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Detailed Information on the
Maternal and Child Health Block Grant Assessment

Program Code 10000268
Program Title Maternal and Child Health Block Grant
Department Name Dept of Health & Human Service
Agency/Bureau Name Health Resources and Services Administration
Program Type(s) Block/Formula Grant
Assessment Year 2008
Assessment Rating Effective
Assessment Section Scores
Section Score
Program Purpose & Design 100%
Strategic Planning 86%
Program Management 100%
Program Results/Accountability 84%
Program Funding Level
(in millions)
FY2007 $693
FY2008 $666
FY2009 $666

Ongoing Program Improvement Plans

Year Began Improvement Plan Status Comments
2008

Developing a program performance measure targeting the ration of racial and ethnic disparities in low birth weight infants.

No action taken New item resulting from 2008 PART reassessment. No action yet taken. (June 08 update)
2008

Promoting evidence-based practices to reduce the incidence (and better understand the causes) of low birth weight.

No action taken New item resulting from 2008 PART reassessment. Not action yet taken. (June 08 update)
2007

Conducting a technical review and evaluation of the States' Title V Maternal and Child Health priority needs, State performance measures, and promising practices.

Action taken, but not completed This work is being done through a contract with the Cecil G. Sheps Center for Health Services Research. A report on State Title V Performance Indicators and Needs Assessments was released in May 2008. Based on the findings of the priority needs review, the contractor will examine State performance and data capacity around three identified emerging issues. (June 08 update)

Completed Program Improvement Plans

Year Began Improvement Plan Status Comments

Program Performance Measures

Term Type  
Long-term Outcome

Measure: National rate of maternal deaths per 100,000 live births


Explanation:Pregnancy and delivery can lead to serious health problems for women, therefore consistent with the purpose of the MCH Block Grant, the program closely monitors and works closely with States to decrease the national rate of maternal deaths. Medical risk factors, such as diabetes and pregnancy-induced hypertension, can cause complications during pregnancy that may result in maternal mortality, particularly if they are not properly identified and treated. The 2015 target is ambitious in light of the following factors: 1. The average rate for diabetes increased from 35.8 per 1,000 deliveries in 2004 to 38.5 per 1,000 deliveries in 2005 (National Vital Statistics System). 2. The average rate of pregnancy-induced hypertension increased from 37.9 per 1,000 deliveries in 2004 to 39.9 per 1,000 deliveries in 2005 (National Vital Statistics System). Both of these rates have been increasing steadily since 1990, when they were 21.3 and 27.2 respectively. 3. Recent changes in the classification and measurement of maternal mortality (that have not yet been fully implemented) have led to increased numbers of cases classified as "maternal mortality" that were not classified as such in the past. This has led to an increase in the number of maternal mortality cases reported in recent years, which will continue to increase in upcoming years as additional states adopt the new guidlelines regarding maternal mortality classification.

Year Target Actual
1999 -- 9.9
2000 -- 9.8
2001 -- 9.9
2002 -- 8.9
2003 -- 12.1
2004 -- 13.1
2005 Baseline 15.1
2015 13.1 Nov-17
Long-term Outcome

Measure: National rate of infant deaths per 1,000 live births.


Explanation:As the mission of the Maternal and Child Health (MCH) Block Grant is to improve the health of all mothers, children, and their families, decreasing the national rate of infant deaths has been and continues to be one of the primary focuses of the Maternal and Child Block Grant program. While the decrease targeted for 2015 for this measure may appear to be modest, it is ambitious in light of the following factors: 1. Increases in the number of births of very small infants (less than 750 grams) 2. Increases in the number of multiple births which are associated with a higher risk profile and increases in low birth weight deliveries. 3. Infant mortality continues to represent an extremely complex problem with many medical, social, and economic determinants, including race/ethnicity, maternal age, education, smoking, and economic status.

Year Target Actual
1990 -- 9.2
1991 -- 8.9
1992 -- 8.5
1993 -- 8.4
1994 -- 8.0
1995 -- 7.6
1996 -- 7.3
1997 -- 7.2
1998 -- 7.2
1999 -- 7.1
2000 -- 6.9
2001 -- 6.8
2002 -- 7.0
2003 -- 6.9
2004 -- 6.8
2005 Baseline 6.9
2015 6.0 Nov-17
Long-term Outcome

Measure: National rate of neonatal deaths per 1,000 live births.


Explanation:As the mission of the Maternal and Child Health (MCH) Block Grant is to improve the health of all mothers, children, and their families, decreasing the national rate of neonatal deaths has been and continues to be one of the primary focuses of the Maternal and Child Block Grant program. While the decrease targeted for 2015 for this measure may appear to be modest, it is ambitious in light of the following factors: 1. Current childbearing patterns including: a. Increasing numbers of births to women over 40 b. Increasing rates of multiple births 2. The numerous medical, social, and economic determinants that influence neonatal mortality rates. Due to the above factors it will be challenging to make further reductions in the overall neonatal mortality rate in upcoming years. For these reasons, the target for Long-Term Measure III, although modest, is ambitious.

Year Target Actual
1990 -- 6.5
1991 -- 6.2
1992 -- 5.8
1993 -- 5.8
1994 -- 5.6
1995 -- 5.4
1996 -- 5.2
1997 -- 5.2
1998 -- 5.2
1999 -- 5.1
2000 -- 5.1
2001 -- 5.0
2002 -- 5.1
2003 -- 5.1
2004 -- 4.9
2005 Baseline 4.6
2015 4.2 Nov-17
Long-term Outcome

Measure: Number of uninsured children.


Explanation:As the mission of the Maternal and Child Health (MCH) Block Grant is to improve the health of all mothers, children, and their families, decreasing the number of uninsured children nationally represents one of the primary focuses of the Maternal and Child Block Grant program. While the decrease targeted for 2015 for this measure may appear modest, it is ambitious in light of recent and proposed revisions to SCHIP eligibility that may further restrict access to this program. MCH Block Grant staff will continue to work closely with States to identify and/or develop other mechanisms for addressing the needs of uninsured children who do not qualify for SCHIP.

Year Target Actual
1994 -- 10.0 M
1995 -- 9.8
1996 -- 10.6
1997 -- 10.7
1998 -- 11.1
1999 -- 10.0
2000 -- 8.4
2001 -- 8.5
2002 -- 8.5
2003 -- 8.4
2004 -- 7.7
2005 -- 8.1
2006 Baseline 8.7
2015 7.7 M Nov-17
Annual Outcome

Measure: Percent of pregnant women who receive prenatal care in the first trimester.


Explanation:Prenatal care is one of the most important interventions for ensuring the health of pregnant women and their infants. Given the increasing prevalence of diabetes, obesity, and pregnancy-induced hypertension during pregnancy, there is a need for such risk factors to be monitored and for timely and appropriate prenatal care to be provided. Research has shown that the likelihood of seeking prenatal care is influenced by a variety of financial, social, and psychological factors, making it difficult to achieve dramatic increases in this area. Regardless, increasing access to prenatal care continues to represent a key area of emphasis for the MCH Block Grant, with modest increases targeted over the next 3 years.

Year Target Actual
1990 -- 75.8
1991 -- 76.2
1992 -- 77.7
1993 -- 78.9
1994 -- 80.2
1995 -- 81.3
1996 -- 81.9
1997 -- 82.5
1998 -- 82.8
1999 -- 83.2
2000 -- 83.2
2001 -- 83.4
2002 -- 83.7
2003 -- 84.1**
2004 -- 84.2**
2005 Baseline 83.9**
2006 84.0% Data lag-Nov-08
2007 84.0% Nov-09
2008 85% Nov-10
2009 86.0% Nov-11
2010 86.5% Nov-12
Annual Outcome

Measure: Incidence of low birth weight births per 100 live births. Objective - Maintain the incidence of low birth weight (LBW) at 8.2% in 2008, 2009, and 2010


Explanation:This measure is linked to Long-term Measure II (reducing the national rate of infant deaths per 1,000 live births), since low birth weight babies are at greater risk of health complications and are more likely than other babies to die during the first year of life. In the past 15 years, the distribution of birth weights in the U.S. has shifted, with the percentage of LBW infants increasing 17 percent since the mid-1990s. From 2002 to 2005, the rate of LBW infants increased from 7.8 percent to 8.2 percent, the highest level reported since 1969. The increasing rate of LBW infants is a recognized concern across the Nation. Increases have been influenced by: 1) The rise in the multiple birth rate, 2) Greater use of obstetric interventions, 3) Increases in maternal age at childbearing and increased use of infertility therapies. Therefore, it is ambitious to maintain the incidence of low birth weight at 8.2% in light of the recent increases LBW rates driven by factors such as demographics and obstetric interventions which are generally outside of the control of public health (and more specifically MCH Block Grant) interventions.

Year Target Actual
1998 -- 7.6
1999 -- 7.6
2000 -- 7.6
2001 -- 7.7
2002 -- 7.8
2003 -- 7.9
2004 -- 8.1
2005 Baseline 8.2
2006 8.2 Data lag-Nov-08
2007 8.2 Nov-09
2008 8.2 Nov-10
2009 8.2 Nov-11
2010 8.2 Nov-12
Annual Outcome

Measure: Percent of very low-birth weight babies who are delivered at facilities for high-risk deliveries and neonates.


Explanation:The third annual measure looks at the percent of very low birth weight babies delivered at facilities for high-risk deliveries and neonates. This measure directly contributes to Long-Term Measure III (reducing the national rate of neonatal deaths per 1,000 live births), since facilities for high-risk deliveries are specially equipped to provide very low birth weight babies with the care necessary to sustain life during the first month of life. The percent of very low birth weight infants delivered at facilities for high-risk deliveries and neonates declined from 74.9% in 2003 to 73.4% in 2005. The full reasons for the decline are unclear and are under investigation. While the MCH Block Grant program has had success working with States to implement perinatal regionalization strategies and protocols for the transfer of high-risk women to level III facilities, there is evidence indicating that these systems may be eroding as health care networks and financing systems change. Therefore, while the increases targeted for 2008, 2009,and 2010 may appear modest, they represent an ambitious effort to reverse this opposing trend.

Year Target Actual
1998 -- 70.6%
1999 -- 72.5%
2000 -- 74.2%
2001 -- 74.2%
2002 -- 75.2%
2003 -- 74.9%
2004 -- 71.7%
2005 -- 73.4%
2006 74.0% Data lag-Nov-08
2007 74.5% Nov-09
2008 75.0% Nov-10
2009 75.5% Nov-11
2010 76.0% Nov-12
Annual Output

Measure: Increase the number of children receiving Title V services who are enrolled in and have Medicaid and SCHIP coverage.


Explanation:The fourth annual measure looks at the number of children (including children with special health care needs) receiving MCH Block Grant services who enroll in and have Medicaid and SCHIP coverage. This annual measure contributes directly to Long-Term Measure IV (reduce the number of uninsured children nationally), since increasing the number of children served by the MCH Block Grant who are enrolled in Medicaid and SCHIP will reduce the number of children with no health insurance. States are expected to further restrict SCHIP eligibility by August 2008 to assure compliance with guidance issued by the Centers for Medicare and Medicaid Services (CMS) in August 2007. States that currently cover children with family incomes up to 300% of the FPL may be required to exclude these children from future coverage. With changes in both SCHIP eligibility requirements and current SCHIP funding levels, it will be difficult to sustain the current number of children recieving MCH Block Grant services who are also enrolled in Medicaid and/or SCHIP. It is therefore ambitious to propose annual increases in the number of children receiving MCH Block Grant services who become enrolled in Medicaid and/or SCHIP (thereby decreasing the number of children without health insurance).

Year Target Actual
1998 -- 4.0 M
1999 -- 9.3 M
2000 -- 6.0 M
2001 -- 8.7 M
2002 -- 5.9 M
2003 -- 9.7 M
2004 -- 9.8 M
2005 -- 10.1 M
2006 6.2 M 11.0 M
2007 9.8 M Nov-08
2008 11.0 M Nov-09
2009 11.5 M Nov-10
2010 12.0 M Nov-11
Annual Efficiency

Measure: Increase the number of children served by the Title V Block Grant per $1 million in funding.


Explanation:This measure of efficiency challenges States to contain costs at the same time that they are asked to expand access to services. The significant increase in children served by the Title V Block Grant per $1 million in funding between 2004 and 2006 reflects numerous factors, including: 1. Improvements in program efficiency, 2. A shift towards more population-based services, such as screening services provided to school-aged children, 3. A reduction in MCH Block Grant funding and reliance on other sources for program funding, such as increasing levels of co-payment by some of those receiving services. The program continues to monitor the number of children served and explore opportunities for efficiencies, but does not anticipate continued increases of the same magnitude in the short-term, given the above changes that led to recent dramatic increases and maximized efficiency in many areas. *The target for 2007 was set before 2006 actual data were available and reflects an increase when compared with actual data available at the time the target was established. The targets for 2008-2009 were set using the current level of efficiency as a starting point and reflect sustained increases over the 2006 actual data. They are based on a presumed increase in the number of children served with no increase over the current level of funding. These targets are ambitious, given recent achievements, including services that extended coverage to a much larger number of children and the shifting of costs to other sources, as well as the inherent challenges faced when working to serve more customers with a similar level of investment.

Year Target Actual
2002 -- 30,906
2004 -- 31,515
2005 -- 38,402
2006 32,394 41,868
2007 32,500 Nov-08
2008 38,000 Nov-09
2009 39,000 Nov-10
2010 40,000 Nov-11

Questions/Answers (Detailed Assessment)

Section 1 - Program Purpose & Design
Number Question Answer Score
1.1

Is the program purpose clear?

Explanation: The mission of the Maternal and Child Health (MCH) Block Grant, as authorized under Title V of the Social Security Act, is to improve the health of all mothers, children, including children with special health care needs, and their families. More specifically Congress authorized the MCH Block Grant with the aim of 1) reducing health disparities, 2) improving access to health care, and 3) improving the quality of health care. The MCH Block Grant is at its core a public health program that reaches across economic lines to improve the health of all mothers and children.

Evidence: Evidence/Data: 1. Title V of the Social Security Act, http://www.ssa.gov/OP_Home/ssact/title05/0500.htm, authorizes this program and clearly states the purpose of the program in section 501. 2. In addition, the mission of the MCH Block Grant is included in the HRSA Fiscal Year 2009 Congressional Budget Justification, pages 139-140, http://www.hrsa.gov/about/budgetjustification09/.

YES 20%
1.2

Does the program address a specific and existing problem, interest, or need?

Explanation: The MCH Block Grant addresses the specific and ongoing problem of lack of access to high quality, comprehensive health care for all mothers, children, including children with special health care needs, and their families, including the poor, the uninsured, the underinsured, and the medically underserved. In 2006, 11.7 percent of all children were uninsured. Disparities related to race, ethnicity, and socioeconomic status continue to pervade the health care system, impeding access to high quality, comprehensive health care for all mothers, children, and their families. A stark example of pervasive racial health disparities is the ratio of the black infant mortality rate to the white infant mortality rate, which was 2.4:1 in 2005. Although prenatal care is one of the most important interventions for ensuring the health of pregnant women and their infants, the rate of increase in prenatal care has been slow in recent years, was unchanged at 83.9 percent from 2004 to 2005, and continues to fall short of the Healthy People 2010 objective of 90 percent.

Evidence: Evidence/Data: 1. U.S. Census Bureau, Current Population Reports, Income, Poverty, and Health Insurance Coverage in the Unites States: 2006, page 31, http://www.census.gov/prod/2007pubs/p60-233.pdf. 2. Agency for Healthcare Research and Quality, National Healthcare Disparities Report, 2006, Key Themes and Highlights, http://www.ahrq.gov/qual/nhdr06/report/. 3. National Vital Statistics Reports, Volume 56, Number 10, January 2008, page 24, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf. 4. Healthy People 2010, Objective 16-16a, http://www.healthypeople.gov/document/html/objectives/16-06.htm.

YES 20%
1.3

Is the program designed so that it is not redundant or duplicative of any other Federal, state, local or private effort?

Explanation: The MCH Block Grant is not redundant or duplicative of any other Federal, State, local or private effort and there are no similar programs at any level. The MCH Block Grant, unique in both its design and scope, is the only Federal program that focuses solely on improving the health of all mothers, adolescents, children, including children with special health care needs, and families, whether insured or not and regardless of income level, carried out through well-established Federal/State partnerships. Through the MCH Block Grant, the Federal Government distributes funding to States, provides oversight by requiring States to report progress annually on key MCH indicators, and offers technical assistance to States to improve performance. Each State is responsible for determining State priorities, based on the needs of its MCH population, targeting funds to address those needs, and reporting annually on its progress. Thus, the MCH Block Grant emphasizes accountability while providing each State with appropriate flexibility to respond to the particular needs of its MCH population. Legislative and program requirements ensure that each State uses the MCH Block Grant funds to address the specific needs of its MCH population, while also assuring that the program provides national leadership in identifying and addressing the needs of the MCH population. In this way the actual MCH Block Grant funds help to fill the gaps in each States' MCH related needs, and the program itself works with the State to create a plan that optimizes all funding resources and coordinates all MCH activities to avoid duplication of effort and maximize effectiveness of finite resources. The MCHBG also helps States support capacity and infrastructure building, population-based and enabling services, as well as direct health care services where no services are available. In this latter role, the MCH Block Grant serves as a safety net for uninsured and underinsured children, including children with special health care needs, and continues to play a valuable, complementary role to the SCHIP and Medicaid programs, which are primarily claims reimbursement programs.

Evidence: Evidence/Data: 1. Title V of the Social Security Act, http://www.ssa.gov/OP_Home/ssact/title05/0500.htm. 2. Title XIX of the Social Security Act, section 1902(a)(11), http://www.ssa.gov/OP_Home/ssact/title19/1902.htm.

YES 20%
1.4

Is the program design free of major flaws that would limit the program's effectiveness or efficiency?

Explanation: The MCH Block Grant has no major design flaws that prevent it from meeting its defined objectives and performance goals. There is no evidence that another approach or mechanism would be more efficient or effective to achieve the intended purpose. Legislative and program requirements ensure that each State uses the MCH Block Grant funds to address the specific needs of its MCH population, while also assuring that the program provides national leadership in identifying and addressing the needs of the MCH population. Every State receiving MCH Block Grant funds must: (1) Conduct a State-wide Needs Assessment every five years that identifies the need for services for pregnant women, mothers, infants, children, and children with special health care needs; (2) Develop a plan annually for meeting the needs identified in the State-wide Needs Assessment; (3) Describe annually how the MCH Block Grant funds will be used to carry out its plan; (4) Identify annually the types of services to be provided; and (5) Identify annually the categories and characteristics of individuals to be served. These State-wide activities, as well as the national MCH leadership that results from the MCH Block Grant, would not be possible without this program. The block grant structure, combined with the required State-wide Needs Assessment, assures that each State identifies the priority needs of its MCH population and then provides the flexibility for each State to target MCH Block Grant funds to address these specific needs. Given the diversity of State needs, the block grant structure is the most effective way to provide these funds and assures the best use of the MCH Block Grant funds in addressing the unique needs of each State's MCH population.

Evidence: Evidence/Data: The authorization directs the program to provide block grants for the provision of health services and related activities, including planning, administration, education, and evaluation, consistent with each State's five-year Needs Assessment and annual plan. Section 503 of the authorization requires that at least 3 of every 4 Federal dollars must be matched by States with non-Federal dollars. The authorization also specifies the population to be served and the services to be provided. In addition to assuring that comprehensive preventive and primary care services are available for pregnant women, mothers, infants, and children, States use MCH Block Grant funds to address the needs associated with chronic conditions for children with special health care needs (Sections 501, 503, and 505 of Title V of the Social Security Act, http://www.ssa.gov/OP_Home/ssact/title05/0500.htm). States are successfully leveraging non-Federal resources, as evidenced by the Title V Information System, Federal-State Title V Block Grant Partnership Expenditures by Source of Funding, https://perfdata.hrsa.gov/mchb/mchreports/Search/special/fin06_special_result.asp.

YES 20%
1.5

Is the program design effectively targeted so that resources will address the program's purpose directly and will reach intended beneficiaries?

Explanation: The MCH Block Grant effectively targets resources to meet the program's purpose of improving the health of all mothers, children, including children with special health care needs, and their families. As indicated above, the block grant structure, combined with the required State-wide Needs Assessment, assures that each State identifies the priority needs of its MCH population and then provides the flexibility for each State to target MCH Block Grant funds to address these specific needs. Given the diversity of State needs, the block grant structure is the most effective way to provide these funds and assures best use of the MCH Block Grant funds in addressing the unique needs of each State's MCH population. The block grant legislation emphasizes accountability through its reporting requirements while providing States with appropriate flexibility to respond to MCH needs and to develop solutions. This theme of assisting States in the design and implementation of MCH programs to meet local needs, while at the same time asking them to account for the use of Federal/State funds, is embodied in the requirements contained in the guidance for the MCH Block Grant application and annual report. The program is intended to provide funding to States to strengthen their public health infrastructure and to address service delivery gaps for mothers and children that are not addressed by any other public or private program. The current funding formula takes into consideration the number of low-income children in a State in proportion to the number of low-income children in the nation. Section 505 of the authorization stipulates a minimum percentage of Federal funds that must be targeted towards specific beneficiaries: at least 30 percent to children and at least 30 percent to children with special health care needs. State annual reports, available through the Title V Information System, demonstrate that the right beneficiaries are being targeted. In addition, the program is designed to be a partnership in which the State also has a significant stake in providing for the services of mothers and children; section 503 of the authorization requires that at least 3 of every 4 Federal dollars must be matched by States with non-Federal dollars.

Evidence: Evidence/Data: 1. Section 503 and 505 of Title V of the Social Security Act, http://www.ssa.gov/OP_Home/ssact/title05/0500.htm. 2. Title V Information System, Federal-State Title V Block Grant Partnership Expenditures by Class of Individuals Served, https://perfdata.hrsa.gov/mchb/mchreports/Search/special/fin07_special_result.asp.

YES 20%
Section 1 - Program Purpose & Design Score 100%
Section 2 - Strategic Planning
Number Question Answer Score
2.1

Does the program have a limited number of specific long-term performance measures that focus on outcomes and meaningfully reflect the purpose of the program?

Explanation: The MCH Block Grant has four specific, easily understood long-term outcome measures that directly and meaningfully support the program's purpose of improving the health of all mothers, children, including children with special health care needs, and their families. Although the MCH Block Grant is extremely broad in scope and difficult to capture in its entirety in a few measures, the 4 long-term measures collectively represent a significant portion of the activities that are the focus of the MCH Block Grant, encompassing critical aspects of the program mission, such as the work addressing racial and ethnic health disparities and the work addressing children with special health care needs. The measures are as follows: Long-Term Measure I: The national rate of maternal deaths per 100,000 live births Long-Term Measure II: The national rate of infant deaths per 1,000 live births Long-Term Measure III: The national rate of neonatal deaths per 1,000 live births Long-Term Measure IV: The number of uninsured children Access to health insurance coverage increases access to appropriate preventive and acute care, which contributes to improved health status of children along with better school attendance and overall quality of life. All four measures focus on the program's mission of improving the health of all mothers and children by assuring that mothers receive the care and support necessary for a safe and healthy pregnancy, infants receive the care and support necessary to grow and develop into healthy children. , and children, which includes children with special health care needs, have access to health insurance so that they can receive the care and support necessary to grow and develop into healthy adults.

Evidence: Evidence/Data: These measures are consistent with measures developed to comply with GPRA and are included in the HRSA Fiscal Year 2009 Congressional Budget Justification, page 144, http://www.hrsa.gov/about/budgetjustification09/.

YES 14%
2.2

Does the program have ambitious targets and timeframes for its long-term measures?

Explanation: The MCH Block Grant has ambitious targets and timeframes for its long-term measures that are expected to be achieved by 2015. All four measures represent key public health measures for the MCH population. In addition, each measure is impacted by many determinants, including medical, social, and economic. Long-Term Measure I: The national rate of maternal deaths per 100,000 live births Baseline: 2005 - 15.1 maternal deaths per 100,000 live births. Target: 2015 - 13.1 maternal deaths per 100,000 live births. Pregnancy and delivery can lead to serious health problems for women. Medical risk factors, such as diabetes and pregnancy-induced hypertension, can cause complications during pregnancy that may result in maternal mortality, particularly if they are not properly identified and treated. The 2015 target is ambitious in light of the following factors: 1. The average rate for diabetes increased from 35.8 per 1,000 deliveries in 2004 to 38.5 per 1,000 deliveries in 2005 (National Vital Statistics System). 2. The average rate of pregnancy-induced hypertension increased from 37.9 per 1,000 deliveries in 2004 to 39.9 per 1,000 deliveries in 2005 (National Vital Statistics System). Both of these rates have been increasing steadily since 1990, when they were 21.3 and 27.2 respectively. 3. Recent changes in the classification and measurement of maternal mortality (that have not yet been fully implemented) have led to increased numbers of cases classified as "maternal mortality" that were not classified as such in the past. This has led to an increase in the number of maternal mortality cases reported in recent years, which will continue to increase in upcoming years as additional states adopt the new guidlelines regarding maternal mortality classification. Long-Term Measure II: The national rate of infant deaths per 1,000 live births Baseline: 2005 - 6.9 infant deaths per 1,000 live births Target: 2015 - 6.0 infant deaths per 1,000 live births The 2015 target for this measure is ambitious in light of the following factors: 1. Increases in the number of births of very small infants (less than 750 grams) 2. Increases in the number of multiple births which are associated with a higher risk profile and increases in low birth weight deliveries. 3. Infant mortality continues to represent an extremely complex problem with many medical, social, and economic determinants, including race/ethnicity, maternal age, education, smoking, and economic status. Long-Term Measure III: The national rate of neonatal deaths per 1,000 live births Baseline: 2005 - 4.6 neonatal deaths per 1,000 live births Target: 2015 - 4.2 neonatal deaths per 1,000 live births Like infant mortality, neonatal mortality is affected by race/ethnicity, maternal age, education, smoking, and number of pregnancies.** (Please see evidence section below for additional explanation regarding the ambitiousness of the 2015 target for this long-term measure.) Long-Term Measure IV: The number of uninsured children Baseline: 2006 - 8.7 million uninsured children Target: 2015 - 7.7 million uninsured children While the decrease targeted for 2015 for this measure may appear modest, it is ambitious in light of recent and proposed revisions to SCHIP eligibility that may further restrict access to this program. MCH Block Grant staff will continue to work closely with States to identify and/or develop other mechanisms for addressing the needs of uninsured children who do not qualify for SCHIP.

Evidence: Evidence: ** The 2015 target for long-term measure III, The national rate of neonatal deaths per 1,000 live births, is ambitious in light of the following: 1. Current childbearing patterns including: a. Increasing numbers of births to women over 40 b. Increasing rates of multiple births 2. The numerous medical, social, and economic determinants that influence neonatal mortality rates. Due to the above factors it will be challenging to make further reductions in the overall neonatal mortality rate in upcoming years. For these reasons, the target for Long-Term Measure III, although modest, is ambitious. Other evidence: 1. National Vital Statistics Reports, Volume 55, Number 1, September 29, 2006, Births: Final Data for 2004, pages 14 and 66, http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_01.pdf. 2. National Vital Statistics Reports, Volume 56, Number 6, December 5, 2007, Births: Final Data for 2005, pages 15 and 66, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf. 3. Maternal Mortality and Related Concepts, Vital and Health Statistics, Series 3, Number 33, February 2007, pages 1 and 5, http://www.cdc.gov/nchs/data/series/sr_03/sr03_033.pdf. 4.. National Vital Statistics Reports, Volume 56, Number 10, January 2008, Deaths: Final Data for 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf. 5. National Vital Statistics Reports, Vol. 54, No. 16, May 3, 2006, pages 4-6, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_16.pdf. 6. Current Population Reports, U. S. Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States, page 71, http://www.census.gov/prod/2007pubs/p60-233.pdf.

YES 14%
2.3

Does the program have a limited number of specific annual performance measures that can demonstrate progress toward achieving the program's long-term goals?

Explanation: The MCH Block Grant has four specific annual performance measures that are discrete and quantifiable and can demonstrate progress toward achieving the program's long-term goals. The four annual performance measures directly support and are logically linked to the program's four long-term goals. Annual Measure I: The percent of pregnant women who receive prenatal care in the first trimester. This measure directly supports Long-Term Measure I, since early prenatal care contributes to early identification of medical risk factors, improving the prospects for a healthy pregnancy and a healthy delivery. (Note: This annual measure replaces an annual measure from the 2002 PART for the MCH Block Grant which has been discontinued. The previous measure looked at the national rate of illnesses and complications due to pregnancy per 100 deliveries. The new annual measure was selected because it more directly reflects the impact of the MCH Block Grant in addressing maternal risk factors, and also because there is no longer a comparable data source for the conditions of pregnancy that were included in the 2002 annual measure.) Annual Measure II: The incidence of low birth weight (2500 grams or less) births. Low birth weight is an important predictor of early death. The lower an infant's birth weight, the greater is the risk for a poor outcome. Therefore, the reduction of the incidence of LBW babies substantially reduces the risk of death in the first year of life. This measure is linked to Long-term Measure II, since low birth weight babies are at greater risk of health complications and are more likely than other babies to die during the first year of life. Annual Measure III: The percent of very low birth weight babies delivered at facilities for high-risk deliveries and neonates. This measure directly contributes to Long-Term Measure III, since facilities for high-risk deliveries are specially equipped to provide very low birth weight babies with the care necessary to sustain life during the first month of life. (Note: The wording of this measure has been corrected since the 2002 PART to reflect "very low birth weight" instead of "low birth weight" babies. The data reported under this measure has always been for very low birth weight babies.) Annual Measure IV: The number of children, including children with special health care needs, receiving MCH Block Grant services who enroll in and have Medicaid and SCHIP coverage. This annual measure contributes directly to Long-Term Measure IV, since increasing the number of children, which includes children with special health care needs, served by the MCH Block Grant who are enrolled in Medicaid and SCHIP will reduce the number of children with no health insurance. In addition, the program's long-term goals are supported by 18 National Performance Measures on which States report annually as part of the MCH Block Grant application and annual report. Data on each of the National Performance Measures is available in the Title V Information System (TVIS).

Evidence: Evidence/Data: The program's annual performance measures are: 1) The percent of pregnant women who receive prenatal care in the first trimester; 2) The incidence of low birth weight births; 3) The percent of very low birth weight babies who are delivered at facilities for high-risk deliveries and neonates; and 4) The number of children, which includes children with special health care needs, receiving Title V services who enroll in and have Medicaid and SCHIP coverage. In addition, data on the 18 National Performance Measures can be found in the Title V Information System at https://perfdata.hrsa.gov/mchb/mchreports/Search/core/cormenu.asp#NPM.

YES 14%
2.4

Does the program have baselines and ambitious targets for its annual measures?

Explanation: The MCH Block Grant has established baselines and ambitious quantified targets, which are challenging but realistic, for each of the four annual measures through 2010. As with the long-term measures, the annual measures represent key public health measures for the MCH population. Annual Measure I: The percent of pregnant women who receive prenatal care in the first trimester: Baseline: 83.9% in 2005 85.0% in 2008 86.0% in 2009 86.5% in 2010 Prenatal care is one of the most important interventions for ensuring the health of pregnant women and their infants. Given the increasing prevalence of diabetes, obesity, and pregnancy-induced hypertension during pregnancy, there is a need for such risk factors to be monitored and for timely and appropriate prenatal care to be provided. Research has shown that the likelihood of seeking prenatal care is influenced by a variety of financial, social, and psychological factors, making it difficult to achieve dramatic increases in this area. Regardless, increasing access to prenatal care continues to represent a key area of emphasis for the MCH Block Grant, with modest increases targeted over the next 3 years. Annual Measure II: The incidence of low birth weight (2500 grams or less) births: Baseline: 8.2% in 2005 Objective (targets) - Maintain the incidence of low birth weight (LBW) at 8.2% in 2008, 2009, and 2010 In the past 15 years, the distribution of birth weights in the U.S. has shifted, with the percentage of LBW infants increasing 17 percent since the mid-1990s. From 2002 to 2005, the rate of LBW infants increased from 7.8 percent to 8.2 percent, the highest level reported since 1969. The increasing rate of LBW infants is a recognized concern across the Nation. Increases have been influenced by: 1) The rise in the multiple birth rate, 2) Greater use of obstetric interventions, 3) Increases in maternal age at childbearing and increased use of infertility therapies. Therefore, it is ambitious to maintain the incidence of low birth weight at 8.2% in light of the recent increases LBW rates driven by factors such as demographics and obstetric interventions which are generally outside of the control of public health (and more specifically MCH Block Grant) interventions. Annual Measure III: The percent of very low birth weight babies delivered at facilities for high-risk deliveries and neonates: Baseline: 73.4% in 2005 75.0% in 2008 75.5% in 2009 76.0% in 2010 While the increases in 2008, 2009,and 2010 may appear modest, they represent an ambitious effort to reverse an opposing trend.** (Please see evidence section below for additional explanation regarding the ambitiousness of the 2015 target for this long-term measure.) Annual Measure IV: The number of children receiving MCH Block Grant services who enroll in and have Medicaid and SCHIP coverage: Baseline: 11.0 million in 2006 11.0 million in 2008 11.5 million in 2009 12.0 million in 2010 States are expected to further restrict SCHIP eligibility by August 2008 to assure compliance with guidance issued by the Centers for Medicare and Medicaid Services (CMS) in August 2007. States that currently cover children with family incomes up to 300% of the FPL may be required to exclude these children from future coverage. With changes in both SCHIP eligibility requirements and current SCHIP funding levels, it will be difficult to sustain the current number of children recieving MCH Block Grant services who are also enrolled in Medicaid and/or SCHIP. It is therefore ambitious to propose annual increases in the number of children receiving MCH Block Grant services who become enrolled in Medicaid and/or SCHIP (thereby decreasing the number of children without health insurance).

Evidence: Evidence: ** The 2015 target for Annual measure III, The percent of very low birth weight babies delivered at facilities for high-risk deliveries and neonates, is ambitious in light of the following: The percent of very low birth weight infants delivered at facilities for high-risk deliveries and neonates declined from 74.9% in 2003 to 73.4% in 2005. The full reasons for the decline are unclear and are under investigation. While the MCH Block Grant program has had success working with States to implement perinatal regionalization strategies and protocols for the transfer of high-risk women to level III facilities, there is evidence indicating that these systems may be eroding as health care networks and financing systems change. Therefore, while the increases targeted for 2008, 2009,and 2010 may appear modest, they represent an ambitious effort to reverse an opposing trend. Additional evidence: 1. Births: Final Data for 2005, National Vital Statistics Reports, December 5, 2007, Volume 56, Number 6, pages 14 and 17, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf. 2. Blondel, B, et al, The Impact of the Increasing Number of Multiple Births on the Rates of Preterm Birth and Low Birthweight: An International Study, American Journal of Public Health, August 2002, Volume 92, Number 8, pages 1323-1330. 3. Kogan, MD, et al, Trends in Twin Birth Outcomes and Prenatal Care Utilization in the United States, 1981-1997, Journal of the American Medical Association, July 19, 2000, Volume 284, Number 3, pages 335-341). 4. Infant Mortality and Low Birth Weight Among Black and White Infants??United States, 1980-2000, Morbidity and Mortality Weekly Report, July 12, 2002, Volume 51, Number 27, pages 589-592. 5. Yang, Q, et al, Associations of Maternal Age- and Parity-Related Factors with Trends in Low-Birthweight Rates: United States, 1980 through 2000, American Journal of Public Health, May 2006, Volume 96, Number 5, pages 856-861. 6. Births: Final Data for 2005, National Vital Statistics Reports, December 5, 2007, Volume 56, Number 6, pages 21-23, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf

YES 14%
2.5

Do all partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) commit to and work toward the annual and/or long-term goals of the program?

Explanation: In 1997, MCHB gained States' support and commitment to reporting requirements developed in collaborative efforts with States to identify performance measures and data that support the annual and long-term goals of the program. Every State sets target values for each of 18 National Performance Measures for a five-year period and reports annually on actual performance. In addition, each State develops 7 to 10 State Performance Measures, based on the State's priorities, to address unique needs that are not captured by the National Performance Measures. The data contained in the annual report and application, submitted each July, report achievements and set targets for the upcoming fiscal year, and reflect State progress towards the annual and long-term measures identified above for the MCH Block Grant, as well as other performance measures related to the MCH population. While each of the measures addresses a different aspect of health care delivery specific to pregnant and breastfeeding women, infants, children, including children with special health care needs, and adolescents, the measures collectively provide a snapshot into the health, safety, and well-being of the Nation's MCH population. In addition, while States are required by statute to match at least 3 of every 4 Federal dollars received under the MCH Block Grant, 85% of States and jurisdictions provide matching funds at a level that exceeds the required amount.

Evidence: Evidence/Data: 1. National Performance Measures can be found at https://perfdata.hrsa.gov/mchb/mchreports/Search/core/cormenu.asp#NPM. 2. State performance measures can be found at https://perfdata.hrsa.gov/mchb/mchreports/Search/neg/negmenu.asp#SPM. 3. The 2008 application and 2006 annual report for each state can be found at https://perfdata.hrsa.gov/mchb/mchreports/Search/core/MchAppContmenu.asp. 4. The Federal allocation and the State matching funds for FY 2008 can be found at: https://perfdata.hrsa.gov/mchb/mchreports/Search/financial/finsch01_result.asp.

YES 14%
2.6

Are independent evaluations of sufficient scope and quality conducted on a regular basis or as needed to support program improvements and evaluate effectiveness and relevance to the problem, interest, or need?

Explanation: Numerous independent and high quality evaluations and reviews of the MCH Block Grant have been conducted in recent years, with 2 currently in process. The scope of these evaluations and reviews, conducted by academic researchers and unbiased, independent contractors, includes a combination of both outcome and process that collectively reflect the mission of the MCH Block Grant, provides information regarding the effectiveness and impact of the MCH Block Grant, and assesses the program's relevance to improving the health of the MCH population. Recent/completed evaluations include: 1) Evaluation of the effects of MCH Block Grant infrastructure investments, conducted by Health Systems Research, Inc., a health policy, training, and technical assistance firm, and completed in December 2007. The primary purposes of this evaluation were to descriptively analyze the extent and nature of MCH Block Grant infrastructure-building investments and to measure the impacts or associated effects they have had on MCH system capacity, program performance, and health outcomes. 2) Review examining the processes used by States to conduct their 2005 Needs Assessment, conducted by Health Systems Research, Inc. and completed in December 2006. Building upon the 2004 review of the Needs Assessment process, the goals of this study were to provide a comprehensive assessment of how States implemented their Title V Needs Assessments in 2005 and to identify promising approaches that other States could adapt in their ongoing Needs Assessment and program planning efforts for the 2010 MCH Block Grant Needs Assessment. 3) Review of the 2000 MCH Needs Assessment and its uses in program planning, conducted by Health Systems Research, Inc. and completed in September 2004. This study had several components, including a review and abstraction of selected States' 2000 Needs Assessments, applications, and annual reports, an analysis of Needs Assessment findings and priorities compared with services provided, and the development and testing of Needs Assessment methodologies for the MCH Block Grant, including the essential elements of the Needs Assessment and its use as an effective program planning tool. 4) MCH Block Grant Customer Satisfaction Survey: In 2004, the MCH Block Grant program was included in a customer satisfaction survey utilizing the American Customer Satisfaction Index, a standardized methodology produced by the University of Michigan and used by both public and private sectors. Recipients of the Title V Block grantees' services were surveyed. The MCH Block Grant received a score of 91 out of a possible 100, the second highest score ever recorded for a government program. Evaluations in process: 1) Technical review and evaluation of the State MCH Block Grant priority needs and State performance measures, conducted by the Child Health Program of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill: This review, which is nearing completion and will be released in 2008, will support program improvements by comparing State Performance Measures and State priorities from 2000 and 2005, as identified through the five-year Needs Assessments. 2) Evaluation of the MCH Block Grant performance measures, conducted by Mathematica Policy Research, Inc. and to be completed in 2008. This evaluation will support program improvements by assessing the utility and comprehensiveness of the performance measures used by the Maternal and Child Health Bureau, including the performance measures used for the MCH Block Grant.

Evidence: Evidence/Data: 1) Assessment and Evaluation of Title V Block Grant Program's Infrastructure-building Activities, Health Systems Research, Inc., December 2007; 2) Review of the Title V 5-Year Needs Assessment Process in the States and Jurisdictions, Health Systems Research, Inc., December 2006; 3) MCH Needs Assessment and its Uses in Program Planning: Promising Approaches and Challenges, Health Systems Research, Inc., September 2004, http://mchb.hrsa.gov/programs/womeninfants/nareport.htm; 4) Facilitating Public Comment on the Title V MCH Block Grant: A Report on States' FY 2005 Practices, Catherine A. Hess, MSW, May 2005; 5) Meeting State MCH Needs: A Summary of State Priorities and Performance Measures, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, to be completed in 2008; 6) Assessment of MCHB Performance Measures, Mathematica Policy Research, Inc., to be completed in 2008; 7) American Customer Satisfaction Index, HRSA Maternal and Child Health Bureau Customer Satisfaction Study, Federal Consulting Group, August 2004. 8) Quality Improvement Opportunities for Maternity Care: California's Innovative Approach, presented March 2008 at the Association for Maternal and Child Health Program Annual Conference. 9) Getting It Right After Delivery: Five Hospital Practices That Support Breastfeeding, Colorado Department of Public Health and Environment, August 2007, http://www.cdphe.state.co.us/ps/mch/gettingitright.pdf.

YES 14%
2.7

Are Budget requests explicitly tied to accomplishment of the annual and long-term performance goals, and are the resource needs presented in a complete and transparent manner in the program's budget?

Explanation: While the MCH Block Grant staff have done an excellent job of listing the program's accomplishments within their budget document, particularly light of the program's annual and long-term performance goals, there is presently insufficient tie in of these accomplishments with the program's budget request (or resource needs).

Evidence: HRSA Fiscal Year 2009 Congressional Budget Justification, http://www.hrsa.gov/about/budgetjustification09/.

NO 0%
2.8

Has the program taken meaningful steps to correct its strategic planning deficiencies?

Explanation: The MCH Block Grant program currently has no strategic planning deficiencies to correct.

Evidence:

NA 0%
Section 2 - Strategic Planning Score 86%
Section 3 - Program Management
Number Question Answer Score
3.1

Does the agency regularly collect timely and credible performance information, including information from key program partners, and use it to manage the program and improve performance?

Explanation: HRSA regularly collects timely and credible performance information from grantees and uses it to manage the program and improve performance. There are three ways in which performance related information is collected: 1. The Title V Information System (TVIS) - TVIS is the principal grantee data system utilized to receive performance and program data from the 59 States and jurisdictions that receive funds through the MCH Block Grant. All States and jurisdictions are required to submit an application and annual report to HRSA, via TVIS, in July of each year. TVIS collects data from States and jurisdictions regarding: a) total expenditures; b) populations served; c) categories of services; d) national and State performance and outcome measures; and e) health system capacity indicators. This information is used by internal and external experts to review each State's performance and budget data based on previous projections and future plans. A review panel, made up of the project officer, 1-2 reviewers with MCH expertise, and in some cases a family representative, meets annually with each State for a face-to-face dialogue regarding the State's performance plan and to provide recommendations for improving performance. As part of this annual review, States may provide additional information to correct necessary data. Information from the annual application and report is shared publicly on the MCHB website so that States may assess their progress compared with other States and use this information to improve performance. Program managers also use this information for ongoing program evaluation, as described in Section 2.6. 2. The Office of Performance Review (OPR) - HRSA's OPR serves as the Agency's focal point for reviewing and enhancing the performance of HRSA supported programs. The OPR conducts performance reviews of over 500 HRSA grants annually. This includes State Strategic Partnership Reviews, which are designed to examine the individual and collective effectiveness of HRSA funded State programs, facilitate State-level collaboration in addressing priority health needs, and provide feedback to the agency about the impact of HRSA policies on State program implementation and performance. OPR works collaboratively with grantees and program managers to assist grantees in their efforts to perform successfully and achieve the best possible results by reviewing performance, analyzing factors affecting performance, and identifying strategies to improve performance. 3. Technical Assistance - States also may submit requests for technical assistance, which are reviewed by program managers for consistency with program goals and State priorities. Program managers use the information from TVIS, the OPR reviews, and the technical assistance requests to provide assistance to grantees throughout the year, for ongoing program evaluation and monitoring, to improve program management and performance, and to identify and improve monitoring of emerging MCH priorities.

Evidence: Evidence/Data: Title V Information System, https://perfdata.hrsa.gov/mchb/mchreports/Search/search.asp. Office of Performance Review, http://www.hrsa.gov/performancereview/.

YES 12%
3.2

Are Federal managers and program partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) held accountable for cost, schedule and performance results?

Explanation: The Associate Administrator for MCHB has a performance contract with the HRSA Administrator that links to performance results set by the program. Grantees are also held accountable for cost, schedule and performance results. This is monitored through the following methods: 1. Applicants are required to provide budget information as part of the application/annual report, consistent with legislative requirements and application guidance. Grantees are directed by HRSA regarding what costs are acceptable and allowable and what costs are prohibited, limitations on any cost categories, such as administrative expenses, and cost sharing/matching requirements, which must be reflected in the application/annual report. This budget information is reviewed as part of the annual block grant review, which links performance with budget. When a State is having significant difficulty making progress in meeting targets, MCHB works with the State to determine technical assistance needs that can be supported by the Federal program, in accordance with responsibilities prescribed in the Title V legislation to strive for continued progress toward improved outcomes. Failure to comply with program requirements would result in conditions on the award or disapproval of the award. 2. The Federal managers of the MCH Block Grant have negotiated with States to develop a national set of 18 performance measures to increase States' accountability. States report on these performance measures annually as part of the MCH Block Grant application/annual report. This information is reviewed as part of the annual block grant review. 3. States develop special State-specific performance measures that address their own priority needs as part of the 5-year needs assessment, and report on and update their performance on these measures as part of the MCH Block Grant application/annual report. 4. The HRSA Grants Management Office is responsible on an ongoing basis for the business management and other non-programmatic aspects of MCH Block Grant awards.

Evidence: Evidence/Data: 1. Performance plan for Associate Administrator for MCHB. 2. Title V Information System, https://perfdata.hrsa.gov/mchb/mchreports/Search/search.asp.

YES 12%
3.3

Are funds (Federal and partners') obligated in a timely manner, spent for the intended purpose and accurately reported?

Explanation: When funds are appropriated the Bureau immediately prepares budget plans for inclusion in the apportionment request. Funds are awarded as soon as possible after the apportionment and allotment of funds to the MCHB. Grant obligations are recorded in the Unified Financial Management System (UFMS) through an automated upload from the Department electronic grant system and are checked for accuracy. MCH Block Grant funds are awarded based on an application and internal review process which assures funds are used for the intended purpose. HRSA/MCHB has obligated its MCH Block Grant funding by quarter consistently over the years. Funds are obligated nearly evenly across all four quarters. Financial status reports show minimal unobligated balances. HRSA's Division of Grants Management Operations monitors grantee expenditures to ensure compliance with legislation, regulation and policies. In addition, section 506(b)(1) of Title V of the Social Security Act requires that each State shall, not less often than once every two years, audit its expenditures from amounts received under the MCH Block Grant and submit a copy of the audit to the Secretary of HHS. When a grantee uses funds inappropriately HRSA would request a refund of the inappropriately used funds. Additionally, if there are monetary audit findings (e.g., questioned costs) HRSA would request documentation from the grantee to determine whether those costs were allowable and benefited the grant or not. If this documentation is not provided HRSA would request a refund of the questioned costs.

Evidence: Evidence/Data: 1. Estimated obligations by quarter in apportionments for FYs 2005-2007. 2. Actual obligations by quarter for FYs 2005-2007. 3. Title V of the Social Security Act, section 506(b)(1), http://www.ssa.gov/OP_Home/ssact/title05/0506.htm. NOTE: All grantees expending above $500,000 in Federal funds provide Single Audit Act reports.

YES 12%
3.4

Does the program have procedures (e.g. competitive sourcing/cost comparisons, IT improvements, appropriate incentives) to measure and achieve efficiencies and cost effectiveness in program execution?

Explanation: The MCH Block Grant has procedures in place to achieve efficiencies. The program's efficiency measure is as follows: The number of children served by the Title V Block Grants per $1 million in funding. Baseline: 41,868 in 2006. 32,500 in 2007* (Please see evidence below) 42,032 in 2008 43,533 in 2009. This measure challenges States to contain costs at the same time that they are asked to expand access to services. The MCH Block Grant achieves other kinds of efficiencies and cost-effectiveness through: 1. Title V Information System (TVIS) - TVIS incorporates all MCH Block grantees into one data reporting mechanism that is integrated for electronic reporting through the HRSA Electronic Handbook. 2. Electronic Handbook (EHB) - HRSA's Grants Management web site for performing the daily work of planning, making, and administering grants is the EHB, which is accessible to HRSA staff involved in grants management and allows interaction and performance of most job functions of monitoring grant online. 3. Contracts - the MCH Block Grant has two multi-year contracts to provide: i) Logistics assistance for MCH Block Grant reviews, technical assistance, and grantee meetings; and ii) IT production and maintenance for TVIS, the electronic, web-based information system. By utilizing contract support for these functions, the program has resources in place when such services are needed, such as to conduct block grant reviews or to assist a grantee with immediate or specialized technical assistance. This arrangement has been efficient and cost-effective. 4. Indefinite Delivery/Indefinite Quantity Contracts (IDIQ) - This type of contract allows for increased administrative efficiencies. The program has the option of contracting for evaluation needs using task orders through the IDIQ process. The IDIQ is limited to contractors who have satisfied the technical merit and already been awarded contracts under a specific task, such as program evaluation. IDIQ administrative procedures and actual award processes significantly simplify and streamline full and open competitions.

Evidence: Ambitiousness of the MCH Block Grant Efficiency Measure: Per $1 Million of funding, the number of children who have received direct, enabling, and population-based services through the MCH Block Grant has increased dramatically in recent years, from 31,515 in 2004 to 41,868 in 2006. The significant increase in children served by the Title V Block Grant per $1 million in funding between 2004 and 2006 reflects numerous factors, including: 1. Improvements in program efficiency, 2. A shift towards more population-based services, such as screening services provided to school-aged children, 3. A reduction in MCH Block Grant funding and reliance on other sources for program funding, such as increasing levels of co-payment by some of those receiving services. The program continues to monitor the number of children served and explore opportunities for efficiencies, but does not anticipate continued increases of the same magnitude in the short-term, given the above changes that led to recent dramatic increases and maximized efficiency in many areas. *The target for 2007 was set before 2006 actual data were available and reflects an increase when compared with actual data available at the time the target was established. The targets for 2008-2009 were set using the current level of efficiency as a starting point and reflect sustained increases over the 2006 actual data. They are based on a presumed increase in the number of children served with no increase over the current level of funding. These targets are ambitious, given recent achievements, including services that extended coverage to a much larger number of children and the shifting of costs to other sources, as well as the inherent challenges faced when working to serve more customers with a similar level of investment. Other Evidence/Date: 1. Title V Information System, https://perfdata.hrsa.gov/mchb/mchreports/Search/search.asp. 2. EHB website, https://grants.hrsa.gov/webexternal/home.asp.

YES 12%
3.5

Does the program collaborate and coordinate effectively with related programs?

Explanation: The MCH Block Grant coordinates and collaborates broadly with Federal, State, local, and private agencies and programs that share one or more of its goals and objectives. Primary partnerships are with State MCH and Children with Special Health Care Needs programs. At the Federal level, the program coordinates with agencies such as the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Center for Medicaid and Medicare Service (CMS). For example, MCHB has an interagency agreement with CDC for conducting the National Survey of Children's Health and the National Survey of Children with Special Health Care Needs. The MCH Block Grant also coordinates and collaborates with national MCH organizations through a cooperative agreement with the Association of Maternal and Child Health Programs (AMCHP) and through the Alliance for Information on MCH (AIM), a partnership that includes numerous organizations concerned about maternal and child health, including the National Conference of State Legislatures, the National Association of County and City Health Officials, and the Association of State and Territorial Health Officials. In total, MCHB has forged partnerships with 275 organizations and programs, including national public and private organizations and State and local governments. These same efforts are replicated at the State level, as required in the MCH Block Grant program guidance approved by OMB, which directs States to coordinate with other Federal agencies and with other State and local public and private organizations, including local health departments, in the determination of MCH priorities and in the development and implementation of MCH initiatives (page 29, MCH Block Grant Guidance). States must conduct a needs assessment every five years which requires that they work collaboratively with other State agencies and organizations to determine and address State MCH priorities. This assures that States create and maintain linkages and partnerships with a broad diversity of programs and entities, such as the Medicaid program, Community Health Centers, School-based Health Clinics, and Family Voices, that share their commitment to improving the health of the MCH population. In addition, States match at least $3 of every $4 Federal dollars provided, which leverages $2.3 billion from States.

Evidence: Evidence/Data: 1. National Survey of Children's Health and the National Survey of Children with Special Health Care Needs, http://www.childhealthdata.org/content/Default.aspx#. 2. Cooperative agreement with the Association of Maternal and Child Health Programs to support State MCH Directors in their efforts to improve the health of the MCH population. 3. MCH Block Grant Guidance describes State partnership requirements on page 29, ftp://ftp.hrsa.gov/mchb/blockgrant/bgguideforms.pdf. 4. Annual grantee meetings include speakers from other Federal agencies and national, State, and local organizations that share a commitment to improving the health of the MCH population. For example, the 2007 Federal/State Partnership Meeting included plenary speakers from the Association of University Centers on Disabilities, the Autism Society of America, the Association of State and Territorial Dental Directors, and SAMHSA; see meeting archive at http://www.cademedia.com/archives/mchb/partnership07/index.html. 5. State needs assessments, available on the TVIS website at https://perfdata.hrsa.gov/mchb/mchreports/needsAssessment.asp, describe State collaborations that support MCH Block Grant activities.

YES 12%
3.6

Does the program use strong financial management practices?

Explanation: Funds are obligated and monitored through the Department's UFMS and PMS system. States are required to report on financial data every year in conjunction with the application and the MCHB Block grant review process. States have 2 years to expend the grant funds (section 503(b), Title V of the Social Security Act). State funds are audited in accordance with the provisions of OMB Circular No. A-133. In addition, HHS received a clean audit in FY 2007, and no material weaknesses were found for the MCH Block grant.

Evidence: Evidence/Data: 1. Title V of the Social Security Act, section 503(b), http://www.ssa.gov/OP_Home/ssact/title05/0503.htm. 2. FY 2007 HHS Audit.

YES 12%
3.7

Has the program taken meaningful steps to address its management deficiencies?

Explanation: At this time the MCH Block Grant program has no management deficiencies to address.

Evidence: Evidence/Data: Chart of MCH Block Grant internal control procedures prepared and updated annually as part of the OMB A-123 audit process.

NA 0%
3.BF1

Does the program have oversight practices that provide sufficient knowledge of grantee activities?

Explanation: The MCHB assures sufficient knowledge and oversight of grantee activities through the following: (1) Title V Information System (TVIS): A wealth of grantee information is available in TVIS, a web-based reporting and tracking system for the MCH Block Grant. This information comes from the application/annual reports submitted by grantees in July of each year and includes reporting on National Performance Measures, State Performance Measures, and use of funds by types of individuals served and types of services; (2) Annual MCH Block Grant Reviews: Face-to-face reviews of the MCH Block Grant are conducted annually with each grantee following submission of the application/annual report. These reviews include the State Title V MCH and Children with Special Health Care Needs (CSHCN) Directors, Federal program staff, independent consultants with MCH expertise, and parent reviewers. The purpose of the review is to discuss the State's system of care for the MCH population as presented in the MCH Block Grant application/annual report, with a focus on strengths and notable accomplishments, including promising practices that can be shared with other States; deficiencies or notable gaps, including required changes, recommended changes, and areas that would benefit from technical assistance; annual progress in meeting national performance measures; and annual progress in addressing state priorities and state performance measures that reflect these priorities. (3) Regional Conference Calls: Regularly-scheduled regional conference calls are held with State Title V Directors and other partners as appropriate to provide program and regional updates and discuss emerging issues and regional issues of concern; (4) MCH Web Casts: Special subject matter web casts are offered periodically to address current and emerging MCH issues. Recent topics have included the Emergency Medical Services for Children (EMSC) State Partnership Performance Measures and the Healthy Start National Evaluation. (5) Technical assistance: Technical assistance is available to grantees to assist in improving the State's MCH performance, including capacity to meet priority needs and performance measure objectives. (6) State Strategic Partnership Reviews conducted by HRSA's Office of Performance Review (OPR); (7) MCH Federal/State Partnership Meeting, the grantee meeting for MCH Block Grant recipients; and (8) Site visits to monitor grantee activities. These activities create a strong relationship between the program and the grantees and assure a high level of understanding of how grantees use the resources allocated to them.

Evidence: Evidence/Data: 1. MCH Block Grant applications/annual reports from all States and jurisdictions are available on the Title V Information System website at https://perfdata.hrsa.gov/mchb/mchreports/Search/search.asp. 2. MCH webcasts, http://www.mchcom.com/. 3. MCH Block Grant technical assistance web site, http://mchtaproject.com/. 4. OPR web site, http://www.hrsa.gov/performancereview/. 5. Archive of MCH Federal/State Partnership Meetings, http://www.mchcom.com/conferences.asp.

YES 12%
3.BF2

Does the program collect grantee performance data on an annual basis and make it available to the public in a transparent and meaningful manner?

Explanation: Performance data are collected from grantees annually and are made available to grantees and the public on the MCHB website through the Title V Information System (TVIS). TVIS contains a wealth of information about the MCH Block Grant, including the following: (1) Financial Data for The Most Recent Year: Users can find data from one or more States on the MCH Block Grant budget for the most recent application year, expenditures for the most recent reporting year, and how funds are allocated by types of individuals served. (2) Program Data for The Most Recent Year: Users can find data from one or more States on selected services and can get quantitative data on the reach of the MCH Block Grant program across different populations. (3) Measurement and Indicator Data: Users can search for national performance and outcome measure data, State health systems capacity indicators, State priority needs, and State performance and outcome measures. (4) Narrative Search: Users can search the narrative of each State's application by section or by text. (5) State MCH Application and Contact Information: Users can find State contact information, including MCH and CSHCN directors and hotline information, and can view a State's entire narrative and forms submitted in the most recent application. (6) Data Summary Reports 2002-2006: Users can view national, state and regional data summaries for expenditures and individuals served for the last five reporting years. (7) State Needs Assessments (2005): States are required to conduct a Needs Assessments every five years, with the last one occurring in 2005. Users can view the 2005 Needs Assessments for each State. (8) State Snapshots of Maternal and Child Health: Users can view the "Title V: A Snapshot of Maternal and Child Health" for each State, which highlights key information from each State's MCH Block Grant application/annual report and shows the impact of the program at the State level.

Evidence: Evidence/Data: 1. Title V Information System, https://perfdata.hrsa.gov/mchb/mchreports/Search/search.asp. 2. State snapshots can be found at https://perfdata.hrsa.gov/mchb/mchreports/snapShot.asp.

YES 12%
Section 3 - Program Management Score 100%
Section 4 - Program Results/Accountability
Number Question Answer Score
4.1

Has the program demonstrated adequate progress in achieving its long-term performance goals?

Explanation: The MCH Block Grant has, to a large extent, demonstrated progress in achieving its long-term performance goals. Long-Term Measure I: The national rate of maternal deaths per 100,000 live births: Largely due to changes in classification and measurement of maternal mortality introduced in 2003, maternal mortality rates have increased since 2003* (Please see Evidence section for more detailed explanation.) In spite of these recent trends in the reported maternal mortality rate indications of progress in meeting the target for Long-Term Measure I can be seen in modest increases in the percent of women entering prenatal care in the first trimester in recent years (from 83.2% in 1999 to 83.9% in 2005), along with findings from the evaluation of MCH Block Grant infrastructure-building activities, which determined that, from 2000 to 2004, the majority of States (52.8%) improved upon or maintained the percent of pregnant women receiving prenatal care in the first trimester. In addition, findings from the Sheps Center's review and evaluation of State priorities and State Performance Measures indicate that more States are working to improve preconceptional and interconceptional health, with 4 times as many States identifying preconceptional and interconceptional health as a priority in 2005 (13 States) compared with 2000 (3 States). Term Measure II: The national rate of infant deaths per 1,000 live births Progress toward meeting the target for Long-Term Measure II is evidenced by modest but steady reductions in infant mortality from 1990 through 2005. The rate increased slightly from 6.8 in 2001 to 7.0 in 2002, reversing, temporarily, a long-term downward trend. The overall infant mortality rate decreased slightly from 7.0 per 1,000 live births in 2002 to 6.9 in 2003 and 6.8 in 2004, but preliminary data shows a slight increase in 2005 to 6.9 per 1,000 live births. An analysis of the 2002 increase concluded that the factors contributing to the increase were: 1) an increase in the number of very small infants (less than 750 grams) 2) the higher risk profile of multiple births In spite of the slight increase in the overall rate in 2002 and 2005, the 2005 rate is lower than the 2002 rate, reflecting progress toward the target for Long-Term Measure II. In addition, findings from the infrastructure-building evaluation indicate that from 2000 to 2004 the majority of States (77.6%) showed improvements or maintained past progress in reducing the infant mortality rate. Long-Term Measure III: The national rate of neonatal deaths per 1,000 live births. Progress toward meeting the target for Long-Term Measure III is indicated in the steady decline in the neonatal mortality rate in recent years, from 6.5 in 1990, to 5.4 in 1995, to 5.1 in 2000, to 4.6 in 2005, the baseline for Long-Term Measure III. In addition, the infrastructure-building evaluation found that from 2000 to 2004 the majority of States (71.4%) showed improvements or maintained prior gains in reducing their neonatal mortality rate. Long-Term Measure IV: The number of uninsured children. Progress toward meeting this measure can be seen by comparing data from the late 1990s with data since 2000. From 1994 to 1999, the number of uninsured children hovered between 10-11 million. Since 2000, it has fluctuated between 8-9 million, maintaining reductions of over 1 million compared with the 1990s. The dominant factors that have influenced the moderate decrease in the targeted number of uninsured children have been the declining economy and decreases in employer-sponsored insurance coverage. Progress toward meeting the target for Long-Term Measure IV also is evidenced by findings from the infrastructure-building evaluation, which determined that, from 2000 to 2004, the majority of States (63.9%) saw improvements or maintained prior gains in reducing the percentage of children without health insurance

Evidence: Evidence/Data: * The reported number of maternal deaths has increased each year since 2003 as a result of the inclusion of a pregnancy status question on the 2003 version of the U.S. Standard Certificate of Death, which asked for the first time about pregnancy at the time of death and pregnancy within 42 days of death. Such a question was not asked on previous versions of the U.S. Standard Certificate of Death. In the absence of a pregnancy question on the death certificate, maternal mortality would only be reported if the person filling out the death certificate mentions the pregnancy in the cause-of-death section. This was not done consistently, which precipitated the development of a question expressly to report maternal mortality. The reported maternal mortality rate will continue to increase as more States adopt the standard pregnancy question from the 2003 U.S. Standard Certificate of Death, but the rate of increase in reported maternal mortality will vary from year to year depending upon the number of States that adopt the 2003 death certificate in a specific year. Other Evidence/Data: 1. National Vital Statistics System, birth certificate data. 2. Meeting State MCH Needs: A Summary of State Priorities and Performance Measures, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, to be completed in 2008. 3 Assessment and Evaluation of Title V Block Grant Program's Infrastructure-building Activities, Health Systems Research, Inc., December 2007. 4. Current Population Survey, Census Bureau. 5. Maternal Mortality and Related Concepts, Vital and Health Statistics, Series 3, Number 33, February 2007, pages 1 and 5, http://www.cdc.gov/nchs/data/series/sr_03/sr03_033.pdf. 6. Holahan J, Cook A. The US economy and changes in health insurance coverage, 2000-2006. Health Affairs (Millwood). 2008; Mar-Apr;27(2):w135-44. Epub 2008 Feb 20. 7. Carmen DeNavas-Walt, et al., "Income, Poverty and Health Insurance Coverage in the United States: 2006," U.S. Census Bureau, Aug. 28, 2007.

LARGE EXTENT 17%
4.2

Does the program (including program partners) achieve its annual performance goals?

Explanation: The MCH Block Grant and its partners are, to a large extent, achieving their annual performance goals. Annual Measure I: Percent of pregnant women receiving prenatal care in the first trimester. Overall, the proportion of pregnant women entering prenatal care in the first trimester has increased over the last decade, from 75.8% in 1990 to 83.9% in 2005, and the target of 84% for 2005 was essentially met. In addition, the evaluation of MCH Block Grant infrastructure-building activities determined that, from 2000 to 2004, the majority of States (52.8%) improved upon or maintained the percent of pregnant women receiving prenatal care in the first trimester. Annual Measure II: Incidence of low birth weight births. From 2002 to 2005, the rate of LBW infants increased from 7.8 percent to 8.2 percent, the highest level reported since 1969. Increases have been influenced by: 1. the rise in the multiple birth rate* (See Evidence section below) 2. greater use of obstetric interventions** 3. increases in maternal age at childbearing*** 4. increased use of infertility therapies These issues are being studied by outside entities to determine what actions are needed to further improve outcomes. The Department also has continued to actively explore the causes of LBW through the work of the Secretary's Advisory Council on Infant Mortality (SACIM). In 2003, at the recommendation of SACIM, the Department established a DHHS Interagency Coordinating Council on LBW and Preterm Birth to stimulate multidisciplinary research, scientific exchange, policy initiatives, and collaboration among DHHS agencies, to assist DHHS in targeting efforts to achieve the greatest advances toward the national goal of reducing infant mortality, and to develop a department-wide research agenda on LBW and pre-term birth. In spite of recent trends in the incidence of low birth weight, evidence of progress toward meeting this annual measure is reflected in the infrastructure-building evaluation, which found that the majority of States (60%) had decreases or maintained progress in reducing the percent of very low birth weight infants from 2000 to 2004. Annual Measure III: Percent of very low birth weight babies delivered at facilities for high-risk deliveries and neonates (level III facilities). A small decline occurred in the percent of very low birth weight babies delivered at level III facilities between 2002 (75.2%) and 2004 (71.7%), but increased in 2005 to 73.4%. The full reasons for the current trend are unclear and MCHB is partnering with State programs to assess influential factors. In addition, as part of the existing evaluation contract with the Sheps Center, MCHB has included a task that involves the assessment of variables impacting the delivery of very low birth weight babies at level III facilities to determine potential interventions. In spite of the recent trend, the infrastructure-building evaluation provides evidence of progress in meeting this measure, indicating that the majority of States (52.8%) showed an increase in this measure from 2000 to 2004. Annual Measure IV: Number of children receiving Title V services who enroll in and have Medicaid and SCHIP coverage. The program is meeting its goals for this measure and substantially exceeded its 2006 goal of 6.2 M, serving 11.0 M children

Evidence: Evidence: * There has been a 42% increase in the multiple birth rate since 1990, driven partly by an increase in assisted reproductive technologies. Multiple births are much more likely to be delivered preterm and LBW. There is also evidence that there is a trend for multiple births to be delivered earlier. ** There has been a dramatic change in the number of women receiving certain obstetric procedures. Since 1990, the percent of women receiving induction of labor has increased from 9.5% to 22.3%. Among singleton births only, there has been a 75% increase. Further, the cesarean section delivery rate has increased about 50% between 1996 and 2006. There has been evidence that the changes in obstetric practice may be shifting the timing of deliveries toward earlier, and therefore, lighter deliveries. *** There has been a 46% rise in the number of infants born to women aged 35 and older since 1990. The risk of delivering a LBW infant increases after age 35. Additional Evidence: 1. HRSA Fiscal Year 2009 Congressional Budget Justification, http://www.hrsa.gov/about/budgetjustification09/. 2. Assessment and Evaluation of Title V Block Grant Program's Infrastructure-building Activities, Health Systems Research, Inc., December 2007. 3. National Vital Statistics System, birth and death certificate data. 4. Current Population Survey, Census Bureau. 5. Blondel, B, et al, The Impact of the Increasing Number of Multiple Births on the Rates of Preterm Birth and Low Birthweight: An International Study, American Journal of Public Health, August 2002, Volume 92, Number 8, pages 1323-1330. 6. Kogan, MD, et al, Trends in Twin Birth Outcomes and Prenatal Care Utilization in the United States, 1981-1997, Journal of the American Medical Association, July 19, 2000, Volume 284, Number 3, pages 335-341). 7. Infant Mortality and Low Birth Weight Among Black and White Infants??United States, 1980-2000, Morbidity and Mortality Weekly Report, July 12, 2002, Volume 51, Number 27, pages 589-592. 8. Yang, Q, et al, Associations of Maternal Age- and Parity-Related Factors with Trends in Low-Birthweight Rates: United States, 1980 through 2000, American Journal of Public Health, May 2006, Volume 96, Number 5, pages 856-861. 9. Births: Final Data for 2005, National Vital Statistics Reports, December 5, 2007, Volume 56, Number 6, pages 21-23, http://www.cdc.gov/nchs/products/pubs/pubd/nvsr/nvsr.htm. 10. Title V Information System, https://perfdata.hrsa.gov/mchb/mchreports/Search/search.asp

LARGE EXTENT 17%
4.3

Does the program demonstrate improved efficiencies or cost effectiveness in achieving program goals each year?

Explanation: The historical data associated with the MCH Block Grant efficiency measure demonstrate the program's improved efficiencies and increased cost-effectiveness. The MCH Block Grant efficiency measure and historical data are: The number of children served by the Title V Block Grants per $1 million in funding. Historical data: 2002 - Actual - 30,906; 2004 - Actual - 31,515; 2005 - Target - 31,771 Actual - 38,402; 2006 - Target - 32,394 Actual - 41,868.

Evidence: 1. HRSA Fiscal Year 2009 Congressional Budget Justification, http://www.hrsa.gov/about/budgetjustification09/. 2. Title V Information System, https://perfdata.hrsa.gov/mchb/mchreports/Search/search.asp. 3. EHB website, https://grants.hrsa.gov/webexternal/home.asp.

YES 25%
4.4

Does the performance of this program compare favorably to other programs, including government, private, etc., with similar purpose and goals?

Explanation: No other program, public or private or at the Federal, State, or local level is comparable to the MCH Block Grant. As stated previously in the answer to question 1.3, the MCH Block Grant is unique in that it: 1) focuses exclusively on the entire MCH population; 2) encompasses infrastructure, population-based, enabling, and direct services for the MCH population; 3) requires a unique partnership arrangement between Federal, State and local entities; 4) requires each State to work collaboratively with other organizations to conduct a needs assessment every 5 years; 5) based on the findings of the needs assessment, requires each State to identify State priorities to comprehensively address the needs of the MCH population and guide the use of the MCH Block Grant funds; 6) may serve as the payer of last resort for direct services for the MCH population that are not covered by any other program; and 7) is not an entitlement program.

Evidence: Evidence: Title V of the Social Security Act, http://www.ssa.gov/OP_Home/ssact/title05/0500.htm

NA 0%
4.5

Do independent evaluations of sufficient scope and quality indicate that the program is effective and achieving results?

Explanation: Several independent and high quality evaluations and reviews of the MCH Block Grant have been conducted in recent years and have concluded that the MCH Block Grant has been effective and is achieving results. The scope of these evaluations and reviews, conducted by academic researchers and unbiased, independent contractors, is sufficient to provide information regarding the effectiveness and impact of the MCH Block Grant and assess the program's relevance to improving the health of the MCH population. These evaluations have examined 1) the effect of the MCH Block Grant infrastructure-building on MCH outcomes; 2) customer satisfaction; and 3) the effectiveness of States in complying with statutory requirements associated with assessing the needs of the MCH population and determining State priorities. The evaluations include the following: 1. Assessment and Evaluation of Title V Block Grant Program's Infrastructure-building Activities, Health Systems Research, Inc., December 2007: The primary purposes of this evaluation were to descriptively analyze the extent and nature of MCH Block Grant infrastructure-building investments and to measure the impacts or associated effects they have had on MCH system capacity, program performance, and health outcomes. The statistical analysis used to test the relationship between infrastructure-building expenditures in 1999 and 2004 performance and outcome measures demonstrated that MCH Block Grant infrastructure-building expenditures were positively and significantly related to Long-Term Measures II, III, and IV, all of which showed improvement or maintained previous gains from 1999 to 2004 in the majority of States. 2. American Customer Satisfaction Index, HRSA Maternal and Child Health Bureau Customer Satisfaction Study, Federal Consulting Group, August 2004: In 2004, the MCH Block Grant program initiated a customer satisfaction survey utilizing the American Customer Satisfaction Index, a standardized methodology used by both public and private sectors. Recipients of the Title V Block grantees' services were surveyed. The MCH Block Grant received a score of 91 out of a possible 100, the second highest score ever recorded for a government program. 3. Review of the Title V 5-Year Needs Assessment Process in the States and Jurisdictions, Health Systems Research, Inc., December 2006: The goals of this study were to provide a comprehensive assessment of how States implemented their Title V Needs Assessments in 2005 and to identify promising approaches that other States can adapt in their own ongoing Needs Assessment and program planning efforts for the 2010 MCH Block Grant Needs Assessment. The findings highlight effective methods that several States used to conduct the 2005 Needs Assessment, which is required by section 505(a)(1) of Title V of the Social Security Act. 4. Facilitating Public Comment on the Title V MCH Block Grant: A Report on States' FY 2005 Practices, Catherine A. Hess, MSW, May 2005: This report was commissioned to support program improvements in facilitating public comment on the MCH Block Grant application, as required by section 505(a) of Title V of the Social Security Act. The findings highlight effective State practices for obtaining public input.

Evidence: Evidence/Data: 1. Assessment and Evaluation of Title V Block Grant Program's Infrastructure-building Activities, Health Systems Research, Inc., December 2007; 2. Review of the Title V 5-Year Needs Assessment Process in the States and Jurisdictions, Health Systems Research, Inc., December 2006; 3. Facilitating Public Comment on the Title V MCH Block Grant: A Report on States' FY 2005 Practices, Catherine A. Hess, MSW, May 2005; 4. American Customer Satisfaction Index, HRSA Maternal and Child Health Bureau Customer Satisfaction Study, Federal Consulting Group, August 2004. 5. Quality Improvement Opportunities for Maternity Care: California's Innovative Approach, presented March 2008 at the Association for Maternal and Child Health Program Annual Conference. 6. Getting It Right After Delivery: Five Hospital Practices That Support Breastfeeding, Colorado Department of Public Health and Environment, August 2007, http://www.cdphe.state.co.us/ps/mch/gettingitright.pdf.

YES 25%
Section 4 - Program Results/Accountability Score 84%


Last updated: 09062008.2008SPR