Bioterrorism preparedness

Expanded access to health care

Disease prevention initiative

Improving quality of care

Next steps for helping those in need

Smoking, teen substance abuse decline

Protecting patient privacy

Regulatory reform

Spending increased ten-fold - HHS' budget for bioterrorism preparedness increased ten-fold, from $305 million in FY 2001 to $2.98 billion in FY 2002.

Support for states and major cities - Of the budget increase, more than $1 billion was provided to states and major cities to support increased preparedness by hospitals and public health systems.  HHS worked with states on preparedness plans, emphasizing coordination and regional cooperation. The objective is local preparedness, with national resources ready to be deployed immediately whenever and wherever needed.

Smallpox and other vaccines - HHS took steps to provide enough smallpox vaccine to be able to vaccinate every American, in the possible event of a release of this disease.  In December, President Bush announced a careful policy of voluntary vaccination for front-line health care and emergency personnel, to ensure effective response if the disease were released.  Vaccination of others is not recommended at this time, in the absence of an emergency.  In addition, production of the current anthrax vaccine was resumed, and research into improved vaccines for anthrax and other diseases was accelerated.

Disease surveillance and communications - In order to detect any possible release of disease agents by terrorists, the nation's disease surveillance system is being expanded, with spending increased from $67 million in FY 2001 to $940 million in FY 2002.  This expansion will also help to quickly identify outbreaks of naturally-occurring diseases. HHS' Centers for Disease Control and Prevention's (CDC) "Epidemic Information Exchange" (Epi-X) is being strengthened.  The nation's network of public health laboratories is being expanded.  And health communications systems overseen by CDC are being improved and expanded.

Pharmaceutical stockpile - The National Pharmaceutical Stockpile completed purchase of more than a billion doses of antibiotics and other materials to be ready on stand-by.  The number of 50-ton "Push Packs," ready to reach any part of the U.S. within 12 hours, was increased from eight to 12.

Research - Research into disease agents, diagnostic tools, vaccines and treatments is being rapidly expanded, a key element of the long-term strategy for countering bioterrorism.  Research funding increased from $53 million in FY 2001 to $151 million for FY 2002, with much larger increases planned for FY 2003 to begin carrying out research agendas developed this year.  The President has proposed building new laboratory facilities for research involving the most dangerous pathogens. Over 700 new research proposals were funded this year.  In addition, new rules were issued for registering and controlling potential bioterror disease agents by researchers.

Food safety - With 80 percent of America's food supply regulated by HHS' Food and Drug Administration (FDA), resources for food inspections were increased.  More than 700 new inspectors were hired, making it possible for FDA to conduct 24,000 on-site import inspections, nearly double the past capacity.  FDA also developed new risk assessment methods for targeting potential problem areas.  Working with the Agriculture Department, FDA also expanded the capacity of its systems for identifying foodborne illness outbreaks.

Personnel and leadership - Training for the nation's health care professionals was increased.  In addition, HHS created a new Office of Public Health Emergency Preparedness to coordinate efforts within HHS and with the new Department of Homeland Security.  HHS also hardened its own information systems, and created a new central command and communications center for emergencies.

Expanding coverage through SCHIP and Medicaid - In 2002, HHS approved waiver and plan amendments for state SCHIP and Medicaid programs that expanded access to health coverage to more than 600,000 additional Americans.  These changes provided additional services to more than 1 million other beneficiaries.  Since the start of Bush Administration, HHS has approved waivers and plan amendments that expand access to coverage to nearly 1.8 million Americans and improved benefits for more than 5 million other Americans.   HHS provides matching funding for coverage provided by states under Medicaid and SCHIP.

Expanding Community Health Centers - In 2002, HHS completed the first full year of President Bush's five-year initiative to add or expand health centers in 1,200 communities by 2006 and to increase the number of patients served annually to more than 16 million -- up from 10 million in 2001.  During the fiscal year, HHS funded 171 new health center sites and awarded 131 grants to existing centers to help them build capacity and expand services.   Together, these new and expanded health centers will serve an additional 1.5 million patients each year, including many without insurance.

Bringing doctors and other clinicians to underserved areas – To support the growth of the health centers, HHS also expanded its National Health Service Corps, which offers scholarships and loan repayment plans to students and fully trained clinicians who agree to serve in health centers and other underserved communities.

Promoting seniors' access to prescription drugs - While Congress failed to enact a Medicare prescription drug benefit, HHS developed a model waiver template in 2002 to encourage states to offer low-income seniors access to prescription drugs through the Medicaid program.  By the end of the year, HHS approved Pharmacy Plus waivers in five states - Florida, Illinois, Maryland, South Carolina and Wisconsin, helping more than half a million seniors afford access to prescription drugs.

Encouraging high-risk insurance pools - In November 2002, HHS launched a new program to help states create high-risk pools that will provide health coverage to individuals who otherwise would have difficulty obtaining coverage because of their health status.  HHS' Centers for Medicare and Medicaid Services (CMS) is offering seed grants of up to $1 million to support state efforts to create high-risk pools, typically non-profit associations.  A total of $20 million is available through this program.  In addition, HHS expects to offer a total of $80 million in grants over two years to help cover losses incurred by states with existing high-risk pools.

Physical Activity - HHS released a report April 7 showing that seven in 10 American adults are not regularly active.  In another report June 21, HHS outlined the special benefits of physical activity and moderate exercise for older Americans.  CDC launched a $190 million multicultural media campaign July 17 aimed at promoting a healthier lifestyle for young people, especially those aged 9 to 13.  HHS also joined with the U.S. Department of Education to encourage communities and businesses to find new ways to support physical activity among children.  And in May, Secretary Thompson marked Older Americans Month with a new campaign, "USA on the Move: Steps to Healthier Aging," in cooperation with the Center on Nutrition and Aging at Florida International University.

Healthy Diet - Secretary Thompson released a report June 20 showing that overweight and obesity cost America $117 billion annually and account for at least 14 percent of deaths in the U.S., or some 300,000 premature deaths each year.  Nearly one-third of U.S. adults now classify as obese, and obesity among young people is growing rapidly.  In April, HHS joined with the U.S. Department of Agriculture in expanding a campaign to promote consumption of fruits and vegetables.  In October, Secretary Thompson and USDA Secretary Ann M. Veneman met with officials from the National Restaurant Association and the National Council of Chain Restaurants to begin a cooperative effort to improve health information and healthy foods, especially for young people.  In December, FDA launched a new effort to improve health labeling for nutritious foods.

Diabetes - Sedentary lifestyle and poor eating habits increase the risk of diabetes, and the prevalence of diabetes and pre-diabetes is increasing rapidly in the U.S.  On November 20, Secretary Thompson launched the first national diabetes prevention campaign, "Small Steps - Big Rewards," which builds on new findings that modest lifestyle changes can have a major impact on preventing the disease.  Earlier in the year, HHS had also launched new steps with the American Diabetes Association (ADA) to better inform those with diabetes of the most severe effects of the disease. HHS also worked with the ADA and the National Association of Chain Drug Stores on a campaign to help women recognize the danger signs of diabetes. The campaign also provided free diabetes screening for women in cities with a high incidence of the disease.  In addition, beginning in October, $100 million was made available to tribal organizations for prevention and treatment of diabetes among American Indians and Alaska Natives, especially children and teenagers. On average, American Indians and Alaska Natives are 2.6 times more likely to have diabetes than non-Hispanic whites of similar age.

HIV/AIDS - In addition to efforts to improve health for all Americans through healthy diet and exercise, HHS maintained and expanded its efforts to prevent HIV/AIDS and support treatment, both domestically and internationally.  Total HHS spending on HIV/AIDS increased from $11.4 billion in FY 2001 to $12.1 billion in FY 2002, with a further increase of almost $1 billion proposed in the President's budget for FY 2003.  HHS' contribution to the global effort against HIV/AIDS increased from $276 million in FY 2001 to $468 million in FY 2002.

Racial and ethnic health disparities - HHS also undertook new efforts toward closing the health gap between non-minority Americans and racial and ethnic minorities.  Total HHS spending especially directed at minority health (not including the Indian Health Service) was $2.6 billion in FY 2002, up from $2.3 billion in FY 2001.  Grants to support elimination of disparities were made nationwide by the HHS Office of Minority Health and the National Institute of Health's (NIH) institutes.  In addition, HHS convened the first National Leadership Summit on Eliminating Racial and Ethnic Disparities in Health; and HHS launched a two-year demonstration project in five states to test new ways of improving flu vaccination rates in minority communities.  HHS' Health Resources and Services Administration (HRSA) expanded its Diabetes Collaboratives to better reach minorities, who suffer disproportionately from diabetes.  And a new effort, "Take a Loved One to the Doctor Day," was launched in partnership with ABC broadcasting's Urban Radio Network to encourage improved health screening and access to health care facilities for minority Americans.

Publishing national nursing home quality measures - In November 2002, HHS launched a national nursing home quality initiative that combines comparative data about quality for consumers with intensified efforts to assist nursing homes to improve the quality of care that they provide to their residents.  The consumer data for all nursing homes serving Medicare and Medicaid patients is available at http://www.medicare.gov or by calling 1-800-MEDICARE.  Ten quality measures, developed with private-sector help, are included in the data.  CMS pilot-tested the consumer data in six states before launching the effort nationally.

Developing hospital quality measures - In December 2002, HHS joined the nation's major hospital trade associations in announcing a new initiative to provide quality information about hospitals to the public. Under the program, HHS will help validate and publish key quality measures involving cardiac care and pneumonia that hospitals voluntarily report.  In addition, AHRQ will develop a standardized patient survey that will provide comparative information about hospitals.

Developing new tools to measure quality - AHRQ continued efforts toward building a national information structure to provide sound measures of health care quality.  During 2002, AHRQ introduced the Prevention Quality Indicators, a software tool for detecting potentially avoidable hospital admissions for illnesses which can be effectively treated with high-quality, community-based primary care.  AHRQ also launched its Inpatient Quality Indicators, a software tool consisting of 29 measures that can be used to help hospitals identify potential problem areas and provide an indirect measure of hospital quality of care.

Hormone therapy - NIH stopped a major clinical trial early, which was looking at risks and benefits of combined estrogen and progestin therapy in healthy menopausal women.  The study was stopped when conclusive evidence was found of increased risk of invasive breast cancer.  The study also found increases in coronary heart disease, stroke and pulmonary embolism.  NIH convened a scientific workshop to review the findings and help clinicians and patients understand the implications of current knowledge for decisions regarding use of such therapy.  The U.S. Preventive Services Task Force published new recommendations on the use of the therapy.  And FDA undertook proceedings to consider appropriate label changes for hormone therapy products.

Welfare caseload stays down - In November, HHS released the latest data on the nation's welfare caseload.  The number of Americans receiving welfare assistance declined again, by about 4.5 percent, between December 2001 and June 2002.  Altogether, the number of individuals receiving welfare has declined 58 percent since enactment of welfare reform law in 1996. Census data released in September also showed that in 2001 the poverty rate for African-American children reached the lowest level ever reported.  As governor of Wisconsin, Secretary Thompson had created the national model for welfare reform, and he led the administration's efforts this year to achieve the next step in reform by reauthorizing and improving the 1996 law.  While a measure passed in the House of Representatives, the Senate failed to take action.  Reauthorization efforts will resume in 2003.

Faith-based initiative - HHS provided $30 million in funding for the President's Faith-Based and Community Initiative, to help level the playing field for religious and other organizations seeking to use HHS funds to help those in need.  Faith- and community-based organizations are often the most effective groups in helping confront poverty, homelessness, substance abuse and other problems addressed by HHS programs.  Yet many do not have the expertise needed to apply for and manage federal funds.  The HHS funding from the new Compassion Capital Fund provides for technical assistance, especially to smaller charities and faith-based organizations, to use HHS funds to help them deliver services to people in need.  In December HHS also published proposed regulations clarifying the rights and responsibilities of religious organizations if they become HHS grantees.

Americans with disabilities - Secretary Thompson led the Administration's efforts under the President's "New Freedom Initiative," aimed at eliminating barriers to community living for Americans with disabilities.  In May, Secretary Thompson delivered to the President the most comprehensive report ever compiled on legal and programmatic barriers, and steps that could be taken across government to help persons with disabilities.  At the same time, HHS released a new waiver template making it easier for states to make changes in their Medicaid programs to serve people with disabilities in their own homes.  The first Independence Plus waiver was granted to New Hampshire in December.  HHS also created a new Secretarial-level Office on Disability to oversee coordination, development and implementation of programs and special initiatives across HHS.  In addition, the President established his "New Freedom Commission on Mental Health," and HHS is helping lead this effort to improve mental health services, especially community-based services.

Early literacy skills for Head Start children - As part of the President's "Good Start/Grow Smart" initiative, HHS took new steps to assure early literacy skills throughout the Head Start program.  New training was provided for Head Start teachers, and development began for a new system to measure early literacy.  The new system will help ensure for the first time that every Head Start child is assessed on development of early literacy skills.

Adoption - HHS' Administration for Children and Families (ACF) launched a cooperative effort to make adoption information available via the internet at AdoptUSKids, a database of children awaiting adoption and families approved to adopt.  In 2001, nearly 50,000 children were adopted with the involvement of the public child welfare system, a 79 percent increase since 1996, when 28,000 adoptions were finalized.

National Youth Summit - ACF sponsored the first National Youth Summit in June, bringing together about 2,000 professionals, parents, advocates, researchers and young people to focus on successful achievements and strategies for youth.  The summit was designed to help build state and regional partnerships to support America's youth.

Teen smoking - Results from the "Monitoring the Future" survey for 2002, released in December, showed a significant decrease in smoking by teens, accelerating a trend that began after teen smoking reached a high point in 1996.  This year's survey also showed that teen alcohol consumption was down, as was teens' use of illicit drugs.

Sales of cigarettes to teens - HHS released data in September showing that retailers are continuing to reduce sales of cigarettes to those under 18.  The retailer violation rate fell to 16.3 percent in 2001, from 40.1 percent in 1996.

Anti-tobacco campaigns - In addition to ongoing public information campaigns, CDC launched a new national campaign aimed at reducing smoking among Hispanics.  HHS launched a Tobacco-Free Sports public education campaign at the 2002 Olympic and Paralympic Winter Games.

Protecting patients from non-routine use and disclosure - Under therule, patients must give specific authorization before covered entities could use or disclose protected information in most non-routine circumstances - such as releasing information to an employer or for use in marketing activities.

Ensuring patients' access to medical records - Patients generally will be able to access their personal medical records and request changes to correct any errors.

Written privacy notice -- Covered entities generally will need to provide patients with written notice of their privacy practices and patients' privacy rights.  Patients will generally be asked to sign or otherwise acknowledge receipt of the privacy notice from direct treatment providers.

Restricting marketing based on protected health information - Pharmacies, health plans and other covered entities must first obtain an individual's specific authorization before sending them marketing materials. At the same time, the rule permits doctors and other covered entities to communicate freely with patients about treatment options and other health-related information, including disease-management programs.

Streamlining home health paperwork - In June, CMS launched a new effort to streamline Medicare's paperwork requirements for home health nurses and therapists so that they can focus more on providing quality care to their patients.  As a result, required assessments will include only those elements needed to promote quality of care and to ensure proper payment.

Promoting appropriate emergency room care - In May, CMS proposed common-sense improvements to clarify the requirements for hospitals to screen and treat emergency room patients. The proposed revisions would ensure that patients with possible emergency conditions receive appropriate care as rapidly as possible.

Eliminating repetitive insurance requests - CMS also reduced the frequency that hospitals must gather detailed information from Medicare beneficiaries about other insurance. This change means hospitals will not have to ask patients repeatedly for the same data.