Bioterrorism
Information on Jurisdictions' Expenditure and Reported Obligation of Program Funds Gao ID: GAO-05-239 February 28, 2005In 1999, the Department of Health and Human Services' (HHS) Centers for Disease Control and Prevention (CDC) began funding jurisdictions' efforts to prepare for bioterrorism attacks through the Public Health Preparedness and Response for Bioterrorism program. After the events of September 11, 2001, and the 2001 anthrax incidents, program funds increased almost twentyfold. Citing jurisdictions' unexpended program funds, HHS reallocated some fiscal year 2004 funds to support other local and national bioterrorism initiatives. Jurisdictions and associations representing jurisdictions disputed HHS's assertion that large amounts of funds remain unused, noting that HHS did not acknowledge obligated funds that had not yet been expended. GAO was asked to provide information on (1) the extent to which jurisdictions had expended the fiscal year 2002 funds awarded for the program's third budget period as of August 30, 2003, and August 31, 2004, and the fiscal year 2003 funds awarded for the program's fourth budget period, as of August 30, 2004; (2) the extent to which fiscal year 2001, 2002, and 2003 funds awarded for the third and fourth budget periods remained unobligated as of August 30, 2004; and (3) factors jurisdictions identified as contributing to delays in expending and obligating funds and actions some jurisdictions took to address them.
Jurisdictions have expended a substantial amount of Bioterrorism program funds. As of August 30, 2004, jurisdictions had expended over four-fifths of the fiscal year 2002 funds awarded during the third budget period through the HHS P accounts--the public assistance accounts that track over 90 percent of all funds awarded. As of that date, they had expended slightly over half of P account funds awarded for the program's fourth budget period. Jurisdictions continued, as authorized, to expend funds beyond the budget period for which they were awarded. For example, some expenditures, such as contract payments, extend beyond one budget period. A t the end of the program's third budget period, jurisdictions reported that less than one-sixth of all bioterrorism funds awarded for that period--including both fiscal year 2001 and 2002 funds--remained unobligated, and some jurisdictions reported that none of their funds remained unobligated. As of August 1, 2004, jurisdictions estimated that less than one-quarter of all funds awarded for the fourth budget period would remain unobligated as of August 30, 2004, and five jurisdictions estimated that they would have no funds remaining unobligated. Many jurisdictions reported facing challenges, partly related to administrative processes, that delayed their obligation and expenditure of bioterrorism funds. These included workforce issues such as hiring freezes; contracting and procurement processes to ensure responsible use of public funds; and lengthy information technology upgrades. Some jurisdictions have simplified these processes to expedite the obligation and expenditure of funds. We provided a draft of this report to HHS for comment, and the agency informed us it had no comments on the draft report.
GAO-05-239, Bioterrorism: Information on Jurisdictions' Expenditure and Reported Obligation of Program Funds
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Report to Congressional Requesters:
United States Government Accountability Office:
GAO:
February 2005:
Bioterrorism:
Information on Jurisdictions' Expenditure and Reported Obligation of
Program Funds:
GAO-05-239:
GAO Highlights:
Highlights of GAO-05-239, a report to congressional requesters:
Why GAO Did This Study:
In 1999, the Department of Health and Human Services‘ (HHS) Centers for
Disease Control and Prevention (CDC) began funding jurisdictions‘
efforts to prepare for bioterrorism attacks through the Public Health
Preparedness and Response for Bioterrorism program. After the events of
September 11, 2001, and the 2001 anthrax incidents, program funds
increased almost twentyfold. Citing jurisdictions‘ unexpended program
funds, HHS reallocated some fiscal year 2004 funds to support other
local and national bioterrorism initiatives. Jurisdictions and
associations representing jurisdictions disputed HHS‘s assertion that
large amounts of funds remain unused, noting that HHS did not
acknowledge obligated funds that had not yet been expended.
GAO was asked to provide information on (1) the extent to which
jurisdictions had expended the fiscal year 2002 funds awarded for the
program‘s third budget period as of August 30, 2003, and August 31,
2004, and the fiscal year 2003 funds awarded for the program‘s fourth
budget period, as of August 30, 2004; (2) the extent to which fiscal
year 2001, 2002, and 2003 funds awarded for the third and fourth budget
periods remained unobligated as of August 30, 2004; and (3) factors
jurisdictions identified as contributing to delays in expending and
obligating funds and actions some jurisdictions took to address them.
What GAO Found:
Jurisdictions have expended a substantial amount of Bioterrorism
program funds. As of August 30, 2004, jurisdictions had expended over
four-fifths of the fiscal year 2002 funds awarded during the third
budget period through the HHS P accounts”the public assistance accounts
that track over 90 percent of all funds awarded. As of that date, they
had expended slightly over half of P account funds awarded for the
program‘s fourth budget period. Jurisdictions continued, as authorized,
to expend funds beyond the budget period for which they were awarded.
For example, some expenditures, such as contract payments, extend
beyond one budget period.
At the end of the program‘s third budget period, jurisdictions reported
that less than one-sixth of all bioterrorism funds awarded for that
period”including both fiscal year 2001 and 2002 funds”remained
unobligated, and some jurisdictions reported that none of their funds
remained unobligated. As of August 1, 2004, jurisdictions estimated
that less than one-quarter of all funds awarded for the fourth budget
period would remain unobligated as of August 30, 2004, and five
jurisdictions estimated that they would have no funds remaining
unobligated.
Many jurisdictions reported facing challenges, partly related to
administrative processes, that delayed their obligation and expenditure
of bioterrorism funds. These included workforce issues such as hiring
freezes; contracting and procurement processes to ensure responsible
use of public funds; and lengthy information technology upgrades. Some
jurisdictions have simplified these processes to expedite the
obligation and expenditure of funds.
We provided a draft of this report to HHS for comment, and the agency
informed us it had no comments on the draft report.
Expenditure Rates of the Third Budget Period‘s Fiscal Year 2002
Bioterrorism Program Funds from P Accounts, by Jurisdiction, as of
August 30, 2003, and August 30, 2004:
[See PDF for image]
Note: These data do not include all funds awarded to jurisdictions
through the Bioterrorism program. For example, while the program‘s
third budget period was a 24-month period, extending from August 31,
2001, to August 30, 2003, and used funds from both fiscal years 2001
and 2002, these expenditure rates reflect data only on fiscal year 2002
funds.
[End of figure]
www.gao.gov/cgi-bin/getrpt?GAO-05-239.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Marjorie Kanof at (202)
512-7114.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
Jurisdictions Have Expended over Four-Fifths of Fiscal Year 2002 Funds
and over Half of Fiscal Year 2003 Funds:
Few Bioterrorism Funds Remained Unobligated, According to Jurisdiction
Reports:
Jurisdictions Identified Administrative Processes and Other Challenges
to Obligation and Expenditure, and Some Jurisdictions Described
Solutions:
Concluding Observations:
Agency Comments:
Appendix I: Scope and Methodology:
Appendix II: Bioterrorism Program's Budget Period Three Expenditures:
Appendix III: Bioterrorism Program's Budget Period Four Expenditures:
Appendix IV: Unobligated Bioterrorism Program Funds Reported by
Jurisdictions:
Appendix V: GAO Contact and Staff Acknowledgments:
GAO Contact:
Acknowledgments:
Related GAO Products:
Tables:
Table 1: Bioterrorism Program Budget Periods:
Table 2: Funds Included in Sources of Bioterrorism Expenditure and
Obligation Data:
Table 3: Public Health Preparedness and Response for Bioterrorism
Program's Budget Period Three Fiscal Year 2002 Funds Expended from P
Accounts, by Jurisdiction, as of August 30, 2003, and August 30, 2004:
Table 4: Public Health Preparedness and Response for Bioterrorism
Program's Budget Period Four Funds Expended from P Accounts, by
Jurisdiction, as of August 30, 2004:
Table 5: Unobligated Public Health Preparedness and Response for
Bioterrorism Program Funds Reported by Jurisdictions, as of the End of
Each Budget Period:
Figures:
Figure 1: Expenditure Rates of the Third Budget Period's Fiscal Year
2002 Bioterrorism Program Funds from P Accounts, by Jurisdiction, as of
August 30, 2003, and August 30, 2004:
Figure 2: Expenditure Rates of the Fourth Budget Period's Fiscal Year
2003 Bioterrorism Program Funds from P Accounts, by Jurisdiction, as of
August 30, 2004:
Figure 3: Unobligated Third and Fourth Budget Period Bioterrorism Funds
Reported by Jurisdictions (percentage):
Abbreviations:
CDC: Centers for Disease Control and Prevention:
DPM: Division of Payment Management:
FMO: Financial Management Office:
FSR: financial status report:
G accounts: general accounts:
HHS: Department of Health and Human Services:
NCA: Notice of Cooperative Agreement:
P accounts: public assistance accounts:
PGO: Procurement and Grants Office:
PMS: Payment Management System:
RFP: request for proposals:
United States Government Accountability Office:
Washington, DC 20548:
February 28, 2005:
The Honorable Joseph I. Lieberman:
Ranking Minority Member:
Committee on Homeland Security and Governmental Affairs:
United States Senate:
The Honorable Edward M. Kennedy:
Ranking Minority Member:
Committee on Health, Education, Labor, and Pensions:
United States Senate:
In 1999, the Department of Health and Human Services' (HHS) Centers for
Disease Control and Prevention (CDC) began funding state and municipal
efforts to prepare for bioterrorism attacks through the Public Health
Preparedness and Response for Bioterrorism program. Total funding
awarded through the program ranged from about $40 million in 1999 to
about $50 million in 2001 annually. The events of September 11, 2001,
increased concern about bioterrorism. In addition, the anthrax
incidents during the fall of 2001 strained the public health system,
including surveillance[Footnote 1] and laboratory workforce capacities,
at the state and municipal levels.[Footnote 2] Following these
incidents, program funding increased almost twentyfold,[Footnote 3] and
this increased level of funding continued in fiscal years 2003 and
2004.[Footnote 4]
With the substantial increase in funding after the terrorist attacks in
2001, CDC modified the program's budget periods.[Footnote 5] The
program's budget periods typically run from August 31 of one year to
August 30 of the next--a 12-month period--and use funds from the fiscal
year under way at the start of the period. However, the third budget
period, which was already under way at the time of the September 11
attack, was extended to 24 months, running from August 31, 2001, to
August 30, 2003. It used funds from both fiscal years 2001 and 2002.
The fourth budget period reverted to a 12-month period, running from
August 31, 2003, to August 30, 2004, and used funds from fiscal year
2003.
In May 2004, HHS reported that large unexpended balances remained of
the fiscal year 2002 and 2003 funds awarded to jurisdictions for the
program's third and fourth budget periods.[Footnote 6] Citing these
large unexpended balances, HHS made the decision to reallocate
approximately $55 million of the funds for the fifth budget period
(August 31, 2004, to August 30, 2005) to support other local and
national bioterrorism initiatives.[Footnote 7] States and national
associations representing jurisdictions have disputed HHS's assertion
that large amounts of funds remain unused, noting that HHS chose to
focus only on expenditures, and did not focus on obligated funds, which
are funds that a jurisdiction has legally committed to spend--for
example, through a contract for services--but has not yet
expended.[Footnote 8]
You asked us to provide information on the expenditure and obligation
of funds awarded under the Public Health Preparedness and Response for
Bioterrorism program cooperative agreements and factors that may affect
these expenditures and obligations.[Footnote 9] In this report, we will
provide information on (1) the extent to which jurisdictions expended
the fiscal year 2002 funds awarded for the program's third budget
period as of August 30, 2003, and August 30, 2004, and fiscal year 2003
funds awarded for the program's fourth budget period, as of August 30,
2004; (2) the extent to which fiscal year 2001, 2002, and 2003 funds
awarded for the third and fourth budget periods remained unobligated by
jurisdictions as of August 30, 2004; and (3) factors that jurisdictions
identified as contributing to delays in expending and obligating funds
and actions some jurisdictions took to address those factors.
To determine the expenditure of fiscal year 2002 funds awarded during
the third budget period as of August 30, 2003, and August 30, 2004, and
the fourth budget period's expenditures as of August 30, 2004, we
analyzed expenditure data obtained from HHS's Division of Payment
Management (DPM) Payment Management System (PMS).[Footnote 10] These
expenditure data come from PMS's public assistance accounts (P
accounts)--awardee accounts that are specific to particular cooperative
agreements, such as the Bioterrorism program, or grants. The
Bioterrorism P accounts do not include fiscal year 2001 funds awarded
during the first half of the third budget period. Therefore, we were
not able to include fiscal year 2001 funds in our analysis of the third
budget period's expenditures. In addition, the P accounts do not
include funds carried over, with CDC's approval, from prior budget
periods, funds related to the Strategic National Stockpile awarded
after fiscal year 2002,[Footnote 11] or funds provided to jurisdictions
as direct assistance.[Footnote 12] However, while the P accounts are a
subset of the total Bioterrorism funds awarded to jurisdictions, they
accounted for over 90 percent of program funds awarded.[Footnote 13] We
determined the percentage of both the third budget period's fiscal year
2002 and fourth budget period's fiscal year 2003 funds expended by
comparing expenditures recorded in the PMS P accounts to the total
funds in the P accounts. We did not conduct a review to determine the
appropriateness of any jurisdiction's expenditures.
To obtain obligation data, we reviewed the financial status reports
(FSR) that CDC required jurisdictions to submit at the end of the third
budget period (August 31, 2001, to August 30, 2003) and the estimated
FSRs for the fourth budget period (August 31, 2003, to August 30, 2004)
that CDC asked jurisdictions to submit by August 1, 2004. We also
reviewed the Notices of Cooperative Agreement (NCA), which are provided
by CDC to jurisdictions and contain information on the total
bioterrorism funds awarded to the jurisdiction for a budget period.
Unlike PMS's P account data, the FSRs and NCAs include information on
all bioterrorism funds awarded as financial assistance, including both
fiscal year 2001 and 2002 funds, funds carried over from prior periods,
and funds related to the Strategic National Stockpile.[Footnote 14]
Because the FSR data related to obligation are self-reported by
jurisdictions, we interviewed officials from CDC, HHS's Office of the
Inspector General (OIG), and jurisdiction audit agencies to obtain
information on any efforts to determine the reliability of these data.
Based on the work of the OIG and jurisdiction audit agencies,
obligation data for the third budget period from 18 jurisdictions and
for the fourth budget period from 1 jurisdiction can be considered
reliable. In other cases, the information presented is as reported by
jurisdictions, and we cannot attest to its reliability.
To describe factors that jurisdictions said contributed to delays in
obligating and expending funds and actions some jurisdictions took to
address those factors, we selected 19 jurisdictions, taking into
account diversity in geographic location, population size, urban and
rural status, and their expenditure and obligation patterns. We e-
mailed these jurisdictions to gather information on why some may have
had unobligated or unexpended funds, and we obtained any necessary
clarification of responses by telephone or e-mail.[Footnote 15]
We did our work from July 2004 through February 2005 in accordance with
generally accepted government auditing standards. (See app. I for
additional details on our scope and methodology.)
Results in Brief:
Jurisdictions have expended a substantial amount of Public Health
Preparedness and Response for Bioterrorism program funds. As of August
30, 2004, they had expended over four-fifths of the fiscal year 2002
funds awarded through the HHS P accounts during the third budget period
(August 31, 2001, to August 30, 2003). (The P accounts make up over 90
percent of all Bioterrorism program funds.) As of August 30, 2004,
jurisdictions had also expended slightly over half of the funds in the
P accounts awarded for the program's fourth budget period (August 31,
2003, to August 30, 2004). As allowed by the CDC cooperative agreement,
jurisdictions have continued to expend funds beyond the budget period
in which they were awarded. Some expenditures, such as contract
payments, take place over a period of time; therefore, it may take
jurisdictions longer than one budget period to expend awarded funds.
At the end of the Bioterrorism program's third budget period,
jurisdictions reported to CDC that less than one-sixth of all fiscal
year 2001 and 2002 bioterrorism funds awarded for that period remained
unobligated, and some jurisdictions reported that no funds remained
unobligated. As of August 1, 2004, jurisdictions estimated that less
than one-quarter of funds awarded for the fourth budget period would
remain unobligated as of August 30, 2004, and five jurisdictions
estimated that no funds would remain unobligated.
Many jurisdictions reported facing challenges, partly related to state
and local administrative processes, that slowed their obligation and
expenditure of bioterrorism funds. These challenges included workforce
issues such as hiring freezes and difficulty recruiting qualified
staff; contracting and procurement processes to ensure the prudent use
of public funds; and lengthy information technology upgrades. Some
jurisdictions found ways to simplify administrative processes to
expedite the obligation and expenditure of funds.
In assessing the pace at which jurisdictions are expending Bioterrorism
funds, it is useful to consider that responsible use of public funds
requires careful and often time-consuming planning before funds are
obligated and expended. In addition, it is important to recognize that
some expenditures take place over a period of time, which also can
affect the speed at which jurisdictions expend funds.
We provided a draft of this report to HHS for comment, and the agency
informed us that it had no comments on the draft report.
Background:
The Bioterrorism cooperative agreement program spans five budget
periods and is scheduled to end August 30, 2005. Under this program,
CDC has made funds available through cooperative agreements with all 50
states, the District of Columbia, and three of the country's largest
municipalities--New York City, Chicago, and Los Angeles County. CDC has
distributed funds to these jurisdictions using a formula under which
each jurisdiction receives a base amount of $5 million, plus additional
funds based on the jurisdiction's population.[Footnote 16] The
program's budget periods typically run from August 31 of one year to
August 30 of the next, although the third budget period was extended to
run from August 31, 2001, to August 30, 2003. (See table 1 for more
information on the budget periods discussed in this report.) Under its
cooperative agreement, a jurisdiction is required to obligate funds
before the end of the specified budget period and expend funds before
the end of the 12 months following that period. However, CDC may give a
jurisdiction permission to obligate or expend funds beyond those time
frames.
Table 1: Bioterrorism Program Budget Periods:
Budget period calendar dates;
Budget period 3: 8/31/01 to 8/30/03;
Budget period 4: 8/31/03 to 8/30/04;
Budget period 5: 8/31/04 to 8/30/05.
Federal fiscal year funds used for each budget period;
Budget period 3: Fiscal year 2001 and fiscal year 2002;
Budget period 4: Fiscal year 2003;
Budget period 5: Fiscal year 2004.
Source: GAO analysis of HHS documents.
Note: The federal fiscal year runs from October 1 through September 30.
For example, federal fiscal year 2002 ran from October 1, 2001, through
September 30, 2002.
[End of table]
CDC's Procurement and Grants Office (PGO) is responsible for awarding
and administering CDC's grants and cooperative agreements. In this
capacity, PGO is responsible for notifying the jurisdictions, through
an NCA, of the funds awarded for each budget period. In addition to
notifying the jurisdictions, PGO also provides this information to
CDC's Financial Management Office (FMO), which processes CDC's grant
awards and cooperative agreements. FMO works with DPM to place the
cooperative agreement funds into the appropriate accounts and to ensure
that jurisdictions have access to their Bioterrorism funds through
PMS's accounts. CDC's Office of Terrorism Preparedness and Emergency
Response, which coordinates emergency response and preparedness across
CDC, is responsible for the programmatic components of the program and
also works with PGO and FMO to provide direct assistance to
jurisdictions on request. To monitor the use of the Bioterrorism funds,
CDC requires that jurisdictions submit regular progress reports that
track their progress toward completing a set of activities.[Footnote
17] Jurisdictions are also required to submit annual FSRs that provide
information on the expenditure and obligation of Bioterrorism funds. In
addition, DPM monitors the funds drawn down by jurisdictions from PMS,
and jurisdictions must submit quarterly federal cash transaction
reports to DPM.
Jurisdictions Have Expended over Four-Fifths of Fiscal Year 2002 Funds
and over Half of Fiscal Year 2003 Funds:
Jurisdictions had expended a substantial amount of fiscal year 2002 and
2003 program funds as of August 30, 2004. They had expended over four-
fifths of the fiscal year 2002 funds awarded through the HHS P accounts
for the program's third budget period and over half of the fourth
budget period funds awarded through the HHS P accounts. As allowed by
CDC's cooperative agreements, jurisdictions continued to expend fiscal
year 2002 funds after the end of the third budget period in August 2003
and have continued to expend funds awarded during the fourth budget
period since the end of that period.
Over 80 Percent of 2002 Bioterrorism Funds Were Expended over the
Course of the Third and Fourth Budget Periods:
As of August 30, 2004, jurisdictions had expended 85 percent of the
fiscal year 2002 funds awarded through the PMS P accounts for the
Bioterrorism program's third budget period.[Footnote 18] There was
considerable variation among jurisdictions' expenditure rates, with
individual jurisdictions' rates ranging from a high of 100 percent to a
low of 27 percent. Ten jurisdictions had expended all fiscal year 2002
funds in the P accounts, and 22 had expended over 90 percent. Three
jurisdictions, Delaware, the District of Columbia, and Massachusetts,
had expended less than half of their funds. (See fig. 1 for information
on the third budget period's fiscal year 2002 funds expended as of
August 30, 2004. App. II provides additional data.)
Jurisdictions continued, as authorized, to expend the third budget
period's fiscal year 2002 P account funds over the course of the
following budget period to pay for obligations incurred during the
third budget period, such as contracts that extended beyond August
2003. Although jurisdictions had expended only 56 percent of the third
budget period's fiscal year 2002 P account funds by the end of that
budget period, they had expended 85 percent of the funds as of August
30, 2004, the end of the fourth budget period. No jurisdiction had
expended all its fiscal year 2002 P account funds by the end of the
third budget period--individual expenditure rates ranged from 4 percent
to 87 percent. (See fig. 1 for information on the third budget period's
fiscal year 2002 funds expended from the P accounts as of August 30,
2003. App. II provides additional data.)
Figure 1: Expenditure Rates of the Third Budget Period's Fiscal Year
2002 Bioterrorism Program Funds from P Accounts, by Jurisdiction, as of
August 30, 2003, and August 30, 2004:
[See PDF for image]
Note: Data from the PMS P accounts do not include all funds awarded to
jurisdictions through the Bioterrorism program. For example, while the
program's third budget period was a 24-month period, extending from
August 31, 2001, to August 30, 2003, and using funds from both fiscal
year 2001 and fiscal year 2002, these expenditure rates reflect only
fiscal year 2002 funds. In addition, the P accounts do not include
funds for the Strategic National Stockpile awarded after fiscal year
2002, funds carried over from budget periods prior to the third budget
period, or funds provided to jurisdictions as direct assistance.
[End of figure]
Over Half of 2003 Bioterrorism Funds Were Expended over the Course of
the Fourth Budget Period:
As of August 30, 2004--the end of the fourth budget period--
jurisdictions had expended 53 percent of the fiscal year 2003
bioterrorism funds awarded through the P accounts for that
period.[Footnote 19] As with fiscal year 2002 funds awarded during the
third budget period, there is variation in individual jurisdictions'
rates of expenditure, which ranged from 93 percent to zero. While
expenditure rates varied, 15 jurisdictions had expended at least two-
thirds of the 2003 funds awarded through the P accounts for the fourth
budget period. (See fig. 2 for information on the fourth budget
period's funds expended from the P accounts. App. III provides
additional data.) While slightly over half of the fourth budget
period's funds in the P accounts had been expended as of August 30,
2004, jurisdictions have continued to expend these funds during the
current budget period--August 31, 2004, to August 30, 2005. The pattern
of expenditure for budget period four funds was similar to that of
budget period three; in both cases, jurisdictions expended just over
half their funds during the budget period and continued to expend the
funds during the next budget period.
Figure 2: Expenditure Rates of the Fourth Budget Period's Fiscal Year
2003 Bioterrorism Program Funds from P Accounts, by Jurisdiction, as of
August 30, 2004:
[See PDF for image]
Note: The program's fourth budget period was a 12-month period,
extending from August 31, 2003, to August 30, 2004, and using fiscal
year 2003 funds. However, data in the PMS P accounts do not include all
funds awarded to the jurisdictions through the Bioterrorism program.
For example, the P accounts do not include funds for the Strategic
National Stockpile awarded after fiscal year 2002 or funds carried over
from budget periods prior to the emergency supplemental appropriation
issued in fiscal year 2002. In addition, the PMS P accounts do not
include funds provided to jurisdictions as direct assistance.
[End of figure]
Few Bioterrorism Funds Remained Unobligated, According to Jurisdiction
Reports:
At the end of the Bioterrorism program's third budget period,
jurisdictions reported that less than one-sixth of fiscal year 2001 and
2002 funds awarded for that period remained unobligated. Similarly, as
of August 1, 2004, jurisdictions estimated that approximately one-fifth
of fiscal year 2003 funds awarded for the program's fourth budget
period would remain unobligated as of August 30, 2004, the end of that
period.
Jurisdiction Reports Indicate That Less Than One-Sixth of Third Budget
Period Funds Remained Unobligated:
According to the jurisdictions' annual FSRs and NCAs, as of the end of
the third budget period (August 31, 2001, to August 30, 2003),[Footnote
20] 14 percent of all bioterrorism funds awarded for that period
remained unobligated.[Footnote 21] As with expenditure rates,
individual jurisdictions' rates of unobligated funds varied, ranging
from none to over three-fifths of the awarded funds. Seven
jurisdictions reported that all their funds from that period had been
obligated, and 44 jurisdictions reported that less than one-quarter of
their third budget period funds remained unobligated. Two
jurisdictions, the District of Columbia and Massachusetts, reported the
highest levels of unobligated third budget period funds--62 percent and
51 percent, respectively. (See fig. 3 for more information on
jurisdiction-reported unobligated Bioterrorism funds. App. IV provides
additional data.)
Figure 3: Unobligated Third and Fourth Budget Period Bioterrorism Funds
Reported by Jurisdictions (percentage):
[See PDF for image]
Note: The total funding awarded includes all funding provided to
jurisdictions as financial assistance through the cooperative
agreement, including funds related to the Strategic National Stockpile
and all funds carried over from prior fiscal years. These data do not
include funds provided as direct assistance.
[A] The program's third budget period was a 24-month period, extending
from August 31, 2001, to August 30, 2003, and encompassing both fiscal
year 2001 and fiscal year 2002 funds. Data on unobligated balances for
this period are based on the FSRs submitted after the end of the budget
period.
[B] The program's fourth budget period was a 12-month period, extending
from August 31, 2003, to August 30, 2004, and using fiscal year 2003
funds. Data on unobligated balances for this period are based on the
estimated FSRs submitted prior to the end of the budget period.
[End of figure]
Jurisdiction Estimates Indicated That One-Fifth of Fourth Budget Period
Funds Remained Unobligated:
According to jurisdiction estimates as of August 1, 2004, approximately
20 percent of all Bioterrorism funds awarded for the program's fourth
budget period (August 31, 2003, to August 30, 2004) would remain
unobligated as of August 30, 2004.[Footnote 22] Jurisdictions'
individual estimated unobligated balances varied greatly, ranging from
none to almost three-quarters of the awarded funds. Five jurisdictions
estimated that all their fourth budget period's funds would be
obligated by the end of the period, and 31 jurisdictions estimated that
less than one-quarter of their fourth budget period's funds would
remain unobligated. Three jurisdictions, Chicago, New Mexico, and
Delaware, estimated that over half of the Bioterrorism funds awarded to
them for the fourth budget period would remain unobligated as of August
30, 2004. (See fig. 3 for more information on jurisdiction-reported
unobligated Bioterrorism funds. App. IV provides additional data.)
Jurisdictions Identified Administrative Processes and Other Challenges
to Obligation and Expenditure, and Some Jurisdictions Described
Solutions:
Many jurisdictions faced challenges, partly related to state and local
administrative processes, that slowed the pace of their obligation and
expenditure of bioterrorism funds. Reported challenges included
workforce issues, contracting and procurement processes to ensure the
prudent use of public funds, and problems stemming from lengthy
information technology upgrades. Some jurisdictions have developed ways
to streamline these administrative processes, facilitating the
obligation and expenditure of funds.
Jurisdictions Reported Challenges to Obligation and Expenditure:
State and municipal officials told us that the obligation and
expenditure of funds were delayed during the Bioterrorism program's
third and fourth budget periods for a variety of reasons, including
issues related to the workforce, contracting and procurement, and
information technology upgrades.
Workforce:
Officials in 16 of 19 jurisdictions we contacted cited workforce issues
related to recruitment and retention and complex staffing processes as
challenges to timely obligation and expenditure of bioterrorism funds.
According to the Association of State and Territorial Health Officials,
75 to 80 percent of bioterrorism funds have been used for personnel
expenditures.
Seven jurisdiction officials we contacted reported difficulties in
recruiting staff, and some officials reported staff retention problems.
As we previously reported,[Footnote 23] such barriers included
noncompetitive salaries and a general shortage of people with the
necessary skills. Officials told us they had difficulty finding
qualified workers, particularly epidemiologists and laboratory
technicians, and two officials indicated that problems related to
recruiting have delayed the expenditure of funds. In one of those
jurisdictions, the public health laboratory had so many vacancies that
there were not enough staff to fully implement a new bioterrorism and
emergency preparedness initiative. Officials indicated that, within
their jurisdictions, skilled workers could find better-paying positions
with other organizations. In one case, a municipality had to persuade a
job candidate to take a significant pay cut to work on the program. In
another instance, the salaries offered by a federal agency within a
state were about 25 percent higher than those offered by the state. The
same state reported that competition from the private sector and other
agencies has resulted not only in a shortage of qualified applicants
for positions, but also in the loss of highly qualified personnel who
had gained extensive experience and expertise working for the state.
Hiring freezes and complex staffing processes were also cited as
delaying the obligation and expenditure of funds. According to
jurisdiction officials with whom we spoke, as well as officials from
the National Association of County and City Health Officials, program
officials in some jurisdictions were not permitted to hire staff during
an across-the-board freeze, regardless of the federal funding
available. Moreover, jurisdiction officials reported that in some cases
the release of a hiring freeze inundated the hiring process,
lengthening it in one state to as long as 10 months. Jurisdiction
officials stated that other staffing constraints also hindered their
hiring process. One state mandated mass layoffs in December 2002, which
resulted in the loss of approximately 60 health agency employees,
including the entire unit that was handling bioterrorism contracts.
This was followed in early 2003 by an early retirement plan that
resulted in the loss of support staff for the cooperative agreement.
The layoffs and early retirement program delayed bioterrorism contract
payments. Moreover, employees who had been laid off had contractual
rights to placement in new positions, which resulted in the placement
into bioterrorism program positions of some employees with little or no
background in public health. Some fiscal support positions remained
unfilled for several months as a result of the layoffs and early
retirement program, which in turn affected the state's ability to
process bioterrorism program payments.
Contracting and Procurement:
Because expenditures related to contracting for services and procuring
equipment can occur after the end of a given budget period, program
officials stressed the importance of being able to expend obligated
funds up to 12 months beyond the budget period, as CDC allows for in
this program. To illustrate the importance of such an allowance, one
official gave the example of a contract for $100,000 that began in June
2003, during the third budget period. Under the terms of the contract,
the contractor would bill the program quarterly. The state in question
would draw down funds for the contract from PMS on a quarterly
basis.[Footnote 24] If the program received the first bill of $25,000
in September 2003, the first drawdown related to this contract would
occur in December 2003 and subsequent drawdowns would occur in March
2004, June 2004, and September 2004, all within the next budget period.
Jurisdiction officials provided a number of examples of the complexity
of their jurisdictions' contracting processes and the resulting effect
on obligations and expenditures.[Footnote 25] An official in one state
reported that the state had to negotiate and develop contracts with
over 100 local health agencies after it received an influx of funding
during the Bioterrorism program's third budget period. After the local
health contracts were developed, they needed approval by the
municipalities or health district boards, a process that in some cases
took several months. Another state indicated that its contracting
process takes a minimum of 2 months. Yet another stated that the
process could take from 3 to 6 months, depending on which complexities
arise. In addition, officials reported that the request for proposals
(RFP) process and bidding requirements delayed their ability to create
contracts and orders for services and equipment. In one state, the RFP
process takes 4 to 7 months, while in another the process can take as
long as 9 months.
The necessity of developing large infrastructure projects related to
the bioterrorism preparedness cooperative agreement has also had an
effect on obligations and expenditures in a number of jurisdictions.
These projects, such as setting up a syndromic surveillance[Footnote
26] system, require the assistance and expertise of a limited number of
national contractors. A state official informed us that since many of
the jurisdictions began these projects at the same time--after the
influx of fiscal year 2002 funds during the third budget period--some
jurisdictions have had to wait for these contractors to become
available. Therefore, some jurisdictions have had to wait to receive
services and equipment, in effect delaying both obligations and
expenditures. In addition, jurisdictions indicated that effective
planning or the development of RFPs for these large projects required
extended periods of time. One official told us the state health
department went through a careful planning process in order to ensure
the proper use of funds, consequently delaying the obligation and
expenditure of funds.
Information Technology Upgrades:
Several jurisdictions reported that their efforts to upgrade their
information technology--a focus area of the Bioterrorism program--
delayed program expenditures. Officials in four jurisdictions noted
that it took time to plan and implement improvements in information
technology systems and equipment. For example, in one state, the
installation of each piece of equipment, including new computer systems
and videoconferencing equipment, required a site survey by the state's
Department of General Services to assess the feasibility of the
proposed location to house the equipment. These site surveys could take
anywhere from 2 to 12 months to complete.
In another state, an official reported that funds were designated to
support the state's Internet connectivity to provide local public
health agencies and their public health partners with continuous, high-
speed Internet access. Because significant areas of the state did not
have access to high-speed Internet services, the state conducted
engineering studies, which delayed distribution of funds to local
public health agencies.
Some Jurisdictions Have Streamlined Administrative Processes to
Facilitate Obligation and Expenditure of Funds:
While officials described challenges to quickly obligating and
expending bioterrorism funds, some also described techniques they had
developed to address workforce and procurement issues. Officials in
three jurisdictions indicated that being exempted from hiring freezes
expedited the obligation of funds. In one case the jurisdiction
exempted bioterrorism positions from hiring freezes and also gave these
positions the highest priority for hiring. According to another state
official, many of the program staff were hired as contractual or "at
will" employees, to bypass the state's lengthy hiring process. Another
state, which was reluctant to hire permanent full-time program staff
because of concern about the sustainability of federal
funding,[Footnote 27] employed temporary staff instead.
Some officials also described techniques they had developed to address
challenges related to procurement issues. Prior to receiving fiscal
year 2002 funds during the program's third budget period, one
jurisdiction's program elected to use a nonprofit fiscal and
administrative intermediary to reduce the delays caused by the
municipality's regulations. A program official told us that using the
intermediary also allowed the program to expedite the routine processes
of recruitment, contracting, purchasing, and ensuring fiscal
accountability. According to the official, the intermediary has a long
history of collaborating with that health agency to quickly and
successfully implement new initiatives and is experienced in grant
management. The official stated that the intermediary has reduced the
time that it takes to implement program procedures because it does not
have to follow the municipality's normal requirements.[Footnote 28] For
instance, unlike the health agency, the intermediary is not subject to
certain municipal contracting and procurement requirements.
Consequently, it is able to use statewide general services contracts
that can have as little as a 2-day turnaround. In addition, the
intermediary has reduced the municipality's RFP process from the usual
6 months to 2 months.
One state official indicated that the state health agency had made a
concerted effort to streamline its procurement process. Prior to this
effort, the procurement process had taken as long as 18 months,
including time for the development and distribution of an RFP and for
appeals. The official said that one of the major improvements involved
compiling a list of preapproved contractors, which enables bioterrorism
program officials to purchase directly from those contractors without
going through the time-consuming RFP process.
Another official told us that the health agency staff can place orders
and contracts more rapidly than usual if they designate them as "sole
source" and "single source" procurement, meaning that the needed
equipment or service is available from only one vendor. The official
indicated that the state's bioterrorism program uses this designation
whenever they can demonstrate that only one vendor can provide the
equipment or service. Additionally, the state has "master price"
agreements with some vendors for certain goods and services that are
commonly needed by the various agencies in the state. The official said
that staff can quickly place orders for goods and services that fall
under the master price agreement and receive these items in 2 to 4 days.
Concluding Observations:
After the terrorist events of 2001, HHS's funding to help jurisdictions
prepare for and defend against a possible bioterrorism attack greatly
increased. In 2004, HHS expressed concern that jurisdictions had not
moved quickly enough to use these funds. However, jurisdictions
expended and obligated a substantial amount of program funds as of
August 30, 2004. In assessing the pace at which jurisdictions are
spending these funds, it is useful to consider that prudent use of
public funds--particularly for new programs--requires careful and often
time-consuming planning. Once plans have been developed, obligating and
expending the funds to implement them takes additional time. It is also
important to recognize that because some expenditures, such as those
for contracts, take place over a period of time rather than as one lump
sum early in the budget period, it may take longer than the program's
budget period to expend these funds. Furthermore, jurisdictions face
additional challenges to quickly obligating and expending funds, partly
related to various administrative processes, although some
jurisdictions have found ways to streamline certain processes.
Agency Comments:
We provided a draft of this report to HHS for comment, and the agency
informed us it had no comments on the draft report. However, HHS
provided technical comments, which we incorporated into the report as
appropriate.
As we arranged with your office, 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 to the
Secretary of Health and Human Services, the Director of the Centers for
Disease Control and Prevention, appropriate congressional committees,
and other interested parties. We will also make copies available to
others who are interested upon request. In addition, the report will be
available at no charge on the GAO Web site at http://www.gao.gov.
If you or your staffs have any questions about this report, please call
Marjorie Kanof at (202) 512-7114. Major contributors to this report are
listed in appendix V.
Signed by:
Janet Heinrich:
Director, Health Care--Public Health Issues:
[End of section]
Appendix I: Scope and Methodology:
For the Department of Health and Human Services (HHS) Centers for
Disease Control and Prevention's (CDC) Public Health Preparedness and
Response for Bioterrorism program cooperative agreement, we provide
information on the extent to which jurisdictions had expended fiscal
year 2002 funds awarded for the third budget period as of August 30,
2003, and August 30, 2004, and had expended fiscal year 2003 funds
awarded for the fourth budget period as of August 30, 2004. We also
provide information on the extent to which fiscal year 2001, 2002, and
2003 Bioterrorism funds awarded for the program's third and fourth
budget periods were obligated, and challenges jurisdictions have faced
when attempting to expend or obligate the Bioterrorism funds. To
provide information on the expenditure and obligation of Bioterrorism
program funds awarded to jurisdictions, we analyzed documents and
interviewed officials from HHS's Office of the Secretary, CDC, Division
of Payment Management (DPM), and Office of the Inspector General (OIG).
In addition, we reviewed documents and interviewed officials from the
Association of State and Territorial Health Officials and the National
Association of County and City Health Officials, two national
associations representing state and local health officials. We also
interviewed jurisdiction audit and Bioterrorism program officials to
obtain information on program obligations and to determine challenges
faced by jurisdictions in expending and obligating funds, and reviewed
documents from the Congressional Research Service, the Association of
Public Health Laboratories, and other organizations.
To determine expenditures as of August 30, 2003, and August 30, 2004,
we analyzed expenditure data from DPM's Payment Management System
(PMS). We obtained and reviewed data from both the public assistance
(P) accounts and the general (G) accounts.[Footnote 29] Funds accounted
for in the P accounts are specific to certain grants or agreements,
while G accounts merge funds from grants and agreements made to one
grantee into one overall account. While over 90 percent of funds
awarded to jurisdictions through the Bioterrorism program are tracked
in P accounts,[Footnote 30] some funds are tracked in the G accounts,
including all unexpended funds from budget periods prior to the fiscal
year 2002 funds awarded during the third budget period and funds
related to the Strategic National Stockpile before and after fiscal
year 2002.[Footnote 31] Because expenditures from the G accounts
related to a specific grant or agreement cannot be linked to funds from
specific budget periods, we are not able to describe the rates of
expenditure of Bioterrorism funds tracked in the G accounts. Moreover,
because all funds awarded to jurisdictions prior to the fiscal year
2002 funds are tracked in the G accounts, we are not able to account
for all expenditures during the program's third budget period--August
31, 2001, to August 30, 2003. Rather, we are able to track expenditures
for only the second portion of that budget period, starting with the
fiscal year 2002 emergency supplemental appropriation.[Footnote 32]
Expenditure data provided in this report were obtained from PMS's P
accounts and include only funds awarded as financial assistance
beginning with the fiscal year 2002 emergency supplemental
appropriation.[Footnote 33] (See table 2 for information on funding
included in the data sources reviewed.) The OIG annually contracts for
an audit that provides reasonable assurance about the design of
controls included in DPM's PMS, including controls for recording award
authorizations, processing awardee requests for funds, and reporting
payment and recipient disbursement information to the awarding
agency.[Footnote 34] We did not conduct a review to determine the
appropriateness of any jurisdiction expenditure.
Table 2: Funds Included in Sources of Bioterrorism Expenditure and
Obligation Data:
Fiscal year 2001 funds;
Bioterrorism funds tracked through the notices of cooperative
agreement;
Bioterrorism funds tracked through the financial status reports.
Fiscal year 2002 funds;
Bioterrorism funds tracked through the PMS P accounts;
Bioterrorism funds tracked through the notices of cooperative
agreement;
Bioterrorism funds tracked through the financial status reports.
Fiscal year 2003 funds;
Bioterrorism funds tracked through the PMS P accounts;
Bioterrorism funds tracked through the notices of cooperative
agreement;
Bioterrorism funds tracked through the financial status reports.
Funds carried forward from budget periods prior to fiscal year 2001;
Bioterrorism funds tracked through the notices of cooperative
agreement;
Bioterrorism funds tracked through the financial status reports.
Funds carried forward from fiscal year 2001[A];
Bioterrorism funds tracked through the notices of cooperative
agreement;
Bioterrorism funds tracked through the financial status reports.
Strategic National Stockpile funds;
Bioterrorism funds tracked through the PMS P accounts: [B];
Bioterrorism funds tracked through the notices of cooperative
agreement;
Bioterrorism funds tracked through the financial status reports.
Source: GAO analysis of HHS documents.
Note: The Notice of Cooperative Agreement also includes data on funds
awarded as direct assistance. We did not include those funds in our
analysis.
[A] Data on funds carried forward from fiscal year 2001 are only
included in the Notices of Cooperative Agreement and the Financial
Status Reports from the fourth budget period forward.
[B] Fiscal year 2002 Strategic National Stockpile Funds are tracked
through the P accounts.
[End of table]
To determine obligation data, we reviewed the financial status reports
(FSR) jurisdictions were required to submit to CDC at the end of the
third budget period (August 31, 2001, to August 30, 2003) and the
estimated FSRs for the fourth budget period (August 31, 2003, to August
30, 2004) that jurisdictions were requested to submit by August 1,
2004. Unlike PMS's P account data, the FSRs include information on all
Bioterrorism funds awarded as financial assistance, including both
fiscal year 2001 and 2002 funds awarded during the third budget period,
funds carried over from prior periods, and funds related to the
Strategic National Stockpile. Along with FSRs for the entire third
budget period, CDC asked jurisdictions to submit FSRs reflecting only
the fiscal year 2002 emergency supplemental appropriation funds.
However, because few jurisdictions submitted such emergency
supplemental FSRs, we were unable to use these FSRs. Because of this,
we are reporting on obligation data obtained from the FSRs for the
entire third budget period, encompassing both fiscal year 2001 and 2002
funds; this is a different period from that used for the expenditure
data provided in this report, which describe only expenditures of the
third budget period's fiscal year 2002 funds. Final FSRs for the fourth
budget period were not available in sufficient time to be used in our
work. For this period, we used the estimated FSRs jurisdictions were
asked to submit prior to the end of the budget period. While the
unobligated amounts reported on the final FSR may vary from the
estimates, CDC determined that these estimates were sufficiently
accurate to use for planning purposes. Seven jurisdictions did not
submit an estimated FSR, but did provide information in their
application for budget period five funds on estimated unobligated
balances as of August 30, 2004. Eight jurisdictions did not provide any
information on estimated unobligated balances and were excluded from
our analysis.[Footnote 35]
In addition to reviewing jurisdictions' FSRs, we also reviewed the
Notices of Cooperative Agreement (NCA), which are provided by CDC to
jurisdictions and provide information on total Bioterrorism program
funds awarded to them for a budget period. Unlike the PMS P account
data, the NCAs include information on all funds awarded for the
program's entire third budget period, including funds from both fiscal
years 2001 and 2002, and information on funds carried over from
previous periods, funds related to the Strategic National Stockpile,
and funds awarded as direct assistance.[Footnote 36] To determine
obligation rates, we compared the information on total funds awarded
obtained from the NCAs and FSRs to obligation data that jurisdictions
reported in the third budget period FSRs and estimated in the fourth
budget period FSRs.
We interviewed CDC staff to resolve any inconsistencies between the
information provided on the FSRs and information provided in the NCAs
and modified data as appropriate. In addition, because the data related
to obligation are self-reported by jurisdictions to CDC, we interviewed
officials at CDC and HHS's OIG to obtain information on any work done
to determine the reliability of these data. We also contacted the
jurisdiction audit agencies in all the jurisdictions by e-mail or
telephone to determine whether they had performed any work to determine
the reliability of the obligation data. Data for the third budget
period from 18 jurisdictions and for the fourth budget period from 1
jurisdiction can be considered reliable based on the work of OIG and
jurisdiction audit agencies.[Footnote 37] However, in many cases,
insufficient work had been done to assess the reliability of the
obligation data reported by jurisdictions. In these cases, the
information presented is as reported by the jurisdictions, and we
cannot attest to its reliability. In addition, we did not conduct a
review to determine the appropriateness of any obligations reported by
jurisdictions to CDC.
To describe factors that jurisdictions say contributed to delays in
obligating and expending funds and actions some jurisdictions took to
address those factors, we contacted selected jurisdictions via e-mail
in two phases. Initially, the team contacted 10 jurisdictions to gather
information on why they may have had unobligated Bioterrorism
funds.[Footnote 38] We analyzed the obligation and expenditure data to
identify jurisdictions with high and low rates of unobligated and
unexpended Bioterrorism funds, for both the third and fourth budget
periods. Jurisdictions were categorized as those with (1) reported high
unobligated balances, (2) reported low unobligated balances, or (3)
reported low unobligated balances and high levels of unexpended funds.
We then selected jurisdictions from each of the groups, taking into
account diversity in geographic location, population size, urban and
rural status, and their expenditure and obligation patterns. We e-
mailed each jurisdiction, and we followed up by telephone to obtain any
necessary clarification on responses.
For phase 2, we e-mailed 3 jurisdictions from the phase 1 group and 9
additional jurisdictions. These 12 jurisdictions had expended from 50
to 87 percent of their third budget period funds by August 30, 2003,
the end of that period, but had expended 100 percent of those funds by
August 30, 2004.[Footnote 39] We followed up by telephone and e-mail to
obtain any necessary clarification on responses.
[End of section]
Appendix II: Bioterrorism Program's Budget Period Three Expenditures:
Table 3: Public Health Preparedness and Response for Bioterrorism
Program's Budget Period Three Fiscal Year 2002 Funds Expended from P
Accounts, by Jurisdiction, as of August 30, 2003, and August 30, 2004:
Jurisdiction: Alabama;
P account funds: $14,900,443;
Percentage of P account funds expended as of August 30, 2003: 70%;
Percentage of P account funds expended as of August 30, 2004: 94%.
Jurisdiction: Alaska;
P account funds: $6,350,514;
Percentage of P account funds expended as of August 30, 2003: 61%;
Percentage of P account funds expended as of August 30, 2004: 100%.
Jurisdiction: Arizona;
P account funds: $16,422,170;
Percentage of P account funds expended as of August 30, 2003: 56%;
Percentage of P account funds expended as of August 30, 2004: 89%.
Jurisdiction: Arkansas;
P account funds: $11,425,317;
Percentage of P account funds expended as of August 30, 2003: 55%;
Percentage of P account funds expended as of August 30, 2004: 87%.
Jurisdiction: California[A];
P account funds: $56,806,825;
Percentage of P account funds expended as of August 30, 2003: 56%;
Percentage of P account funds expended as of August 30, 2004: 87%.
Jurisdiction: Colorado;
P account funds: $14,475,766;
Percentage of P account funds expended as of August 30, 2003: 62%;
Percentage of P account funds expended as of August 30, 2004: 89%.
Jurisdiction: Connecticut;
P account funds: $10,366,586;
Percentage of P account funds expended as of August 30, 2003: 56%;
Percentage of P account funds expended as of August 30, 2004: 85%.
Jurisdiction: Chicago;
P account funds: $11,447,312;
Percentage of P account funds expended as of August 30, 2003: 65%;
Percentage of P account funds expended as of August 30, 2004: 100%.
Jurisdiction: Delaware;
P account funds: $6,744,505;
Percentage of P account funds expended as of August 30, 2003: 30%;
Percentage of P account funds expended as of August 30, 2004: 50%.
Jurisdiction: District of Columbia;
P account funds: $11,273,558;
Percentage of P account funds expended as of August 30, 2003: 20%;
Percentage of P account funds expended as of August 30, 2004: 27%.
Jurisdiction: Florida;
P account funds: $40,581,081;
Percentage of P account funds expended as of August 30, 2003: 76%;
Percentage of P account funds expended as of August 30, 2004: 97%.
Jurisdiction: Georgia;
P account funds: $24,045,179;
Percentage of P account funds expended as of August 30, 2003: 26%;
Percentage of P account funds expended as of August 30, 2004: 86%.
Jurisdiction: Hawaii;
P account funds: $7,546,593;
Percentage of P account funds expended as of August 30, 2003: 57%;
Percentage of P account funds expended as of August 30, 2004: 89%.
Jurisdiction: Idaho;
P account funds: $7,880,688;
Percentage of P account funds expended as of August 30, 2003: 63%;
Percentage of P account funds expended as of August 30, 2004: 82%.
Jurisdiction: Illinois[A];
P account funds: $26,101,381;
Percentage of P account funds expended as of August 30, 2003: 63%;
Percentage of P account funds expended as of August 30, 2004: 86%.
Jurisdiction: Indiana;
P account funds: $18,491,799;
Percentage of P account funds expended as of August 30, 2003: 25%;
Percentage of P account funds expended as of August 30, 2004: 63%.
Jurisdiction: Iowa;
P account funds: $11,110,544;
Percentage of P account funds expended as of August 30, 2003: 62%;
Percentage of P account funds expended as of August 30, 2004: 98%.
Jurisdiction: Kansas;
P account funds: $10,985,143;
Percentage of P account funds expended as of August 30, 2003: 87%;
Percentage of P account funds expended as of August 30, 2004: 100%.
Jurisdiction: Kentucky;
P account funds: $13,937,647;
Percentage of P account funds expended as of August 30, 2003: 47%;
Percentage of P account funds expended as of August 30, 2004: 62%.
Jurisdiction: Los Angeles County;
P account funds: $24,511,171;
Percentage of P account funds expended as of August 30, 2003: 20%;
Percentage of P account funds expended as of August 30, 2004: 52%.
Jurisdiction: Louisiana;
P account funds: $14,949,145;
Percentage of P account funds expended as of August 30, 2003: 65%;
Percentage of P account funds expended as of August 30, 2004: 100%.
Jurisdiction: Maine;
P account funds: $8,203,236;
Percentage of P account funds expended as of August 30, 2003: 48%;
Percentage of P account funds expended as of August 30, 2004: 65%.
Jurisdiction: Maryland;
P account funds: $16,791,405;
Percentage of P account funds expended as of August 30, 2003: 56%;
Percentage of P account funds expended as of August 30, 2004: 100%.
Jurisdiction: Massachusetts;
P account funds: $19,134,801;
Percentage of P account funds expended as of August 30, 2003: 4%;
Percentage of P account funds expended as of August 30, 2004: 27%.
Jurisdiction: Michigan;
P account funds: $27,125,655;
Percentage of P account funds expended as of August 30, 2003: 64%;
Percentage of P account funds expended as of August 30, 2004: 89%.
Jurisdiction: Minnesota;
P account funds: $16,525,446;
Percentage of P account funds expended as of August 30, 2003: 82%;
Percentage of P account funds expended as of August 30, 2004: 97%.
Jurisdiction: Mississippi;
P account funds: $11,332,975;
Percentage of P account funds expended as of August 30, 2003: 54%;
Percentage of P account funds expended as of August 30, 2004: 59%.
Jurisdiction: Missouri;
P account funds: $17,456,448;
Percentage of P account funds expended as of August 30, 2003: 72%;
Percentage of P account funds expended as of August 30, 2004: 100%.
Jurisdiction: Montana;
P account funds: $7,008,529;
Percentage of P account funds expended as of August 30, 2003: 61%;
Percentage of P account funds expended as of August 30, 2004: 95%.
Jurisdiction: Nebraska;
P account funds: $8,809,733;
Percentage of P account funds expended as of August 30, 2003: 45%;
Percentage of P account funds expended as of August 30, 2004: 91%.
Jurisdiction: Nevada;
P account funds: $9,448,659;
Percentage of P account funds expended as of August 30, 2003: 49%;
Percentage of P account funds expended as of August 30, 2004: 86%.
Jurisdiction: New Hampshire;
P account funds: $7,451,193;
Percentage of P account funds expended as of August 30, 2003: 33%;
Percentage of P account funds expended as of August 30, 2004: 68%.
Jurisdiction: New Jersey;
P account funds: $23,732,611;
Percentage of P account funds expended as of August 30, 2003: 16%;
Percentage of P account funds expended as of August 30, 2004: 62%.
Jurisdiction: New Mexico;
P account funds: $9,049,686;
Percentage of P account funds expended as of August 30, 2003: 68%;
Percentage of P account funds expended as of August 30, 2004: 100%.
Jurisdiction: New York[A];
P account funds: $29,418,122;
Percentage of P account funds expended as of August 30, 2003: 55%;
Percentage of P account funds expended as of August 30, 2004: 92%.
Jurisdiction: New York City;
P account funds: $20,274,180;
Percentage of P account funds expended as of August 30, 2003: 70%;
Percentage of P account funds expended as of August 30, 2004: 99%.
Jurisdiction: North Carolina;
P account funds: $22,919,940;
Percentage of P account funds expended as of August 30, 2003: 60%;
Percentage of P account funds expended as of August 30, 2004: 97%.
Jurisdiction: North Dakota;
P account funds: $6,429,710;
Percentage of P account funds expended as of August 30, 2003: 35%;
Percentage of P account funds expended as of August 30, 2004: 96%.
Jurisdiction: Ohio;
P account funds: $30,803,150;
Percentage of P account funds expended as of August 30, 2003: 67%;
Percentage of P account funds expended as of August 30, 2004: 78%.
Jurisdiction: Oklahoma;
P account funds: $12,682,086;
Percentage of P account funds expended as of August 30, 2003: 61%;
Percentage of P account funds expended as of August 30, 2004: 83%.
Jurisdiction: Oregon;
P account funds: $12,616,956;
Percentage of P account funds expended as of August 30, 2003: 48%;
Percentage of P account funds expended as of August 30, 2004: 76%.
Jurisdiction: Pennsylvania;
P account funds: $32,340,936;
Percentage of P account funds expended as of August 30, 2003: 56%;
Percentage of P account funds expended as of August 30, 2004: 81%.
Jurisdiction: Rhode Island;
P account funds: $7,333,840;
Percentage of P account funds expended as of August 30, 2003: 50%;
Percentage of P account funds expended as of August 30, 2004: 100%.
Jurisdiction: South Carolina;
P account funds: $13,931,820;
Percentage of P account funds expended as of August 30, 2003: 71%;
Percentage of P account funds expended as of August 30, 2004: 79%.
Jurisdiction: South Dakota;
P account funds: $6,680,486;
Percentage of P account funds expended as of August 30, 2003: 62%;
Percentage of P account funds expended as of August 30, 2004: 89%.
Jurisdiction: Tennessee;
P account funds: $16,581,744;
Percentage of P account funds expended as of August 30, 2003: 72%;
Percentage of P account funds expended as of August 30, 2004: 100%.
Jurisdiction: Texas;
P account funds: $51,421,771;
Percentage of P account funds expended as of August 30, 2003: 56%;
Percentage of P account funds expended as of August 30, 2004: 100%.
Jurisdiction: Utah;
P account funds: $9,447,160;
Percentage of P account funds expended as of August 30, 2003: 59%;
Percentage of P account funds expended as of August 30, 2004: 99%.
Jurisdiction: Vermont;
P account funds: $6,355,413;
Percentage of P account funds expended as of August 30, 2003: 60%;
Percentage of P account funds expended as of August 30, 2004: 76%.
Jurisdiction: Virginia;
P account funds: $20,758,682;
Percentage of P account funds expended as of August 30, 2003: 61%;
Percentage of P account funds expended as of August 30, 2004: 82%.
Jurisdiction: Washington;
P account funds: $20,190,120;
Percentage of P account funds expended as of August 30, 2003: 56%;
Percentage of P account funds expended as of August 30, 2004: 87%.
Jurisdiction: West Virginia;
P account funds: $8,980,655;
Percentage of P account funds expended as of August 30, 2003: 76%;
Percentage of P account funds expended as of August 30, 2004: 86%.
Jurisdiction: Wisconsin;
P account funds: $16,940,986;
Percentage of P account funds expended as of August 30, 2003: 81%;
Percentage of P account funds expended as of August 30, 2004: 91%.
Jurisdiction: Wyoming;
P account funds: $6,430,629;
Percentage of P account funds expended as of August 30, 2003: 55%;
Percentage of P account funds expended as of August 30, 2004: 67%.
Jurisdiction: Total;
P account funds: $894,962,130;
Percentage of P account funds expended as of August 30, 2003: 56%;
Percentage of P account funds expended as of August 30, 2004: 85%.
Source: GAO analysis of Department of Health and Human Services
Division of Payment Services Payment Management System data.
Note: These data do not include all funds awarded to jurisdictions
through the Bioterrorism program. While the program's third budget
period was a 24-month period, extending from August 31, 2001, to August
30, 2003, and using funds from both fiscal years 2001 and 2002, these
expenditure data reflect only fiscal year 2002 funds. In addition, the
public assistance (P) accounts do not include funds awarded for the
Strategic National Stockpile awarded after fiscal year 2002. Those
funds are tracked in general (G) accounts, and cannot be tracked by a
specific budget period. The P accounts also do not include funds
provided to jurisdictions as direct assistance.
[A] Data on funds awarded to California, Illinois, and New York do not
include funds awarded to Los Angeles County, Chicago, or New York City.
[End of table]
[End of section]
Appendix III: Bioterrorism Program's Budget Period Four Expenditures:
Table 4: Public Health Preparedness and Response for Bioterrorism
Program's Budget Period Four Funds Expended from P Accounts, by
Jurisdiction, as of August 30, 2004:
Jurisdiction: Alabama;
P account funds: $15,138,887;
Percentage of P account funds expended as of August 30, 2004: 59%.
Jurisdiction: Alaska;
P account funds: $6,041,857;
Percentage of P account funds expended as of August 30, 2004: 75%.
Jurisdiction: Arizona;
P account funds: $17,586,381;
Percentage of P account funds expended as of August 30, 2004: 35%.
Jurisdiction: Arkansas;
P account funds: $10,664,828;
Percentage of P account funds expended as of August 30, 2004: 69%.
Jurisdiction: California[A];
P account funds: $61,994,981;
Percentage of P account funds expended as of August 30, 2004: 44%.
Jurisdiction: Chicago;
P account funds: $11,378,246;
Percentage of P account funds expended as of August 30, 2004: 37%.
Jurisdiction: Colorado;
P account funds: $15,048,945;
Percentage of P account funds expended as of August 30, 2004: 58%.
Jurisdiction: Connecticut;
P account funds: $12,450,843;
Percentage of P account funds expended as of August 30, 2004: 2%.
Jurisdiction: Delaware;
P account funds: $6,429,371;
Percentage of P account funds expended as of August 30, 2004: 27%.
Jurisdiction: District of Columbia;
P account funds: $10,877,012;
Percentage of P account funds expended as of August 30, 2004: 47%.
Jurisdiction: Florida;
P account funds: $43,372,308;
Percentage of P account funds expended as of August 30, 2004: 51%.
Jurisdiction: Georgia;
P account funds: $23,655,673;
Percentage of P account funds expended as of August 30, 2004: 0%.
Jurisdiction: Hawaii;
P account funds: $7,450,193;
Percentage of P account funds expended as of August 30, 2004: 70%.
Jurisdiction: Idaho;
P account funds: $7,639,590;
Percentage of P account funds expended as of August 30, 2004: 74%.
Jurisdiction: Illinois[A];
P account funds: $27,855,766;
Percentage of P account funds expended as of August 30, 2004: 67%.
Jurisdiction: Indiana;
P account funds: $18,869,769;
Percentage of P account funds expended as of August 30, 2004: 54%.
Jurisdiction: Iowa;
P account funds: $11,493,758;
Percentage of P account funds expended as of August 30, 2004: 44%.
Jurisdiction: Kansas;
P account funds: $10,948,648;
Percentage of P account funds expended as of August 30, 2004: 72%.
Jurisdiction: Kentucky;
P account funds: $13,766,539;
Percentage of P account funds expended as of August 30, 2004: 59%.
Jurisdiction: Los Angeles County;
P account funds: $27,263,067;
Percentage of P account funds expended as of August 30, 2004: 30%.
Jurisdiction: Louisiana;
P account funds: $15,137,245;
Percentage of P account funds expended as of August 30, 2004: 41%.
Jurisdiction: Maine;
P account funds: $7,474,025;
Percentage of P account funds expended as of August 30, 2004: 66%.
Jurisdiction: Maryland;
P account funds: $17,314,106;
Percentage of P account funds expended as of August 30, 2004: 64%.
Jurisdiction: Massachusetts;
P account funds: $19,721,554;
Percentage of P account funds expended as of August 30, 2004: 76%.
Jurisdiction: Michigan;
P account funds: $28,981,577;
Percentage of P account funds expended as of August 30, 2004: 79%.
Jurisdiction: Minnesota;
P account funds: $15,788,416;
Percentage of P account funds expended as of August 30, 2004: 93%.
Jurisdiction: Mississippi;
P account funds: $11,322,442;
Percentage of P account funds expended as of August 30, 2004: 59%.
Jurisdiction: Missouri;
P account funds: $17,908,941;
Percentage of P account funds expended as of August 30, 2004: 74%.
Jurisdiction: Montana;
P account funds: $7,147,269;
Percentage of P account funds expended as of August 30, 2004: 63%.
Jurisdiction: Nebraska;
P account funds: $8,624,463;
Percentage of P account funds expended as of August 30, 2004: 27%.
Jurisdiction: Nevada;
P account funds: $9,490,029;
Percentage of P account funds expended as of August 30, 2004: 55%.
Jurisdiction: New Hampshire;
P account funds: $7,164,384;
Percentage of P account funds expended as of August 30, 2004: 36%.
Jurisdiction: New Jersey;
P account funds: $24,725,667;
Percentage of P account funds expended as of August 30, 2004: 48%.
Jurisdiction: New Mexico;
P account funds: $9,342,376;
Percentage of P account funds expended as of August 30, 2004: 51%.
Jurisdiction: New York[A];
P account funds: $31,675,789;
Percentage of P account funds expended as of August 30, 2004: 50%.
Jurisdiction: New York City;
P account funds: $23,024,362;
Percentage of P account funds expended as of August 30, 2004: 71%.
Jurisdiction: North Carolina;
P account funds: $24,002,282;
Percentage of P account funds expended as of August 30, 2004: 44%.
Jurisdiction: North Dakota;
P account funds: $6,257,186;
Percentage of P account funds expended as of August 30, 2004: 49%.
Jurisdiction: Ohio;
P account funds: $31,484,830;
Percentage of P account funds expended as of August 30, 2004: 70%.
Jurisdiction: Oklahoma;
P account funds: $13,228,697;
Percentage of P account funds expended as of August 30, 2004: 41%.
Jurisdiction: Oregon;
P account funds: $13,237,862;
Percentage of P account funds expended as of August 30, 2004: 61%.
Jurisdiction: Pennsylvania;
P account funds: $33,719,067;
Percentage of P account funds expended as of August 30, 2004: 35%.
Jurisdiction: Rhode Island;
P account funds: $7,305,761;
Percentage of P account funds expended as of August 30, 2004: 44%.
Jurisdiction: South Carolina;
P account funds: $14,174,122;
Percentage of P account funds expended as of August 30, 2004: 65%.
Jurisdiction: South Dakota;
P account funds: $6,338,591;
Percentage of P account funds expended as of August 30, 2004: 43%.
Jurisdiction: Tennessee;
P account funds: $18,175,779;
Percentage of P account funds expended as of August 30, 2004: 59%.
Jurisdiction: Texas;
P account funds: $55,225,049;
Percentage of P account funds expended as of August 30, 2004: 44%.
Jurisdiction: Utah;
P account funds: $9,914,452;
Percentage of P account funds expended as of August 30, 2004: 70%.
Jurisdiction: Vermont;
P account funds: $6,246,379;
Percentage of P account funds expended as of August 30, 2004: 62%.
Jurisdiction: Virginia;
P account funds: $22,068,328;
Percentage of P account funds expended as of August 30, 2004: 66%.
Jurisdiction: Washington;
P account funds: $16,389,229;
Percentage of P account funds expended as of August 30, 2004: 59%.
Jurisdiction: West Virginia;
P account funds: $8,811,416;
Percentage of P account funds expended as of August 30, 2004: 65%.
Jurisdiction: Wisconsin;
P account funds: $17,361,226;
Percentage of P account funds expended as of August 30, 2004: 60%.
Jurisdiction: Wyoming;
P account funds: $5,839,684;
Percentage of P account funds expended as of August 30, 2004: 48%.
Jurisdiction: Total;
P account funds: $925,110,907;
Percentage of P account funds expended as of August 30, 2004: 53%.
Source: GAO analysis of Department of Health and Human Services
Division of Payment Services Payment Management System data.
Note: The program's fourth budget period was a 12-month period,
extending from August 31, 2003, to August 30, 2004, using fiscal year
2003 funds. The Payment Management System's public assistance (P)
accounts do not include funds for the Strategic National Stockpile
awarded after fiscal year 2002 or funds carried over from budget
periods prior to the emergency supplemental appropriation issued in
February 2002. In addition, the P accounts do not include funds
provided to jurisdictions as direct assistance.
[A] Funds awarded to California, Illinois, and New York do not include
funds awarded to Los Angeles County, Chicago, or New York City.
[End of table]
[End of section]
Appendix IV: Unobligated Bioterrorism Program Funds Reported by
Jurisdictions:
Table 5: Unobligated Public Health Preparedness and Response for
Bioterrorism Program Funds Reported by Jurisdictions, as of the End of
Each Budget Period:
Jurisdiction: Alabama[D];
Budget period three[A]: Total award[C]: $16,559,338;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 7%;
Budget period four[B]: Total award[C]: $16,786,043;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 18%.
Jurisdiction: Alaska[D];
Budget period three[A]: Total award[C]: $7,738,197;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 0%;
Budget period four[B]: Total award[C]: [E];
Budget period four[B]: Percentage of awarded funds reported
unobligated: [E].
Jurisdiction: Arizona[F];
Budget period three[A]: Total award[C]: $17,998,231;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 9%;
Budget period four[B]: Total award[C]: $20,377,936;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 12%.
Jurisdiction: Arkansas[F];
Budget period three[A]: Total award[C]: $12,612,579;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 16%;
Budget period four[B]: Total award[C]: $13,032,389;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 26%.
Jurisdiction: California[G];
Budget period three[A]: Total award[C]: $62,166,027;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 14%;
Budget period four[B]: Total award[C]: $70,101,613;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 47%.
Jurisdiction: Chicago[D, H];
Budget period three[A]: Total award[C]: $12,627,939;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 4%;
Budget period four[B]: Total award[C]: $11,977,908;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 59%.
Jurisdiction: Colorado[F];
Budget period three[A]: Total award[C]: $16,531,912;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 11%;
Budget period four[B]: Total award[C]: $17,896,688;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 5%.
Jurisdiction: Connecticut[I];
Budget period three[A]: Total award[C]: $11,864,756;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 18%;
Budget period four[B]: Total award[C]: $14,196,592;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 17%.
Jurisdiction: Delaware;
Budget period three[A]: Total award[C]: $8,054,596;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 41%;
Budget period four[B]: Total award[C]: $9,881,459;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 74%.
Jurisdiction: District of Columbia[F, H];
Budget period three[A]: Total award[C]: $12,705,295;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 62%;
Budget period four[B]: Total award[C]: $16,953,474;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 35%.
Jurisdiction: Florida[H];
Budget period three[A]: Total award[C]: $43,649,932;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 2%;
Budget period four[B]: Total award[C]: $46,997,742;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 2%.
Jurisdiction: Georgia[H];
Budget period three[A]: Total award[C]: $26,817,366;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 33%;
Budget period four[B]: Total award[C]: $34,365,094;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 38%.
Jurisdiction: Hawaii;
Budget period three[A]: Total award[C]: $8,929,643;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 12%;
Budget period four[B]: Total award[C]: $8,801,780;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 2%.
Jurisdiction: Idaho;
Budget period three[A]: Total award[C]: $8,515,356;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 17%;
Budget period four[B]: Total award[C]: $9,366,998;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 12%.
Jurisdiction: Illinois[D, G, H];
Budget period three[A]: Total award[C]: $27,849,480;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 2%;
Budget period four[B]: Total award[C]: [E];
Budget period four[B]: Percentage of awarded funds reported
unobligated: [E].
Jurisdiction: Indiana;
Budget period three[A]: Total award[C]: $19,243,012;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 25%;
Budget period four[B]: Total award[C]: $26,971,704;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 0%.
Jurisdiction: Iowa[F];
Budget period three[A]: Total award[C]: $11,823,150;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 5%;
Budget period four[B]: Total award[C]: $12,726,247;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 16%.
Jurisdiction: Kansas;
Budget period three[A]: Total award[C]: $12,384,717;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 0%;
Budget period four[B]: Total award[C]: [E];
Budget period four[B]: Percentage of awarded funds reported
unobligated: [E].
Jurisdiction: Kentucky[D];
Budget period three[A]: Total award[C]: $14,025,286;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 35%;
Budget period four[B]: Total award[C]: $18,169,281;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 12%.
Jurisdiction: Los Angeles County[H];
Budget period three[A]: Total award[C]: $25,726,260;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 3%;
Budget period four[B]: Total award[C]: [E];
Budget period four[B]: Percentage of awarded funds reported
unobligated: [E].
Jurisdiction: Louisiana;
Budget period three[A]: Total award[C]: $16,811,200;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 5%;
Budget period four[B]: Total award[C]: $17,009,305;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 36%.
Jurisdiction: Maine;
Budget period three[A]: Total award[C]: $8,894,028;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 37%;
Budget period four[B]: Total award[C]: [E];
Budget period four[B]: Percentage of awarded funds reported
unobligated: [E].
Jurisdiction: Maryland[D, H];
Budget period three[A]: Total award[C]: $18,607,520;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 0%;
Budget period four[B]: Total award[C]: [E];
Budget period four[B]: Percentage of awarded funds reported
unobligated: [E].
Jurisdiction: Massachusetts[H, J];
Budget period three[A]: Total award[C]: $22,124,540;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 51%;
Budget period four[B]: Total award[C]: $32,377,306;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 23%.
Jurisdiction: Michigan[D, H];
Budget period three[A]: Total award[C]: $30,104,203;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 7%;
Budget period four[B]: Total award[C]: $35,271,511;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 8%.
Jurisdiction: Minnesota;
Budget period three[A]: Total award[C]: $18,534,985;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 7%;
Budget period four[B]: Total award[C]: $18,182,765;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 2%.
Jurisdiction: Mississippi;
Budget period three[A]: Total award[C]: $12,197,005;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 42%;
Budget period four[B]: Total award[C]: $17,112,807;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 40%.
Jurisdiction: Missouri[F];
Budget period three[A]: Total award[C]: $19,060,349;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 1%;
Budget period four[B]: Total award[C]: $19,160,450;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 3%.
Jurisdiction: Montana;
Budget period three[A]: Total award[C]: $8,292,560;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 10%;
Budget period four[B]: Total award[C]: $7,380,744;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 16%.
Jurisdiction: Nebraska;
Budget period three[A]: Total award[C]: $9,526,033;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 3%;
Budget period four[B]: Total award[C]: [E];
Budget period four[B]: Percentage of awarded funds reported
unobligated: [E].
Jurisdiction: Nevada;
Budget period three[A]: Total award[C]: $10,886,894;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 16%;
Budget period four[B]: Total award[C]: $10,953,790;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 30%.
Jurisdiction: New Hampshire;
Budget period three[A]: Total award[C]: $8,426,601;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 15%;
Budget period four[B]: Total award[C]: $8,725,305;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 12%.
Jurisdiction: New Jersey[H];
Budget period three[A]: Total award[C]: $26,367,685;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 22%;
Budget period four[B]: Total award[C]: $30,660,360;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 14%.
Jurisdiction: New Mexico;
Budget period three[A]: Total award[C]: $12,546,177;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 20%;
Budget period four[B]: Total award[C]: $13,319,379;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 70%.
Jurisdiction: New York[G, H];
Budget period three[A]: Total award[C]: $33,962,894;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 1%;
Budget period four[B]: Total award[C]: $35,863,566;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 4%.
Jurisdiction: New York City;
Budget period three[A]: Total award[C]: [K];
Budget period three[A]: Percentage of awarded funds reported
unobligated: [K];
Budget period four[B]: Total award[C]: [K];
Budget period four[B]: Percentage of awarded funds reported
unobligated: [K].
Jurisdiction: North Carolina[H];
Budget period three[A]: Total award[C]: $24,548,953;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 2%;
Budget period four[B]: Total award[C]: $26,020,533;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 0%.
Jurisdiction: North Dakota;
Budget period three[A]: Total award[C]: $6,747,355;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 0%;
Budget period four[B]: Total award[C]: $6,423,043;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 0%.
Jurisdiction: Ohio[H];
Budget period three[A]: Total award[C]: $32,724,507;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 21%;
Budget period four[B]: Total award[C]: $35,368,314;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 35%.
Jurisdiction: Oklahoma;
Budget period three[A]: Total award[C]: $13,322,159;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 17%;
Budget period four[B]: Total award[C]: $16,248,592;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 14%.
Jurisdiction: Oregon;
Budget period three[A]: Total award[C]: $14,667,495;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 18%;
Budget period four[B]: Total award[C]: $17,039,499;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 7%.
Jurisdiction: Pennsylvania[H];
Budget period three[A]: Total award[C]: $33,209,653;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 15%;
Budget period four[B]: Total award[C]: $38,212,027;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 35%.
Jurisdiction: Rhode Island;
Budget period three[A]: Total award[C]: $8,634,168;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 0%;
Budget period four[B]: Total award[C]: $7,545,070;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 0%.
Jurisdiction: South Carolina[F];
Budget period three[A]: Total award[C]: $14,954,089;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 24%;
Budget period four[B]: Total award[C]: $15,077,330;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 10%.
Jurisdiction: South Dakota;
Budget period three[A]: Total award[C]: $7,134,836;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 7%;
Budget period four[B]: Total award[C]: $6,975,546;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 35%.
Jurisdiction: Tennessee;
Budget period three[A]: Total award[C]: $17,231,897;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 0%;
Budget period four[B]: Total award[C]: $19,452,073;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 5%.
Jurisdiction: Texas[H];
Budget period three[A]: Total award[C]: $54,035,277;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 14%;
Budget period four[B]: Total award[C]: $68,858,586;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 16%.
Jurisdiction: Utah;
Budget period three[A]: Total award[C]: $11,821,907;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 0%;
Budget period four[B]: Total award[C]: $10,423,316;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 2%.
Jurisdiction: Vermont;
Budget period three[A]: Total award[C]: $7,704,711;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 20%;
Budget period four[B]: Total award[C]: $7,973,690;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 32%.
Jurisdiction: Virginia[D, H];
Budget period three[A]: Total award[C]: $24,026,543;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 19%;
Budget period four[B]: Total award[C]: $29,313,295;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 0%.
Jurisdiction: Washington;
Budget period three[A]: Total award[C]: $22,116,478;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 11%;
Budget period four[B]: Total award[C]: [E];
Budget period four[B]: Percentage of awarded funds reported
unobligated: [E].
Jurisdiction: West Virginia;
Budget period three[A]: Total award[C]: $10,316,254;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 17%;
Budget period four[B]: Total award[C]: $10,007,010;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 5%.
Jurisdiction: Wisconsin;
Budget period three[A]: Total award[C]: $18,846,878;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 11%;
Budget period four[B]: Total award[C]: $20,255,129;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 11%.
Jurisdiction: Wyoming;
Budget period three[A]: Total award[C]: $7,362,222;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 25%;
Budget period four[B]: Total award[C]: $5,953,862;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 12%.
Jurisdiction: Total;
Budget period three[A]: Total award[C]: $987,149,159;
Budget period three[A]: Percentage of awarded funds reported
unobligated: 14%;
Budget period four[B]: Total award[C]: $957,787,150;
Budget period four[B]: Percentage of awarded funds reported
unobligated: 19.
Source: GAO analysis of jurisdiction Financial Status Reports (FSR) and
annual program applications.
[A] The program's third budget period was a 24-month period, extending
from August 31, 2001, to August 30, 2003, and encompassing both fiscal
year 2001 and 2002 funds. Obligation data for this period are based on
the FSR submitted after the end of the budget period.
[B] The program's fourth budget period was a 12-month period, extending
from August 31, 2003, to August 30, 2004, and encompassing fiscal year
2003 funds. Obligation data for this period are based on the estimated
FSR submitted prior to the end of the budget period.
[C] Total funding awarded to jurisdictions as financial assistance
through the cooperative agreement, including all funds carried over
from prior budget periods.
[D] Data on awarded funds were not consistent between jurisdiction FSRs
and the Notices of Cooperative Agreement. Based on information provided
by officials at the Centers for Disease Control and Prevention, we
determined the correct award amounts. In no case did the difference
account for more than 4 percent of the total awarded funds.
[E] No data fiscal year 2003 data were available for these
jurisdictions.
[F] These jurisdictions did not submit estimated FSRs for the fourth
budget period, but did provide information in their application on
estimated unobligated balances as of August 30, 2004.
[G] Data on funds awarded to California, Illinois, and New York do not
include funds awarded to Los Angeles County, Chicago, and New York City.
[H] Data for the third budget period have been determined to be
reliable.
[I] Data for the third and fourth budget period have been determined to
be reliable.
[J] Data on funds awarded to Massachusetts were not consistent between
the jurisdiction FSR and the Notice of Cooperative Agreement. The
jurisdiction did not account for $6,682,740 carried over from prior
budget periods in its fourth budget period estimated FSR.
[K] Data comparable to other jurisdictions were not available.
[End of table]
[End of section]
Appendix V: GAO Contact and Staff Acknowledgments:
GAO Contact:
Marjorie Kanof, (202) 512-7114:
Acknowledgments:
In addition to the person named above, key contributors to this report
were Helene Toiv, Emily Gamble Gardiner, Lucia P. Fort, Roseanne Price,
and Jessica Cobert.
[End of section]
Related GAO Products:
HHS Bioterrorism Preparedness Programs: States Reported Progress but
Fell Short of Program Goals for 2002. GAO-04-350R. Washington, D.C.:
February 10, 2004.
Bioterrorism: Public Health Response to Anthrax Incidents of 2001. GAO-
04-152. Washington, D.C.: October 15, 2003.
Emerging Infectious Diseases: Review of State and Federal Disease
Surveillance Efforts. GAO-04-877. Washington, D.C.: September 30, 2004.
Emergency Preparedness: Federal Funds for First Responders. GAO-04-
788T. Washington, D.C.: May 13, 2004.
Bioterrorism: Preparedness Varied across State and Local Jurisdictions.
GAO-03-373. Washington, D.C.: April 7, 2003.
Bioterrorism: The Centers for Disease Control and Prevention's Role in
Public Health Protection. GAO-02-235T. Washington, D.C.: November 15,
2001.
Bioterrorism: Review of Public Health Preparedness Programs. GAO-02-
149T. Washington, D.C.: October 10, 2001.
Bioterrorism: Public Health and Medical Preparedness. GAO-02-141T.
Washington, D.C.: October 9, 2001.
Bioterrorism: Coordination and Preparedness. GAO-02-129T. Washington,
D.C.: October 5, 2001.
Bioterrorism: Federal Research and Preparedness Activities. GAO-01-
915. Washington, D.C.: September 28, 2001.
Combating Terrorism: Observations on Biological Terrorism and Public
Health Initiatives. GAO/T-NSIAD-99-112. Washington, D.C.: March 16,
1999.
FOOTNOTES
[1] Public health surveillance uses systems that provide for the
ongoing collection, analysis, and dissemination of health-related data
to identify, prevent, and control disease.
[2] See U.S. GAO, Bioterrorism: Public Health Response to Anthrax
Incidents of 2001, GAO-04-152 (Washington, D.C.: Oct. 15, 2003).
[3] In February 2002, CDC awarded $918 million through the Bioterrorism
program. An additional $100 million was later awarded to support
smallpox vaccination programs.
[4] Throughout this report, the term fiscal year refers to the federal
fiscal year, which is from October 1 through September 30. In fiscal
year 2003, $870 million was awarded to states, selected municipalities,
and territories. Approximately $844 million was awarded to states,
selected municipalities, and territories in fiscal year 2004.
[5] Throughout this report, the term "budget period" is used to
describe each of the five periods for which funds were awarded within
the multiyear program period.
[6] Throughout this report, the term "jurisdictions" refers to the 50
states, the District of Columbia, and the three funded municipalities-
-New York City, Chicago, and Los Angeles County. The Bioterrorism
program also awards funds to the territories of American Samoa, Guam,
and the U.S. Virgin Islands; the commonwealths of the Northern Mariana
Islands and Puerto Rico; the Federated States of Micronesia; and the
republics of Palau and the Marshall Islands. These awardees were
outside the scope of our work.
[7] These initiatives included the Cities Readiness Initiative, which
funded 21 cities to help develop their capacity to deliver medicines
and medical supplies in case of a public health emergency. In addition,
funds were used to expand the capacity of CDC's quarantine stations and
to support the BioSense surveillance program, an already existing
program to detect emerging diseases by collecting data from national,
regional, and local data sources such as hospital systems, ambulatory
care sites, and pharmacy chains.
[8] Obligated funds do not include future planned activities unless
those activities are actually contracted for. Expended funds refer to
funds the jurisdiction has issued as checks, disbursements of cash, or
electronic transfers to liquidate an obligation.
[9] A cooperative agreement is a mechanism used to provide financial
support when substantial interaction is expected between a federal
agency and a state, local government, or other recipient carrying out
the funded activity.
[10] DPM is a division within HHS that provides grant payment, cash
management, and grant accounting support services to HHS and other
federal departments and agencies. PMS is a DPM-operated centralized
payment system designed to expedite and manage the flow of cash for
grants and cooperative agreements from federal agencies to awardees and
to provide information on the disbursement of funds to the awarding
agency.
[11] The Strategic National Stockpile is a repository of
pharmaceuticals and medical supplies that can be delivered to the site
of a biological or other attack. Responsibility for activities related
to the stockpile had been CDC's in prior years, but, in March 2003,
this responsibility was transferred to the Department of Homeland
Security. However, CDC entered into a reimbursable agreement with the
Department of Homeland Security so that the Strategic National
Stockpile funds were included in the Bioterrorism awards CDC made to
jurisdictions in fiscal year 2003.
[12] Direct assistance refers to assistance jurisdictions ask CDC to
provide in the form of equipment, training, staff, or other services,
rather than as funds, referred to as financial assistance. We did not
include direct assistance in our analysis.
[13] The funds in the P accounts make up approximately 92 percent of
bioterrorism funds awarded to jurisdictions for the third budget
period--August 31, 2001, to August 30, 2003--and approximately 93
percent of funds awarded for the fourth budget period--August 31, 2003,
to August 30, 2004. When funds carried over from prior periods are
included, the P accounts make up 91 percent of all funds awarded during
the third budget period and 85 percent of all funds awarded during the
fourth budget period.
[14] While the NCAs include funds awarded as direct assistance, the
FSRs do not.
[15] We contacted the following jurisdictions: Alaska, Chicago,
Connecticut, Delaware, Georgia, Kansas, Los Angeles County, Louisiana,
Maryland, Massachusetts, Michigan, Minnesota, Missouri, New Mexico, New
York City, North Dakota, Rhode Island, Tennessee, and Texas.
[16] For the program's fifth budget period, the base amount provided to
most jurisdictions was decreased to $3.9 million, and funds from the
program were redirected to other bioterrorism efforts. Jurisdictions
that received larger amounts during the fifth budget period included
the District of Columbia, which continued to receive a base amount of
$10 million, and New York City, Chicago, and Los Angeles County, which
continued to receive base amounts of $5 million.
[17] Jurisdictions are required to conduct activities in the following
areas: preparedness planning and readiness assessment, surveillance and
epidemiology, laboratories, communications and information technology,
risk communication and health information dissemination, and education
and training.
[18] The fiscal year 2002 funds in the P accounts make up 92 percent of
funds awarded to jurisdictions during the Bioterrorism program's third
budget period--August 31, 2001, to August 30, 2003. When funds carried
over from periods prior to August 31, 2001, are included, the P
accounts make up 91 percent of all funds awarded to jurisdictions for
that period.
[19] The fiscal year 2003 funds in the P accounts make up 93 percent of
funds awarded to jurisdictions during the Bioterrorism program's fourth
budget period--August 31, 2003, to August 30, 2004. When funds carried
over from periods prior to August 31, 2003, are included, the P
accounts make up 85 percent of all funds awarded to jurisdictions for
that period.
[20] Jurisdictions are required to submit final FSRs no more than 90
days after the end of the budget period--November 30. However, many
jurisdictions continued to submit final FSRs after that point. CDC uses
the FSRs to collect annual data on unobligated funds from all
jurisdictions. However, while CDC reviews the obligation data, it has
not taken steps to verify the data's reliability, and many
jurisdictions also do not verify the reliability of obligation data.
[21] This does not include funds awarded as direct assistance, but does
include funds awarded in fiscal years 2001 and 2002, funds carried over
from previous years, and funds related to the Strategic National
Stockpile. With approval from CDC, jurisdictions can carry forward
funds that were not obligated during the budget period for use during
the next budget period. Data from New York City were not comparable to
those from other jurisdictions. Because of this, the jurisdiction was
excluded from our budget period three obligations analysis, which we
conducted using data from the remaining 53 jurisdictions.
[22] This does not include funds awarded as direct assistance, but does
include fiscal year 2003 funds, as well as funds carried over from
previous years and funds related to the Strategic National Stockpile.
In early August 2004, jurisdictions provided CDC with an estimate of
what their unobligated fourth budget period funds would be as of August
30, 2004, the end of the budget period. Jurisdictions were not required
to provide these estimates if they did not anticipate requesting that
funds remaining unobligated as of August 30 be carried forward into the
next budget period. Eight jurisdictions did not submit estimated FSRs:
Alaska, Los Angeles County, Illinois, Kansas, Maine, Maryland,
Nebraska, and Washington. In addition, data comparable to other
jurisdictions were not available for New York City. These jurisdictions
were excluded from our budget period four obligation analysis, which we
conducted using data from the remaining 45 jurisdictions.
[23] See Bioterrorism: Preparedness Varied across State and Local
Jurisdictions (GAO-03-373, Apr. 7, 2003), and HHS Bioterrorism
Preparedness Programs: States Reported Progress but Fell Short of
Program Goals for 2002 (GAO-04-360R, Feb. 10, 2004).
[24] The schedule for drawing down funds is determined by each
jurisdiction and varies across jurisdictions. For example, another
jurisdiction draws funds on a weekly basis.
[25] Issues related to lengthy contracting and procurement requirements
are not limited to this cooperative agreement. For more information on
other domestic preparedness activities affected, see U.S. GAO,
Emergency Preparedness: Federal Funds for First Responders, GAO-04-788T
(Washington, D.C.: May 13, 2004).
[26] The term "syndromic surveillance" applies to surveillance using
health-related data that precede diagnosis and signal a sufficient
probability of a case or an outbreak to warrant further public health
response. For example, in 1993, Milwaukee public health officials
discovered that the Cryptosporidium parasite, found in tainted water,
had infected some 400,000 people, after they became aware that there
were increased purchases of an antidiarrheal agent from pharmacies.
Public health officials are increasingly exploring the utility of
syndromic surveillance for detecting outbreaks associated with
bioterrorism. See U.S. GAO, Emerging Infectious Diseases: Review of
State and Federal Disease Surveillance Efforts, GAO-04-877 (Washington,
D.C.: Sept. 30, 2004).
[27] Our previous work has also reported this concern. See GAO-03-373.
[28] Officials in this municipality indicated that the intermediary
follows all federal regulations, but has the authority to bypass some
municipal regulations.
[29] All Bioterrorism program funds awarded are accounted for in one of
these two accounts. PMS data do not account for any funds provided to a
jurisdiction as direct assistance and we did not include direct
assistance in our analysis.
[30] The funds in the P accounts make up approximately 92 percent of
bioterrorism funds awarded to jurisdictions for the third budget
period--August 31, 2001, to August 30, 2003--and approximately 93
percent of funds awarded for the fourth budget period--August 31, 2003,
to August 30, 2004. When funds carried over from prior periods are
included, the P accounts make up 91 percent of all funds awarded during
the third budget period and 85 percent of all funds awarded during the
fourth budget period.
[31] Prior to the fiscal year 2002 emergency supplemental
appropriation, all funds for the Bioterrorism program were tracked in G
accounts. At CDC's request, starting with the 2002 emergency
supplemental appropriation, DPM placed almost all program funding into
P accounts in order to better track expenditures.
[32] Department of Defense and Emergency Supplemental Appropriation for
Recovery from and Response to Terrorist Attacks on the United States
Act, Pub. L.107-117, 115 Stat. 2230 (2002).
[33] In 10 jurisdictions, funding provided for smallpox activities in
May 2003 was credited to the jurisdiction's fiscal year 2003 period. In
these cases, the funds should have been credited to the fiscal year
2001/2002 period, and the P account data in this report reflect the
corrected funding levels. These jurisdictions were Arkansas,
California, Connecticut, Georgia, Los Angeles County, Maine, Minnesota,
Ohio, Washington, and Wyoming.
[34] See HHS OIG, Report on Department of Health and Human Services,
Program Support Center, Division of Payment Management's Controls
Placed in Operation and Tests of Operating Effectiveness, A-17-03-
000009 (Washington, D.C.: Oct. 6, 2003), and HHS, HHS FY 2004
Performance and Accountability Report (Washington, D.C.: Dec. 13, 2004).
[35] These jurisdictions were Alaska, Illinois, Kansas, Los Angeles
County, Maine, Maryland, Nebraska, and Washington. In addition, data
from New York City were not comparable to those from other
jurisdictions. Because of this, this jurisdiction was excluded from our
obligations analysis.
[36] Because the NCAs include awarded funds not included in the P
accounts, they could not be used to describe expenditure rates for
specific budget periods. In addition, we did not include data on direct
assistance in our analysis.
[37] OIG determined that the third budget period obligation data
reported by Chicago, the District of Columbia, Florida, Georgia,
Illinois, Los Angeles County, Maryland, Massachusetts, Michigan, New
Jersey, New York, New York City, North Carolina, Ohio, Pennsylvania,
Texas, and Virginia were reliable. In addition, our interviews with
jurisdiction audit bodies identified work performed to determine the
reliability of Connecticut's third and fourth budget period obligation
data.
[38] These jurisdictions were Chicago, Connecticut, Delaware, Georgia,
Los Angeles County, Maryland, Massachusetts, Michigan, New York City,
and North Dakota.
[39] These jurisdictions were Alaska, Kansas, Louisiana, Minnesota,
Missouri, New Mexico, Rhode Island, Tennessee, Texas, and three
jurisdictions also included in the first e-mail phase--Chicago,
Maryland, and New York City.
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