GAO Report Critical of HRSA Grantee Oversight

A recent report by the Government Accountability Office (GAO) entitled, "Ryan White CARE Act: Improvements Needed in Oversight of Grantees" issued several critical findings about the oversight of Ryan White Program Part A and Part B grantees. The GAO released the report on June 11 to four key members of the Senate's Committee on Health, Education, Labor and Pensions (HELP). The Senators were Tom Harkin (D-IA, HELP Chair), Michael Enzi (R-WY, Ranking Member), Richard Burr (R-NC), and Tom Coburn (R-OK).

The report states that the Health Resources Services Administration (HRSA), which is responsible for the Ryan White Program, did not consistently follow the Department of Health and Human Services' or its own guidance for "documenting routine monitoring, prioritizing grantee site visits, reviewing annual single audit findings, or clearly communicating with grantees about the restrictive drawdown process." The report also found that there is a lack of follow up when problems are documented and that a lack of records and frequent changes in project officers challenges HRSA's oversight functions.

The GAO noted that HRSA "did not demonstrate a clear strategy for selecting the grantees it visited from 2008 through 2011" -- for example, prioritizing site visits based on the time since a previous visit, a history of problems or the size of the grantee. Several recent news articles and blogs noted that relatively small grantees such as the Virgin Islands or Puerto Rico, received visits during the winter. However it should be noted that both of those grantees have been the focus of specific community concerns that were communicated to HRSA and the Office of National AIDS Policy (ONAP). A remaining notable issue is that implementation of national standards for grantee monitoring of service providers (subgrantees) created additional problems because grantees did not have adequate technical assistance or guidance in implementing the standards.

The GAO made five specific recommendations to HRSA to improve oversight. They are:

• Ensure that the agency is implementing the key elements of grantee oversight consistent with HHS and HRSA guidance, including routine monitoring, the provision of technical assistance, site visits and restrictive drawdown.
• Assess and revise its record retention management program so that complete grantee files are available for a period of time that HRSA determines will satisfy all of the agency's grantee oversight needs.
• Develop a strategic, risk-based approach for selecting grantees for site visits that better targets the use of available resources to ensure that HRSA visits grantees at regular and timely intervals.
• Update and maintain a program manual for grantees.
• Use the results of HRSA's survey of grantees to identify grantees' training needs to allow them to comply with the National Monitoring Standards.

HRSA has stated that it agrees with the recommendations and will seek to follow them.

On another note, HRSA completed a series of four regional listening sessions this week to seek commentary regarding a possible Ryan White CARE Act reauthorization. The sessions included a listening session for the South on July 9, Midwest on July 11, the West on July 16 and Northeast on July 18. HRSA continues to seek comments regarding reauthorization via the internet. Comments are due July 31st and can be provided here.