).
As reported by HHS, most PPHF-funded grants for fiscal years 2010 and  2011 were new grants, followed by supplemental and continuation grants  (see table 5).
HHS has not published a comprehensive list of agencies and activities for  which PPHF funding was allocated and has not published a  comprehensive list of all of the entities receiving PPHF funding in fiscal  years 2010 and 2011; PPACA did not require HHS to do so. For PPHF  funding in fiscal year 2012, HHS established a website to provide  information on activities supported from the PPHF, in response to  provisions in the Consolidated Appropriations Act, 2012. According to  HHS officials, HHS does not plan to include information on activities  funded in fiscal years 2010 and 2011 on this website, and as of May  2012, was still evaluating how it will use the website in fiscal year 2013.
section_title: Process and Criteria for Allocating and Awarding PPHF Funds for Fiscal Years 2010 and 2011
paragraphs: HHS implemented an abbreviated process to allocate PPHF funds for  fiscal years 2010 and 2011 because of the timing when PPACA was  enacted, according to HHS. PPACA was signed into law on March 23,  2010, 1 week before the midpoint of fiscal year 2010 and over a month  after the President had released his fiscal year 2011 budget request. (See  fig. 2 for a timeline of key events.)
HHS implemented an abbreviated process for allocating PPHF funds for  fiscal years 2010 and 2011 due to the timing of PPACA in relation to the  budget formulation process for those years. That is, because the  President’s budget request, along with agency justifications, had already  been submitted, HHS did not have the opportunity to lay out its plans for  how PPHF funds would be spent for fiscal years 2010 and 2011.  According to ASFR officials, for fiscal years 2012 and 2013 HHS  considered which activities to support with PPHF funding through the  annual budget formulation process.
In its abbreviated process, HHS requested proposals for PPHF funding  from agencies. HHS did not develop HHS-wide criteria for fiscal years  2010 and 2011; instead HHS instructed agencies to use activities cited in  the PPACA provisions establishing the PPHF as guidance for developing  proposals for activities for which HHS could allocate PPHF funding.  According to HHS, the proposed activities were also aligned with existing  departmental priorities. HHS then evaluated agency proposals and  allocated and transferred PPHF funds to the corresponding  appropriations accounts, guided in fiscal year 2011 by proposed  legislative language. Agencies then evaluated applications and selected  projects to fund with their available PPHF funds. Table 6 provides a  description of actions taken in each step for allocating and awarding  PPHF funds for fiscal years 2010 and 2011, as reported by HHS and  agency officials.
As part of the abbreviated process HHS used for fiscal years 2010 and  2011, following the enactment of PPACA, HHS developed a PPHF  allocation plan then consulted with staff from the authorizing and  appropriations committees prior to transferring the funds. Specifically,  HHS told us that prior to transferring PPHF funds within HHS for fiscal  years 2010 and 2011, officials notified minority and majority staff from  authorizing and appropriations committees including: the House  Appropriations Subcommittee on Labor, Health and Human Services,  Education, and Related Agencies; the Senate Appropriations  Subcommittee on Labor, Health and Human Services, Education, and  Related Agencies; the House Energy and Commerce Committee; and,  the Senate Committee on Health, Education, Labor and Pensions. In  addition, for fiscal year 2011, HHS told us that the department used  language for the proposed allocation in the fiscal year HHS   as a guide for allocating the $750 million available from  appropriationthe PPHF that year. HHS also reported consulting with the authorizing  and appropriations committees prior to executing the transfer of funds for  the fiscal year 2011 allocation.
For fiscal years 2010 and 2011, HHS did not formally solicit input from  outside stakeholders on the PPHF allocation process, according to HHS  officials. But HHS officials reported that a wide range of stakeholders,  including states, nonprofit organizations, community-based organizations,  and coalitions, proactively provided HHS and agencies with input on the  use of PPHF funds, which was considered by HHS leadership during the  decision-making process.
section_title: HHS Reporting of Performance Measures, Targets, and Outcomes of Activities and Projects Receiving PPHF Funding
paragraphs: HHS has relied on its agencies to establish performance measures and  targets and to track outcomes of PPHF activities. For the 23 activities for  which PPHF allocations were made and that received funding through  regular appropriations, performance measures, targets, and outcomes  data were generally not specific to PPHF-funded projects, but applied to  the entire activity regardless of the funding source. For example,  SAMHSA used both regular appropriations and PPHF funds for existing  activities, such as suicide prevention. Moreover, SAMHSA evaluates the  performance of the suicide prevention activities as a whole and does not  have separate performance measures for the PPHF-funded projects. For  individual projects receiving PPHF funding, performance measures were  frequently established in funding opportunity announcements.
HHS agency officials told us that it is too early to report outcomes for  many activities for which PPHF funding was allocated because many  projects receiving PPHF funding in fiscal year 2010, 2011, or both are  multiyear projects or have not yet completed project evaluations, and  outcomes have not been measured or reported. For example, one  performance measure of HRSA’s Primary Care Training and  Enhancement activity—an activity that received PPHF funding in fiscal  year 2010—is the number of primary care physicians supported with  PPHF funding who complete their education; however, while data on the  number of individuals training to be physicians who are supported with  PPHF funding are available, outcome data on the numbers completing  their programs will not be available until fiscal year 2014, the year the first  cohort of physicians supported by fiscal year 2010 PPHF funding will  finish their training. Table 7 presents information on performance  measures and available information on targets and outcomes for the  three HHS activities for which the largest PPHF allocations were made for  fiscal years 2010 and 2011. Collectively, HHS allocated a total of   $198.1 million for fiscal year 2010 and $246.3 million for fiscal year 2011  for these three activities.
As of July 2012, information was available on some projects receiving  PPHF funding in fiscal years 2010 and 2011—for example, CDC posted  information on activities planned by individual projects funded by its  Community Transformation Grants program, which was initiated in late  fiscal year 2011. At the same time, however, information on all fiscal  year 2010 and 2011 outcomes was not reported.
section_title: Agency Comments
paragraphs: HHS reviewed a draft of this report and provided technical comments,  which we incorporated as appropriate.
As arranged with your offices, unless you publicly announce its contents  earlier, we plan no further distribution of this report until 30 days after its  issue date. At that time, we will send copies of this report to the Secretary  of Health and Human Services and interested congressional committees.  In addition, the report will be available at no charge on the GAO website  at http://www.gao.gov.
If you or your staff have any questions regarding this report, please  contact me at (202) 512-7114 or iritanik@gao.gov. Contact points for our  Office of Congressional Relations and Public Affairs may be found on the  last page of this report. GAO staff who made key contributions to this  report are listed in appendix VI.
section_title: Appendix I: Agency for Healthcare Research and Quality—Prevention and Public Health Fund Awards by Activity
paragraphs: This appendix presents information on awards made by the Agency for  Healthcare Research and Quality (AHRQ) for Prevention and Public  Health Fund (PPHF) activities with funds allocated and transferred from  the PPHF for fiscal years (FY) 2010 and 2011. For each AHRQ activity  that received PPHF funding, tables 8 through 12 summarize information  on awards made with those funds through grants and contracts for each  fiscal year. Award information was provided by the Department of Health  and Human Services’ (HHS) Assistant Secretary for Financial Resources,  AHRQ, or reported in the funding opportunity announcements (FOA) HHS  identified as being associated with the activity and awards.
The information presented in this appendix, including the purpose of the  PPHF-funded activity, was obtained from HHS. Due to the large number  of awards, we did not edit the award recipient information to correct  typographical or grammatical errors, or clarify the information provided. In  general, we reprinted the abbreviations and acronyms provided by HHS  and the legislative authority cited in the FOA or otherwise provided by  HHS. We did not independently verify the legislative authority. Totals in  this appendix (reported obligations) may not match—for example, they  may be lower than—the amounts in table 2 (reported allocations).  According to HHS officials, to carry out an activity, an agency may incur  administrative expenses, including an agency’s internal costs associated  with managing and overseeing grants and contracts, not reflected in  award amounts. Further, to the extent that an appropriation has not  identified a particular amount for a specific activity, an agency may  reallocate unobligated funds from that activity to another during the  course of a fiscal year.
Activity: Clinical Preventive Services Task Force  The purpose of this activity is to support the U.S. Preventive Services  Task Force (USPSTF), an independent panel of private-sector experts in  prevention and primary care, including support for a Scientific Resource  Center, a preventive medicine residency rotation program, staff support,  and to develop and finalize updated evidence reports.
Fiscal year 2010: $5.0 million (2 contracts)
Fiscal year 2011: $6.8 million (2 contracts)
Activity: Clinical Preventive Services Research  The purpose of this activity is to support integrated, multiproject research  programs that will work with a well-defined, central research focus to  contribute to addressing the research and implementation gaps identified  as part of the development of the HHS National Prevention and National  Quality Strategies.
Fiscal year 2010: None
Fiscal year 2011: $4.8 million (3 grants totaling $4.3 million and   1 contract for $0.5 million)
section_title: Appendix II: Centers for Disease Control and Prevention—Prevention and Public Health Fund Awards by Activity
paragraphs: This appendix presents information on awards made by the Centers for  Disease Control and Prevention (CDC) for Prevention and Public Health  Fund (PPHF) activities with funds allocated and transferred from the  PPHF for fiscal years (FY) 2010 and 2011. For each CDC activity that  received PPHF funding, tables 13 through 62 summarize information on  awards made with those funds through grants and contracts for each  fiscal year. Award information was provided by HHS’s Assistant  Secretary for Financial Resources, CDC, or reported in the funding  opportunity announcements (FOA) HHS identified as being associated  with the activity and awards.
The information presented in this appendix, including the purpose of the  PPHF-funded activity, was obtained from HHS. Due to the large number  of awards, we did not edit the award recipient information to correct  typographical or grammatical errors, or clarify the information provided. In  general, we reprinted the abbreviations and acronyms provided by HHS  and the legislative authority cited in the FOA or otherwise provided by  HHS. We did not independently verify the legislative authority. Totals in  this appendix (reported obligations) may not match—for example, they  may be lower than—the amounts in table 2 (reported allocations).  According to HHS officials, to carry out an activity, an agency may incur  administrative expenses, including an agency’s internal costs associated  with managing and overseeing grants and contracts, not reflected in  award amounts. Further, to the extent that an appropriation has not  identified a particular amount for a specific activity, an agency may  reallocate unobligated funds from that activity to another during the  course of a fiscal year.
Activity: Community Transformation Grants Program  The purpose of this activity is to support community-level efforts to reduce  chronic diseases such as heart disease, cancer, stroke, and diabetes. By  promoting healthy lifestyles, especially among population groups  experiencing the greatest burden of chronic disease, these funded  projects are designed to help improve health, reduce health disparities,  and control health care spending.
Fiscal year 2010: None
Fiscal year 2011: $139.3 million (68 grants in three funding  announcements totaling $107.9 million and contracts totaling   $31.4 million)
Activity: Section 317 Immunization Program  The purpose of this activity is to provide funding for immunization  operations and infrastructure necessary to implement a comprehensive  immunization program at the federal, state, and local levels.
Fiscal year 2010: None
Fiscal year 2011: $99.8 million (73 grants in six funding  announcements totaling $46.5 million and contracts totaling   $53.3 million)
Activity: National Public Health Improvement Initiative   is to systematically increase the capacity of  The purpose of this activitypublic health departments to detect and respond to public health events  requiring highly coordinated interventions to improve and/or sustain the  performance (efficiency/effectiveness) of public health organizations,  systems, practices, and essential services. It is intended to promote the  development, dissemination, and adoption of evidence-based practices.
Fiscal year 2010: $47.9 million (80 grants in two funding  announcements totaling $46.4 million and three contracts totaling   $1.5 million)
Fiscal year 2011: $40.2 million (80 grants in three funding  announcements totaling $36.7 million and four contracts totaling   $3.5 million)
Activity: Tobacco Prevention (Media and Quitlines)
The purpose of this activity is to raise awareness and shift key attitudes  and beliefs about the harms of tobacco use and exposure to secondhand  smoke in areas of the country with some of the highest rates of tobacco  use prevalence.
Fiscal year 2010: $14.1 million (46 grants in two funding  announcements totaling $3.9 million and seven contracts totaling  $10.2 million)
Fiscal year 2011: $49.1 million (43 grants in two funding  announcements totaling $5.0 million and 11 contracts totaling  $44.1million)
Activity: Epidemiology and Laboratory Capacity Grants  The purpose of this activity is to enhance the ability of state, local, and  territorial Epidemiology and Laboratory Capacity (ELC) and EIP grantees  to strengthen and integrate capacity for detecting and responding to  infectious diseases and other public health threats.
Fiscal year 2010: $19.2 million (68 grants in two funding  announcements)
Fiscal year 2011: $40.0 million (68 grants in two funding  announcements totaling $38.4 million and two contracts totaling   $1.6 million)
Activity: Coordinated Chronic Disease Prevention Program  The purpose of this activity is to establish or strengthen Chronic Disease  Prevention and Health Promotion programs within state health  departments, to provide leadership and coordination, support  development, implementation, and evaluation of CDC funded Chronic  Disease and Health Promotion programs. The focus is on the top five  leading chronic disease causes of death and disability (i.e., heart disease,  cancer, stroke, diabetes, and arthritis) and their associated risk factors.
Fiscal year 2010: None
Fiscal year 2011: $51.5 million (75 grants in three funding  announcements totaling $49.8 million and two contracts totaling   $1.7 million)
Activity: CDC Healthcare Surveillance and Statistics  The purpose of this activity is to support the efforts of CDC programs  including: Health Information Exchange, Enhancing Healthcare Data  Access and Use and Health Service Research Capacity, National Health  and Nutrition Examination Survey, Public Health Surveillance Program  Office—National Center for Health Statistics Centers for Medicare and  Medicaid Services Data Project, National Health Interview Survey,  National Youth Fitness Survey, and Behavioral Risk Factor Surveillance  System.
Fiscal year 2010: $19.4 million (two grants in two funding  announcements totaling $0.7 million and 12 contracts totaling   $18.7 million)
Fiscal year 2011: $29.5 million (13 contracts)
Activity: ARRA: Communities Putting Prevention to Work  The purpose of this activity is to address two of the leading preventable  causes of death and disability, obesity and tobacco use, through the  locally driven initiative Communities Putting Prevention to Work.
Fiscal year 2010: $35.0 million (nine grants in one funding  announcement totaling $29.0 million and eight contracts totaling   $6.0 million)
Fiscal year 2011: None Activity: Environmental Public Health Tracking  The purpose of this activity is to establish and maintain a nationwide  tracking network to collect, integrate, analyze, and translate health and  environmental data for use in public health practice and policy  development. This activity is designed to build environmental public  health surveillance (tracking) capacity in additional state and local health  departments by enhancing infrastructure, data, partnerships, and  workforce.
Fiscal year 2010: None
Fiscal year 2011: $30.8 million (30 grants in five funding  announcements totaling $22.8 million and contracts totaling   $8.0 million)
Activity: Public Health Workforce  The purpose of this activity is to help ensure a prepared, diverse,  sustainable public health workforce. PPHF funding leverages critical  workforce development activities supported with CDC’s core budget.
Fiscal year 2010: $ 4.7 million (four grants in one funding  announcement totaling $0.8 million and 17 contracts totaling   $3.8 million)
Fiscal year 2011: $18.5 million (four grants in two funding  announcements totaling $4.7 million and 27 contracts totaling   $13.8 million)
The purpose of this activity is to support demonstration projects to identify  and implement a “combination approach” to enhance effective HIV  prevention programming in hard-hit areas across the country. These  efforts are designed to both supplement existing programs in these  communities and help jurisdictions to better focus efforts on key at-risk  populations and fulfill unmet needs.
Fiscal year 2010: $ 29.2 million (88 grants in three funding  announcements totaling $21.6 million and six contracts totaling   $7.6 million)
Fiscal year 2011: None Activity: Racial and Ethnic Approaches to Community Health (REACH)
The purpose of this activity is to serve as the cornerstone of CDC’s efforts  to eliminate racial and ethnic disparities in health. REACH supports  community coalitions that design, implement, evaluate, and disseminate  community-driven strategies to eliminate health disparities in key health  areas, such as heart disease, diabetes, breast and cervical cancer,  immunization, asthma, hepatitis B, and infant mortality.
Fiscal year 2010: None
Fiscal year 2011: $24.6 million (43 grants in three funding  announcements totaling $24.5 million and one contract totaling   $0.1 million)
Activity: Public Health Research  The purpose of this activity is to fund research projects through the ACA  Prevention and Public Health Fund that investigate the effectiveness of  public health services and systems in real world settings. The specific  requirements for projects to be supported within this initiative are to   (1) examine evidence-based practices related to prevention, with a  particular focus on high-priority areas consistent with the National  Prevention Strategy and Healthy People 2020, including comparisons of  community-based public health interventions in terms of effectiveness  and cost; (2) analyze the effective translation of interventions from  academic settings to real world settings; and (3) identify effective  strategies to organize, finance, or deliver public health services in real  world community settings, including comparisons of state and local health  department structures and systems in terms of effectiveness and cost.
Fiscal year 2010: None
Fiscal year 2011: $19.9 million (12 grants in three funding  announcements totaling $11.5 million and 12 contracts totaling   $8.4 million)
Activity: Community Guide/Community Preventive Services Task Force  The purpose of this activity is to help people choose programs and  policies to improve health and prevent disease in communities using the  Community Guide, a free resource. The activity’s findings are used by  partners at federal, state, and local levels within governments, health  departments, worksites, community-based organizations, and elsewhere  to guide and improve public health programs, policies, and research.
Fiscal year 2010: $5.0 million (six grants in one funding  announcement totaling $2.2 million and six contracts totaling   $2.8 million)
Fiscal year 2011: $6.0 million (six grants in one funding  announcement totaling $1.3 million and seven contracts totaling   $4.7 million)
Activity: Healthcare-Associated Infections (HAI)
The purpose of this activity is to expand state prevention activities  through funding to health departments that have already demonstrated  successes and capacity to implement HAI prevention programs and to  build upon advances made through Recovery Act investments. This  program is designed to accelerate electronic reporting to detect HAIs at  the state level by decreasing data entry burden. Electronic reporting will  increase validation of data and the ability of states and healthcare  facilities to measure the impact of prevention efforts.
Fiscal year 2010: None
Fiscal year 2011: $11.4 million (54 grants in two funding  announcements totaling $9.4 million and four contracts totaling   $2.0 million)
Activity: Prevention Research Centers  The purpose of this activity is to help alter the individual behaviors and  community environmental factors that put people at risk for the leading  causes of death and disability—chronic diseases, such as cancer, heart  disease, and diabetes. Centers may also address risks for injury,  infectious disease, mental health, global health, and the health effects of  impairments such as deafness. The activity is designed to bridge gaps  between research findings and the translation of those findings into public  health practice and policy.
Fiscal year 2010: None
Fiscal year 2011: $10.0 million (15 grants in one funding  announcement)
The purpose of this activity is to engage and recruit through a national  organization, groups of 10-15 employers and lead them through the  process of building a core workplace health program.
Fiscal year 2010: None
Fiscal year 2011: $9.2 million (six contracts)
Activity: National Youth Fitness Survey  The purpose of this activity is to gather data on physical activity and  fitness in children and teens through the National Youth Fitness Survey.  The survey is conducted by the National Center for Health Statistics, part  of the Centers for Disease Control and Prevention.
Fiscal year 2010: None
Fiscal year 2011: $5.9 million (four contracts)
Activity: ARRA: Evaluation  The purpose of this activity is to support the Behavioral Risk Factor  Surveillance System (BRFSS) in tracking health conditions and risk  behaviors in the United States.
Fiscal year 2010: $4.0 million (nine grants in one funding  announcement totaling $3.6 million and five contracts totaling   $0.4 million)
Fiscal year 2011: None Activity: ARRA: Media  The purpose of this activity is to provide enhanced media  buying/placement support to the National Prevention Media Initiative to  increase exposure of audiences to campaign messages in communities  that received Communities Putting Prevention to Work awards. The goal  of this activity is to achieve maximum additional exposure of existing/in- development creative campaign materials.
Fiscal year 2010: $3.9 million (three contracts)
Fiscal year 2011: None Activity: Education and Outreach Campaign Regarding Preventive  Benefits  The purpose of this activity is to support the Pharmacy Outreach Project  to increase pharmacists’ capacity and interest in providing over-the- counter advice to patients with high blood pressure, especially  encouraging medication adherence and the use of available preventive  clinical services.
Fiscal year 2010: None
Fiscal year 2011: $1.8 million (four contracts)
Activity: National Prevention Strategy  The purpose of this activity is to guide our nation in the most effective and  achievable way to improve health and well being; the National Prevention  Strategy prioritizes prevention by integrating recommendations and  actions across multiple settings to improve health and save lives.
Fiscal year 2010: $0.01 million (one contract)
Fiscal year 2011: $0.7 million (four contracts)
Activity: Promoting Obesity Prevention in Early Childhood Programs  The purpose of this activity is to encourage child care providers across  the nation to adopt healthier policies and practices around physical  activity and nutrition, including limiting screen time and supporting  breastfeeding.
Fiscal year 2010: None
Fiscal year 2011: $0.7 million (seven contracts)
section_title: Appendix III: Health Resources and Services Administration—Prevention and Public Health Fund Awards by Activity
paragraphs: This appendix presents information on awards made by the Health  Resources and Services Administration (HRSA) for Prevention and Public  Health Fund (PPHF) activities with funds allocated and transferred from  the PPHF for fiscal years (FY) 2010 and 2011. For each HRSA activity  that received PPHF funding, tables 63 through 70 summarize information  on awards made with those funds through grants and contracts for each  fiscal year. Award information was provided by HHS’s Assistant  Secretary for Financial Resources, HRSA, or reported in the funding  opportunity announcements (FOA) HHS identified as being associated  with the activity and awards.
The information presented in this appendix, including the purpose of the  PPHF-funded activity, was obtained from HHS. Due to the large number  of awards, we did not edit the award recipient information to correct  typographical or grammatical errors, or clarify the information provided. In  general, we reprinted the abbreviations and acronyms provided by HHS  and the legislative authority cited in the FOA or otherwise provided by  HHS. We did not independently verify the legislative authority. Totals in  this appendix (reported obligations) may not match—for example, they  may be less than—the amounts in table 2 (reported allocations).  According to HHS officials, to carry out an activity, an agency may incur  administrative expenses, including internal costs associated with  managing and overseeing grants and contracts, not reflected in award  amounts. Further, to the extent that an appropriation has not identified a  particular amount for a specific activity, an agency may reallocate  unobligated funds from that activity to another during the course of a  fiscal year.
Activity: Primary Care Training and Enhancement  The purpose of this activity is to support and develop primary care  physician and physician assistant programs. The program deploys its  resources to strengthen medical education for physician and physician  assistants to improve the quantity, quality, distribution, and diversity of the  primary care workforce.
Fiscal year 2010: $197.5 million (110 grants in two funding  announcements)
Fiscal year 2011: None Activity: Public Health Workforce Development  The purpose of this activity is to support the training of public health  workers. Public health workers protect and improve the health of  communities through education, disease prevention and health  promotion, and monitoring, diagnosis, research, and provision of services  to address community health problems.
Fiscal year 2010: $14.8 million (24 grants in one funding  announcement)
Fiscal year 2011: $20.0 million (32 grants in one funding  announcement)
section_title: Appendix IV: Office of the Secretary— Prevention and Public Health Fund Awards by Activity
paragraphs: This appendix presents information on awards made by the Office of the  Secretary (OS) for Prevention and Public Health Fund (PPHF) activities  with funds allocated and transferred from the PPHF for fiscal years (FY)  2010 and 2011. For each OS activity that received PPHF funding, tables  71 through 77 summarize information on awards made with those funds  through grants and contracts for each fiscal year. Award information was  provided by HHS’s Assistant Secretary for Financial Resources and OS  officials.
The information presented in this appendix, including the purpose of the  PPHF-funded activity, was obtained from HHS. Due to the large number  of awards, we did not edit the award recipient information to correct  typographical or grammatical errors, or clarify the information provided. In  general, we reprinted the abbreviations and acronyms provided by HHS.  Totals in this appendix (reported obligations) may not match—for  example, they may be lower than—the amounts in table 2 (reported  allocations). According to HHS officials, to carry out an activity, an agency  may incur administrative expenses, including an agency’s internal costs  associated with managing and overseeing grants and contracts, not  reflected in award amounts. Further, to the extent that an appropriation  has not identified a particular amount for a specific activity, an agency  may reallocate unobligated funds from that activity to another during the  course of a fiscal year.
Activity: Obesity Media Activities  The purpose of this activity is to develop and execute innovative  communication campaigns, including both print and online materials  development for anti-obesity and healthy lifestyle initiatives.
Fiscal year 2010: $9.1 million (one contract)
Fiscal year 2011: $8.6 million (two contracts)
Activity: Tobacco Prevention Media  The purpose of this activity is to launch a mass-media countermarketing  campaign to prevent youth initiation, promote cessation among adults,  and change social norms, using social media initiatives, a website, and  smart phone applications.
Fiscal year 2010: None
Fiscal year 2011: $10.1 million (12 contracts)
section_title: Appendix V: Substance Abuse and Mental Health Services Administration—Prevention and Public Health Fund Awards by Activity
paragraphs: This appendix presents information on awards made by the Substance  Abuse and Mental Health Services Administration (SAMHSA) for  Prevention and Public Health Fund (PPHF) activities with funds allocated  and transferred from the PPHF for fiscal years (FY) 2010 and 2011. For  each SAMHSA activity that received PPHF funding, tables 78 through 83  summarize information on awards made with those funds through grants  and contracts for each fiscal year. Award information was provided by  HHS’s Assistant Secretary for Financial Resources, SAMHSA, or  reported in the funding opportunity announcements (FOA) HHS identified  as being associated with the activity and awards.
The information presented in this appendix, including the purpose of the  PPHF-funded activity, was obtained from HHS. Due to the large number  of awards, we did not edit the award recipient information to correct  typographical or grammatical errors, or clarify the information provided. In  general, we reprinted the abbreviations and acronyms provided by HHS  and the legislative authority cited in the FOA or otherwise provided by  HHS. We did not independently verify the legislative authority. Totals in  this appendix (reported obligations) may not match—for example, they  may be lower than—the amounts in table 2 (reported allocations).  According to HHS officials, to carry out an activity, an agency may incur  administrative expenses, including an agency’s internal costs associated  with managing and overseeing grants and contracts, not reflected in  award amounts. Further, to the extent that an appropriation has not  identified a particular amount for a specific activity, an agency may  reallocate unobligated funds from that activity to another during the  course of a fiscal year.
Activity: Primary and Behavioral Health Care Integration  The purpose of this activity is to improve the physical health status of  people with serious mental illnesses by supporting communities to  coordinate and integrate primary care services in community mental  health and other community-based behavioral health settings.
Fiscal year 2010: $20.0 million (35 grants in two funding  announcements)
Fiscal year 2011: $35.0 million (43 grants in two funding  announcements)
Activity: Screening, Brief Intervention, and Referral to Treatment  The purpose of this activity is to implement screening, brief intervention,  and referral to treatment services for adults in primary care and  community health settings, for substance misuse and substance use  disorders. This program is designed to expand/enhance the state and  tribal continuum of care for substance misuse services and reduce  alcohol and drug consumption and its negative health impact; increase  abstinence and reduce costly health care utilization; and promote  sustainability and behavioral health information technology.
Fiscal year 2010: None
Fiscal year 2011: $25.0 million (three grants in one funding  announcement)
Activity: SAMHSA Health Surveillance  The purpose of this activity is to support a number of federal, state, local,  and tribal governments, as well as researchers and nongovernmental  organizations, to develop timely and credible data and statistical  information to improve the quality and outcomes of services provided to  individuals, families, communities, and tribal communities.
Fiscal year 2010: None
Fiscal year 2011: $17.9 million (seven contracts)
The Garrett Lee Smith (GLS) Memorial Act authorizes SAMHSA to  manage two significant youth suicide prevention programs and a resource  center. The GLS State/Tribal Youth Suicide Prevention and Early  Intervention Grant Program supports the development and  implementation of youth suicide prevention and early intervention  strategies involving public-private collaborations among youth-serving  institutions. The GLS Campus Suicide Prevention program provides  funding to institutions of higher education to prevent suicide and suicide  attempts. The Suicide Prevention Resource Center (SPRC) develops  effective strategies and best practices to ensure the field has access to  the most crucial information.
Fiscal year 2010: None
Fiscal year 2011: $10.1 million (11 grants in four funding  announcements totaling $10.0 million and one contract for   $0.1 million)
section_title: Appendix VI: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, Kim Yamane, Assistant Director;  George Bogart; Carolyn Garvey; Laurie Pachter; and Terry Saiki made  key contributions to this report.