Nationwide Audit of State and Local Government Efforts to Record and Monitor Subrecipients' Use of Bioterrorism Hospital Preparedness Program Funds

EXECUTIVE SUMMARY:

Since April 1, 2002 the Health Resources and Services Administration (HRSA) has awarded $623 million to 59 State, territorial, and selected municipal offices of public health to upgrade the preparedness of the Nation's hospitals and collaborating entities to respond to bioterrorism.  We reviewed bioterrorism grant programs in 14 States and 4 major metropolitan areas.  We found that improvements are needed to ensure that bioterrorism program funds are efficiently and effectively utilized.  We recommended that HRSA:  (1) identify awardees not meeting budget restrictions and ensure that all awardees account for funds in accordance with their cooperative agreements, (2) provide guidance to awardees on monitoring subrecipient expenditures and measuring subrecipient performance, including emphasizing the need for awardees to make site visits to directly review subrecipients' expenditures and assess subrecipients' progress in improving bioterrorism preparedness, and (3) identify the reason for large unobligated balances and assist the awardees in overcoming barriers to a more timely use of funds.  HRSA officials concurred with our recommendations.