Health Careers Opportunity Program
Process for Awarding Competitive Grants Included Independent Review Gao ID: GAO-07-137 February 2, 2007To support the education and training of health professionals, the Health Resources and Services Administration (HRSA), in the Department of Health and Human Services (HHS), administers health professions education programs authorized under title VII of the Public Health Service Act. One of these programs, the Health Careers Opportunity Program (HCOP), provides grants to health professions schools and other entities to help students from disadvantaged backgrounds prepare for health professions education and training. Funding preference is given to grant applications that demonstrate a comprehensive approach involving other educational or health-related partners. Congressional committees have encouraged HRSA to give priority to applications from schools with a historic mission of educating minority students for health professions. In 2004, the appropriations conference committee asked GAO to review HRSA's process for awarding grants. This report addresses, for fiscal years 2002 through 2005, (1) HRSA's process for awarding HCOP grants and (2) the number and characteristics of HCOP applicants and grantees. GAO reviewed data from HRSA, interviewed HRSA officials, and reviewed relevant federal laws and agency documents from HHS and the Department of Education.
HRSA followed a standard process to award HCOP grants, distributing funds on a noncompetitive basis to continue funding existing HCOP grants within their approved project periods, and then awarding the remaining funds on a competitive basis. For each of fiscal years 2002-05, HRSA competitively awarded between $4 million and $15 million from the approximately $34 million annually available for HCOP. To award competitive grants, HRSA used independent reviewers who assessed applications against published criteria, scored applications that met minimum criteria, and determined if they qualified for the funding preference. HRSA ranked the applications from highest to lowest score--putting those with the funding preference first--and awarded grants in decreasing rank order until the available funds were exhausted. Although HRSA had discretion to award grants out of rank order, the agency did not do so for fiscal years 2002-05. For fiscal years 2002-05, HRSA awarded a total of 99 competitive HCOP grants from 439 grant applications reviewed. Overall, minority-serving institutions submitted about 25 percent of the applications reviewed and received about 30 percent of the competitive grants; historically black colleges and universities were the most numerous grantees among minority-serving institutions, followed by Hispanic-serving institutions. HRSA commented that a draft of this report met the goals of describing the award process and outlining the number and characteristics of HCOP applicants and grantees.
GAO-07-137, Health Careers Opportunity Program: Process for Awarding Competitive Grants Included Independent Review
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Report to Congressional Committees:
United States Government Accountability Office:
GAO:
February 2007:
Health Careers Opportunity Program:
Process for Awarding Competitive Grants Included Independent Review:
GAO-07-137:
GAO Highlights:
Highlights of GAO-07-137, a report to congressional committees
Why GAO Did This Study:
To support the education and training of health professionals, the
Health Resources and Services Administration (HRSA), in the Department
of Health and Human Services (HHS), administers health professions
education programs authorized under title VII of the Public Health
Service Act. One of these programs, the Health Careers Opportunity
Program (HCOP), provides grants to health professions schools and other
entities to help students from disadvantaged backgrounds prepare for
health professions education and training. Funding preference is given
to grant applications that demonstrate a comprehensive approach
involving other educational or health-related partners.
Congressional committees have encouraged HRSA to give priority to
applications from schools with a historic mission of educating minority
students for health professions. In 2004, the appropriations conference
committee asked GAO to review HRSA‘s process for awarding grants. This
report addresses, for fiscal years 2002 through 2005, (1) HRSA‘s
process for awarding HCOP grants and (2) the number and characteristics
of HCOP applicants and grantees.
GAO reviewed data from HRSA, interviewed HRSA officials, and reviewed
relevant federal laws and agency documents from HHS and the Department
of Education.
What GAO Found:
HRSA followed a standard process to award HCOP grants, distributing
funds on a noncompetitive basis to continue funding existing HCOP
grants within their approved project periods, and then awarding the
remaining funds on a competitive basis. For each of fiscal years
2002–05, HRSA competitively awarded between $4 million and $15 million
from the approximately $34 million annually available for HCOP. To
award competitive grants, HRSA used independent reviewers who assessed
applications against published criteria, scored applications that met
minimum criteria, and determined if they qualified for the funding
preference. HRSA ranked the applications from highest to lowest
score”putting those with the funding preference first”and awarded
grants in decreasing rank order until the available funds were
exhausted. Although HRSA had discretion to award grants out of rank
order, the agency did not do so for fiscal years 2002–05.
For fiscal years 2002–05, HRSA awarded a total of 99 competitive HCOP
grants from 439 grant applications reviewed. Overall, minority-serving
institutions submitted about 25 percent of the applications reviewed
and received about 30 percent of the competitive grants; historically
black colleges and universities were the most numerous grantees among
minority-serving institutions, followed by Hispanic-serving
institutions.
HRSA commented that a draft of this report met the goals of describing
the award process and outlining the number and characteristics of HCOP
applicants and grantees.
Figure: Results of Competitive HCOP Process, Fiscal Years 2002-05:
[See PDF for Image]
Source: GAO analysis of HRSA data.
Note: The reviewers did not score applications they found were not
responsive to the review criteria.
[End of Figure]
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-137].
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Leslie G. Aronovitz at
(312) 220-7600 or aronovitzl@gao.gov.
[End of Section]
Contents:
Letter:
Results in Brief:
Background:
HRSA Followed a Standard Process to Award HCOP Grants:
Applications from Minority-Serving Institutions Generally Received
Grants in Greater Proportion Than All Applications:
Agency Comments:
Appendix I: Identification of Minority-Serving Institutions:
Appendix II: HCOP Competitive Applications and Grants, by Location of
Grant Applicant, Fiscal Years 2002 through 2005:
Appendix III: Comments from the Health Resources and Services
Administration:
Appendix IV: Contact and Acknowledgments:
Related GAO Products:
Tables:
Table 1: Review Criteria for HCOP Applications, Fiscal Year 2005:
Table 2: Number of Applications for Competitive HCOP Grants and
Competitive Grants Awarded, Fiscal Years 2002-05:
Table 3: Applications and Awards for Competitive HCOP Grants, by
Minority-Serving Status, Fiscal Years 2002-05:
Table 4: Numbers of HCOP Applications from, and Competitive Awards to,
Designated Minority-Serving Institutions, Fiscal Years 2002-05:
Table 5: Minority-Serving Institution Designations, Criteria, and
Approximate Number as of Fiscal Year 2005:
Table 6: Entities Applying for and Receiving Competitive HCOP Grants,
by Location, Fiscal Years 2002-05:
Figures:
Figure 1: Funds Awarded through the Health Careers Opportunity Program
as Noncompetitive Continuations and Competitive Grants, Fiscal Years
2002-05:
Figure 2: Process for Awarding Competitive HCOP Grants:
Figure 3: Scores and Funding Preference for Competitive HCOP
Applications and Grants, Fiscal Years 2002-05:
Abbreviations:
HCOP: Health Careers Opportunity Program:
HHS: Department of Health and Human Services:
HRSA: Health Resources and Services Administration:
United States Government Accountability Office:
Washington, DC 20548:
February 2, 2007:
The Honorable Tom Harkin:
Chairman:
The Honorable Arlen Specter:
Ranking Minority Member:
Subcommittee on Labor, Health and Human Services, Education, and
Related Agencies:
Committee on Appropriations:
United States Senate:
The Honorable David R. Obey:
Chairman:
The Honorable James T. Walsh:
Ranking Minority Member:
Subcommittee on Labor, Health and Human Services, Education, and
Related Agencies:
Committee on Appropriations:
House of Representatives:
An appropriate supply of health professionals is vital to ensuring that
all Americans have adequate access to health care. To support the
education and training of health professionals, the Health Resources
and Services Administration (HRSA), an agency within the Department of
Health and Human Services (HHS), administers numerous health
professions education and training programs authorized under title VII
of the Public Health Service Act. One such program, the Health Careers
Opportunity Program (HCOP), provides grants to health professions
schools--such as medical or dental schools--and other entities to help
students from disadvantaged backgrounds prepare for, and succeed in,
education and training for the health professions.[Footnote 1] HCOP
grants are generally approved for a period of 3 years and support
activities such as training to help students prepare for health
professions education as well as counseling and mentoring for those
already enrolled. Preference in funding HCOP grants is given to
applications for projects with a comprehensive approach, including
partnerships among health or educational entities to develop a pool of
individuals from disadvantaged backgrounds interested in pursuing
health careers.[Footnote 2] Applications that receive this funding
preference are considered for funding ahead of applications that do
not.
For each of fiscal years 2002 through 2005, HRSA awarded about $34
million for HCOP grants, including grants awarded on a competitive
basis as well as funds distributed on a noncompetitive basis to
continue funding existing HCOP grant projects within their approved
project periods.[Footnote 3] For fiscal year 2006, in response to
direction received during the appropriations process,[Footnote 4]
funding made available for HCOP by HRSA from its appropriations was
reduced significantly. As a result, HRSA cancelled the competition for
grants and distributed all funds available for HCOP for fiscal year
2006--about $4 million--on a noncompetitive basis to continue funding 4
of 58 existing HCOP grant projects within their approved project
periods.[Footnote 5] In response to guidance in an appropriations
committee report, which strongly urged HRSA to give priority to those
institutions with a historic mission of training minorities in the
health professions,[Footnote 6] the agency distributed the $4 million
for fiscal year 2006 to continue funding existing HCOP grant projects
at four institutions that met that criterion.[Footnote 7]
All projects supported by HCOP grants focus on individuals who are
either educationally or economically disadvantaged.[Footnote 8] In
reports accompanying HHS appropriations bills for fiscal years 2002
through 2004, congressional appropriations committees with
responsibility for HHS programs noted with approval that HRSA had given
"priority consideration for HCOP grants to minority health professions
institutions."[Footnote 9] In the conference report accompanying the
fiscal year 2005 appropriations act, however, the conference committee
expressed concern that several applications for new or competitive
continuation grants from historically minority health professions
schools had not been funded for fiscal year 2004.[Footnote 10] In this
report, the conference committee also directed us to study the HCOP
grant award process.[Footnote 11] As discussed with the appropriations
subcommittees with responsibility for HHS programs, this report
addresses, for fiscal years 2002 through 2005, (1) HRSA's process for
awarding HCOP grants and (2) the number and characteristics of HCOP
applicants and grantees.
To conduct our work, we analyzed HRSA's data on HCOP applications,
including the scores and funding preference determinations made during
the application review process, and HCOP grant award decisions for
fiscal years 2002 through 2005.[Footnote 12] We assessed the
reliability of HRSA's data on HCOP grant awards by discussing with
agency officials the validation and internal controls applied to HRSA's
grant data and by comparing the data with HRSA documents, such as
records of HCOP grant award decisions. We determined that the HCOP data
were sufficiently reliable for our purposes. In addition, we
interviewed HRSA officials and reviewed relevant federal laws,
congressional committee reports, and agency documents. In reviewing the
characteristics of entities submitting HCOP applications and of HCOP
grantees, we included only those applications that HRSA officials
determined met the initial screening requirements to be considered for
awards. To determine whether applicants and grantees that were
institutions of higher education met criteria for designation as
minority-serving institutions,[Footnote 13] we used Department of
Education documents and other sources. We conducted our work from
October 2005 through January 2007 in accordance with generally accepted
government auditing standards.
Results in Brief:
HRSA followed a standard process to award HCOP grants each year,
distributing available funds on a noncompetitive basis to continue
funding existing grant projects (subject to HRSA officials' review of
each grantee's progress report), then awarding the remaining funds on a
competitive basis. For each of fiscal years 2002 through 2005, HRSA
awarded as competitive grants between $4 million and $15 million from
the approximately $34 million annually available for HCOP. The
competitive process relied on independent reviewers: individuals with
experience in fields related to health and education and who were
unaffiliated with either HRSA or current HCOP grant applicants. These
reviewers first scored applications in accordance with HRSA's review
criteria, then determined if the applications qualified for the funding
preference for projects with a comprehensive approach. HRSA ranked the
applications according to the results of this review--those with the
funding preference first, from highest to lowest score, followed by
those without the funding preference. HRSA then awarded grants in rank
order, starting with the highest-ranked application and proceeding in
order of decreasing rank until the funds available for competitive
grants that year were exhausted. Although HRSA officials have
discretion to award grants in an order that departs from the
recommendation of the independent reviewers, the agency did not do so
for fiscal years 2002 through 2005.
Overall, less than one-fourth of all applications for competitive HCOP
grants were funded; minority-serving institutions submitted about 25
percent of the applications and received about 30 percent of the
competitive grants. For fiscal years 2002 through 2005, HRSA reviewed a
total of 439 applications for competitive HCOP grants and awarded 99
grants. The number of HCOP grants awarded on a competitive basis ranged
from a low of 10 (for fiscal year 2003) to a high of 34 (for fiscal
year 2005). HRSA awarded the fewest competitive grants for fiscal year
2003 because that year the agency distributed almost 90 percent of
available funds to continue funding existing HCOP grant projects on a
noncompetitive basis. HCOP grantees consisted primarily of
postsecondary educational institutions, such as community colleges,
medical schools, and state university systems. Of the 30 grants awarded
to minority-serving institutions for fiscal years 2002 through 2005,
grants to historically black colleges and universities were the most
numerous (18), followed by grants to Hispanic-serving institutions (10)
and tribal colleges and universities (2).
In commenting on a draft of this report, HRSA stated that the report
met the goals of describing the award process and outlining the number
and characteristics of HCOP applicants and grantees.
Background:
First authorized in 1971,[Footnote 14] the program currently known as
HCOP was last reauthorized in 1998.[Footnote 15] The Secretary of
Health and Human Services is authorized to make HCOP grants "for the
purpose of assisting individuals from disadvantaged backgrounds . . .
to undertake education to enter a health profession."[Footnote 16] A
wide range of entities are eligible to receive HCOP grants, including,
for example, schools of medicine, dentistry, and pharmacy; schools with
graduate programs in behavioral and mental health; programs to train
physician assistants; and other public or private nonprofit health or
educational entities.[Footnote 17] HCOP grant funds may be used for a
variety of activities, such as recruiting individuals from
disadvantaged backgrounds interested in health careers; facilitating
their entry into health professions schools; providing counseling,
mentoring, and other support activities designed to assist them to
complete this education; providing information on financial aid; and
providing experience in primary health care settings.
The 1998 reauthorization of HCOP emphasized the importance of outreach
activities by adding a funding preference for HCOP applications for
projects that "involve a comprehensive approach by several public or
private nonprofit health or educational entities to establish, enhance
and expand educational programs that will result in the development of
a competitive applicant pool of individuals from disadvantaged
backgrounds who desire to pursue health professions careers."[Footnote
18] Applications qualifying for this funding preference have an
advantage because they must be considered for funding ahead of
applications that do not.
Projects supported by HCOP grants focus on individuals from
disadvantaged backgrounds, and Congress has recognized that such
individuals may be members of minority groups. The Public Health
Service Act directs the Secretary of Health and Human Services "to the
extent practicable, [to] ensure that services and activities [funded by
HCOP] are adequately allocated among the various racial and ethnic
populations who are from disadvantaged backgrounds."[Footnote 19]
Section 739 of the Public Health Service Act does not specify any
particular populations or methods that HRSA must use to ensure this
allocation, leaving these decisions to the agency's discretion.
According to HRSA officials, in the 1990s, the agency allocated
additional points to the scores of applications from historically black
colleges and universities, Hispanic-serving institutions, and tribal
colleges and universities to improve their chances of receiving an HCOP
grant. HRSA reported that for 1997 this practice resulted in its
awarding eight more HCOP grants to historically black colleges and
universities than it had awarded for the previous year.[Footnote 20]
HRSA Followed a Standard Process to Award HCOP Grants:
For fiscal years 2002 through 2005, HRSA followed a standard process to
award HCOP grant funds, distributing the program's available funds on a
noncompetitive basis to continue funding existing grant projects, then
awarding the remaining funds on a competitive basis. For competitive
HCOP grants, HRSA published criteria and relied on the assessment of
independent reviewers. Grants were awarded in accordance with the
applications' rank order as determined by the independent reviewers.
HRSA Funded Existing HCOP Projects Before Awarding Competitive Grants:
The amount of HCOP funds HRSA distributed each year on a noncompetitive
basis to continue funding existing grant projects determined the amount
that remained available for competitive grants and, consequently, the
number of competitive grants HRSA awarded. For fiscal years 2002
through 2005, the amounts HRSA made available for HCOP grants from its
annual appropriations remained relatively stable, with an average of
about $34 million a year over the 4 fiscal years. Before making
competitive awards, HRSA distributed funds each year on a
noncompetitive basis to support existing HCOP grant projects in their
second or subsequent years.[Footnote 21] These noncompetitive
continuation awards were subject to HRSA officials' approval after the
agency reviewed each grantee's annual progress report. Once the
noncompetitive continuation awards were made, HRSA awarded the
remaining HCOP funds on a competitive basis, including new grants to
entities that did not have an HCOP grant for a particular project and
competitive continuation grants to entities that applied for continued
funding after the end of their authorized HCOP grant period. As shown
in figure 1, the amounts distributed on a noncompetitive basis to
continue funding existing grant projects varied, from a low of $18
million for fiscal year 2005 to a high of $30 million for fiscal year
2003, and the remaining funds awarded as competitive grants ranged from
a low of $4 million for fiscal year 2003 to a high of $15 million for
fiscal year 2005.
Figure 1: Funds Awarded through the Health Careers Opportunity Program
as Noncompetitive Continuations and Competitive Grants, Fiscal Years
2002-05:
[See PDF for image]
Source: GAO analysis of HRSA data.
[End of figure]
HRSA's Process for Awarding Competitive Grants Was Based on Published
Criteria:
For each of fiscal years 2002 through 2005, HRSA published a
notification of upcoming grant opportunities, including those for HCOP
grants. This notification provided an overview of the HCOP program,
including the entities eligible to receive HCOP grants and a
description of the funding preference for projects with a comprehensive
approach. For detailed review criteria, the annual notification
referred prospective HCOP applicants to the HCOP program guidance
available on request or, for fiscal year 2005, through HRSA's Web
site.[Footnote 22]
The review criteria HRSA published in its HCOP program guidance
addressed different aspects of a successful HCOP project. Each
criterion carried a specified number of potential points, for a maximum
total score of 100. For some criteria, the point values differed
according to whether the application was for a new grant or a
competitive continuation grant.[Footnote 23] This difference reflected
the fact that applications for competitive continuation grants were
required to include a summary of the grantee's management of its
previous HCOP grant project and of progress toward meeting its
objectives. For all applications for competitive grants--both new and
competitive continuations--HRSA assigned the greatest number of
potential points to the criterion that addressed plans to implement the
HCOP activities authorized in the Public Health Service Act. Table 1
summarizes the criteria used by reviewers to assess HCOP applications
for fiscal year 2005.[Footnote 24]
Table 1: Review Criteria for HCOP Applications, Fiscal Year 2005:
Criterion: Response: An effective, well-delineated plan for carrying
out the HCOP program activities authorized by the Public Health Service
Act;[A] identifying the targeted health disciplines; and providing
measurable objectives linked to sections within the application's
methodology, evaluation, and budget sections;
Weight in points: Competitive continuation: 35;
Weight in points: New: 50.
Criterion: Evaluative measures: A progress summary showing successful
management of a previous grant and meeting of its objectives;
Weight in points: Competitive continuation: 20;
Weight in points: New: Not applicable.
Criterion: Cultural competence development: Clearly defined goals and
objectives for teaching cultural competence, with activities
appropriate to each educational level.[B];
Weight in points: Competitive continuation: 15;
Weight in points: New: 10.
Criterion: Need: Well-established need for the project, supported by
data on the targeted health disciplines and health professions
workforce needs in the geographic area and on the academic and social
needs of the individuals participating in proposed HCOP activities;
Weight in points: Competitive continuation: 10;
Weight in points: New: 10.
Criterion: Support requested: A cost-effective, reasonable budget
consistent with the project's objectives and activities;
Weight in points: Competitive continuation: 10;
Weight in points: New: 10.
Criterion: Resources and capabilities: A demonstrated commitment to
disadvantaged students, underserved communities, or both, with
experience using institutional resources and activities to develop,
train, and strengthen the academic performance of disadvantaged
students at all educational levels, including health professional
schools. A well-delineated plan to meet the needs of underserved
communities in the area;
Weight in points: Competitive continuation: 5;
Weight in points: New: 15.
Criterion: Impact: A clearly designed plan to disseminate and implement
HCOP project results to the regional or national education and health
professions communities;
Weight in points: Competitive continuation: 5;
Weight in points: New: 5.
Source: U.S. Department of Health and Human Services, Health Resources
and Services Administration, Health Careers Opportunity Program (HCOP):
New Competition, Program Guidance, Fiscal Year 2005, HRSA 05-098
(Rockville, Md.: Oct. 28, 2004).
Note: Reviewers did not approve for funding or assign scores to
applications they determined were not responsive to these criteria.
[A] HRSA's guidance for this criterion required that applications
address all of the following HCOP activities listed in the Public
Health Service Act: (1) identifying and recruiting individuals from
disadvantaged backgrounds; (2) facilitating their entry into health
professions education; (3) providing counseling, mentoring, and support
services; (4) providing preparatory education and health research
training; (5) disseminating information on financial aid; (6)
supporting programs that provide experience in primary care settings;
and (7) conducting activities to develop a competitive health
professions applicant pool through community partnerships. In addition
to the activities that all applications had to address in this
criterion, the Public Health Service Act authorized grantees to use
HCOP funds to pay for stipends or scholarships for health professions
programs--subject to the approval of the Secretary of Health and Human
Services, 42 U.S.C. § 293c(a)(2). The program guidance for fiscal year
2005 stated that grantees could provide stipends, with justification
and approval by the Secretary, but that grantees could not use funding
to pay for scholarships.
[B] For purposes of the HCOP program, HRSA defines cultural competence
as the skills required to provide effective clinical care to patients
from diverse racial or ethnic groups.
[End of Table]
The HCOP program guidance also included information on how to apply
for, and receive, the funding preference for projects involving a
comprehensive approach. To receive the funding preference, applicants
were required to meet all four of the following statutory requirements:
* Demonstrate a commitment to a comprehensive approach through formal
signed agreements that specify common objectives and establish
partnerships with institutions of higher education, school districts,
and other community-based entities.
* Enter into formal signed agreements reflecting the coordination of
educational activities and support services and the consolidation of
resources within a specific area.
* Design activities that establish a competitive health professions
applicant pool of individuals from disadvantaged backgrounds by
focusing on both academic and social preparation for health careers.
* Describe educational activities that focus on developing a culturally
competent health care workforce to serve needy populations in the
geographic area.[Footnote 25]
HRSA's HCOP program guidance for fiscal years 2002 through 2005
specified that, to receive the funding preference, copies of formal
agreements between applicants and community-based partners must be
included with the application.
HRSA's Process for Awarding Competitive Grants Relied on Assessment by
Independent Reviewers:
For fiscal years 2002 through 2005, HRSA's standard process for
awarding competitive HCOP grants relied on independent reviewers to
assess applications against the agency's published review criteria.
HRSA officials generally limited their own review of applications for
competitive HCOP grants to screening for applicant eligibility and
compliance with technical requirements such as format and length.
After determining which applications met basic eligibility
requirements, HRSA officials forwarded all eligible HCOP applications
to the agency's Division of Independent Review to arrange for
assessment and scoring.[Footnote 26] To assess HCOP applications, the
division selected reviewers with health-related educational,
counseling, academic, or project management experience who were not
employed by HRSA and who were free from conflicts of interest,
including employment or consulting arrangements with any entity that
was applying for an HCOP grant for that fiscal year.[Footnote 27] The
division sent each reviewer about eight applications to read in
advance, then convened multiple panels in which reviewers met to
discuss the merits of those applications. The reviewers were instructed
to apply the published HCOP review criteria and reach consensus within
each panel on their funding recommendations. The reviewers did not
recommend for approval those applications they determined were not
responsive to the review criteria. For each application recommended for
approval, the reviewers assigned a score and determined whether the
application qualified for the funding preference. The reviewers also
had the opportunity to comment on applications' proposed budgets and to
recommend adjustments for reasonableness.[Footnote 28]
After the independent reviewers completed their assessments, HRSA
officials used a statistical method to standardize the results from all
HCOP review panels for a given year into a single ranked list, placing
all applications receiving the funding preference ahead as a group,
from highest to lowest score, followed by applications without the
funding preference, from highest to lowest score. HRSA officials used
this rank-order list as their basis for recommending which applications
should receive grants for a given fiscal year and the amount of each
award. The HRSA officials' recommendations were included in memorandums
to the HRSA Administrator, who made the final award decisions for
fiscal years 2002 through 2005.[Footnote 29] Figure 2 provides an
overview of the process for awarding competitive HCOP grants.
Figure 2: Process for Awarding Competitive HCOP Grants:
[See PDF for image]
Source: GAO and HRSA.
[A] HRSA has discretion to award grants to applications out of rank
order for documented policy reasons, such as ensuring geographic
distribution, targeting high-priority health professions, or allocating
HCOP services and activities among disadvantaged minority populations.
[End of figure]
When awarding HCOP grants, HRSA had the discretion to consider
additional factors, such as geographic diversity, targeted health
professions, and the allocation of HCOP-funded services and activities
among minority populations who are disadvantaged. According to a HRSA
official responsible for administering the HCOP program, the agency
could have used this discretion to depart from the rank-order list
resulting from the independent review process but did not do so for
fiscal years 2002 through 2005. This official said that 80 percent of
HCOP program participants in fiscal year 2004 came from disadvantaged
minority groups, regardless of the entity that received the HCOP
grants, and that HRSA had concluded that no divergence from the rank-
order list was required since the allocation of HCOP-funded activities
among minority populations was consistent with the Public Health
Service Act.[Footnote 30] For fiscal year 2004, however, HRSA reduced
all competitive HCOP grant budgets by 10 percent--an action that
enabled the agency to fund five additional grants, including three at
historically black colleges and universities that would not otherwise
have been funded.
Applications from Minority-Serving Institutions Generally Received
Grants in Greater Proportion Than All Applications:
For fiscal years 2002 through 2005, HRSA reviewed a total of 439
applications for competitive HCOP grants and awarded 99 HCOP
grants.[Footnote 31] The number of competitive HCOP grants awarded
depended on the availability of funds each year, and HRSA was unable to
fund many high-scoring applications that received the funding
preference. Over the 4 fiscal years, minority-serving institutions
submitted 25 percent of the applications for competitive HCOP grants
and received 30 percent of the awards.
Number of Competitive Grants Awarded Depended on Availability of Funds:
Both the number of applications and the number of competitive grants
awarded varied from year to year (see table 2).[Footnote 32] Overall,
for fiscal years 2002 through 2005, applications for new HCOP grants
outnumbered applications for competitive continuations by nearly three
to one, but applications for new grants received about the same number
of awards as applications for competitive continuation grants.
Table 2: Number of Applications for Competitive HCOP Grants and
Competitive Grants Awarded, Fiscal Years 2002-05:
Fiscal year: 2002;
Applications for competitive grants: Total: 107;
Applications for competitive grants: New: 77;
Applications for competitive grants: Competitive continuations: 30;
Competitive grants awarded: Total: 31;
Competitive grants awarded: New: 18;
Competitive grants awarded: Competitive continuations: 13.
Fiscal year: 2003;
Applications for competitive grants: Total: 93;
Applications for competitive grants: New: 84;
Applications for competitive grants: Competitive continuations: 9; [
Competitive grants awarded: Total: 10;
Competitive grants awarded: New: 7;
Competitive grants awarded: Competitive continuations: 3.
Fiscal year: 2004;
Applications for competitive grants: Total: 116;
Applications for competitive grants: New: 91;
Applications for competitive grants: Competitive continuations: 25;
Competitive grants awarded: Total: 24;
Competitive grants awarded: New: 12;
Competitive grants awarded: Competitive continuations: 12.
Fiscal year: 2005;
Applications for competitive grants: Total: 123;
Applications for competitive grants: New: 78;
Applications for competitive grants: Competitive continuations: 45;
Competitive grants awarded: Total: 34;
Competitive grants awarded: New: 15;
Competitive grants awarded: Competitive continuations: 19.
Fiscal year: Total;
Applications for competitive grants: Total: 439;
Applications for competitive grants: New: 330;
Applications for competitive grants: Competitive continuations: 109;
Competitive grants awarded: Total: 99;
Competitive grants awarded: New: 52;
Competitive grants awarded: Competitive continuations: 47.
[End of table]
Source: GAO analysis of HRSA data.
The number of competitive grants awarded in a given year depended more
on the availability of funds for competitive HCOP grants than on the
applications' scores. Each year, the score of the lowest-scoring
application receiving a grant differed little from the score of the
next application on the list, which did not receive a grant. While all
applications that received grants for fiscal years 2002 through 2005
qualified for the funding preference for comprehensive projects, the
preference did not guarantee that an application would be funded. In
some years, applications that received the funding preference and
scored in the 80s (out of 100 possible points) were not funded. As
shown in figure 3, the majority of applications that were approved for
funding by the independent reviewers received the funding preference,
but not all were funded.
Figure 3: Scores and Funding Preference for Competitive HCOP
Applications and Grants, Fiscal Years 2002-05:
[See PDF for image]
Source: GAO analysis of HRSA data.
Note: Reviewers did not approve for funding or score applications that
they determined were not responsive to the review criteria for HCOP
applications.
[End of figure]
About One-Third of Competitive HCOP Grants Were Awarded to Minority-
Serving Institutions:
For fiscal years 2002 through 2005, minority-serving institutions
submitted a total of 25 percent of all applications for competitive
HCOP grants and received about 30 percent of awards.[Footnote 33]
Although minority-serving institutions received awards in greater
proportion than their representation among all applications for HCOP
grants over the 4 fiscal years, the proportions varied from year to
year. For fiscal years 2002, 2004, and 2005, minority-serving
institutions were represented among grantees in the same, or in
greater, proportion than they were among applications, submitting 25-28
percent of applications and receiving 25-35 percent of grants. Fiscal
year 2003 stands out because of the smaller number of competitive
grants awarded; that year, 10 competitive HCOP grants were awarded, 1
of which was awarded to a minority-serving institution (see table 3).
The smaller number of competitive grants was mainly due to the
relatively high number of noncompetitive continuation grants that
received funding for that fiscal year.
Table 3: Applications and Awards for Competitive HCOP Grants, by
Minority-Serving Status, Fiscal Years 2002-05:
2002;
Applications: Total: 107;
Applications: Number from minority- serving institutions: 30;
Applications: Percentage from minority- serving institutions: 28;
Awards: Total: 31;
Awards: Number to minority-serving institutions: 11;
Awards: Percentage to minority- serving institutions: 35.
2003;
Applications: Total: 93;
Applications: Number from minority- serving institutions: 20;
Applications: Percentage from minority- serving institutions: 22;
Awards: Total: 10;
Awards: Number to minority-serving institutions: 1;
Awards: Percentage to minority- serving institutions: 10.
2004;
Applications: Total: 116;
Applications: Number from minority- serving institutions: 29;
Applications: Percentage from minority- serving institutions: 25;
Awards: Total: 24;
Awards: Number to minority-serving institutions: 6;
Awards: Percentage to minority- serving institutions: 25.
2005;
Applications: Total: 123;
Applications: Number from minority- serving institutions: 32;
Applications: Percentage from minority- serving institutions: 26;
Awards: Total: 34;
Awards: Number to minority-serving institutions: 12;
Awards: Percentage to minority- serving institutions: 35.
Total;
Applications: Total: 439;
Applications: Number from minority- serving institutions: 111;
Applications: Percentage from minority- serving institutions: 25;
Awards: Total: 99;
Awards: Number to minority-serving institutions: 30;
Awards: Percentage to minority- serving institutions: 30.
Source: GAO analysis of HRSA data.
Note: Total applications and total awards include entities other than
institutions of higher education, such as health care providers, to
which formal designation as a minority-serving institution does not
apply. For grant competitions for fiscal years 2002 through 2005, such
entities submitted less than 25 percent of all applications and
received less than 12 percent of all competitive awards for any one
fiscal year.
[End of table]
Among minority-serving institutions, historically black colleges and
universities submitted the most applications and received the most
awards, followed by Hispanic-serving institutions (see table 4).
Table 4: Numbers of HCOP Applications from, and Competitive Awards to,
Designated Minority-Serving Institutions, Fiscal Years 2002-05:
2002;
Historically black colleges and universities: Applications: 17;
Historically black colleges and universities: Awards: 6;
Hispanic-serving institutions: Applications: 10;
Hispanic-serving institutions: Awards: 4;
Tribal colleges and universities: Applications: 3;
Tribal colleges and universities: Awards: 1;
Native Hawaiian-and Alaska Native-serving institutions: Applications:
0;
Native Hawaiian-and Alaska Native-serving institutions: Awards: 0.
2003;
Historically black colleges and universities: Applications: 11;
Historically black colleges and universities: Awards: 1;
Hispanic-serving institutions: Applications: 7;
Hispanic-serving institutions: Awards: 0;
Tribal colleges and universities: Applications: 2;
Tribal colleges and universities: Awards: 0;
Native Hawaiian-and Alaska Native-serving institutions: Applications:
0;
Native Hawaiian-and Alaska Native-serving institutions: Awards: 0.
2004;
Historically black colleges and universities: Applications: 21;
Historically black colleges and universities: Awards: 5;
Hispanic-serving institutions: Applications: 6;
Hispanic-serving institutions: Awards: 0;
Tribal colleges and universities: Applications: 2;
Tribal colleges and universities: Awards: 1;
Native Hawaiian-and Alaska Native-serving institutions: Applications:
0;
Native Hawaiian-and Alaska Native-serving institutions: Awards: 0.
2005;
Historically black colleges and universities: Applications: 18;
Historically black colleges and universities: Awards: 6;
Hispanic-serving institutions: Applications: 11;
Hispanic-serving institutions: Awards: 6;
Tribal colleges and universities: Applications: 2;
Tribal colleges and universities: Awards: 0;
Native Hawaiian-and Alaska Native-serving institutions: Applications:
1;
Native Hawaiian-and Alaska Native-serving institutions: Awards: 0.
Total;
Historically black colleges and universities: Applications: 67;
Historically black colleges and universities: Awards: 18;
Hispanic-serving institutions: Applications: 34;
Hispanic-serving institutions: Awards: 10;
Tribal colleges and universities: Applications: 9;
Tribal colleges and universities: Awards: 2;
Native Hawaiian-and Alaska Native-serving institutions: Applications:
1;
Native Hawaiian-and Alaska Native-serving institutions: Awards: 0.
Source: GAO analysis of HRSA data.
[End of table]
Some entities submitted more than one application over the 4 fiscal
years of our review, and a given entity may have received more than one
grant. For example, an entity may have applied for an HCOP grant for
fiscal year 2002 and failed to receive a grant, then tried again in
subsequent years. A new fiscal year 2002 grantee would have had to
apply for a competitive continuation grant for fiscal year 2005 after
the end of its 3-year project period. It is also possible for the same
entity to have had more than one HCOP grant at the same time, provided
that each grant had a distinct purpose and budget.
Agency Comments:
In written comments on a draft of this report (see app. III), HRSA
stated that the report met the goals of describing the award process
and outlining the number and characteristics of HCOP applicants and
grantees. HRSA suggested that, due to the small number of grantees, the
summary of findings on our Highlights page present the numbers, rather
than percentages, of minority institutions that were awarded grants
between 2005 and 2006. For the summary, we believe it is appropriate to
use percentages to convey that applications from minority-serving
institutions generally received grants in greater proportion than all
applications. As noted in the draft report, the percentages we present
are for the 4-year period of fiscal years 2002 through 2005. HRSA
provided two other comments suggesting revisions to clarify our
discussion, which we generally incorporated. In addition, HRSA provided
technical comments which we incorporated as appropriate.
We are sending copies of this report to the Administrator of HRSA and
appropriate congressional committees. We will also provide copies to
others upon request. In addition, the report is available at no charge
on the GAO Web site at [hyperlink, http://www.gao.gov].
If you or your staff members have any questions about this report,
please contact me at (312) 220-7600 or aronovitzl@gao.gov. Contact
points for our Offices of Congressional Relations and Public Affairs
may be found on the last page of this report. GAO staff who made major
contributions to this report are listed in appendix IV.
Signed by:
Leslie G. Aronovitz:
Director, Health Care:
Appendix I: Identification of Minority-Serving Institutions:
We determined whether Health Careers Opportunity Program (HCOP)
applicants and grantees were minority-serving institutions by using
statutory definitions, lists of institutions that fall under these
statutory definitions, and data from the Department of Education. The
term "minority-serving institution" refers to an accredited institution
of higher education eligible for federal support under title III or
title V of the Higher Education Act of 1965;[Footnote 34] this support
is administered by the Department of Education. These institutions
include historically black colleges and universities, American Indian
tribally controlled (or tribal) colleges and universities, Hispanic-
serving institutions, Native Hawaiian-serving institutions, and Alaska
Native-serving institutions.[Footnote 35]
For our review, we defined historically black colleges and universities
and tribal colleges and universities as institutions that met certain
statutory definitions for institutions eligible to receive federal
support under title III of the Higher Education Act of 1965.[Footnote
36] To identify an HCOP applicant or grantee as a historically black
college or university, we compared a list of historically black
colleges and universities published by the White House Initiative on
Historically Black Colleges and Universities[Footnote 37] with the data
we obtained from the Health Resources and Services Administration
(HRSA) on HCOP grant applicants and recipients. To identify HCOP
applicants and grantees that were designated as a tribal college or
university, we compared a list published by the White House Initiative
on Tribal Colleges and Universities[Footnote 38] with the data we
obtained from HRSA on HCOP grant applicants and recipients.
Hispanic-serving institutions, Native Hawaiian-serving institutions,
and Alaska Native-serving institutions are eligible for federal funding
under title III or title V of the Higher Education Act of
1965.[Footnote 39] Unlike historically black colleges and universities
and tribal colleges and universities, however, eligibility of these
institutions for funding is based on the percentage of enrolled
minority students.[Footnote 40] As a result, the number of institutions
that qualify as Hispanic-serving institutions, Native Hawaiian-serving
institutions, and Alaska Native-serving institutions can vary from year
to year. For our review, we defined Hispanic-serving institutions as
those that received grants through the Developing Hispanic-Serving
Institutions Program under title V of the Higher Education Act of
1965[Footnote 41] for fiscal years 2002 through 2005. That is, we
determined an institution's status as a Hispanic-serving institution
for a particular fiscal year on the basis of whether the institution
had a title V grant that year. To identify HCOP applicants and grantees
that were Hispanic-serving institutions at the time of our review, we
obtained lists of title V grantees for the Developing Hispanic-Serving
Institutions Program from the Department of Education's Web site for
fiscal years 1999 through 2005.[Footnote 42] We cross-checked the title
V grantee lists with the membership of the Hispanic Association of
Colleges and Universities[Footnote 43] and with lists of schools with
significant Hispanic enrollment from the Department of Education's
Office of Civil Rights.[Footnote 44] We compared these lists with the
data we obtained from HRSA on HCOP grant applicants and recipients. In
addition, we counted all HCOP applicants and grantees located in Puerto
Rico as Hispanic-serving institutions. Because not all institutions
that could be eligible for grants under title V of the Higher Education
Act of 1965 apply for or receive title V grants, our counts of Hispanic-
serving institutions at a given time are likely to be conservative.
Likewise, we defined Native Hawaiian-serving institutions and Alaska
Native-serving institutions as those that were eligible to receive
grants under title III of the Higher Education Act of 1965[Footnote 45]
and that received such grants for fiscal years 2002 through 2005.
As noted above, the exact number of entities designated as minority-
serving institutions may vary from year to year. While we were able to
classify the HCOP applicants and grantees for fiscal years 2002 through
2005, table 5 summarizes the different minority-serving institution
designations and provides approximate counts for fiscal year 2005, the
most recent year for which total counts were available.
Table 5: Minority-Serving Institution Designations, Criteria, and
Approximate Number as of Fiscal Year 2005:
Designation: Historically black colleges and universities;
Designation criteria: Defined under title III of the Higher Education
Act of 1965 as "any [accredited] historically Black college or
university that was established prior to 1964, whose principal mission
was, and is, the education of Black Americans."[A];
Approximate number as of fiscal year 2005: 104.
Designation: Tribal colleges and universities;
Designation criteria: Defined under title III of the Higher Education
Act of 1965 as an accredited institution of higher education that is
formally controlled, or has been formally sanctioned or chartered, by
the governing body of an Indian tribe.[B];
Approximate number as of fiscal year 2005: 35.
Designation: Hispanic-serving institutions;
Designation criteria: Defined under title V of the Higher Education Act
of 1965 as an accredited institution of higher education with at least
a 25 percent full-time-equivalent undergraduate enrollment of Hispanic
students, of whom at least 50 percent must be low income (at or below
150 percent of the federal poverty level).[C];
Approximate number as of fiscal year 2005: 179.
Designation: Native Hawaiian-serving institutions;
Designation criteria: Defined under title III of the Higher Education
Act of 1965 as an accredited institution of higher education with a
student body consisting of at least 10 percent Native Hawaiian
students.[D];
Approximate number as of fiscal year 2005: 9.
Designation: Alaska Native-serving institutions;
Designation criteria: Defined under title III of the Higher Education
Act as an accredited institution of higher education with a student
body consisting of at least of 20 percent Alaska Native students.[E];
Approximate number as of fiscal year 2005: 10.
Source: GAO, HRSA, the Department of Education, the White House
Initiative on Historically Black Colleges and Universities, the White
House Initiative on Tribal Colleges and Universities, and the Hispanic
Association of Colleges and Universities.
[A] 20 U.S.C. § 1061.
[B] 20 U.S.C. § 1059c; 25 U.S.C. § 1801(a)(4).
[C] 20 U.S.C. § 1101a.
[D] 20 U.S.C. § 1059d.
[E] 20 U.S.C. § 1059d.
[End of table]
Appendix II: HCOP Competitive Applications and Grants, by Location of
Grant Applicant, Fiscal Years 2002 through 2005:
Table 6 shows, by location, applications and awards for competitive
HCOP grants for fiscal years 2002 through 2005. The numbers represent
applications, rather than individual applicant entities. An entity may
have applied for a competitive HCOP grant more than once, and a single
entity may have had more than one HCOP grant for separate and distinct
HCOP projects. The locations are those of the grant applicants,
although partnerships may cross state lines and result in HCOP-funded
activities and services in more than one state.
Table 6: Entities Applying for and Receiving Competitive HCOP Grants,
by Location, Fiscal Years 2002-05:
State or territory of grant applicant: Alabama;
HCOP applications: 17;
HCOP awards: 5.
State or territory of grant applicant: Alaska;
HCOP applications: 2;
HCOP awards: 2.
State or territory of grant applicant: American Samoa;
HCOP applications: 0;
HCOP awards: 0.
State or territory of grant applicant: Arizona;
HCOP applications: 4;
HCOP awards: 0.
State or territory of grant applicant: Arkansas;
HCOP applications: 6;
HCOP awards: 2.
State or territory of grant applicant: California;
HCOP applications: 30;
HCOP awards: 7.
State or territory of grant applicant: Colorado;
HCOP applications: 3;
HCOP awards: 0.
State or territory of grant applicant: Commonwealth of the Northern
Mariana Islands;
HCOP applications: 0;
HCOP awards: 0.
State or territory of grant applicant: Connecticut;
HCOP applications: 2;
HCOP awards: 1.
State or territory of grant applicant: Delaware;
HCOP applications: 1;
HCOP awards: 0.
State or territory of grant applicant: District of Columbia;
HCOP applications: 13;
HCOP awards: 3.
State or territory of grant applicant: Federated States of Micronesia;
HCOP applications: 0;
HCOP awards: 0.
State or territory of grant applicant: Florida;
HCOP applications: 20;
HCOP awards: 6.
State or territory of grant applicant: Georgia;
HCOP applications: 13;
HCOP awards: 3.
State or territory of grant applicant: Guam;
HCOP applications: 2;
HCOP awards: 0.
State or territory of grant applicant: Hawaii;
HCOP applications: 3;
HCOP awards: 0.
State or territory of grant applicant: Idaho;
HCOP applications: 0;
HCOP awards: 0.
State or territory of grant applicant: Illinois;
HCOP applications: 7;
HCOP awards: 1.
State or territory of grant applicant: Indiana;
HCOP applications: 2;
HCOP awards: 0.
State or territory of grant applicant: Iowa;
HCOP applications: 3;
HCOP awards: 0.
State or territory of grant applicant: Kansas;
HCOP applications: 2;
HCOP awards: 1.
State or territory of grant applicant: Kentucky;
HCOP applications: 11;
HCOP awards: 2.
State or territory of grant applicant: Louisiana;
HCOP applications: 9;
HCOP awards: 2.
State or territory of grant applicant: Maine;
HCOP applications: 1;
HCOP awards: 0.
State or territory of grant applicant: Maryland;
HCOP applications: 7;
HCOP awards: 1.
State or territory of grant applicant: Massachusetts;
HCOP applications: 17;
HCOP awards: 1.
State or territory of grant applicant: Michigan;
HCOP applications: 15;
HCOP awards: 5.
State or territory of grant applicant: Minnesota;
HCOP applications: 6;
HCOP awards: 1.
State or territory of grant applicant: Mississippi;
HCOP applications: 2;
HCOP awards: 0.
State or territory of grant applicant: Missouri;
HCOP applications: 4;
HCOP awards: 2.
State or territory of grant applicant: Montana;
HCOP applications: 5;
HCOP awards: 2.
State or territory of grant applicant: Nebraska;
HCOP applications: 8;
HCOP awards: 1.
State or territory of grant applicant: Nevada;
HCOP applications: 5;
HCOP awards: 0.
State or territory of grant applicant: New Hampshire;
HCOP applications: 2;
HCOP awards: 0.
State or territory of grant applicant: New Jersey;
HCOP applications: 8;
HCOP awards: 3.
State or territory of grant applicant: New Mexico;
HCOP applications: 8;
HCOP awards: 2.
State or territory of grant applicant: New York;
HCOP applications: 34;
HCOP awards: 7.
State or territory of grant applicant: North Carolina;
HCOP applications: 15;
HCOP awards: 4.
State or territory of grant applicant: North Dakota;
HCOP applications: 11;
HCOP awards: 3.
State or territory of grant applicant: Ohio;
HCOP applications: 13;
HCOP awards: 5.
State or territory of grant applicant: Oklahoma;
HCOP applications: 5;
HCOP awards: 3.
State or territory of grant applicant: Oregon;
HCOP applications: 4;
HCOP awards: 3.
State or territory of grant applicant: Pennsylvania;
HCOP applications: 11;
HCOP awards: 3.
State or territory of grant applicant: Puerto Rico;
HCOP applications: 4;
HCOP awards: 0.
State or territory of grant applicant: Republic of the Marshall
Islands;
HCOP applications: 0;
HCOP awards: 0.
State or territory of grant applicant: Republic of Palau;
HCOP applications: 1;
HCOP awards: 0.
State or territory of grant applicant: Rhode Island;
HCOP applications: 1;
HCOP awards: 0.
State or territory of grant applicant: South Carolina;
HCOP applications: 12;
HCOP awards: 0.
State or territory of grant applicant: South Dakota;
HCOP applications: 3;
HCOP awards: 0.
State or territory of grant applicant: Tennessee;
HCOP applications: 10;
HCOP awards: 3.
State or territory of grant applicant: Texas;
HCOP applications: 42;
HCOP awards: 6.
State or territory of grant applicant: United States Virgin Islands;
HCOP applications: 2;
HCOP awards: 2.
State or territory of grant applicant: Utah;
HCOP applications: 8;
HCOP awards: 2.
State or territory of grant applicant: Vermont;
HCOP applications: 1;
HCOP awards: 0.
State or territory of grant applicant: Virginia;
HCOP applications: 4;
HCOP awards: 1.
State or territory of grant applicant: Washington;
HCOP applications: 9;
HCOP awards: 1.
State or territory of grant applicant: West Virginia;
HCOP applications: 2;
HCOP awards: 1.
State or territory of grant applicant: Wisconsin;
HCOP applications: 9;
HCOP awards: 2.
State or territory of grant applicant: Wyoming;
HCOP applications: 0;
HCOP awards: 0.
State or territory of grant applicant: Total;
HCOP applications: 439;
HCOP awards: 99.
Source: GAO analysis of HRSA data.
[End of table]
[End of section]
Appendix III: Comments from the Health Resources and Services
Administration:
Office of the Assistant Secretary for Legislation:
Department Of Health & Human Services:
Washington, D.C. 20201:
Jan 22 2007:
Leslie G. Aronovitz:
Director, Health care:
Government Accountability Office:
Washington, DC 20548:
Dear Ms. Aronovitz:
Enclosed are the Department's comments on the U.S. Government
Accountability Office's (GAO) draft report entitled, "Health Careers
Opportunity Program: Process for Awarding Competitive Grants Included
Independent Review" (GAO-07-137).
The Department has provided several technical comments directly to your
staff.
The Department appreciates the opportunity to comment on this draft
report.
Sincerely,
Signed by:
Vincent J. Ventimiglia:
Assistant Secretary for Legislation:
Comments Of The Department Of Health And Human Services On The
Government Accountability Office (GAO) Draft Entitled: "Health Careers
Opportunity Program: Process For Awarding Competitive Grants Included
Independents Review" (GAO-07-137):
General Comments:
The GAO's report on the competitive award process for the Health
Careers opportunity Program (HCOP) is comprehensive and concise. GAO's
report meets the goals of describing the award process and outlining
the number and characteristics of HCOP applicants and grantees.
On the first page of the report, under GAO's summary of findings, the
first sentence needs to be changed to:
HHS followed a standard process to award HOOP grants, first
distributing funds on a noncompetitive basis to continue funding
existing HCOP grants within their approved project periods, and then
awarding the remaining funds on a competitive basis.
In the second paragraph of GAO's summary of findings, when describing
the number of minority institutions that were awarded grants between
2005 and 2006, HRSA suggests that due to the small number of grantees
the figures should not be presented in percentages. Instead, the
information presented should be described as follows:
Of the 99 grants that were awarded, 30 grants were awarded to minority
institutions comprising: 18 historically black colleges and
universities (HBCUs), 10 Hispanic serving-institutions, and 2 tribal
colleges and universities.
As a point of clarification, on page 15, in the first paragraph, in the
last sentence, HRSA did reduce the competitive grants budgets by ten
percent in the Fiscal Year 2004 competitive grant cycle. This resulted
in five additional institutions being funded, of which two were not
HBCUs and three were HBCUs.
[End of section]
Appendix IV: Contact and Acknowledgments:
GAO Contact:
Leslie G. Aronovitz at (312) 220-7600 or aronovitzl@gao.gov:
Acknowledgments:
In addition to the contact named above, Kim Yamane, Assistant Director;
Matt Byer; Ellen W. Chu; Karlin Richardson; Suzanne Rubins; and Hemi
Tewarson made key contributions to this report.
Related GAO Products:
Health Professions Education Programs: Action Still Needed to Measure
Impact. GAO-06-55. Washington, D.C.: February 28, 2006.
Low-Income and Minority-Serving Institutions: Department of Education
Could Improve its Monitoring and Assistance. GAO-04-961. Washington,
D.C.: September 21, 2004.
Health Professions Education: Clarifying the Role of Title VII and VIII
Programs Could Improve Accountability. GAO/T-HEHS-97-117. Washington,
D.C.: April 25, 1997.
FOOTNOTES
[1] See Public Health Service Act, title VII, § 739 (codified, as
amended, at 42 U.S.C. § 293c).
[2] 42 U.S.C. § 293c(b).
[3] All recipients of noncompetitive continuation grants initially
competed for their HCOP grants and must compete for additional funding
following the end of their approved project periods; for awards made
for fiscal years 2002 through 2005, this period was 3 years. Funding
after the initial year of each project period is awarded
noncompetitively, subject to the availability of funds and HRSA's
review of each grantee's annual progress report.
[4] H.R. Rep. No. 109-337, at 135 (2005) (accompanying the Departments
of Labor, Health and Human Services, and Education, and Related
Agencies Appropriations Act, 2006).
[5] According to officials with HRSA's grants management office, about
$26 million would have been required for fiscal year 2006 to fund all
58 HCOP grants that would otherwise have been considered for
noncompetitive continuation grants for that year.
[6] S. Rep. No. 109-103, at 38 (2005).
[7] On January 27, 2006, HRSA notified the 54 remaining HCOP grantees
that, because of reductions in the funding available for HCOP, they
would not receive noncompetitive continuation grants.
[8] For HCOP, HRSA has defined educationally disadvantaged individuals
as those from an environment that has inhibited their obtaining the
knowledge, skills, and abilities to enroll in and graduate from a
health professions school or allied health program; it has defined
economically disadvantaged individuals as those from families with
annual incomes at or below the low-income thresholds published by the
U.S. Bureau of the Census. See, for example, U.S. Department of Health
and Human Services, Health Resources and Services Administration,
Health Careers Opportunity Program (HCOP): New Competition, Program
Guidance, Fiscal Year 2005, HRSA 05-098 (Rockville, Md.: Oct. 28,
2004).
[9] See, for example, S. Rep. No. 107-84, at 55-56 (2001); H.R. Rep.
107-229, at 25 (2001); S. Rep. No. 107-216, at 48 (2002); H.R. Rep. 108-
188, at 24 (2003); and S. Rep. No. 108-81, at 49 (2003).
[10] H.R. Conf. Rep. No. 108-792, at 1156 (2004).
[11] Id.
[12] Some entities applied for more than one HCOP grant or operated
more than one HCOP-supported project. The numbers of HCOP applications
presented in this report represent the applications and not the
individual entities that applied for, or received, HCOP grants.
[13] These minority-serving institutions include historically black
colleges and universities, American Indian tribally-controlled (or
"tribal") colleges and universities, Hispanic-serving institutions,
Native Hawaiian-serving institutions, and Alaska Native-serving
institutions. The term "minority-serving institution" includes
institutions of higher education eligible for federal funding under
title III or title V of the Higher Education Act of 1965, Pub. L. No.
89-329, title III, §§ 301-305 et seq., 79 Stat. 1229-1231 (1965), as
amended (codified, as amended, at 20 U.S.C. §§ 1051 et seq.); Pub. L.
No. 89-329, title V, §§ 501-528, 79 Stat. 1254-1260 (1965), as amended
(codified, as amended at 20 U.S.C. § 1101 et seq.) See app. I for a
detailed description of our methodology for determining an entity's
status as a minority-serving institution for the analyses in this
report.
[14] This program was authorized as Health Manpower Education
Initiative Awards. See Comprehensive Health Manpower Training Act of
1971, Pub. L. No. 92-157, § 774(b), 85 Stat. 446-448 (1971).
[15] Health Professions Education Partnerships Act of 1998, Pub. L. No.
105-392, 112 Stat. 3534-3536 (1998) (codified, as amended, at 42 U.S.C
§293c). The 1998 reauthorization resulted in the grouping of the more
than 40 health professions education and training programs, including
HCOP, in existence at the time into seven clusters. The Senate report
accompanying the reauthorization legislation stated that the purposes
of the cluster that included HCOP were to (1) provide for the training
of minority and disadvantaged health professionals to improve health
care access in underserved areas, (2) improve representation in the
health professions, and (3) provide administrative flexibility and
simplification. See S. Rep. No. 105-220, at 2 (1998). See also "Related
GAO Products" at the end of this report.
[16] 42 U.S.C. § 293c(a)(1). These provisions also authorize the
Secretary of Health and Human Services to enter into contracts with
eligible entities. A HRSA official responsible for administering HCOP
informed us that, for fiscal years 2002 through 2005, the agency
entered into such contracts for administrative and logistical services,
such as arranging meetings for HCOP project directors.
[17] Schools of nursing are not eligible for HCOP grants; nursing
education programs are supported under title VIII of the Public Health
Service Act.
[18] See Health Professions Education Partnerships Act of 1998, Pub. L.
No. 105-392, title I, § 739(b), 112 Stat. 3534-3536 (1998)(codified, as
amended, at 42 U.S.C. § 293c(b)).
[19] 42 U.S.C. § 293c(c).
[20] U.S. Department of Health and Human Services, Health Resources and
Services Administration, Fiscal Year 1999 Justification of Estimates
for Appropriations Committees, vol. 1, Budget (Washington, D.C.) The
Federal Register notifications describing the factors to be considered
in awarding HCOP grants for fiscal years 1996 through 1998 did not
specify that additional points would be allocated to minority-serving
institutions, and the HRSA official responsible for administering HCOP
informed us that additional points were not allocated to applications
from these institutions after fiscal year 1998.
[21] For fiscal years 2002 through 2005, HRSA authorized project
periods of 3 years for HCOP. For fiscal year 2001, HRSA authorized
project periods of up to 5 years.
[22] For fiscal years 2002 through 2004, these notifications, called
"HRSA Preview," were published in the Federal Register along with
announcements for other HRSA grant opportunities. For fiscal year 2005,
HRSA published a notice in the Federal Register that referred
interested parties to the HRSA Preview available through the HRSA Web
site. See 69 Fed. Reg. 61026 (Oct. 14, 2004).
[23] Competitive grants consisted of both new grants to entities that
did not have an HCOP grant for a particular project and competitive
continuation grants to entities that applied for funding after the end
of a previously authorized HCOP project period.
[24] HRSA made minor revisions to the format and terminology of the
published HCOP review criteria each year, but they remained
substantially similar for fiscal years 2002 through 2005. For example,
the fiscal year 2005 criterion titled "Resources and Capabilities" was
called "Institutional Commitment" in the guidance from 2002 through
2004, although it required essentially the same documentation for all
years.
[25] U.S. Department of Health and Human Services, Health Resources and
Services Administration, Health Careers Opportunity Program (HCOP): New
Competition, Program Guidance, Fiscal Year 2005, HRSA 05-098
(Rockville, Md.: Oct. 28, 2004); 42 U.S.C. § 293c(b).
[26] HRSA's Division of Independent Review selected independent
reviewers and organized reviews of applications for competitive grants
for HRSA-administered grant programs. Division officials briefed
reviewers on the review process and sent reviewers a manual with
detailed instructions on their responsibilities, along with the
applications they were assigned to read. The division then convened
panels of reviewers and facilitated their discussions.
[27] The Division of Independent Review obtained a conflict-of-interest
certification from each reviewer. Reviewers needed to be free from
biases and to certify that they did not have a conflict of interest,
including employment or consulting arrangements, with an entity
applying for an HCOP grant during that fiscal year. According to the
Director of the Division of Independent Review, employment information
supplied by potential reviewers was compared to applicant organization
entities to identify obviously excludable reviewer candidates.
Otherwise, the division accepted the conflict-of-interest
certifications at face value unless the prospective reviewers declared
either a potential conflict of interest or the potential perception of
a conflict of interest. In such cases, the division determined whether
to disqualify the prospective reviewers after contacting them directly
and discussing the nature of the potential conflict.
[28] For each application, the reviewers also prepared a summary
statement of its strengths and weaknesses.
[29] For fiscal years 2002 through 2005, the HRSA Administrator's award
decisions were consistent with these recommendations.
[30] The Public Health Service Act's provision requiring that HCOP
services and activities be adequately allocated among racial and ethnic
populations from disadvantaged backgrounds refers to populations served
by grantees and not to the grantee institutions. See 42 U.S.C. §
293c(c).
[31] The total number of applications included only those that passed
HRSA's initial screening and were sent to the independent reviewers.
[32] For information on the number of applications and grants by
location, see app. II.
[33] The designation of a minority-serving institution applies only to
institutions of higher education that may be eligible for federal
funding under title III or title V of the Higher Education Act of 1965,
as amended.
[34] Higher Education Act of 1965, Pub. L. No. 89-329, title III, §§
301-305 et seq., 79 Stat. 1229-1231 (1965), as amended (codified, as
amended, at 20 U.S.C. §§ 1051 et seq.); Pub. L. No. 89-329, title V, §§
501-528, 79 Stat. 1254-1260 (1965), as amended (codified, as amended,
at 20 U.S.C. §§ 1101 et seq.) For the remainder of this appendix, we
will refer to the U.S. Code when referencing provisions of the Higher
Education Act of 1965.
[35] We included only educational institutions in our counts of
applications from, and HCOP grants to, minority-serving institutions.
We did not categorize applications from other entities, such as area
health education centers (academic-community partnerships that train
health care providers in rural or underserved areas), even if they
served a minority population. Consequently, the non-minority-serving
institution categories of HCOP grantees include institutions of higher
education as well as entities that are not colleges or universities,
which do not fall under the definition of minority-serving institutions
as used in this report.
[36] 20 U.S.C. §§ 1059c, 1061.
[37] U.S. Department of Education, "List of HBCUs--White House
Initiative on Historically Black Colleges and Universities,"
[Hyperlink, http://www.ed.gov/about/inits/list/whhbcu/edlite-list.html]
(downloaded November 21, 2005). This list represents entities that met
certain criteria for Historically Black Colleges and Universities,
regardless of whether the institutions had or were currently receiving
federal funding under title III of the Higher Education Act of 1965.
[38] U.S. Department of Education, "White House Initiative on Tribal
Colleges and Universities: Tribal Colleges and Universities Address
List," [Hyperlink, http://www.ed.gov/about/inits/list/whtc/edlite-
tclist.html] (downloaded Nov. 30, 2005). This list represents entities
that met certain criteria for tribal colleges and universities,
regardless of whether the institutions had or were currently receiving
federal funding under title III of the Higher Education Act of 1965.
[39] 20 U.S.C. §§ 1051 et seq; 20 U.S.C. §§ 1101 et seq.
[40] For example, title V of the Higher Education Act of 1965, as
amended, defines a "Hispanic-serving institution" as an institution of
higher education that has an enrollment of full-time-equivalent
undergraduate students consisting of at least 25 percent Hispanic
students, and provides assurances that not less than 50 percent of its
Hispanic students are low-income (at or below 150 percent of the
federal poverty level). 20 U.S.C. § 1101a.
[41] 20 U.S.C. §§ 1101 et seq.
[42] Department of Education, "Developing Hispanic-Serving Institutions
Program--Title V," [Hyperlink,
http://www.ed.gov/programs/idueshsi/awards.html] (downloaded Mar. 28,
2006).
[43] Hispanic Association of Colleges and Universities, "HACU Member
Hispanic-Serving Institutions," [Hyperlink,
http://www.hacu.net/assnfe/CompanyDirectory.asp?STYLE=2&COMPANY_TYPE=1,5
&SEARCH_TYPE=0] (downloaded Apr. 28, 2006).
[44] Department of Education, Office of Civil Rights, "United States
Department of Education Accredited Postsecondary Minority Institutions:
Institutions with High Hispanic Enrollment," [Hyperlink,
http://www.ed.gov/about/offices/list/ocr/edlite-minorityinst-list-hisp-
tab.html] (downloaded Mar. 28, 2006).
[45] 20 U.S.C. § 1059d.
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