FAC Explorer

Finding 1156861 (2024-011)

Material Weakness Repeat Finding
Requirement
N
Questioned Costs
-
Year
2024
Accepted
2025-09-30
Audit: 369219
Organization: State of Missouri (MO)
Auditor: Office of the Missouri State Auditor

AI Summary

  • Core Issue: The Department of Health and Senior Services (DHSS) is not completing facility surveys on time, with 17% of deficiency statements sent late and 4% of revisits exceeding the required timeframe.
  • Impacted Requirements: Compliance with 42 CFR Section 431.108 and State Operations Manual guidelines, which mandate timely notification of deficiencies and timely revisits to ensure provider compliance.
  • Recommended Follow-Up: DHSS should implement measures to ensure surveys are conducted within required timeframes, addressing staffing shortages and workload increases to minimize delays.

Finding Text

Federal Agency: Department of Health and Human Services (DHHS) Federal Program: 93.777 COVID-19 - State Survey and Certification of Health Care Providers and Suppliers (Title XVIII) Medicare 93.777 State Survey and Certification of Health Care Providers and Suppliers (Title XVIII) Medicare 2023 and 2024 - TITLEXVIII 2023 and 2024 - TITLEXIXSS 2023 and 2024 - CLIA 2023 and 2024 - XVIIIIMPAC 2023 - TITLE18CRS (COVID) State Agency: Department of Health and Senior Services (DHSS) - Section for Long-Term Care Regulation (SLCR) Type of Finding: Nonmaterial Noncompliance Compliance Requirement: Special Tests and Provisions As similarly noted in our 3 prior audit reports, the SLCR did not perform facility survey procedures within required timeframes. In our test of compliance with facility survey requirements for 60 surveys performed during the year ended June 30, 2024, we noted 10 Statements of Deficiencies and Plan of Corrections were sent 11 to 20 days after the survey exit instead of within 10 days, and 1 facility revisit was completed in 64 days instead of within 60 days of the initial survey date. The DHSS is the state survey agency charged with inspecting providers of the Medical Assistance Program (Medicaid), including hospitals, nursing facilities, and other long-term care facilities. Under 42 CFR Section 431.108, as a basis for participation in Medicaid, providers are subject to survey and certification by the DHHS - Centers for Medicare and Medicaid Services (DHHS-CMS) or the DHSS to ensure providers and suppliers are in compliance with regulatory health and safety standards and conditions of participation. During the year ended June 30, 2024, the DHSS through the SLCR surveyed 523 providers, including 483 long-term care nursing facilities, 9 intermediate care facilities for individuals with intellectual disabilities, and 31 non-deemed hospitals. The DHHS-CMS provides the State Operations Manual (SOM) to state agencies as guidelines for the survey and certification of providers. SOM Chapter 2, Section 2728, requires the state agency to mail to the provider a copy of Form CMS-2567 (Statement of Deficiencies and Plan of Correction) within 10 working days after the survey exit. In addition, SOM Chapter 7, Section 7317.2, requires onsite revisits for long-term care nursing facilities to occur any time between the last correction date on the plan of correction and the 60th day from the survey date to confirm the facility is in substantial compliance, and in certain cases, has the ability to remain in substantial compliance. To test compliance with survey and certification requirements, we randomly selected 60 surveys including 44 long-term care nursing facility surveys, 5 intermediate care facility for individuals with intellectual disabilities surveys, and 11 non-deemed hospital surveys, performed between July 1, 2023, and June 30, 2024. Of the 58 surveys that required a Statement of Deficiencies and Plan of Correction, 10 statements (17 percent) were sent to facilities between 11 and 20 working days after the survey exit instead of within 10 working days as required. In addition, of the 27 long-term care nursing facilities that required a revisit, the revisit to 1 facility (4 percent) was completed 64 days after the initial survey date instead of within 60 days as required. DHSS officials indicated there were multiple contributing factors for these delays including DHSS staffing shortages, industry labor shortages, insufficient state and federal funding, increased workloads due to increased volume and severity of complaints received and violations identified, and the backlog of surveys due. DHSS officials stated they hired part-time retired surveyors and contracted with outside survey companies to help with the increased workload and backlog. They further indicated they are working with the DHHS-CMS to minimize the delays. Conducting survey procedures within required timeframes helps to ensure providers are timely notified of deficiencies requiring correction so that timely follow up on those deficiencies can occur to provide assurance facilities are providing services to their clients that are in compliance with health and safety standards and conditions of participation. Recommendation The DHSS through the SLCR ensure survey procedures are conducted within required timeframes. Auditee's Response We partially agree with the auditor's finding. Our Corrective Action Plan includes an explanation and specific reasons for our disagreement and any planned actions to address the finding. Auditor's Comment The DHSS Corrective Action Plan states the DHSS disagrees that the revisit error should be a finding and that corrective action is needed because the error rate identified in the audit sample was less than the performance criteria (70 percent) used to measure compliance and require corrective action in the DHHS-CMS State Performance Standards System. However, the performance criteria is intended to measure the DHSS's level of compliance and identify when corrective action is needed to address deficiencies, and does not remove the DHSS's responsibility to comply with the timeframes required by the SOM.

Corrective Action Plan

State of Missouri Single Audit Corrective Action Plan Year Ended June 30, 2024 State Agency: Department of Health and Senior Services Audit Finding Number: 2024-011 – Medicaid Facility Survey Timeliness Name of the contact person responsible for corrective action: Tracy Niekamp, Administrator, Section for Long Term Care Regulation, Division of Regulation and Licensure Anticipated completion date for corrective action: December 31, 2026 Corrective action planned is as follows: Missouri Department of Health and Senior Services (DHSS) partially agrees with the audit finding. Regarding the timeliness of revisits DHSS does not agree with the finding or that corrective action is needed. The reasons for disagreement are stated below. Related to timely mailing of Statements of Deficiencies, DHSS agrees with the finding and the corrective action plan is stated below. As previously stated, since 2019, DHSS has seen increases in the number and severity of complaints, and the severity of violations found in long term care facilities. Complaints increased overall by thirty-six percent (36%) from 9,011 complaints in FY2019 to 12,236 in FY2023. In FY2024, DHSS investigated 12,237 complaints. The largest increase has been in severe complaints, including immediate jeopardy complaints (which require an onsite investigation within 24 hours to seven days) and non-immediate jeopardy, high priority complaints (which require onsite investigation within 15 working days). Because of the seriousness of these complaints, often surveyors have to be reassigned to investigate these complaints, which results in a delay in conducting revisits or sending a statement of deficiencies timely. In addition to frequency and severity of complaints, changes to the survey process, and increased regulatory requirements, DHSS continues to see increases in the number of citations issued per recertification survey and in complaint investigations. Since 2019, the average number of health citations issued to a facility during a recertification survey has increased by 25% and the number of citations issued from stand-alone complaint findings has increased 100% during the same timeframe. These increases require additional time devoted to investigating often complex violations, increase time spent with write up activities, including the creation of the Statement of Deficiency, plan of correction review, onsite and offsite revisit activity and communication with complainants and facilities. Increases in this workload often require team members to begin investigating new complaints prior to the write up activities or revisits related to other processes being completed. Additionally, subsequent complaint investigations often cause revisits to be delayed due to open enforcement cases and substantial compliance date conflicts. DHSS continues to experience staffing shortages, particularly in the Registered Nurse job classification, which impacts the ability to complete work consistently within the prescribed time frames. Each recertification survey requires at least one team member to be Registered Nurse and due to the nature of many complaints, a Registered Nurse must also complete these investigations. There has been no meaningful increase in the federal budget since 2015, which further impacts the ability to hire and retain Registered Nurses. In addition, there is an ongoing labor shortage in the labor market for these professionals. The shortage has driven salaries well beyond the surveyor salary structure. DHSS has experienced turnover among surveyors leaving for other opportunities at a much higher salary. DHSS invests at least one calendar year into training new surveyors. This is training required by CMS in order to meet the stringent surveyor qualifications. In 2015, the number of RN vacancies the Section for Long-Term Care had averaged around 14 positions. In 2023, the average vacancy was 27 positions. In 2024 SLCR was able to hire several Registered Nurse positions statewide. Given the required training to independently conduct complaint investigations takes 12 months, SLCR hopes to see continued improvement in meeting deadlines in FY2025 due to a greater number of trained and qualified team members. DHSS has seen significant progress in meeting expectations since FY2023. During the FFY23 audit, 19 of the sampled statements of deficiency did not meet the 10-day timeframe for release to the facility and 9 of the sampled revisits did not occur within 60 calendar days of the exit date. Results of the FFY24 audit shows improvement in DHSS performance: 10 of the sampled statements of deficiency did not meet the 10-day timeframe for release to the facility and only one of the sampled revisits did not occur within 60 calendar days of the exit date. DHSS has and will continue to request increased funding from both federal and state sources to support competitive salaries for Registered Nurses and other survey staff. DHSS will continue to hire retired, federally qualified surveyors part-time to help with survey and complaint backlog, as able. DHSS continually works toward identifying inefficiencies and implementing measures to address them, such as bundling complaint investigations with other regulatory processes. As a short-term, time-limited solution possible through one-time additional funding from the Centers for Medicare and Medicaid Services and Centers for Disease Control and Prevention Epidemiology and Laboratory Capacity (CDC-ELC), DHSS contracted with three third-party contractors to assist with workload completion. However, this funding was terminated on March 24, 2025. DHSS will continue to track timeframes for completion of Statements of Deficiencies and revisits and make every effort to meet those timeframes. DHSS will continue to assign workload based on CMS’ stated priorities in the Mission and Priority Document, taking into account the potential for direct impact on residents. The agency does not agree with the audit findings and believes that corrective action is not required for timely revisits within 60 days. Explanation and specific reasons are as follows: The Centers for Medicare and Medicaid Services (CMS) completes performance standard reviews of states each federal fiscal year. The CMS expectation provided in the Fiscal Year (FY) 2024 State Performance Standards System (SPSS) Guidance is that the state meets the requirement for revisits within 60 days 70% of the time. States are not required to submit a corrective action plan to the CMS unless they fall below the 70% threshold. During the FFY24 audit, only one of the sampled revisits did not occur within 60 calendar days of the exit date, which means DHSS did meet the timeframe requirement 96.3% of the time. This percentage is well above the CMS’s acceptable rate of 70% and, therefore, should not require a finding or corrective action plan.

Categories

Special Tests & Provisions Matching / Level of Effort / Earmarking

Other Findings in this Audit

  • 1156821 2024-014
    Material Weakness Repeat
  • 1156822 2024-014
    Material Weakness Repeat
  • 1156823 2024-014
    Material Weakness Repeat
  • 1156824 2024-014
    Material Weakness Repeat
  • 1156825 2024-014
    Material Weakness Repeat
  • 1156826 2024-014
    Material Weakness Repeat
  • 1156827 2024-014
    Material Weakness Repeat
  • 1156828 2024-008
    Material Weakness Repeat
  • 1156829 2024-009
    Material Weakness Repeat
  • 1156830 2024-006
    Material Weakness Repeat
  • 1156831 2024-017
    Material Weakness Repeat
  • 1156832 2024-017
    Material Weakness Repeat
  • 1156833 2024-017
    Material Weakness Repeat
  • 1156834 2024-015
    Material Weakness Repeat
  • 1156835 2024-007
    Material Weakness Repeat
  • 1156836 2024-016
    Material Weakness Repeat
  • 1156837 2024-006
    Material Weakness Repeat
  • 1156838 2024-006
    Material Weakness Repeat
  • 1156839 2024-006
    Material Weakness Repeat
  • 1156840 2024-006
    Material Weakness Repeat
  • 1156841 2024-006
    Material Weakness Repeat
  • 1156842 2024-013
    Material Weakness Repeat
  • 1156843 2024-013
    Material Weakness Repeat
  • 1156844 2024-013
    Material Weakness Repeat
  • 1156845 2024-006
    Material Weakness Repeat
  • 1156846 2024-006
    Material Weakness Repeat
  • 1156847 2024-006
    Material Weakness Repeat
  • 1156848 2024-001
    Material Weakness Repeat
  • 1156849 2024-002
    Material Weakness Repeat
  • 1156850 2024-003
    Material Weakness Repeat
  • 1156851 2024-004
    Material Weakness Repeat
  • 1156852 2024-005
    Material Weakness Repeat
  • 1156853 2024-006
    Material Weakness Repeat
  • 1156854 2024-001
    Material Weakness Repeat
  • 1156855 2024-002
    Material Weakness Repeat
  • 1156856 2024-003
    Material Weakness Repeat
  • 1156857 2024-004
    Material Weakness Repeat
  • 1156858 2024-005
    Material Weakness Repeat
  • 1156859 2024-006
    Material Weakness Repeat
  • 1156860 2024-011
    Material Weakness Repeat
  • 1156862 2024-001
    Material Weakness Repeat
  • 1156863 2024-002
    Material Weakness Repeat
  • 1156864 2024-003
    Material Weakness Repeat
  • 1156865 2024-004
    Material Weakness Repeat
  • 1156866 2024-005
    Material Weakness Repeat
  • 1156867 2024-006
    Material Weakness Repeat
  • 1156868 2024-010
    Material Weakness Repeat
  • 1156869 2024-001
    Material Weakness Repeat
  • 1156870 2024-002
    Material Weakness Repeat
  • 1156871 2024-003
    Material Weakness Repeat
  • 1156872 2024-004
    Material Weakness Repeat
  • 1156873 2024-005
    Material Weakness Repeat
  • 1156874 2024-006
    Material Weakness Repeat
  • 1156875 2024-010
    Material Weakness Repeat
  • 1156876 2024-012
    Material Weakness Repeat

Programs in Audit

ALN Program Name Expenditures
93.778 Medical Assistance Program $11.60B
10.551 Supplemental Nutrition Assistance Program $1.51B
20.205 Highway Planning and Construction $1.38B
84.425 Covid-19 - American Rescue Plan Elementary and Secondary School Emergency Relief (arp Esser) Fund $638.88M
21.027 Coronavirus State and Local Fiscal Recovery Funds $623.00M
93.767 Children's Health Insurance Program $396.31M
17.225 Unemployment Insurance $281.85M
10.555 National School Lunch Program $264.71M
84.010 Title I Grants to Local Educational Agencies $262.55M
84.027 Special Education Grants to States $254.44M
93.558 Temporary Assistance for Needy Families $194.70M
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $184.03M
66.458 Clean Water State Revolving Fund $119.81M
93.268 Immunization Cooperative Agreements $100.17M
10.542 Pandemic Ebt Food Benefits $97.49M
10.553 School Breakfast Program $96.10M
10.557 Wic Special Supplemental Nutrition Program for Women, Infants, and Children $88.62M
84.126 Rehabilitation Services Vocational Rehabilitation Grants to States $85.51M
93.658 Foster Care Title IV-E $81.92M
10.561 State Administrative Matching Grants for the Supplemental Nutrition Assistance Program $80.06M
93.659 Adoption Assistance $75.89M
93.575 Child Care and Development Block Grant $73.50M
84.425 Covid-19 - Elementary and Secondary School Emergency Relief (esser) Fund $71.43M
10.558 Child and Adult Care Food Program $68.82M
64.015 Veterans State Nursing Home Care $66.44M
93.667 Social Services Block Grant $58.51M
12.401 National Guard Military Operations and Maintenance (o&m) Projects $58.24M
93.568 Low-Income Home Energy Assistance $55.76M
96.001 Social Security Disability Insurance $52.78M
14.228 Community Development Block Grants/state's Program and Non-Entitlement Grants in Hawaii $49.23M
21.029 Coronavirus Capital Projects Fund $47.65M
93.596 Child Care Mandatory and Matching Funds of the Child Care and Development Fund $45.41M
10.569 Emergency Food Assistance Program (food Commodities) $39.04M
93.563 Child Support Services $38.96M
84.367 Supporting Effective Instruction State Grants (formerly Improving Teacher Quality State Grants) $36.06M
16.575 Crime Victim Assistance $30.57M
84.048 Career and Technical Education -- Basic Grants to States $30.35M
15.611 Wildlife Restoration and Basic Hunter Education and Safety $30.16M
93.788 Opioid Str $29.01M
93.959 Block Grants for Prevention and Treatment of Substance Abuse $28.15M
93.958 Block Grants for Community Mental Health Services $24.46M
93.917 Hiv Care Formula Grants $23.33M
20.106 Airport Improvement Program, Infrastructure Investment and Jobs Act Programs, and Covid-19 Airports Programs $21.82M
93.569 Community Services Block Grant $21.16M
93.777 State Survey and Certification of Health Care Providers and Suppliers (title Xviii) Medicare $20.83M
11.031 Broadband Infrastructure Program $19.34M
84.424 Student Support and Academic Enrichment Program $19.01M
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $18.70M
20.509 Formula Grants for Rural Areas and Tribal Transit Program $17.61M
81.042 Weatherization Assistance for Low-Income Persons $17.57M
93.090 Guardianship Assistance $17.57M
84.287 Twenty-First Century Community Learning Centers $16.98M
20.933 National Infrastructure Investments $15.80M
10.559 Summer Food Service Program for Children $15.69M
66.605 Performance Partnership Grants $15.10M
93.045 Special Programs for the Aging, Title Iii, Part C, Nutrition Services $14.56M
84.425 Covid-19 - American Rescue Plan Emergency Assistance to Non-Public Schools (arp Eans) $14.11M
14.267 Continuum of Care Program $14.01M
93.994 Maternal and Child Health Services Block Grant to the States $13.83M
17.259 Wioa Youth Activities $12.69M
20.934 Nationally Significant Freight and Highway Projects $12.57M
93.434 Every Student Succeeds Act/preschool Development Grants $11.40M
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $11.37M
84.181 Special Education-Grants for Infants and Families $10.99M
93.967 Centers for Disease Control and Prevention Collaboration with Academia to Strengthen Public Health $10.22M
17.258 Wioa Adult Program $10.15M
93.069 Public Health Emergency Preparedness $10.14M
17.278 Wioa Dislocated Worker Formula Grants $10.14M
97.039 Hazard Mitigation Grant $10.10M
20.218 Motor Carrier Safety Assistance $9.73M
84.002 Adult Education - Basic Grants to States $9.52M
10.565 Commodity Supplemental Food Program $9.41M
93.136 Injury Prevention and Control Research and State and Community Based Programs $9.02M
20.526 Buses and Bus Facilities Formula, Competitive, and Low Or No Emissions Programs $8.96M
15.605 Sport Fish Restoration $8.93M
93.243 Substance Abuse and Mental Health Services Projects of Regional and National Significance $8.85M
93.044 Special Programs for the Aging, Title Iii, Part B, Grants for Supportive Services and Senior Centers $8.59M
20.616 National Priority Safety Programs $8.16M
66.468 Drinking Water State Revolving Fund $8.03M
17.207 Employment Service/wagner-Peyser Funded Activities $8.00M
20.600 State and Community Highway Safety $7.98M
97.042 Emergency Management Performance Grants $7.51M
93.940 Hiv Prevention Activities Health Department Based $7.22M
10.560 State Administrative Expenses for Child Nutrition $7.15M
97.045 Cooperating Technical Partners $6.92M
84.173 Special Education Preschool Grants $6.69M
16.034 Coronavirus Emergency Supplemental Funding Program $6.42M
84.369 Grants for State Assessments and Related Activities $6.33M
84.425 Covid-19 - Governor's Emergency Education Relief (geer) Fund $6.00M
84.365 English Language Acquisition State Grants $5.60M
93.645 Stephanie Tubbs Jones Child Welfare Services Program $5.60M
93.556 Marylee Allen Promoting Safe and Stable Families Program $5.52M
15.916 Outdoor Recreation Acquisition, Development and Planning $5.33M
94.006 Americorps State and National 94.006 $5.28M
20.607 Alcohol Open Container Requirements $5.09M
97.067 Homeland Security Grant Program $5.06M
84.371 Comprehensive Literacy Development $4.32M
16.738 Edward Byrne Memorial Justice Assistance Grant Program $4.31M
93.791 Money Follows the Person Rebalancing Demonstration $4.27M
84.425 Covid-19 - Coronavirus Response and Relief Supplemental Approprriations Act, 2021-Emergency Assistance to Non-Public Schools (crrsa Eans) Program $3.93M
10.182 Pandemic Relief Activities: Local Food Purchase Agreements with States, Tribes, and Local Governments $3.85M
10.582 Fresh Fruit and Vegetable Program $3.79M
93.053 Nutrition Services Incentive Program $3.76M
15.252 Abandoned Mine Land Reclamation (amlr) $3.67M
93.870 Maternal, Infant and Early Childhood Home Visiting Grant $3.67M
93.674 John H. Chafee Foster Care Program for Successful Transition to Adulthood $3.66M
93.991 Preventive Health and Health Services Block Grant $3.59M
93.052 National Family Caregiver Support, Title Iii, Part E $3.47M
10.649 Pandemic Ebt Administrative Costs $3.46M
93.889 National Bioterrorism Hospital Preparedness Program $3.45M
84.425 Covid-19 - American Rescue Plan - Elementary and Secondary School Emergency Relief - Homeless Children and Youth $3.44M
93.898 Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations $3.39M
45.310 Grants to States $3.21M
84.358 Rural Education $3.08M
95.001 High Intensity Drug Trafficking Areas Program $3.02M
20.513 Enhanced Mobility of Seniors and Individuals with Disabilities $2.96M
14.231 Emergency Solutions Grant Program $2.94M
20.224 Federal Lands Access Program $2.78M
10.665 Schools and Roads - Grants to States $2.64M
97.012 Boating Safety Financial Assistance $2.63M
90.404 Hava Election Security Grants $2.50M
16.588 Violence Against Women Formula Grants $2.50M
93.155 Rural Health Research Centers $2.37M
93.747 Elder Abuse Prevention Interventions Program $2.34M
12.112 Payments to States in Lieu of Real Estate Taxes $2.29M
93.499 Low Income Household Water Assistance Program $2.29M
93.671 Family Violence Prevention and Services/domestic Violence Shelter and Supportive Services $2.26M
17.801 Jobs for Veterans State Grants $2.19M
93.669 Child Abuse and Neglect State Grants $2.11M
16.554 National Criminal History Improvement Program (nchip) $2.11M
16.576 Crime Victim Assistance/discretionary Grants $2.08M
10.676 Forest Legacy Program $2.05M
66.460 Nonpoint Source Implementation Grants $2.01M
16.833 National Sexual Assault Kit Initiative $1.97M
10.664 Cooperative Forestry Assistance $1.97M
93.387 National and State Tobacco Control Program $1.96M
93.103 Food and Drug Administration Research $1.90M
93.775 State Medicaid Fraud Control Units $1.88M
17.235 Senior Community Service Employment Program $1.86M
93.630 Developmental Disabilities Basic Support and Advocacy Grants $1.79M
10.578 Wic Grants to States (wgs) $1.74M
20.325 Consolidated Rail Infrastructure and Safety Improvements $1.74M
15.438 National Forest Acquired Lands $1.72M
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $1.60M
84.013 Title I State Agency Program for Neglected and Delinquent Children and Youth $1.58M
39.003 Donation of Federal Surplus Personal Property $1.58M
17.504 Consultation Agreements $1.58M
93.599 Chafee Education and Training Vouchers Program (etv) $1.57M
66.961 Superfund State and Indian Tribe Combined Cooperative Agreements (site-Specfic and Core) $1.53M
97.137 State and Local Cybersecurity Grant Program Tribal Cybersecurity Grant Program $1.51M
93.977 Sexually Transmitted Diseases (std) Prevention and Control Grants $1.49M
10.475 Cooperative Agreements with States for Intrastate Meat and Poultry Inspection $1.47M
10.568 Emergency Food Assistance Program (administrative Costs) $1.45M
93.070 Environmental Public Health and Emergency Response $1.45M
81.041 State Energy Program $1.37M
20.505 Metropolitan Transportation Planning and State and Non-Metropolitan Planning and Research $1.36M
66.817 State and Tribal Response Program Grants $1.34M
84.196 Education for Homeless Children and Youth $1.31M
93.310 Trans-Nih Research Support $1.29M
93.110 Maternal and Child Health Federal Consolidated Programs $1.19M
15.634 State Wildlife Grants $1.18M
64.101 Burial Expenses Allowance for Veterans $1.18M
97.008 Non-Profit Security Program $1.17M
10.934 Feral Swine Eradication and Control Pilot Program $1.14M
93.324 State Health Insurance Assistance Program $1.13M
93.426 The National Cardiovascular Health Program $1.13M
66.804 Underground Storage Tank (ust) Prevention, Detection, and Compliance Program $1.08M
10.069 Conservation Reserve Program $1.04M
20.219 Recreational Trails Program $1.03M
66.805 Leaking Underground Storage Tank Trust Fund Corrective Action Program $1.03M
93.686 Ending the Hiv Epidemic: A Plan for America — Ryan White Hiv/aids Program Parts A and B $1.03M
93.235 Title V State Sexual Risk Avoidance Education (title V State Srae) Program $1.02M
93.590 Community-Based Child Abuse Prevention Grants $1.01M
17.002 Labor Force Statistics $989,933
64.024 Va Homeless Providers Grant and Per Diem Program $967,358
16.813 Nics Act Record Improvement Program $958,420
15.904 Historic Preservation Fund Grants-in-Aid $957,474
93.435 The Innovative Cardiovascular Health Program $956,703
10.025 Plant and Animal Disease, Pest Control, and Animal Care $941,193
93.150 Projects for Assistance in Transition From Homelessness (path) $939,991
14.241 Housing Opportunities for Persons with Aids $935,800
45.025 Promotion of the Arts Partnership Agreements $912,725
16.741 Dna Backlog Reduction Program $902,935
84.423 Supporting Effective Educator Development Program $877,678
10.093 Voluntary Public Access and Habitat Incentive Program $868,014
66.802 Superfund State, Political Subdivision, and Indian Tribe Site-Specific Cooperative Agreements $859,582
93.336 Behavioral Risk Factor Surveillance System $800,949
93.439 State Physical Activity and Nutrition (span $799,242
93.092 Affordable Care Act (aca) Personal Responsibility Education Program $791,120
97.088 Disaster Assistance Projects $781,211
10.727 Inflation Reduction Act Urban & Community Forestry Program $750,000
20.700 Pipeline Safety Program State Base Grant $743,502
84.011 Migrant Education State Grant Program $740,785
17.277 Wioa National Dislocated Worker Grants / Wia National Emergency Grants $739,390
66.485 Support for the Gulf Hypoxia Action Plan $713,516
20.200 Highway Research and Development Program $710,686
12.113 State Memorandum of Agreement Program for the Reimbursement of Technical Services $699,848
15.608 Fish and Aquatic Conservation - Aquatic Invasive Species $696,618
84.177 Rehabilitation Services Independent Living Services for Older Individuals Who Are Blind $683,675
93.564 Child Support Services Research $679,671
93.464 Acl Assistive Technology $665,864
93.071 Medicare Enrollment Assistance Program $660,425
93.436 Well-Integrated Screening and Evaluation for Women Across the Nation (wisewoman) $615,631
64.115 Veterans Information and Assistance $612,572
93.116 Project Grants and Cooperative Agreements for Tuberculosis Control Programs $607,732
93.165 Grants to States for Loan Repayment $587,087
93.988 Cooperative Agreements for Diabetes Control Programs $584,666
84.224 Assistive Technology $576,323
16.017 Sexual Assault Services Formula Program $576,088
66.034 Surveys, Studies, Research, Investigations, Demonstrations, and Special Purpose Activities Relating to the Clean Air Act $566,765
17.271 Work Opportunity Tax Credit Program (wotc) $560,269
16.839 Stop School Violence $542,173
11.032 State Digital Equity Planning and Capacity Grant $542,083
84.368 Competitive Grants for State Assessments $541,486
17.285 Registered Apprenticeship $535,590
66.040 Diesel Emissions Reduction Act (dera) State Grants $530,743
93.586 State Court Improvement Program $520,179
17.600 Mine Health and Safety Grants $517,239
10.698 State & Private Forestry Cooperative Fire Assistance $517,045
93.301 Small Rural Hospital Improvement Grant Program $512,437
93.478 Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees $511,595
15.978 Upper Mississippi River Restoration Long Term Resource Monitoring $509,308
84.425 Covid-19 - Higher Education Emergency Relief Fund (heerf) Institutional Aid $503,409
93.043 Special Programs for the Aging, Title Iii, Part D, Disease Prevention and Health Promotion Services $499,346
15.810 National Cooperative Geologic Mapping $495,533
10.187 The Emergency Food Assistance Program (tefap) Commodity Credit Corporation Eligible Recipient Funds $490,937
10.170 Specialty Crop Block Grant Program - Farm Bill $489,953
93.366 State Actions to Improve Oral Health Outcomes and Partner Actions to Improve Oral Health Outcomes $486,725
94.003 Americorps State Commissions Support Grant $485,269
97.047 Bric: Building Resilient Infrastructure and Communities $484,339
16.710 Public Safety Partnership and Community Policing Grants $478,034
93.240 State Capacity Building $477,869
93.367 Flexible Funding Model - Infrastructure Development and Maintenance for State Manufactured Food Regulatory Programs $471,420
93.982 Mental Health Disaster Assistance and Emergency Mental Health $454,697
93.241 State Rural Hospital Flexibility Program $452,763
84.323 Special Education - State Personnel Development $435,314
20.528 Rail Fixed Guideway Public Transportation System State Safety Oversight Formula Grant Program $431,261
16.540 Juvenile Justice and Delinquency Prevention $429,264
93.270 Viral Hepatitis Prevention and Control $426,403
93.042 Special Programs for the Aging, Title Vii, Chapter 2, Long Term Care Ombudsman Services for Older Individuals $406,231
14.268 Rural Housing Stability Assistance Program $402,596
97.023 Community Assistance Program State Support Services Element (cap-Ssse) $399,665
16.742 Paul Coverdell Forensic Sciences Improvement Grant Program $396,316
93.197 Childhood Lead Poisoning Prevention Projects, State and Local Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children $391,437
17.245 Trade Adjustment Assistance $374,339
20.703 Interagency Hazardous Materials Public Sector Training and Planning Grants $364,287
93.643 Children's Justice Grants to States $355,776
64.203 Veterans Cemetery Grants Program $345,949
64.053 Payments to States for Programs to Promote the Hiring and Retention of Nurses at State Veterans Homes $344,573
93.369 Acl Independent Living State Grants $337,724
16.585 Treatment Court Discretionary Grant Program $336,880
59.061 State Trade Expansion $328,601
17.005 Compensation and Working Conditions $326,088
66.454 Water Quality Management Planning $323,911
93.236 Grants to States to Support Oral Health Workforce Activities $318,757
17.273 Temporary Labor Certification for Foreign Workers $315,681
20.500 Federal Transit Capital Investment Grants $305,857
11.035 Broadband Equity, Access, and Deployment Program $304,941
16.593 Residential Substance Abuse Treatment for State Prisoners $304,571
64.005 Grants to States for Construction of State Home Facilities $302,035
84.187 Supported Employment Services for Individuals with the Most Significant Disabilities $277,064
30.001 Employment Discrimination Title Vii of the Civil Rights Act of 1964 $273,462
66.444 Voluntary School and Child Care Lead Testing and Reduction Grant Program (sdwa 1464(d)) $264,820
16.750 Support for Adam Walsh Act Implementation Grant Program $260,661
84.326 Special Education Technical Assistance and Dissemination to Improve Services and Results for Children with Disabilities $242,675
10.579 Child Nutrition Discretionary Grants Limited Availability $239,733
10.479 Food Safety Cooperative Agreements $237,573
20.232 Commercial Driver's License Program Implementation Grant $227,767
93.251 Early Hearing Detection and Intervention $219,962
93.334 The Healthy Brain Initiative: Technical Assistance to Implement Public Health Actions Related to Cognitive Health, Cognitive Impairment, and Caregiving at the State and Local Levels $208,232
93.130 Cooperative Agreements to States/territories for the Coordination and Development of Primary Care Offices $205,293
15.622 Sportfishing and Boating Safety Act $200,000
84.325 Special Education - Personnel Development to Improve Services and Results for Children with Disabilities $194,554
94.008 Americorps Commission Investment Fund 94.008 $194,261
66.433 State Underground Water Source Protection $194,007
93.597 Grants to States for Access and Visitation Programs $189,398
66.046 Climate Pollution Reduction Grants $185,281
20.614 National Highway Traffic Safety Administration (nhtsa) Discretionary Safety Grants and Cooperative Agreements $180,617
15.250 Regulation of Surface Coal Mining and Surface Effects of Underground Coal Mining $174,399
10.525 Farm and Ranch Stress Assistance Network Competitive Grants Program $171,246
66.032 State and Tribal Indoor Radon Grants $167,421
20.215 Highway Training and Education $158,052
93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs $153,246
93.234 Traumatic Brain Injury State Demonstration Grant Program $149,785
15.073 Earth Mapping Resources Initiative $148,802
93.876 Antimicrobial Resistance Surveillance in Retail Food Specimens $141,836
84.902 National Assessment of Education Progress $140,099
93.314 Early Hearing Detection and Intervention Information System (ehdi-Is) Surveillance Program $137,138
93.913 Grants to States for Operation of State Offices of Rural Health $136,542
10.556 Special Milk Program for Children $123,483
15.615 Cooperative Endangered Species Conservation Fund $122,422
10.153 Market News $117,620
84.144 Migrant Education Coordination Program $116,675
93.603 Adoption and Legal Guardianship Incentive Payments Program $114,881
94.013 Americorps Volunteers in Service to America 94.013 $114,626
10.185 Local Food for Schools Cooperative Agreement Program $109,025
16.609 Project Safe Neighborhoods $99,966
93.041 Special Programs for the Aging, Title Vii, Chapter 3, Programs for Prevention of Elder Abuse, Neglect, and Exploitation $99,187
93.008 Medical Reserve Corps Small Grant Program $99,003
15.814 National Geological and Geophysical Data Preservation $97,632
16.582 Crime Victim Assistance/discretionary Grants $95,308
16.812 Second Chance Act Reentry Initiative $95,219
81.136 Long-Term Surveillance and Maintenance $92,637
93.079 Cooperative Agreements to Promote Adolescent Health Through School-Based Hiv/std Prevention and School-Based Surveillance $91,257
93.945 Assistance Programs for Chronic Disease Prevention and Control $90,334
20.507 Federal Transit Formula Grants $82,256
12.617 Economic Adjustment Assistance for State Governments $80,782
10.645 Farm to School State Formula Grant $80,647
84.372 Statewide Longitudinal Data Systems $80,192
11.307 Economic Adjustment Assistance $76,847
12.U01 Excess Property Program $74,526
97.041 National Dam Safety Program $63,403
66.419 Water Pollution Control State, Interstate, and Tribal Program Support $61,232
97.082 Earthquake State Assistance $59,837
97.056 Port Security Grant Program $54,580
66.461 Regional Wetland Program Development Grants $51,034
10.535 Snap Fraud Framework Implementation Grant $46,070
20.240 Fuel Tax Evasion-Intergovernmental Enforcement Effort $44,516
12.620 Troops to Teachers Grant Program $41,185
16.922 Equitable Sharing Program $37,662
15.684 White-Nose Syndrome National Response Implementation $36,253
12.630 Basic, Applied, and Advanced Research in Science and Engineering $29,931
10.572 Wic Farmers' Market Nutrition Program (fmnp) $28,748
15.018 Energy Community Revitalization Program (ecrp) $26,186
16.U01 FBI Joint Terrorism Task Force $24,658
93.981 Improving Student Health and Academic Achievement Through Nutrition, Physical Activity and the Management of Chronic Conditions in Schools $22,753
10.680 Forest Health Protection $22,037
81.128 Energy Efficiency and Conservation Block Grant Program (eecbg) $20,837
15.808 U.s. Geological Survey Research and Data Collection $20,768
10.576 Senior Farmers Market Nutrition Program $19,408
66.608 Environmental Information Exchange Network Grant Program and Related Assistance $18,723
21.016 Equitable Sharing $14,545
10.171 Organic Certification Cost Share Programs $10,963
89.003 National Historical Publications and Records Grants $10,342
66.818 Brownfields Multipurpose, Assessment, Revolving Loan Fund, and Cleanup Cooperative Agreements $8,560
81.254 Grid Infrastructure Deployment and Resilience $8,542
20.721 Phmsa Pipeline Safety Program One Call Grant $8,021
10.435 State Mediation Grants $7,404
10.605 Quality Samples Program $5,499
10.541 Child Nutrition-Technology Innovation Grant $4,475
81.138 State Heating Oil and Propane Program $3,895
17.270 Reentry Employment Opportunities $111
97.050 Presidential Declared Disaster Assistance to Individuals and Households - Other Needs $-227,353