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The HIV/AIDS Bureau (HAB), formed in August 1997, consolidated all programs funded under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. Domestically, the CARE Act funds primary care and support services designed to improve the quality and availability of care for people with HIV/AIDS and their families. Today, CARE Act programs are in every State, 51 major metropolitan areas throughout the Nation, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, and five U.S. Pacific Territories and Associated Jurisdictions (American Samoa, the Commonwealth of the Northern Mariana Islands, the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau). Through the Department’s global HIV/AIDS Program, HRSA and HAB are committed to improving the care and support services for people living with HIV/AIDS in severely affected regions of the world.

On October 20, 2000, the President signed the Ryan White CARE Act Amendments of 2000 (Public Law 106-345) into law, reauthorizing the CARE Act through 2005. The following six overarching themes are reflected in the reauthorized CARE Act:

1. Improving access to care for those HIV-positive individuals who are aware of their sero-status but not in care
2. Quality management and health services
3. Capacity development
4. Targeting resources to meet the needs of underserved communities and populations increasingly affected by the epidemic
5. Early intervention
6. Coordination and linkages (participation of other Department of Health and Human Services agencies)

The HIV/AIDS Bureau’s role has been, and continues to be, the establishment of policies and administrative practices that are responsive to the reauthorizing legislation.

HAB manages CARE Act programs to benefit low-income, uninsured, and underinsured individuals and families affected by HIV/AIDS. In serving people and families affected by HIV/AIDS, HAB has identified four principles that guide its mission and programs:

• The HIV/AIDS epidemic is growing among traditionally underserved and hard-to-reach populations.
• The quality of emerging HIV/AIDS therapies can make a difference in the lives of people with HIV/AIDS.
• Changes in the economics of health care are affecting the HIV/AIDS care network.
• Policy and funding increasingly are determined by outcomes.

It is around these four principles that HAB has developed programs that focus on the most important issues in HIV/AIDS, including managed care, HIV/AIDS drugs, treatment adherence, data and evaluation, measuring outcomes, and reaching the most vulnerable populations.

The Bureau of Primary Health Care (BPHC) administers HRSA’s Health Centers Program, a critical primary care safety net program that served 11.3 million poor and near poor Americans in FY 2002.

For more than 35 years, BPHC has been a national leader in providing access to primary care for underserved populations. These include people who are poor or near poor, Medicaid recipients, the uninsured, and racially and ethnically diverse low-income adults, children, and seniors. It also includes homeless individuals and families, migrant and seasonal farm-workers, people living in isolated rural and frontier areas, residents of public housing, immigrants, residents of the U.S./Mexico border, Native Hawaiians and Pacific Islanders, persons living with Hansen’s disease, and persons living with Black Lung disease.

One in six Americans is without health insurance. People without health insurance are less likely to seek out health care, resulting in poor health. Some 50 million Americans do not have access to primary health care because of barriers such as a lack of health insurance, a lack of providers in their community, a lack of transportation to get to a provider, and cultural or linguistic differences. These underserved populations often experience health disparities, which are differences in health status by race, ethnicity, gender, insurance status, or income level compared to the general population. BPHC is committed to changing this picture through the following mechanisms:

• Strengthening the safety net of community-based, financially viable, competitive primary care systems;
• Creating new access to primary care by fostering community development, expanding the number of primary care sites and the services they offer, and developing new partnerships at the national, State, and community levels; and
• Committing to practice excellence for all sites supported by BPHC grants.

• Health Centers Program
• Native Hawaiian Health Care Improvement Program
• Black Lung Clinics
• Radiation and Exposure Screening and Education Program
• Healthy Communities Access Program
• National Hansen’s Disease Program

The Maternal and Child Health Bureau (MCHB) provides National leadership, in partnership with key stakeholders, to reduce disparities, assure the availability of quality health care, and strengthen the Nation’s maternal and child health (MCH) infrastructure in order to improve the physical and mental health, safety and well-being of the MCH population - all women, infants, children, adolescents, and their families, including fathers and children with special health care needs (CSHCN). MCHB programs pay special attention to families with low incomes, those with diverse racial and ethnic heritages, and those living in rural or isolated urban areas without access to care.

MCHB draws on nearly a century of commitment and experience addressing maternal and child health issues. MCHB’s predecessor, the Children’s Bureau, was established in 1912. In 1935, Congress enacted Title V of the Social Security Act, which authorized the Maternal and Child Health Services Program, the foundation and structure for ensuring the health of women and children.

• Maternal and Child Health Services Block Grant (Title V of the Social Security Act)
• Healthy Start Initiative (Title III of the Public Health Service Act)
• Community Based Abstinence Education Program (Title V of the Social Security Act)
• Abstinence Education Program (Title V of the Social Security Act)
• Traumatic Brain Injury (Title XII of the Public Health Service Act)
• Universal Newborn Hearing Screening (Title III of the Public Health Service Act)
• Emergency Medical Services for Children Program (Title XIX of the Public Health Service Act)
• Poison Control Centers (Public Law 106-174, The Poison Control Center Enhancement & Awareness Act)
• Trauma-Emergency Medical Services Systems (Title XII of the Public Health Service Act)
• Hospital Preparedness (Bioterrorism) (Title III of the Public Health Service Act)

The Bureau of Health Professions (BHPr) provides National leadership in coordinating, evaluating, and supporting the development and utilization of the Nation’s health professions workforce, through efforts focusing on educational infrastructure and workforce distribution, retention, diversity, and specialization.

BHPr’s program goals are to help ensure access to quality health care to all segments of the population in all geographic areas by developing, placing, and retaining a diverse, flexible, well-trained and well-distributed health professions workforce, and by promoting greater access to health careers for underrepresented minorities.

To achieve its goals, BHPr employs a variety of strategies aimed at bringing the health care workforce into balance with population needs, including programs to increase the representation of minorities in health professions training, to increase the number of trained professionals in disciplines with identified shortages, and to provide incentives for health professionals to practice in medically underserved communities.

BHPr also focuses on educating the health care workforce of the future, by investing in educational infrastructure and by taking into account the changing demands brought about by the aging of the U.S. population, the need for health professions education to keep up with the pace of scientific and technological innovation, and changing conditions in the health care workplace brought about by cost-containment pressures and managed care.

BHPr’s National Center for Health Workforce Analysis supports the Bureau’s mission by assessing the Nation’s health personnel supply and requirements relative to current and future needs and disseminating information on workforce characteristics, capacities and needs to lawmakers and to the public.

• Health Professions Education and Nursing Training
• National Center for Health Workforce Analysis
• National Health Service Corps
• Health Education Assistance Loans
• Healthcare Integrity and Protection Data Bank
• National Practitioner Data Bank
• Children’s Hospitals Graduate Medical Education Payment Program
• Ricky Ray Hemophilia Relief Fund Program

The Office of Special Programs (OSP) provides Federal oversight and funding for the Nation’s organ procurement, allocation, and transplantation system; coordinates National organ and tissue donation activities; and funds research to learn more about what works to increase donation. This includes the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients contracts. The Office also provides funding support to the National Marrow Donor Program (NMDP), a network of U.S. and some foreign donor centers, collection centers, transplant centers, and minority recruitment groups. The NMDP operates a Coordinating Center that helps patients suffering from leukemia or other blood diseases find matching, unrelated volunteer marrow donors for transplants. The NMDP also is a research organization, studying the effectiveness of unrelated marrow derived hematopoietic stem cell transplants and related treatments.

• Organ Procurement and Transplantation Program
• Health Care and Other Facilities Programs
• National Bone Marrow Donor Program
• National Vaccine Injury Compensation Program
• State Planning Grant Program, and
• Assistance to the Department of Housing and Urban Development (HUD) in operating its mortgage insurance for hospitals program

The Office of the Administrator (OA) leads and directs HRSA’s programs and activities and advises the Office of the Secretary of HHS about policy for the Agency’s programs and activities. The OA comprises offices for coordinating and administering various program activities, and advises and supports the Administrator. The offices are:

• Office of Information Technology (OIT) which directs, coordinates and implements HRSA’s information resource management policies and procedures.
• Office of Planning and Evaluation which serves as the Administrator’s primary staff and principal source of advice on program planning and evaluation.
• Office of Legislation which serves as the Administrator’s primary staff and principal source of advice on legislative affairs.
• Office of Communications which provides leadership, general policy, and direction for HRSA’s communications and public affairs activities.
• Office of Minority Health which provides HRSA leadership for minority issues.
• Office of Equal Opportunity and Civil Rights which directs, coordinates, develops, and administers HRSA’s equal employment opportunity and civil rights activities.

The Office of Management and Program Support (OMPS) provides HRSA with support and management to assure the effective operation of the Agency’s Bureaus and Offices. OMPS provides management expertise, advice, and support to the administrator in program and policy formulation and execution. The OMPS is responsible for planning, directing, and coordinating HRSA’s administrative activities related to:

• Financial management
• Grants and procurement management
• Human resources and development
• Management services

The Office of Rural Health Policy (ORHP) promotes better health care service in rural America. The Office was established in 1987 to advise the Secretary of HHS on matters affecting rural hospitals and health care, to coordinate activities that relate to rural health care within HHS, and to maintain a national information resource. the ORHP works both within the Government at Federal, State, and local levels, and in the private sector with associations, foundations, providers, and community leaders to seek solutions to rural health care problems.

• Advises the Secretary of HHS about the effect of the Department’s policies and regulations on the rural population;
• Promotes Federal, State, and local cooperation by supporting and working with State Offices of Rural Health;
• Supports rural health research through six national rural health research centers across the country; and
• Sponsors a national clearinghouse to collect and disseminate rural health information.

The Office of Performance Review (OPR) contributes to HRSA’s mission to improve health outcomes for all Americans by sharing geographical expertise with HRSA Bureaus and Offices and information on HRSA program opportunities with State/National/Regional partners, and other Federal agencies. OPR, through its Headquarters staff and ten Field Offices, works in partnership with HRSA Bureaus and Offices to provide program oversight and assistance for major HRSA programs including: Health Centers; National Health Service Corps; Maternal and Child Health grant programs; Ryan White Title II State grants; Ryan White Title III (b) community planning grants; and health facilities construction under the Hill-Burton Program.

Organized into State teams, the Field Offices are uniquely positioned to facilitate the delivery and coordination of high quality health care, including preventive services for underserved and vulnerable populations. Through State teams, field staff are able to:

• Develop a better understanding of a State’s specific public health environment.
• Apply appropriate State knowledge that will allow for better customer service when providing or arranging for assistance to HRSA grantees.
• Facilitate the use of shared knowledge across HRSA programs to discover new opportunities to leverage resources, while meeting program and grantee needs.

The ten OPR Field Offices are located in major cities across the United States. The cities are Boston, MA; New York, NY; Philadelphia, PA; Atlanta, GA; Chicago, IL; Dallas, TX; Kansas City, MO; Denver, CO; San Francisco, CA; and Seattle, WA.

HRSA Field Offices

Region 1 Boston, MA Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont	Region 2 New York, NY New Jersey New York Puerto Rico Virgin Islands	Region 3 Philadelphia, PA Delaware District of Columbia Maryland Pennsylvania Virginia West Virginia	Region 4 Atlanta, GA Alabama Florida Georgia Kentucky Mississippi North Carolina South Carolina Tennessee	Region 5 Chicago, IL Illinois Indiana Michigan Minnesota Ohio Wisconsin
Region 6 Dallas, TX Arkansas Louisiana New Mexico Oklahoma Texas	Region 7 Kansas City, MO Iowa Kansas Missouri Nebraska	Region 8 Denver, CO Colorado Montana North Dakota South Dakota Utah Wyoming	Region 9 San Francisco, CA Arizona California Hawaii Nevada Guam Pacific Islands American Samoa	Region 10 Seattle, WA Alaska Idaho Oregon Washington

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