Unites States Department of Health and Human Services - Essay Example

UNITED S DEPARTMENT OF HEALTH & HUMAN SERVICES HHS is a Cabinet-level Department presently led by Secretary Michael Leavitt. The Department of Education Organization Act of October 17, 1979 split HEW into ED and HHS. Main HHS aims are safeguarding health of American citizens and providing them basic human services. Accordingly, wide ranging services are contained in charters of the 10 HHS divisions. HHS manages more grant dollars than all other federal agencies combined. Its 2007 Budget of $ 698 billion is split among its 10 divisions and OS. HHS has issued several transformational and transactional regulations (as demonstrated by 3 examples). HHS has taken several enforcement actions (as demonstrated by 4 examples). There are many U.S. Court rulings of interest regarding HHS (as demonstrated by 6 examples). A) Background – How the HHS was born The Cabinet is the highest executive branch of the federal government of the United States of America. It consists of officers (each designated as ‘Secretary’ except the Attorney General) whose nomination is first made by the President and later confirmed by the Senate. Each Secretary is the head of a Department (Wikipedia, 2007). Prior to 1979, there existed the Department of Health, Education and Welfare (HEW). In operation since 1953, its affairs were managed by the United States Secretary of Health, Education & Welfare. The last Secretary of this Department was Patricia Roberts Harris (1979). In the years leading up to 1979 there was an increasingly uneasy feeling that the HEW was over-burdened as health, education and welfare assumed greater importance as the American population grew. With its finger on the pulse of the American people, the ruling Democrats took the revolutionary step of reorganizing the HEW. On October 17, 1979, the 39th President of the United States, Jimmy Carter, signed as ordinance the Department of Education Organization Act (PL 96-98). Marking the one and only time in U.S. history that a President used his inherent authority to reorganize a Cabinet-level Department, this Act officially separated the HEW into two Departments – the United States Department of Health & Human Services (HHS), and the United States Department of Education (ED). Both HHS and ED started operating officially on May 4, 1980 (Wikipedia, 2007). The HHS was further strengthened on March 31, 1995, when the welfare portfolio was taken from it and entrusted to a newly created independent federal agency called Social Security Administration headed by a commissioner who reported directly to the President. The glaring defects of the much-criticized Aid to Families with Dependent Children (AFDC) - commonly called ‘welfare’ - program were rectified when President Bill Clinton signed the Welfare Reform Act on August 22, 1996, laying greater emphasis on work as opposed to the earlier regular guaranteed payment to women. The overall result was that the HHS emerged as a de facto Department of Health (Answers. com, 2007). B) Charter, Stature and Budget of HHS The HHS in its vital role as the only Department entrusted with its citizens’ health by the U.S. government, has a simple yet formidable charter, namely, “protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves” (Answers.com, 2007). The funds provided to HHS are quite substantial, comprising nearly one-fourth of total federal outlays. The 2007 budget of the HHS is $ 698 billion (hhs.gov/about/, 2007), slightly higher than its 2006 budget of $ 640.7 billion (Wikipedia, 2007). The HHS has the distinction of being the only Department that manages more grant dollars than any other agency in the country {in fact, it administers more grant dollars than all the other federal agencies clubbed together}. The HHS maintains close links with state and local governments, and several HHS financed services are made available to local people via the conduit of state agencies, county agencies or private sector grantees (hhs.gov/about/, 2007). C) Charter of HHS – Division Wise The overall charter of the HHS is reflected in the more than 300 programs which are managed by its 11 operating divisions. 1) Centers for Medicare & Medicaid Services (CMS) The CMS is easily the largest division of the HHS, having its headquarters in Baltimore, Maryland, and enjoying the largest slice of the Department’s Budget {the CMS 2007 Budget is $ 596 billion} (hhs.gov/about/, 2007). Formerly known as the Health Care Financing Administration (HCFA) within the framework of the previous HEW (Wikipedia, 2007), the CMS oversees wide-ranging programs that are carried out by federal-state cooperation, making health care available to approximately one-fourth of the total number of American citizens. The CMS services are carried out along 3 main lines: Medicare, a federal service run in conjunction with the Social Security Commission, which provides health insurance to approximately 43 million elderly and disabled American citizens; Medicaid, a federal-state service which provides health insurance for low-income American citizens (currently estimated to be 51.6 million, including 25.1 million children); and State Children’s Health Insurance Program {SCHIP} which oversees insurance coverage to around 4.6 million American children. The present number of employees in the CMS is 4,770 led by Acting Administrator Leslie V. Norwalk, Esq. (hhs.gov/about/, 2007). 2)Administration for Children & Families (ACF) The ACF which has its headquarters in Washington D.C., is the second largest division of the HHS, appropriating $ 47 billion as its 2007 budget. The ACF oversees the implementation of more than 60 programs aimed at improving the economic and social welfare of American families and children. A few exemplary programs include the Temporary Assistance for Needy Families program that currently makes available assistance to about 4.4 million Americans (including 4 million children); the Head Start program that provides assistance to around 900,000 pre-school children; the National Child Support Enforcement system that collects payments due from non-custodial parents (it collected around $ 21.2 billion in 2003); the Foster Care & Adoption Assistance program that rehabilitates orphan children; and the Domestic Violence & Child Abuse Prevention program that seeks to maintain harmony in American families. The ACF presently employs 1,267 persons; the division is headed by Assistant Secretary Wade F. Horn, Ph.D. (hhs.gov/about/, 2007). 3) National Institutes of Health (NIH) The NIH is the third largest division of the HHS, having $ 28.6 Billion as its 2007 budget. Headquartered in Bethesda, Maryland, it is the main agency in the country that handles biomedical research (hhs.gov/about/, 2007). The NIH is the successor (validated by the Ransdell Act of 1930) of the Laboratory of Hygiene formed in 1887. The aim of the NIH is to find new ways to detect, diagnose, treat and prevent all forms of disease and disabilities that afflict mankind. It has two divisions: the Intramural sector that carries out biomedical research, and the Extramural sector that provides funding for biomedical research in areas outside the NIH framework (such as scientists in research institutions, hospitals, medical schools and universities within the country as well as outside the U.S.). The NIH runs 20 National Institutes covering diseases and disabilities ranging from cancer (National Cancer Institute {NCI}), to heart and lung diseases (National Heart, Lung & Blood Institute {NHLBI}), to infectious diseases (National Institute of Allergy & Infectious Diseases {NIAID}), to drug abuse (National Institute on Drug Abuse {NIDA}), to mental illness (National Institute of Mental Health {NIMH}), to aging (National Institute on Aging {NIA}), and Alcohol related problems (National Institute on Alcohol Abuse & Alcoholism {NIAAA}). The division is currently led by director Elias Zerhouni, M.D. (Wikipedia, 2007) and has 17,655 employees (hhs.gov/about/, 2007). 4) Centers for Disease Control & Prevention (CDC) The CDC is the fourth largest division of the HHS having its headquarters in Atlanta, Georgia and a 2007 budget of $ 8.4 billion (hhs.gov/about/, 2007). A successor of the Communicable Disease Center established in 1946 (Wikipedia, 2007), the CDC is recognized as the country’s top agency responsible for safeguarding public health. Working in cooperation with state governments, the CDC provides vital services such as maintaining national health statistics, providing immunization and other disease prevention services, monitoring health patterns with the aim of forestalling disease outbreaks (including the increasingly dangerous and very real bioterrorist threat). The CDC also controls the Agency for Toxic Substances & Disease Registry (ATSDR) that is entrusted with monitoring and preventing exposure to hazardous wastes in the country. At present, the CDC has 8,325 employees led by director Julie Louise Gerberding (hhs.gov/about/, 2007). 5) Health Resources & Services Administration (HRSA) The HRSA ranks as the fifth largest division of the HHS. Its headquarters are in Rockville, Maryland, and it has a 2007 budget of $ 6.3 billion. Through its health centers, the HRSA makes medical care available to underprivileged American citizens (such as those having low income, no insurance, or living in areas not having proper health care facilities). In 2005, it was estimated that HRSA provided medical facilities to around 14 million people through 3,700 sites around the country. The HRSA also provides several programs (like Organ Transplantation, National Health Service Corps) to improve the health of underprivileged people, including the Ryan White CARE Act program that is designed to improve the health of those living with HIV/AIDS affected patients. The HRSA currently has 1,858 employees led by administrator Elizabeth M. Duke, Ph.D. (hhs.gov/about/, 2007). 6) Indian Health Service (IHS) The IHS has its headquarters in Rockville, Maryland. It is the sixth largest division of the HHS, having a 2007 budget of $ 4.0 billion (hhs.gov/about/, 2007). Following the dictates of Article 1, Section 8 of the U.S. Constitution, the IHS makes available federal health services to those American Indians and Alaska Natives whose tribes are recognized by the federal government. It is currently estimated that 1.8 million American Indians and Alaska Natives classified under 557 federally recognized tribes spread over 35 states received IHS health care from its network of 33 hospitals, 59 health centers and 50 health stations (Wikipedia, 2007). Currently, the IHS has 15,848 employees. Director Charles W. Grim, D.D.S., M.H.S.A is in charge of the division (hhs.gov/about/, 2007). 7) Substance Abuse & Mental Health Services Administration (SAMHSA) The SAMHSA has a 2007 budget of 3.2 billion, making it the seventh largest division of the HHS. Its headquarters are in Rockville, Maryland. A successor of the 1974 Alcohol, Drug Abuse & Mental Health Administration, SAMHSA seeks to better the existing national response to problems associated with substance abuse and mental illness by looking for new ways (or improvement of existing methods) of providing treatment, rehabilitation and prevention of this ever-increasing problem mainly caused by the evil actions of powerful drug syndicates. The SAMHSA currently has 535 employees (hhs.gov/about/, 2007) led by administrator Terry Cline, Ph.D. (Wikipedia, 2007). 8) Food & Drug Administration (FDA) The FDA is the eighth largest division of the HHS, having its headquarters in Rockville, Maryland. Its 2007 budget is $ 1.9 billion. The FDA is the successor of the 1906 Bureau of Chemistry {that was empowered by the Pure Food & Drugs Act} (hhs.gov/about/, 2007). The FDA runs extensive checks before certifying products fit for consumption or use such as food, drugs, biologics, blood products, medical tools and cosmetics (Wikipedia, 2007). The supervisory role of the FDA is very important as these products attract one fourth of normal U.S. consumer spending. There are 10,047 employees presently in the FDA, led by Acting Commissioner Andrew C. von Eschenbach, M.D. (hhs.gov/ about/, 2007). 9) Administration on Aging (AoA) The AoA ranks as the ninth largest division of the HHS. Its headquarters are in Washington D.C., and it has a 2007 budget of 1.3 billion. The aim of the AoA is to make life easy for elderly American citizens, elevating their status to be self-supporting, healthy, safe and free from worry (hhs.gov/about/, 2007). Following the regulations of the Older Americans Act (Wikipedia, 2007), the AoA allocates funds to state-run agencies to provide services such as meals, transportation, information and help, providing non-government nursing-home complaint investigator, medical worker or allied health professional to assist in management of illness or disability, and elder rights protection and health care. The AoA currently has 117 employees led by Assistant Secretary Josefina G. Carbonell (hhs.gov/about/, 2007). 10) Agency for Healthcare, Research & Quality (AHRQ) The AHRQ is the HHS’ tenth largest division. It has a 2007 budget of 319 million and its headquarters are in Rockville, Maryland (hhs. gov/about/, 2007). A successor of the Agency for Health Care Policy & Research (AHCPR), the AHRQ seeks to improve existing health care provided to Americans citizens. It funds research on all aspects of health care such as quality, cost, availability, and results with the aim of achieving improvement on all fronts. The AHRQ uses four modules during its research – Prevention Quality Indicators, Patient Safety Indicators, Pediatric Quality Indicators and Inpatient Safety Indicators – to evaluate all existing features of health care from hospital data within the country. There are 309 persons presently employed in the AHRQ, and the division is led by Director Carolyn Clancy, M.D. (hhs.gov/about/, 2007). 11) Office of the Secretary of Health (OS) The OS is the leadership division of the HHS, overseeing the operations of its ten divisions. The current HHS Secretary is Republican politician Michael Okerlund Leavitt (Wikipedia, 2007) with Alex Alzar as his deputy. The OS has several subordinate offices contained within its sphere such as the Program Support Center (hhs.gov/about/, 2007) currently headed by director Philip van Landingham (Wikipedia, 2007), Office of Civil Rights, Office of the Inspector General and Office of Public Health & Science (hhs.gov/about/, 2007). D) Recent HHS regulations The HHS has introduced several new regulations since it started operating. Some of these have been transactional while others have been transformational. Three examples are cited below. September 1999 witnessed the tragic death of 18 year old Jesse Gelsinger during a gene transfer experiment conducted by the NIH division of the HHS. Following the public uproar in the wake of this tragedy (with echoes even emanating from the U.S. Congress), the HHS introduced new regulations to strengthen protection measures to be taken by human subjects during the course of biomedical research. The new regulations featured on 3 levels: on the federal level (HHS), by improving transparency of its human subjects protection measures; on the institutional level (research institutions, universities, medical centers), by collecting more information about their research activities and strengthening surveillance of their activities with the aim of seeing that they strictly adhere to governing regulations; and on the individual investigator level (scientists, physicians, and other professionals), by enhancing efforts to educate them, thereby supplementing their knowledge about awareness of regulations and proper compliance of such rules with ethical prudence (Heinrich, 2001). This regulation is transformational as it changed existing procedures, transforming them into methods that generated more trust and satisfaction from the public. In a second example, following an alarming increase in frauds involving unauthorized use of medical records and other health information of patients, the HHS introduced new regulations (that took effect from April 14, 2003) representing the first of its kind federal privacy regulations to limit the use of medical and other health information of patients by doctors, hospitals and other suppliers of health care. The new regulations required health care providers to allow patients access to their own medical records within 30 days, even allowing them to request correction for what they consider erroneous information about them; the health care provider should then give written notices to patients about how the former could use the information, and get the patients to sign the notice denoting their agreement to allow their personal information to be used by the health care provider as stated in the notice (hhs.gov/news/, 2003). This regulation too is transformational as it transforms the information providing system, preventing fraud and thereby changing it from a hazardous one to a tampering-proof procedure, thereby safeguarding the interest of American citizens. In a third example, the HRSA division of HHS announced a new regulation, increasing existing fees for information from the National Practitioner Data Bank (NPDB) from $ 3.15 to $ 4.75. This regulation, backed by applicable laws that allow the Department to recover the full cost of operating the Data Bank through user fees, came into force on May 9, 2006 (oig.hhs.gov/authorities/, 2006). This regulation is transactional, as it is just a mathematical addition to already existing fees, taken within the scope of related regulations that govern it. E) Recent HHS enforcement actions During the course of its operations, the HHS has taken many enforcement actions. In one example, in November 2006 a podiatrist in Arizona was charged with theft of government funds. The practitioner had supplied standard foot care service, and knowing that Medicare does not cover such a service, he instead fraudulently billed Medicare for surgical removal of foreign material and dead tissue from a wound in order to prevent infection and promote healing. The podiatrist had to pay $ 400,000 in restitution for his crime. In a second example, in October 2006 a professional heavyweight male boxer in Michigan was ordered to pay $ 49,000 and serve a 5 year probation sentence for not paying child support for his daughter. In a third example, in September 2006 a physician in Georgia was given a 8 month prison sentence accompanied by a $ 136,000 fine because he put forward claims to Medicare supported by a forged signature prescription for motorized wheelchairs. In a fourth example, in August 2006 a physician in Michigan who recommended OxyContin to several patients as a remedy for long-lasting, recurring pain had to pay $ 194,000 in restitution and fines for mail fraud. His crime was not paying attention to the drug-seeking tendency of some patients thereby causing them to become addicted to OxyContin; in addition, several insurers including Medicaid were obliged to pay for drugs that were in fact not for a genuine purpose (oig.hhs.gov/fraud/, 2006). F) Recent U.S. court rulings of interest regarding HHS There have been several U.S. court rulings of interest regarding HHS. Some recent examples (by U.S. District, Circuit and Supreme Court) are cited below. On 13 April 2005, in Nutraceutical Corp. v. DHHS (Utah), U.S. District Judge Tena Campbell ruled against the FDA’s plea to prevent Nutraceutical Corp. and Solaray Inc. from selling a dietary addition that contained 10 mg or less of ephedrine alkaloids in each daily dose on the grounds that it provoked “unreasonable risk of illness or injury.” The Court ruled that the FDA had not produced sufficient evidence to back its claim, adding that rather than requiring Nutraceutical Corp. to prove innocence, it was the duty of the FDA to properly prove guilt (fda.gov/, 2005). On July 1, 2005, in Baystate Health System v. Leavitt (the lead case for nearly 600 hospitals with similar grievance), the District of Columbia Circuit Court of Appeals ruled against the HHS, ordering it to allow disproportionate share hospital (‘DSH’) cost figures to include all eligible Medicaid days within a 3 year period starting from February 29, 1997 (ppsv.com/, 2005). On June 22, 2000, in Olmstead v. L.C., the U.S. Supreme Court ruled that helping disabled persons return to good health and a normal life by providing training and therapy without any good reason or explanation constitutes “unjustified institutionalization” and contravenes the rights of such persons as provided by the Americans with Disabilities Act (ADA). The U.S. Supreme Court also pronounced rulings on that same day in 3 other disability related cases – Sutton v. United Air Lines Inc., Murphy v. United Parcel Service Inc., and Albertsons Inc. v. Kirkingburg. In all 3 cases, the Court ruled that disabled persons taking corrective medicines or using assistive tools (like eyeglasses) are not eligible for protection under the ADA (mentalhealth.samhsa.gov/, 2000). G) Conclusion 34th U.S. President Dwight D. Eisenhower who once said: “There is nothing wrong with America that the faith, love of freedom, intelligence and energy of her citizens cannot cure” (usa-patriotism.com), would be delighted at the progress the HEW has made since he initiated it on April 11, 1953. Aided by lavish funding from successive U.S. governments, HEW successor HHS has shrugged off hindering burdens of other portfolios (Education, Welfare) and has grown from strength to strength, improving and growing in stature as time goes by. Perhaps the best indication of the present high stature of the HHS is contained in the wistful claim of Andy Stern, President of the largest union of health care workers in the U.S., who is known to have said: “America needs a plan for the 21st century. Not a Democratic or Republican plan, or a business or labor plan. We need an American plan to ensure that every man, woman and child living in this country has access to quality care they can afford” (CommonDreams.org, 2007). The fact that very-hard-to-please Stern, during a meeting with HHS Secretary Mike Leavitt on January 22, 2007, not only warmly lauded Leavitt’s devotion and dedication towards bringing into existence greater transparency in the country’s health care system, but also added his name in support of Leavitt’s “Four Cornerstones of Value-driven Health Care” {a set of basic assumptions targeting the radical improvement in public reporting standards of health care cost and quality information} (CommonDreams,org, 2007), is just one indication that the HHS is moving in the right direction, faithfully abiding by the charter entrusted to it by the nation, truly proving the famous words of 43rd U.S. President George W. Bush: “There is no limit to the greatness of America!” (usa-patriotism.com). References used: Anon. (2007). About HHS. Retrieved February 1, 2007, from HHS Web site: http://www.hhs.gov/about/whatwedo.html/ Anon. (2005). Court Decisions & Updates. Retrieved February 1, 2007, from FDA Web site: http://www.fda.gov/ora/about/enf_story/ch7/default.pdf Anon. (2005). District of Columbia Circuit Decision in Baystate Health System v. Leavitt. Retrieved from Powers Pyles Sutter & Verville P.C. Web site: http:// www.ppsv.com/issues/baystate.htm Anon. (2006). Healthcare Integrity and Protection Data Bank: Change in User Fees. Retrieved February 1, 2007, from HHS OIG Web site: http://www.oig. hhs.gov/authorities/docs/06/hipdb%202006%20user%20fee%20notice.pdf Anon. (2006). HHS-OIG – Fraud Prevention & Detection – Enforcement Actions. Retrieved February 1, 2007, from HHS OIG Web site: http://www.oig.hhs.gov /fraud/enforcement/criminal/criminal.html Anon. (n.d.). Famous Quotes. Retrieved February 3, 2007, from usa-patriotism.com Web site: http://www.usa-patriotism.com/tribute/quotes/_list.htm Anon. (2003). Protecting the Privacy of Patients’ Health Information. Retrieved February 1, 2007, from HHS Web site: http://www.hhs.gov/news/ facts/privacy.html Anon. (2000). Rights Round Up: Supreme Court Decisions. Retrieved February 1, 2007, from HHS-SAMHSA Web site: http://mentalhealth.samhsa.gov/ publications/allpubs/cmh00-5024/cabvo400-06.asp Anon. (2007). United States Department of Health and Human Services. Retrieved February 1, 2007, from Wikipedia Web site: http://en.wikipedia.org/ wiki/ United_States_Department_of_Health_and_Human_Services Anon. (2007). United States Department of Health & Human Services. Retrieved February 3, 2007, from Answers.com Web site: http://www.answers.com/topic/ united-states-department-of-health-and-human-services Heinrich, Janet. (2003). Human Subjects Research: HHS Takes Steps to Strengthen Protection, But Concerns Remain. Retrieved February 1, 2007, from GAO Web site: http://www.gao.gov/new.items/d01775t.pdf Howard, Sara. (2007). President of Nation’s Largest Health Care Union Meets with HHS Secretary Mike Leavitt. Retrieved February 3, 2007, from CommonDreams.org Web Site: http://www.commondreams.org/news2007/0122-10.htm Read More