Health Careers Opportunity Program: Process for Awarding	 
Competitive Grants Included Independent Review (02-FEB-07,	 
GAO-07-137).							 
                                                                 
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.					 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-07-137 					        
    ACCNO:   A65525						        
  TITLE:     Health Careers Opportunity Program: Process for Awarding 
Competitive Grants Included Independent Review			 
     DATE:   02/02/2007 
  SUBJECT:   Disadvantaged persons				 
	     Education program evaluation			 
	     Educational grants 				 
	     Eligibility determinations 			 
	     Employment assistance programs			 
	     Employment opportunities				 
	     Grant administration				 
	     Health care personnel				 
	     Higher education					 
	     Minorities 					 
	     Medical education					 
	     Health Careers Opportunity Program 		 

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GAO-07-137

   

     * [1]Results in Brief
     * [2]Background
     * [3]HRSA Followed a Standard Process to Award HCOP Grants

          * [4]HRSA Funded Existing HCOP Projects Before Awarding Competiti
          * [5]HRSA's Process for Awarding Competitive Grants Was Based on
          * [6]HRSA's Process for Awarding Competitive Grants Relied on Ass

     * [7]Applications from Minority-Serving Institutions Generally Re

          * [8]Number of Competitive Grants Awarded Depended on Availabilit
          * [9]About One-Third of Competitive HCOP Grants Were Awarded to M

     * [10]Agency Comments
     * [11]Appendix I: Identification of Minority-Serving Institutions
     * [12]Appendix II: HCOP Competitive Applications and Grants, by Lo
     * [13]Appendix III: Comments from the Health Resources and Service
     * [14]Appendix IV: Contact and Acknowledgments

          * [15]GAO Contact
          * [16]Acknowledgments

     * [17]Related GAO Products

          * [18]Order by Mail or Phone

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

Contents

Letter 1

Results in Brief 4
Background 5
HRSA Followed a Standard Process to Award HCOP Grants 7
Applications from Minority-Serving Institutions Generally Received Grants
in Greater Proportion Than All Applications 15
Agency Comments 19
Appendix I Identification of Minority-Serving Institutions 21
Appendix II HCOP Competitive Applications and Grants, by Location of Grant
Applicant, Fiscal Years 2002 through 2005 25
Appendix III Comments from the Health Resources and Services
Administration 27
Appendix IV Contact and Acknowledgments 29
Related GAO Products 30

Tables

Table 1: Review Criteria for HCOP Applications, Fiscal Year 2005 10
Table 2: Number of Applications for Competitive HCOP Grants and
Competitive Grants Awarded, Fiscal Years 2002-05 16
Table 3: Applications and Awards for Competitive HCOP Grants, by
Minority-Serving Status, Fiscal Years 2002-05 18
Table 4: Numbers of HCOP Applications from, and Competitive Awards to,
Designated Minority-Serving Institutions, Fiscal Years 2002-05 19
Table 5: Minority-Serving Institution Designations, Criteria, and
Approximate Number as of Fiscal Year 2005 24
Table 6: Entities Applying for and Receiving Competitive HCOP Grants, by
Location, Fiscal Years 2002-05 25

Figures

Figure 1: Funds Awarded through the Health Careers Opportunity Program as
Noncompetitive Continuations and Competitive Grants, Fiscal Years 2002-05
8
Figure 2: Process for Awarding Competitive HCOP Grants 14
Figure 3: Scores and Funding Preference for Competitive HCOP Applications
and Grants, Fiscal Years 2002-05 17

Abbreviations

HCOP Health Careers Opportunity Program
HHS Department of Health and Human Services
HRSA Health Resources and Services Administration

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separately.

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.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.2 Applications that receive this funding
preference are considered for funding ahead of applications that do not.

1See Public Health Service Act, title VII, S 739 (codified, as amended, at
42 U.S.C. S 293c).

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.3 For
fiscal year 2006, in response to direction received during the
appropriations process,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.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,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.7

242 U.S.C. S 293c(b).

3All 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.

4H.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).

5According 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.

6S. Rep. No. 109-103, at 38 (2005).

7On 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.

All projects supported by HCOP grants focus on individuals who are either
educationally or economically disadvantaged.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."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 2004.10 In this
report, the conference committee also directed us to study the HCOP grant
award process.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 2005.12 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,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.

8For 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).

9See, 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).

10H.R. Conf. Rep. No. 108-792, at 1156 (2004).

11Id.

12Some 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.

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.

13These 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, SS 301-305 et
seq., 79 Stat. 1229-1231 (1965), as amended (codified, as amended, at 20
U.S.C. SS 1051 et seq.); Pub. L. No. 89-329, title V, SS 501-528, 79 Stat.
1254-1260 (1965), as amended (codified, as amended at 20 U.S.C. S 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.

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 1971,14 the program currently known as HCOP was last
reauthorized in 1998.15 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."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.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.

14This program was authorized as Health Manpower Education Initiative
Awards. See Comprehensive Health Manpower Training Act of 1971, Pub. L.
No. 92-157, S 774(b), 85 Stat. 446-448 (1971).

15Health Professions Education Partnerships Act of 1998, Pub. L. No.
105-392, 112 Stat. 3534-3536 (1998) (codified, as amended, at 42 U.S.C
S293c). 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.

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."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."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.20

1642 U.S.C. S 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.

17Schools of nursing are not eligible for HCOP grants; nursing education
programs are supported under title VIII of the Public Health Service Act.

18See Health Professions Education Partnerships Act of 1998, Pub. L. No.
105-392, title I, S 739(b), 112 Stat. 3534-3536 (1998)(codified, as
amended, at 42 U.S.C. S 293c(b)).

1942 U.S.C. S 293c(c).

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.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.

20U.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.

21For 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.

Figure 1: Funds Awarded through the Health Careers Opportunity Program as
Noncompetitive Continuations and Competitive Grants, Fiscal Years 2002-05

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.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.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 2005.24

22For 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).

23Competitive 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.

24HRSA 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.

Table 1: Review Criteria for HCOP Applications, Fiscal Year 2005

                                                         Weight in points
                                                       Competitive            
Criterion                                          continuation        New 
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.                                         35         50 
Evaluative measures: A progress summary showing                            
successful management of a previous grant and                          Not 
meeting of its objectives.                                   20 applicable 
Cultural competence development: Clearly defined                           
goals and objectives for teaching cultural                                 
competence, with activities appropriate to each                            
educational level.b                                          15         10 
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.                                    10         10 
Support requested: A cost-effective, reasonable                            
budget consistent with the project's objectives                            
and activities.                                              10         10 
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.                          5         15 
Impact: A clearly designed plan to disseminate and                         
implement HCOP project results to the regional or                          
national education and health professions                                  
communities.                                                  5          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.

aHRSA'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. S 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.

bFor 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.

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:

           o 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.

           o Enter into formal signed agreements reflecting the coordination
           of educational activities and support services and the
           consolidation of resources within a specific area.

           o 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.

           o Describe educational activities that focus on developing a
           culturally competent health care workforce to serve needy
           populations in the geographic area.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.
			  
			  HRSAï¿½s 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.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.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.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 2005.29 Figure 2 provides an overview of the
           process for awarding competitive HCOP grants.

           Figure 2: Process for Awarding Competitive HCOP Grants

           aHRSA 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.

           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.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.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).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

                Applications for competitive        
                           grants                 Competitive grants awarded
Fiscal                         Competitive                     Competitive
year       Total New         continuations  Total New        continuations
2002         107  77                     30    31  18                   13
2003          93  84                      9    10   7                    3
2004         116  91                     25    24  12                   12
2005         123  78                     45    34  15                   19
Total        439 330                    109    99  52                   47		  

           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.


25U.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. S 293c(b).

26HRSA'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.

27The 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.

28For each application, the reviewers also prepared a summary statement of
its strengths and weaknesses.

29For fiscal years 2002 through 2005, the HRSA Administrator's award
decisions were consistent with these recommendations.

30The 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. S 293c(c).

31The total number of applications included only those that passed HRSA's
initial screening and were sent to the independent reviewers.

32For information on the number of applications and grants by location,
see app. II.

Figure 3: Scores and Funding Preference for Competitive HCOP Applications
and Grants, Fiscal Years 2002-05

Note: Reviewers did not approve for funding or score applications that
they determined were not responsive to the review criteria for HCOP
applications.

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.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.

33The 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.

Table 3: Applications and Awards for Competitive HCOP Grants, by
Minority-Serving Status, Fiscal Years 2002-05

                    Applications                                Awards
                 Number from  Percentage from               Number to    Percentage to
            minority-serving minority-serving        minority-serving minority-serving
      Total     institutions     institutions  Total     institutions     institutions
2002    107               30                28    31               11               35
2003     93               20                22    10                1               10
2004    116               29                25    24                6               25
2005    123               32                26    34               12               35
Total   439              111                25    99               30               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.

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

                                                                              Native
                                                                          Hawaiian- and
       Historically black                            Tribal colleges          Alaska
          colleges and         Hispanic-serving            and            Native-serving
          universities           institutions         universities         institutions
      Applications Awards  Applications Awards  Applications Awards  Applications Awards
2002            17       6           10       4            3       1            0      0
2003            11       1            7       0            2       0            0      0
2004            21       5            6       0            2       1            0      0
2005            18       6           11       6            2       0            1      0
Total           67      18           34      10            9       2            1      0

Source: GAO analysis of HRSA data.

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 http://www.gao.gov.

If you or your staff members have any questions about this report, please
contact me at (312) 220-7600 or [email protected]. 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.

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;1 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.2

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 1965.3 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
Universities4 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 Universities5 with the data we obtained
from HRSA on HCOP grant applicants and recipients.

1Higher Education Act of 1965, Pub. L. No. 89-329, title III, SS 301-305
et seq., 79 Stat. 1229-1231 (1965), as amended (codified, as amended, at
20 U.S.C. SS 1051 et seq.); Pub. L. No. 89-329, title V, SS 501-528, 79
Stat. 1254-1260 (1965), as amended (codified, as amended, at 20 U.S.C. SS
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.

2We 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.

320 U.S.C. SS 1059c, 1061.

4U.S. Department of Education, "List of HBCUs--White House Initiative on
Historically Black Colleges and Universities,"
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.

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 1965.6 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.7 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 19658 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 2005.9 We cross-checked the title V grantee lists with the
membership of the Hispanic Association of Colleges and Universities10 and
with lists of schools with significant Hispanic enrollment from the
Department of Education's Office of Civil Rights.11 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 196512 and
that received such grants for fiscal years 2002 through 2005.

5U.S. Department of Education, "White House Initiative on Tribal Colleges
and Universities: Tribal Colleges and Universities Address List,"
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.

620 U.S.C. SS 1051 et seq.; 20 U.S.C. SS 1101 et seq.

7For 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. S 1101a.

820 U.S.C. SS 1101 et seq.

9Department of Education, "Developing Hispanic-Serving Institutions
Program--Title V," http://www.ed.gov/programs/idueshsi/awards.html
(downloaded Mar. 28, 2006).

10Hispanic Association of Colleges and Universities, "HACU Member
Hispanic-Serving Institutions,"
http://www.hacu.net/assnfe/CompanyDirectory.asp?STYLE=2&COMPANY_TYPE=1,5&SEARCH_TYPE=0
(downloaded Apr. 28, 2006).

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.

11Department of Education, Office of Civil Rights, "United States
Department of Education Accredited Postsecondary Minority Institutions:
Institutions with High Hispanic Enrollment,"
http://www.ed.gov/about/offices/list/ocr/edlite-minorityinst-list-hisp-tab.html
(downloaded Mar. 28, 2006).

1220 U.S.C. S 1059d.

Table 5: Minority-Serving Institution Designations, Criteria, and
Approximate Number as of Fiscal Year 2005

                                                                  Approximate 
                                                                 number as of 
Designation           Designation criteria                fiscal year 2005 
Historically black    Defined under title III of the                   104 
colleges and          Higher Education Act of 1965 as                      
universities          "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                                         
Tribal colleges and   Defined under title III of the                    35 
universities          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                  
Hispanic-serving      Defined under title V of the Higher              179 
institutions          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                                     
Native                Defined under title III of the                     9 
Hawaiian-serving      Higher Education Act of 1965 as an                   
institutions          accredited institution of higher                     
                         education with a student body                        
                         consisting of at least 10 percent                    
                         Native Hawaiian students.d                           
Alaska Native-serving Defined under title III of the                    10 
institutions          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                     

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.

a20 U.S.C. S 1061.

b20 U.S.C. S 1059c; 25 U.S.C. S 1801(a)(4).

c20 U.S.C. S 1101a.

d20 U.S.C. S 1059d.

e20 U.S.C. S 1059d.

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        HCOP applications HCOP awards 
Alabama                                                     17           5 
Alaska                                                       2           2 
American Samoa                                               0           0 
Arizona                                                      4           0 
Arkansas                                                     6           2 
California                                                  30           7 
Colorado                                                     3           0 
Commonwealth of the Northern Mariana Islands                 0           0 
Connecticut                                                  2           1 
Delaware                                                     1           0 
District of Columbia                                        13           3 
Federated States of Micronesia                               0           0 
Florida                                                     20           6 
Georgia                                                     13           3 
Guam                                                         2           0 
Hawaii                                                       3           0 
Idaho                                                        0           0 
Illinois                                                     7           1 
Indiana                                                      2           0 
Iowa                                                         3           0 
Kansas                                                       2           1 
Kentucky                                                    11           2 
Louisiana                                                    9           2 
Maine                                                        1           0 
Maryland                                                     7           1 
Massachusetts                                               17           1 
Michigan                                                    15           5 
Minnesota                                                    6           1 
Mississippi                                                  2           0 
Missouri                                                     4           2 
Montana                                                      5           2 
Nebraska                                                     8           1 
Nevada                                                       5           0 
New Hampshire                                                2           0 
New Jersey                                                   8           3 
New Mexico                                                   8           2 
New York                                                    34           7 
North Carolina                                              15           4 
North Dakota                                                11           3 
Ohio                                                        13           5 
Oklahoma                                                     5           3 
Oregon                                                       4           3 
Pennsylvania                                                11           3 
Puerto Rico                                                  4           0 
Republic of the Marshall Islands                             0           0 
Republic of Palau                                            1           0 
Rhode Island                                                 1           0 
South Carolina                                              12           0 
South Dakota                                                 3           0 
Tennessee                                                   10           3 
Texas                                                       42           6 
United States Virgin Islands                                 2           2 
Utah                                                         8           2 
Vermont                                                      1           0 
Virginia                                                     4           1 
Washington                                                   9           1 
West Virginia                                                2           1 
Wisconsin                                                    9           2 
Wyoming                                                      0           0 
Total                                                      439          99 

Source: GAO analysis of HRSA data.

Appendix III: Comments from the Health Resources and Services
Administration

Appendix IV: Contact and Acknowledgments

GAO Contact

Leslie G. Aronovitz at (312) 220-7600 or [email protected]

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. [19]GAO-06-55 . Washington, D.C.: February 28, 2006.

Low-Income and Minority-Serving Institutions: Department of Education
Could Improve its Monitoring and Assistance. [20]GAO-04-961 . Washington,
D.C.: September 21, 2004.

Health Professions Education: Clarifying the Role of Title VII and VIII
Programs Could Improve Accountability. [21]GAO/T-HEHS-97-117 . Washington,
D.C.: April 25, 1997.

(290496)

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Highlights of [29]GAO-07-137 , a report to congressional committees

February2007

HEALTH CAREERS OPPORTUNITY PROGRAM

Process for Awarding Competitive Grants Included Independent Review

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.

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.

Results of Competitive HCOP Process, Fiscal Years 2002-05

Note: The reviewers did not score applications they found were not
responsive to the review criteria.

References

Visible links
  19. http://www.gao.gov/cgi-bin/getrpt?GAO-06-55
  20. http://www.gao.gov/cgi-bin/getrpt?GAO-04-961
  21. http://www.gao.gov/cgi-bin/getrpt?GAO/T-HEHS-97-117
  29. http://www.gao.gov/cgi-bin/getrpt?GAO-07-137
*** End of document. ***