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. 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. 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. 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. 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. 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) 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) 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) 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) 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) 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.

Summary: In March 2010, PPACA established the PPHF to provide for expanded and sustained national investment in prevention and public health programs, including prevention research, health screenings, and immunization programs. PPACA appropriated $500 million for fiscal year 2010, $750 million for fiscal year 2011, and additional amounts for future fiscal years to operationalize the PPHF. HHS allocates funding from the PPHF for specific prevention and public health activities administered by HHS agencies. The agencies, once funds are transferred to them, use the PPHF funds to support individual projects through, for example, grants and contracts. GAO was asked to provide information on how PPHF funds were allocated for fiscal years 2010 and 2011. This report describes, for those fiscal years, (1) the HHS agencies and activities for which PPHF allocations were made, (2) the process and criteria HHS used to allocate PPHF funds, and (3) HHS reporting of the outcomes of activities receiving PPHF funding. GAO reviewed agency documents, including budget justifications, funding announcements, data on PPHF allocations and awards of PPHF-funded grants, contracts, and interagency agreements; examined agency websites; and interviewed HHS officials. HHS provided technical comments on a draft of this report, which were incorporated as appropriate. For 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.