FRC- Department of Health

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DEPARTMENT OF HEALTH AND HUMAN SERVICES – NEW

“…..We also have an unprecedented commitment from health care industry leaders, many of whom opposed health reform in the past. Monday, I met with some of these health care stakeholders, and they pledged to do their part to reduce the health care spending growth rate, saving more than two trillion dollars over the next ten years — around $2,500 for each American family. Then on Tuesday, leaders from some of America’s top companies came to the White House to showcase innovative ways to reduce health care costs by improving the health of their workers.
Reforming health care should also involve you. Think of other people who may want to stay up to date on health care reform and other national issues and tell them to join us here: http://www.whitehouse.gov/EmailUpdates
Health care reform can’t come soon enough. We spend more on health care than any country, but families continue to struggle with skyrocketing premiums and nearly 46 million are without insurance entirely. It is a priority for the American people and a pillar of the new foundation we are seeking to build for our economy.”
– Barack Obama

“Health care is more than Medicaid and Medicare, its more than special programs for the low income and minorities. Health care is about nutrition, exercise, prevention, and affordable care when it’s required. Health care touches every American with a far greater impact than taxes.
Providing affordable health care requires more than programs and visions. The Department of Health and Human Services, with 1,030 separate targets to meet in 2008, requires execution. This vast complexity and diversity will only represent 33% of the programs met their targets and 60% of the programs didn’t even provide reports.
We can, and we will, provide health care for all American’s and we can do it with more efficiency, not more programs, visions and ideals.
– Bryant Delaney, DOI2.com

This is a summary (yes a long page summary) of the thousands of pages the Department of Commerce provides to the public as a review and report card of their performance. The details can be found in a soon to be published book – “FAKE THE NATION” – The Peoples Last Stand.

The federal government reports 80% of federal program are performing when the data represents only 7% of the programs have reported current data and 60% of all programs haven’t reported any results in at least 3 years.

Every agency creates their own programs and provides an annual report of the results of each program. The Government Accountability Office (GAO) sets the parameters for these reports and claims 80% of all government programs are on target. If a private business only reported 7% accurate data, their leaders would be in jail. What about the leaders of the biggest business in America? Shouldn’t they be held accountable to the same rules and principles as private business?

“Fake the Nation” developed out of the frustration of seeing taxes increase year after year with no end in sight. The turning point for writing this book was when the federal government started running private businesses.

For the past 200 years, government has passed more and more rules on business creating a monster with 3 heads that affects every American. First, compliance with the rules and regulations is a cost that businesses pass on to the purchasers of their products. Second, the balance of international trade has regulated many businesses out of business. Third, the laws of Government have created a false sense of security creating the mentality that the Government is watching for bad business practices protecting American’s from corrupt business executives.
We define these basic principles in detail. But unlike most essays on the failure of government, Fake the Nation goes the extra mile to demonstrate proven business practices that will make the government operate efficiently.

To support American we do not need bigger government. We need leadership. It’s been said that “experience equals knowledge, the application of knowledge equals wisdom”. It is impossible to attain wisdom in a vacuum. If our leaders to not have the breadth and depth of experience they cannot apply their experiences to become wise.

The two party political system perpetuates the waste of American tax payer dollars. Fake the Nation tracks of $111 TRILLION of waste created because the federal government leadership doesn’t understand business – yet they now run the financial and automotive industries in America.

Fake the Nation provides proof of the problems and solutions to control the expenses of the federal government through 3 simple principles:

1. The federal government has no obligation to provide any service that can be provided by private business and/or state and local government. The federal government’s responsibility is only applied where the services would be duplicated by the majority of the states or where the services are for the protection on one state from the actions of another state.
2. State responsibilities only apply when the services offered by the State benefit all local level governments. State governments will not regulate any aspect of private business except to protect the rights of all citizens within the state.
3. Local governments shall have the responsibility to set the rules and laws for the citizens of their community. No state or federal law, rule or regulation shall dictate to the local governments except where the rules, laws or regulations adversely affect the lives of citizens within other local governments. This is not to be extended to include civil rights, only criminal activities

This can only be accomplished when the American people stop adopting the platforms of political parties and mandate politicians adopt the Peoples Platform. We the People decide the agenda politicians enact the vision of the American people.

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DEPARTMENT OF HEALTH AND HUMAN SERVICES – CURRENT
Mission
To enhance the health and well-being of Americans by providing for effective health and human services, and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.

Statistics

• 36 Percent of patients with diabetes who received care through the Indian Health Service demonstrated ideal blood sugar control during FY 2005, a two percent increase from FY 2004. (IHS)
• 69 Percent of Head Start teachers hold an associate, baccalaureate or advanced qualifying degree, exceeding the FY 2005 target of 65 percent. (ACF)
• 73 Percent of clinicians at Huron Hospital utilize Computerized Physician Order Entry, and residents are placing 93% of their orders in the Electronic Medical Record. (AHRQ)
• 91 Percent of original generic drug applications were reviewed and acted on by the Center for Drug Evaluation and Research within six months of submission. (FDA)
• 96 Percent of participants in Substance Abuse Prevention Programs of Regional and National Significance rated substance abuse as wrong or very wrong in FY 2004. (SAMHSA)
• 100 Microarray datasets derived from National Institute of Environment Health Sciences/ National Center for Toxicogenomics Research, as well as pharmaceutical companies, were deposited in Chemical Effects in Biological Services. (NIH)
• 70,926 Field examinations of imported food were conducted by the Center for Food Safety and Applied Nutrition and Office of Regulatory Affairs in FY 2004 (a 6-fold increase from 12,000 field import examinations conducted in FY 2001). (FDA)
• 293,500 Severely disabled elders received home-delivered meals in 2004, allowing more elders to remain in their homes in the community. (AoA)
• 534,000 TANF recipients were placed by states in new jobs in 2004. (ACF)
• 700,000 OraQuick rapid HIV test kits have been purchased and distributed by CDC since 2003. The test kits have been used by 137 health departments and Community Based Organizations in settings lacking immediate access to clinical laboratory services. (CDC)
• 5,696,526 People served by the public mental health system in FY 2004. (SAMHSA)
• 6,900,000 Children enrolled in the State Children’s Health Insurance Program in FY 2004. (CMS)
• 13,120,000 Persons were provided access to primary and preventive health care in FY 2004 through the Health Centers program. (HRSA)
• 30,000,000 Americans would be protected from the effects of anthrax exposure due to antibiotic purchases for the Strategic National Stockpile in 2004. (CDC)
• 41,900,000 Poor and disabled individuals provided medical assistance by Medicaid in FY 2005. (CMS)
• 42,400,000 Individuals covered by Medicare in FY 2005 .(CMS)
• 21,900,000,000 Billion dollars in child support payments were collected and distributed, representing a 3.2 percent increase over the previous fiscal year. (ACF)

Overview
The HHS Operating Division’s (OPDIV) FY 2007 Annual Plans contain over 700 hundred performance goals that HHS OPDIVs track and report annually in their Congressional Justifications.

1. Health Care: While the majority of Americans get their health care coverage through their workplace or from public programs like Medicare, Medicaid and the State Children’s Health Insurance Program (SCHIP), improving access for the forty-five million Americans currently without health insurance presents a large challenge. In the last year reported, the Health Resources and Services Administration (HRSA) funded 337 new or significantly expanded health care sites. Currently more than 7,000 service delivery sites nationwide provide care to an estimated 16.1 million patients with insufficient access to care. The Centers for Medicare and Medicaid (CMS) is also striving to improve the quality of patient care by releasing ratings of Medicare and Medicaid-certified nursing homes. Nursing homes can be compared online at http://www.medicare.gov/NHCompare.

2. Public Health: HHS prevention efforts are an important component of public health protection. For example, food-borne illnesses are a substantial health risk in the United States, with surveillance data indicating that each year 76 million Americans suffer illness from food they consume. To help improve food safety and prevent food-borne illnesses, the Food and Drug Administration (FDA) has established offices in areas such as China that export food and other FDA-regulated products to our country.

3. Human Services: The economic and social well-being of all Americans continues to be a major issue of concern, especially given the current downturn in the economy. The HHS Temporary Assistance for Needy Families (TANF) program not only assists individuals in times of need, it helps to return those individuals to working status. Most recently, 36 percent of TANF recipients became newly employed.

4. Scientific Research and Development: Basic science is the foundation for improved health and humans services. The continuum from basic to applied research to practice is a significant emphasis of our scientific research and development enterprise. HHS conducts research and development activities. For example, the National Institutes for Health (NIH) has been working to create new treatments for Type 2 diabetes and chronic kidney disease though randomized clinical trials. In FY 2008, NIH reviewed and evaluated the raw data from the study’s indicators and has made a determination that the science is progressing appropriately and should continue.

500-DAY PLAN
In May 2005, HHS Secretary Michael O. Leavitt introduced his 500-Day Plan, which outlines his priorities for the Department. The 500-Day Plan supports the Strategic Plan in guiding the Department in achieving its broad policy and program objectives. The six initiative areas in the 500-Day Plan are:
• Transform the Health Care System
• Modernize Medicare and Medicaid
• Advance Medical Research
• Secure the Homeland
• Protect Life, Family, and Human Dignity
• Improve the Human Condition Around the World

Before
• $737B
• 53,000 Employees
Score
• 0% Fail
Score Summary
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Score Detail
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Strategic Goal 1: – $619B
Reduce the major threats to the health and well-being of Americans

The FY 2007 budget funding for immunizations will be used to help ensure that no child, adolescent, or adult will needlessly suffer from a vaccine-preventable disease. Prevention remains at the center of the HHS approach to fighting HIV/AIDS, sexually transmitted diseases, and tuberculosis. HHS is making considerable progress toward slowing the transmission of HIV from pregnant women to their children and preventing the spread of tuberculosis.
1a. National Immunization Program (CDC)
Performance Measure: Achieve or sustain immunization coverage of at least 90% in children 19- to 35-months of age for: 4 doses DTaP vaccine1, 3 doses Hib vaccine, 1 dose MMR vaccine2, 3 doses hepatitis B vaccine, 3 doses polio vaccine, 1 dose varicella vaccine, 4 doses pneumococcal conjugate vaccine (PCV7)3. Vaccines are one of the most successful and cost effective public health tools for preventing disease and death.
1b. HIV/AIDS Prevention in the U.S. (CDC)
Reduce the number of HIV infection cases diagnosed each year among people under 25 years of age, from 2,100 in 2000. Decrease the number of perinatally acquired AIDS cases from the 1998 base of 235 cases.
1c. Substance Abuse Prevention and Treatment Block Grant (SAMHSA)
Performance Measure: Increase the number of clients served.

Strategic Goal 2: – $8B
Enhance the ability of the Nation’s health care system to effectively respond to terrorism and other public health challenges

HHS has a number of initiatives and programs directed at protecting Americans from bioterrorist attacks and other public health challenges. The events of September 11, 2001 and subsequent anthrax attacks have reinforced the HHS role in protecting Americans from attacks on our health and food supply by enhancing preparedness and response capabilities.
2a. Field Foods Program (FDA)
Performance Measure: Perform prior notice import security reviews on food and animal feed line entries considered to be at risk for bioterrorism and/or to present the potential of a significant health risk.
The Field Foods Program promotes and protects the public’s health by ensuring that the U.S. food supply is safe, sanitary, wholesome, and honestly labeled, and that cosmetic products are safe and properly labeled. As a result of the terrorist attacks of September 11, 2001, and the passage of the Bioterrorism Act of 2002, the FDA took on a food security/defense role to improve the protection of the nation’s food supply, which is among the world’s safest.
• Strategies used to ensure effective targeting will include:
• Intelligence regarding countries at risk for terrorism
• Intelligence regarding commodities susceptible to or exploited by terrorism
• Intelligence specific to shipment or shipping entities
• Information gleaned from Foreign and Domestic Establishment Inspection Reports that identify security breaches
• Sample collection and analysis for counterterrorism
• Prior Notice discrepancies reported during import field exams
• Filer evaluation field audits
2b. Bioterrorism Hospital Preparedness Program (HRSA)
Performance Measure: Percent of awardees that have developed plans to address surge capacity.
Plans for surge capacity must address the following issues:
• Hospital bed capacity for adults and children
• The capability for isolation and decontamination
• Appropriate staffing
• Appropriate medical prophylaxis and treatment for hospital staff and their family members
• Personal protective equipment
• Capacity for trauma and burn care
• Capacity for mental health care
• Communications and information technology
• Hospital laboratory connectivity and capacity
The FY 2007 target measure is for 100 percent of grant recipients to have developed plans to address surge capacity. In FY 2005, 100 percent of Hospital Preparedness program awardees had developed surge capacity plans, meeting the target. This represented an increase from 89 percent in FY 2004. In the future, the program will track various aspects of the implementation of these plans.
2c. Terrorism Preparedness and Emergency Response Program (CDC)
Performance Measures: 100 percent of State public health agencies are prepared to use material contained in the SNS as demonstrated by evaluation of standard functions as determined by CDC. 100 percent of State public health agencies improve their capacity to respond to exposure to chemicals or category A agents by annually exercising scalable plans and implementing corrective action plans to minimize any gaps identified.
Following are the CDC preparedness goals:
• Prevent: Increase the use and development of interventions known to prevent human illness from chemical, biological, radiological agents and naturally occurring health threats.
• Detect / Report: Decrease time needed to classify health events as terrorism or naturally occurring in partnership with other agencies.
• Detect / Report: Decrease time needed to detect and report chemical, biological, and radiological agents in tissue, food, or environmental samples that cause threats to the public’s health.
• Detect / Report: Improve the timeliness and accuracy of communications regarding threats to the public’s health.
• Investigate: Decrease time to identify causes, risk factors, and appropriate interventions for those affected by threats to the public’s health.
• Control: Decrease time needed to provide countermeasures and health guidance. Activities include distribution of materials from the Strategic National Stockpile (SNS).
• Recover: Decrease time needed to restore health services and environmental safety to pre-event levels.
• Recover: Improve long-term follow-up provided to those affected by threats.
• Improve: Decrease time needed to implement recommendations from after-action reports. Activities include State and Local Readiness cooperative agreement and program services.

Strategic Goal 3: – $44B
Increase the percentage of the Nation’s children and adults who have access to health care services, and expand consumer choices

HHS is committed to its many efforts aimed at increasing the percentage of the Nation’s children and adults who have access to care and to expanding consumer choices. Over 34 HHS programs in six OPDIVs contribute to achieving this strategic goal. Five programs are highlighted in this strategic goal:
1. HRSA’s Health Centers Program: Provides regular access to high quality, family oriented, and comprehensive primary and preventive health care regardless of patients’ ability to pay.
2. Indian Health Service (IHS) National Diabetes Program: Works with communities to prevent and treat diabetes in American Indian/ Alaska Native people.
3. Centers for Medicare and Medicaid (CMS) Medicare program: Helps pay medical bills for millions of aged and disabled Americans and has provided them with comprehensive health benefits.
4. CMS’ Medicaid program: Serves as the primary source of health care for a large population of medically vulnerable Americans, including poor families, the disabled, and persons with developmental disabilities requiring long-term care.
5. CMS’ State Children’s Health Insurance Program (SCHIP): Stimulates enormous change in the availability of health care coverage for children, in coordination with Medicaid.
3a. Health Center Program (HRSA)
Performance Measure: Increase the number of uninsured and underserved persons served by health centers. Increase new and expanded health center sites.
Expansion of this program, which is nearly 40 years old, is a Presidential initiative to increase health care access for those Americans who are most in need. Millions of Americans are uninsured and lack access to a regular source of health care. The projection is that the Health Centers program will serve 15.8 million persons in FY 2007. The Health Centers program served 13.1 million people in FY 2004
3b. National Diabetes Program (IHS)
Performance Measure: Address the proportion of patients with diagnosed diabetes that have demonstrated glycemic control at the ideal level (HbA1c<7).
The mission of the DDTP is to develop, document, and sustain a public health effort to prevent and control diabetes in AI/ANs. IHS currently has seven diabetes performance measures within its annual Performance Budget.
3c. Medicare (CMS)
Performance Measures: Implement the new Medicare Prescription Drug Benefit.
Improve Satisfaction of Medicare Beneficiaries With the Health Care Services They Receive
CMS is helping the Department meet its goal of expanding consumer choice and access to healthcare by implementing the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) which extends Medicare prescription drug coverage to Medicare beneficiaries.
3d. Medicaid (CMS)
Performance Measure: Improve the Quality of Health Care for Medicaid Beneficiaries through Demonstrated Enhancements to Overall State Quality Strategies.
The Medicaid program directly supports HHS Strategic Goal 3 by providing the primary source of health care coverage for a large population of medically vulnerable Americans, including poor families, people with disabilities, and people with long-term care needs. Additionally, many other low-income uninsured individuals, who are not otherwise eligible for Medicaid, receive coverage through the use of waivers. In FY 2005, there were 49.1 million individuals enrolled in Medicaid, including those enrolled through the use of waivers.
3e. State Children’s Health Insurance Program (CMS)
Performance Measure: Improve Health Care Quality Across SCHIP.
To date, SCHIP has 6.9 million beneficiaries enrolled and continues its focus on increasing healthcare enrollment for low income children.

Strategic Goal 4: – $27B
Enhance the capacity and productivity of the Nation’s health science research enterprise

HHS recognizes the important role research plays in improving the Nation’s health. As a result, many of the strategies that HHS has identified in achieving its other strategic goals incorporate a research base. This goal, therefore, focuses on creating the underlying knowledge and strategies that improve and maintain the research infrastructure that produces advances in health science.
HHS places a high priority on improving the coordination, communication, and application of health research results. Strategies to meet this goal include:
• Provide for easy access by academia and industry to HHS databases and findings from HHS research, with appropriate privacy and confidentiality protection.
• Expand the use of electronic technology and media channels to gather and transfer research information to researchers, practitioners, and the public.
• Establish quality standards for the dissemination and strategic application of consumer/communication research findings.
• Establish partnerships with health professional associations, industry groups, patient representatives, community groups, disability groups, and purchasers of care to more widely disseminate research findings.
• Support “implementation research” to determine how innovative, effective interventions can be implemented in actual settings and populations, including the means to reach diverse communities.
• Ensure that consumer research, demonstration, and evaluation results are communicated effectively across HHS agencies and to all decision makers.
• Support development of data-based quality of care and outcome measurement systems to track adoption of evidence-based practices.
4a. Knowledge Base on Chemical Effects in Biological Systems (NIH)
Performance Measure: By 2012, develop a knowledge base on chemical effects in biological systems using a systems toxicology or toxicogenomics approach. A new scientific field, toxicogenomics, is evolving to examine how chemical exposures disrupt biological processes at the molecular level.
CEBS will build the capacity for public electronic sharing of toxicogenomics data and information, making this data fully searchable and downloadable. Also, it will include traditional toxicology/ pathology data. This capability provides a way to use these very different types of data to estimate animal toxicity as well as to determine safe exposure levels in people.

Strategic Goal 5:
Improve the quality of health care services
Improving the quality of life in the United States includes improving the quality of the health care services that individuals receive by reducing medical errors, improving consumer and patient information, and accelerating the development and use of electronic health information. To achieve this goal, HHS will continue implementation of a variety of strategies designed to improve the delivery of health care services.
5a. Medical Product Surveillance Network (FDA)
Performance Measure: Expand actively participating sites in MedSun Network.
The FDA Modernization Act (FDAMA) mandates that FDA replace universal user facility reporting with the Medical Product Surveillance Network (MedSun), a network of user facilities that together will provide a representative profile of reports from major medical device product users such as hospitals. When fully implemented, MedSun will serve as an advance warning system for device problems and a laboratory for research and two-way communication between FDA and the user-facility community. Furthermore, MedSun will improve patient safety through recognition and management of use-related errors and offer feedback to manufacturers to improve device design.
MedSun is designed to improve FDA decision making about device problems by generating more useful and diverse reports from trained, engaged reporters. The program collects reports on deaths and serious injuries associated with the use of medical devices. Participating facilities are also highly encouraged to submit reports about close calls, which allow FDA to evaluate a device issue before patient injury occurs.
FDA plans to use the following strategies to accomplish this:
• FDA is currently piloting the use of ‘Regional Representatives’ to travel to the MedSun hospitals and work with their staff to encourage event reporting as well as solicit feedback for improvements to the system.
• FDA is currently piloting two new educational tools designed to increase device-problem reporting within facilities, and then encourage the facilities to submit those reports to MedSun. Based on the success of these pilot programs, FDA will distribute these tools throughout the MedSun network and provide special follow-up calls and visits to non-reporting sites.
• FDA is planning to add regional meetings to its current annual Users’ Conference. It is anticipated that these meetings will promote best practices with medical devices as well as generate increased reporting.
• FDA will make special overtures to non-reporting sites to encourage them to attend these regional meetings. FDA will begin implementing regional meetings in FY 2006.
5b. Prevention Portfolio (AHRQ)
Performance Measure: Improve the timeliness and responsiveness of the United States Preventive Services Task Force (USPSTF) to emerging needs in clinical prevention.
The United States Preventative Services Task Force (USPSTF) is a vital component of the Prevention Portfolio. The overall goal of the USPSTF is to provide evidence-based recommendations relevant to primary care providers. The Task Force works to improve the effectiveness and efficiency of healthcare delivery by promoting patient safety and by providing evidence-based recommendations for essential and non-essential clinical preventive services.

Strategic Goal 6:
Improve the economic and social well-being of individuals, families, and communities, especially those most in need
HHS promotes and supports interventions that help empower disadvantaged and distressed individuals, families, and communities to improve their economic and social well-being. To achieve this strategic goal, HHS supports targeted efforts to increase the independence and stability of low-income families, people with disabilities, older Americans, Native Americans, victims of domestic violence, refugees, and distressed communities. HHS will also continue to support community and faith-based organizations that provide services to individuals and communities in need.
Approximately thirteen HHS programs in two OPDIVs contribute to achieving this strategic goal. Two programs are highlighted under this strategic goal including the Administration for Children and Families’ (ACF) Temporary Assistance for Needy Families program and Administration on Aging (AoA) Aging Services Program.
6a. Temporary Assistance for Needy Families (ACF)
Performance Measure: Increase the percentage of adult TANF recipients/former recipients employed in one quarter that were still employed in the next two consecutive quarters.
Temporary Assistance for Needy Families (TANF) program, Title IV-A of the Social Security Act, support HHS Strategic Goal 6.1. TANF provides assistance to needy families; reduces dependency by promoting job readiness, employment, and marriage; prevents and reduces out-of-wedlock pregnancies; and encourages the formation and maintenance of two-parent families. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), which established TANF, dramatically changed the nation’s welfare system into one that requires employment while time-limiting assistance. States, territories, and tribes each receive a block grant allocation with a requirement for states to maintain a historical level of state spending for welfare and other services for low-income families known as Maintenance of Effort. The block grant covers benefits, administrative expenses, and services. States, territories, and tribes determine eligibility and benefit levels as well as services provided to needy families.
6b. Aging Services Program (AoA)
Performance Measure: Increase the number of severely disabled clients who receive home-delivered meals.
The Aging Services Program of the Administration on Aging (AoA), which encompasses all AoA programs, provides grants to states, tribal organizations, and other community service providers. Together these entities comprise the National Aging Services Network, which makes comprehensive supportive services available to vulnerable elderly individuals and their family caregivers. These services help to keep America’s rapidly growing older population healthy, secure and independent in the community, where they prefer to reside. AoA programs, for a fraction of the cost of institutional care, are helping families to keep their loved ones at home for as long as possible. These services complement existing medical and health care systems and support some of life’s most basic functions: food for the undernourished; transportation for the immobile; respite and counseling for caregivers; and personal care to those who need assistance getting in and out of bed, feeding and bathing themselves.

Strategic Goal 7:
Improve the stability and healthy development of our Nation’s children and youth
In order to promote the development and stability of our Nation’s children and youth, HHS will support programs that increase the involvement and financial support of non-custodial parents; increase the percentage of children and youth living in a safe and stable environment; and, continue to support the social and cognitive development of preschool children. Over twelve HHS programs in one OPDIV contribute to achieving this strategic goal. Three programs are highlighted in this strategic goal including ACF Child Support Enforcement, Child Welfare, and Head Start programs.
The Child Support Enforcement program assures that support is available to children by locating parents and establishing paternity and support obligations. These efforts will continue to be an integral part of the Department’s effort to increase parental responsibility by promoting the involvement of non-custodial parents in the lives of their children.
7a. Child Support Enforcement (ACF)
Performance Measure: Increase the IV-D (child support) collection rate for current support.
In accordance with HHS Strategic Goal 7, HHS is taking steps to improve the stability and healthy development of the Nation’s children and youth. Child Support Enforcement (CSE) demonstrates this commitment to the Nation’s children and youth in several ways. The CSE program ensures that support is available to children by locating parents, establishing paternity, and enforcing support obligations. Since the creation of the Child Support Enforcement program, child support collections within the program have grown annually. States have increased collections by using a wide variety of approaches such as income withholding, offset of income tax refunds, and reporting to credit bureaus.
• Strategies to increase collections in recent years have resulted in the following:
• The government collected $1.5 billion in overdue child support from federal income tax refunds for tax year 2004 on behalf of more than 1.4 million families.
• A program to match a list of delinquent parents with financial institution records found over 1.9 million accounts during 2004 belonging to about 1.1 million delinquent non-custodial parents nationwide with a value in excess of $4 billion.
• A program to match a list of delinquent parents with financial institution records found over 1.9 million accounts during 2004 belonging to about 1.1 million delinquent non-custodial parents. These efforts resulted in reported collections of over $98 million. (The $98 million includes some collections from in- State matches as not all States are able to separate collections.)
• The Passport Denial program resulted in reported lump sum collections of over $13.25 million of child support payments in FY 2004.
• Using the expanded Federal Parent Locator Services, OCSE was able to provide States information on nearly 4.2 million non-custodial parents and putative fathers.
7b. Foster Care, Adoption, and other Child Welfare Programs (ACF)
Performance Measure: Increase the adoption rate (for children with involvement in the public
child welfare system).
The Administration for Children and Families (ACF) Child Welfare programs prevent maltreatment of children, provide in-home services for at-risk children and families, find temporary foster placements for children who must be removed from their homes, and achieve safe and stable permanent placements for children in foster care. Foster Care provides stable environments for those children who cannot remain safely in their homes and ensures children’s safety and well-being while their parents attempt to resolve the difficulties that led to the out-of-home placement. When the family cannot be reunified, it provides a stable environment until the child can be placed permanently with an adoptive family, in a guardianship arrangement or some other permanent placement. Federal adoption programs work to facilitate adoptions for children with involvement in the public child welfare system by providing funds to States for adoption assistance agreements with parents who adopt children with special needs; promoting recruitment of adoptive parents; providing financial incentives to states to encourage adoptions; and working to eliminate barriers to adoption.
7c. Head Start (ACF)
Performance Measure: Increase the percentage of teachers with AA, BA, Advanced Degree, or a degree in a field related to early childhood education.
Intended for preschoolers from low-income families, Head Start promotes school readiness by enhancing the social and cognitive development of children through the provision of educational, health, nutritional, social, and other services. Head Start programs emphasize cognitive, language, and socio-emotional development to enable each child to develop and function at his or her highest potential. Head Start also engages parents in their children’s learning and helps parents to make progress toward their educational, literacy, and employment goals.
• The Head Start Act requires that at least 50 percent of all teachers have an AA, BA, or degree in a field related to early childhood education. Head Start grantees are required to develop plans for using their allocation to increase the number of teachers with degrees.
• Implement and operate a National Reporting System designed to assess every 4-year-old in Head Start in the fall and spring of their preschool year. Head Start has already implemented the NRS, which assesses the school readiness of children via three cognitive measures. Assessments of children in every Head Start center were completed in Fall 2003, Spring 2004, Fall 2004, Spring 2005, and Fall 2005 through the NRS, which examined success in preparing children for school.
• Work with Congress to pass a bill that would better integrate Head Start, child care and state operated pre-school programs. Head Start reauthorization proposals, which contain elements that increase Head Start-preschool integration, are currently awaiting action in Congress.
• Develop annual performance measures that assess the progress of individual grantees in improving school readiness and better measure the impact on children. The Secretary established an Advisory Committee on Head Start Accountability and Educational Performance Measures to make recommendations about further development of the National Reporting System and other performance monitoring activities that assess progress of grantees in improving children’s school readiness.

Strategic Goal 8:
Achieve excellence in management practices
HHS is committed to improving the efficiency and effectiveness of the Department’s programs by creating an organization that has a citizen-based focus, is results oriented, and is market-driven, where practicable. Approximately three HHS programs in three OPDIVs contribute to achieving this strategic goal. The Medicare Integrity Program initiative is highlighted in this section. Program integrity efforts ensure the Medicare program pays the right amount to legitimate providers for covered, reasonable, and necessary services that are provided to eligible beneficiaries.
8a. Medicare Integrity Program (CMS)
Performance Measure: Reduce the Percentage of Improper Payments Made Under the Medicare Fee-for- Service Program
The Medicare Integrity Program (MIP) plays a crucial role in meeting the requirements of improving financial performance under HHS Strategic Plan Goal 8 to achieve success in management practices. CMS started measuring the percentage of improper payments made under the Medicare program in 1996 and created a goal to reduce this percentage. CMS now has five goals representing the MIP. These include reducing the contractor error rate and improving the provider compliance error rate.
One of CMS’ major goals is to pay claims properly the first time. Paying right the first time saves resources and ensures the proper expenditure of limited Medicare trust fund dollars

Organization Chart

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Budget
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Agencies:
1. OS – Office of the Secretary
2. ACF – Administration for Children & Families
3. AoA – Administration on Aging
4. AHRQ – Agency for Healthcare Research & Quality
5. ATSDR – Agency for Toxic Substances & Disease
6. CDC – Centers for Disease Control & Prevention
7. CMS – Centers for Medicare & Medicaid Services
8. FDA – Food & Drug Administration
9. HRSA – Health Resources & Services Administration
10. IHS – Indian Health Service
11. NIH – National Institutes of Health
12. OIG – Office of Inspector General
13. SAMHSA – Substance Abuse & Mental Health Services Administration

Challenges:

Management Challenge Progress Assessment Management Response Future Plans
Oversight of Medicare Part D CMS has demonstrated progress in: payment accuracy and internal controls; program safeguards; beneficiary protections. CMS has made progress in its use of bid audits. MEDICs have not conducted data analysis to identify potential fraud. CMS has issued 9/18 chapters of the Prescription Drug Benefit Manual. CMS will develop a centralized data repository to warehouse data on Medicare Parts A, B, D and Medicaid to provide a single source of information for CMS fraud, waste, and abuse activities.
Integrity of Medicare Payments CMS has demonstrated vigilance in monitoring the gross paid claims error rate and is developing appropriate corrective action plans. The CMS FY 2007 gross paid claims error rate of 3.9 percent is 6.2 percent lower than the FY 2004. CMS has made progress in its general and applicable controls and has begun implementing the Healthcare Integrated General Ledger Accounting System. HHS will continue to address potential improper payment exposure for durable medical equipment under a 2-year effort aimed at stopping fraudulent billing to protect beneficiaries and taxpayers.
Appropriateness of Medicaid and SCHIP Payments CMS has annually updated its 5-year Comprehensive Medicaid Integrity Plan to promote the proper expenditure of Medicaid fund, improve integrity performance, and foster collaboration with stakeholders. The final Medicaid payment error rate is reported in the IPIA Report, included in the FY 2008 Agency Financial Report, Section III. CMS plans to start educating providers on payment and billing integrity as well as quality-of-care issues related to personal care services in FY 2009. CMS is working to create a new database to store all State’s Medicaid data.
Quality of Care Progress continues to strengthen oversight of the quality of care paid for by the Medicare and Medicaid programs. CMS has promoted quality by collecting and publishing quality-related data on nursing homes and hospitals. Progress continues to strengthen oversight of the quality of care paid for by the Medicare and Medicaid programs. CMS plans to improve hospice oversight by improving the survey process and proposes to amend the hospice section of the State Operations Manual to enable State surveyors to make more consistent decisions regarding compliance with Medicare regulations.
Public Health and Medical Emergency Preparedness States and localities are making progress in strengthening their bioterrorism preparedness programs. Federal, State and local health departments are striving to work cooperatively to ensure that potential bioterrorist attacks are detected early and responded to appropriately. HHS issued an updated Purchase Card Guide and a 2-page Quick Reference Guide that highlights key information about emergency situations related to HHS purchase card policies and procedures. CDC implemented stronger performance measures, which will continue to expand in future years, for the Public Health Emergency Preparedness cooperative agreement. Clearer guidance was developed for grantees to reporton measures.
Oversight of Food, Drug, and Medical Device Safety HHS has implemented many changes to protect human research subjects and to strengthen FDA and NIH oversight of scientific research. During FY 2008, FDA established offices in China to facilitate inspections of Chinese food and drugs before they are imported to the U.S. As a major milestone in the globalization of efforts to enhance the safety of imported food and medical products, FDA announced plans to establish overseas offices in China, India, Europe and Latin American in 2008, with a fifth office in the Middle East in 2009. FDA is developing an internal listing of all ongoing clinical trials as part of a broader effort to manage FDA’s regulated product information electronically. FDA is also developing recommendations for improving the quality of its post-marketing study commitment processes.
Grants Management HHS has worked to develop more consistent policies and practices, and has undertaken a leadership role in implementation of key legislation, along with the availability of grants funding opportunities via grants.gov. AHRQ has established practices to ensure the integrity of grant data, timeliness of grantee reporting, and closeout procedures. Emphasis is being placed on timely financial closeout of ended projects.
Integrity of IT Systems and the Implementation of Health IT HHS has made progress in the security of its most critical and essential assets, such as laboratories, computer systems, and data communication networks. CMS has made progress in oversight of the HIPAA Security rules. ONC issued the ONC-coordinated Federal Health IT Strategic Plan, outlining two goals covering patient-focused health care and population health. ONC is actively involved in several activities including the drafting of a privacy and security framework for electronic health information exchange and other supplemental materials. Significant progress also continues with collaborative initiatives involving state leadership and other stakeholders to address issues that have direct benefit to U.S. citizens, and cannot be resolved at the Federal level. HHS plans to a privacy and security framework to increase trust among consumers and users of electronic individual health information and to govern all privacy and security efforts related to electronic health information exchange. In FY 2009, plans are to continue to develop best practices, tools, training and outreach mechanisms that could be built into existing initiatives.
Ethics Program Oversight and Enforcement Both NIH and FDA have strengthened processes for reviewing outside activities. Additionally, the OGC Ethics Division continues to expand its ethics program oversight, guidance and training activities. HHS continued program reviews at NIH and other components. The Program Review Section, uncovered significant vulnerabilities in a number of component ethics programs and has issued formal reports this year containing recommendations for improvement. The OGC Ethics Division is planning to issue a package with waiver guidance and information regarding delegation of authority to issue waivers. The Ethics Division oversees component ethics program operations, including the review of waivers.
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