SUMMARY OF FULL COST *

(Dollars in Millions)

* Full cost data for the measures under each performance program area are shown as non-adds.  The sum of full costs of performance measures may not equal the full cost of the performance program area, to the extent the program has elements for which there are no current measures.  Programs that do not have performance measures are not included in this table.

        ** Total Program Level.

Notes:

Estimation methodology provided on the page following the footnotes.

¹     The Health Centers program’s overarching goals are to expand and to strengthen primary care services for underserved populations.  Providing quality care is integral to both goals.  Federal appropriations to HRSA constitute approximately 25% of total Health Centers’ operating costs.  The remainder of full cost is attributable to FTCA funding.

²     The full cost of Hansen’s Disease Activities is distributed between Objectives 1.2 and 4.3.  The distribution by program measure does not equal 100 percent of full cost because a portion of costs goes towards inpatient care, patient stipends, other research, and other administrative expenses.

³     MCH Block Grant full cost is distributed between Objectives 1.2 and 1.3.  The distribution by performance measures does not equal 100 percent of full cost because the Block Grant provides a variety of services for mothers and children.  These measures only represent a portion of all the services provided. The MCH Block grant allows the flexibility to serve populations based on their individual needs.  Therefore we estimate 25% of their funds go to State specific activities not captured in the specific performance measures.

⁴     Ryan White full costs are distributed between Objectives 1.2 and 1.3.  The distribution by performance measure does not equal 100 percent of full costs because the remainder of Ryan White funds are awarded for State and Local Administration and Planning, Technical Assistance, and Evaluation.

⁵     The undistributed portion of Part A funds are awarded for State and Local Administration and Planning, Technical Assistance, and Evaluation.                

⁶     The undistributed portion of Part B funds are awarded for State and Local Administration and Planning, Technical Assistance, and Evaluation.

⁷     The undistributed portion of Part C funds are awarded for other services including case management and eligibility assistance, outreach, social work, prevention education and harm reduction and other Title II-eligible optional services, and administration-related costs.

⁸     The undistributed portion of Part D funds are awarded for the provision of services for men.  As Part D projects provide family-centered care, support services are provided to male care givers of infected women, and to male infants, children and youth.

⁹     This program includes both the Rural Health Outreach and the Rural Health Network Development grant programs, which are funded under the same line.  A larger portion (approximately 60%) of resources is devoted to the Outreach program.

¹⁰     The performance measures focus on the activities supported by the Rural Hospital Flexibility Program (Flex).  Distributions do not add to 100% because the performance measures do not take into account the portion of this funding that supports the Small Hospital Improvement Program.

¹¹     Ninety percent of the program’s appropriation is devoted to clinical service delivery. Conference report language accompanying the Title X annual appropriation legislation states, “The Committee intends that at least 90 percent of funds appropriated for Title X activities be for clinical services authorized under section 1001 of the Act.”  The other 10 percent of the program appropriation is used for administrative support, as well as to support three key functions aimed at assisting clinics in responding to clients’ needs: (1) training for family planning clinic personnel through general training programs, as well as training for clinicians; (2) information dissemination and community-based education and outreach activities; and (3) data collection and research to improve the delivery of family planning services.  It is important to note that this cost estimate represents only the Federal appropriation of the program.  Various other sources of revenue (e.g., Medicaid reimbursements, State and local funds, patient fees, other Federal grant programs) supplement appropriated family planning grant funds to support the full cost of client care. Title X funding comprises approximately one-fourth of the operating budgets of family planning clinics.           

¹²   The undistributed portion of full cost is taken up by other activities, including provision of technical assistance to States for EMSC data collection, analysis and data linkage, development of model systems (i.e., model of pediatric component for State disaster plans), linkage to research, enhancing pediatric patient safety, and development of clinical practice guidelines.

¹³   The performance measure focuses solely on the Rural Health Research Center Grant program, which receives approximately 40 percent of the funds allocated under this funding.  The undistributed portion of the funding supports the other policy related activities of the Office that are explained in narrative.

¹⁴   The performance measures focus on the activities supported by the State Office of Rural Health Program, which are only partially supported by Federal funding as all grantees must match that funding on a 3:1 basis.  The undistributed portion of funding is attributed to other program activities within the scope of the program authority as explained earlier in the program narrative.

¹⁵   The undistributed portion of AETC funds are provided for the provision of AETC training intervention programs for non-racial/ethnic minorities.

¹⁶   The undistributed portion of funding is attributable to programs and activities not represented in the performance measures.

¹⁷   This is the successor program to the National Bone Marrow Registry.  The measures were developed for the Registry and they will be reviewed/revised in the future to reflect the new program. Approximately 95% of the available budget supports the established performance goals.  An additional 5 % is spent to support activities such as: managing patient searches for donors, assisting patients in dealing with financial and other barriers to transplant, conducting research to improve transplant outcomes, developing ways to complete donor searches more quickly, and ensuring that the network of transplant centers, donor centers and other organizations comply with all applicable Federal requirements and with program policies.

¹⁸     While these measures are extremely important in improving the provision of care, the vast bulk of program resources are directed toward maintaining the current poison control centers as accredited, effective entities.

¹⁹   Approximately 20% of the available budget supports the established performance goals outlined in the table above.  This is based upon the salaries and benefits of staff that perform work, both full-time and part-time, in the authorization and discharge of compensation payments.  The remaining 80% of the budget provides for operations in program management, policy development and implementation, outreach and communication, case review and medical analysis, the Expert Witness Program (EWP), as well as in support of the statutorily-required quarterly meetings of the Advisory Commission on Childhood Vaccines. Note: Congress appropriates “such sums as may be necessary.”

Methodology - Estimated Full Cost

The table above provides estimates of the full cost of each HRSA performance program area.  The full cost was estimated by adding program management cost to the program levels from the APT (except in the cases when the latter includes program management cost). The program management cost was allocated, where appropriate, across programs based on the proportion of total program level cost represented by each program. 

The table also includes information on the full cost of each program area by performance measures. These distributions are based on professional judgments, supported to the extent possible by financial and other statistical data.  In many cases, performance measures are aggregated in the distributions of cost because of the interdependence of the activities and goals represented by the measures.

The cost distributions by performance measures are presented for “active” measures in a given year, excluding efficiency measures.  That is, measures that are to be deleted are included only for the applicable year(s) before their deletion; new measures are included beginning with the first year in which performance data are expected.  When the cost distributions by performance measure do not add to total cost for a given program area, explanatory notes are provided.