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.