DOCUREIqT FPSURE 04527 - [B13494752] (Restricted) [Administration of Family Planning Grants Awa:ded to Geaases Family Planning Program, Inc. ]. HRD-78-24; B- 4031(5),. December 13, 1977. 3 pp. + 2 enclosures (10 pp.). Report to Rep. Barber B. Conable, Jr.; Rep. Prank Horton; by Elmer B. Staats, Comptroller General. Issue Area: Health Programs: Efficiency and Effectiteness of Grantees and contractors in Providing Treatment Services (1215). Contact: Human Resources Div. Budget Function: Health: Health Caze Services (551). Organizaticn Concerned: Department of Health, Education, and Welfare; Genesee Region Family Planning :Progzan, Inc, : Rochester, BY. Congressional Relevance: Rep. Barber B. Conable, Jr.; Rep. Frank Horton. Authority: Public Health Service Act, as amended, title X (42 U.S.C. 300 et seq.). Genesee Region Family Planning Prograw, Inc., of Rochester, New York, is a consolidated grantee responsible for developing, organizing, administering, coordinating, and funding seven family planning projects in the Genesee area of upstate New York. Questions were raised about the administration of one of the projects, Planned Parenthood--Rochester, by the administration office (core office) of the region. Findings/Conclusions: Allegations of inefficiency in administration and improper allocation of Federal funds by the core office were inaccurate. The office allocated funds to the seven participating projects equitably. The Genesee Region was in general compliance with the Department of Health, Education, and welfare's (HEW's) family planning program regulations and has made services available to its seven projects in accordance with its plan of operations presented to HEW. Administrative costs incurred by the Geneses Region exceeded HEW guidelines, but other family planning projects in the HEW region also exceeded the guidelines. although no serious administrative inefficiencies were found, questions were raised about the effectiveness of the Genesee Region in Oroviding services. Cooperation between the projects and the core office was found to be inadequate. Although HEW has encouraged consolidating family planning projects and single grant awards, it has not established guidelines for management or an adequate system for monitoring the grants. Recommendations: The Secretary of HER should direct that the Regional Health Administrator require the projects and the core office which make up the Genesee Region to reevaluate the core office's role and to assist such projects by designing admiListrative guidelines and improving HBW's review of applications for consolidated family planning program grants and monitoring of activities carried out under such grants. COMPNROLLER GENERAL OP TZI UNITED NTATEa ~i, ~~~)I~ 2WASHINTON. O.C. UI tSTRerTgrd ot to be rpqe.,td c}pJ ;v$ the aC.'eral A¢COLtnPt · '.. .........--. , tA,)eSK;cO approval by the w..a oi _.,_u..l B-164031(5) Wl The Honorable Barber B. Conable, Jr. The Conorable Frank Horton House of Representatives As reques':ed in your March 28, 1977, letter and as subsequently agreed with your offices, we reviewed the ad- ministration of a grant for family planning services' awarded to the Genesee Region Family Planning Program, Inc., of Rochester, :ew York (Genesee Region) by the Department of Health, Education:. and Welfare (HEW). Funds were provided under title X. Public Health Service Act, as amended (42 U.S.C. 330 et seq.). We also made a limited review of the procedures used by HEW region II, to review and approve the Genesee Region's application for family planning funds and region II's monitoring of the grantee's operations. As Instructed by your offices, we did not obtain official written comments from HEW, but the matters included in this report were discussed with HEW regional and headquarters officials. Our observations, conclusions, and recommenda- tions are summarized below. More detailed information is contained in enclosure I. BACKGROUND Genesee Region is a consolidated grantee responsible for developing, organizing, adminis ering, coordinating, and fund- ing seven family planning projects in the Genesee area of upstate New York. These projects are (1) Planned Parenthood of Rochester and Monroe County, Inc. (Planned Parenthood-- Rochester), (2) Orleans County Family Planning Services, Inc., (3) Wayne County Rural Comprehensive Health Program, (4) Planned Parenthood of Ontario County, Inc., (5) Yates County Family Planning Services, Inc., (6) Livingston County Health Department, and (7) Planned Parenthood of the South.rn Tier, Inc. Your request was prompted by questions raised by one of the seven projects, Planned Parenthood--Rochester, which generally alleged inefficient use of grant funds by the administration office, or core office, of the Genesee Region. HRD-78-24 (102025) B-164031(5) As agreed, our efforts concentrated on -- assessing the reasonableness of project grant funds' allocation from the core office to the projects, amphasiziag administrative cost- of the core office and the effect of these costs tn direct family plan- ning servicesa ·--determining Genesee Region's compliance with applicable laws and its; plan of operations submitted to HEWN and -- investigating the responses to Congressman Conable, dated July 16, 1976, and to Planned Parenthood-- Rochester, dated September 13, 1976, from officials of HEW headquarters and region II, respectively, for consistency concerning the projects' discussion of the core office performance. SUMMARY We determined that allegations of inefficiency in admin- istration and improper allocation of Federal funds by the core office of the Genesee Region are inaccurate. The core office allocated title X funds to the seven participating projects equitably. We found the Geneses Region's operations in general compliance with HEW's family planning program regulations. Pe also concluded that the Geneses Region has continually made available services to its seven projects in accordance with its plan of operations as set forth in grant applica- tions and documents requested by HEW at a meeting with the Genesee Region on July 9, 1976. The administrative costs incurred by the Genesee Region exceeded HEW guidelines. We noticed, however, that the ad- ministrative costs incurred by other family planning proj- ects, including consolidated grantees, in the HEW region also exceeded HEW guidelines. Although we did not find serious inefficiencies in admin- istration of the core office, we questioned the effectiveness of the Genesee Region, especially its limited capability to provide services needed by the projects. We believe that the seven projects and the core office have not cooperated to im- prove the core office's responsiveness to the needs of each project. 2 B-164031!5) The questionable usefulness of a consolidated grant arrangement for family planning projects in the Geneses might be due to a lack of direction from the projects Region and HEW's apparent "laissez faire" attitude toward consolidatedto grantees. Although HEW has encouraged consolidating planning projects and single grant awards, it has not family lished (1) guidelines for managing and (2) an adequate estab- for monitoring consolidated family planning program system grants. Finally, we did not find significant HEW responses to Congressman Conable and toinconsistencies in Planned Parenthood-- Rochester concerning discussion of the performance of the core office of Genesee Region by the projects. We learned, that HEW region II's however, staff did not review the Genesee Region. This review had been cited in the letter to Congressman as the primary remedial action which would be taken. Conable RECOMMENDATIONS TO THE SECRETARY OF HEW We recommend that the Secretary of HEW direct that the Regional Health Administrator require the projects and the core office which make up the Genesee Region to reevaluate the core office's role and to assist such projects by design- ing administrative guidelines and improving HEW's review applications for consolidated family planning program of grants and monitoring of activities carried out under such grants. As agreed, your offices will make distribution report to interested parties. Subsequently we will of this send copies to the Secretary of HEW and will also make copies available for public distribution. We trust that the material provided herein is responsive to your request. Comptrcller General of the united States Enclosures - 2 3 ENCLOSURE I ENCLOSURE I SUMMARY OF INFORMATION OBTAINED-- DESCRIPTION OF GENESEE REGION FAMLY PLANNING PROGRAM, XNC. The Genesee Region Family Planning Program, Inc., established November 1, 1972, to offer organized family was planning services in the Finger Lakes area of New York. The area consists cf 5,794 square miles, encompassing ten counties--Chemung, Livingston, Monroe, Ontario, Orleans, Schuyler, Seneca, Steuben, Wayne, and Yates. Except for Monroe County, most of the area is rural An organization chart of the Genesee Region is illustrated below. ORGANIZATION CHART OF GINIuI RGION FAMILY PLANNING PROGRAM, INC. Planned Parenthood of Rochester and Monroe County.1n. Wayne County Rual Cpngrehenev Health Program .nciOl County Fami hYao Pla nni Srvic Inc. klnpm lxrutive ~ WiLuvrn County Health Department - Prenthood of ota Southern Tier. Inc. wnCned learauryI loo1fa Dirct At , |' Trainln Education ENCLOSURE I ENCLOSURE I The board of directors is the policy setting body of Genesee Region. Assisting the board in financial matters is a budget and finance committee. In addition, an executive committee handles any business, not specifically allocated to other committees, between bimonthly meetings of the board. The board of directors appoints an executive director who conducts the family planning program in accordance with board po- licies. The executive director employs and supervises a staff in the administrative office (known as the "core office") who, among other responsibilities, allocate the Federal grant funds and provide technical and professional assistance to the projects (the local agencies which actually.deliver the family planning services). Genesee Region has contracts with seven health projects throughout the Genesee area. They are (1) Planned Parent- hood of Rochester and Monroe County, Inc., (Planned Parenthood-- Roches'.tr), (2) Orleans County Family Planning Services, Inc., (3) Wayne County Rural Comprehensive Health Program, (4) Planned Parenthood of Ontario County, Inc., (5) Yates County Family Planning Services, Inc., (6) Livingston County Health Depart- ment, and (7) Plenned Parenthood of the Southern Tier, Inc. These projects are responsible to their own local boards of directors. ALLOCATION OF TITLE X FUNDS APPEARS EQUITABLE Under title X of the Public Health Service Act, as amended (42 U.S.C. 300 et seq.), "Population Research and Voluntary Family Planning Program," the Secretary of HEW may award grants and contracts to family, planning service providers. HEW specifies that the awards be made available to public or nonprofit agencies, institucions, organizations, or consortia of eligible applicants acting jointly. The Genesee Region is one of several consolidated family planning program grantees in New York State currently receiving title X funding from HEW. In its earlier years, the Genesee Region generally received the title X funds it requested. Recently, however, Genesee Region's budgets and funding requests for the fiscal years ended March 31, 1977, and ending March 31, 1978, were reduced by about 16 and 11 percent, respectively. HEW recommended that each project share in the funding cuts. however, as a core office official stated, instead 2 ENCLOSURE I ENCLOSURE I of across-the-board cuts, the Genesee Region to allocate the funds among the projects from was allowed the total grant amount. In fiscal year 1977, Geneses Region's executive and finance committees allocated title X funds and budget patient workload, unmet need for clinic services,based on current on the project's budget. The allocation procedure and impact with officials from all projects before final was discussed implementation. HEW approved the allocation with only a few minor adjustments. For fiscal year 1978, allocation of made by the budget and finance committee. title X funds was projects to absorb the grant reduction, the In selecting committee's objective was to avoid reducing patient services. Our review of the allocation of title X funds years 1977 and 1978 and the expenditures for fiscal of the core office from 1975 to 1977 disclosed that -- the core office, as shown below, absorbed the largest Proportional reduction in funds (26 percent) and nearly the same (11 percent) as most of in 1977 the projects in 1978. 0celson eofLnee Reqion aoily Planninq [Odor 117 ellALi _ s ealr 977 Fisc7l year 1978 I Dif:erenci Geneso· tegion between funds between funds Funds Funds requested and Funds Funds agenclog requested requerted and apIroved approved requested aproved 4Pproved lenn d Parenthood 31,35 -26 144,033 $127,884 -11 otf ochester and Monroe County, Orlen County 253,913 21074 -17 231,233 206,100 -11 Family Planning Countyc. icyne 94,161 75,329 -20 Wayne County aural 68,983 61,000 -12 Comp. Enalth Pnogra n 63,546 50,637 -20 Planned Parenthood 61,463 51,120 -17 of Ontario County, In. 3,Coun3 77030 +21 Tates County Family 104,265 92,025 -12 Planning Services, Lin.ton County 29000 25625 Livingston county -12 29,000 25,807 -11 Heanth repatheont 22,540 19,846 -12 Planned Parenthood 20,995 18,702 -11 of the Couth- ern Tier, Inc. 179.426 155,615 -13 166.438 562 - 8 motal 663.34 7 1746.389 -16 $826,1 5735,200 -11 3 ENCLOSURE I ENCLOSURE I -- from 1975-77 the core office reduced its expenditures by 36 percent, from $211,158 to $135,122, even title X funding within the total Genesee Region though for the same period was cut only 4.4 percent. grant to the Genesee Region's fiscal year 1978 grant According the funding restrictions resulted in cutbacks proposal, in some professional positions by abolishing or converting them to part-time. --only Planned Parenthood--Rochester was discontented with the allocations made by the core office. In view of our findings, we believe that title X funds awarded to the Genesee Region for fiscal years were reasonably allocated to the core office 1977 and 1975 and the projects. HIGH ADMINISTRATIVE COSTS OF GENESEE REGION ARE NOT UNIQUE On October 1, 1976, HEW instituted a new reporting system to monitor, among other things, adherence to limit a grantee's administrative costs to 20 guidelines which percent of total federally and nonfederally funded by family planning grantees for thecosts. Most data submitted period January to June 1977 showed administrative costs exceeded 20 percent of total cocts. Genesee Region's administrative costs of total costs (4.4 percent incurred by the were 28.6 percent 24.2 percent by the projects), while region core office and administrative costs averaged 26.1 percent andII and the Nation's of total costs, respectively. In addition, 25.6 percent draft report to HEW by Analysis, Management, we noted in a and In.., which evaluated the effectiveness of family Planning, organizations in the Eastern United States, planning that a consolidated Irantee closely resembling Genesee Region had administrative costs (39 percent) among the the 1lghest granteies evaluated. THE CORE OFFICE COMPLIES WITH APPLICABLE FEDERAL GNT REGULATIONS AND ITS NPLANOF OPERATIONS HEW's Bureau of Community Health Services, Administration, which administers the domestic Health Services funded family planning programs, began a programfederally 1970s to encourage consolidating or integrating in the of individual family planning project grants into larger umbrella The Bureau assumed that through economies of grants. scale planning services would be provided more efficiently(1) family effectively and (2) more resources would be and available for patient care services. 4 ENCLOSURE I ENCLOSUtRE I However, HEW has not established guidelines and regulations ior the functions, organization, and the aspects of consolidated grantees. Therefore, we could compare operations of the Gene- see Region's core office only to (1) HEW's broadly stated Federal family planning program grant regulations and (2) the Genesee Region's plan of operations as stated in its grant applications and related documents. Compliance with HEW's family planning program regulatlons and guidelines We found that the core office's oer'rcions have generally followed the broadly stated HEW family glanning program regu- lations. However, we found it difficult to determine the Genesee Region's compliance with the guidelines, such as a 20-percent limit on grantee administrative costs established by HEW for the family planning program. According to HEW officials, using these guidelines is presently discretionary for determining appropriate levels of Region-approved grant support. Therefore, although Genesee Region's ad:ainistrative program costs do not comply with the guidelines, we cannot question such costs :ith- out firm implementation of the guidelines by HEW in approving grant support levels. Compliance with Genesee Region plan In the fiscal year 1978 grant application, functions of the core office were -- to provide a setting within which delegate agencies (projects) can best provide family planning services and -- to provide technical and professional assistance to the delegate agencies to meet local needs effectively and efficiently. In line with these functions, the core office has con- tinued to make available grant-related and technical services to projects and educational services for community groups. EFFECTIVENESS OF THE CORE OFFICE Not all the services provided by the core office ara useful to all projects The core office guides projects in preparing budgets and narratives for grant application for title X funds; 5 ENCLOSURE I ENCLOSURE I prepares its own budget and other reports reviews 1 documents prepared by the projects for mathematical accuracy, and reasonableness! verifies that assurances consistency, and certifications required for the grant application are executeda then submits and obtains approval of the grant application from the budget ant' finance committee and the board of directors i: to HEW. before sending All projects use core office assistance in some phases of the grant application process, depending or all needs. During the grant application process on their the year, the core office serves as the HEW and throughout liaison for the whole Genesee Region. A staff consisting of a full-time and a program evaluator, a nurse consultant, anda part-time educator, sultant gives technical assistance to Genesee a financial con- board of directors, and committees and other Region's projects, community agencies. The larger pr,,Jects, however, have limited need for the tech- nical staff's services, particularly the educators' Most small,- projects need and use such services, skills. some educators' services as too sophisticated. but one views Furthermore, some technical services similar to those offered by srme projects, offered appear Bureau of Family Planning, and HEW. Examplesthe New York State include training and educating some segments of these services of nursing consultations, and evaluating projects. the community, In a March 1976 review of the Genesee Regin's grant application, HEW region II official noted that excluding one one project, he found no movement among the projects to integrate planning services with other comprehensive health family providers. In our opinion, the Genesee Re;gJn service to determine wh.:h services are most essential projects need which services would be better performed by one to the projects, of the projects or obtainable from, or more economical to integrate another family planning agency. with, The projects are not working jointly to achieve the goals of the consolidation - Our review also noted four occasions in showed lack of interest in the consolidation which most projects goals. Some projects did not respond when core office staff solicited garding the suggestions re- --regional health services plan, -- distribution of funds for fiscal year 1978, 6 ENCLOSURE I ENCLOSURE I -- project participation in the Genesee Region decision- making process, and -- training the projects require. We believe that the most obvious means for addressing the projects' problems is through the boards of directors of the individual projects and the Genesee Region. in example of limited effort by the boards of directors to resolve their probleis jointly is the controversZ between the Genesee Re- gion and Planned Parenthood--Rochester. HEW's grantee review and monitoring functions'ae another obvious channel for addressing the projects' prob- lems. To fulfill these functions, HEW regional officials review the grant application document, obtain performance reports, and make site visits. Although HEW attempted to have regions jointly consider Planned Parenthood--Rochester's concerns, it failed to follow up and assure resolving the problems. Site visits might have helped HEW to better moni- tor the operations of the grantee and resolve problems such as the Planned Parenthood--Rochester/core office ronflict. However, since September 1, 1976, the project officer Lnade only three visits to Genesee Region, and the third site visit made in July 1977 was about a special grant for se:v- ices to teenagers. HEW can also assist a consolidated grantee by estab- lishing guideln-es for administering a conso'idation, How- ever, as discussed earlier, even though HEW encouraged such consolidation, it does not have guidelines for it. HEW DID NOT REVIEW THE DOCUMENTS REUESTED FROM GENESEE REGION - Because of complaints about the core office by Planned Parenthood--Rochester, region II's staff met with all proj- ects on July 9, 1976, to determine if other projects had similar complaints. HEW found that the six did not have the same problem and stated so other projects in separate letters to Congressman Conable on July 16, 1976, and to Planned Parenthood--Rochester on September 13, 1976. In the letter to Congressman Conable. HEW stated it had requested that the Genesee Region p epare a morethat de- tailed plan ot operations to justify the present core of- fice staff budget. This plan was to be reviewed by and, if necessary, changes would be made in the grantHEWaward. 7 ENCLOSURE I ENCLOSURE I The plan of operations requested by NEW consisted of "job descriptions, resumes for all c6re office employees," evaluation of the core office, the program evaluator an- nual report, training and education plans for 1976-77, and workshop reports on progress toward goals for 1976-77. How- ever, although these documents were submitted by the core office, HSW never reviewed them. An HEW official stated that review of these papers was not done due to a significant organizational change, that is, a new executive director at Geneses Region's core office. CONCLUSIONS Allegations of inefficieincies in administration and improper allocation of Federal funds by the core office of the Genesee Region and of inconsistency in HEW responses to Congressman Conable and Planned Parenthood--Rochester are inaccurate. We believe, however, that the controversy between the Genesee Region and Planned Parenthood--Rochester resulted from a lack of effort by the core office and the projects to determine and satisfy their more important needs. While the core office has made available services which are our- lined in the Geneses Region's plans and stated functions, not all such services are useful to the projects. Also, the Genesee Region does not have adequate di- rection regarding its functions and organization. Although HEW has encouraged consolidating family planning projects and single grant awards; it has not established (1) guide- lines for managing and (2) an adequate system for monitoring consolidated family planning program grants. RECOMMENDATIONS TO THE SECRETARY OF HEW Because of limited use of core office services and the title X funds going to the core office, we recommend that the Secretary of HEW direct the Regional Health Ad- ministrator to require that the seven projects and core office representatives reevaluate jointly the services and functions of the core office. Such a reevaluation should reach agreement on (1) the purpose of consolida- tions; (2) the most effective use of the resources and services of the core office; and (3) the capability of the seven projects to coordinate and share individual resources and services and to use services offered by other community agencies, the Bureau of Family Planning (New York State), and HEW, in addition to, or in lieu of, the core office. ENCLOSURS I ENCLOSURE I We further recommend that the Secrtary direct the Re- gional saelth Administrator to aasist Genesee Region in its' deliberations by designing administrative guidelines which should specifically include (1) the benefits the Federal Government obtains from a consolidated family planning grant and (2) the means by which the Department can assure that the administrative costs incurred by a consolidated grantee do not detract from direct provision of family planning services. Once guidelines have been established, HEW should improve its review of applications for consoli- dated family planning program grants and its monitoring activities carried out under such grants for all regions.of 9 ENCLOSURE II ENCLOSURE II PRANK HORTON U.r. WSUWCAI IW so o.--.,o Con et o! '--'-II IliRhKI"IM rry mfm JOINT COMMIT'" OlN MoIreto of *ke tat b stelwM $14 eM, r ATOMIC ENCROY Roukmoftp2esflaitl Nw&Yl k1n1 me ..,,, SI4a March 28 1 3 7 7 Honorable Elmer S. Staats Comptroller General General Accounting Office 441 G Street Washington, D. C. 20548 Dear Elmers We recently had the opportunity to meet with Mrs. Barbara Zartxran and Mr. Dave Cruthis of the Planned Parenthood Rochester and Monroe County, Inc. These meetings grew of out of correspondence we had with Mrs. Zartman regarding ner concern that federal family planning money should be used primarily for patient services rather than to maintain groups charged with providing these services. We share this concern over the use of these federal and are requesting that the General Accounting Officefunds investigate whether or not present law is being complied witn in these cases. The Department of Health, Education Welfare has commented on this situation in meetings and officials of Planned Parenthood of Rochester as well with as by letter. For your information, we are enclosing copies of correspondence on this matter. Thank you for your assistance in this matter and we look forward to receiving the results of the GAO investigation. Sincerely, Barber B. Conable, Jr. Hoon 10
Administration of Family Planning Grants Awarded to Genesee Family Planning Program, Inc.
Published by the Government Accountability Office on 1977-12-13.
Below is a raw (and likely hideous) rendition of the original report. (PDF)