United States Department of Health and Human Services

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United States Department of Health and Human Services
US Department of Health and Human Services seal.svg
Seal of the U.S. Department of Health & Human Services
Flag of the United States Department of Health and Human Services.svg
Flag of the U.S. Department of Health & Human Services
Hubert H. Humphrey Building, located at the foot of Capitol Hill, Washington, D.C LCCN2013634632.jpg
Hubert H. Humphrey Building, Department headquarters
Department overview
FormedMay 4, 1980
Preceding agencies
Jurisdiction Federal Government of the United States
Headquarters Hubert H. Humphrey Building
Washington, D.C.
Employees83,202  OOjs UI icon edit-ltr-progressive.svg
Annual budget$1.631 trillion (2022) [1]
Department executives
Website www.hhs.gov OOjs UI icon edit-ltr-progressive.svg

The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of the U.S. people and providing essential human services. Its motto is "Improving the health, safety, and well-being of America". [2] Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).

Contents

HHS is administered by the secretary of health and human services, who is appointed by the president with the advice and consent of the United States Senate. The position is currently held by Xavier Becerra.

The United States Public Health Service Commissioned Corps, the uniformed service of the PHS, is led by the surgeon general who is responsible for addressing matters concerning public health as authorized by the secretary or by the assistant secretary for health in addition to his or her primary mission of administering the Commissioned Corps.

History

Federal Security Agency

The Federal Security Agency (FSA) was established on July 1, 1939, under the Reorganization Act of 1939, P.L. 76–19. The objective was to bring together in one agency all federal programs in the fields of health, education, and social security. The first Federal Security Administrator was Paul V. McNutt. [3] The new agency originally consisted of the following major components: (1) Office of the Administrator, (2) Public Health Service (PHS), (3) Office of Education, (4) Civilian Conservation Corps, and (5) Social Security Board.[ citation needed ]

Department of Health, Education, and Welfare

Seal of the United States Department of Health, Education, and Welfare.svg
Flag of the Department of Health, Education, and Welfare.png
The seal and flag of the U.S. Department of Health, Education, and Welfare until 1979

The Department of Health, Education, and Welfare (HEW) was created on April 11, 1953, when Reorganization Plan No. 1 of 1953 became effective. HEW thus became the first new Cabinet-level department since the Department of Labor was created in 1913. The Reorganization Plan abolished the FSA and transferred all of its functions to the secretary of HEW and all components of the agency to the department. The first secretary of HEW was Oveta Culp Hobby, a native of Texas, who had served as commander of the Women's Army Corps in World War II and was editor and publisher of the Houston Post . Sworn in on April 11, 1953, as secretary, she had been FSA administrator since January 21, 1953.[ citation needed ]

The six major program-operating components of the new department were the Public Health Service, the Office of Education, the Food and Drug Administration, the Social Security Administration, the Office of Vocational Rehabilitation, and St. Elizabeth's Hospital. The department was also responsible for three federally aided corporations: Howard University, the American Printing House for the Blind, and the Columbia Institution for the Deaf (Gallaudet College since 1954). [4]

Department of Health & Human Services

The Department of Health, Education, and Welfare was renamed the Department of Health & Human Services (HHS) on October 17, 1979, [5] when its education functions were transferred to the newly created United States Department of Education under the Department of Education Organization Act. [6] HHS was left in charge of the Social Security Administration, agencies constituting the Public Health Service, and Family Support Administration.[ citation needed ]

In 1995, the Social Security Administration was removed from the Department of Health & Human Services, and established as an independent agency of the executive branch of the United States government.

The 2010 United States federal budget established a reserve fund of more than $630 billion over 10 years to finance fundamental reform of the health care system. [7]

Organization

Internal structure

The Department of Health & Human Services is led by the United States Secretary of Health and Human Services, a member of the United States Cabinet appointed by the President of the United States with the consent of the United States Senate. The secretary is assisted in managing the department by the Deputy Secretary of Health and Human Services, who is also appointed by the president. The secretary and deputy secretary are further assisted by seven assistant secretaries, who serve as top departmental administrators.[ citation needed ]

As of January 20, 2018, this is the top level of the organizational chart. HHS provides further organizational details on its website. [8]

Several agencies within HHS are components of the U.S. Public Health Service (PHS), as noted below.

Immediate Office of the Secretary

The Immediate Office of the Secretary (IOS) is the top-level unit that directly reports to the Secretary of Health and Human Services. They assist in the administration of HHS and include the following components:

Office of the Secretary

The Office of the Secretary (OS) is the unit directly below the Immediate Office of the Secretary, but still directly reports to the Secretary. This unit consists of the offices of assistant secretaries including:[ citation needed ]

Office of Intergovernmental and External Affairs

The Office of Intergovernmental and External Affairs (IEA) serves as the liaison to state, local and tribal governments as well as NGOs. Through the IEA, HHS directs and oversees current federal health programs at the regional and tribal levels.

HHS IEA Regional Offices
RegionRegional DirectorSubordinated States
Region 1Paul JacobsenConnecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
Region 2Dennis GonzálezNew Jersey, New York, Puerto Rico, and the Virgin Islands
Region 3Dalton PaxtanDelaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia
Region 4Thomas BowmanAlabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee
Region 5Joshua DevineIllinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
Region 6Julia LothropArkansas, Louisiana, New Mexico, Oklahoma, and Texas
Region 7Scott ConnerIowa, Kansas, Missouri, and Nebraska
Region 8Elsa RamirezColorado, Montana, North Dakota, South Dakota, Utah, and Wyoming
Region 9Bonnie PrestonArizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the Northern Mariana Islands,
Federated States of Micronesia, Guam, Marshall Islands, and Republic of Palau
Region 10Renée BouvionAlaska, Idaho, Oregon, and Washington

U.S. Public Health Service

Within HHS is a collection of agencies and offices that fall under the Public Health Service. The PHS also is home to the Public Health Service Commissioned Corps (PHSCC).[ citation needed ]

The subordinate operating agencies under the Public Health Service:

Human Services agencies

This list includes the subordinate agencies that do not fall under the Public Health Service, but are under HHS:

Office of Inspector General

The Office of Inspector General, U.S. Department of Health and Human Services (OIG) investigates criminal activity for HHS. The special agents who work for OIG have the same title series "1811" as other federal criminal investigators, such as the FBI, HSI, ATF, DEA and Secret Service. They receive their law enforcement training at the U.S. Department of Homeland Security's Federal Law Enforcement Training Center in Glynco, Georgia. OIG Special Agents have special skills in investigating white collar crime related to Medicare and Medicaid fraud and abuse. Organized crime has dominated the criminal activity relative to this type of fraud.[ citation needed ]

HHS-OIG investigates tens of millions of dollars in Medicare fraud each year. In addition, OIG will continue its coverage of all 50 states and the District of Columbia by its multi-agency task forces (PSOC Task Forces) that identify, investigate, and prosecute individuals who willfully avoid payment of their child support obligations under the Child Support Recovery Act.[ citation needed ]

HHS-OIG agents also provide protective services to the Secretary of HHS, and other department executives as necessary.

In 2002, the department released Healthy People 2010, a national strategic initiative for improving the health of Americans.

With the passage of the Fraud Enforcement and Recovery Act of 2009, and the Affordable Care Act of 2010, the Office of the Inspector General has taken an emboldened stance against healthcare-related non-compliance, most notably for violations of Law and the Anti-Kickback Statute. [10]

In 2015, the OIG issued a fraud alert as a warning to hospitals and healthcare systems to monitor and comply with their physician compensation arrangements. [11]

Recent years have seen dramatic increases in both the number and the amounts of Stark Law violation settlements, prompting healthcare experts to identify a need for automated solutions that manage physician arrangements by centralizing necessary information concerning physician–hospital integration. [12] Contract management software companies such as Meditract provide options for health systems to organize and store physician contracts. Ludi Inc introduced DocTime Log®, an SaaS solution that specifically addresses this growing concern, automating physician time logging in compliance with contract terms to eliminate Stark Law and Anti-Kickback Statute violations. [13]

According to a report released by the OIG in July 2019, more than 80 percent of the 4,563 U.S. hospice centers that provide care to Medicare beneficiaries surveyed from 2012 to 2016 have at least one deficiency and 20 percent have at least one "serious deficiency". [14]

From January 2020, Christi Grimm became the principal deputy inspector general. She assumed the duties of an acting inspector general because the inspector general post was empty. [15] In April 2020, Grimm released a report which surveyed the state of hospitals in late March during the COVID-19 pandemic in the United States. The hospitals reported "severe shortages of testing supplies", "frequently waiting 7 days or longer for test results", which extended the length of patient stays and strained resources, and "widespread shortages of PPE". [16] President Trump called the report "wrong" and questioned Grimm's motives. Later he called the report "Another Fake Dossier!" [17] In May 2020, Trump nominated Jason Weida to be the permanent inspector general, pending confirmation by the U.S. Senate. According to a department spokeswoman, Grimm will remain as principal deputy inspector general. [18]

Former operating divisions and agencies

Budget and finances

The Department of Health and Human Services was authorized a budget for fiscal year 2020 of $1.293 trillion. The budget authorization is broken down as follows: [19]

ProgramBudget authority (in millions)
Food and Drug Administration$3,329
Health Resources and Services Administration$11,004
Indian Health Service$6,104
Centers for Disease Control and Prevention$6,767
National Institutes of Health$33,669
Substance Abuse and Mental Health Services Administration$5,535
Agency for Healthcare Research and Quality$0
Centers for Medicare & Medicaid Services$1,169,091
Administration for Children and Families$52,121
Administration for Community Living$1,997
Departmental Management$340
Non-Recurring Expense Fund$-400
Office of Medicare Hearings and Appeals$186
Office of the National Coordinator$43
Office for Civil Rights$30
Office of Inspector General$82
Public Health and Social Services Emergency Fund$2,667
Program Support Center$749
Offsetting Collections$-629
Other Collections$-163
TOTAL$1,292,523

The FY2020 budget included a $1.276 billion budget decrease for the Centers for Disease Control and Prevention and a $4.533 billion budget decrease for the National Institutes of Health. These budget cuts, along with other changes since 2019, comprised a total decrease of over $24 billion in revised discretionary budget authority across the entire Department of Health and Human Services for Fiscal Year 2020. [19]

Additional details of the budgeted outlays, budget authority, and detailed budgets for other years, can be found at the HHS Budget website. [20]

Programs

The Department of Health & Human Services administers 115 programs across its 11 operating divisions. [21] The United States Department of Health & Human Services (HHS) aims to "protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves." [22] These federal programs consist of social service programs, civil rights and healthcare privacy programs, disaster preparedness programs, and health-related research. HHS offers a variety of social service programs geared toward persons with low income, disabilities, military families, and senior citizens. [23] Healthcare rights are defined under HHS in the Health Insurance Portability and Accountability Act (HIPAA) which protect patient's privacy in regards to medical information, protects workers health insurance when unemployed, and sets guidelines surrounding some health insurance. HHS collaborates with the Office of the Assistant Secretary for Preparedness and Response and Office of Emergency Management to prepare and respond to health emergencies. [24] [25] A broad array of health-related research is supported or completed under the HHS; secondarily under HHS, the Health Resources & Service Administration houses data warehouses and makes health data available surrounding a multitude of topics. [26] [27] HHS also has vast offering of health-related resources and tools to help educate the public on health policies and pertinent population health information. Some examples of available resources include disease prevention, wellness, health insurance information, as well as links to healthcare providers and facilities, meaningful health-related materials, public health, and safety information. [28] [29] [30] [31] [32] [33]

Some highlights include:

The Health Insurance Portability and Accountability Act (HIPAA)

This program is to ensure the accountability of medical professionals to respect and carry out basic human health rights, under the act of the same name. In the United States, the government feels that it is essential for the American people to understand their civil duty and rights to all of their medical information. That includes health insurance policies or medical records from every doctor or emergency visit in one's life. Through Health & Human Services one can file a complaint that their HIPAA rights have been violated or a consultant will be able to decide if their rights were violated.

Social Services

This branch has everything to do with the social justice, wellness, and care of all people throughout the United States. This includes but is not limited to people who need government assistance, foster care, unaccompanied alien children, daycares (headstart included), adoption, senior citizens, and disability programs. Social services is one of (if not) the largest branch of programs underneath it that has a wide variety throughout the United States at a state and local level.[ citation needed ]

Prevention and Wellness

The prevention and wellness program's main idea is to give the American people the ability to live the healthiest and best lifestyle physically that they can. They are the ones who deal with vaccines and immunizations, which fight from common diseases to deadly ones. The nutrition & fitness program are the basics of healthy eating and regular exercise. Health screenings & family health history are crucial in the knowledge of each individual's health and body. A severely important one especially in today's society is mental health and substance use where they help people with mental illness and drug abuse. Lastly, they help with environmental health where people are researching and studying how our environments both physical and metaphorical have short- and long-term effects on our health and wellness.

Strengthening Communities Fund

In June 2010, the Department of Health & Human Services created the Strengthening Communities Fund [35] as part of the American Recovery and Reinvestment Act. The fund was appropriated $50 million to be given as grants to organizations in the United States that were engaged in Capacity Building programs. The grants were given to two different types of capacity builders:

Biodefense

HHS plays a role in protecting the United States against bioterrorism events. In 2018, HHS released a new National Biodefense Strategy required by the passage of the 2016 Biodefense Strategy Act. The Biodefense Strategy required the implementation of a biodefense strategy after a 2015 Blue Ribbon Study Panel on Biodefense report found that the 2009 National Strategy for Countering Biological Threats was inadequate in protecting the U.S. The strategy adopted these five central recommendations: creating a single centralized approach to biodefense; implementing an interdisciplinary approach to biodefense that brings together policymakers, scientists, health experts, and academics; drawing up a comprehensive strategy to address human, plant, and animal health; creating a defense against global and domestic biological threats; and creating a proactive policy to combat the misuse and abuse of advanced biotechnology. [37]

HHS also runs the Biodefense Steering Committee, which works with other federal agencies including the U.S. Department of State, U.S. Department of Defense, U.S. Food and Drug Administration, U.S. Department of Homeland Security (DHS), and the Environmental Protection Agency. [37] HHS specifically oversees Project BioShield, established in 2003 and operating since 2004, and its development and production of vaccines.

Criticisms and controversies

In 2016, a published US Senate report revealed that several dozen unaccompanied children from Central America, some as young as 14 years old, were released from custody to traffickers where they were sexually assaulted, starved, or forced to work for little or no pay. [38] The HHS sub agency Office of Refugee Resettlement (ORR) released approximately 90,000 unaccompanied children during 2013–2015 but did not track their whereabouts or properly screen families accepting these children. [39]

To prevent similar episodes, the Homeland Security and Health & Human Services Departments signed a memorandum of understanding in 2016 and agreed to establish joint procedures within one year for dealing with unaccompanied migrant children. As of 2018, they have failed to do so. Between October and December 2017, officials from ORR tried to contact 7,635 children and their sponsors. From these calls, officials learned that 6,075 children remained with their sponsors. Twenty-eight had run away, five had been removed from the United States and fifty-two had relocated to live with a nonsponsor. However, officials have lost track of 1,475 children. [40] ORR claims it is not legally liable for the safety and status of the children once released from custody. [41]

HHS is evidenced to be actively coercing and forcing bio-substances such as antipsychotics [42] on migrating children without consent, and under questionable medical supervision. Medical professionals state that wrongly prescribed antipsychotics are especially dangerous for children, and can cause permanent psychological damage. [43] Medical professionals also state DHS and HHS incarceration and separation policies are likewise causing irreparable mental harm to the children. [44] [45]

Children are also dying in HHS custody. [46] The forced drugging, deaths, and disappearances of migrating Mexican and Central American children might be related to DHS falsely labeling them and their families as 'terror threats' before HHS manages their incarcerations. Despite a federal court order, [47] the DHS separation practices started by Obama [48] and mandated by the Trump administration's "zero-tolerance" policy [49] have not been halted, and HHS has not stopped forcing drugs on the children it incarcerates.

In August 2022, the Office of the Inspector General for Health and Human Services reported that NIH had failed in its oversight of clinical trials, with slightly over half of sample trial results either being tardy for publication or remaining unpublished on ClinicalTrials.gov after several years from the stated completion dates. [50]

Freedom of Information Act processing performance

In the latest Center for Effective Government analysis of 15 federal agencies which receive the most Freedom of Information Act (FOIA) requests published in 2015 (using 2012 and 2013 data, the most recent years available), the DHHS ranked second to last, earning an F by scoring 57 out of a possible 100 points, largely due to a low score on its particular disclosure rules. It had deteriorated from a D− in 2013. [51]

See also

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References

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  6. ↑ Full text of the Department of Education Organization Act; Archived May 7, 2018, at the Wayback Machine , P.L. 96-88.
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  10. ↑ Ellison, Ayla (January 8, 2015). "4 trends in the current Stark Law enforcement climate". Becker's Hospital Review. Archived from the original on August 29, 2015.
  11. ↑ "Fraud Alert: Physician Compensation Arrangements May Result in Significant Liability" (PDF). OIG. June 9, 2015. Archived (PDF) from the original on July 1, 2015.
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  14. ↑ Yancey-Bragg, N'dea; Hines, Morgan (July 9, 2019). "Hundreds of US hospices have at least one 'serious deficiency,' report says". USA TODAY. Retrieved July 15, 2019.
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