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StrategicGoal7 ImprovetheStabilityandDevelopmentofOurNations #    ChildrenandYouth..............................................................................................page99 $!  StrategicGoal8 AchieveExcellenceinManagementPractices...................................page111 ^&l # Ѐ N'\!$  MajorManagementChallenges ....................................................................................page123 &)4#& Ѐ *$$'   ,&*   THISPAGEINTENTIONALLYBLANK    P@<l \'" << `@XEx 8L   7    IampleasedtopresenttheDepartmentofHealthandHumanServicesPerformancePlan iw forFY2004.OurmissionistoenhancethehealthandwellbeingofAmericansbyprovidingfor U c effectivehealthandhumanservicesandbyfosteringstrong,sustainedadvancesinthesciences A O underlyingmedicine,publichealthandsocialservices.Inexecutingthismission,the - ; Departmentmanagesover300programsthattouchthelivesofeveryAmerican.Weareworking  ' toprotectpeoplefromillnessandinjuryintheeventofanotherterroristattack;controlchronic   diseaseslikeasthma,diabetesandobesity;expandhealthcareservicesforruralAmericansand   peoplewithouthealthinsurance;andseekvaccinesandcuresforthemosttroublingdiseases.     Insomecases,HealthandHumanServicesworksdirectlywiththoseinneed.Oftenthe   DepartmentworkswithState,local,andtribalgovernments,andmanyHHS-fundedservicesare   providedatthelocallevelbyState,countyortribalagencies,orthroughprivatesectorgrantees.   WhilethisPlanconcentratesontheDepartmentsdiscretionarybudget,asignificantpercentof   thebudgetisdedicatedtograntsandentitlementprograms.Wearethelargestgrantmaking y  agencyintheFederalgovernment,andprovidesome60,000grantsperyear.TheDepartments es Medicareprogramisthenation'slargesthealthinsurer,handlingmorethan900millionclaims Q_ peryear. =K   ThisPlanprovidesasummaryofthegoodworkthatHealthandHumanServicesdoes. )7 Forexample: #  >*,-./012(x3+"*3"   *3|23  0    Wewillachieveandmaintainimmunizationcoverageofatleast90%inchildren19to  35monthsofageinsevenimportantvaccines. *3|݌(#(# Ќ  "*3"  *323  0     Wewillreviewandactuponoriginalgenericdrugapplicationswithin6monthsafter  submissiondate. *3݌(#(# Ќ  "*3"  *323  0     Wewillincreasethenumberofadoptionsofchildreninthepublicfostercaresystemto  60,000. *3=݌}(#(# Ќ   +(#3x>*,-./012  ThesearejustasampleoftheperformancetargetstheDepartmenthassetforitself.If Q _ youwouldlikemoredetailaboutaparticularagency,Iencourageyoutolookattheindividual =!K AnnualPerformancePlansthatcanbefoundatwww.hhs.gov/budget/03gpra. )"7   TheproudhistoryoftheDepartmentreachesbacktothelateeighteenthandnineteenth ## century,whenourpredecessorscaredforseafarers,andopenedaone-roomlaboratoryfordisease $  research.Asweenterthetwentyfirstcentury,HHScanpointtomanysuccesses,andanticipate $! anewenvironmentfullofcomplexchallenges.ThisPlanprovidesaglimpseonhowweintend %" tosucceedinthatenvironment. & #   Sincerely, ("%   KerryWeems u*$'   ActingAssistantSecretaryforBudget,TechnologyandFinance  a+o%( _  THISPAGEINTENTIONALLYBLANK  bp  S P@<l \'" << `@XES LC   S TheFY2004DepartmentPerformancePlansummarizestheperformancemeasuresthat iw willleadtoaccomplishingHHSstrategicgoals,asreflectedintheDepartmentsdraftFY2003 U c Є2008StrategicPlan.AlthoughtheDepartmentStrategicPlaniscurrentlyindraft,thegoals A O willremainstableandsoourPerformancePlanorganizesprogramsandmeasuresaroundthe - ; StrategicPlangoals.Forexample,thefirststrategicgoal,ReducetheMajorThreatstothe  ' HealthandWellBeingofAmericans,integratestheoutcomesofseveralperformancemeasures   fromtheCentersforDiseaseControlandPrevention,theHealthResourcesandServices   Administration,andtheSubstanceAbuseandMentalHealthServicesAdministration.    S HHShasover300programs,andfromthesewehaveselectedapproximately40   illustrativeprograms.Foreachprogramorprogramcluster,wediscussthemeansandstrategies   usedtoachieveeachprogramsobjectivesandprovideexamplesofperformancemeasuresthat   willhelpusreachtheobjectives.ProgramsthatareprioritiesofthePresidentortheSecretary y   NN(#(#areidentifiedbytheappropriateseal: es  NNm9)%`|08 `-.ENF]wm m9)%`|0 `ssESm  S     [      (#(#Theperformancemeasuresassociatedwitheachprogramaretakenfromtheagencyannual # performanceplansandarerepresentativeoftheprogramsgoals.Asummarytableofthe  measuresisprovidedatthebeginningofeachsection.Wherethereispastperformanceto  report,itisincludedinthissummarytable.ManynewmeasuresforFY2004haveyettoreport  performance,andintheseinstancesanasterisk(*)refersthereadertotheappropriateagency  performanceplan.   S TheassociatedbudgetrequestforFY2004isalsodisplayed.Eachofthesebudget  figurescontributetoanoveralltotalbudgetforeachStrategicGoal.Thebudgetfigures u associatedwitheachStrategicGoalrepresentthatgoalsfractionofthetotaldiscretionary a o budgetrequestof$70billion.Importantnote:wealsodiscusssomeprogramsthatarepartof M![ themandatorybudget,butthosedollarsareshowninitalicsandhavenotbeenaddedintothe 9"G totalsforeachStrategicGoal. %#3  ReducetheMajorThreatstotheHealthandWellBeingofAmericans  $ ! HHSistakingstepstoreducehealththreatsthroughpromotionofhealthybehaviorsand & # buildingpartnershipswithStates,communities,andhealthprofessionals.Anewprevention '!$ initiative,explainedunderGoal1,isacoordinatedeffortthatemphasizeshealthybehaviorsand ("% choicesinpreventingdiseaseandillness.Wealsocontinuetofightsubstanceabuseandthe )#& spreadofHIV/AIDS. *$'   m+{%(     EnhancetheAbilityoftheNationsPublicHealthSystemtoEffectivelyRespondto  BioterrorismandOtherPublicHealthChallenges   HHShastheleadroleinprotectingAmericansfromattacksonourfoodandhealth.The  Departmenthasincreasedbioterrorismspending,andwillfurtherenhancetheabilityofour   Nationshealthcaresystemtoeffectivelyrespondtobioterrorism.Weintendtoextendhospital   preparednessandcompletethe122citymetropolitanMedicalResponseSystem.The r  Departmenthasmadesignificantprogressindevelopingasmallpoxvaccinestockpileand ^ l anticipateprogressonananthraxvaccine. J X  IncreasethePercentageoftheNationsChildrenandAdultsWhoHaveAccesstoRegular "0  HealthCare,andExpandConsumerChoices     ThethreatofbioterrorismisnottheonlythreatfacingtheNation.Disparitiesinhealthcarefor   ourpopulationareofgreatconcerntoHHS,andweareworkingtoexpandaccesstohealthcare   foreveryone.Weseektoexpandaccesstocriticalhealthcareservicesfortheuninsured,   especiallyinunderservedruralandurbanareas.TheDepartmentalsointendstoexpandthe  NationalHealthServiceCorpstoafieldstrengthofover3,000andassistnursetrainingand  recruitmentactivitiestoensurethatourhospitalsandnursinghomesremainthebestintheworld. z  EnhancetheCapacityandProductivityoftheNationsHealthScienceResearchEnterprise  R` HHSiscommittedtostrengtheningthebaseofqualifiedhealthandbehavioralscience &4 researchersinordertoadvancetheunderstandingofbasicbiomedicalandbehavioralscience.   TheFY2004budgetincludesincreasesforbioterrorismandnonbioterrorismresearch.Other   prioritiesincludesupportinganextramuralresearchcommunityofapproximately50,000  scientists,basicandclinicalbiomedicalresearch,andcompletionoftheJohnEdwardPorter  NationalNeuroscienceResearchCenteratNIH.   ImprovetheQualityofHealthCareServices    Improvingthequalityofhealthcareservicesmeansreducingmedicalerrorsandimproving n"| consumerandpatientprotections.TheDepartmentisdevelopingaproposaltomodernizethe Z#h  electronichealthinformationinfrastructurethatwillreducemedicalerrors,increaseefficiency F$T! andimprovethesafetyinourNationshospitals.Similarly,FDAseekstoimproveadverseevent 2%@" reportingandAHRQisfocusingonnewactivities,withanemphasisonsmallcommunityand &, # ruralhospitals,thatwillfocusontheroleinformationtechnologycanplayinensuringsafercare.  '!$  ImprovetheEconomicandSocialWellBeingofIndividuals,Families,andCommunities, ("& EspeciallyThoseMostinNeed  )#' HHSwillcontinuetosupporteffortstoincreasetheindependenceoflowincomefamilies, +%) welfarerecipients,thedisabled,andolderAmericans.ThenewlycreatedHHSOfficeof ,&* Disabilitywilloverseethecoordination,development,andimplementationofprogramswithin v-'+ HHSthatimpactpeoplewithdisabilities.AdministrationonAgingprogramscomplement b.p(, existinghealthcaresystems,andaimtoimprovelocalsystemsofcarebybetterintegrating_AoA_,  Medicare,Medicaid,andotherserviceprograms.   ImprovetheStabilityandDevelopmentofOurNationsChildrenandYouth   ThePresidenthasoutlinedthenextcriticalstepineducationreform:theneedtopreparechildren   toreadandsucceedinschool.OurGoodStart,GrowSmartinitiativewillsupportStatesefforts v  todevelopliteracyguidelines,educationandtrainingplans,andcoordinateearlychildhood b p programs.TheHeadStartprogramwillimplementanationaltrainingprogram,increasethe N \ numberofchildrenservedandsupportnewefforts. :H   AchieveExcellenceinManagementPractices    HHSiscommittedtoimprovingtheefficiencyandeffectivenessoftheDepartmentsprograms   andachievingthegoalsofthePresidentsManagementAgenda,bycreatinganorganizationthat   iscitizencentered,marketbased,andresultsoriented.Aspartofouroverallcommitmentto   goodmanagement,HHSisdedicatedtosuccessfullymeetingthechallengesidentifiedbythe  OfficeoftheInspectorGeneral.     `     h      p      x  ThetablebelowdisplaystheDepartmentsFY2004budget,organizedbyStrategicGoal. n| FundingforindividualgoalsmaynotaddpreciselytotheDepartmenttotalduetorounding Zh errors. FT *Vddd Xdd Xdd X(#(#,8dd ,dd ,&dd ,dd +  ,, Goal   GoalText '" 'GoalBudget '" 'HHSTotal " Goal1   ReducingtheMajorThreatstotheHealthand  WellBeingofAmericans   $6,480 2" 2 -#! " -Goal2  n|! EnhancingtheAbilityoftheNationsPublic n|" HealthSystemtoEffectivelyRespondto Z h# BioterrorismandOtherPublicHealth F!T$ Challenges  2"@% $3,160 2n|&" 2 -#!n|'" -Goal3  #( IncreasingthePercentageoftheNations #) ChildrenandAdultsWhoHaveAccessto $* regularHealthCare,andExpandingConsumer %+ Choices  v& , $9,481 2#-" 2 -#!#." -Goal4  '"/ EnhancingtheCapacityandProductivityof '"0 theNationsHealthScienceResearch ("1 Enterprise )#2   *$3 $28,619 2'"4" 2 -#!'"5" -Goal5  :,H&6 ImprovingtheQualityofHealthCareServices  :,H&7 $682 2:,H&8" 2 -#!:,H&9" -Goal6  Vd ImprovingtheEconomicandSocialWell Vd  BeingofIndividuals,Families,and BP Communities,EspeciallyThoseMostinNeed  .< $4,769 2Vd" 2 -#!Vd" -Goal7    ImprovingtheStabilityandDevelopmentof   OurNationsChildrenandYouth     $10,274 2  " 2 -#!  " -Goal8   (  AchievingExcellenceinManagement   (   Practices    $2,449 2 (" 2 -#! (" -      Total '" '$64,845"" "ЌXX  (DollarsinMillions)#X>XЌ2Q#      ft    M=9l L'"<< `@XddddExtt4*    Q Goal1:ReducetheMajorThreatstotheHealthandWellbeingofAmericans.    *Vd d8dd 8dd &dd &dd V(#(#,dd ,dd ,dd +  )   )ЌXX>PerformanceMeasure '!/" '#X>XЌT#ЌXX>Agency '!/" '#X>XЌT#ЌXX>MostRecentResults #!/"  ##X>XЌU#ЌXX>Prevent50,000hospitalizationsduetoasthma.  w  #X>XЌzU#ЌXX>CDC  w  #X>XЌU#ЌXX>ЌЌDataunavailable.#ЌЌxV##X>XЌYV#ЌXX>*  w  #X>XЌW#ЌXX>Prevent75,000to100,000Americansfromdevelopingdiabetes.    #X>XЌ[W#ЌXX>CDC    #X>XЌW#ЌXX>ЌЌDataunavailable.#ЌЌhX##X>XЌIX#ЌXX>    #X>XЌX#ЌXX>Prevent100,000to150,000Americansfromdevelopingobesity.  '5  #X>XЌ5Y#ЌXX>CDC  '5  #X>XЌY#ЌXX>ЌЌDataunavailable.#ЌЌBZ##X>XЌ#Z#ЌXX>  '5  #X>XЌZ#ЌXX>Increaseby25%thenumberoflocal,state,nationalandinternational   healthpoliciesthatincorporateeffectivepreventionelements.  CQ #X>XЌ[#ЌXX>_OPHS_    #X>XЌ\#ЌXX>ЌЌFY01Baseline:   25,064(website CQ visitors/clearinghouse  inquiries.#ЌЌ\##X>XЌ{\#ЌXX>   #X>XЌ|]#ЌXX>Increaseby9%thereachof_OPHS_Ԁpreventioncommunications.  #1 #X>XЌ]#ЌXX>_OPHS_  #1 #X>XЌ^#ЌXX>ЌЌFY01Baseline: #1 11,462,477(website  visitors/clearinghouse  inquiries.#ЌЌ_##X>XЌ_#ЌXX>  o} #X>XЌ`#ЌXX>Increaseby11%thenumberofpoliciesinresearchinstitutionsthat  improvetheresearchenterprise.#X>XЌ[`#    ЌXX>_OPHS_  ! #X>XЌ,a#ЌXX>ЌЌFY01Baseline: " 38,317(website # visitors/clearinghouse O]$ inquiries.#ЌЌa##X>XЌa#ЌXX>  !% #X>XЌb#X>XXX>ЌXX>Decreasethenumberof_perinatally_ԀacquiredAIDScasesfromthe1998 ky& baselineof235cases.#ЌЌb#ЌЌ#X>XЌc#ЌXX>Ԁ#ЌЌc##X>XЌ0d#  /=' ЌXX>CDC  ky( #X>XЌd#ЌXX>Met:FY00:102.#X>XЌe#ЌXX>  ky) #X>XЌWe#X>XXX>ЌXX>Reducetheincidenceofgonorrheainwomenages1544.#ЌЌe##X>XЌe#   * ЌXX>CDC   + #X>XЌ~f#ЌXX>Notmet.ЌЌFY01:  , 286/100,000.#ЌЌg##X>XЌf#ЌXX>ԀTarget K!Y- <250  ". #X>XЌg#X>XXX>ЌXX>ReducethenumberofHIVinfectionsdiagnosedamongpeopleyounger g#u/ than25yearsold.#ЌЌh##X>XЌ$h#  +$90 ЌXX>CDC  g#u1 #X>XЌi#ЌXX>FY00baseline:1,805 g#u2 cases.#X>XЌai#ЌXX>  +$93 #X>XЌi#X>XXX>ЌXX>IncreasethepercentageofTBpatientswhocompleteacourseofcurative %4 TBtreatmentwithin12monthsofinitiationoftreatment.#ЌЌ*j#ЌЌ#X>XЌIj#ЌXX>Ԁ#ЌЌ!k##X>XЌck#  G&U 5 ЌXX>CDC  %6 #X>XЌk#ЌXX>Notmet.FY99: %7 79.9%.Target85%.  G&U 8 #X>XЌ8l#X>XXX>ЌXX>Reducetoormaintainat0thenumberofindigenouscasesofmeaslesin '!9 childrenunder5by2010.[FY99:66;FY00:63;.]#ЌЌl##X>XЌl#  c(q": ЌXX>CDC  '!; #X>XЌm#ЌXX>Notmet.FY01:61 '!< (provisional)#X>XЌHn#ЌXX>  c(q"= #X>XЌn#X>XXX>ЌXX>Achieveormaintainimmunizationcoverageofatleast90percentin )#> children19to35monthsofageinatleast7vaccines.  #ЌЌo##X>XЌ4o#  *$? ЌXX>CDC  )#@ #X>XЌKp#ЌXX>Varies.SeeCDC )#A Report.  *$B #X>XЌp#X>XXX>ЌXX>95%oftechnicalassistanceeventswillresultinsystems,programor +%C practicechange. #X>XЌGq# #X>XXX>(q#X>XXX>ЌXX>Ԁ#ЌЌ#r##X>XЌBr#   ,&D ЌXX>SAMHSA  +%E #X>XЌr#ЌXX>Met.FY01:96%#X>XЌ&s#ЌXX>  +%F #X>XЌws#ЌXX>BuildITcapabilitiesandcapacitythroughalllevelsofpublichealth Vd  (local,state,andfederal)toservethevarietyofpublichealthfunctions.#X>XЌs#X>XXX>  ( ЌXX>CDC  Vd #X>XЌt#ЌXX>Dataunavailable.#X>XЌYu#ЌXX>#ЌЌt#ЌЌ  Vd #X>XЌu#ЌXX>EnsurepublichealthITworksasacoherentnetworkandhastheability r toconnectothergroups.#X>XЌEv##X>XXX>u#X>XXX>  6 D ЌXX>CDC  r #X>XЌRw#ЌXX>Dataunavailable.#X>XЌw#ЌXX>#ЌЌw#ЌЌ  r #X>XЌw#ЌXX>Evaluatenetworkfunctionalityandensureinteroperability,security,and    reliability.#X>XЌx##X>XXX>Ax#X>XXX>  R `  ЌXX>CDC     #X>XЌy#ЌXX>Dataunavailable.#X>XЌy#ЌXX>#ЌЌgy#ЌЌ     #X>XЌHz# Goal2:EnhancetheAbilityoftheNationsHealthCareSystemtoEffectivelyRespondto , BioterrorismandOtherPublicHealthChallenges.     *Vdddd dd dd V(#(#,dd ,dd ,dd +     ЌXX>Enhancepreparednessbyassuringthat50percentofState,territorial, FT  andlocalprojectshavewrittenplanstorespondtobiological,chemical,    andmasstraumahazardsrelatingtoterrorism.#X>XЌ|#    ЌXX>CDC  FT  #X>XЌ}#ЌXX>#ЌЌz#ЌЌDataunavailable.#ЌЌ~##X>XЌE~#ЌXX>  FT  #X>XЌ~#ЌXX>90percentofStateshavedevelopedplanstoaddresssurgecapacity#X>XЌT#.  &4 ЌXX>HRSA  &4 #X>XЌ#ЌXX>ЌЌDataunavailable.#ЌЌi##X>XЌJ#ЌXX>  &4 #X>XЌ߀#ЌXX>ImproveHHSresponseassetstosupportmunicipalitiesandstatesas  needed(anticipated).#X>XЌ6#  jx ЌXX>_OASPHEP_   #X>XЌ#ЌXX>ЌЌDataunavailable.#ЌЌ##X>XЌx#ЌXX>   #X>XЌ #ЌXX>Coordinatethedevelopmentandprocurementofsaferandmore  effectivevaccinesagainstsmallpoxandanthrax(anticipated)#X>XЌd#ЌXX>.#X>XЌ5#   ЌXX>_OASPHEP_    #X>XЌ#ЌXX>ЌЌDataunavailable.#ЌЌ*##X>XЌ #ЌXX>  ! #X>XЌ#ЌXX>Overseethereinforcementandaugmentingbordercoverageofall " importedproducts(anticipated)#X>XЌ#ЌXX>.#X>XЌ#  # ЌXX>_OASPHEP_  $ #X>XЌ#ЌXX>ЌЌDataunavailable.#ЌЌ##X>XЌ#ЌXX>  % #X>XЌ#ЌXX>AchieveadoptionoftheFoodCodebyatleastonestateagencyin42 & StatesintheUSA.#X>XЌo#  ' ЌXX>FDA  ( #X>XЌ1#ЌXX>Met.FY01:28states ) adoptedfoodcode * (target25states)#X>XЌ#ЌXX>  + #X>XЌ0#ЌXX>Inspect95percentoftheestimated7000highriskdomesticfood , establishmentsonceeveryyear .#X>XЌ#  - ЌXX>FDA  . #X>XЌX#ЌXX>Notmet.FY01: / inspected80%of 0 6800foodest.(target b p1 90%)#X>XЌ#ЌXX>  &!42 #X>XЌl#ЌXX>Perform48,000physicalexamsandconductsampleanalysesonproducts ~"3 withsuspecthistories#X>XЌÌ#ЌXX>.#X>XЌu#  B#P4 ЌXX>FDA  ~"5 #X>XЌ͍#ЌXX>FY01Baselinedata: ~"6 12,169ЌЌ#X>XЌ'#ЌXX>Ԁ#ЌЌu#physicalexams#X>XЌ#ЌXX>  B#P7 #X>XЌ+#X>XXX>ЌXX>ExpandFederal/State/localinvolvementinFDAs_eLEXNET_Ԁsystemby $8 having79laboratoriesparticipateinthesystem.#ЌЌ##X>XЌ#  ^%l9 ЌXX>FDA  $: #X>XЌŐ#ЌXX>ЌЌDataunavailable.#ЌЌ>##X>XЌ#ЌXX> $;  #X>XЌ# Goal3: IncreasethePercentageoftheNationsChildrenandAdultsWhoHaveAccessto *(8"= RegularHealthCareandExpandConsumerChoices.  )(#> *Vd ddd dd dd V(#(#,dd ,dd ,dd +  *%@*% X>XXX>ЌXX>ImprovesatisfactionofMedicarebeneficiarieswiththehealthcare V+d%A servicestheyreceive.#ЌЌړ##X>XЌ#  ,(&B ЌXX>CMS  V+d%C #X>XЌ#ЌXX>ЌЌDataunavailable.#ЌЌo##X>XЌP#ЌXX>  V+d%D #X>XЌ#X>XXX>ЌXX>Increaseannualinfluenza(flu)andlifetime_pneumococcal_Ԁvaccinations.#ЌЌ<##X>XЌ[#  r-'E ЌXX>CMS  r-'F #X>XЌ<#ЌXX>ЌЌDataunavailable.#ЌЌ##X>XЌ#ЌXX>  r-'G #X>XЌ+#X>XXX>ЌXX>Increasebiennialmammographyrates.#ЌЌ##X>XЌ#  .(H ЌXX>CMS  .(I #X>XЌ?#ЌXX>Met.FY01:51.6% .(J (target51%)#X>XЌ#ЌXX>  /)K #X>XЌ #X>XXX>ЌXX>ImprovethebeneficiaryunderstandingofbasicfeaturesoftheMedicare Vd program.#ЌЌd##X>XЌ#  ( ЌXX>CMS  Vd #X>XЌa#ЌXX>ЌЌDataunavailable.#ЌЌڛ##X>XЌ#ЌXX>  Vd #X>XЌP#X>XXX>ЌXX>IncreasethepercentageofMedicaidtwoyearoldchildrenwhoarefully r immunized.#ЌЌ##X>XЌƜ#  6 D ЌXX>CMS  r #X>XЌ#ЌXX>ЌЌDataunavailable.#ЌЌ##X>XЌ#ЌXX>  r #X>XЌ#X>XXX>ЌXX>DecreasethenumberofuninsuredchildrenbyworkingwithStatesto    implement_SCHIP_ԀandbyenrollingchildreninMedicaid.#ЌЌ##X>XЌ #  R `  ЌXX>CMS     #X>XЌ3#ЌXX>Met.FY01    3,441,000. -VV R `  -#X>XЌ#X>XXX>ЌXX>  IncreasetheproportionofI/T/Uclients(by2%overFY03level)with F T diagnoseddiabetes#X>XЌE#ЌXX>#ЌЌ&#ЌЌԀthathaveimproved_glycemic_Ԁcontrol[FY01:30%of   I/T/Udiabeticshaveimproved_glycemic_Ԁcontrolafourpercentincrease   overFY00]. -#!VV -#X>XЌ#ЌXX>IHS#ЌЌB#ЌЌ  F T #X>XЌ#ЌXX>#ЌЌ#ЌЌMet.FY0026% F T (target25%).   #X>XЌ?#ЌXX>MaintaintheproportionofeligiblewomenwhohavehadaPapSmear   withinthepreviousthreeyearsattheFY2003level.#ЌЌ#ЌЌ#X>XЌ#ЌXX>    #X>XЌ#ЌXX>IHS#ЌЌݥ#ЌЌ    #X>XЌv#ЌXX>#ЌЌ#ЌЌMet.FY0142%   (target18%increase).    #X>XЌ#ЌXX>Maintain100percentaccreditationofallIHShospitalsandoutpatient   clinics.#X>XЌ#ЌXX>#ЌЌT#ЌЌ    #X>XЌ#ЌXX>IHS#ЌЌ̨#ЌЌ    #X>XЌ##ЌXX>#ЌЌh#ЌЌFY01:100%#ЌЌ#ЌЌ#X>XЌ#ЌXX>    #X>XЌ#ЌXX>Providesanitationfacilitiesprojectsto18,150IndianHomeswithwater,   sewagedisposal,and/orsolidwastefacilities#ЌЌN#ЌЌ#X>XЌ#ЌXX>.   #X>XЌ#ЌXX>IHS#ЌЌ#ЌЌ     #X>XЌO#ЌXX>#ЌЌ#ЌЌMet.FY01:provided  ! facilitiestototalof " 18,002homes(target # 14,730homes).#ЌЌ-#ЌЌ#X>XЌ#ЌXX>  HV$ #X>XЌ?#ЌXX>FlexibilityGrants:By2004,675appropriateruralfacilitieswillbe % assistedinconvertingtoCriticalAccessHospital(_CAH_)status.#ЌЌ#ЌЌ#X>XЌ#ЌXX>  dr& #X>XЌԯ#ЌXX>HRSA  ' #X>XЌ+#ЌXX>Met.FY02,657 ( hospitalsassisted dr) (target240).#X>XЌ#ЌXX>#ЌЌ#ЌЌԀ  (6* #X>XЌ #ЌXX>Increaseto13.75millionthenumberofuninsuredandunderserved + personsservedbyHealthCenters.#X>XЌ#ЌXX>#ЌЌb#ЌЌ  DR, #X>XЌs#ЌXX>HRSA#ЌЌ#ЌЌ  - #X>XЌ #ЌXX>#ЌЌR#ЌЌNotmet.FY01,10.3 . millionpeoplewere DR/ served(target10.5 0 million)#ЌЌ#ЌЌ#X>XЌ#ЌXX>  1 #X>XЌ#ЌXX>Decreaseto6.77percentthepercentofHealthCenterprenatalpatients $22 withbirths<2,500grams#ЌЌ#ЌЌ#X>XЌH#ЌXX>.  3 #X>XЌ@#ЌXX>HRSA#ЌЌ#ЌЌ  $24 #X>XЌ#ЌXX>#ЌЌ޶#ЌЌNotmet.FY2001 $25 7.13%.#ЌЌw#ЌЌ#X>XЌ5#ЌXX>  6 #X>XЌ'#ЌXX>Increaseto900thenumberofnewnursingloanrepaymentcontracts @ N7 awarded.#X>XЌ~#ЌXX>#ЌЌ#ЌЌ  !8 #X>XЌ#ЌXX>HRSA#ЌЌa#ЌЌ  @ N9 #X>XЌ#ЌXX>#ЌЌ#ЌЌMet.FY2001443 @ N: newcontracts(target !; 200)#ЌЌ#ЌЌ#X>XЌU#ЌXX>.  !< #X>XЌo#ЌXX>Increaseto22%theproportionof_NELRP_Ԁsupportednursesservingin  #.= criticalshortagefacilitieswhoextendtheircontractforathirdyear.#ЌЌ-#ЌЌ#X>XЌǻ#ЌXX>  #> #X>XЌ #ЌXX>HRSA#ЌЌɼ#ЌЌ   #.? #X>XЌb#ЌXX>#ЌЌ#ЌЌBaseline21%#ЌЌA#ЌЌ#X>XЌ#ЌXX>   #.@ #X>XЌѾ#ЌXX>Decreasetheinfantmortalityrateto6.8/1000.#X>XЌ(#ЌXX>#ЌЌ#ЌЌ  <%JA #X>XЌ#ЌXX>HRSA#ЌЌۿ#ЌЌ  <%JB #X>XЌ2#ЌXX>#ЌЌx#ЌЌNotmet.FY99 <%JC 7.1/1000#ЌЌ#ЌЌ#X>XЌ#ЌXX>  & D #X>XЌ#ЌXX>Reduceillnessandcomplicationduetopregnancyto26per100 X'f!E deliveries.#ЌЌ#ЌЌ#X>XЌ#ЌXX>  (*"F #X>XЌ#ЌXX>HRSA#ЌЌ#ЌЌ  X'f!G #X>XЌQ##X>XXX>̗#X>XXX>1998baseline: X'f!H 31.2/100.#X>XXX>#  D(R"I ЌXX>Increaseto96percentthepercentofnewbornswithatleastone )#J screeningforeachofPKU,hypothyroidism,_galactosemia_,and *$K _hemoglobinopathies_.  L+Z%L HRSAЌЌ  )#M #ЌЌ#ЌЌNotmet.FY9994%.  )#N Increasematernalsurvivalto8maternaldeathsper100,000livebirths#ЌЌ#ЌЌ.  ,&O HRSA  ,&P Dataunavailable.  ,&Q #X>XЌ#ЌXX>PartAServeaproportionofwomenandracial/ethnicminoritiesinTitle Vd IfundedprogramsthatexceedstheirrepresentationinnationalAIDS ( prevalencedata,asreportedbytheCDC,byaminimumoffive   percentagepoints.#ЌЌ#ЌЌ#X>XЌp#ЌXX>   #X>XЌ#ЌXX>HRSA#ЌЌ#ЌЌ  Vd #X>XЌq#ЌXX>#ЌЌ#ЌЌMet.FY0070.4% Vd (target57.3%).  ( #X>XЌ#ЌXX>ForPartB,increaseby4%thenumberof_ADAP_Ԁclientsreceiving   HIV/AIDSmedicationsthroughState_ADAPs_Ԁduringatleastonemonth    oftheyear.#X>XЌ#ЌXX>#ЌЌP#ЌЌ     #X>XЌ#ЌXX>HRSA#ЌЌW#ЌЌ     #X>XЌ#ЌXX>#ЌЌ#ЌЌMet.FY0173,784    (target72,000).     #X>XЌK#ЌXX>Increaseby2%annuallythenumberofpersonswholearntheir_serostatus_   fromRyanWhiteCareActprograms.#ЌЌ#ЌЌ#X>XЌ#ЌXX>    #X>XЌ@#ЌXX>HRSA#ЌЌ#ЌЌ    #X>XЌ#ЌXX>#ЌЌ#ЌЌDataunavailable.#ЌЌv#ЌЌ#X>XЌ4#ЌXX>     #X>XЌ #ЌXX> ReducedeathsduetoHIVinfectionbelow3.6per100,000peopleby   2010.#X>XЌh#ЌXX>#ЌЌ#ЌЌ    HRSA    Dataunavailable.    #X>XЌ #ЌXX>Maintainat80percentthepercentofNHSCcliniciansretainedinservice   totheunderserved.#X>XЌ#ЌXX>#ЌЌN#ЌЌ    #X>XЌ#ЌXX>HRSA    #X>XЌ0#ЌXX>#ЌЌ#ЌЌMet.FY01,80%of   NHSCclinicians   remainedinservice   (target75%)#ЌЌ#ЌЌ#X>XЌ#ЌXX>. ^l   #X>XЌ# Goal4.EnhancetheCapacityandProductivityoftheNationsHealthScienceResearch *8 Enterprise.  $ *Vdddd dd dd V(#(#,dd ,dd ,dd +  ! ЌXX>DevelopanAIDSvaccineby2007.#X>XЌ#ЌXX>#ЌЌ#ЌЌ  R`" #X>XЌ.#ЌXX>NIH  R`# #X>XЌ#ЌXX>Met*  R`$ #X>XЌ!#ЌXX>Conductmedicationdevelopmentwithuseofanimalmodels,andbegin % toconductPhaseIandIItrialsoftwopotentialtreatmentsfor n|& alcoholism:_cannabinoid_Ԁantagonist_Rimonabant_Ԁandcorticotropin 2@' releasinghormoneantagonist_Antalarmin_.  ( #X>XЌ|#ЌXX>NIH  ) #X>XЌ]#ЌXX>Dataunavailable.#X>XЌ#ЌXX>#ЌЌp#ЌЌ  * #X>XЌ #ЌXX>By2006,developoneormoreprototypesforalowpower,highly N\+ directionalhearing_aiid_Ԁmicrophonetohelphearingimpairedpersons  , betterunderstandspeech_ina_Ԁnoisybackground.#X>XЌ##X>XXX>L#X>XXX>  - ЌXX>NIH  N\. #X>XЌW#ЌXX>Dataunavailable.#X>XЌ#ЌXX>#ЌЌ##ЌЌ  N\/ #X>XЌ#ЌXX>By2007,demonstratethefeasibilityofislettransplantationin .!<0 combinationwithimmunetoleranceinductionforthetreatmentoftypeI !1 diabetesinhumanclinicalstudies.#X>XЌ##X>XXX>F#X>XXX>  "2 ЌXX>NIH  .!<3 #X>XЌ #ЌXX>Dataunavailable.#X>XЌd#ЌXX>#ЌЌ#ЌЌ  .!<4 #X>XЌ#ЌXX>By2009,evaluatetheefficacyoftwonovelapproachestopreventweight $5 gainand/ortreatobesityinclinicaltrialsinhumans.#X>XЌP##X>XXX>#X>XXX>  $6 ЌXX>NIH  $7 #X>XЌ}#ЌXX>Dataunavailable.#X>XЌ#ЌXX>#ЌЌI#ЌЌ  $8 Developmethodsthatcanclassifyatleast75%ofproteinsfromsequence *&8 9 _genomes_Ԁaccordingtoevolutionaryoriginandbiologicalstructure.  & : NIH#ЌЌl#ЌЌ#X>XЌ*#ЌXX>  *&8 ; Dataunavailable.#X>XЌ#ЌXX>#ЌЌ#ЌЌ  *&8 < Identifyatleastoneclinicalinterventionthatwilldelaytheprogression, F(T"= delaytheonset,orpreventAlzheimersdisease.   )#> NIH#X>XЌD#ЌXX>#ЌЌ#ЌЌ  F(T"? Dataunavailable.#ЌЌ#ЌЌ#X>XЌ#ЌXX>  F(T"@ By2010,developoneuniversalantibioticeffectiveagainstmultiple b*p$A classesofbiologicalpathogens.  &+4%B NIH#ЌЌ3#ЌЌ#X>XЌu#ЌXX>  b*p$C Dataunavailable.#X>XЌ#ЌXX>#ЌЌ]#ЌЌ  b*p$D Determinetheefficacyofusingsalivarydiagnosticstomonitorhealth ~,&E anddiagnoseatleastonesystemicdiseaseby2013.  B-P'F NIH#X>XЌ#ЌXX>#ЌЌI#ЌЌ  ~,&G Dataunavailable.#ЌЌ#ЌЌ#X>XЌF#ЌXX>  ~,&H By2005,developtwonewanimalmodelstouseinresearchonatleast .(I oneagentof_bioterror_.  ^/l)J NIH#ЌЌ#ЌЌ#X>XЌ2#ЌXX>  .(K Dataunavailable.#X>XЌt#ЌXX>#ЌЌ2#ЌЌ  .(L By2005,developimprovedanimalmodelsthatbestrecapitulate Vd  ParkinsonsDisease(_PD_),basedmergingscientificfindingsofgeneticor ( environmentalinfluences,orinteractionsofgenesandtheenvironment  onthedevelopmentof_PD_.   NIH#X>XЌ#ЌXX>#ЌЌ#ЌЌ  Vd Dataunavailable.#ЌЌK#ЌЌ#X>XЌ #ЌXX>  Vd ByFY2007,identify20smallmoleculesthatareactiveinmodelsof   nervoussystemfunctionordiseaseandshowpromiseasdrugs,   diagnosticagents,orresearchtools.     NIH#ЌЌ#ЌЌ#X>XЌ#ЌXX>     Dataunavailable.#X>XЌv#ЌXX>#ЌЌ4#ЌЌ     By2007,evaluatethreenewtreatmentsstrategiesforHIVinfectionin    PhaseII/IIIhumanclinicaltrialsinanefforttoidentifydrugsthatare    moreeffective,lesstoxic,and/orsimplertousethanthecurrent bp recommendedHIVtreatmentregimen.  &4  NIH#X>XЌ#ЌXX>#ЌЌ #ЌЌ    Dataunavailable.#ЌЌ#ЌЌ#X>XЌ#ЌXX>    Establishingtheefficacyofstainsinpreventingprogressionof ~  atherosclerosisinchildrenwithSystemicLupus_Erthermatosus_Ԁ(_SLE_Ԁor BP  lupus).    NIH#ЌЌl#ЌЌ#X>XЌ#ЌXX>  ~  Dataunavailable.#X>XЌU#ЌXX>#ЌЌ#ЌЌ  ~  By2008,reducethedisparitybetweenAfricanAmericanandwhite ^l  infantsinbacksleepingby50percenttofurtherreducetheriskof "0 SuddenInfantDeathSyndrome(SIDS).   NIH#X>XЌ#ЌXX>#ЌЌ#ЌЌ  ^l  Dataunavailable.#ЌЌ#ЌЌ#X>XЌ@#ЌXX>  ^l  Expandtherangeofavailablemethodsusedtocreate,analyze,and >L utilizechemicallibraries,whichcanbeusedtodiscovernewmedicines.  Specifically,usethesechemicallibrariestodiscover10newandunique  chemicalstructuresthatcouldserveasthestartingpointfornewdrugs.   NIH#ЌЌ#ЌЌ#X>XЌ,#ЌXX>  >L  Dataunavailable.#X>XЌ8#ЌXX>#ЌЌ#ЌЌ  >L! Identifythegenesthatcontroltheriskforthedevelopmentofagerelated " maculardegenerationandglaucomainhumans.  # NIH#X>XЌ#ЌXX>#ЌЌ#ЌЌ  $ Dataunavailable.#ЌЌ#ЌЌ#X>XЌ#ЌXX>  % By2011,assesstheefficacyofatleastthreenewtreatmentstrategiesfor  & reducingcardiovascularmorbidity/mortalityinpatientswithtype2 ' diabetesand/orchronickidneydisease.  ( NIH#ЌЌ#ЌЌ#X>XЌ#ЌXX>   ) Dataunavailable.#X>XЌY#ЌXX>#ЌЌ#ЌЌ   * By2012,developaknowledgebaseonChemicalEffectsinBiological + Systemsusinga systemstoxicologyor_toxicogenomics_Ԁapproach.  , NIH#X>XЌ#ЌXX>#ЌЌ#ЌЌ  - Dataunavailable.#ЌЌn#ЌЌ#X>XЌ,#ЌXX>  . By2005,evaluate10commonlyused_botanicals_Ԁforinhibition/induction  / ofenzymesthatmetabolizedrugsasamethodofidentifyingpotential !0 botanical/druginteractions.  "1 NIH#ЌЌ#ЌЌ#X>XЌ#ЌXX>   2 Dataunavailable.#X>XЌ#ЌXX>#ЌЌx#ЌЌ   3 By2006,integrate_nanotechnology_Ԅbasedcomponentsintoasystem #4 capableofdetectingspecific_biomarker_(s)(molecularsignatures)to $5 establishproofofconceptforanewapproachtotheearlydetectionof b%p6 cancerand,ultimately,cancerpreemption.  &&4 7 NIH#X>XЌ"#ЌXX>#ЌЌd#ЌЌ  #8 Dataunavailable.#ЌЌ#ЌЌ#X>XЌG#ЌXX>  #9 By2005,createthenextgenerationmapofthehumangenome,aso ~'!: called _halotype_Ԁmap(_HapMap_),byidentifyingthepatternsofgenetic B(P"; variationacrossallhumanchromosomes.  )#< NIH#ЌЌ#ЌЌ#X>XЌ3#ЌXX>  ~'!= Dataunavailable.#X>XЌ #ЌXX>#ЌЌ #ЌЌ  ~'!> By2007,determinethegenomesequenceofanadditional45human ^*l$? pathogensandthreeinvertebratevectorsofinfectiousdiseases.  "+0%@ NIH#X>XЌj #ЌXX>#ЌЌ #ЌЌ  ^*l$A Dataunavailable.#ЌЌ #ЌЌ#X>XЌ #ЌXX>  ^*l$B Identifyandcharacterizetwomolecularinteractionsofpotentialclinical z,&C significancebetweenboneformingcellsandcomponentsofbone.Such >-L'D interactionsaredefinedasthosehavingsignificantimpactontheactual .(E ofbonemassortheactualmechanicalperformanceofbone(i.e.,fracture .(F resistance)inlaboratoryanimals.  /)G NIH#ЌЌZ #ЌЌ#X>XЌ #ЌXX>  z,&H Dataunavailable.#X>XЌ#ЌXX>#ЌЌ#ЌЌ  z,&I BuildapubliclyaccessibleCollectionofReferenceSequencestoserve Vd  asthebasisformedical,functional,anddiversitystudies.A ( comprehensiveReferenceSequenceCollectionwillserveasafoundation  for_genomic_Ԁresearchbyprovidingacentralized,integrated,non  redundantsetofsequences,including_genomic_ԀDNA,transcript(RNA), f t and_proteome_Ԁ(proteinproduct)sequences,integratedwithothervital * 8 informationforallmajorresearchorganisms.    NIH#X>XЌL#ЌXX>#ЌЌ#ЌЌ  Vd Dataunavailable.#ЌЌ#ЌЌ#X>XЌ#ЌXX>  Vd  By2009,assesstheimpactoftwomajorInstitutionalDevelopment F T  Award(_IdeA_)programsonthedevelopmentofcompetitiveinvestigators    andtheircapacitiestocompeteforNIHresearchfunding.     NIH#ЌЌ[#ЌЌ#X>XЌ#ЌXX>  F T  Dataunavailable.#X>XЌW#ЌXX>#ЌЌ#ЌЌ  F T By2010,demonstratethroughresearchacapacitytoreducethetotal &4  yearslosttodisability(_YLDs_)intheU.S.by10percentby1)developing   treatmentalgorithmstoimprovethemanagementoftreatmentresistant   andrecurrentdepressionand2)elucidatingthemechanismsbywhich r  depressioninfluencesatleasttwo_comorbid_Ԁphysicalillnesses(e.g.,heart 6D  disease,cancer,Parkinsonsdisease,ordiabetes).Majordepressionis   nowtheleadingcauseof_YLDs_Ԁinthenation.    NIH#X>XЌ#ЌXX>#ЌЌ#ЌЌ  &4  Dataunavailable.#ЌЌh#ЌЌ#X>XЌ&#ЌXX>  &4  ByFY2010,identifyculturallyappropriate,effectivestrokeprevention $ programsfornationwideimplementationinminoritycommunities.   NIH#ЌЌ#ЌЌ#X>XЌ#ЌXX>  $ Dataunavailable.#X>XЌ_#ЌXX>#ЌЌ#ЌЌ  $ #X>XЌ##X>XXX> #ЌXX>Reviewandacton90%ofstandardNewDrugApplicationswithin10 2@ monthsand90%ofpriority_NDAs_Ԁwithin6months.#X>XЌ#X>XXX>   ЌXX>FDA  2@ #X>XЌ#ЌXX>Met.FY0190% 2@ (target70%of   standard_NDAs_) ! FY01100%(target ~" 90%ofpriority BP# _NDAs_).  $ #X>XЌ##X>XXX>k#ЌXX>Completereviewandactupon_fileable_Ԁoriginalgenericdrugapplications ^l% within6monthsaftersubmissiondate[FY01:reviewed84%of298 "0& applications(target50%)].#X>XЌo#X>XXX>  ' ЌXX>FDA#ЌЌ #ЌЌ  ^l( #X>XЌ #ЌXX>Met.FY0184% ^l) (target:50%).  "0* #X>XЌo!##X>XXX>!#ЌXX>Increasethenumberofdrugsthatareadequatelylabeledforchildren.#X>XЌ"#X>XXX>  >L+ ЌXX>FDA#ЌЌ"#ЌЌ  >L, #X>XЌ"#ЌXX>Dataunavailable.#X>XЌs##ЌXX>#ЌЌ##ЌЌ  >L- #X>XЌ###X>XXX>$#ЌXX>Acton90percentof_Rx_ԀtoOTCswitchapplicationswithin10months.#X>XЌ$#X>XXX>   . ЌXX>FDA#ЌЌ(%#ЌЌ   / #X>XЌ\%#ЌXX>Dataunavailable.#X>XЌ%#ЌXX>#ЌЌ%#ЌЌ   0 #X>XЌK&#ЌXX>Completereviewandactionon90percentofPremarketApproval !1 Application(_PMA_)onanestimated80(_PMA_)firstactionswithin180 "2 days.#X>XЌ&##X>XXX>̍&#X>XXX>  v#3 ЌXX>FDA#ЌЌ:(#ЌЌ  !4 #X>XЌn(#ЌXX>Met.FY0297% !5 (target:90%).  "6 #X>XЌ )#ЌXX>Completereviewandactionon95percentofanestimated725_PMA_ $7 supplementfinalactionswithin180days.#X>XЌ)##X>XXX>̳(#X>XXX>  %8 ЌXX>FDA#ЌЌ*#ЌЌ  $9 #X>XЌ*#ЌXX>Met.FY0295% $: (target90%).  %; #X>XЌh+#ЌXX>Complete95percentof_PMA_Ԁ Determinationmeetingswithin30days & < [FY01:100%of3(target95%)].#X>XЌ+##X>XXX>+#X>XXX>  '!= ЌXX>FDA#ЌЌ,#ЌЌ  & > #X>XЌ'-#ЌXX>Met.FY01100% & ? (target95%). '!@ " #X>XЌ-##X>XXX>l-#ЌXX>*MorerecentdatamaybecomeavailableinindividualagencyReports.#X>XЌs.#X>XXX> ("@     >+L%C Goal5:#X>XXX>.#ImprovetheQualityofHealthCareServices. X>XXX>  *Vd#ddd dd dd V(#(#,dd ,dd ,dd +   ЌXX>DecreasebyfivepercentthehospitalizationratesforpediatricAsthma.#X>XЌ0##X>XXX>̮/#X>XXX>  .< ЌXX>AHRQ  .< #X>XЌ1#ЌXX>Dataunavailable.#X>XЌ(2#ЌXX>#ЌЌ1#ЌЌ  .< #X>XЌ{2#ЌXX>Producea_CAHPS_Ԁmoduleforconsumerassessmentsofhospitalquality.#X>XЌ3##X>XXX>̽2#X>XXX>    ЌXX>AHRQ#ЌЌ3#ЌЌ    #X>XЌ4#ЌXX>Dataunavailable.#X>XЌ4#ЌXX>#ЌЌW4#ЌЌ    #X>XЌ5#ЌXX>Fivetechnologiescurrentlyshowntobeeffectiveinotherclinical    settingswillbetestedinnursinghomestoevaluatetheimpactonsafety,    quality,andcostofcare.#X>XЌ5##X>XXX>C5#X>XXX>  f t  ЌXX>AHRQ#ЌЌ6#ЌЌ     #X>XЌ7#ЌXX>Dataunavailable.#X>XЌ7#ЌXX>#ЌЌJ7#ЌЌ     #X>XЌ7#ЌXX>Decreasetheprevalenceofrestraintsinnursinghomes.#ЌЌ68##X>XЌ8#X>XXX>    ЌXX>CMS    #X>XЌ]9#ЌXX>Notmet.FY029.9%   interimdata(target  10%).  FT  #X>XЌ9#ЌXX>Decreasetheprevalenceofpressureulcersinnursinghomes.#ЌЌ)9##X>XЌe:#X>XXX>    ЌXX>CMS    #X>XЌ:;#ЌXX>Met.10.3%interim   data(target9.5%).  bp  #X>XЌ;#ЌXX>Expandimplementationofthe_MeDSuN_ԀSystemtoanetworkof300   facilities[FY01:FDAbeganfeasibilitytestingwith25hospitalsand ~  workedonsoftwarechangesneededforwebsitehealthdatasecurity BP (targetrecruit75hospitalstoreportadverseevents)].#X>XЌ&<##X>XXX>;#X>XXX>   ЌXX>FDA    #X>XЌ>#ЌXX>Dataunavailable.#X>XЌv>#ЌXX>#ЌЌ=#ЌЌ    #X>XЌ>#ЌXX>Enhance_postmarketing_Ԁdrugsafety.#X>XЌb?##X>XXX> ?#X>XXX>  ^l ЌXX>FDA  ^l #X>XЌ=@#ЌXX>Dataunavailable.#X>XЌ@#ЌXX>#ЌЌ @#ЌЌ  ^l #X>XЌ@#ЌXX>Expandtheautomatedextractionof_GPRA_Ԁclinicalperformance   measuresandimprovedataquality.#X>XЌA##X>XXX>,A#X>XXX>  z! ЌXX>IHS  " #X>XЌB#ЌXX>Dataunavailable.#X>XЌ C#ЌXX>#ЌЌ{B#ЌЌ  # #X>XЌ\C#ЌXX>BuildITcapabilitiesandcapacitythroughalllevelsofpublichealth $ (local,state,andfederal)toservethevarietyofpublichealthfunctions.#X>XЌC##X>XXX>̞C#X>XXX>  % ЌXX>CDC  & #X>XЌ5E#ЌXX>Dataunavailable.#X>XЌE#ЌXX>#ЌЌE#ЌЌ  ' #X>XЌE#ЌXX>EnsurepublichealthITworksasacoherentnetworkandhastheability ( toconnectothergroups.#X>XЌ{F##X>XXX>$F#X>XXX>  ) ЌXX>CDC  * #X>XЌG#ЌXX>Dataunavailable.#X>XЌG#ЌXX>#ЌЌTG#ЌЌ  + #X>XЌ5H#ЌXX>Evaluatenetworkfunctionalityandensureinteroperability,security,and  , reliability.#X>XЌH##X>XXX>wH#X>XXX>  - ЌXX>CDC   . #X>XЌI#ЌXX>Dataunavailable.#X>XЌ+J#ЌXX>#ЌЌI#ЌЌ  / #X>XЌ~J# Goal6:#X>XXX>J# XX>ImprovetheEconomicandSocialWellBeingofIndividuals,Families,and !1 Communities,EspeciallyThoseMostinNeed. #X>X LK#X>XXX> "2 *Vd ddd dd dd V(#(#,dd ,dd ,dd +  $4$ ЌXX>ForFY2003,increaseto44%thepercentageofadult_TANF_Ԁrecipients $5 whobecomenewlyemployed.FY2004targetstobeestablishedafter %6 _TANF_Ԁreauthorization.#X>XЌVM##X>XXX>L#X>XXX>  n&| 7 ЌXX>ACF  $8 #X>XЌN#ЌXX>Met.FY0046.4% $9 (target42%).  %: #X>XЌOO#ЌXX>ForFY2003,increaseto68%thepercentageofadult_TANF_ '!; recipients/formerrecipientsemployedinonequarteroftheyearwho ("< continuetobeemployedinthenexttwoquarters.#X>XЌO##X>XXX>N#X>XXX>  N)\#= ЌXX>ACF  '!> #X>XЌjQ#ЌXX>Dataunavailable.#X>XЌQ#ЌXX>#ЌЌ6Q#ЌЌ  '!? #X>XЌR#ЌXX>Increasethetargetingindexof_LIHEAP_Ԁrecipienthouseholdshavingat *$@ leastonemember60yearsoroldercomparedtononvulnerable_LIHEAP_ j+x%A recipienthouseholds.#X>XЌR##X>XXX>YR#X>XXX>  .,<&B ЌXX>ACF  *$C #X>XЌQT#ЌXX>Dataunavailable.#X>XЌT#ЌXX>#ЌЌT#ЌЌ  *$D #X>XЌT#ЌXX>Increasethetargetingindexof_LIHEAP_Ԁrecipienthouseholdshavingat -'E leastonemember5yearsorundercomparedtononvulnerable_LIHEAP_ J.X(F recipienthouseholds.#X>XЌU##X>XXX>@U#X>XXX>  /)G ЌXX>ACF  -'H #X>XЌ8W#ЌXX>Dataunavailable.#X>XЌW#ЌXX>#ЌЌW#ЌЌ  -'I #X>XЌW#ЌXX>AsignificantpercentageofOlderAmericanActTitleIIIservice Vd  recipientsliveinruralareas.#ЌЌ'X##X>XЌX#X>XXX>  ( ЌXX>_AoA_  Vd #X>XЌY#ЌXX>Dataunavailable.#X>XЌZ#ЌXX>#ЌЌkY#ЌЌ  Vd #X>XЌlZ#ЌXX>Maintainahighratioofleveragedfundsto_AoA_Ԁfunds.#X>XЌ[##X>XXX>̮Z#X>XXX>  r ЌXX>_AoA_  r #X>XЌ[#ЌXX>Dataunavailable.#X>XЌo\#ЌXX>#ЌЌ[#ЌЌ r  #X>XЌ\# Goal7:ImprovetheStabilityandDevelopmentofourNationsChildrenandYouth. #X>XXX>]#X>XXX> > L  *Vdddd dd dd V(#(#,dd ,dd ,dd +   $  $ ЌXX>Achieveatleastanaverage34%gaininwordknowledgeforchildren z   completingtheHeadStartprogram. #X>XЌ_##X>XXX>]#X>XXX>  >L  ЌXX>ACF  z  #X>XЌ5`#ЌXX>Met.FY0032% z  (target19%).  >L #X>XЌ`#ЌXX>Achieveatleastanaverage52%gaininmathematicalskillsforchildren   completingHeadStartprograms.#X>XЌa##X>XXX>`#X>XXX>  Zh  ЌXX>ACF#ЌЌa#ЌЌ    #X>XЌ,b#ЌXX>Met.FY0043%   (target30%).  Zh  #X>XЌb#ЌXX>Achieveatleastanaverage70%gaininletteridentificationforchildren   completingtheHeadStartprogram(theaveragegainamongallchildren v  duringthepreKyearis50%).[Goalnotmet:Gainincreasedto38%, :H  fallingshortof70%]#X>XЌPc##X>XXX>qb#X>XXX>    ЌXX>ACF#ЌЌd#ЌЌ    #X>XЌe#ЌXX>Notmet.38%(target   70%).  v  #X>XЌe#ЌXX>Increasethenumberofchildrenreceivingchildcareservicesthrough Vd _CCDF_,_TANF_Ԅdirectand_SSBG_Ԁfunds. ( #X>XЌ4f##X>XXX>We#X>XXX>   ЌXX>ACF#ЌЌg#ЌЌ  Vd  #X>XЌg#ЌXX>Dataunavailable.#X>XЌZh#ЌXX>#ЌЌh#ЌЌ  Vd! #X>XЌh#ЌXX>Increasetheproportionofcentersandhomesthatservefamiliesand ^l" childrenreceivingchildcaresubsidies. #X>XЌFi##X>XXX>h#X>XXX>  "0# ЌXX>ACF#ЌЌ2j#ЌЌ  ^l$ #X>XЌfj#ЌXX>Dataunavailable.#X>XЌk#ЌXX>#ЌЌj#ЌЌ  ^l% #X>XЌUk#ЌXX>IncreasethenumberofStatesthatencourageprovidertrainingthrough z& bonusesorothercompensation.#X>XЌk##X>XXX>̗k#X>XXX>  >L' ЌXX>ACF#ЌЌl#ЌЌ  z( #X>XЌm#ЌXX>Dataunavailable.#X>XЌm#ЌXX>#ЌЌFm#ЌЌ  z) #X>XЌm#ЌXX>Increasethepaternityestablishmentpercentage(PEP)to99%.#X>XЌn##X>XXX>2n#X>XXX>  * ЌXX>ACF#ЌЌ,o#ЌЌ  + #X>XЌ`o#ЌXX>Met.FY01102% , (target96%).  Zh- #X>XЌo#ЌXX>IncreasetheTitleIVDcollectionrateto60%. #X>XЌp##X>XXX>̥o#X>XXX>  . ЌXX>ACF#ЌЌ q#ЌЌ  / Met.FY0157% 0 (target54%).#X>XЌTq#ЌXX>  v1 #X>XЌ!r#ЌXX>Increasethenumberofadoptionsofchildreninthepublicfostercare  2 systemto60,000.#X>XЌxr##X>XXX>̙q#X>XXX>  !3 ЌXX>ACF#ЌЌIs#ЌЌ   4 #X>XЌ}s#ЌXX>Notmet.FY01  5 50,000(target !6 51,000).  V"d7 #X>XЌt#ЌXX>Ofthechildrenwhoexitfostercarethroughreunification,maintainthe #8 percentageofchildrenwhodothiswithinoneyearofplacementat67%. r$9 [FY2001goalmet:68%(target67%).]#X>XЌt##X>XXX>s#X>XXX>  6%D: ЌXX>ACF#ЌЌv#ЌЌ  #; #X>XЌ6v#ЌXX>Met.FY0168% #< (target67%). r$= #X>XЌv# Goal8.AchieveExcellenceinManagementPractices.  ("?  >*,-./012(x3+*Vd ddd dd dd V(#(#,dd ,dd ,dd +  )#A)# ЌXX>AchieveMedicare/Medicaidtotalexpectedrecoveriesandsavingsper >*L$B dollarinvestedof$156:1.  +%C #X>XЌ9y#ЌXX>OIG  >*L$D #X>XЌz#ЌXX>Dataunavailable.#X>XЌ\z#ЌXX>#ЌЌ{v#ЌЌ  >*L$E #X>XЌz#ЌXX>WorkwithCMStoreducetheMedicareerrorpaymentrateto[arate Z,h&F determinedbyCMS].  -,'G #X>XЌH{#ЌXX>OIG  Z,h&H #X>XЌ |#ЌXX>Dataunavailable.#X>XЌc|#ЌXX>#ЌЌz#ЌЌ  Z,h&I #X>XЌ|#ЌXX>Obtainacleanauditopinion.#ЌЌ|#ЌЌ  v.(J #X>XЌO}#ЌXX>ACF  v.(K #X>XЌ~#ЌXX>Met.FY01clean v.(L audit.  :/H)M #X>XЌ_~##X>XXX>̮}#ЌXX>MaintainacleanunqualifiedopiniononCMSs_FYs_Ԁ2002,2003and Vd  2004financialstatements. #X>XЌ# X>XXX>  ( ЌXX>CMS  Vd #X>XЌ-#ЌXX>Met.FY01clean Vd audit.  ( #X>XЌ##X>XXX>#ЌXX>CompleteconstructionofInfectiousDiseaseLab,Building109,to r replaceBuildings4,6,7,8and9onthe_Chamblee_ԀCampus.[FY03: 6 D PhaseIIconstructioncomplete]#X>XЌ-#X>XXX>    ЌXX>CDC  r  #X>XЌ#ЌXX>Met.FY02on r  schedule.  6 D  #X>XЌ##X>XXX>[#ЌXX>DesignandconstructanEnvironmentalToxicologyLab,Building110, R `  toreplaceBuildings17,25,31and32onthe_Chamblee_ԀCampus.[FY  $  03:Constructiononschedule]#X>XЌ#X>XXX>.    ЌXX>CDC  R ` #X>XЌ#ЌXX>Met.FY02 R ` constructionbegun.  $  #X>XЌL#      THISPAGEINTENTIONALLYBLANK   8>XXdd8BOCP@<l \'" Ip `@XddddEIpttaL    D,----#M=9l|z~t ` dE. tf7  (#(#       (#(#*,X,` XX*(X@(#(#(  HHSistakingstepstoreducehealth   threatsthroughthepromotionofhealthy   behaviorsandbuildingpartnershipswith o  States,communities,andhealth [  professionals.Reinforcinghealthy Gk behaviorsinyouth,fromabstinencetoskill 3W building,iscritical.TheSecretaryisleading C theDepartmentinStepstoaHealthierUS,a  / coordinatedHHSeffortthatemphasizes  healthybehaviorsandchoicesinpreventing  andcontrollingdiseasewithaspecialfocus  onasthma,diabetesandobesity.Steps  advancesPresidentBushsHealthierUS  Program,whichmobilizestheFederal  governmenttoalerttheAmericanpeopleto  thevitalhealthbenefitsofsimpleand k modestimprovementsinphysicalactivity, W{ nutrition,andbehavioralchoicessuchas C g eliminatingtobaccoandillegaldruguse. /!S   PreventionisalsoahallmarkofHHSs "? approachtofightingHIV/AIDS,sexually #+ transmitteddiseases,andtuberculosis.We # aremakingconsiderableprogressslowing $  thetransmissionofAIDSfrompregnant %! womentotheirchildren,andpreventingthe & " spreadoftuberculosis.Similarly,theHHS '!# vaccineprogramprotectsthepopulation ("$ fromawidevarietyofinfectiousdiseases, {)#% includingdiphtheria,measles,polio,and g*$& influenza. S+w%'   Ariskbehavioraffectingyouthandother ?,c&( segmentsoftheU.S.populationis +-O') substanceabuse.ConsistentwiththeOffice  ) ofNationalDrugControlPolicysoverall  * recommendations,theFY2004budget o + requestmakesathirdinstallmentonthe [ , PresidentsDrugTreatmentInitiative,and Gk- HHScontinuestoworkwithONDCPto 3W. implementaneffectivedrugstrategy.#X>XXX>̽#EX>XXX> C/ ? ,X,` XDX,X,` X? D SeveralillustrativeprogramsatHHS,  /0 detailedbelow,#X>XXEX>~#haveannualperformance 1 measuresthatspeaktoreducingthethreats 2 tothehealthandwellbeingofAmericans. 3 Thesemeasuresarerepresentativeofthe 4 programsbeingdescribedandserveas 5 examplesofhowHHScontinuestotrack 6 theirprogresstowardsthisstrategicgoal.  7  D   (#(#K(# D  ?,c&G (X@(  /')G BO BeX B  *F:Gdddd dd dd V(#(#,4\R,\R,\R+  <VVV#' <    HHSStrategicGoal AVVV#,! "VVV# AX>XXX>Agencies/   Programs   AVVV#,! "VVV# AFY2004PerformanceMeasures#X>XXX>̦#X>XXX> TVVC, " VVV# T#X>XXX>̃#X>XXX>&'%XX>GOAL1:Reducethe q  majorthreatstothe I`  healthandwellbeingof !8  Americans.   #X>X%&'<##X>XXX>#X>XXX>ЌXX> NVV=2 "PPVV N#ЌЌ@##X>XЌ_#ЌXX> CDC   Chronic   Disease I ` Preventionand  $ Health   Promotion#X>XЌ#X>XXX> =VV,!"VV =  ЌXX>Ԅ#ЌЌ#ЌЌԀPrevent50,000hospitalizationsduetoasthma.*    *,-./012(yx>*,-./012ӄPrevent75,000100,000Americansfromdeveloping   diabetes.* I ` ЄPrevent100,000150,000Americansfromdeveloping  $ obesity.#X>XЌY#*    >*,-./012(xy*,-./012#X>XXX>̜#X>XXX>ЌXX> OVV>' VV O 7VV&VV 7#ЌЌ#ЌЌ#X>XЌ;#ЌXX>_OPHS_   #ЌЌ# Disease Of Preventionand *  Health   Promotion#X>XЌE# =VV,! "VV =  ЌXX>ԄIncreaseby25%thenumberoflocal,State,nationaland   internationalhealthpoliciesthatincorporatepreventionelements Of! identifiedby_OPHS_Ԁaseffective.* * "  *,-./012(yx>*,-./012ӄIncreaseby9%thereachof_OPHS_Ԁprevention  # communications.  $ ЄIncreaseby11%thenumberofpolicesinresearchinstitutions _v % thatimprovetheresearchenterprise.#X>XЌ#* #: &  >*,-./012(xy*,-./012ЌXX>ЌЌ OVV>'& ' VV O 7VV& 'VV 7 #ЌЌ##X>XЌ#ЌXX> CDC  ( HIV/AIDS, ) Sexually e|* Transmitted )@+ Diseasesand , Tuberculosis#X>XЌ#ЌXX>ЌЌ -  =VV,!u."VV =#X>XЌ##X>XXX> # ЌXX>ЌЌԄDecreasethenumberof_perinatally_ԀacquiredAIDScasesfrom  / the1998baselineof235cases.#ЌЌ#ЌЌ#X>XЌƧ#ЌXX>Ԁ[FY99:171;FY00:102.] 0 ЄReducetheincidenceofgonorrheainwomenages1544.[FY e|1 99:286/100,000;FY00:278;FY01:286.] )@2 ЄReducethenumberofHIVinfectionsdiagnosedamongpeople 3 youngerthan25yearsold.[2000baseline:1,805cases.] 4 ЄIncreasethepercentageofTBpatientswhocompleteacourse u5 ofcurativeTBtreatmentwithin12monthsofinitiationof 9P6 treatment.#ЌЌ#ЌЌ#X>XЌ#ЌXX>Ԁ[FY99:79.9%.] OVV>'7 VV O 7VV&7VV 7CDC 8 Immunization 9 Program Sj:  =VV,!<"VV =ЄReducetoormaintainat0thenumberofindigenouscasesof = measlesinchildrenunder5by2010.[FY99:66;FY00:63;FY > 01:61(provisional).] Sj?  *,-./012(yx>*,-./012ӄAchieveormaintainimmunizationcoverageofatleast90 .@ percentinchildren19to35monthsofageinatleast7 A vaccines. *  B  >*,-./012(xy*,-./012 #X>XЌ#ЌXX>#ЌЌD#ЌЌ OVV>'e!|C VV O 7VV&3"JCVV 7SAMHSA 3"JD  #ЌЌӯ##X>XЌ#ЌXX> Substance "E Abuse #F Preventionand $G Treatment C%ZH BlockGrant &I Program#X>XЌܰ#ЌXX>ЌЌ =VV,!&J"VV = #ЌЌ##X>XЌ# ЌXX> *,-./012(yx>*,-./012ЌЌԄ95%oftechnicalassistanceeventswillresultinsystems, 3"JK programorpracticechange. #X>XЌ# #X>XXX>.#X>XXX>ЌXX>Ԁ#ЌЌ ##X>XЌ+# X>XXX>ЌXX>[FY99:66%FY00:84%;FY01: "L 96%]#ЌЌ##X>XЌ#X>XXX>  #M  >*,-./012(xy*,-./012 #X>XXX>X#ЌXX>ЌЌ OVV>'$N VV O 7VV&'NVV 7CDC 'O PublicHealth ](t P Information !)8!Q Network =VV,!)!R"VV =ЄBuildITcapabilitiesandcapacitythroughalllevelsofpublic 'S health(local,state,andfederal)toservethevarietyofpublic ](t T healthfunctions.* !)8!U ЄEnsurepublichealthITworksasacoherentnetworkandhas )!V theabilitytoconnectothergroups.* *"W ЄEvaluatenetworkfunctionalityandensureinteroperability, m+#X security,andreliability.*#ЌЌ_#ЌЌ#X>XЌ@#ЌXX>7-+1,H$Y  VV 7  *Seeagencyperformanceplan/reportforadditionalinformation.#X>XЌҹ##X>XXX>̐#X>XXX>  ,%Y H #K;7l| ^ `BdE^  (#(#       (#(#    (X@(#(#(ProgramBackgroundandContext  I` <,` X ,X,` XDX<  Chronicdiseasesareleadingcausesof !8  disabilityanddeathintheUnitedStates.  $  Everyyear,chronicdiseasesclaimthelives   ofmorethan1.7millionAmericans.These   diseasesareresponsibleforsevenofevery   10deathsintheUnitedStates.Chronic   diseasescausemajorlimitationsindaily  livingformorethanoneofevery10  Americans,or25millionpeople.CDCs  ChronicDiseasePreventionandHealth m Promotionismadeupofavarietyofefforts, Yp includingBreastandCervicalCancer, E\ TobaccoUsePrevention,CommunityBased 1H PreventionResearch,HeartDiseaseand 4 Stroke,Arthritis,theNationalProgramof    CancerRegistries,HIVPreventionAmong   SchoolAgedYouth,andBehavioralRisk  Surveillance.     AstheleadFederalagencyforprotecting ! thehealthandsafetyofAmericans,CDC " worksdiligentlytopreventdisease,injury # anddisability.AmongCDCshighest }$ prioritiesistorespondforcefullytothe i%  epidemicsofasthma,diabetes,andobesity U&l! thataresweepingallsectorsofsociety. A'X"   Eachyear,asthmacausesabout5,000 -(D # deathsand2millionemergencyroomvisits. )0!$ Nearly17millionpeoplehavediabetes,of *"% which90percentto95percentofthecases *#& aretype2diabetes,whichisassociatedwith +#' obesityandphysicalinactivity.Inaddition, ,$( nearly50millionadultsbetweentheagesof -%) 20and74areobese,andmorethan108 .&* millionadults(61percent)areeitherobese /'+ oroverweight.ArecentHHSreportcites I`+ that300,000peopledieeachyearfrom 5L, diseasesandhealthconditionsrelatedtoa !8 - sedentarylifestyleandpooreatinghabits.  $ . TheHHSreportpulledtogetherdatafrom  / variousstudiesandscientificsourcesto  0 illustratethecorrelationbetweeninactivity  1 andpoorhealth,particularlytheonsetof  2 diseasessuchasdiabetesandobesity. 3  ProgramPerformancePlanning  5  D JoiningwithHRSA,AHRQ,andNIH, Yp7 CDChasbegunacoordinatedand E\8 comprehensivenewinitiativetoprevent 1H9 asthma,diabetes,andobesityandtheir 4: complications.TheHealthyCommunities   ; Initiativeprovidesfortargetedprograms  < focusingonreducingthehealthimpactsof = asthma,diabetes,andobesity.Thisinitiative  > supportstheHealthyPeople2010goalsto !? promoterespiratoryhealthGoal24),reduce "@ thediseaseandeconomicburdenofdiabetes #A (Goal5),andreducechronicdisease }$B associatewithdietandweight(Goal19). i%C  D Acoordinatedgrantannouncement, U&lD application,andreviewprocesswillassure A'XE coordinationandintegrationattheStateand -(D F locallevel.Theinitiativeisaimedat )0!G achieving: *"H   *,-./012(yx>*,-./012"*3"  *32H3  0 D   Preventing50,000hospitalizationsdue +#J toasthma,*3݌,$KD(#D(# Ќ   >*,-./012(xy*,-./012  *,-./012(yx>*,-./012"*3"  *32H3  0 D   Preventing75,000100,000Americans -%L  fromdevelopingdiabetes,and*3݌ .&MD(#D(# Ќ   "*3"  *32H3  0    Preventing100,000150,000   Americansfromdevelopingobesity.*3݌ Ќ   >*,-./012(xy*,-./012 L@ MeansandStrategies    < ,X,` XDpX,` X<  TheChronicDiseasebudgetrequestfor   FY2004is$834million,anincreaseof m  approximately$124millionovertheFY Yp 2003appropriation.Complementingthose E\ meansareseveralstrategiesthatCDChasto 1H  translatethenewscienceofprimary 4  preventionintopublichealthaction.The    highlightedmeasuresexemplifythese   strategies.    *,-./012(2xx>*,-./012"*3"  *3y223  0    Asthma: In1999,anestimated26.7   millionAmericansreportedthattheyhad  beendiagnosedwithasthmasometimein  theirlives.Anestimated10.5million  reportedanasthmaattackintheprevious m 12months.CDCsAsthmaControl Yp Programusestracking,interventionand E\ partnershipstoreducethenumberof 1H deaths,emergencyroomvisits,schoolor 4 workdaysmissedandlimitationson    activityduetoasthma.Sofar,25States   haveimplementedasthmaprogramswith  CDCshelp.*3y݌  Ќ   *,-./012(2xx*,-./012"*3"  *3223  0    Diabetes: CDCcontinuestoachieveits ! targetsforincreasingthepercentageof " personswithdiabeteswhoreceive # annualfootexams.Diabetesisthe $ leadingcauseofnontraumaticlower m%  extremityamputations,yetoverhalfof Y&p! theover80,000amputationsthatoccur E'\" annuallycouldbepreventedthrough 1(H # appropriatepreventivecareand )4!$ treatment.CDCisnowestablishinga  * "% baselineinStateswithprediabetes * #& programssothat,by2010,theycan +#' achievea25percentdecreaseamong ,$( peoplewhohaveprediabeteswho -%) advancetodiabetes.*3݌.&* Ќ   *,-./012(2xx*,-./012"*3"  *3223  0 D   Obesity: InitialCDCprogramsto * addresstheepidemicofobesityin + AmericahavefocusedonbuildingState  , capacitytodevelopcomprehensive  - nutritionandphysicalactivityprograms.  . SinceFY2000,twelveStateshavebeen  / fundedtobuildcapacity.Theyare u 0 developingplansfortargeted ax1 populations,developingpartnershipsto Md2 carryouttheplans,anddeveloping, 9P3 conducting,andevaluatingnutritionand %< 4 physicalactivityinterventionprojectsin ( 5 populations.*3݌ 6D(#D(# Ќ   ExternalFactors   8  D Thereiscurrentlynowaytopreventthe : initialonsetofasthma,andthereisnocure. ; However,peoplewhohaveasthmacanstill < leadquality,productivelivesiftheycontrol q= theirasthma.Asthmacanbecontrolledby ]t> takingmedicationandbyavoidingcontact I`? withenvironmental"triggers."These 5L@ environmentaltriggersincludecockroaches, !8A dustmites,furrypets,mold,tobaccosmoke,  $B andcertainchemicals. C  D Agreatdealremainsunknownaboutthe D riskfactorsfordiabetes,particularlygenetic  E riskfactors.Anumberofstudieshave !F shownthatlifestyleinterventions "G significantlyreducetheriskofdeveloping #H type2diabetes.Inhighriskpopulations, $I type2diabetesalsoappearstobeassociated m%J withobesity.Researchersaremaking Y&pK progressinidentifyingtheexactgenetics E'\L and"triggers"thatpredisposesome 1(H M individualstodeveloptypeonediabetes,but )4!N prevention,aswellasacure,remains  * "O elusive. * #P  D Behavioralandenvironmentalfactorsare +#Q themaincontributorstooverweightand ,$R obesity.Whilethesefactorsprovidethe -%S greatestopportunitiesforpreventionand .&T treatment,theyarealsoamongthemost  difficulttoinfluence.Heredityalsoplaysa  largeroleindetermininghowsusceptible   peoplearetooverweightandobesity.   (      (X@(M #K;7l|k `BdEk_ (#(#         (#(# (X@(#(#( (#(#ProgramBackgroundandContext  q    WithintheOfficeofPublicHealthand I` Science(_OPHS_),severalprogramsprovide 5L  leadershipwithintheDepartmentandindeed !8  nationallyinpromotinghealthand  $  preventingdisease.Sometargetspecific   audiencesorissues.TheOfficeofMinority   Health(_OMH_)coordinatesandmonitors   effortsrelatedtoracialandethnicminorities.   TheOfficeonWomensHealth(_OWH_)is  thegovernmentschampionandfocalpoint  forwomenshealthactivities.TheOfficeof  PopulationAffairs/AdolescentFamilyLife m Program(_OPA_)supportsabstinence Yp educationprogramsforteens.The E\ PresidentsCouncilonPhysicalFitnessand 1H Sports(_PCPFS_)promotesphysicalactivity 4 forallages.The_OPHS_ԀOfficeofDisease    PreventionandHealthPromotion(_ODPHP_)   leadscrosscuttingnationalinitiativeswithin  and/oronbehalfoftheDepartment.Taken   together,_OPHS_Ԁprogramsprovidethe ! coordinationneededforagenciestoworkas "  OneHHSintacklingthecomplex # preventionchallengesfacingournation. }$   #X>XXX>#_OPHS_,through_ODPHP_,coordinates i%  PresidentBushsHealthierUSinitiativeand U&l! SecretaryThompsonsinitiative,Stepsto A'X" HealthierUS,onbehalfoftheDepartment. -(D # X>XXX>Together,theseinitiativesfocusbothon )0!$ preventingdiseasebyaddressingmajorrisk *"% factors(suchasphysicalinactivityandpoor *#& nutrition)andonreducingtheburdenof +#' diseasethroughappropriatehealth ,$( _screenings_Ԁandpreventionofsecondary -%) conditions.StepstoaHealthierUS#X>XXX>̣#X>XXX>will .&* haveaspecialemphasisondiabetes,obesity, q * andasthma.Itwillpromotehealth ]t+ informationtosupportresponsiblehealth I`, choices,communityinitiativestopromote 5L- andenablehealthychoices,healthcareand !8 . insurancesystemsthatputpreventionfirst  $ / (reducingriskfactorsandreducing  0 complicationsofchronicdisease),andState  1 andfederalpoliciesthatinvestinthe  2 promiseofpreventionforallAmericans.W.` hp x (# ,X,` XDpXW#X>XXX>̞#  3 _ODPHP_Ԁalsocoordinatestheimplementation 4 ofHealthyPeople2010.X>XXX>HealthyPeople 5 2010(HP)supportsthePresidents 6 HealthierUSinitiativebyofferingspecific m7 goalsacrossarangeofhealthareas. Yp8 Throughconcreteobjectivesandmeasurable E\9 targets,itprovidesaframeworkfor 1H: programsnecessarytoachievethe 4; Presidentsvision.#X>XXX>B#X>XXX>   <  p TheAssistantSecretaryforHealth  = monitorsandreportsonprogresssothatthe > nationcanjudgewhatworksandhowfarwe  ? stillhavetogotoreachourobjectives. !@  p Inaddition,_OPHS_Ԁstrengthensthe "A preventionscienceenterprisethroughits #B uniqueeffortsintheareasofassuring }$C researchintegrityandprotectinghuman i%D subjects.ThroughitsOfficeofResearch U&lE IntegrityanditsOfficeforHumanResearch A'XF Protections,theresearchthatunderpins -(D G publichealthpolicyandclinicaltreatments )0!H isguidedandmonitoredtoensureadherence *"I tothehighestethicalandlegalrequirements. *#J  ProgramPerformancePlanning  ,$L   -%M   _OPHS_Ԁhassetperformancemeasures   tocaptureitsspecialcontributionstothe  Departmentsandthenationsprevention   effort.Specifically,_OPHS_Ԁshapes   preventionpolicyatthenational,State,and   locallevelsbygettingkeyprioritiesintothe   agendaandprogramsofthemyriad q  stakeholderspublicandprivatewhose ]t effortsareneededtoimprovethehealthof I` individualsandcommunities.Itmobilizes 5L  thesestakeholdersthroughtargeted !8  leadershipandbroadpartnerships._OPHS_  $  providesmajorpreventioncommunication   channelsforthenation,notablyitsaward   winning_Websites_:_healthfinder_,the   nationalInternethealthportal,4Woman.gov,   the_OMH_ԀResourceCenterWebsite,and  _SurgeonGeneral.gov_Ԁwhichareusedbyover  13millionvisitorseachyear.    Thefollowingmeasuresillustratethe m goals_OPHS_Ԁhassettoenergizenational Yp effortsaroundsoundpreventionpoliciesand E\ practices: 1H   *,-./012(yx*,-./012"*3"  *3R2H3  0    Increaseby25percentthenumber    oflocal,State,nationaland   internationalhealthpoliciesthat  incorporatepreventionelements   identifiedby_OPHS_Ԁaseffective.*3R݌! Ќ   *,-./012(xy*,-./012  *,-./012(yx*,-./012"*3"  *3-2H3  0    Increaseby9percentthereachof " _OPHS_Ԁpreventioncommunications.*3-Z݌# Ќ  "*3"  *3b 2H3  0    Increaseby11percentthenumber i$ ofpolicesinresearchinstitutions U%l  thatimprovetheresearch =&T! enterprise.*3b  ݌%'<" Ќ   *,-./012(xy*,-./012NLMeansandStrategies  ( !$   The_OPHS_Ԁbudgetrequestforallof *"& itsdiseasepreventionandhealthpromotion +#' programis$139million.ToachieveourFY ,$( 2004performancegoalsinacontextof -%) limitedresources,_OPHS_Ԁwilltargetseveral }.&* importantpreventionactivities.The * followingreflecttherangeof_OPHS_Ԁefforts:  +  *,-./012(2xx*,-./012"*3"  *3.223  0 p   _OPHS_Ԁwillpromoteknowledgeof  -  bestpracticesrelatedtothe  . physicalactivity,nutrition,  / overweightandobesity,tobaccouse q 0 andsubstanceabuse,andpreventive ]t1 _screenings_#X>XXX>,#X>XXX>Ԁasopportunitiesfor I`2 individuals,communities, 5L3 businesses,healthcareproviders, !8 4 andmajororganizationstofocus  $ 5 theiractionsforpersonaland  6 collectivehealthimprovement;  7 increasethenumberforformal  8 agreementswithstakeholder  9 organizationstostrengthentheirown : activityrelatedtoprevention.*3.[݌;p(#p(# Ќ  "*3"  *3m223  0 p   _OPHS_Ԁwillincreaseoutreachefforts < topromotephysicalactivitythrough m= itsPresidentsChallengeAwards Yp> programandthePresidentialSports E\? Award.*3m݌1H@p(#p(# Ќ  "*3"  *3+223  0 p   _OPHS_Ԁwilldevelopanational 4A Hispanicmediacampaign,building   B onitssuccessfulnationalradio  C partnership,ClosingtheHealthGap, D toincreaseawarenessofthehealth  E disparitiesbetweenmajorityand !F minoritypopulationsandsteps "G consumerscantaketoassume #H controloftheirhealth.*3+X݌}$Ip(#p(# Ќ  "*3"  $XX$*3223  0 p   Itwillincreaseoutreachtowomen i%J throughtheNationalWomens U&lK HealthInformationCenterand A'XL 4Woman.gov;tothegeneralpublic -(D M through_healthfinder.gov_;andto )0!N underservedpopulationsthrough *"O specialsectionson_healthfinder_Ԅ *#P including_healthfinder_Ԁ_espanol_!and +#Q onthe_OMHRC_Ԁsite.Itwillexpand ,$R itscommunicationofhealthand -%S sciencemessagesthroughnewspaper .&Tp(#p(# andjournal  articlesand  otherchannelsreachingprofessionals   aswellasthepublic.*3݌  Ќ  "*3"  *3&223  0    Itwillincreaseitsabstinence   educationprogramsforbothpre   adolescentsandadolescents,both q  maleandfemale.Theseprograms ]t willaddressthepreventionof_STDs_, I` HIV/AIDS,andotherhealthrisks 5L  suchastobacco,alcohol,drugsand !8  violence.*3&S݌ $  Ќ   v(8x*,-./012 ExternalFactors      Achievingourpreventiongoals   dependsonnumeroushealthprogramsand  providers,alllevelsofgovernment,andthe  effortsoftheprivatesectoraswellas  individualcontributions._OPHS_ m contributionsareinmanyinstancesthevital Yp firststepwithoutwhichthesuccessofother E\ inputswouldbediminishedorinjeopardy; 1H inotherinstances_OPHS_Ԁprovidesthe 4 leadershipand gluethatmakesthe    differenceincollectiveefforts.The   complexityofhumanbehaviorchange,for  whichthescienceisstillevolving,isa   fundamentalchallengetotheultimategoal ! ofhealthierlivesforallAmericans. "   A'X"  p  " (X@(O #K;7l|!^ `BdE ^){  (#(#         (#(#(X@(#(#(ProgramBackgroundandContext ]t    CDChasbeeninvolvedinthefight 5L  againstHIV/AIDSfromtheearliestdaysof !8  theepidemic,andremainsadomesticand  $  globalleaderinHIV/AIDSpreventionand   control.ThroughJune2001,over793,000   AmericanswerereportedwithAIDSand58   percenthaddied.Anestimated850,000to   950,000personsarelivingwithHIV  infectionintheU.S.,andasmanyas40,000  newcasesdevelopeveryyear.CDCs  approachincludessurveillance,early m detection,intervention,andprevention. Yp   TheU.S.continuestorecordthe E\ highestratesofsexuallytransmitteddiseases 1H (_STDs_)intheindustrializedworld.CDC 4 assistshealthdepartments,health-care    providers,andnon-governmental   organizationsbydeveloping,translating,and  disseminatingscience-basedinformation;   developingnationalgoalsandpolicies,and ! otherprogramsthatmeettheneedsof " communities.ThecostbenefitofSTD # preventionisconservativelyestimatedto }$ save$10indirecthealthcarecostsforevery i%  $1spentonprevention. U&l!   Tuberculosis(TB)wasoncethe A'X" leadingcauseofdeathintheU.S.Public -(D # HealthServiceActSection317Echarges )0!$ CDCwiththeresponsibilityof *"% administeringaprogramtoprevent,control *#& andeliminateTB.All50Statesandthe +#' DistrictofColumbiacontinuetoreportTB ,$(  caseseveryyear,andeachnewcasehasthe -%) potentialtospreadifnotpromptlydiagnosed ]t) andtreated. I`*  ProgramPerformancePlanning  !8 ,  p CDChasseveralperformance  . measuresforHIV/AIDS,_STDs_,andTB.  / Together,thesesupportHealthyPeople  0 2010goalstopreventHIVinfectionand  1 relatedillnessanddeath(Goal13),prevent 2 sexuallytransmitteddiseases(Goal25),and 3 preventinfectiousdiseases(Goal14).The 4 followingmeasuresillustratekeyactivities m5 ineacharea: Yp6   *,-./012(y8v"*3"  *3/2H3  0 p   Decreasethenumberof_perinatally_ 1H8 acquiredAIDScasesfromthe1998 49 baselineof235cases.*3//݌:p(#p(# Ќ  spS?/+b|"J( `."@E( (   s ;  v(8y*,-./012/  *,-./012(y8v"*3"  *322H3  0 p   Reducetheincidenceofgonorrhea )+!< inwomenages1544.*322݌*"=p(#p(# Ќ  "*3"  *332H3  0 p   ReducethenumberofHIV *"> infectionsdiagnosedamongpeople +#? youngerthan25yearsold.*333݌,$@p(#p(# Ќ  "*3"  *342H3  0 p   IncreasethepercentageofTB -%A patientswhocompleteacourseof .&Bp(#p(# curativeTBtreatmentwithin12  monthsofinitiationoftreatment.*344݌ Ќ   v(8y*,-./012 2 *,-./012(2x8v     VN MeansandStrategies      TheCDCbudgetforHIV/AIDS, i  _STDs_,andTBis$1,281million,$46million Ul morethantheFY2003appropriation. AX CDCsstrategiesfordealingwiththese -D  diseasesincludessurveillance,education, 0  prevention,andtreatment.Theperformance   measures,detailedbelow,demonstrate   CDCscommitmenttothestrategies:   "*3"  *39223  0    Decliningratesof_perinatally_   acquiredAIDScases(102inFY  2000)havebeenassociatedwith  increasingzidovudineusein y pregnantwomenwhowereawareof e| theirHIVstatus.CDChasbeen Qh successfulinmeetingandexceeding =T itstargets,butmustcontinueto )@ stresstreatmentandother , opportunitiestopreventtransmission  tocontinuetomeetthetargetofno  morethan139casesinFY2004.*399݌ Ќ  "*3"  *3<223  0     ReducethenumberofHIV   infectionsdiagnosedamongpeople ! youngerthan25yearsold. #X>XXX>#X>XXX>*3<%=݌" Ќ   *,-./012(2xx*,-./012"*3"  *3>223  0    TheU.S.experienceda73.9percent # declineinthereportedrateof m$ gonorrheafrom1975to1997.The Y%p  ratereflectedaonetimeincreasein E&\! 1998,buthassinceheldsteady. 1'H" CDCsgoalistoreducethe (4 # incidenceto250casesper100,000  ) !$ women.*3>'?݌) "% Ќ   *,-./012(2xx*,-./012"*3"  *3A223  0    Themosteffectivewaytoreducethe *"& spreadofTBistocomplete +#' treatment.Forthisreason,promptly ,$( completingacourseoftreatmentisa -%) highpriority.CDCaimstoachievea.&* 88percentcompletionratebyFY * 2004bydesigningimprovedtraining + aidsforhealthdepartments,and  , employingoutreachworkersfrom  - language,culturalandethnicgroups  . thathavehighTBincidence.*3AA݌ /p(#p(# Ќ  ExternalFactors  ]t1  p Potentnew_antiretroviral_Ԁtherapies 5L3 aredelayingorpreventingthedevelopment !8 4 ofAIDSinmanyHIVaffectedpersons.But  $ 5 thereisnovaccineorcure.And  6 surveillancerevealsthatHIV/AIDS  7 epidemicareemerginginIndia,China,the  8 Ukraine,andotherpartsoftheworld.  9  p Whilecommonbacterial_STDs_Ԁcan : becontrolledandcured,thereareno ; vaccinesforbacterial_STDs_.Onlyhepatitis < B,whichiscausedbyavirus,canbe m= preventedthroughvaccination.This Yp> complicateseffortstoreducethesediseases. E\?  p AnincreasingproportionofTBcases 1H@ intheU.S.areamongpersonsbornoutside 4A theCountry.Foreignbornindividualsnow   B accountfornearlyhalfofallU.S.TBcases.  C Also,ifapersonwithTBdoesnotcomplete D afullcourseoftreatmenttheymaydevelop  E andspreadadrugresistantstrainofthe !F disease.Onecaseofamultidrugresistant "G caseofTBcancostasmuchas$1millionto #H treat. }$I (X@( W #K;7l|@^ `BdE)^)  (#(#          (#(#(X@(#(#( (#(#ProgramBackgroundandContext  ]t   CDCprotectsthehealthofchildren 5L  fromdisabilityanddeathassociatedwith !8  vaccinepreventablediseasesbydeveloping  $  andimplementingimmunizationprograms   andmonitoringvaccineuse.Vaccinesare   responsibleforcontrollingmanyinfectious   diseases,includingdiphtheria,measles,   mumps,andpertussis.    Vaccineinterventionshavereduced  casesofallvaccinepreventablediseasesby  morethan97percentfrompeaklevels m beforevaccineswereavailable,makingthem Yp amongthegreatestpublichealth E\ achievementsoftheTwentiethCentury. 1H Vaccinesarealsocosteffective.CDC 4 estimatesthateverydollarspenton    _Diptheria_ԄTetanusacellularPertussis   vaccinesaves$27thatwouldbespent  treatingotherwisepreventabledisease.    ProgramPerformancePlanning  "   CDChas12performancemeasures }$ thatcoverallaspectsofitsimmunization i%  program.ThemeasuressupportHealthy U&l! People2010Goal14,topreventdisease, A'X" disabilityanddeathfrominfectiousdiseases, -(D # includingvaccinepreventablediseases.The )0!$ followingmeasuresillustratekey *"% programmaticmissionandactivities: *#&   *,-./012(yx*,-./012"*3"  *3!T2H3  0    Reducetoormaintainat0the ,$(  numberofindigenouscasesof-%) measlesinchildrenunder5by ]t) 2010.*3!TNT݌E\*p(#p(#    *,-./012(2xy*,-./012S  *,-./012(yx*,-./012"*3"  *3V2H3  0 p   Achieveormaintainimmunization -D+ coverageofatleast90percentin 0 , children19to35monthsofagein  - atleast7vaccines.*3VV݌ .p(#p(# Ќ   *,-./012(2xy*,-./012#VMeansandStrategies   0  p Thefollowingmeansandstrategies 2 illustratehowtheprogramcontinually }3 strivestowardsachievingperformance i4 measures. Ul5 "*3"  *3Y223  0 p   Resources :Thebudgetrequestfor -D7 FY2004is$621million,anincrease 48 ofapproximately$7millionoverthe   9 FY2003appropriation.Thereisalso  : $802millionanticipatedforthe ; mandatoryprogram,Vaccinesfor < Children.*3YY݌ =p(#p(# Ќ   *,-./012(2xx*,-./012"*3"  *37\223  0 p   Theeffortcontinuestoreduceto !> zerothenumberofindigenouscases "? ofvaccinepreventablediseases. }#@ ProvisionaldatafromFY2001 i$A revealsthatindigenouscasesofpolio U%lB are0;rubella19;measles61; A&XC influenza183;diphtheriatwo; -'DD congenitalrubellatwo;andtetanus (0 E 27.*37\d\݌)!Fp(#p(# Ќ   *,-./012(2xx*,-./012"*3"  <" ,X,` XD,0*XX<*3"_223  0 D   Similarly,CDChassustainedtheirgoal )"G ofimmunizationcoverageofatleast90 *"H percentofchildrenages19to35months.*3"__݌+#ID(#D(# Ќ  ExternalFactors  -%K  .&L   WhiletheU.S.currentlyhasrecord,or  nearrecord,lowcasesofvaccine-  preventablediseases,thevirusesand   bacteriathatcausethemstillexist.Even   diseasesthathavebeeneliminatedinthis   country,suchaspolio,canbeintroducedby   travelersandimmigrants.Ifwestopped q  immunization,vaccinepreventablediseases ]t wouldincreasetopre-vaccinelevels.Before I` poliovaccinewasavailable,13,000to 5L  20,000casesofparalyticpoliowerereported !8  eachyearintheUnitedStates.  $          [\ #K;7l|Q; `BdEQ;         ProgramBackgroundandContext  ]t #X>XXX>>#X>XXX>d  T#X>XXX>e#X>XXX>heSubstanceAbusePreventionand 5L  TreatmentStateBlockGrant#X>XXX>1f#X>XXX>(_SAPTBG_) !8  supportsStatescapacitiestorespondtothe  $  treatmentneedsofcitizenswhoareat   greatestriskofabusingalcoholandillegal   drugs.#X>XXX>f#X>XXX>dTheBlockGrantaccountsfor   approximately40percentofallpublicfunds   expendedbytheStatesforsubstanceabuse  treatmentandprevention(_NASADAD_,  unpublisheddata).#X>XXX> h#`X>XXX>Ԁ`ɴ X`X>Ԁ#`X>X `ɴi#TwentytwoStates  reportedthatgreaterthan50percentoftheir m totalfundingforsubstanceabuseprevention Yp andtreatmentprogramscamefromthe E\ Federalblockgrant.The_SAPTBG_Ԁprogram 1H providesfundingto60Statesandterritories 4 (includingoneTribalGovernment)X>XX`X>Ԁto    providetreatmentandpreventionservices   forpersonsabusingalcoholandotherdrugs  orconsideredtobeatrisk.Theprogram   wasestablishedin1981asaconsolidation ! ofearliercategoricalprogramsin " communitymentalhealthandsubstance # abuseservices#`X>XXX>vk# }$ aX>XX`X>  Thisprogramalsorepresentsamajor i%  portionofSAMHSAscontributionto U&l! closingthetreatmentgap,whichisa A'X" nationaltreatmentplangoalsharedamong -(D # SAMHSA,theOfficeofNationalDrug )0!$ ControlPolicy,andmanypartners.#`X>XXaX>`m# *"%  ProgramPerformancePlanning  +#'     SAMHSAhassevenperformance -%) measuresthatdemonstratetheircommitment .&*  (#(#       (#(#toclosingthetreatmentgap.Additional ]t1 measuresforStatepartnersarebeing I`2 developed.CurrentlyaFederalRegister 5L3 Notice(_FRN_)onPerformancePartnership !8 4 Grantdevelopmentalmeasureshasbeen  $ 5 approvedbyHHSandONDCP.Comments  6 inresponsetothe_FRN_Ԁwillbeusedin  7 furtherdevelopingoutcomemeasureswith  8 Statepartners.The_SAPTBG_Ԁsupportsthe  9 HealthyPeople2010goalofreducing : substanceabusetoprotectthehealth,safety ; andqualityoflifeforall,especiallychildren. < Thefollowingmeasurefocuseson m= empiricallybasedimprovementstothe Yp> qualityoftreatmentsystems,programsor E\? practicesproducedbytechnicalassistance 1H@ eventswhichareanimportantcomponentof 4A theblockgrantprogramgoal.   B    *,-./012(yx*,-./012 "*3"  *3u2H3  0 D   X>XX`X>SAMHSAwillexpectthat95percentof  E technicalassistanceeventswillresultin !F systems,programorpracticechange.#`X>XXX>Ov#*3uv݌"GD(#D(# Ќ   *,-./012(xy*,-./012Ou bV MeansandStrategies  u$I  D Theperformancemeasure,detailed a%xJ below,demonstrateSAMHSAs M&dK commitmenttothestrategies: 9'PL "*3"  *3x223  0 D   Additionalblockgrantoutcome )(!N measuresarecurrentlybeingdeveloped )"O withHHS,ONDCP,OMBandState *#P participation.*3xy݌+#QD(#D(# Ќ   *,-./012(2xx*,-./012"*3"  *3z223  0 D   TheStateSystemTechnicalAssistance -%S Project(_SSTAP_)trackingreportwas .&TD(#D(# [! [ [  implementedtomonitorthestatusof ) Statestechnicalassistanceactivities.X>XX`X>    ThisyearssurveyoftheStatesrevealed   significantandimprovedsystemchanges   asaresultoftechnicalassistance   provided.#`X>XXX>̋|#ԀTheFY2001targetforthis   measurewasmetat96percent,   exceedingtheFY2001expectedtarget  x of85percent.Specifically,therewasan d 11percentincreaseinStatessatisfaction yP  withhow_CSAT_stechnicalassistance e<  hasledtosomeimprovementsinthe Q(  systemoverthepast12months.Ninety =  onepercentoftheStatesreported )  _CSATs_technicalassistancehasledto   noticeableoutcomeresults,either   directlyorindirectlylinkedtothe  technicalassistance.Thisisa6percent  increasefromFY2000surveyresults  (85percent).InFY2004,SAMHSA  willmaintainat95percenttheX>XX`X>Ԁtechnical t assistanceeventsthatresultinsystems, ` programorpracticechange#`X>XXX>h#.*3zz݌uL Ќ  "*3"  *3f223  0    Resources: TheSAMHSAbudget M$ requestforthe_SAPTBG_Ԁis$1,785 = million.*3f݌) Ќ   v(8x*,-./012 *,-./012(2x8v ExternalFactors  !   SAMHSAsestablishednetworkswith " itsgranteesandexternalpartnerscontribute # significantlytotheeffectivenessofthe $  Agency.Partnersandstakeholdersinclude %t! participationfrommultiplesectors &`" including: u'L #  *,-./012(2xx*,-./012"*3"  *3ņ223  0    Stateandlocalgovernments;`&'%X`X>*3ņ݌a(8!$ Ќ   *,-./012(2xx*,-./012"*3"  *38223  0    #`X>X%`&'U#Nonprofittreatmentproviderssuchas M)$"% communitymentalhealthclinics, 9*#& substanceabuseclinicsandother %+#'  communityorganizations;*38e݌,$( Ќ   *,-./012(2xx*,-./012"*3"  *3Z223  0 D   Awiderangeofgranteessuchas )( hospitals,universities,community ) agenciesandresearchinstitutes;*3Z݌ *D(#D(#    *,-./012(2xx*,-./012"*3"  *3(223  0 D   FoundationssuchastheRobertWood  + JohnsonFoundation,theCaseyFamily  , FoundationandtheKaiserFamily  - Foundation.*3(U݌ .D(#D(# Ќ  "*3"  *3223  0 D   Consumers/clientsofsubstanceabuse  t/ servicesandtheirfamilies.*3݌`0D(#D(# Ќ   D cX>XX`X>c&>XXcX>PartnerssuchasDepartmentofJustice a8 2 focusonreducingthe#`&'%Xc&>̮#d&>X%`&'availablesupplyof M$ 3 illegaldrugs.Bothareductioninsupplyand 9 4 demandareneededtoreducethetreatment % 5 gap.Inaddition,otherFederalpartnerssuch  6 asDepartmentofEducation,National  7 InstitutesofHealth,#`&'%Xd&>`#c&>X%`&'ԀandtheOfficeof 8 NationalDrugControlPolicyareworking 9 togethertoincreasetreatmentcapacities.#`&'%Xc&>ܐ##`X>X%`&'͎#  :   p< X>XX`X>1 [X`1 #K ;7l|^ `BdE^=}       ProgramBackgroundandContext         Publichealthinfrastructureiscomposed  t ofanarrayoflocal,State,andFederal ` organizationsthatarefurtherdividedinto uL  functionallyorganizedunitsaroundclinical, a8  healthdepartment,laboratory,disease M$  program,andotheroperationaldivisions. 9  Thecomplexresponsibilitiesand %  interactionsbetweenthesepublichealth   partnersrequiresignificantcoordinationof   informationtechnologyandinformation  sharingmethodologiestomeetgeneral  publichealthaswellasemergency  preparednessandresponseneeds.    Informationtechnologyoffersgreat p opportunitiesforadvancingpublichealth. \ Becausepublichealthisbeingtestedbynew qH preparednessandresponseneeds,itistime ]4 toadvanceaunifiedinformationtechnology I  frameworktoaddresstheseneeds.The 5  PublicHealthInformationNetwork(_PHIN_) ! isaninitiativethatwillinitiallybe   composedofseveralcurrentprojects,   bringingthemtogetherinastandardsbased ! frameworkthatwillenhancetheir " interoperability._PHIN_Ԁwillsupportspecific # informationtechnologyfunctionsthatcross $  programboundariesandprovideintegrated %l! servicesforanefficientpublichealth &X" informationtechnologyinfrastructure.The m'D # functionsofthe_PHIN_Ԁwillbe:B  X>XXX>#`X>XXX>##X>XX`X>#`X>XXX>ě#fX##XX`X>ԍ̎ Y(0!$     Ӎ̎    C  r#fX##X#XfX#゛##`X>X#XfX##X>XX`X>B  ԍ̎    C  #`X>XXX>#"*3"  X>XX`X>  *3223  0    #`X>XXX>̬#X>XX`X>Detectionandmonitoring:supportof 1*#& diseaseandthreatsurveillance,national +#' healthstatusindicators#`X>XXX>@#fX##XX`X>*3ם݌ ,$( Ќ  #`X>X#XfX##X>XX`X>"*3"  *3223  0    #`X>XXX>̗#X>XX`X>Analysis:facilitatingrealtime ,%) evaluationoflivedatafeeds,turning-&*  (#(#     (#(#dataintoinformationforpeopleatall  / levelsofpublichealth*3݌ 0(#(# Ќ  #`X>XXX>M#X>XX`X>"*3"    *3e223  0    #`X>XXX>F#X>XX`X>Informationresourcesandknowledge  t1 management:referenceinformation, `2 distancelearning,decisionsupport*3e݌uL3(#(# Ќ  #`X>XXX>#X>XX`X>"*3"    *3>223  0    #`X>XXX>#X>XX`X>Alertingandcommunications:#`X>XXX>#X>XX`X> a8 4 transmissionofemergencyalerts,routine M$ 5 professionaldiscussions,collaborative 9 6 activities*3>w݌% 7(#(# Ќ  #`X>XXX>?#X>XX`X>"*3"  *3|223  0    #`X>XXX>]#X>XX`X>Response:managementsupportof  8 recommendations,prophylaxis,  9 vaccination,etc.*3|݌:(#(# Ќ    W+ ` hp x  ,X,` XD,0*XW#`X>XXX>#X>XX`X> ProgramPerformancePlanning  < $,XX$  ThePublicHealthInformationNetwork p> supportsHealthyPeople2010Goal23,to \? ensurethathealthagencieshavethe qH@ infrastructuretoprovideessentialpublic ]4A healthserviceseffectively.ForFY2004, I B _PHIN_Ԁhascommittedtoseveralprocess 5 C orientedmeasures.Outputsandoutcomes !D willdependonthepartnershipsthatcanbe  E developedwithconstituentprogramsandthe  F speedwithwhichpartnerscanimplement !G _PHIN_Ԁstandardsinthecomingyear.The "H measuresbelowillustratekeyprogrammatic #I objectivesfor_PHIN_: $J #`X>XXX>r#! ! *,-./012(xx*,-./012X>XX`X>"*3"  *3K2H3  0    #`X>XXX>,#X>XX`X>BuildITcapabilitiesandcapacitythrough &XL alllevelsofpublichealth(local,state, m'D M andfederal)toservethevarietyofpublic Y(0!N healthprogramsandfunctions.*3Kx݌E)"O(#(# Ќ   *,-./012(2xx*,-./012#`X>XXX>#! ! *,-./012(xx*,-./012X>XX`X>"*3"  *` X,X**32H3  0    #`X>XXX>p#X>XX`X>EnsurepublichealthITworksasa 1*#P coherentnetworkandhastheabilityto +#Q connecttoothergroups(i.e.,clinicalcare,  ,$R  lawenforcement).*3݌ ,%S(#(# Ќ   *,-./012(xx*,-./012! ! *,-./012(xx*,-./012#`X>XXX>P#X>XX`X>"*3"  *32H3  0    #`X>XXX>γ#X>XX`X>E   valuatenetworkfunctionalityand ) ensureinteroperability,security,and  reliability.*3݌  Ќ   *,-./012(2xx*,-./012*  #`X>XXX>̄#X>XX`X> MeansandStrategies    N4X` hp x ` XN  CDCisusingseveralmeansand   strategiestoachieveitsgoal.  p ! ! *,-./012(2xx*,-./012"*3"  *3223  0    Resources: TheFY2004budgetrequest \ is$10million,whichrepresentsanew uL  budgetrequestforthisinitiative.These a8  fundsarerequestedinadditiontothe M$  ongoingfundingofsystemsthatwillbe 9  integratedintothisnetwork.Meansand %  strategieswillbedefinedtohelpthe   _PHIN_Ԁcontinuallystrivetowards   achievingtheperformancemeasures.*3݌ Ќ  "*3"    *3223  0    Atfullimplementation,_PHIN_Ԁwillbea  live,secure,Internetbasednetworkfor  exchangingcomparablecriticalhealth  informationbetweenalllevelsofpublic p health(local,StateandFederal)and \ othercriticalinformationsystems qH (clinicalcare,laboratories,first ]4 responders,etc.).The_PHIN_Ԁwillconnect I  thediversegroupsparticipatinginpublic 5  healthusingstandardsbased ! collaboration,communicationsand   alertingcapabilities.Improveddata   analysisandvisualizationincluding ! automatedalgorithmsforeventdetection " willaidinmoretimelypublichealth # decisionmaking.K.4 <DL XXK*3݌$  Ќ    #`X>XXX>-#X>XX`X> &X"  )" ( [@(#`X>XXX>̲#  Y(0!"   op1ppqP@<l \'" Ip `@XddddEIpttaLM    r,----#M=9l|z~t ` dE. tf  (#(#        (#(# 0,X,` XX 0(X@(#(#(  HHShasdevelopedanumberof   initiativesandprogramsanddevoted   numerousresources,increasingbioterrorism   spendingbymorethanthirteenfoldbetween k 2001and2003,toprotectAmericansfrom W _bioterrorist_Ԁattacksandotherpublichealth lC carechallenges.TheeventsofSeptember X/ 11,2001,andsubsequentanthraxattacks D havereinforcedHHSsroleinprotecting 0 peopleinAmericafromattacksonourfood  andhealthbyenhancingemergency  preparedness.    TheOfficeoftheAssistantSecretaryfor  PublicHealthEmergencyPreparedness  (ASPHEP)wasestablishedtodirectthe  Departmentseffortsinpreparingfor,  { protectingagainst,respondingto,and !g recoveringfromallactsofbioterrorismand |"S otherpublichealthemergenciesthataffect h#? thecivilianpopulation.ASPHEPservesas T$+ thefocalpointwithinHHSforthese @% activities,directingandcoordinatingthe ,&  developmentandimplementationofa '! comprehensiveHHSstrategy.  ( "   CDChasanintegralrolein (!# strengtheningStateandlocalpublichealth  # infrastructuretoeffectivelyrespondto  $ emergencies.HRSAworkstoprepare  % hospitalsandothermedicalfacilitiesforthe k& healthconsequencesofbioterrorismand W' othermasscasualtyevents. NIHconducts lC( andfundsaresearchprogramtogainthe X/) newknowledgeneededtodevelopnewor D* improveddiagnostics,drugsandvaccines 0+ againstthemajorbiologicalagentsmost , likelytobeusedbyterrorists.FDAworks - toprovideresponsiveregulatoryreviewof . newbiodefensemedicalcountermeasures / andplaysamajorrolebyinspectinghigh 0 riskdomesticfoodmanufacturersand 1 enhancingfoodimportinspectionstoprotect  {2 ourNationsfoodsupplyandpreventfood !g3 borneillness. |"S4 ? ,X,` XDX,X,` X? D Thesemeasuresarerepresentativeofthe h#?5 programsbeingdescribedandserveas T$+6 examplesofhowHHScontinuestotrack @%7 theirprogresstowardsbuildingthenecessary ,&8 infrastructuretorespondto_bioterrorist_Ԁand '9 otherpublichealthchallenges. ( : (X@( *#:  x.O'> *stdd4\R4\R\RF:G(#(#,\R,\R,I\R+  <VVV#')) <HHSStrategicGoal AVVV#,!3 "VVV# AX>XX`X>Agencies/ 3  Programs   AVVVV#,! "VVV# AFY2004PerformanceMeasures#`X>XXX># TVVC,3 " VVVV# T GOAL2:` X`X>Enhancethe   Abilityofthe    NationsPublic    HealthandHealth   CareSystemsto   EffectivelyRespond   toBioterrorismand   OtherPublicHealth   Challenges. #`X>X` N#    NVV=2 "@VV N`ЌX`X>PublicHealth   Emergency   Preparedness  ` (ASPHEP) ?VVV,!M $"VV ?ASPHEPisintheprocessofdevelopingperformance   measures.Keyactivitiesinclude:   ЄImprovingHHSresponseassetstosupportmunicipalitiesand  ` statesasneeded. M $ ЄCoordinatingthedevelopmentandprocurementofsaferand   moreeffectivevaccinesagainstsmallpoxandanthrax.   ЄOverseethereinforcementandaugmentingbordercoverage p ofallimportedproducts.* OVV>']4 VVV OЌ`Ќ 7VV&+ VV 7#`ЌЌE#Stateand +  Local   Cooperative   Agreement wN ! (CDC ; " &HRSA) ?VVV,! #"VV ?ЄEnhancepreparednessbyassuringthat100percentofState, + $ territorial,andlocalprojectshavewrittenplanstorespondto  % biological,chemical,andmasstraumahazardsrelatingto  & terrorism.(CDC).* wN ' Є100percentofStateshavedevelopedplanstoaddresssurge ; ( capacity.(HRSA).* OVV>' ) VVV O 7VV& )VV 7FoodSafety  * (FDA) ?VVV,!h+"VV ? AchieveadoptionoftheFoodCodebyatleastonestate  , agencyin42StatesintheUSA[FY01:28statesadoptedfood h- code(target25states)]. U,.  *,-./012(yx*,-./012ӄInspect95percentoftheestimated7000highriskdomestic / foodestablishmentsonceeveryyear [FY01:inspected80%of 0 6800foodest.(target90%)].  x1  *,-./012(2xy*,-./012 Perform48,000physicalexamsandconductsampleanalyses e<2 onproductswithsuspecthistories(FY01Baselinedata: )3 12,169Ќ`ЌԀ#`ЌЌc#physicalexams).Ќ`Ќ 4 ЄExpandFederal/State/localinvolvementinFDAs_eLEXNET_ 5 systembyhaving79laboratoriesparticipateinthesystem.*#`ЌЌ#Ќ`Ќ OVV>'uL6 VVV O 7VV&C6VV 7Biodefense C7 Medical 8 Counter 9 Measures f: Authority S *; (ASPHEP) ?VVV,!!<"VV ?ASPHEPisintheprocessofdevelopingperformancemeasures C= fortheuseofthisnewauthority.Oneofthefirstprioritiesisto > developanongoingthreatanalysisforbiologicalthreatagents ? andprioritizationofthesethreats.Theanalysiswillinclude: f@ ЄAnassessmentofthepotentialpublichealthconsequences S *A ensuingfromterroristuseofthesethreatagents. !B ЄRegularupdatesfrom_DHS_Ԁregardingnewspecificthreat !C informationthatmightrequirespecialactionwithrespecttothe "vD developmentofmedicalcountermeasures. c#:E ЄHHSalsowillassessthescientificfeasibilitytoproducesafe '$F andeffectivemedicalcountermeasures.7-+$G  VVV 7*Seeagencyperformanceplan/reportforadditionalinformation.#`ЌЌ#Ќ`Ќ %G      `  }&TH u #K;7l|:Q; `BdEcQ; )= (#(#         (#(##`ЌЌ?#Ќ`ЌX>XЌ(w@(#(#(ProgramBackgroundandContext#`X>XXX>i#X>XX`X>     HHSistheleadagencywithinthe   Federalgovernmentresponsiblefor l  coordinatingthesupportof12Federal X  agenciesinthepreparednessfor,response mD  to,andrecoveryfromthemedical Y0  consequencesofnaturalandmanmade E disasters,includingactsofterrorism.The 1 OfficeoftheAssistantSecretaryforPublic  HealthEmergencyPreparedness(ASPHEP)   withintheOfficeoftheHHSSecretarywas  establishedbytheSecretarytointegrate  HHSsemergencypublichealth  preparednessandresponseprogramsintoa  moreefficient OneDepartmentactivity. | ASPHEPcoordinatesmedicalandhealth h relatedassistanceinnationalemergencies }T anddeploysmedicalpersonnel,equipment, i@ andmedicalproductsandsuppliestoassist U , victimsofamajordisaster,emergencyor A! terroristattack. -"  ProgramPerformancePlanning  $!   ASPHEPisintheprocessofdeveloping %# performancemeasures.Theydirectand &$ coordinatetheDepartmentseffortsinthe ' % followingareas: (x!&   *,-./012(yx*,-./012"*3"  *32H3  0    Enhancingstateandlocal y*P#( preparedness.*3݌e+<$) Ќ  "*3"  *32H3  0     ImprovingHHSresponseassetsto M,$%* supportmunicipalitiesandstatesas 9-&+ needed.*3݌!.&, Ќ   *,-./012(xy*,-./012 *,-./012(xx*,-./012 "*3"  *32H3  0 D   Coordinatingthedevelopmentand , procurementofsaferandmore*3݌-D"D" Ќ  ݀effectivevaccinesagainstsmallpoxand | . Ѐanthrax. d /  *,-./012(yx*,-./012 "*3"  *32H3  0 D    Overseethereinforcementand uL 0 augmentingbordercoverageofall a8 1 importedproducts.*3݌I 2D"D" Ќ   *,-./012(xy*,-./012N yb MeansandStrategies  4   PrioritiesforHHScounterterrorismefforts 6 aretheresultoftheconfluenceofthepriorities 7 articulatedbythePresidentinhisbudget 8 requestsandtheprioritiesspecifiedbythe 9 Congressintheregularandsupplemental |: appropriationsforFY2002.ASPHEPs h; budgetrequestforFY2004is$41.8millionin }T< thePublicHealthandSocialServices i@= EmergencyFund.HHSisdirectingits U,> investmentstowardimmediatelyenhanced A ? preparednessforbioterrorism,otheroutbreaks -!@ ofinfectiousdisease,andotherpublichealth "A threatsandemergencies.ASPHEPsprimary #B emphasisareasareasfollows: #C    D  *,-./012(2xx*,-./012"*3"   *3223  0 D   StateandLocalPreparedness: With %E respecttoStateandlocalpreparedness, &F ASPHEPwillfocusonimprovingthe 'x G capabilitiesofstatehealthdepartments, (d!H localhealthdepartments,hospitals,and y)P"I otherhealthcareentitiestorespondto e*<#J terroristrelatedevents,includingthe Q+($K abilitytocommunicateatalllevels =,%L amongrespondersandthepublicduring )-&M apublichealthemergency.Capabilities .&ND"D" op1' o o  ofStateandlocalhealthdepartments ) willbeenhancedwithrespectto  surveillanceandepidemiology,   laboratories,informationtechnology,   publicinformation,andeducation   andtraining.Hospitalsarenow   developingcoordinatedpreparedness   planstoaddressanexpectedsurgein  t thenumberofpatients.Local ` governmentsmustcontemplateusing uL  nontraditionalvenuesforpatient a8  care!e.g.,schools,convention M$  centers,sportsarenas,andhotels! 9  fordistributingantibioticsor %  accommodatingthelargenumbersof   casualtiesthatcouldresultfromthe   intentionalreleaseofabiological  agent.*3(݌ Ќ  "*3"  *3 223  0     NationalLevelPreparedness: With  respecttonationallevelpreparedness,  ASPHEPwillalsofocusonimproving p theinfectiousdiseasesurveillanceand \ broaderemergencyresponsecapabilities qH oftheCDC,augmentingthesizeand ]4 scopeofmaterialswithintheStrategic I  NationalStockpile,andensuringrapid 5  deploymentofthesematerialsasneeded. ! ЀHighpriorityisbeingaccordedtothe   developmentofnewandimproved   vaccinesforsmallpoxandanthraxas ! wellasanexpandedresearchprogramin " the_genomics_Ԁofmicroorganismslikely # tobeusedinterrorismevents.*3 6݌$  Ќ    ExternalFactors  &X"   Theunpredictablenatureandextentof Y(0!$ naturalormanmadedisastersisone E)"% externalfactor.Deficienciesinthepublic 1*#& healthinfrastructure,especiallyintheareaof +#' infectiousdiseases,aresubstantialandlong  ,$( standing;andthecorrectionofthese ,%) deficiencieswillrequiresustained -&* investmentovermanyyears.Moreover,the .'+ developmentandcommercializationofnew )+ diagnostics,drugs,andvaccinesaresorely , neededbutaredifficultscientificandtechnical  - endeavorsthatrequiresubstantialtimeand  . effort.  /   0 (w(#`X>XXX>#X>XX`X>   (#(#       (#(#}  z #K;7l| 0^ `BdE^)    `     h     (X@(#(#(ProgramBackgroundandContext  L     AfutureterroristthreattotheU.S.may $  involvebiological,chemical,orradiological   weapons.Localemergencymedical,fire,   police,andpublichealthagenciesstandon   thefrontlinesofanyresponse.Howwell z  theU.S.responds,therefore,dependsonthat f localpreparednessandthereadinessofState R andFederalgovernmenttoaugmentlocal > efforts. *   CDCiskeytothatFederal p augmentation.CDCisresponsiblefor \ leadingnationaleffortstodetect,respondto, H andpreventillnessandinjurythatresults 4 fromthedeliberatereleaseofbiological   agents.Additionally,CDCplaysakeyrole   indealingwithhealthrelatedissuesarising  fromthereleaseofchemicalorradiological   agents,aswellasmasstraumathatcould v! resultfromtheuseofweaponsofmass b" destruction. N#   HRSAalsomakesasignificant :$ contributiontoreadiness.Oneeffort,the &%  HospitalPreparednessProgram,seeksto &l! upgradethepreparednessofStateshealth &X" caresystemstorespondto_bioterrorist_Ԁor 'D # othermasscasualtyevents. (0!$  ProgramPerformancePlanning  *#&   CDChasperformancetargetsfor ,$( trainingandexercisesthataddress r-%) preparednessinthefaceofterroristevents. ^.&* HRSAhasaperformancetargetfor L* upgradingthepreparednessofStateshealth 8 + caresystemstorespondtoa_bioterrorist_Ԁor $ , othermasscasualtyevent.Theyare  - summarizedbelow:  .   *,-./012(xx*,-./0123   ,X,` XDX3"*3"  *32H3  0    #`X>XXX>#X>XX`X> Enhancepreparednessbyassuringthat z 0 100percentofState,territorial,and f1 localprojectshavewrittenplansto N2 respondtobiological,chemical,and 63 masstraumahazardsrelatingto x4 terrorism.(CDC ).*3݌`5 (# (# Ќ   *,-./012(xx*,-./012 *,-./012(xx*,-./012"*3"  *32H3  0     100percentofStateshavedeveloped L6 planstoaddresssurgecapacity. 87 (HRSA).*3݌ 8 (# (# Ќ  ~y MeansandStrategies  :   HHSfundingforStateandLocal r < Preparednessis$1.5billion!CDCsbudget ^!= requestforthisprograminFY2004is J"> $940million;HRSAsbudgetrequestfor 6#? theHospitalPreparednessProgramis "$|@ $518million.Thefollowingmeansand %hA strategiesillustratehowtheprogramwill %TB strivetowardsachievingperformance &@C measures: ', D  *,-./012(2xx*,-./012"*3"  *3223  0 (    CDC: Preparingforaterroristevent )"F continuestobeapriorityfortheU.S. *"G publichealthcommunity.Allfacets +#H ofthepublichealthsystemrequire n,$I extensivetraininginorderto Z-%J effectivelyrespondtosuchapotential F.&K((#((# pp) pc} p  event.CDCprovidesfundingto50  States,fourlocalities,andeight x territoriestoenhancebioterrorism d  preparedness.Toensurethatthe P  publichealthsystemispreparedfor <  allterrorismhazards,CDCwillwork (  withprojectstoexpandpreparedness   plansforrespondingtobiological, t chemical,radiologicalandmass ` traumahazardsrelatingtoterrorism. L  OnehundredpercentofStateswill 8  developcompleteallhazardsplansin $  FY2004.*3݌  Ќ   *,-./012(2xx*,-./012"*3"   *3X!223  0    HRSA: TheHospitalPreparedness   ProgramprovidesfundingtoStatesto t  improvethecapacityoftheNations `  hospitalstorespondtoevents L involvinglargescalecasualties.In 8 thewakeofSeptember11,2001,it $ becameclearthattherewasaneedfor  traininginhandlingcasualtiesof p weaponsofmassdestruction.FY \ 2004fundingwillsupportthe H implementationofneedsassessments 4 andplansinordertoimprovethe   healthcaresystemscapabilitytodeal   withterroristandnonterroristevents.*3X!!݌ Ќ  ExternalFactors  \!   Theexactnatureandextentofinjury 4# fromafutureterroristeventisdifficultto  $ quantify.Thenumberofpotentialtargetsin  %  theU.S.,combinedwiththewidearrayof %l! possiblechemical,biological,radiological, &X" andexplosiveweaponsthatmightbe 'D # availabletoterroristscreatesanearlyinfinite (0!$ rangeofpossibilities. )"%    x& (X@( +#& 0 #K;7l| ^ `BdE^)Z (#(#      (#(#                        (  0  8  @  H  P  X  `  h ([XZ@(#(#( ProgramBackgroundandContext  t   " FDA,inclosecollaborationwithother L  agencieslikeCDC,U.S.Departmentof 8  Agriculture,andEnvironmentalProtection $  Agency,hasbeenworkingtoreducethe   incidenceoffoodborneillnessthrough   regulatoryaction,highriskfoodinspection t  activitiesaswellasmonitoringandreducing `  theamountofpesticidesinfoods.Theevents L ofSeptember11,2001,reinforcedFDAs 8 roleinprotectingourNationsfoodsupplyby $ focusingeffortsonfoodsundertheirstatutory  authority,whichincludesallfoodsapartfrom p meatandfrozenanddriedeggs,whichare \ regulatedbytheUSDA.FDAhasbegunthe H processofhiringandtraining655new 4 investigators,analysts,andothersupport   personnel,asauthorizedbytheFY2002   CounterTerrorismSupplemental  Appropriation.Thesepersonnelimprovethe p  Agencyscapacitytorespondtoterrorist \! threatsandattacksandaugmentdomestic H" foodsafetyandsecurity.Manyofthese 4# employeesareinvestigatorsandanalystswho  $ closelymonitorthehighestriskimports  %  enteringthecountry,andhaveenabledFDA %l! toincreaseborderpresencebydoingmore &X" fieldexams,samplecollectionandanalysis, 'D # domesticinspectionsandlaboratoryanalysis. (0!$ FDAisprojectinga100percentincreasein )"% physicalexamsinFY2002and2003with *#& sustainedeffortsinFY2004.  +#' ProgramPerformancePlanning  X-%)  D.&*   FDAhassevenmeasuresgearedtowards t* thepostmarketsurveillanceandinspections `+ ofmarketedorimportedfoods.The L, followingfourmeasuresillustratekey 8 - activitiesineffectivelyrespondingtoand $ . preventingpublichealthemergencies:  /   *,-./012(yx*,-./012"*3"  *3F42H3  0    AchieveadoptionoftheFoodCodebyat t 1 leastonestateagencyin42Statesinthe ` 2 USA.*3F4s4݌H3'#'# Ќ   *,-./012(2xy*,-./0123 *,-./012(yx*,-./012"*3"  *362H3  0    Inspect95percentoftheestimated7000 04 highriskdomesticfoodestablishments 5 onceeveryyear.*366݌x6'#'# Ќ  sp?/+b|2~A, `.!@E, , 6 s `7 "*3"  *3V82H3  0    Perform48,000physicalexamsand %8 conductsampleanalysesonproducts &w9 withsuspecthistories.*3V88݌&_:'#'# Ќ  "*3"  *392H3  0    ExpandFederal/State/localinvolvement 'G ; inFDAs_eLEXNET_Ԁsystembyhaving79 (3!< laboratoriesparticipateinthesystem.*399݌)"='#'# Ќ   *,-./012(2xy*,-./012 6      ?.&B ~  MeansandStrategies    " Thefollowingmeansandstrategies d  illustratehowFDAcontinuestorespondand P  preventfoodrelatedpublichealth <  emergencies: (   "  *  2  :  *,-./012(2xx*,-./012"*3"  *3=223  0 *   FoodCode: Inordertoreducethe t incidenceoffoodborneillness,FDA d continuestoencourageStatesto P  voluntarilyadopttheFoodCode,#`X>XXX>%#X>XX`X>a <  referencedocumentforregulatory (  #`X>XXX>>#X>XX`X>agenciesresponsibleforoverseeing   foodsafetyinretailoutlets,suchas   restaurantsandgrocerystores,and x  institutions.#`X>XXX>̌?#ԀTheFoodCoderesultsin d  uniformnationalstandardsX>XX`X>Ԁonfood P safety,sanitation,andfairdealingthat < maybeuniformlyadoptedbytheretail ( foodindustry#`X>XXX>@#.Italsoprovidespublic  healthandregulatoryagencieswith t practicaladviceandenforceable ` provisionsinordertomitigaterisk L factorsknowntocontributetofood 8 borneillness . X>XX`X>Ԁ#`X>XXX>B#ԀInFY2004,FDAwill $ buildontheirpasteffortstoincrease  thenumberofparticipatingStatesfrom  28inFY2001to42StatesinFY x  2004.?+ 4 <DL! ?Ӏ *3==݌d!*u*u Ќ  "*3"  *3D223  0 r   HighRiskFoodInspections: FDA, P" intheireffortstopreventfoodborne @# illness,targetshighriskfood ,$ establishments.Theydefinehighrisk %  asthoseestablishmentswhich &x! producefoodwiththegreatestriskof &d" microbialcontamination,including 'P # seafood,cheese,freshvegetables, ( whereinspectorsconductashort `? term,intensesurveillanceofaproduct L@ atallorselectedportsofentry.FDA 8A willalsoimplementaprogramwith $B CanadaandMexicotoenhance C advancedidentificationof D transshippedcargo.*3II݌t E%'#%'# Ќ   *,-./012(2xx*,-./012"*3"  *3O223  0 %   LaboratoryPreparedness: FDAis `!F activelyworkingtocoordinate P"G multipleagencieseffortsin <#H protectingtheNationsfoodsupply. ($I TheyarebuildingonFY2001efforts %J todevelopanelectronicLaboratory &tK ExchangeNetwork(_eLEXNET_), &`L whichisaseamless,integratedand 'L M securenetworkenablingthemultiple (8!N agenciesengagedinfoodsafety )$"O activities(Federal,State,andlocal *#P healthlaboratoriesonavoluntary +#Q basis)tocompare,coordinate,and t,$R communicatelaboratoryfindings `-%S fromfoodsamples.Thissystemisa L.&T%'#%'# keycomponentofthetotal  foodlaboratoryresponse x networkandispatternedafterCDCs d  laboratoryresponsenetwork.InFY P  2004,FDAplanstoexpandthe <  systemwithatotalof79laboratories (  participatinginthenetwork!an   increaseof25laboratoriesoverthe t FY2003target.*3OO݌`ruru Ќ   v(8x*,-./012 p   ([XZ@uu( H  #K;7l|^ `BdE^)m (#(#      (#(# X>XX`X>([X[@(#(#( uu(#(#ProgramBackgroundandContext #`X>XXX>̭W#    r Someofthemosteffectivedefenses ` againstbioterrorismorotherpublichealth L  emergenciesarevaccines,antitoxins,and 8  othertherapeutics.Theapplicationof $  vaccinesinanticipationofadiseasethreator   therapeuticstotreatemergingdisease   outbreaksreducesthepotentialforepidemics t  andthehealthconsequencesandmortally `  thataccompanythem.HHShastakenthe L roleoftheleadFederalagencyresponsible 8 forcarryingoutthePresidentssmallpox $ vaccinationpolicyinordertopreemptany  threatfromthevirusduetobioterrorism. p  r Tocombatfuturediseasethreats, \ naturalormanmade,thePresidentsBudget H includesaproposalfora_BioDefense_ԀMedical 4 CountermeasureAuthoritythatwillenable   HHS,incollaborationwiththeDepartmentof   HomelandSecurity(_DHS_),tocontinueto  developandproducesafeandeffective p  pharmaceuticalsthatcanbeusedto \! counteractbiologicalagentsthatposeathreat H" tothehealth,safetyandsecurityofthe 4# Nation.Akeycomponentofthisauthorityis  $ anew,permanent,indefiniteappropriation  %  thatwouldbeusedtofinancemedical %l! countermeasuresforwhichsufficient &X" researchhasbeencompletedtoconcludethat 'D # theproductwillultimatelybelicensablefor (0!$ thatpurpose.WithinHHS,ASPHEPis )"% responsibleforcoordinatingthe *#& Departmentsinvolvementwiththe +#' _BioDefense_ԀMedicalCountermeasure l,$( Authority. X-%)  D.&*  ProgramPerformancePlanning   *  % ASPHEPisintheprocessof \, developingperformancemeasuresfortheuse H- ofthisnewauthority.Oneofthefirst 4 . prioritiesforHHS,incollaborationwith_DHS_  / andconsultationwithOHS,_OSTP_ԀandOMB  0 willbetodevelopandmaintainanongoing  1 threatanalysisforbiologicalthreatagentsand p 2 prioritizationofthesethreats.Theanalysis \ 3 willinclude: H4  *,-./012(x8v "*3"  'hXDpXX'*3(d2H3  0    Anassessmentofthepotentialpublic  6 healthconsequencesensuingfrom |7 terroristuseofthesethreatagents.*3(d|d݌d8(#(# Ќ  "*3"  *3e2H3  0    Regularupdatesfrom_DHS_Ԁregarding 4: newspecificthreatinformationthat ; mightrequirethespecialactionwith < respecttothedevelopmentofmedical x= countermeasures.*3ee݌`>(#(# Ќ    HHSalsowillassessthescientific 4!@ feasibilitytoproducesafeandeffective  "A medicalcountermeasures.  #B  MeansandStrategies  $XD   Wheneverathreatanalysisandan &,F assessmentofscientific/industrialfeasibility ' G indicateaconfluenceofneedandopportunity (!H toproduceanewbiodefensemedical |)!I countermeasure,theSecretariesofHHSand h*"J _DHS_ԀwouldrecommendtothePresidentthe T+#K useoffundsunderthisauthority.Intheir @,$L recommendationstothePresident,the ,-%M Secretarieswouldcertifythatthisuseofthe .&N authorityisforthepurchaseandstockpileof  abiodefensemedicalcountermeasurefor x which: d   "*3"  *3Pk2H3  0 F   Thereiscurrentlynotasignificant <  commercialmarketotherthan $  homelandsecurity;*3Pk}k݌ FuFu Ќ  "*3"  *3l2H3  0 F   Thecountermeasureiswell P characterizedandhasbeenscientifically 8  determinedtobelicensableonthebasis   ofproofofprincipleestablishedby   animalstudies,clinicalexperience,or |  clinicaltrials;*3ll݌d FuFu Ќ  "*3"  *3kn2H3  0 F   Industrialproductionofthe 4  countermeasurehasbeenjudged  feasible. *3knn݌xFuFu Ќ   F Thefirstthreeproductsexpectedtomeet L thiscriteriaareanextgenerationsmallpox 8 vaccinethatcanbeusedforimmunizationof $ vulnerablepopulations,ananthraxvaccine  thatrequiresfewerdosesthanthecurrently  marketedvaccine,andbotulismantitoxin. t Thefundalsowillfinanceforpreparedness ` againstpandemicinfluenza.Themedical L countermeasuresfinancedbythefundwould 8  beintendedforcivilianuseonly. $!  ExternalFactors  "l  F Byitsnature,terrorism,including $@  bioterrorism,isunpredictable.New %,! countermeasurescouldproveineffective &" againstgeneticallyalteredthreatagents. ' # Also,newviralstrainscanbeexpectedto |( $ evolveovertimeandposeunanticipated h)!% healthconsequences. T*"&  .x&* (#(#K(#  * c9,----#SC?n|?s  ` d@E s  "@<UEAl|71 `@XddddEttL2F ^ 22uu 2222 2222 22         uu     F Thethreatofbioterrorismisnottheonly B  threatfacingourNation.Disparitiesinhealth .  carewithintheU.S.populationareofgreat   concerntoHHS.Weareworkingtoexpand  healthcaretoall.Therefore,HHSseeksto  createnew,affordablehealthinsurance  optionsandexpandthehealthcaresafetynet.  TheFY2004budgetrequestcontinuesto p expandaccesstocriticalhealthcareservices \ fortheuninsured,especiallyinunderserved H ruralandurbanareas. z4  F Additionally,weaimtostrengthenand f  improveMedicareaswellashelptotrainan R  adequatesupplyofnurses.TheFY2004 > budgetincludesanincreasedemphasison *  expandingbaccalaureatetrainingfornurses ! andanexpansionofthenursingloan " repaymentandscholarshipprograms.We " alsoplantoexpandaccesstohealthcare # servicesforpopulationswithspecialneeds. $  Over530,000lowincomeanduninsured %l! individualsdependontheRyanWhiteCare &X" Actprogramformedicalcareandother 'D # essentialsupportservices. v(0!$  F Additionalfunds,whichwillbeused b)"% primarilyforincreasingoperatingcostsofthe N*#& healthcaresystem,addingstaffatthree :+#'  -&*  (#(#            (#(#newlyconstructedhealthcarefacilities,and V 6 purchasingadditionalmedicalcarefromthe B 7 privatesector(e.g.,500,000outpatientvisits) . 8 areneededtomaintainandimproveaccessto  9 healthcarefor1.6millionAmericanIndians : andAlaskaNatives.Theseprogramshave ; annualperformancemeasureswhichspeakto < increasingaccesstoregularhealthcareand = theexpansionofconsumerchoices.These p> measuresalsorepresenthowHHScontinues \? totrackitsprogresstowardsthisstrategic H@ goal. z4A @;     % (#(#K(# :+#Q ([X[@uu(*:dd\R\RI\RIst(#(#,\R,F\R,\R+  ?V#*FF ? HHSStrategicGoalX>XX`X> DVV#/!P "V# D#`X>XXX>̱#Agencies/ P  ProgramsX>XX`X> DVV#/!<"VV# D#`X>XXX>f#FY2004PerformanceMeasuresX>XX`X> WVF,P " VV#  W#`X>XXX>#X>XX`X>&'%XX>GOAL3:Improvethe    QualityofHealthCare  t  Services L  #X>X%&'ͅ##`X>XXX>̮#X>XX`X>ЌXX> NVV=2)"/"  V N#`ЌЌ##`X>X`Ќʆ#X>XX`X>ЌXX> CMS  2 0  Medicare   1  =VV,! t2"VV =#`ЌЌ##`X>X`Ќȇ# X>XX`X>ЌXX>  ӄImprovesatisfactionofMedicarebeneficiarieswiththe 2 3 healthcareservicestheyreceive.*  4 ЄIncreaseannualinfluenza(flu)andlifetime_pneumococcal_  t5 vaccinations[FY01:67.4%(flu),FY01:63.3% ~ 86 (_pneumococcal_]. B 7 ЄIncreasebiennialmammographyrates[FY01:51.6%(target  8 51%)].  9 ЄImprovethebeneficiaryunderstandingofbasicfeaturesof H: theMedicareprogram(Developmental).* OVV>'R ; VV O 7VV& ;VV 7#`ЌЌ##`X>X`Ќ߈#`ЌX`X>Ќ`ЌCMS  < GrantstoStates  = forMedicaid/ b > Medicaid l& ? Agencies 0 @  =VV,! A"VV =#`ЌЌP##`X>X`Ќ1#X>XX`X>ЌXX>  ӄIncreasethepercentageofMedicaidtwoyearoldchildren  B whoarefullyimmunized(Developmental).* OVV>' C VV O 7VV&| CVV 7#`ЌЌ##`X>X`Ќ#X>XX`X>ЌXX>CMS | D StateChildrens @E HealthInsurance JF Program =VV,!G"VV =#`ЌЌ##`X>X`Ќ8#`ЌX`X>Ќ`Ќ  ӄDecreasethenumberofuninsuredchildrenbyworkingwith | H Statestoimplement_SCHIP_Ԁandbyenrollingchildrenin @I Medicaid[FY02:1,200,000]. OVV>'JJ VV O 7VV&JVV 7#`ЌЌe##`X>X`ЌF#`ЌX`X>Ќ`ЌIHS K IndianHealth ZL Services =VV,!dM"VV =#`ЌЌQ##`X>X`Ќ2#X>XX`X>ЌXX>  ӄIncreasetheproportionofI/T/Uclients(by2%overFY03 N level)withdiagnoseddiabetes#X>XЌT#ЌXX>#`ЌЌ5#Ќ`ЌԀthathaveimproved_glycemic_ ZO control[FY01:30%ofI/T/Udiabeticshaveimproved dP _glycemic_ԀcontrolafourpercentincreaseoverFY00]. (Q ЄMaintaintheproportionofeligiblewomenwhohavehada R PapSmearwithinthepreviousthreeyearsattheFY2003 jS level[FY01:21%ofwomenreceivedpapscreeningwithin t.T oneyear,42%withininthreeyearsincreaseoverFY00 8U levels,12%withinoneyear,18%withinthreeyears]. V ЄMaintain100percentaccreditationofallIHShospitalsand zW outpatientclinics[FY01:100%,FY00:100%]. OVV>'>X VV O 7VV&R XVV 7#`ЌЌR##`X>X`Ќ#X>XX`X>ЌXX>IHS R Y Sanitation !Z Facilities ![ Construction =VV,!"X\"VV =#`ЌЌC##`X>X`Ќb#`ЌX`X>Ќ`Ќ  ӄDuringFY2004,providesanitationfacilitiesprojectsto R ] 18,150IndianHomeswithwater,sewagedisposal,and/or !^ solidwastefacilities[FY01:providedfacilitiesto3,551 !_ new/likenewhomes,14,451existinghomes,totalof18,002 "X` homes(targettotal14,730homes)]. OVV>'b#a VV O 7VV&0$aVV 7#`ЌЌ##`X>X`Ќf#`ЌX`X>Ќ`ЌHRSA 0$b RuralHealth $c  =VV,!%rd"VV =  ӄFlexibilityGrants:By2004,675appropriateruralfacilities 0$e willbeassistedinconvertingtoCriticalAccessHospital $f (_CAH_)status[ByFY2002,657hospitalshavebeenassisted %rg (target240)]. OVV>'|&6h VV O 7VV&J' hVV 7HRSA J' i Community ( j HealthCenters (!k  =VV,!+#n"VV =  ӄIncreaseto13.75millionthenumberofuninsuredand J' o underservedpersonsservedbyHealthCenters[InFY2001, ( p 10.3millionpeoplewereserved(target10.5million)].* (!q ЄDecreaseto6.77percentthepercentofHealthCenter )P"r prenatalpatientswithbirths<2,500grams[FY2001 Z*#s 7.13%].* OVV>'+#t VV O 7VV&2 VV 7HRSA 2  Nursing   Workforce   ЀDevelopment =VV,!~ L"VV =  ӄIncreaseto900thenumberofnewnursingloanrepayment 2  contractsawarded[InFY2001therewere443newcontracts   (target200)].   ЄIncreaseto22%theproportionof_NELRP_Ԁsupportednurses ~ L  servingincriticalshortagefacilitieswhoextendtheir B   contractforathirdyear[baseline21%].* ?5'   VV ? (VV    (HRSA    Maternaland f  ChildHealth \*  BlockGrant    =VV,!v"VV =  ӄDecreasetheinfantmortalityrateto6.8/1000[Healthy   People2010InFY1999theinfantmortalityratewas f 7.1/1000].* \* ЄReduceillnessandcomplicationduetopregnancyto26per   100deliveries[In1998therewere31.2/100  illnesses/complicationsduetopregnancy.].* v ЄIncreaseto96percentthepercentofnewbornswithatleast l:  onescreeningforeachofPKU,hypothyroidism, 0  _galactosemia_,and_hemoglobinopathies_Ԁ[HealthyPeople2010   ЄinFY1999theratewas94%.].*   Є#X>XЌڛ#ЌXX>ԀIncreasematernalsurvivalto8maternaldeathsper100,000 |J  livebirths#X>XЌ~##`X>XXX>#X>XX`X>. ?5'@  VV ? (VV 6 (ЌXX>HRSA 6 RyanWhite  AIDSProgram   =VV,!P "VV =  ӄPartAServeaproportionofwomenandracial/ethnic 6! minoritiesinTitleIfundedprogramsthatexceedstheir " representationinnationalAIDSprevalencedata,asreported # bytheCDC,byaminimumoffivepercentagepoints[InFY P$ 2000,70.4%ofPartArecipientswereracial/ethnic F% minorities;comparedto57.3_AIDs_Ԁprevalence.].  & ЄForPartB,increaseby4%thenumberof_ADAP_Ԁclients ' receivingHIV/AIDSmedicationsthroughState_ADAPs_ `( duringatleastonemonthoftheyear[FY200173,784clients V$) receivedmedications(target72,000)]. * ЄIncreaseby2%annuallythenumberofpersonswholearn + their_serostatus_ԀfromRyanWhiteCareActprograms.New p, performancemeasure.* f 4- ЄReducedeathsduetoHIVinfectionbelow3.6per100,000 *!. peopleby2010.#`ЌЌ?#Ќ`Ќ ?5'!/ VV ? )V "/ )#X>XЌƨ#ЌXX>HRSA "0 NationalHealth #N1 ServiceCorps D$2 Program >V/!%3"V >  ӄIncreaseto79percentthepercentofNHSCclinicians "4 retainedinservicetotheunderserved[InFY2001,80%of #N5 NHSCcliniciansremainedinservicebeyondtheperiodof D$6 servicecommitment(target75%).].7-+%7 V 7*Seeagencyperformanceplan/reportforadditionalinformation.  %7  (#(#        (#(# F  #K;7l| 0^ `BdEv^ F r    "  z    *   (X@(#(#(#X>XЌۮ#ProgramBackgroundandContext  *   F TheCMSadministersMedicare,the   Nationslargesthealthinsuranceprogram,   whichcoversmorethan41million   Americans.Medicareprovideshealth   insurancetopeopleage65andover,those l  whohavepermanentkidneyfailure,and X  certainpeoplewithdisabilities.Forover D threedecades,thisprogramhashelpedpay v0 medicalbillsformillionsofAmericans, b providingthemwithcomprehensivehealth N benefitstheycancounton. :  ProgramPerformancePlanning    F CMSsprimarymissionistoassure  healthcaresecurityforitsbeneficiaries.  Also,CMSstrivestoencouragechoicein | theMedicarebeneficiarycommunityfor h medicalcoveragewhilemaintaininghigh  T qualitycare.Thereare25measures !@ associatedwiththisprogramforFY2004. r", Thefollowingmeasuresillustratethekey ^#  programmaticmissionandactivities: J$!  F    *,-./012(yx*,-./012"*3"  *3I2H3  0 F   ImprovesatisfactionofMedicare "&# beneficiarieswiththehealthcare '$ servicestheyreceive.*3Iv݌' %F*F* Ќ   *,-./012(xy*,-./012ȸ *,-./012(xx*,-./012 "*3"  *32H3  0 F   Increaseannualinfluenza(flu)and (!& lifetime_pneumococcal_Ԁvaccinations.*3݌)"'F*F* Ќ  ! ! *,-./012(xx*,-./012 "*3"  *3t2H3  0 F   Increasebiennialmammographyrates.*3t݌*l#(F*F* Ќ  ! ! *,-./012(xx*,-./012 "*3"  *32H3  0 F    Improvethebeneficiaryunderstanding +X$) ofbasicfeaturesoftheMedicare ,D%* program(Developmental).*3)݌r-,&+F*F* Ќ    Z.',   MeansandStrategies  *, < ,X,` XDpXhXDpX<  Thefollowingmeansandstrategies . illustratehowtheprogramcontinually  / strivestowardsachievingitsperformance  0 measures:  1  *,-./012(2xx*,-./012"*3"  *38223  0    BeneficiarySatisfaction: TheCMSs X 3 multiyeareffortstoimprovebeneficiary H4 satisfactionwiththehealthcarereceived z45 applytobothmanagedcareandfeefor f 6 service(_FFS_).Fortheincreasestobe R 7 statisticallysignificant,therearelong >8 termtargetswithreportingdueattheend *9 ofthe5yearperiod.*38e݌:"" Ќ   *,-./012(2xx*,-./012"*3"  *3X223  0    TheCMSsongoingeffortstoimprove ; beneficiarysatisfactioninclude < continuingtocollectandshare = ConsumerAssessmentHealthPlans > Surveys(_CAHPS_)informationfrom l? beneficiariesandmakingspecific  X@ presentationstoindividualMedicare !DA ManagedCareplans,toQuality v"0B ImprovementOrganizations(QIOs)at b#C meetingsoftheAmericanHealthQuality N$D Association,andtobeneficiariesonthe :%E MedicareHealthPlanComparewebsite.*3X݌&&F"" Ќ   *,-./012(2xx*,-./012"*3"  *36223  0    AdultImmunizations: FY2001marked 'G thefirstreportingyearforwhichanew ( H datasource(MedicareCurrent (!I BeneficiarySurvey,_MCBS_)wasusedto )"J measureannualfluandlifetime *#K _pneumococcal_Ԁimmunizationrates.This +l$L sourcealsoincludesinstitutionalized ,X%M beneficiariesandmoreaccurately -D&N reflectsCMSsinterventions.*36c݌ v.0'O"" Ќ  "*3"  *3223  0 F   TheCMSandtheCDCareactively F addressingtheunknownimpactofthe 2 2000and2001fluvaccineshortagesand   delayeddeliveryontheiradult   immunizationperformancemeasureand   arecloselymonitoringrecenttrends.*3A݌ F*F* Ќ  "*3"  *3223  0 F   Mammography: TheCMSintendsto   increasethepercentageofMedicare  x womenage65andoverwhoreceivea d _mammogram_Ԁeverytwoyears.*33݌P F*F* Ќ  "*3"  *3223  0 F   SincetheNationalCommitteefor <  QualityAssurance(_NCQA_)revisedits n(  technicalspecificationsforthebreast Z  cancerscreeningmeasure,CMSis F  currentlymodifyingbaselineandfuture 2  targets,beginningwithFY2003,to   attainconsistencywiththeFY2002   _HEDIS_measureandtoreflectchanges  inbillingcodesfordigital  mammograms,conversionoffilmto  digitalimages,andforcomputeraided t screening.*3݌`F*F* Ќ  "*3"  *3 223  0 F   BeneficiaryUnderstanding: To L promotebeneficiaryandpublic < understandingofCMSanditsprograms, n( CMSisdevelopingagoaltoimprove Z beneficiaryawarenessof(1)thecore F featuresofMedicareneededtousethe 2  programeffectively,and(2)CMS ! sourcesfromwhichadditional  " informationcanbeobtainedifneeded.*3 9݌"F*F* Ќ  "*3"  *3223  0 F   TheCMSworksacrosstheorganization # toensuremaximumandefficientuseof $  existinginfrastructurestocarrykey %t! Medicaremessagesandinformationto &`" beneficiariesincludingthosevulnerable 'L # populationswhohaveproblemswith ~(8!$ accesstoinformation.TheCMSs j)$"% NationalMedicare&YouEducation V*#& Program(_NMEP_)isanexampleofone B+#' beneficiarycenteredprogramthatstrives .,$( toprovideinformationtoimprove -%) awarenessofMedicarecorefeaturesand.&*F*F* sourcesusingavarietyofinformation F* channels(includingprintmaterials 2+ mailedtoallbeneficiaries,tollfree  , telephoneservice,anInternetsite,and  - directcounselingsupportthroughthe  . StateHealthInsurance&Assistance  / Program).Inadditiontothe_NMEP_,  0 othernationalandlocalprogramsstrive  t1 toraisebeneficiaryawarenessfrom `2 differentperspectives;forexample, L3 publicnursinghomecampaignsthrough ~8 4 theQualityImprovementOrganizations.*3݌j$ 5"" Ќ  "*3"  *3223  0    Resources: Medicarebenefitoutlaysfor V 6 _Fy_Ԁ2004are$278,632millioninFY F 7 2004,anincreaseofapproximately 2 8 $11,000millionfromFY2003.*3+݌ 9"" Ќ  ExternalFactors  ;   AdultImmunizations: Therecentflu = vaccineshortagesanddelayed x> immunizationshaveimpactedthedelivery d? ofimmunizations.Theinabilitytoquantify P@ theimpactoftheseshortagestodatereduces <A theconfidencewehaveinachieving our n(B targetsfortheaffectedyears,andforreliably ZC settingfuturetargets.TheCMSandthe FD CDCareactivelyaddressingtheunknown 2 E impactofthe2000and2001fluvaccine !F shortagesanddelayeddeliveryonouradult  "G immunizationperformancegoalsandare "H closelymonitoringrecenttrends. #I   Mammography: Inlate2001early $J 2002,therewasagreatdealofcontroversy %xK inthepressregardingtheeffectivenessof &dL mammography.Eventhoughtherewere 'P M subsequentpressreleasesfromthe ( tovulnerablepopulations.Threemeasures *  havebeenselectedtorepresentthisprogram ! forFY2004. " "*3"  *3223  0 F   ThepercentageofMedicaidtwoyearold # childrenwhoarefullyimmunized.*3݌$ F*F* Ќ  "*3"  *3223  0 F   AssistStatesinconductingMedicaid %l! paymentaccuracystudiesforthepurpose &X" ofmeasuringandultimatelyreducing 'D # Medicaidpaymenterrorrates.*3݌v(0!$F*F* Ќ  "*3 "  *3*223  0 F   HealthcarequalityacrosstheMedicaid b)"% andStateChildrensHealthInsurance N*#& Program(_SCHIP_)assessedthroughthe :+#' CMS/StatePerformanceMeasurement &,$( PartnershipProject.*3*W݌-%)F*F* Ќ   -&*   Thefollowingmeasureillustratesoneof  t* thekeyprogrammaticmissionsand `+ associatedactivitiesoftheMedicaid L, program: ~8 -  *,-./012(xx *,-./012"*3"  *3i2H3  0    IncreasethepercentageofMedicaid V / twoyearoldchildrenwhoarefully B 0 immunized(Developmental).*3i݌* 1"" Ќ  MeansandStrategies    :  3   Thefollowingmeansandstrategies 5 illustratehowtheprogramcontinually x6 strivestowardsachievingitsperformance d7 measure:  P8  ! ! *,-./012(2xx*,-./012"*3"  *3223  0    TheCMS,workinginconjunctionwith j$: theStatesandtheDistrictofColumbia, V; hasdevelopedathreestageprocessfor B< itsMedicaidimmunizationmeasure.*3݌.="" Ќ  "*3"  *3 223  0    Duringthebaselinedevelopmentyears,  > CMSwillworkcloselywiththeStatesto !? assistthemindevelopingabaseline !@ methodologytomeasureimmunization "A ratesoftwoyearoldMedicaidchildren #B andtechnicalassistancewillbeprovided $pC throughCDCandCMSasdetermined %\D necessarybyStatesandCMS.*3 7݌&HE"" Ќ  "*3"  *3u223  0    TheCMShasworkedcloselywith z'4 F States,theCDC,andtheAmerican f( !G PublicHumanServicesAssociation R) "H (_APHSA_)todevelopastrategyforthis >*"I performancegoal,and_APHSA_Ԁwill *+#J continuetoactasaliaisonbetweenthe ,$K StatesandCMS.*3u݌-%L"" Ќ   -&M Ї"*3"  *3223  0 F    Resources: TheAdministrationsmost F recentestimateofMedicaidbenefitswas 6 inthePresidentsBudgetforFY2004, "  releasedinFebruary2003.Using   PresidentsBudgetestimatesMedicaid   benefitoutlaysareprojectedtobe   $176,754millioninFY2004,an   increaseofapproximately$14,388  x millionoverFY2003. *3 ݌dF*F* Ќ  ExternalFactors  ~8   F Theoriginaldevelopmental_timeline_Ԁfor V  thegoalallottedoneyearfordevelopment B  andreportingofbaselinemeasuresforthe .  States.AfterworkingwithGroupIStates   forayear,itbecameevidentthatmoretime  wouldbeneededbyStatestofullydevelop  theirmeasurementmethodologies.Reasons   fortheextensionincludevariationsinState  reportingcyclesforimmunizationdata,data p problems,andstaffandresourcelimitations. \    F  F  r  -&* Ї V 6 (X@**(e #K;7l|,^ `BdEF^.FZ #(##(#(#(#  F  #(##(##(##(# #(##(##(##(# #(##(##(##(# #(##(##(##(# #(##(##(##(# (#(##(##(# ([X[@(#(#(ProgramBackgroundandContext   t  F TheBalancedBudgetActof1997created L  theStateChildrensHealthInsurance ~8  Program(_SCHIP_).Thisprogrammakesan j$  unprecedentedinvestmenttowardsimproving V  thequalityoflifeformillionsofvulnerable, B  uninsured,lowincomechildren.Thestatute .  authorizesandappropriatesanannualamount   thatCMSgrantstoStatesandterritorieswith  anapproved_SCHIP_Ԁplan.Statesweregiven  theoptiontoexpandtheirMedicaidprogram,  establishaseparate_SCHIP_Ԁprogramora  combinationofboth.Currently,allStates p andterritorieshaveapproved_SCHIP_Ԁplans. \ ManyStatesaresubmittingplanamendments H and1115waiverstofurtherexpandinsurance z4 coverageunder_SCHIP_. f   ProgramPerformancePlanning  >  F Theimplementationof_SCHIP_Ԁhasdriven ! enormouschangeintheavailabilityofhealth " carecoverageforchildrenandintheway " governmentsponsoredhealthcareis # delivered.Thefollowingmeasureillustrates $  thekeyprogrammaticmissionandactivities: %l!  F    *,-./012(yx*,-./012"*3"  *3 2H3  0 F   Decreasethenumberofuninsured 'D # childrenbyworkingwithStatesto v(0!$ implement_SCHIP_Ԁandbyenrolling ^)"% childreninMedicaid.*3  ݌F*#&FuFu Ќ   *,-./012(2xy*,-./012T   F   F  ,$(      MeansandStrategies   t(   Thefollowingmeansandstrategies L* illustratehowtheprogramcontinuallystrives ~8 + towardsachievingitsperformancemeasure: j$ , "*3"  *3A223  0    AccordingtotheStatisticalEnrollment B . DataSystem(_SEDS_),approximately4.6 . / millionchildrenparticipatedin_SCHIP_Ԅ  0 fundedcoverage(eitheraseparatechild 1 healthprogramoraMedicaidexpansion) 2 inFY2001,andmanymorewere 3 enrolledin regularTitleXIXMedicaid 4 throughincreasedoutreacheffortsand p5 applicationsimplificationstrategies \6 undertakenasaresultof_SCHIP_.*3An݌H7(#(# Ќ  "*3"  *3223  0    ToassurethatbothMedicaidand_SCHIP_ z48 fulfilltheirpotential,CMSisworking f 9 withStates,variousoperatingdivisions R : withinHHS,otherFederalagencies,and >; theprivatesectoronabroadarrayof * < outreachactivities.*3݌!=(#(# Ќ  "*3"  *3223  0    Resources: Thestatutorilymandated "> allotmentforFY2004is$5,090million, "? anincreaseofapproximately$400 #@ millionovertheFY2003allotment.*3݌$A(#(# Ќ     %  }    -  ExternalFactors  &\C   Despitemanysuccessesof_SCHIP_,many z(4!E eligiblechildrenandfamiliesarenot f) "F enrolledin_SCHIP_ԀorMedicaid.Recent  R* #G studiesrevealthatkeybarriersinclude:1) F burdensomeapplicationoreligibility 2 determinationprocesses;2)lackofawareness   abouttheprograms;3)assumptionsby   familiesthattheyarenoteligible;and4)the   lingeringstigmaattachedtogovernment   sponsoredassistance.   uu'u  t  F  L  L  -%%  j$ % 5@(#(#[X[@ul5 F  #K;7l|^ `BdE2^2Z (#(#      (#(#(X@(#(#( ProgramBackgroundandContext  ` <XX ,X,` XDpX< F HospitalandHealthClinicfunding, ~8  includinginsurancereimbursement(e.g. j$  Medicare,Medicaid),supportsinpatientand V  ambulatorycareandsupportservicessuchas B  nursing,pharmacy,laboratory,nutrition, .  medicalrecordsprovidedinfacilitiesrunby   theIndianHealthService,Tribal,orUrban  groups(I/T/U).IHScontinuestofocus  fundingonevidencebasedtreatmentand  preventionstrategiesinaddressingthose  healthconditionsthatdisproportionately p affectAmericanIndian/AlaskanNatives \ (AI/AN)likediabetes,obesity,heartdisease H amongothers.Inthefaceofagrowing z4 populationandhealthcareinflation,IHShas f  beensuccessfulinachievingmanyoftheir R  performancemeasuressuchasmanaging > diabetesbykeepingbloodsugarunder *  controlaswellconductingnecessary ! _screenings_;improvingpapsmearand " mammographyratesamongeligiblewomen; " andmaintaining100percentaccreditationof # allIHSrunhospitals.InFY2004,with $  continuedcollaborationwithCDCandother %l! agenciesaswellasproposedincreasesin &X" SpecialDiabetesFunding,IHSwillaimto 'D # improvethequalityofcareforAI/_ANs_. v(0!$  F  r    "  z   ProgramPerformancePlanning  :+#'  F Thisprogramhas21performance -%) measuresgearedtowardsallfacetsofthe -&* hospitalsandclinicsfunding.Thefollowing `* measuresillustrateIHScommitmentto L+ treatmentstandards,prevention,andoverall ~8 , qualityofIndian/Tribal/Urbanhospitalsand j$ - clinics: V .      *,-./012(yx*,-./012"*3"  *3$2H3  0    DuringFY2004,improvetheFY2003 . 0 performancelevelfor_glycemic_Ԁcontrol  1 intheproportionofI/T/Uclientswith 2 diagnoseddiabetes.*3$$݌3(#(# Ќ   "*3"  *3S&2H3  0    DuringFY2004,maintainthe 4 proportionofeligiblewomenwhohave x5 hadaPapSmearwithintheprevious `6 threeyearsattheFY2003level.*3S&&݌H7(#(# Ќ   "*3"  *3'2H3  0    DuringFY2004,maintain100percent v08 accreditationofallIHShospitalsand b9 outpatientclinics.*3'(݌J:(#(# Ќ   *,-./012(xy*,-./012.$   MeansandStrategies  <   Thefollowingmeansandstrategies  > illustratehowIHSaimstocurbrising !? mortalityratesinAI/ANcommunitiesand "@ improvethequalityofcare: #tA  *,-./012(2xx*,-./012"*3"  *3[+223  0    DiabetesStandardsofCare: IHS %LC continuestoimplementevidencebased &<D standardsofcareinmanagingdiabetes, n'( E whichimprovediabeticpatientoutcomes. Z(!F Thesestandardsincludeimproving F)"G diagnoseddiabeticsbloodsugarand 2*"H bloodpressurecontrolthrough +#I medicationandhealthylifestylechanges;  ,$J assessingdiabeticsforLDLcholesterol, ,%K whichimpactsheartdiseasemortality; -&L assessingdiabeticsforendstagerenal .'M(#(# disease;andanewperformance F initiativeforFY2004,increasingthe 2 rateofdiabeticswhohavereceiveda   retinalscreeninginpreventingdiabetes   relatedblindness.*3[++݌ FuFu Ќ   *,-./012(2xx*,-./012"*3"  *30223  0 F   AI/ANdiabeticswillalsobenefitfrom   the$50millionincreaserequested   SpecialDiabetesProgramforIndians  t FundinginFY2004.Inadditiontothe ` programsemphasisonprimary L  prevention,athirdofthesegrants ~8  specificallyfocusonmanagingdiabetes j$  complications,whichwillinsome V  instancessupplementlocaleffortsto B  implementthestandardsofcareandwill .  improveperformanceon_GPRA_   measures.Additionally,IHSwill  continuetonegotiatebetterwholesale  pricesonnewer,moreeffective  medicationstohelpimprovediabetics  overallhealthstatus.*30J0݌pFuFu Ќ   *,-./012(2xx*,-./012"*3"  *34223  0 F   PapSmearScreening: IHSwill \ encourageallIHSproviderstoprovide L screeningandnecessaryfollowup ~8 servicesforeligiblewomen.IHSwillalso j$ provideadditionaltrainingforproviders V toperform_colposcopy_Ԁandworkto B aggressivelytrackabnormalPapSmears .  inordertopreventcervicalcancer.*345݌!FuFu Ќ   *,-./012(2xx*,-./012"*3"  *37223  0 F   Papscreeningrateswillalsobepartof " thePerformanceAppraisalofeachIHS " AreaDirectortoencouragelocal # participation. *37#8݌$ FuFu Ќ   *,-./012(2xx*,-./012"*3"  *39223  0 F   TheproposedFY2004IHSbudgetwill %p! supportthecapacitytomaintaincurrent &\" screeninglevelsinthefaceofpopulation 'H # growthandrisingcostsoftreatment.*39:݌z(4!$FuFu Ќ   *,-./012(2xx*,-./012"*3"  *3<223  0 F   100percentAccreditationofIHS f) "% Hospitals,HealthClinics: IHSwill V*#& continuetobuildonpastsuccessby F+$' maintaining100percentaccreditation 2,$( fromtheJointCommissiononthe -%) AccreditationofHealthCare .&*FuFu Organizations(_JCAHO_)andthe F* AmericanAssociationofAmbulatory 2+ HealthCenters(_AAHC_).IHSwill  , continuetorelyonAreaOfficesand  - Headquartersinprovidingsupportand  . thelocalI/T/U_multidisciplinary_Ԁteam,  / whichprovidesongoingquality  0 managementforlocalhospitalsand  t1 clinics.*3<.<݌`2(#(# Ќ  ExternalFactors  ~8 4   IHSfaceschallengesintherecruitment V 6 andretentionofhealthcareproviders, B 7 particularlyinthemostruralareas.Poverty . 8 isalsoamajorchallenge.IHSservesseveral  9 ofthepoorestcommunitiesinthecountry. : Therelationshipbetweenhigherlevelsof ; morbidityandmortalityforbothacuteand < chronicdiseasesandconditionsiswell = documentedworldwide.Additionally,there p> isalackofcosteffectiveinterventionsfor \? chronicdiseases. H@ @;(#(#K(#  N*#P 5@(#(#X@u5O #K;7l|^ `BdEW^Fk (#(#  F       (#(#(X@(#(#( uu(#(# ProgramBackgroundandContext     F TheIHSSanitationFacilities ` ConstructionProgramisanintegral L  componentoftheIHSdiseaseprevention ~8  activityandhasprovidedAI/ANpotable j$  waterandwastedisposalfacilitiessince V  1960.Asaresultofsuchactivities,infant B  mortalityratesforgastroenteritisandother .  environmentallyrelateddiseaseshave   decreasedby80percentsince1973.IHS,in  collaborationwithTribesandotheragencies,  designsandbuildswaterconnectionsand  solidwastefacilitiesinthoseareasthatare  economicallyfeasibleandinneed.InFY p 2004,IHSwillcontinuetoaddresssanitation \ andcleanwaterneeds.Currently,92.5 H percentofAI/ANhomeshavesafewaterin z4 thehomecomparedwith99percentofall f  U.S.homes.NavajoandAlaska,inparticular, R  facesomeofthelargestdeficiencieswith > only83percentofNavajosand65percentof *  AlaskanNativeshavingsafewaterinthe ! home.IHSwillworktowardslongterm " goalstosignificantlyreducecleanwaterand " sewagedeficienciesby2010inthefaceof # populationgrowth. $   ProgramPerformancePlanning  &X"  F Thisprogramhasonemeasureaimedat v(0!$ providingnewandupgradedwater b)"% connectionsand/orsolidwastefacilitiesfor N*#& AI/AN: :+#'   F    &,$(  *,-./012(yx*,-./012"*3"  *3NM2H3  0        DuringFY2004,providesanitation  ( facilitiesprojectsto18,150Indian  t) Homeswithwater,sewagedisposal, \* and/orsolidwastefacilities.*3NM{M݌D+(#(# Ќ   *,-./012(xy*,-./012L MeansandStrategies  ^ -   Thefollowingmeansandstrategies 6 / illustratehowtheSanitationFacilities " 0 Programaimstowardsreducingtheoverall  1 needforcleanwaterandsolidwaste 2 facilities: 3  *,-./012(2xx*,-./012"*3"  *3RQ223  0    AssessingNeed: Theprogramutilizes x5 TheSanitationDeficiencySystem(SDS) h6 andProjectDataSystemstotrackAI/AN T7 homesthatlackwaterorsewagefacilities @8 orneedanupgradebecauseofaging r,9 infrastructureormorerigorous ^: regulations.*3RQQ݌J;(#(# Ќ   *,-./012(2xx*,-./012"*3"  *3S223  0    LeveragingOutsideContributions 6< fromEPA,HUD: IHS,inFY2004,will & = continueitspartnershipswiththese !> agenciesinobtaininggrantstobuildmore "? sanitationfacilities.IHSwillcontinueto "@ collaboratewithStateandTribalagencies #A inconductingenvironmentalreviewsand $B communityplanningactivities.*3S$T݌%lC(#(# Ќ   *,-./012(2xx*,-./012"*3"  *3V223  0    IHSwillutilizefundinginFY2004to &XD expandthenumberofnewandupgraded 'D E sanitationfacilities.*3V!W݌v(0!F(#(#    b)"G O< ee        ExternalFactors  F  F Theneedforsanitationfacilities   continuestoriseduetonewenvironmental   laws,populationgrowth,inflationandthe   continuedcostofupgradingdeteriorating   facilitiestocontinuetoprovidesafeservices.   Inaddition,thereistheimpactofthe  t economyonnewhousingstarts,whichbased ` onendofyear2001datacaused L  approximately1000homestobeconstructed ~8  thatcouldnotbeservedwithIHSfunds. j$   "  F  (X@OO( #  -&(  2"(#2"(#(#(# #K;7l|B^ `BdE ^D" (#(#2"(#2"(#(X(#(#(ProgramBackgroundandContext  `   HRSAsOfficeofRuralHealthPolicy ~8  (_ORHP_)istheonlyofficeintheDepartment j$  solelyconcernedwiththeruralhealthcare V  needsofthenation.Itisactivein B  coordinatingruralhealthcareprogramsand .  policieswithinHRSA,withCMS,andwith   otherFederalDepartmentssuchasthe  DepartmentofAgricultureandthe  DepartmentofHousingandUrban  Development._OHRP_Ԁalsoprovides  leadershipfortheSecretarysRuralTask p Force.Programsadministeredby_ORHP_ \ includeRuralHealthPolicyDevelopment, H RuralHealthOutreachGrants,RuralAccess z4 toEmergencyDevices,RuralHospital f  FlexibilityGrants,StateOfficesofRural R  Healthandthe_Denali_ԀProject. >  ProgramPerformancePlanning  !   HRSAsFY2004performanceplan " includes6performancemeasuresforthe # ruralhealthprograms.Thefollowing $  measureexemplifiesHRSAscommitment %l! toenhancedprogramperformanceinrural &X" health:     'D #  *,-./012(yx*,-./012  "*3"  *3c2H3  0    FlexibilityGrants:By2004,675 ^)"% appropriateruralfacilitieswillbe J*#& assistedinconvertingtoCriticalAccess 2+#' Hospital(_CAH_)status.*3cd݌,$( Ќ   *,-./012(xy*,-./012Ec  MeansandStrategies  -&* Ї c _OHRP_Ԁengagesinawidespectrumof `* activity,fromresearchandpolicy L+ developmenttodemonstrationgrantsfor ~8 , newruralservicedeliverysystems._OHRP_ j$ - employsvarioustoolsandstrategiesto V . enhanceprogramperformance: B /  *,-./012(2xx*,-./012"*3"  *3gh223  0 c   TheStateOfficesofRuralHealth  1 programstrengthensruralhealthcare 2 deliverysystemsbycreatingafocal 3 pointforruralhealthineachStateand 4 coordinatingruralhealthatlocallevels; 5 resultinginthecreationofanational p6 ruralinformationnetwork.*3ghh݌\7cG"cG" Ќ  "*3"  *3j223  0 c   TheFlexProgramhasestablisheda H8 trackingprojectpermitting_ORHP_Ԁto z49 providefeedbackand bestpractice f : informationtoStates,aswellassessing R ; responsivenesstotechnicalassistance >< needs.*3jj݌* =cG"cG" Ќ  "*3"  *3l223  0 c   InFY2004,theRuralNetwork !> DevelopmentAwardswillincreaseto "? 20.*3ll݌"@cG"cG" Ќ   *,-./012(2xx*,-./012"*3"  *3>n223  0 c   Resources: ThebudgetrequestforFY #A 2004is$85.3million,anincreaseof $B approximately$5millionovertheFY %pC 2003Presidentsbudget.The$5million &\D increaseintheRuralHealthOutreach 'H E grantsprogramwillsupportthe z(4!F developmentofamodelforthe f) "G ExtendedStayPrimaryCareClinic,and R* #H expanditscurrentsmallhospital >+#I improvementinitiativefromthe *,$J MississippiDeltatootherisolatedrural -%K communities.A$10millionincreasein .&LcG"cG" theRuralHospitalFlexibilityGrants F programwillsupportfrontier 2 technologyandhealthcaremodels   demonstrationsthroughtechnologyand   capitalequipmentgrantstohealthcare   providersinruralareas.*3>nkn݌  Ќ  ExternalFactors   t   Factorswhichcanimpactprogram L  performanceare:1)amountofState/local ~8  resourcesdevotedtoruralhealth;2) j$  financialstabilityofruralhospitals;3) V  numbersofuninsuredand_underinsured_;4) B  managedcare;5)impactofbiological, .  chemicalorradiologicalweaponssurge   capacity;and6)healthcaredeliveryvia  telecommunicationandInternetaccessto  healthinformationandservices.     >  F 5(#(#X\5 !  -&( ЇOY (X(#(#( #K;7l|-k `BdE_kT2         ProgramBackgroundandContext  L  Thiscommunitybasednetworkdelivers j$  preventiveandprimarycareservicesforthe V  neediest,poorestandsickestpatientsinrural B  andinnercityareasthroughaFederal,State .  andcommunitypartnershipapproach.     ProgramPerformancePlanning     HRSAsFY2004PerformancePlan p contains13performancemeasuresforthe \ HealthCentersprogram.Thefollowing H measuresexemplifytheprograms z4 commitmenttoprovidingqualityhealthcare f  tounderservedpopulations: R       *,-./012(yx*,-./012"*3"  *3{2H3  0    Increaseto13.75millionthenumberof *  uninsuredandunderservedpersons ! servedbyHealthCenters.*3{{݌! Ќ   "*3"  *3}2H3  0    Decreaseto6.77percentthepercentof " HealthCenterprenatalpatientswith # births<2,500grams.*3}>}݌$t  Ќ   *,-./012(xy*,-./012B{  MeansandStrategies  &H"   TheHealthCentersprogramemploys f( !$ numerousstrategiestoassureunderserved R) "% populationsreceivequalityhealthservices: >*"&  *,-./012(2xx*,-./012"*3"  *3k223  0    HRSAshealthdisparities_collaboratives_ ,$( addresspreventionandchronicdisease -%) managementforunderserved-&*  78c87G"cG" 78c878c8 78c878c8 78c878c8 78c878c8 78c878c8 78c878c8 78c878c8 7G"cG"78c8populationsandhasgenerated L2 outstandingnationallyrecognized ~8 3 outcomes.*3k݌j$ 4cG"cG" Ќ  "*3"  *3a223  0 c   HealthCentersaresuccessfulin V 5 leveragingotherfunding;only25 B 6 percentofHealthCentersrevenues . 7 comefromtheFederalHealthCenter  8 grant.*3a݌9cG"cG" Ќ  "*3"  *3223  0 c   HealthCentersareenrollingtheir : patientsinthe_SCHIP_Ԁprogram.*3(݌;cG"cG" Ќ   *,-./012(2xx*,-./012"*3"  *3223  0 c   InFY2004,120newHealthCenter < accesspointswillbeestablishedand110 p= existingsiteswillbeexpanded.*3Ԇ݌\>cG"cG" Ќ   v(8x*,-./012"*3"  *3s2  A  .3  0 c   Resources: ThebudgetrequestforFY H? 2004is$1,627million,anincreaseof ~8@ approximately$170millionovertheFY j$A 2003Presidentsbudget.Thisincrease VB willenabletheprogramtofund BC additionalaccesspointsandexpand . D servicesatexistingsites,therebyserving !E anadditional1.2millionpersons.*3s݌"FcG"cG" Ќ   *,-./012(2x8v ExternalFactors  #H  c NumerousfactorscanimpactHealth %pJ Centersprogramperformanceincluding:1) &\K theavailabilityofprimarycareproviders 'H L willingtoserveunderservedpopulations;2) z(4!M theeconomy;3)decliningStaterevenues; f) "N 4)increaseinmarketpressures;and5) R* #O emergingpopulations. >+#P  #K ;7l|k `BdELkF`           78787G"7G" 78787878 78787878 78787878 78787878 78787878 7G"7G"7878    1XX`1 ProgramBackgroundandContext  `      HRSAsBureauofHealthProfessions ~8  currentlyadministersprogramswhich j$  collectivelyaddressNursingWorkforce V  Developmentnamely;AdvancedEducation B  Nursing(Section811ofthePublicHealth .  ServiceAct),NursingWorkforceDiversity   (Section821ofthePublicHealthService  Act),NurseEducation,PracticeandRetention  Grants(Section831ofthePublicHealth  ServiceAct),andtheNursingEducationLoan  RepaymentProgram(Section846(h)ofthe p PublicHealthServiceAct).Newauthorities \ arepartoftheNurseReinvestmentActwhich H amendsandexpandsexistingTitleVIII z4 legislation.Collectivelythesenewauthorities f  whichincludePublicService R  Announcements,NurseScholarships,Nurse > FacultyLoansandComprehensiveGeriatric *  Educationaddressfactorswhichwillhelp !  alleviatethenursingshortage. "!   ProgramPerformancePlanning  ##   HRSAscurrent_GPRA_Ԁplanincludes %l% specificperformancemeasuresforonlythe &X& NursingEducationLoanRepaymentProgram 'D ' (_NELRP_).Performancefortheothernursing v(0!( programsisaggregatedwithallotherTitle b)") VIIandTitleVIIIhealthprofessions N*#* programs.HRSAiscurrentlyexaminingthe :+#+ feasibilityofestablishingseparate &,$, performancemeasuresfortheprograms -%- associatedwithNursingWorkforce -&. Development.Intheinterim,theperformance `. measuresforthe_NELRP_Ԁwillbeusedas L/ proxies: ~8 0      *,-./012(yx*,-./012"*3"  *32H3  0    Increaseto900thenumberofnew V 2 nursingloanrepaymentcontracts B 3 awarded.*3A݌* 4(#(# Ќ  "*3"  *3C2H3  0    Increaseto22%theproportionof  5 _NELRP_Ԁsupportednursesservingin 6 criticalshortagefacilitieswhoextend 7 theircontractforathirdyear.*3Cp݌8(#(# Ќ   *,-./012(xy*,-./012  MeansandStrategies  X:   Thefollowingmeansandstrategiesare v0< employedtoaffectimprovedprogram b= performance: N>  *,-./012(2xx*,-./012"*3"  *3՝223  0    _NELRP_Ԁisemployingenhancedmarketing &@ strategieswhichshouldresultinabroader  A distributionofcontractawardsto_RNs_  B workingineligiblehealthfacilitiesin !C moreStates.*3՝݌"D(#(# Ќ   *,-./012(2xx*,-./012"*3"  *3J223  0    InFY2004,HRSAwillincrease #|E opportunitiesforindividualsfrom $hF disadvantagedbackgroundstopursue %TG nursingeducation.TheNursing &@H WorkforceDiversityProgramwill r', I implementthescholarshipauthority.*3Jw݌^(!J(#(# Ќ  "*3"  *3/223  0    Resources: ThebudgetrequestforFY J)"K 2004is$98million.Thisrequest :*"L reallocatesthebasefundingforAdvanced &+#M EducationNursing,NursingWorkforce ,$N DiversityandNurseEducation,Practice ,%O andTraining.Itwillalsoprovidean -&P(#(# increaseof$12millionforthe F NursingEducationLoanRepayment 2 Programandprovidefundsto   implementthenewnursingauthorities   establishedintheNurseReinvestment   Act.*3/\݌ 'O'O Ќ  ExternalFactors   t   Factorswhichwilleffectprogram L  performanceare:1)nursingworkforce ~8  shortage;2)agingworkforce;3)aging j$  population;4)publichealthrequirementsfor V  abioterrorismresponse(surgecapacity);and B  5)technologyandemerginghealthcare .  issues.        F (X@OO(    -%'  #K ;7l| 0^ `BdEb^ 2   (#(#                               (#(#  (X@(#(#( OO(#(# ProgramBackgroundandContext  `   ThemissionoftheMaternalandChild ~8  Health(_MCH_)BlockGrantprogram,as j$  authorizedunderTitleVoftheSocial V  SecurityAct,istoimprovethehealthofall B  mothers,childrenandtheirfamilies.Created .  asapartnershipwithStateTitleVprograms   whichhavebroadStatediscretion,the_MCH_  BlockGrantappropriatedformulagrantfunds  areusedforanumberofactivitiesincluding;  capacityandsystemsbuilding,public  informationandeducation,outreachand p programlinkage,supportfornewborn \ screening,leadpoisoningandinjury H prevention,supportservicesforchildrenwith z4 specialhealthcareneeds,andthepromotion f  ofhealthandsafetyinchildcaresettings. R   ProgramPerformancePlanning  *    TheFY2004HRSAPerformancePlan " containssevenperformancemeasuresforthe " _MCHBG_ԀProgram.Measureslistedbelow # reflectthebroadnatureoftheprograms $  impact: %l! Ѐ   &X"  *,-./012(yx*,-./012"*3"  *32H3  0    Decreasetheinfantmortalityrateto 'D # 6.8/1000.{HealthyPeople2010}*3$݌v(0!$OO Ќ   "*3"  *32H3  0    Reduceillnessandcomplicationdueto ^)"% pregnancyto26per100deliveries.*3?݌J*#&OO Ќ   "*3"  *322H3  0    Increaseto96percentthepercentof 2+#' newbornswithatleastonescreeningfor ,$( eachofPKU,hypothyroidism, -%) _galactosemia_,and_hemoglobinopathies_. -&* {HealthyPeople2010}*32_݌.'+OO Ќ  "*3"  *3%2H3  0    Increasematernalsurvivalto8maternal `+ deathsper100,000livebirths.*3%R݌H,(#(# Ќ   *,-./012(xy*,-./012vMeansandStrategies  v0 -   TheMaternalandChildHealthBureau N / employsvariousmeansandstrategiesto : 0 achieveprogramperformance: & 1  *,-./012(2xx*,-./012"*3"  *35223  0    SpecialProjectsofNationalSignificance 3 (_SPRANS_)andCommunityIntegrated 4 ServiceSystems(CISS)activitiesfund 5 grantsorcontractswhichhaveproduced |6 guidelinesfor,asexamples,childhealth h7 supervision,nutritioncareduring T8 pregnancy,andchildhoodinjury @9 prevention.*35b݌r,:(#(# Ќ  "*3"  *3223  0    InFY2003,specialTitleVfunded ^; improvementprojectswilladdresssuch J< topicsasadolescenthealth,SIDS,medical 6= homesandchildcarehealthandsafety. " > _SPRANS_ԀandCISScomplementandhelp !? ensurethesuccessofStateTitleV, !@ Medicaidand_SCHIP_Ԁprograms.*3ع݌"A(#(# Ќ  "*3"  *3223  0    Resources: ThebudgetrequestforFY #B 2004is$751million,$19millionmore $|C thantheFY2003Presidentsbudget %hD request.ThisrequestisforFederalfunds &TE totheStates,_SPRANS_,andCISS '@ F activities.*3I݌r(,!G(#(#    ^)"H OYC e        ExternalFactors     Otherfactorswhichmayimpactprogram i  performanceare:1)theeconomy;2)declining U  Staterevenues;3)maternalcharacteristics A  suchasrace/ethnicity,age,education,and -  smoking;4)thenumberofuninsured;and5)   advancesintechnology. t    (X@OO( #K ;7l| 0^ `BdE^     (#(#                                  (#(#   (@(#(#( (#(#ProgramBackgroundandContext  t   TheRyanWhiteComprehensiveAIDS L  ResourcesEmergency(CARE)Act 8  programs,authorizedbyTitleXXVIofthe $  PublicHealthServiceAct,fundsthe   provisionofHIVmedicalcareandrelated   servicesforlowincomeandmedically y  underservedpersons.Therearefourmajor e  TitlesoftheRyanWhiteCAREAct.TitleI, Q theHIVEmergencyReliefGrants(PartA), = providesfundingtoeligiblemetropolitan ) areasdisproportionatelyimpactedbythe  HIVepidemicfortheprovisionof p ambulatoryoutpatienthealthandsupport \ services.TitleII,HIVCAREActGrantsto H States(PartB),providesformulagrantsfor 4 thepurposeofprovidinghealthcareand   supportservicesforpeoplelivingwithHIV   disease.AseparateearmarkunderPartB  providesfundingforHIV/AIDStherapies u  throughtheAIDSDrugAssistanceProgram a! (_ADAP_).TitleIIIfundsprogramsthat M" provideearlyinterventionservices.TitleIV 9# fundsHIVPediatricGrants.TheCAREAct %$ alsoprovidesfundingforAIDSEducation %  TrainingandDentalReimbursement. %l!  ProgramPerformancePlanning  'D #   TheFY2004HRSAPerformancePlan )"% has16FY2004performancemeasuresfor *#& alltheCAREActprogramsnotedabove. +#' ThefollowingexamplesreflectHRSAs q,$( commitmenttoenhancedprogram ]-%) performance:   I.&* Ї *,-./012(yx*,-./012"*3"  *32H3  0    PartAServeaproportionofwomen t* andracial/ethnicminoritiesinTitleI `+ fundedprogramsthatexceedstheir H, representationinnationalAIDS 0 - prevalencedata,asreportedbytheCDC,  . byaminimumoffivepercentagepoints.*3݌ /G"G" Ќ  sp?/+b|" _( `.J!@Ey_( _( V. !s y 0  "*3"  *3<2H3  0    ForPartB,increaseby4%thenumber 1 of_ADAP_ԀclientsreceivingHIV/AIDS 2 medicationsthroughState_ADAPs_Ԁduring t3 atleastonemonthoftheyear.*3<i݌\ 4G"G" Ќ  "*3"  *32H3  0    Increaseby2%annuallythenumberof D!5 personswholearntheir_serostatus_Ԁfrom ,"6 RyanWhiteCareActprograms.*30݌#7G"G" Ќ  "*3"  *3l2H3  0    ReducedeathsduetoHIVinfection #k8 below3.6per100,000peopleby2010.*3l݌$S9G"G" Ќ   *,-./012(xy*,-./012,  MeansandStrategies  &';   Thefollowingtoolsandstrategiesare ( = employedtowardtheachievementof |)!> improvedprogramperformance: h*"?  *,-./012(2xx*,-./012"*3"  *3223  0    Ensureresourcesandservicesareprovided @,$A tolowincomeandmedicallyunderserved ,-%B personsinminoritycommunities.*3݌ .&CG"G" Ќ   *,-./012(2xx*,-./012"*3"  *3T223  0    RequirecoordinationbetweenCARE  Actgranteesinthedevelopmentofa } StatewideCoordinatedStatementof i  Need.*3T݌U  Ќ  "*3"  *3223  0    By2001,State_ADAPs_Ԁparticipatingin A  theSection340DrugDiscountProgram -  increasedto50increasingcostrecovery   savingstoaprojected$65.5million.*3݌t Ќ   *,-./012(2xx*,-./012"*3"  *3223  0    Resources: ThebudgetrequestforFY ` 2004is$2,010million,anincreaseof P  approximately$100millionovertheFY <  2003PresidentsBudget.Thisincrease (  isforPartBandisdesignatedforState   AIDSDrugAssistanceprograms.*3݌  Ќ  ExternalFactors  i    TheperformanceoftheRyanWhite A CareActprogramsmaybehelpedor - hinderedbyvariousfactorsincluding:1)  advancesintherapeutics;2)rateofgrowth t oftheepidemic;3)Stateandlocal ` commitmentsandresources;4)insurance L coverage;and5)costofcare,support 8 servicesandanti_retroviral_Ԁdrugtherapy. $   (@(    #K ;7l|^ `BdE;^)" (#(#       (#(#(X@(#(#( ProgramBackgroundandContext  `   TheNationalHealthServiceCorps 8  (NHSC)programassistshealthprofessional $  shortageareastomeettheirprimary,oral,and   mentalhealthserviceneeds.Overits30year   history,theNHSChasofferedrecruitment y  incentivessuchasscholarshipsandloan e  repaymentsupporttomorethan22,000health Q professionalscommittedtoservingthe = underserved.Forexample,NHSCprovidesa ) culturallycompetentworkforceforFederally  fundedHealthCentersandothersiteswhich p finditdifficulttorecruitclinicians.Over50 \ percentoftheNHSCfieldstrengthservein H HealthCenters. 4  ProgramPerformancePlanning      Thefollowingperformancemeasure u  demonstratestheprogramseffectivenessin a! reachingtheunderserved: M"    '    *,-./012(yx*,-./012"*3"  *3:2H3  0    Maintainat80percentthepercentof %$ NHSCcliniciansretainedinserviceto %  theunderserved.*3:g݌%h!OO Ќ   *,-./012(xy*,-./012  MeansandStrategies '< #   *,-./012(2xx*,-./012"*3"  *3223  0    TheNHSCwillemploythefollowing )"% toolstoforwardtheirretentiongoal:*3݌*#&OO Ќ  ݀"*3"  *3223  0    TheNHSCAnnualRetentionReportand i,$(  theprogramevaluationconductedin2000U-%)OO demonstratethattherateofretentionin `) servicetotheunderservedisincreasing.*3݌L*(#(#   "*3"  *3223  0    Tocontinuecarefulmonitoringofthis 8 + trend,NHSCplanstomeasureretentionat $ , oneyearafterserviceobligationends,and  - tofollowcohortsofcliniciansovertheir  . workinglivestoassessretentionatlonger y / intervals.*3݌e 0(#(# Ќ  "*3"  *3223  0    InFY2004,theNHSCwillincrease Q1 scholarshipawardsandloanrepayments.*3݌=2(#(# Ќ   *,-./012(2xx*,-./012"*3"  *3"223  0    Resources: ThebudgetrequestforFY 4 2004is$213million,anincreaseof t5 approximately$23millionovertheFY `6 2003Presidentsbudget.Theincrease L7 willsupporttheadditionalscholarships 88 andloanrepaymentsbetterenabling $9 NHSCtosupporttheneedofgrant : supportedHealthCenterstorecruit ; additionalprimarycarephysiciansinline y < withthePresidentsInitiativetoincrease e!= HealthCenteraccesspointsby1,200in Q"> fiveyears.*3"O݌=#?(#(# Ќ  ExternalFactors %A   Factorsimpactingprogramperformance &\C are:1)healthcareworkforcepipelineissues; 'H D 2)theabilityofcommunitiestoattract (4!E providers;and3)theeconomy. ) "F   +#H 1[ X`OO10  0'**V#FBn \72 8; `@Xdddd@E'};ttSL_ #}'*'* ,----#M$=9l|2 ` dE2 bj p d$ jj**3,X,` XXX3   **jj  HHSiscommittedtostrengtheningthe z  baseofqualifiedhealthandbehavioral f  scienceresearcherstoadvancethe R  understandingofbasicbiomedicaland >  behavioralscience,whereby,NIH,the *  worldslargestandmostdistinguished  organizationdedicatedtomaintainingand q improvinghealththroughmedicalscience,is ] leadingtheeffortstomeettheseobjectivesas I wellasadvancingtheunderstandingofbasic 5 biomedicalandbehavioralscience. !   HHSisalsocommittedtoacceleratingthe   privatesectordevelopmentofnewdrugs,  biologictherapies,andmedicaltechnology. v TheFDAsCenterforDrugEvaluationand b Research(_CDER_)meetstheirmissionby N thoroughlyreviewingallnewdrug :  applications,_generics_Ԁapplications,overthe &! counterlabelingandassuringtheavailability " ofdrugstotreatvictimsofapotential "m bioterrorismorterroristattack. #Y   TheMedicalDevicesandRadiological $E HealthProgramisresponsibleforensuring %1 thesafetyandeffectivenessofmedical &  devicesandeliminatingunnecessaryhuman ' ! exposuretomanmaderadiation,ofwhich, ( " premarketreviewisamajorprogram r)!# component.Themedicaldeviceindustryis ^*"$ growingrapidlyanddevicessubmittedfor J+#% reviewarebecomingincreasinglycomplex. 6,$&  .}&( Ї 78787"7" 78787878 78787878 78787878 78787878 78787878 78787878 78787878 7"7"7878theseprogramshaveannualperformance $ 3 measureswhichspeaktoenhancingthe  4 capacityandproductivityoftheNations  5 ResearchEnterprise.Theseprograms y 6 representHHScontinuedeffortstoseek e 7 enhancementinHealthScienceResearch. Q8    p      p       ""J" ]-%Q ([ @**(  ЌXX>#`ЌЌ1#Ќ`Ќ    *:d d\RF\RF\R:(#(#,\R,d\R,\R+  <VVV#'   <#X>XЌ# HHSStrategicGoal AVVV#,!# "VVV# A#`X>XXX>#X>XX`X>Agencies/ #  Programs  ~  AVVVV#,! j"VVV# AFY2004PerformanceMeasures#`X>XXX># TVVC,# " VVVV# TGOAL4:` X`X>Enhancethe  L  Capacityand  J  Productivityofthe H  NationsHealth F  ScienceResearch D  Enterprise.#`X>X` '# B  X>XX`X> NVV=2@ " VV NЌXX>#`ЌЌD# NIH  ` #`X>X`Ќ#X>XX`X> ?VVV,! $"VV ?#`X>XXX>4#X>XX`X>ЌXX>ddBy2007,determinethegenomesequenceofanadditional45  ` humanpathogensandthreeinvertebratevectorsofinfectious  $ diseases.*#X>XЌ#ЌXX>#`ЌЌ#Ќ`Ќ y  #X>XЌ#ЌXX>#`ЌЌ#    `X>X`Ќ`X>XX`X>  #`X>XX`X>g#`ЌX`X>    Ќ`ЌԄBy2005,developagenomewide_haplotype_Ԁmapbyidentifying = the_haplotype_Ԁblocksandthecommon_haplotypes_Ԁinthehuman p _genome.*#`ЌЌ#Ќ`Ќ#X>XЌ@#ЌXX>k݌ 4 Ќ    ЌЌ  #`ЌЌ#Ќ`Ќ By2005,developtwonewanimalmodelsforatleastoneagent  of_bioterror_.*#`ЌЌ #Ќ`Ќ#X>XЌ+ #ЌXX>Ԁ#`ЌЌ #Ќ`Ќ M  ЄBy2010,developoneuniversalantibioticeffectiveagainst   multipleclassesofbiologicalpathogens.*d#`ЌЌ, #Ќ`Ќ#X>XЌ #ЌXX> D  #`ЌЌ # #`X>X`ЌG #d`ЌX`X>Ќ`ЌdIncreaseawarenessofNIHsponsoredresearchresultsamong   thegeneralpublic.*d ]  ЄIncreasethepoolofclinicianresearchers#`ЌЌ ##`X>X`Ќ #X>XX`X>ԀЌXX>trainedtoconduct !  patientorientedresearch.*#X>XЌ$##`X>XXX>#X>XX`X> OVV>' | VVV O#`X>XXX>#X>XX`X> 7VV&JVV 7ЌXX>#`ЌЌ\#FDA J  HumanDrugs ?VVV,!!"VV ?ЄReviewandacton90%ofstandardNewDrugApplications J" within10monthsand90%ofpriority_NDAs_Ԁwithin6months # [FY00:reviewed79%of92Std._NDAs_Ԁ(target50%);reviewed c$ 100%of10priority_NDAs_Ԁ(target90%)]. '% ЄReviewandactupon90percentof_fileable_Ԁoriginalgeneric Z& drugapplicationswithin6monthsaftersubmissiondate[FY01: ' reviewed84%of298applications(target50%)]. s( ЄIncreasethenumberofdrugsthatareadequatelylabeledfor 7) children.* j* ЄActon90percentof_Rx_ԀtoOTCswitchapplicationswithin10 .+ months.* OVV>', VVV O 7VV&Q,VV 7#`X>X`Ќ#`ЌX`X>FDA Q- Medical  . Devices ?VVV,! H/"VV ?#`X>X`Ќ~#X>XX`X>ԄЌXX>Reviewandcomplete90percentofPremarketApproval Q0 Application(_PMA_)firstactionswithin180days[FY = 1 01:Reviewed97%of70_PMAs_Ԁ(target90%)]. !p2 ЄReviewandcomplete90percentof_PMA_Ԁsupplementfinal !43 actionswithin180days[FY01:Reviewed98.4%of641(target "4 90%)]. M#5 ЄComplete95percentof_PMA_Ԁ Determinationmeetingswithin $6 30days[FY01:100%of3(target95%)].#X>XЌ[#7-+$D7  VVV 7ЌXX>*Seeagencyperformanceplan/reportforadditionalinformation. %7        `     h      p      x  +'9 Ї#X>XЌ]# (X@(#(#( #K;7l|5k `BdEk:%         ProgramBackgroundandContext  `   Foundedin1887,theNationalInstitutes 8  ofHealth(NIH)istheFederalfocalpointfor $  medicalresearchintheUnitedSates.NIH   fundsresearchondiseasesandconditions   rangingfromtherarestgeneticdisorderto y  thecommoncold.NIHsupportsresearchof e  nonFederalscientistsinuniversities, Q medicalcenters,hospitals,andresearch = institutionsthroughoutthecountryand ) abroad;conductsresearchinitsown  laboratories;helpstotrainresearch p investigators;andfosterscommunicationof \ medicalinformationtothepublic,health H careproviders,andthescientific 4 community.    ProgramPerformancePlanning     NIHinveststhepublicsresourcesand a! supportformedicalscienceinthreebasic M" andinterrelatedways.Firstandforemost, 9# NIHconductsandsupportsmedical %$ research.Second,itcontributestothe %  developmentandtrainingofthepoolof %l! scientifictalent.Third,itparticipatesinthe &X" support,construction,andmaintenanceof 'D # thelaboratoryfacilitiesnecessaryfor (0!$ conductingcuttingedgeresearch.ForFY )"% 2004,NIHhas35goals.Ofthosegoals,24 *#& areassociatedwiththeresearchprogram. +#' Theresearchoutcomessectionofthat q,$( programhas11goals.Thefollowing ]-%) measuresillustratethekeyprogrammatic I.&*  78787G"7G" 78787878 78787878 78787878 78787878 78787878 78787878 78787878 7G"7G"7878missionandactivities: `2      *,-./012(2xx*,-./012"*3"  * ,X,` X* *3$223  0 W   ݀By2007,determinethegenome 8 4 sequenceofanadditional45human  5 pathogensandthreeinvertebrate  6 vectorsofinfectiousdiseases.#`X>XXX>:#X>XX`X>*3$%݌ 7WG"WG" Ќ  "*3"  *3&223  0 W   By 2005,developagenomewide i 8 _haplotype_Ԁmapbyidentifyingthe U 9 _haplotype_Ԁblocksandthecommon =: _haplotypes_Ԁinthehumangenome.*3&&݌%;WG"WG" Ќ  "*3"  *3u(223  0 W   #`X>XXX><&#X>XX`X>By2005,developtwonewanimal  |< modelsforatleastoneagentof d= _bioterror_.*3u((݌L>WG"WG" Ќ  "*3"  *3*223  0 W   #`X>XXX> )#X>XX`X>By2010,developoneuniversal 4? antibioticeffectiveagainstmultiple @ classesofbiologicalpathogens.d*3*-*݌AWG"WG" Ќ  #`X>XXX>̖*#d X>XX`X>"*3"  *3+223  0 W   IncreaseawarenessofNIHsponsored }B researchresultsamongthegeneral iC public.*3+,݌QDWG"WG" Ќ   "*3"  *3-223  0 W   Increasethepoolofclinician 9 E researcherstrainedtoconductpatient %!F orientedresearch.*3-?-݌ "|GWG"WG" Ќ  #`X>XXX≯+#X>XX`X>  MeansandStrategies  #PI   Thefollowingmeansandstrategies %(K illustratehowNIHcontinuestostrive &L towardachievingitsperformancemeasures: ' M "*3"   D,*3/223  0 c   _Genomic_Ԁresearch: NIHs_genomic_ i)!O researchfocusesonthehumangenome, Y*"P the_genomes_Ԁofanimalmodels,and E+#Q pathogen_genomes_.Twospecific 1,$R  _genomic_Ԁresearchgoalsare:*3//݌ -%ScG"cG" Ќ  ! ! *,-./012(xx*,-./012",;"  ,;20  23  0'  Utilizingthesequenceofthehuman   genome,NIHisgeneratingamapof } patternsofgeneticvariationacross i  populations,a _haplotype_map.,;22݌U '' Ќ  ",;"  ,;y40  23  0'  Initiatingsequencingofthe_genomes_ A  ofadditionalpathogens#`X>XXX>r.#X>XX`X>,tocontinue -  generatingsequenceinformation,   whichcanbeexploitedinmanyways t fordrugandvaccinediscoveryand ` development.,;y44݌L '' Ќ   *,-./012(2xx*,-./01272 *,-./012(2xx*,-./012"*3"    #`X>XXX>̓5#X>XX`X>*37223  0    Biodefenseresearch :NIHhasadetailed 8  strategicplanforbiodefenseresearch. (  TwoofNIHsgoalsinthisarenaareas   follows:*37H8݌  Ќ   *,-./012(xx*,-./012",;"    #`X>XXX>)8#X>XX`X>,;:0  23  0'  Animalmodelswillbecriticalto }  FDAapprovalofbiodefense i  therapiesandvaccines,since,inmost U cases,clinicaltrialsinhumanstotest A efficacyarenotpossibleorethical. - Developmentofpromisingcandidate  therapiesandvaccinesisbeing t delayedbecauseofthelackof ` standardizedanimalmodelsinwhich L toevaluatethesecandidates.New 8 modelsneedtobedeveloped, $ particularlyfornonhumanprimates.,;::݌'' Ќ  ",;"  ,;=0  23  0'  Microbesthatwereonceeasily  controlledbyantimicrobialdrugsare y  causinginfectionsthatnolonger e! respondtotreatmentwiththese Q" drugs.Inaddition,new,frightening, =# andunforeseeninfectiousdisease )$ threatshaveemerged,including %  threatsposedbyagentsof &p! bioterrorism.A universal &\" antibiotic,adrugeffectiveagainsta 'H # widespectrumofinfectiousdiseases, (4!$ wouldhelpaddressthesechallenges.,;==݌) "%'' Ќ   *,-./012(2xx*,-./0129#`X>XXX>u:#X>XX`X>  *,-./012(2xx*,-./012"*3"  *3@B223  0    AwarenessofNIHResearchResults:  u,$( NIHisfocusingon:1)enhancingNIH e-%) operationstoimprovetheQ.&* communicationofresearchresults;2) * strengtheningcollaborationswithother }+ organizationsinvolvedinhealth i , communications;3)developingand U - implementingcommunication A . campaignsonspecifichealthissues;and - / 4)increasingthepublicsawarenessof  0 specifichealthissuesandtheroleof t1 NIH.*3@BmB݌`2cG"cG" Ќ  "*3"  *3oE223  0 c   Toimprovethecommunicationof L3 researchresults,NIHisenhancingthe 8 4 onlinehealthinformationresource, $ 5 _MEDLINEplus_;partneringwith  6 providersandvolunteerstoextendthe  7 impactoftheKnowStroke:Knowthe y 8 Signs.ActinTime.campaign;using e 9 mediaapproachestocommunicatethe Q: importanceofeatingfivefruitsand =; vegetablesaday;collaboratingtofoster )< implementationofcholesterolclinical = practiceguidelines;implementing p> campaignsregardingidentificationand \? treatmentofhearingloss;and H@ disseminatingresourcestoassisthearing 4A professionalsinfollowinguponearly  B identificationofhearingloss.*3oEE݌ CcG"cG" Ќ  "*3"  *3I223  0 c   ClinicianResearchers: NIHestablished D andcontinuestosupportthreenew y E careerdevelopmentmechanisms e!F designedtoencouragepatientoriented Q"G research.Theawardcurriculum =#H development,protectedtimefor )$I clinicianstopursueresearchandmentor %J beginningclinicalinvestigators,and &pK supervisedstudyandresearchfor &\L clinicallytrainedprofessionalswiththe 'H M potentialforproductiveclinicalresearch (4!N careers.NIHexpectsthattheactivities ) "O stimulatedbytheawardswillhelpto * #P increasethenumberofclinicianstrained +#Q toconducthighquality,patientoriented u,$R clinicalresearch.*3I!J݌a-%ScG"cG" Ќ   M.&T "*3"  *3BN223  0    Resources: ThebudgetrequestforFY  2004is$27,893million.Medical  innovationisoneoftheprincipal m  foundationsonwhichAmericaspast Y  successesinimprovinghealthand E  healthcarehavebeenbuilt.The 1  investmentinNIHresearchbothbasic   andclinicalinvestigationshaveledto  x newunderstandingsaboutthemost d intricatebiologicalandbehavioral P  processesoflife.NIHwillcontinueto <  supportresearchtoexpandfundamental (  knowledgeaboutthenatureandbehavior   oflivingsystemswiththegoalsof   improvingexisting,anddevelopingnew, }  strategiesforthediagnosis,treatment, i  andpreventionofdisease;andreducing U theburdensofdiseaseanddisability. A TheincreaseintheNIHbudgetwillalso - supportpublichealthconcernssuchas  biodefense,healthdisparities,andthe t specialneedsofvulnerablepopulations.*3BNoN݌` Ќ  ExternalFactors  8   Morethan$8outofevery$10  appropriatedtoNIHflowouttothe  scientificcommunityatlarge.This y   extramuralsystemispremisedon e! independence,embodiedin investigator Q" initiatedresearch;onselfgovernance, =# embodiedinpeerreviewofscientistsby )$ scientistsastheprimarybasisforjudging %  themeritsofresearchproposalsand &p! awardingfunds;andonthepowerful &\" incentiveofcompetitionamongthemost 'H # highlytrainedscientistsintheworld.Thus, (4!$ themajorityofresearchfundedbytheNIH ) "% isconductedbyinvestigatorslocatedat * #& universities,hospitals,andotherresearch +#' facilitiesexternaltotheNIH.Thisexternal u,$( factormeansthatachievementofNIHs a-%) researchoutcomegoalsishighlydependent M.&* ontheactionsofindividualsandinstitutions * outsideoftheNIH.  }+ (X@(OY     (#(#                               (#(#     #K;7l| 0^ `BdE^ }& '  S        / (X@(#(#( *,-./012(yx*,-./012 ProgramBackgroundandContext  L    Inmeetingtheirmissionto promote $  publichealthbyassuringthatsafeand   effectivedrugsareavailabletotheAmerican   people,_CDER_Ԁthoroughlyreviewsallnew y  drugandgenericdrugapplications;works e  ondevelopingOvertheCounter(OTC) Q medicationlabelingandincreasingtherange = ofOTCmedicationavailableonthemarket; ) increasestheavailabilityofdrugsadequately  labeledforchildren;andwiththeSeptember p 11terroristattack,assurestheavailabilityof \ drugstotreatvictimsofabioterrorismor H terroristattack._CDER_Ԁwithmajorreforms 4 suchasthePrescriptionDrugUserFeeAct   (_PDUFA_)hassignificantlyshortenedreview   timeswithoutcompromisingpatientsafety.  Under_PDUFA_,FDAhasapprovedover30 u  newmedicinesforCancer,37medicinesfor a! AIDSamongothers.Theyhavealso M" increasedtherangeofgenericdrugsonthe 9# market,whichsavestheAmericanpublic %$ andgovernment$8to$10billioneachyear %  accordingtotheCongressionalBudget %l! Office.InFY2001,FDAapprovedthe &X" genericforProzacand_Pepcid_.Theywill 'D # continuetomakeimprovementsinboth (0!$ genericandnewdrugreviewsinFY2004. )"%  ProgramPerformancePlanning  q,$(   ]-%)  c Thisprogramhaseightperformance L)  measuresgearedtowardsarangeofpre 8 * marketdrugreviewactivities.The $ + followingmeasuresillustratehownew  , _PDUFA_ԀIIIlegislationwillimprovereview  - timesandstreamlinereviewprocessand y . howFDAcontinuestoincreasetherangeof e / genericandOTCmedicationsavailableas Q0 wellasimprovingthesafetyand =1 effectivenessofmedicationforchildren. )2  c    *,-./012(2xy*,-./012+[ *,-./012(xx*,-./012 "*3"  *3*g2H3  0 c   Meet_PDUFA_ԀIIIcommitmentsforthe p4 reviewoforiginalNewDrug \5 Applications(_NDAs_).*3*gWg݌D6cG"cG" Ќ  sp?/+b|2Vv `.[@E7Vv Vv Z 's 8 "*3"  *3*i2H3  0 c   Reviewandactupon90percentof ( 9 _fileable_Ԁoriginalgenericdrug )u!: applicationswithin6monthsafter )]"; submissiondate.*3*iWi݌*E#<cG"cG" Ќ  "*3"  *3j2H3  0 c   Increasethenumberofdrugsthatare +-$= adequatelylabeledforchildren.*3jj݌,%>cG"cG" Ќ  "*3"  *3k2H3  0 c   Acton90percentof_Rx_ԀtoOTCswitch -&? applicationswithin10months.*3kk݌ ~.&@cG"cG" Ќ    MeansandStrategies  } 3 ,X,` XDpXD,3  Thefollowingmeansandstrategies U  illustratehow_CDER_Ԁstrivestowards A  increasingtheavailabilityofsafeand -  effectivedrugs:   ! ! *,-./012(2xx*,-./012"*3"  *3o223  0    NewDrugApplicationReviews: Under ` _PDUFA_Ԁandreauthorized,_PDUFA_ԀII P  andIII,FDAwillcontinuetocollectuser <  feeswhichprovideadditionalresources (  tohiremoremedicalandscientific   reviewers,supportstaffandfield   investigatorstospeeduptheapplication }  process,aswellastobuildaneededIT i  infrastructure. InFY2004,FDAwill U collectincreaseduserfeesunder_PDUFA_ A IIItohelpaddressfinancialchallenges - experiencedin_PDUFA_ԀII.Theamount  ofuserfeescollectedinthelastyearsof t _PDUFA_ԀIIweresubstantiallylessthan ` thecostofperformingreviewactivities. L FDAwillestablishafeestructureto 8 addressthisshortfall.*3oJo݌$ Ќ  ! ! *,-./012(2xx*,-./012"*3"  *3t223  0     InformationTechnology  Enhancements: _PDUFA_ԀIIIalsocalled  foranumberofITenhancements.FDA y  hasdevelopedanewperformancegoal e! forFY2004aimedatincreasingthe Q" numberofelectronicsubmissionofdrug =# applicationswhichhelpsimprovepre )$ marketreviewefficiency.*3tu݌%  Ќ   *,-./012(2xx*,-./012"*3"  *3w223  0    GenericDrugs: FDAcontinuestorefine &p! thereviewprocesstodecreasereview &`" timessuchasincreasingtheamountof 'L # electronicsubmissions.#`X>XXX>̘A#ԀAproposed (8!$ increaseinFY2004willgotowards )$"% improvingreviewtimesbyhiring *#& additionalreviewersandinspectorsto +#' increaseinspectionsofdomesticand y,$( foreignfirmsassociatedwithgeneric e-%) drugproduction.MoneywillalsofundQ.&* researchon_bioequivalence_Ԁmethods& * standards,whichwillevaluatewaysto }+ enableapprovalofgenericdrugsinareas i , thatcurrentlylackgenericalternatives, U - suchas_inhalational_Ԁortopicaldrug A . products.Thisproposedincreasewill - / alsosupportITenhancementand  0 increasecoverageofimportedgeneric t1 drugstobettermonitorthequalityof `2 finisheddrugproductsandbulkdrug L3 substancesfromoverseaswillalsohelp 8 4 FDAachievetheirpremarketreview $ 5 goal.*3wx݌ 6cG"cG" Ќ  "*3"  *3~223  0 c   PharmaceuticalsforChildren: FDA  7 continuestoencouragepharmaceutical } 8 companiestoconductpediatricdrug i 9 studiesthroughwrittenrequestsby U: grantingsixmonthexclusivity.These A; studieshaveuncoveredcrucialdosing -< andsafetyinformationtohelp = Pediatriciansandother_prescribers_Ԁtreat t> children.The2002Best `? PharmaceuticalsforChildrenAct L@ (_BPCA_)renewsthisauthorityandallows 8A forthecollectionofuserfeesfor $B reviewingpediatricsupplements.FDA C willalsopartnerwithNIHtoupdatea D PriorityListofdrugs.AproposedFY y E 2004increasewillsupportthe e!F implementationof_BPCA_Ԁthroughhiring Q"G 36additional_FTEs_.Theincreasewill =#H supporttheirFY2004targetbyissuing )$I writtenrequestsforstudies,reviewing %J studies,makingnecessarylabeling &pK changeswithinthe6monthtimeframe, &\L enhancingsurveillanceofadverseevents 'H M inchildren,andcoordinatingthe (4!N developmentofoffpatentdrugswith ) "O NIH.FDAwillpartnerwithNIHin * #P increasingthenumberofpediatric +#Q studies.*3~=~݌u,$RcG"cG" Ќ  "*3"  *3M223  0 c   OvertheCounterMedication: FDAhas a-%S devotedextensiveresourcestohaving Q.&TcG"cG" safeandeffectiveOTCdrugproductsin  theUS.FDAwillcontinuetowork } towardstheirgoalofincreasingthe i  rangeofOTCmedicationavailableto U  Americanconsumersbyconsideringkey A  foreigndrugsandkeypotential -   prescription(_Rx_)toOTCswitches.   Withaproposedincrease,FDAwill t devoteresourcestowardsincreasingthe ` staffdedicatedtoOTCreviewandto L  updatingexistingmonographsinorderto 8  achieveFY2004targetsofactingon90 $  percentof_Rx_ԄtoOTCapplications   within10monthsandcompleting10   monographs( recipesformarketing y  OTCdrugproductswithouttheneedfor e  FDApreclearance).*3Mz݌Q Ќ  ExternalFactors  ) 9,X ,X,` XDpX9  Reviewtimesarecontingentonthe p qualityandcomplexityofthesponsors \ application.FDAhelpstoimprovenew H drugsapplicationsthroughindustrysponsor 4 conferencesandothersupportactivities   fundedbyUserfees.   & I.&* Ї U - (X@(   '       #K;7l| 0^ `BdE^ }(   (#(#                               (#(#   (X@(#(#( (#(#ProgramBackgroundandContext  `   TheMedicalDevicesandRadiological 8  HealthProgramisresponsibleforensuring $  thesafetyandeffectivenessofmedical   devicesandeliminatingunnecessaryhuman   exposuretomanmaderadiationfrom y  medical,occupational,andconsumer e  products.Ofwhich,premarketreviewisa Q majorprogramcomponent.Medicaldevice = manufacturersmustseekFDAclearanceor ) approvaloftheirproductstoensurethat  marketeddevicesmeettoughsafety p regulations.Themedicaldeviceindustryis \ rapidlygrowinganddevicessubmittedfor H reviewarebecomingincreasinglycomplex. 4 SomeofthedevicesapprovedinFY2001   includethefirstAutomatedExternal   _Defibrillator_Ԁ(_AED_)forchildren,implants  forthetreatmentofextremeobesity,andthe u  firstglucosemonitoringdevicethatdoesnt a! puncturetheskin.Theprogramplansto M" improvereviewtimesinFY2004through 9# streamliningthereviewprocessandother %$ strategies. %   ProgramPerformancePlanning  &X"   TheCenterforDevicesandRadiological (0!$ Health(_CDRH_)atFDAhasseven )"% performancemeasuresgearedtowardspre *#& marketreview.Thefollowingmeasures +#' illustratekeystatutoryreviewactivities: q,$(       ]-%)  *,-./012(yx*,-./012"*3"  *3ږ2H3  0 c   Reviewandcomplete90percentofPre `)   marketApprovalApplication(_PMA_) L* firstactionswithin180days.*3ږ݌4 +cG"cG" Ќ   "*3"  *3_2H3  0 c   Reviewandcomplete90percentof  , _PMA_Ԁsupplementfinalactionswithin  - 180days.*3_݌ .cG"cG" Ќ   "*3"  *32H3  0 c   Complete95percentof_PMA_ i /  Determinationmeetingswithin30 U 0 days.*3݌=1cG"cG" Ќ   *,-./012(xy*,-./012Y  MeansandStrategies  3  c Thefollowingmeansandstrategies X5 illustratehow_CDRH_Ԁcontinuallystrives D6 towardsimprovingthereviewprocesswhile 07 maintainingtoughsafetystandards: 8  *,-./012(2xx*,-./012"*3"  *3n223  0 c   _PMAs_ԀFirstActions: _PMAs_Ԁareoften : highriskdevices,whichcan u; significantlyimprovepatienttreatment. a < InFY2004,theywillcontinueto M!= redirectresourcestothereviewofhigher 9"> riskdevices.FDAwillalsocontinueto %#? expeditethereviewprocessthroughre $@ engineering,byholdingearlymeetings $lA withmanufacturers,modularreviewetc. %XB Thisgoalisgearedtowardsthefirst &DC cycleofthereviewprocessas_PMA_ '0 D reviewgenerallyrequiresmultiple (!E cycles.*3n݌)"FcG"cG" Ќ   *,-./012(2xx*,-./012"*3"  *3š223  0 c   _PMA_ԀSupplementFinalActions:  *"G Thesesupplementsaregenerallyadded u+#H featurestoalreadyapproveddevicesor a,$I technologychanges.FDAcontinuesto M-%J offermanufacturerstheoptionof real 9.&KcG"cG" OYP    timereviews,whichareconductedvia  teleconferenceorfacetofaceandenable } manufacturerstodiscussallFDAreview i  issuesatonetime.*3š݌U  Ќ   *,-./012(2xx*,-./012"*3"  *3^223  0    ReviewProcessImprovements: FDA A  willdrasticallyimprovereviewtimes 1  overafiveyearperiodbyincreasing   timeforreviewertraining;updating  x guidancetoindustry;enhancingIT;more d preapprovalinspections;andincreased P  collaborationwithindustrytoimprove <  theapplicationprocess.Withsuch (  fundinginplace,FDAwilladopt   additionalperformancegoalswhich   speaktototaldecisiontime!thetotal }  timespentbyFDAinreviewingdevices. i  *3^݌  Ќ  ExternalFactors  A   Asin_CDER_,reviewtimesare  contingentonhowcompletedevice t applicationsareaswellthelevelofdevice ` complexity.Proposed_MTEA_Ԁlegislation L callsforincreasedcoordinationwith 8 industry,whichwillultimatelyserveto $ improvethequalityofapplications.     '     /    y  @??:?  (X@( Q"   ) "#    P)@<l \'" Ip `@XddddEIpttaL)    ,----#M=9l|ztQ ` dE. tQf * ff(#(# ffff ffff ffff ffff ffff ffff (#(#ff(X@(#(#(0,X,` X,X0  Thisgoalaimstoimprovethequalityof `  healthcareservicesbyreducingmedical L  errors,improvingconsumerandpatient 8  protection,andacceleratingthedevelopment $  anduseofelectronichealthinformation.Our   FY2004budgetincludesrequeststoreach k thisgoal.Theprogramsdiscussedinthis W sectionillustrateHHSscommitmentto C healthcareresearch;upholdinghealth,safety / andqualitystandardsininstitutionsthatserve  MedicareandMedicaidbeneficiaries;and  modernizingelectronichealthinformationfor  theultimateoutcomeofimprovingpatient p safetyandhealthcarequality.TheAgency \ forHealthCareResearchandQuality H (AHRQ)continuestobeattheforefrontof 4 healthcarequalityresearchinpromoting   improvementsinclinicalhealthsystemsand  !{ practices.AHRQspatientsafetyrequestof !g $84millionincludes$38millioninnew "S activitieswillfocusonenhancingtheroleof #? informationtechnologyinhospitalsby $+ incorporatinginteroperableclinicaland % messagestandardswhichwillhelpto &  modernizeourelectronicinfrastructure.Of '! thisamount,$26millionwillbesetasidefor l( " patientsafetyandqualityITactivitiesinsmall X)!# communityand_rual_Ԁhospitals.IndianHealth D*"$ Service(IHS)continuestoenhancetheirIT 0+#% systemanduseofelectronicpatient ,$& information,whichenablesIHStoprovide -w%' qualityhealthcaretoindividualpatients,as -c&( wellastrackpopulationhealthstatistics. ` ( CMScontinuestofocustheireffortson L ) improvingthequalityofcareofCMS 8 * beneficiariesinnursinghomes.FDA,witha $ + proposed$4millionincrease,willenhance  , adverseeventsurveillanceandinhouse k- medicalerrortrackingsystems.Finally,CDC W. willcontinuetobuildtheiremergency C/ preparednessthroughthePublicHealth /0 InformationNetwork.Theseprograms, 1 amongothers,illustrateHHScommitmentto 2 improvinghealthcarequality. 3  ,$E (X@OO(  *dd\Rd\Rd\R:(#(#,\R,d\R,\R+  <VVV#'}} < HHSStrategicGoal AVVV#,!"VVV# AX>XX`X>Agencies/  Programs s   AVVVV#,!_ "VVV# AFY2004PerformanceMeasures#`X>XXX>#X>XX`X> TVVC," VVVV# T#`X>XXX>#X>XX`X>&'%XX>GOAL5:Improvethe t  QualityofHealthCare L  Services $  #X>X%&'##`X>XXX>|#X>XX`X>ЌXX> NVV=2 " WWVV N#`ЌЌs#Ќ`Ќ#X>XЌ#ЌXX> AHRQ#X>XЌg#ЌXX>#`ЌЌ%#Ќ`Ќ U  Researchon   HealthCare  L Qualityand   Outcomes ?VVV,!e"VV ? >*,-./012(xx*,-./012  Decreasebyfivepercentthehospitalizationratesforpediatric U  Asthma.[BaselinewillbeestablishedinFY2003.]   ЄProducea_CAHPS_Ԁmoduleforconsumerassessmentsof  L hospitalquality.*#X>XЌ#ЌXX>#`ЌЌ#Ќ`Ќ   ЄFivetechnologiescurrentlyshowntobeeffectiveinother e clinicalsettingswillbetestedinnursinghomestoevaluatethe ) impactonsafety,quality,andcostofcare.* #`ЌЌ##`X>X`Ќ# `ЌX`X>Ќ`Ќ OVV>'\ VVV O 7VV&* VV 7#`ЌЌN#Ќ`Ќ#X>XЌ/#ЌXX>CMS *  Nursing   Home C  QualityState v  Surveyand :  Certification   Program ?VVV,!S !"VV ?#X>XЌX#ЌXX>#`ЌЌ#Ќ`Ќ  ӄDecreasetheprevalenceofrestraintsinnursinghomes.[FY02: * " 9.9%(interimdata),(Target:10%)/FY01:10%(Target:10%)]  # ЄDecreasetheprevalenceofpressureulcersinnursinghomes.#`ЌЌ#Ќ`Ќ#X>XЌ#ЌXX> C $ [FY02:10.3%(interimdata),(Target:9.5%)/FY01:10.5% v % (Target:9.6%)] OVV>': & VVV O 7VV&!&VV 7AHRQ,FDA, !' IHS T( Information ) Technology m* forHospitals, 1+ Pharmacies, d, and (- Healthcare }. Providers#`ЌЌ##`X>X`ЌG#`ЌX`X>Ќ`Ќ ?VVV,!A/"VV ?#X>XЌ##`X>XXX>̽#X>XX`X>ЌXX>ԄExpandimplementationofthe_MeDSuN_ԀSystemtoanetwork !0 of300facilities[FY01:FDAbeganfeasibilitytestingwith25 T1 hospitalsandworkedonsoftwarechangesneededforwebsite 2 healthdatasecurity(targetrecruit75hospitalstoreportadverse m3 events)]. 14 ЄEnhance_postmarketing_Ԁdrugsafety.* d5 ЄExpandtheautomatedextractionof_GPRA_Ԁclinical (6 performancemeasuresandimprovedataquality.*#`ЌЌa##`X>X`Ќ#`ЌX`X>Ќ`Ќ7-+}7  VVV 7#X>XЌ]#ЌXX>*Seeagencyperformanceplan/reportforadditionalinformation.#X>XЌ# ~7    .9    (#(#                               (#(#     #K;7l| 0^ `BdE^ }+     `     h   (X@(#(#(ProgramBackgroundandContext  L    AHRQpromoteshealthcarequality $  improvementbyconductingandsupporting   healthservicesresearchthatdevelopsand   presentsscientificevidenceregardingall y  aspectsofhealthcare.TheAgencys e  missionistoimprovetheoutcomesand Q qualityofhealthcareservicesthroughthe = establishmentofabroadbaseofscientific ) researchandthroughthepromotionof  improvementsinclinicalandhealthsystems p practices,includingthepreventionof \ diseasesandotherhealthconditions. H   InFY2004,AHRQwillconcentratenew 4 fundingonprojectstoadvancethe   Secretaryseffortstoimprovepatientsafety   andqualitybyensuringthathealth  informationinfrastructuresaremade u  availableinhospitals,primarilyinsmalland a! ruralcommunities. M"  ProgramPerformancePlanning  %$   AHRQiscurrentlyrestructuring %l! performancemeasurementtoprovidea &X" greaterfocusonprogrammaticoutcomes.In 'D # FY2004,AHRQsplanincludes23 (0!$ performancemeasureswhichsupportboth )"% longtermandshortertermperformance *#& goals.AHRQsplanhasamixofagency +#' specificperformancemeasuresandbroad q,$( healthoutcomegoalswhichmaybe ]-%) impactedbytheresultsofAHRQresearch. I.&* Examplesofbothtypesofperformance L* measurementforHealthCareQualityand 8 + Outcomesareasfollows: $ ,      *,-./012(xx>*,-./012 "*3"  ? ,X,` XDX,X,` X?*3H2H3  0 D   Decreasebyfivepercentthe  . hospitalizationratesforpediatric y / asthma.*3H݌a 0DG"DG" Ќ   *,-./012(xx*,-./012"*3"  *342H3  0 D   Producea_CAHPS_Ԁmodulefor I1 consumerassessmentsofhospital 52 quality.*34a݌3DG"DG" Ќ  ! ! *,-./012(xx*,-./012"*3"  *32H3  0 D   Fivetechnologiescurrentlyshownto t4 beeffectiveinotherclinicalsettings `5 willbetestedinnursinghomesto H6 evaluatetheimpactonsafety,quality 07 andcostofcare.*3K݌8DG"DG" Ќ    MeansandStrategies  }:   Thefollowingareexamplesofstrategies U < whichAHRQwillemploytoenhance A!= programperformance: -">  *,-./012(2xx*,-./012"*3"  *3F223  0 D   SecretarysPreventionInitiative:  $t@ AHRQwillawardabout20challenge $dA grantstoimplementtheSecretarys %PB PreventionInitiativetoapplicants &<C demonstratingexpertiseinworking '( D withpatients,providers,andhealth (!E caresystemstopreventdiabetes, )"F obesityandasthmaandtheir }*"G complications.*3Fs݌i+#HDG"DG" Ќ   *,-./012(2xx*,-./012"*3"  *3R223  0 D   Thesegrantswillbeawardedwithin U,$I fourAHRQprogramareascurrently A-%J meetingtheabovecriteria:Practice -.&KDG"DG" BasedResearchNetworks(_PBRNs_),  IntegratedDeliverySystemResearch } Networks*3R݌i  Ќ  (_IDSRNs_),ExcellenceCenterstoEliminate U  Ethnic/RacialDisparities(EXCEED)and A  TranslatingResearchintoPractice(TRIP). -       *,-./012(2xx*,-./012"*3"  *3223  0    ElectronicHealthInformation: For t the21stCenturyHealthCare d Initiative,AHRQwillimplement P  demonstrationprojectsfocusedon <  importantissuessuchas (  ComputerizedPhysicianOrderEntry,   ElectronicMedicalRecordsand   Electronicprescribingandlaboratory }  data,andenhancingtheclinicalhealth i  carepublichealthinformation U infrastructureinterface.*3݌A Ќ  "*3"  *3223  0    AHRQwillalsofacilitatethe - applicationofhealthinformation  technologyintopracticebyexpanding t itsPatientSafetyChallengeGrants, ` whichprovideincentivestoput L systemsbasedinterventionsinplace 8 inhealthcareorganizationsto $ acceleratetheuseofexistingIT  knowledge,reducemedicationerrors,  reducehospitalacquiredinfections y  andimprovecompliancewith e! acceptedclinicalcareguidelines.*3݌Q" Ќ  "*3"  *3223  0    Resources: Thebudgetrequestfor =# ResearchonHealthCosts,Quality -$ andOutcomesforFY2004is$279 %  million.AHRQwillspend$26 &t! millionforresearchgrantstosmall &`" communityandruralhospitalsto 'L # assistwithinformationtechnology (8!$ developmentsthatwillimprove )$"% healthcarequalityandpatientsafety.*3 ݌*#& Ќ  ExternalFactors  y,$(   e-%)   Anumberofexternalfactorswillimpact )  AHRQprogramperformanceincluding:1) }* theeconomy;2)advancesinmedical i + treatments;3)advancesinIT;4)managed U , care;5)decliningStateandlocalrevenues; A - 6)financialstatusofhospitals;and7) - . emphasisonpublichealthpreparednessfor  / bioterrorism. t0    `1 (X@( #K;7l| 0^ `BdE^ ,   (#(#                                  (#(#   (X[@(#(#( (#(#ProgramBackgroundandContext  t   TheStateSurveyandCertification L  programensuresthatinstitutionsproviding 8  healthcareservicestoMedicareand $  MedicaidbeneficiariesmeetFederalhealth,   safetyandqualitystandards.Aspartofthe   NursingHomeOversightImprovement y  Program,surveyorshavebeeninstructedto e  payparticularattentiontonursinghomes Q useofphysicalrestraintsandtotheirability = topreventandtreatpressureulcers. )  ProgramPerformancePlanning  p   TheSurveyandCertificationprogram H includesfundstostrengthenandcontinue 4 activitiesfocusedonensuringthatCMS   beneficiariesinnursinghomesreceive   qualitycareinasafeenvironment.The  programcurrentlyhasthreemeasureswhich u  speaktotheheartoftheprogram.The a! followingmeasuresillustratekey M" programmaticmissionandactivities: 9#      *,-./012(yx*,-./012"*3"  *3d2H3  0    Decreasetheprevalenceofrestraints %  innursinghomes.*3d݌%l! Ќ  "*3"  *3q2H3  0     Decreasetheprevalenceofpressure &T" ulcersinnursinghomes.*3q݌'@ # Ќ   *,-./012(xy*,-./012  MeansandStrategies  )"%   Thefollowingmeansandstrategies }+#' illustratehowtheprogramcontinually i,$( strivestowardsachievingperformance U-%) measures: A.&* Ї *,-./012(2xx*,-./012"*3"  *3223  0 D   PhysicalRestraints :StateandCMS t* surveyorswhoconductannual d+ inspectionsofnursinghomespayclose P, attentiontonursinghomesuseof < - restraintsandcitenursinghomesfor ( . deficientpracticeswhentheydiscover  / thatresidentsarerestrainedwithout  0 clearmedicalreason.*3݌} 1D"D" Ќ  "*3"  *3223  0 D   CMSwillcontinuetostressrestraint i 2 reductionasaprogramgoal, U3 maintainingthetargetat10percent A4 whileevaluatingtheeffectofcurrent -5 policiesandconsideringthe 6 introductionofnewones.*31݌t7D"D" Ќ  "*3"  *3223  0 D   CMSwillbeconductingatraining `8 programforStatesurveyors,which L9 willbebroadcastbysatelliteand 8: carriedliveovertheinternet.The $; topicoftheprogramisreducing < physicalrestraintuseinnursing = homes.*3݌y >D"D" Ќ  "*3"  *3223  0 D   PressureUlcers :CMSsponsorsa e!? varietyofpressureulceractivities, U"@ including:asatellitebroadcast A#A educationprogram;enhancing -$B methodsofsurveyordetectionof %C pressureulcersusingMinimumData &tD Set(_MDS_)dataandqualityindicator &`E reports;moredetailedguidanceto 'L F surveyorstodetectpressureulcer (8!G assessmentandtreatmentdeficiencies; )$"H andnationaleducationprogramsinthe *#I preventionandtreatmentofpressure +#J ulcers.*3݌y,$KD"D" Ќ   *,-./012(2xx*,-./012"*3"  *3223  0 D   CMSisdevelopingaprogramto e-%L educateprovidersaboutmoreaccurate Q.&MD"D" V    assessmentandcodinginthe  identificationofpressureulcers,as } wellasnewprotocolsaimedatonsite i  auditproceduresthatwillverifythe U  accuracyofnursinghomes_MDS_ A  assessments.*3݌-  Ќ   *,-./012(2xx*,-./012"*3"  *3 223  0    CMSwillexaminethemethodology   usedtocalculatetheprevalenceof t pressuresorestoseeifimprovements ` inthatmethodologymaybemadeto L  decreasetheeffectofrandom 8  variationonthereportedmeasure.*3 D ݌$  Ќ  "*3"  *3 223  0    Resources: Thebudgetrequestfor   FY2004is$248million.This   requestwillfundinitialsurveysand }  complaintvisitsandcontinuetheFY i  2003PresidentsbudgetNursing U HomeOversightImprovement A Program(_NHOIP_)activities.This - requestwillalsoallowforthe  inspectionoflongtermcarefacilities t atthelegislativelymandated ` frequencies.*3 , ݌L Ќ  ExternalFactors  $   Theprevalenceofpressureulcersin  nursinghomesappearstohaveincreased y  slightlyoverthe2001baseline.Thereare e! severalplausibleexplanationsforthe Q" increaseinprevalence.First,iftherehas =# beenanincreaseincasemix(severityof )$ illness)ofthenursinghomepopulation,itis %  possibleandevenlikelytherewouldbean &p! associatedincreaseintheprevalenceof &\" relatedconditions,includingpressureulcers. 'H # Itisalsopossiblethefacilitieshave (4!$ respondedpositivelytotheeducational ) "% efforts,andaremorecarefullyassessing * #& residentsandmoreaccuratelystagingand +#' codingpressureulcers. u,$( &       9/'+  + (X[@((#(#K(#    #K;7l| +^ `BdE^ }-   (#(#                               (#(#         `    (X@(#(#(ProgramBackgroundandContext  L    Akeyelementofthisstrategicgoalisthe $  developmentofelectronichealth   informationinfrastructuretoimprovepatient   careandespecially,patientsafety.In y  particular,AHRQasdiscussedearlierinthis e  section,FDA,andIHSaresomeoftheHHS Q agencieswhicharedevelopingtechnologyto = preventmedicalerrors.  )   FDAiswellknownfortheirpostmarket  regulatoryroleintrackingtheeffectiveness p andsafetyofmedicaldevices,humandrugs \ and_biologics_Ԁonthemarket.Thisprogramis H alsolinkedtoStrategicGoal2inthatsuch 4 ITsystemshelptheagencyrespondtopublic   healthchallenges.Inordertoimprovethe   qualityofcareforpatients,FDAcontinues  theireffortstomaintaintheirAdverseEvent u  ReportingSystems(_AERS_)databasewhere a! physiciansandothersreportanyadverse M" reactionstodrugsortherapeuticbiological 9# products.MedicalDeviceSurveillance %$ Network(_MeDSuN_),anotheradverseevent %  system,isactuallyplacedinseveralhealth %l! carefacilitiesandtracksinjuriesordeaths &X" attributedtouseormisuseofmedical 'D # devices. (0!$   #`X>XXX>|#IHSutilizesanintegratedhealth )"% informationsystemthroughoutitshealth *#& caredeliverynetwork.Thissystem,RPMS +#' (ResourcePatientManagementinformation q,$( System)consistsofanintegratedsuiteof ]-%) clinical,administrative,andfinancial I.&* softwareapplications.Thissystemenables 5/'+ IHStoprovidequalityhealthcareto L+ individualpatientsaswellastrack 8 , populationhealthstatistics.TheRPMS $ - systemsupportsindividualclinical  . endeavorsthroughapplicationsthatinclude,  / forexample,immunizationtracking, y 0 diabetescasemanagement,andpharmacy; e 1 thesediversebutintegratedapplications Q2 resultinanindividualelectronicpatient =3 healthsummary.Thissummaryisusedby )4 theproviderstotrackclinicalinformationas 5 wellasguidemedicalcaredecisions. p6   Populationhealthismonitoredusing \7 aggregatedataretrievedfromRPMS.This H8 dataenablesIHStotrackclinicalquality. 49 Qualityismeasuredbypredetermined  : guidelines(e.g.HealthyPeople2010  ; measures,_GPRA_,_HEDIS_Ԁ!measureswhich < trackhealthcarequalityinmanagedcare u = organizations),andreportsareavailablefor a!> reviewatalocal,regionalandnationallevel.X>XX`X> M"? #`X>XXX>F$#  ProgramPerformancePlanning  %$A   Thesevariousagencieshavedevoteda %lC numberofperformancemeasuresforthe &XD implementation,maintenance,orexpansion 'D E ofITdevotedtoimprovingthequalityof (0!F patientcare.Thefollowingmeasures )"G illustratekeyprogrammaticactivities: *#H  "*3"  *3b&223  0 D   FDA:Expandimplementationofthe q,$J _MeDSuN_ԀSystemtoanetworkof300 ]-%K  facilities. *3b&&݌ E.&LDG"DG" Ќ  "*3"  *3'223  0     FDA:Enhance_postmarketing_Ԁdrug   safety.*3''݌} Ќ  sp? /+b|2eh "B `.w@Ee "B "B   .s e   "*3"  *3u)223  0    IHS:Expandtheautomated   extractionof_GPRA_Ԁclinical   performancemeasuresandimprove z  dataquality. *3u))݌b Ќ    MeansandStrategies  6   Thefollowingmeansandstrategies }  illustratehowtheseprogramsarestrivingto i  enhanceelectronichealthinformation: U   *,-./012(2xx*,-./012"*3"  *3,223  0    FDA_MeDSuN_: Inordertodetermine - thelevelofinjuriesanddeaths  associatedwithmedicaldeviceusage   ormisusage,FDAcontinuestowork   towardsdevelopingarepresentative r! networkofmedicaldeviceusersby ^" recruitingandenrollinghealthcare J# facilitiestoreportdeviceusage.Of 6$ theproposed$4millionforFY2004, "% $2millionwillgotowardsexpanding &} facilityparticipationintheMedical &i DeviceSurveillanceNetwork 'U  (_MeDSuN_)aswellasenhancingerror (A! monitoring,electronicreporting,and )-" specialreportingforinvitro *# diagnostics.FDAwillincreasethe +$ enrollmentto 300facilitiesinFY ,$ 2004.Thiswillentailmaintaining n-% currentfacilitiesandrecruitingnew Z.&  facilitiestoparticipateintheprogram.F/'! Additionally,FDAplanstousethe ! cohortof300facilitiestopilotthe }" effectivenessofvariousincentives,to i # pilotuseofthe_MeDSuN_Ԁfacilitiesas U $ alaboratorytoobtainspecificmedical A % productinformation,andencourage - & reportingbythefacilities.*3,,݌ 'DG"DG" Ќ  "*3"  *33223  0 D   FDA_AERS_: Incalendaryear2001, t( FDAreceivedover285,000reportsof d) suspecteddrugrelatedadverseevents P* forentryintotheAdverseEvents < + ReportingSystem.TheAgency ( , thoroughlyreviewsadverseevent  - reportsandifnecessary,disseminates  .  DearHealthcareProfessionalletters } / ortakesregulatoryaction.FDAis i 0 alsocoordinatingwithMedical U1 Devicecontractorsinimplementinga A2  drug_MeDSuN_Ԁwherehealth -3 professionalsinuserfacilitiescan 4 inputadversedrugevents.They t5 wouldusetheproposed$2million `6 increaseinFY2004tosupportthe L7 hiringof15additional_FTEs_Ԁandto 88 designandimplementimprovements $9 to_AERS_Ԁsuchasmoreelectronic : reporting;riskbasedguidanceto ; industry;andgreateranalytic y < capability.*333݌e!=DG"DG" Ќ  "*3"  *3U9223  0 D   IHSautomatedextractionofdata:  Q"> IHScontinuestoemphasizethevalue A#? of'transparent'dataextractionfor -$@ providersinhealthcarefacilities.IHS %A developedanddeployedanew &tB softwareapplication,_GPRA_+,inFY &`C 2002.Thisapplication,coupledwith 'L D ongoingeffortstoimproveclinical (8!E dataquality,shouldresultin )$"F increasinglyreliable,accurate,and *#G timelydata.*3U99݌+#HDG"DG" Ќ  "*3"  *3g<223  0 D   Medicationerrors: Recognitionand y,$I monitoringofmedicationerrorsisa i-%J crucialpartofimprovinghealth U.&K quality.TheIHSisintheprocessof A/'LDG"DG" evaluatingwaystostandardize  medicationerrorreporting,and } implementingwaystoreducethese i  errors.IHSplansondetermininga U  baselinemedicationerrorrate,and A  identifyingtherootcausesforthe -  mostfrequentmedicationerrors.*3g<<݌  Ќ  "*3"  *3q?223  0    QualityHealthCareforDiabetics:  t IHSroutinelyevaluatescareto d diabeticpatients,baseduponnational P  qualitydiabeticstandards.IHSalso <  monitorsadditionalindicatorsthatare (  importanttoourdiabeticpopulations.   ThisaggregatedataallowsIHSto   trackandimprovethequalityofcare }  deliveredtodiabeticpatients.`ЌX`X>Ќ`Ќ*3q??݌i  Ќ  #`ЌЌA##`X>X`ЌA# ExternalFactors  A   Overall,FDAssuccessinexpanding  thesesystemsfortheendgoalofpreventing t andreducingmedicalerrorshingesonthe ` healthcommunitysabilitytoadequately L reportadverseeventsrelatedtomedication, 8 therapeutic_biologics_Ԁorevenmedical $ devices._MeDSuN_Ԁdependsonthe  cooperationofvarioushealthcarefacilities  acrossthecountryaswellasthetechnology y  infrastructurenecessaryforfull e! implementation.InFY2001,forexample, Q" FDAdevotedresourcestoaddressing =# securityrequirements,infrastructure )$ necessaryforfullimplementation. %    IHSsuccessisdependentuponongoing &p! supportforourcurrenthealthinformation &\" system(RPMS),aswellasourabilityto 'H # procureadditionalsupportand (4!$ enhancements.Manyofthesenewsoftware ) "% applicationscanbesuccessfullydeveloped * #&  inhouse.Successisalsodependenton +#' cooperationfromhealthcareprovidersand u,$( supportstaff,availabilityoftraining,and a-%) deploymentissues.Tribescanelecttouse M.&* RPMSorotherhealthinformationsystems. 9/'+ Atthecurrenttime,themajorityoftribal + programscontinuetouseRPMS,andexport }, aggregateddatatothenationalIHSprogram. i - Tribalsharingofdatawillcontinuetobe U . criticaltoourabilitytoreportonclinical A / qualityindicators. - 0   1   W.4 <DL  ,X,` XDXW  (X@( i    THISPAGEINTENTIONALLYBLANK    v(8x*,-./012@P/@<l \'" "c `@XddddE}"ctt:L/ } ,----#M=9l|z~tH ` dE.] tHf 0 ff(#(# ffff ffff ffff ffff ffff ffff ffff (#(#ff0,X,` XX 0(X@(#(#(    Toachievethisstrategicgoal,HHSwill +  continuetosupporteffortstoincreasethe   independenceoflowincomefamilies,welfare r  recipients,thedisabled,olderAmericansEX>XX`X>, ^ NativeAmericansand#`X>XXEX>̙O#Refugees.EX>XX`X>HHSis J committedtosupportingfamilieswhocare 6 fortheirdisabledchildrenathomeand " providescholarshipstoincreasethenumber  ofdirectsupportworkerswhoassist  individualswithdevelopmentaldisabilities.#`X>XXEX>P# w Also,theDepartmentwillsupportcommunity c andfaithbasedorganizationswhoare O providingservicestoindividuals_transitioning_ ; fromwelfaretoselfsufficiency.EX>XX`X> ' Additionally,theDepartmentisfocusingon +  increasingtheproportionofolderAmericans   whostay#`X>XXEX>̢R#active,healthyandindependentEX>XX`X>Ԁand r  provideassistancetofamilieswhoarethe ^ mainstayoflongtermcareforelderly J persons.#`X>XXEX>̢S#EX>XX`X>Ԁ#`X>XXEX>T#EX>XX`X> 6   TheHHSprograms,detailedinthis " section,#`X>XXEX>T#haveannualperformancemeasures  thatspeaktoimprovingtheeconomicand   socialwellbeingofindividuals,families,and w! communities.Thesemeasuresserveas c" examplesofhowHHSwillimprovethe O# economicandsocialwellbeingof ;$ individuals,familiesandthecommunities. '%        `    n%    n% (X@OO(    *:dd\Rd\Rd\R(#(#,\R,\R,I\R+  <VVV#'}} < HHSStrategicGoal AVVV#,!"VVV# AX>XX`X>Agencies/  Programs s   AVVV#,!_ "VVV# AFY2004PerformanceMeasures#`X>XXX>6Y# TVVC," VVV# TGOAL6:Improvethe A  EconomicandSocial -   WellBeingof   Individuals,Families, t  andCommunities, `  EspeciallyThoseMost L  inNeed 8  X>XX`X>ЌXX> NVV=2$ " VV N#X>XЌ[#ЌXX>#`ЌЌs[# ACF U  _TANF_ =VV,! "VV =#`X>X`Ќ"\#X>XX`X>ЌXX>  ӄForFY2004,increaseto44%thepercentageofadult_TANF_ U  recipientswhobecomenewlyemployed.{FY200046.4%   (target42%.)  L ЄForFY2004,increaseto66%thepercentageofadult_TANF_   recipients/formerrecipientsemployedinonequarteroftheyear e whocontinuetobeemployedinthenexttwoquarters.*{InFY ) 2000,65%ofemployedrecipients/formerrecipientssustained \ employmentforthesubsequenttwoquarters(thetargetof83%   wasnotattainedbecausethemeasurewasrevisedtocapture u  employmentinthetwosubsequentquartersinsteadofjustthe 9  secondsubsequentquarter;amuchmorerigorousstandard.}#X>XЌ%]##`X>XXX>]#X>XX`X>ЌXX> ?5'l  VV ? (VV :  (ACF :  _LIHEAP_ =VV,! "VV =  ӄIncreasethetargetingindexof_LIHEAP_Ԁrecipienthouseholds :  havingatleastonemember60yearsoroldercomparedtonon   vulnerable_LIHEAP_Ԁrecipienthouseholds.[InFY2001,the S ! targetingindexwas90]* " ЄIncreasethetargetingindexof_LIHEAP_Ԁrecipienthouseholds J# havingatleastonemember5yearsorundercomparedtonon $ vulnerable_LIHEAP_Ԁrecipienthouseholds.[InFY2001,the c% targetingindexwas109.]* OVV>''& VV O 7VV&d&VV 7#X>XЌ+a#ЌXX>#`ЌЌ a#_AoA_ d' Community (( BasedServices }) ProgramЌ`Ќ =VV,!A*"VV =#X>XЌe##`X>XXX>Mf#`ЌX`X>Ќ`Ќ  ӄAsignificantpercentageofOlderAmericanActTitleIII d+ servicerecipientsliveinruralareas.[FY1999:33.6%;FY (, 2000:32.9%]#`ЌЌg#Ќ`Ќ#X>XЌf#ЌXX> }- ЄMaintainahighratioofLeveragedfundsto_AoA_Ԁfunds.[FY A. 2000:$1.90to$1.00;FY2001:$2.10to$1.00#X>XЌJh#ЌXX>#`ЌЌh#Ќ`Ќ]#X>XЌ@i#ЌXX>#`ЌЌi#Ќ`Ќ7-+t/  VV 7*Seeagencyperformanceplan/reportforadditionalinformation B/   0 A2   (#(#                                    (#(#     #K;7l| 0^ `BdE^ U1     `     h   (X@(#(#(#X>XЌi#ProgramBackgroundandContext  9    Thepurposesofthe_TANF_Ԁprogramare   to:a)providetimelimitedassistanceto l  needyfamilies;b)reducedependencyby X  promotingjobreadiness,workandmarriage; D  c)preventoutofwedlockpregnancies;and 0  d)encouragetheformationandmaintenance  oftwoparentfamilies.UnderTitleIVAof  theSocialSecurityAct,asamendedbythe  PersonalResponsibilityandWork q OpportunityReconciliationActof1996 ] (_PRWORA_),Statesandterritoriesreceivea I blockgrantallocationandarerequiredto 5 operatetheirownprograms.States ! determineeligibilityandbenefitlevelsand  | servicesoffered.Tribeshavethisoption,as h well. T   ProgramPerformancePlanning   ,   Theprimarygoalofthe_TANF_Ԁlegislation " istomoverecipientsfromwelfaretowork #  andselfsufficiency.Inpartnershipwith m$! States,ACFhasachievedunprecedented Y%" levelsofperformance. E&#   _TANF_Ԁsharesacommongoalwiththe 1'$ morethan48jobtrainingprogramsin10 ( % Federalagencies!toimproveparticipants  )x!& employmentandearnings.Whilethese )d"' programsvaryconsiderablyinthetypesof *P#( servicesprovidedandtargetpopulations +<$) served,theseagencies(ACF/HHS, ,(%* DepartmentofLabor,Education,Housing -&+ andUrbanDevelopment,Interior,and .', VeteransAffairs)incoordinationwiththe 9, OfficeofManagementandBudget,have %- developedacommonsetofmeasuresforjob  . trainingandemployment.Twoofthese l / measuresarelistedbelowandreflect X 0 _TANF_scoregoaltomoveindividualsfrom D 1 welfaretowork: 0 2    *,-./012(x8v"*3"  * ,X,` X**3{w2H3  0 W   ForFY2004,increaseto44percentthe 4 percentageofadult_TANF_Ԁrecipients 5 whobecomenewlyemployed.*3{ww݌m6WG"WG" Ќ   v(8x*,-./012v.,X,` Xw.* ,X,` X* *,-./012(x8v "*3"  *3sz2H3  0 W    ForFY2004,increaseto66percentthe U7 percentageofadult_TANF_ A8 recipients/formerrecipientsemployed )9 inonequarteroftheyearwhocontinue : tobeemployedinthenexttwo h; consecutivequarters.*3szz݌P<WG"WG" Ќ   v(8x*,-./012y *,-./012(2x8v.,X,` Xy.MeansandStrategies   > ? ,X,` XDpX,X,` X? c ACFwillemployvarioustoolsand  ? strategiestoenhance_TANF_Ԁprogram !@ performance. u"A "*3"  *3~223  0 c   ACFprovidesleadershiptoStates, M$C TerritoriesandTribesastheydesignand 9%D implementtheirprograms.Efforts %&E includeanaggressivetechnical 'F assistanceandoutreachapproach, 'l G includingaPeerTechnicalAssistance (X!H Network.*3~݌)D"IcG"cG" Ќ  "*3"  *3223  0 c   _PRWORA_Ԁestablishedwork *0#J participationstandardsandcreateda +$K HighPerformanceBonusincentive ,%L systemforFY1999FY2003.Stateand -%M Territoriesreceivefinancialrewardsfor q.&NcG"cG" highperformanceandsignificant  improvementaswellaspenaltiesfornot } meetingtheworkparticipationtargets. i  TheAdministrationsReauthorization U  proposalrestructuresthesegrantsto A  focusonemploymentachievement.*3%݌-  Ќ   *,-./012(2xx*,-./012"*3"  *3223  0    Presidents_TANF_ԀReauthorization   Proposal: TheAdministrationsFY  x 2004budget_reproposes_ԀitsFY2003 h _TANF_Ԁreauthorizationproposal.TheFY T  2004Budgetrequests$17,609million @  forFamilyAssistanceGrantstoStates, ,  TribesandTerritories;MatchingGrants   toTerritories;SupplementalGrants;and   NativeEmploymentWorksattheir   currentlevels.Therequestalso m  includesfundingforHighPerformance Y Bonus.ContingencyFundisavailable E fromprioryears.Theproposalalso 1 strivestostrengthenfamilies.Itincludes  amatchinggrantprogramforinitiatives  x topromotehealthymarriages.The d proposalwouldalsoreplacetheoutof P wedlockbonuswithanewinitiativeto < fundresearch,demonstrations,and ( technicalassistanceactivities,primarily  targetedtowardsfamilyformation.*3݌ Ќ  ExternalFactors  i!   Theperformanceofthe_TANF_Ԁprogram A# willbesignificantlyimpactedbyanumber -$ offactorswhichmayhelporhinder %  performancegoalachievementincluding:1) &t! thenationaleconomy;2)wageand &`" employmentrates;3)socialand 'L # demographictrendssuchasdivorceand (8!$ nonmaritalbirthrates;and4)increasing )$"% proportionofclientswithbarriersto *#& employmentsuchaslackoffluencyin +#' English,mentalhealthproblems,substance y,$( abuse,disabilityordomesticviolence. e-%)  Q.&*  c  c      ?     *#P         1 #K2;7l|  `BdE sk"Z2 ProgramBackgroundandContext  t   Thepurposeof_LIHEAP_Ԁistoassistlow L  incomehouseholdsthatpayahigh 8  proportionofhouseholdincomeforhome $  energytomeettheirimmediateneeds.   States,FederallyorStaterecognizedIndian   Tribes/Tribalorganizations,andInsular y  AreasreceiveFederal_LIHEAP_Ԁblockgrants e  toadministertheprogramatthecommunity Q level.The_LIHEAP_Ԁstatutetargetstwo = prioritygroupsoflowincomehouseholds ) needingenergyassistance:1)Vulnerable  Households;and2)HighEnergyBurden p Households.Vulnerablehouseholdsare \ definedashouseholdswithfrailolder H individuals,individualswithdisabilities,or 4 veryyoungchildrenthatmeet_LIHEAP_   incomeeligiblestandards.     ProgramPerformancePlanning  u    LastyearACFintroducedthefollowing M" twonewperformancemeasureswhichfocus 9# ontargetingassistancetovulnerable %$ households: %    *,-./012(yx*,-./012"*3"  *32H3  0    Increasethetargetingindexof &X" _LIHEAP_Ԁrecipienthouseholdshaving 'D # atleastonemember60yearsorolder (,!$ comparedtononvulnerable_LIHEAP_ )"% recipienthouseholds.*3/݌*"& Ќ   *,-./012(2xy*,-./012  *,-./012(yx*,-./012"*3"  *32H3  0    Increasethetargetingindexof u+#' _LIHEAP_Ԁrecipienthouseholdshaving a,$( atleastonememberfiveyearsorunder I-%) *3'݌1.&* Ќ   78787G"7G" 78787878 78787878 78787878 78787878 78787878 7G"7G"7878comparedtononvulnerable_LIHEAP_  X1 recipienthouseholds. @2  *,-./012(2xy*,-./012yMeansandStrategies  (3  c ACFwillusethefollowingtoolsand  5 strategiestoenhanceprogramperformance: } 6  *,-./012(2xx*,-./012"*3"  *3|223  0 c   Developmentofa_LIHEAP_Ԁbrochurethat U 8 includesinformationrelatinghealthand A 9 safetyissuestovulnerableandhigh -: energyburdenhouseholdneedsfor ; energyassistance.*3|݌t<cG"cG" Ќ   *,-./012(2xx*,-./012"*3"  *3˟223  0 c   PartneringwithotherHHSofficessuch `= astheHeadStartBureau,the L> AdministrationonAgingandthe 8? DevelopmentalDisabilities $@ Administrationfordisseminationofthe A outreachbrochureatthecommunity B level.*3˟݌yCcG"cG" Ќ   *,-./012(2xx*,-./012J *,-./012(2xx*,-./012"*3"  *3ע223  0 c   Resources: Thebudgetrequestforthe eD blockgrantforFY2004is$1,700 U E million,plusan$300millionemergency A!F fund.ThiswillenableStatestobetter -"G meetenergyemergenciesdueto #H extremesintemperature.Overthepast $tI year,Stateshaveseenanincreaseinthe $`J numberofapplications/requestsfor %LK energyassistance.*3ע݌&8LcG"cG"    '$ M _       ExternalFactors  t   Thereareanumberofexternalfactors L  whichwillimpactonprogramperformance. 8  Inadditiontothekeyfactor,theweather, $  otherfactorsare:1)volatilityinpricesfor   keyheatingfuels;2)theeconomy;3)wage   andemploymentrates;and4)declining  t Staterevenues.  /    `   &   '    ,.&* Ї  $I                    + #K3;7l| `BdEtQtI Z3߰ ProgramBackgroundandContext  t  0  TheCommunityBasedServicesL  ЀProgram(_CBSP_)providesgrantstoStates 8  toprovidecomprehensivesocialand $  supportiveservicestovulnerableelderly   individualsandtheirfamily_caregivers_. p  Intendedtocomplementexistingmedical \  andhealthcaresystems,forafractionofthe H  cost,the_CBSP_Ԁsupportssomeoflifesmost 4 fundamentalfunctionsforelderly   individualsatriskof_institutionalization_,   including:foodfortheundernourished;  criticaltransportationfortheimmobile; p respiteandsupportfor_caregivers_;and \ personalcaretothosewhoneedassistance H gettinginandoutofbed._AoA_Ԁcarriesout 4 the_CBSP_Ԁthroughanationalagingnetwork   thatincludes56StateUnitsonAging,655   AreaAgenciesonAging,236IndianTribal l Organizations,andover29,000public, X  privateandvoluntarydirectservice D! providers.Thisincludesover10,000senior 0" centers,ofwhichmorethanhalf(6,000)are #  communityfocalpointsthatcoordinate $ andintegrateservicesinthecommunity, $  specificallyfortheelderly.The_CBSP_Ԁisthe %l! primaryinstrumentof_AoA_Ԁandthenational &X" agingnetworktohelpvulnerableelderly 'D # individualsmaintaintheirindependencein (0!$ thecommunityandavoid_institutionalization_ )"% infacilitiessuchasnursinghomes.The |*#& _CBSP_Ԁandrelatedprogramsarecriticalto h+#' thesuccessandenhancementofPresidents T,$( NewFreedomInitiative,andintegrationof @-%) servicesisahighpriorityoftheSecretary ,.&*  78787G"7G" 78787878 78787878 78787878 78787878 78787878 7G"7G"7878and_AoA_Ԁtoensurecoordinationand  t1 programefficiencyinsupportoftheelderly. `2  ProgramPerformancePlanning  8 4  c   The_CBSP_Ԁcurrentlyhas22  6 performancemeasuresacrossfourfocus p 7 areas:1)targetingservicestothe \ 8 vulnerable;2)systemsintegrationand H 9 efficiency;3)programoutput;and4) 4: consumerbasedprogramoutcomes.  ; Measurableoutcomesbasedonnational  < _CBSP_Ԁconsumerassessmentsurveysacross = sixservicedomainsbecomeavailablelatein p> 2002toassess_CBSP_Ԁprogramimpacts. \? Existingprogramdatademonstrate H@ effectivenessintargetingservicestothose 4A whoneedservicesthemost,andin  B integratingFederal,Stateandlocalresources  C insupportoftheelderly,asthefollowing lD resultsforFY2000illustrate: X E .  D!F  *,-./012(yx*,-./012"*3"  *32H3  0 c   #`X>XXX>j#Approximately10percentofU.S. 0"G elderlyindividualsarepoorandover30 #H percentof_CBSP_Ԁclientsarepoor. $I Fewerthanonequarteroftheelderly $xJ populationlivesinruralareasandover %`K 33percentof_CBSP_Ԁclientsliveinrural &HL areas.*3޺݌'0 McG"cG" Ќ    *,-./012(2xy*,-./0120 *,-./012(yx*,-./012"*3"  *3>2H3  0 c   Stateandlocalentitiesleveragealmost (!N $2infundingfromothersourcesfor x)"O every$1_AoA_Ԁprovidesfor_CBSP_.For `*"P themostvulnerableelderlywhoneed H+#Q intensiveservicessuchaspersonal 0,$R  care,adultdaycareandhome_delivere_ -%ScG"cG" A2a A A  meals,networkentitiesleverage$3for  everydollar_AoA_Ԁprovides.*3>k݌{    *,-./012(xy*,-./012  sp ? /+b|2y `.#@EO y y  7 4s O  MeansandStrategies & H   Basedontheanalysisofperformance   measuresandotherprogramdata,_AoA_Ԁhas   identifiedanumberoftoolsandstrategiesin   itsFY2004budgettoeffectimproved w  programperformance: c   v(8x*,-./012 *,-./012(2x8v[ *,-./012(2xx*,-./012"*3"  *3223  0    ImproveStateandcommunity ;  integrationoffunding,services,and ' healthandsocialsupportsbyidentifying   andreplicatingmodelsystems  l integrationpracticesacrossthenation.*3݌!X Ќ   *,-./012(2xx*,-./012"*3"  *3223  0    Focuselderlyclientindependenceefforts "D onpreventivehealthprogramsthat*3I݌#0 Ќ  0  improvehealthandwellbeing,and $ coordinate_CBSP_Ԁeffortswiththe % SecretarysPreventionInitiative.& "*3"  *3223  0    ݀Fosterenhanceddevelopmentnewly s' authorized_caregiver_Ԁservicesunderthe _(  _CBSP_Ԁthroughrapidandcoordinated K)! disseminationof_caregiver_ 7*" demonstrationinnovationscurrently #+# underdevelopmentthroughouttheaging ,|$  network.*3;݌,h% Ќ  "*3"  *3223  0 c      UndertheSecretarys OneHHS  initiative,_AoA_Ԁisworkingtoenhance  partnershipswithCMS,CDC,HRSA, k  AHRQ,IHS,NIH,andotherHHS W   componentstoimproveservice C ! integrationatthecommunitylevelon / " behalfofvulnerableelderlyindividuals.*3݌ #cG"cG" Ќ  "*3"  *3223  0 c   ConsistentwithHHSemphasis,focus t$ programassessmentactivitiesonthe `% qualityofaccesstoservicesbyelderly L& individualslivinginruralareas,andon 8 ' theavailabilityofservicesofgreatest $ ( needtoruralelders,suchas  ) transportation.*3݌ *cG"cG" Ќ   *,-./012(2xx*,-./012"*3"  *3223  0 c   Resources: ThebudgetrequestforFY { + 2004is$1,344million.*3݌k ,cG"cG" Ќ   c    W-  *,-./012(2xx*,-./012 ExternalFactors  C.  c X>XX`X>Ԁ#`X>XXX>x#_AoA_ԀandtheStateandlocalentitiesthat 0 comprisetheagingnetworkworktogetherto t1 addresschallengesthatcanaffect `2 performance.Nevertheless,selected L3 externalfactorsmayingivenyearsaffectthe 84 achievementofperformancetargets.The $5 followingareillustrationsoffactorsthatcan 6 affectprogramresults: 7 "*3"  *3223  0 c   Economicfactors,suchasincreasesin g!9 thepriceofgasoline,haveaffectedthe S": leveloftransportationservicesthatState ?#; andareaagenciescanprovide.*3݌+$<cG"cG" Ќ  "*3"  *3F223  0 c   Demographicfactors,suchastherapid %= growthoftheelderlypopulation,will &p> haveasignificanteffectonthelevelof &\? servicesthatwillberequiredinthe 'H @  future.X>XX`X>*3Fs݌ (4!AcG"cG" Ќ  "*3"  *3223  0    #`X>XXX≯#   Relianceondispersedentitiesfor  programdatahaseffectedthetimeliness  oftheavailabilityofprogramdatainthe k  past.However,_AoA_ԀandtheStateshave W  reduceddelaysinprogramdata C  availabilitybyninemonths,will /  continuetoreducesuchtimelags,and   willincreasinglyrelyonsamplesurvey t data,whichbecomeavailableonamore ` timelybasis.X>XX`X>Ԁ#`X>XXX>#Ԁ*3H݌L  Ќ     $        (X@( {  \ S ! ! 3*,-./012("xx*,-./012   O"   p1P@<l \'" Ip `@XddddEIpttaL5    ,----#M=9l|z~t ` dE.l tf 6 ff(#(# ffff ffff ffff ffff ffff ffff ffff (#(#ff?,X,` X ,X,` XDpX?(X@(#(#( (#(#  HHShasanumberof_effforts_Ԁtoimprove N  thestabilityanddevelopmentofournations :  childrenandyouth.Theseeffortsinclude &  promotingfamilyformationandhealthy   marriagesandinstitutingcreativeand k innovativewaystoimprovethelearning W readinessofpreschoolchildren. C Additionally,weaimtoincreasethe / involvementandfinancialsupportofnon  custodialparentsinthelivesoftheir  childrenandincreasethepercentageof  childrenandyouthlivinginapermanent, r safeenvironment. ^   AspartofthePresidentsGoodStart, J GrowSmartinitiative,HeadStartwillbe 6 implementinganewaccountabilitysystem "  wherebyHeadStartprogramswillassess !{ enrolledchildrenagainstestablished !g standardsoflearninginearlyliteracy, "S language,andnumeracyskills. #?   X>XX`X>ACFanticipatescontinuingtopromote $+ theavailabilityofchildcareservicesasa % keyelementinitsstrategyforhelping &  familiesachieveeconomicindependence '! andsupportingchilddevelopmentand n( " schoolreadiness.#`X>XXX>̻# Z)!#   TheChildSupportEnforcementprogram F*"$ assuresthatsupportisavailabletochildren 2+#% bylocatingparents,establishingpaternity ,$& X>XX`X>andsupportobligations,and#`X>XXX>#ԀX>XX`X>isanintegral  -w%' partoftheDepartmentsefforttoincrease -c&( parentalresponsibilitybypromotingfathers N ( involvementinthelivesoftheirchildren.#`X>XXX>w# : )   X>XX`X>ProgramssuchasFosterCareand & * IndependentLivingprovidesafeandstable  + environmentsforthosechildrenwhocannot k, remainsafelyintheirownhomes.#`X>XXX>̱#X>XX`X>  W- ЀThisAdministrationhasdevelopeda C. numberofprograminitiatives,emphasizing // theinvolvementoffaithandcommunity 0 basedorganizations,tostrengthenthe 1 nationsfamilies;namely1)theCompassion 2 CapitalFund,2)thePromotionandSupport r3 ofResponsibleFatherhoodandHealthy ^4 Marriageprogram,3)the_Mentoring_ J5 ChildrenofPrisonersprogramand4)the 66 MaternityGroupHomesprogram.#`X>XXX># " 7 ? ,X,` XDpX,X,` X? c TheHHSprogramsinthissection,and !{8 theirrepresentativeperformancemeasures, !g9 illustrateourcommitmenttoimprovingthe "S: stabilityanddevelopmentofournations #?; childrenandyouth.Theyareexamplesof $+< howHHScontinuestotrackprogress %= towardsthisstrategicgoal. &> p1e    (X@(*dd\R\RI\RI:(#(#,\R,F\R,\R+  <VVVV#' < HHSStrategicGoalX>XX`X> AVVVV#,! "VVVV# A#`X>XXX>D#Agencies/   ProgramsX>XX`X> AVVVV#,!"VVVV# A#`X>XXX>#FY2004PerformanceMeasuresX>XX`X> VVVVVC, " VVVV# V#`X>XXX>̞#X>XX`X>&'%XX>GOAL7:Improvethe /   stabilityand t  developmentofour L  Nationschildrenand $  youth.   #X>X%&'Y##`X>XXX>:#X>XX`X>ЌXX> PVVVV=2g " VVVV P#`ЌЌ##`X>X`Ќ#X>XX`X>ЌXX> ACF   HeadStart ?VVVV,!C "VVVV ?#`ЌЌ]##`X>X`Ќ|# X>XX`X>ЌXX>  ӄAchieveatleastanaverage34%gaininwordknowledgefor   childrencompletingtheHeadStartprogram(theaverage C  gainamongallchildrenduringthepreKyearis19%).{Goal  t met:32%gainmaintainedinFACES2000}  8 ЄAchieveatleastanaverage52%gaininmathematicalskills   forchildrencompletingHeadStartprograms(theaverage S  gainamongallchildrenduringthepreKyearis30%).{Goal  met:43%gainmaintainedinFACES2000}  H Є Achieveatleastanaverage70%gaininletteridentification   forchildrencompletingtheHeadStartprogram(theaverage e gainamongallchildrenduringthepreKyearis50%).{Goal )  notmet:Gainincreasedto38%,fallingshortof70%}* OVV>'Z  VVVV O 9VVVV&( VV 9ACF (  ChildCare ?VVVV,! "VVVV ?  ӄIncreasethenumberofchildrenreceivingchildcareservices (  through_CCDF_,_TANF_Ԅdirectand_SSBG_Ԁfunds.{New   Measure:BaselinewillbeestablishedinFY2003.}* C ! ЄIncreasetheproportionofcentersandhomesthatserve t " familiesandchildrenreceivingchildcaresubsidies.{New 8# measure:BaselinewillbeestablishedinFY2003 .} * $ ЄIncreasethenumberofStatesthatencourageprovider U% trainingthroughbonusesorothercompensation.{New & measure:BaselinewillbeestablishedinFY2003.}* OVV>'J' VVVV O 9VVVV&'VV 9ACF ( ChildSupport o) Enforcement ?VVVV,!3*"VVVV ?  ӄIncreasethepaternityestablishmentpercentage(PEP)to + 99%.{FY2001goalmet:102%(target96%)(represents o, currentpaternityestablishmentsandcompletionofbacklog 3- cases).} d. ЄIncreasetheTitleIVDcollectionrateto60%.{FY2001  (/  goalmet : Collectionrate57%(target54%)} ?5'0 VVVV ? *VVVV O0 *ACF O1 Strengthening 2 Families ?VVVV,!D3"VVVV ?  ӄIncreasethenumberofStatesimplementinginitiativesto O4 promotehealthymarriages.{New_TANF_Ԁmeasure:Baseline 5 willbeestablishedinFY2003.}* OVV>'D6 VVVV O 9VVVV& 6VV 9ACF  7 FosterCare/ i!8 Adoption -"9 Assistance/Child "^: Welfare ?VVVV,!#";"VVVV ?#`ЌЌW##`X>X`Ќv#`ЌX`X>Ќ`Ќ  ӄIncreasethenumberofadoptionsofchildreninthepublic  < fostercaresystemto60,000.{FY2001goalnotmet:50,000 i!= adoptions(target51,000).}* -"> ЄOfthechildrenwhoexitfostercarethroughreunification, "^? maintainthepercentageofchildrenwhodothiswithinone #"@ yearofplacementat67%.{FY2001goalmet:68%(target y$A 67%).}7-+=%B  VVVV 7*Seeagencyperformanceplan/reportforadditionalinformation.   &xB    (#(#                                    (#(#  0&   '  #K;7l| 0^ `BdE^ 7    /      7   #X>XЌ#(@(#(#(ProgramBackgroundandContext  w     '     /     HeadStartprovidesgrantstolocal O  publicandprivatenonprofitandnotfor ;  profitagenciestoprovidecomprehensive '  childdevelopmentservicestochildrenand   families.Intendedprimarilyforpreschool l  agechildreninlowincomefamilies,Head X  Startpromotesschoolreadinessby D enhancingthesocialandcognitive 0 developmentofchildrenthroughthe  provisionofeducational,health,nutritional,  social,andotherservices.Aspartofthe  PresidentsGoodStart,GrowSmart s initiative,HeadStartwillbeimplementinga _ newaccountabilitysystemwherebyHead K Startprogramswillassessenrolledchildren 7 againstestablishedstandardsoflearningin # earlyliteracy,language,andnumeracyskills. |  ProgramPerformancePlanning   T   TheHeadStartprogramcurrentlyhas ", numerousperformancemeasuresreflecting #  programperformanceforliteracy,language $! andnumeracybasedonanationalsampleof %" informationcollectedintheFamilyand o&# ChildrenExperiencesSurvey.Theywillbe ['$ developingnewmeasurestocapture G( % performanceasreflectedbythenew 3)!& outcomebasedperformancesystemonceit *"' isimplemented.ExamplesofHeadStart  +x#( performancemeasuresforFY2004areas +d$) follows: ,P%*   -<&+  *,-./012(yx3*,-./012"*3"  *3D2H3  0     Achieveatleastanaverage34percent w+   gaininwordknowledgeforchildren c, completingtheHeadStartprogram. K- (Theaveragegainamongallchildren 3 . duringthepreKyearis19percent.)*3Dq݌ /G"G" Ќ  3 ] ,X,` XDpX3 3*,-./012(xy*,-./012 *,-./012(xx3*,-./012 "*3"  *3\2H3  0    Achieveatleastanaverage52percent p 0 gaininmathematicalskillsforchildren \ 1 completingtheHeadStartprogram.(The D 2 averagegainamongallchildrenduring ,3 thepreKyearis30percent.)*3\݌4G"G" Ќ   3*,-./012(xx*,-./012 *,-./012(xx3*,-./012 "*3"  *332H3  0     Achieveatleastanaverage70percent 5 gaininletteridentificationforchildren {6 completingHeadStart.(Theaveragegain c7 amongallchildrenduringthepreKyear K8 is50percent.)*33`݌39G"G" Ќ   7 ,X,` XDpX]7 MeansandStrategies t;    ACFwillemploynumeroustoolsand L= strategiestoaffectimprovedprogram 8> performanceandenhancedprogram  $? performancemonitoring,consistentwiththe !@ PresidentsGoodStart,GrowSmartinitiative. "A  *,-./012(2xx*,-./012"*3"  *3>223  0    ImplementHeadStartsNational g$C ReportingSystemofchilddevelopment S%D outcomes.*3>k݌?&EG"G" Ќ  "*3"  *3n223  0    Implementanationaltrainingprogramin +'F earlyliteracyteachingtechniquesfor ( G nearly50,000HeadStartteachers.*3n݌)p!HG"G" Ќ   *,-./012(2xx*,-./012"*3"  *3?223  0    Continuefundingresearcheffortsdesigned )\"I toidentifythemosteffectiveearlyliteracy *H#J andteachingstrategiesforchildren.*3?l݌+4$KG"G" Ќ   *,-./012(2xx*,-./012"*3"  *3 223  0    ContinuetosupporttheHeadStartFamily , %L  LiteracyProjectwhichwillwork_with - &MG"G" HeadStartprogramstoimprovethe  qualityoffamilyliteracyservices.*3 I ݌   "*3"  *3!223  0    FundingselectedCentersofExcellence k  onLiteracywhichwilldevelopresearch W  basedtrainingmaterialsthatcanbe C  sharedwithHeadStartgrantees.*3!"݌/  Ќ   *,-./012(2xx*,-./012"*3"  *3#223  0    Resources: ThebudgetrequestforFY   2004is$6,816million,anincreaseof  x approximately$148millionovertheFY d 2003Presidentsbudget.Thisincrease P  willallowHeadStarttoserve14,200 <  additionalchildren,supporttheNational (  ReportingSystemandcontinueother   effortstoimproveearlyliteracy.*3# $݌  Ќ  ExternalFactors  k    TheperformanceoftheHeadStart C programwillbesignificantlyimpactedbya / numberoffactorswhichmayhelporhinder  performancegoalachievementincluding:1) t changesinlocalresourcesavailableto ` supportlowincomechildren,suchasthe L availabilityandqualityofchildcareand 8 publicschoolsupportedpreschool $ programs;2)changesinthedemographic  makeupofHeadStartchildren,suchas  morenonEnglishspeakingchildren;3) {  changesintheavailabilityofhealth g! resources,suchasMedicaid;and4)changes S" intheHeadStartworkforcedue,for ?# example,tohigherturnoverratesofHead +$ Startteachersbecauseofwagecompetition %  fromsimilarprograms. &p!   & * #& G"G"IG" p: (@( w,$:   c-%;  4 #K8;7l|^ `BdE^Z8 "(#"(#(#(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# "(#"(#"(#"(# (#(#"(#"(# (X@(#(#(ProgramBackgroundandContext  t   TheChildCareandDevelopmentFund L  (_CCDF_)wasestablishedunderthePersonal 8  ResponsibilityandWorkOpportunity $  ReconciliationActof1996tohelpworking   lowincomefamiliesachieveandmaintain   economicselfsufficiencyandtoimprovethe {  overallqualityofchildcare.Administeredby g  ACFinpartnershipwithStateandlocal S governments,_CCDF_ԀconsistsofMandatory, ? MatchingandDiscretionaryfunds(ChildCare + DevelopmentBlockGrant)._TANF_ԀandSocial  ServicesBlockGrant(_SSBG_)fundsarealso p usedforchildcare.ACFanticipates \ continuingtopromotetheavailabilityofchild H careservicesasakeyelementinitsstrategyfor 4 helpingfamiliesachieveeconomic   independenceandsupportingchild   developmentandschoolreadiness.    TheChildrensBureauisactivelyengaged, c! withHeadStartandtheDepartmentof O" Education,inimplementingthePresidents ;# GoodStart,GrowSmartinitiative.This '$ initiative,designedtoensurethatchildcareand %  earlychildhoodprogramsmaximizethe %l! opportunitytofurtherearlylearningand &X" literacyinyoungchildren,willrequireStatesto 'D # developvoluntaryguidelinesforschool (0!$ readiness.ThiswillinvolveState_CCDF_ԀLead )"% AgenciesaswellasStateEducationagencies. *#&  ProgramPerformancePlanning  s,$(   _-%)  D ACFisintheprocessofrevisingthe t)  performancemeasuresfortheChildCare `* programforFY2004.Currentmeasures L+ underestimateFederallysubsidizedchild 8 , careservicesbecausetheyexcludechildren $ - servedthroughnon_CCDF_ԀFederalfunding  . streamsincluding_SSBG_Ԁand_TANF_Ԅdirect.  / TheFY2004ACFplanincludesfivechild { 0 careperformancemeasures,fourofwhich g 1 aredevelopmental.ACFwillbedeveloping S2 baselinesforthesemeasuresinFY2003. ?3 ExamplesofFY2004measuresarethe +4 following:   5   *,-./012(yx*,-./012"*3"  *3J92H3  0 D   Increasethenumberofchildren \7 receivingchildcareservicesthrough H8 _CCDF_,_TANF_Ԅdirectand_SSBG_Ԁfunds.*3J9w9݌09D(#D(# Ќ  "*3"  *3:2H3  0 D    Increasetheproportionofcentersand : homesthatservefamiliesandchildren ; receivingchildcaresubsidies.*3:(;݌<D(#D(# Ќ  "*3"  *3R<2H3  0 D    IncreasethenumberofStatesthat g = encourageprovidertrainingand S!> educationthroughbonusesorother ;"? compensation.*3R<<݌##@D(#D(# Ќ   D Thethirdperformancemeasure,whichis $`B new,willassessStateeffortstoencourageor %LC requireincreasedprovidertraining.Given &8D theassociationthatexistsinresearch '$ E betweenprovidertraining/compensation, (!F childcarequalityandoutcomesforchildren, )!G thismeasurewillserveasaproxyforquality {*"H andoutcomesforchildren.Longerterm,in g+#I connectionwithreauthorizationofthe S,$J _CCDF_Ԁ,includingtheGoodStart,Grow ?-%K Smartsetaside,theBureauwillconsultwith +.&L 0&h    Statesandothersaboutamoredirectapproach   toassessingchildoutcomes,whichcould   includeameasurebasedon   Stateassessmentofschoolreadinessat   kindergartenentry.    ̀   *,-./012(xy*,-./0128MeansandStrategies  xl   ACFemploysnumeroustoolsand PD  strategiestoaddresstheavailabilityandquality <0  ofchildcareservicesandimproveprogram (  performance.    *,-./012(2xx*,-./012"*3"  *3TD223  0    TheChildCareBureaupartnerswithHead   StarttosponsortheQUILT(Qualityin   LinkingTogether)projectthatHeadStart  andchildcaregranteesaswellasStatepre  kindergartenprogramsformpartnerships  towardtheprovisionoffullday,fullyear | earlychildhoodservices.*3TDD݌th Ќ  "*3"  *3F223  0    ACFpartnerswithHRSAsMaternaland `T ChildHealthBureautosponsortheHealthy L@ ChildAmericaCampaigninorderto 8, improvehealthandsafetyinchildcare.*3FF݌$  Ќ  "*3"  *3(H223  0    TheChildCareBureauiscurrentlyplacing ! specialemphasisonpartneringwithHead ! StartandtheDepartmentofEducationto " implementthePresidentsGoodStart # GrowSmartinitiative.*3(HUH݌$ Ќ  "*3"  *3I223  0    ACFprovidesextensivetechnical % assistancetoimprovethequalityofState & andTribaldatasubmission.TheChild 'x  CareAutomationResourceCenterandthe p(d! newStateDataandResearchCapacity \)P" GrantsassistStatesinresolvingdata H*< # reportingproblemsandenhancetheir 4+(!$ capacitytoreportaccuratedata.*3I#J݌ ,"% Ќ   *,-./012(2xx*,-./012"*3"  *3L223  0    Resources: The$4,817millionbudget  -#& requestforFY2004includes$2,700-#' millionformandatoryprograms,$2,100  ' millionfortheChildCareand  ( DevelopmentBlockGrant.󀀀Inpart,  ) thesefundscouldpromotestatewide  * planningandimplementationofefforts  + relatedtodevelopingandrefiningearly , learningguidelines,expanding - professionaldevelopmentcapacity,and t. supportingcrossprogramcoordination.*3LM݌l`/D(#D(# Ќ  ExternalFactors  D8 1  D TheperformanceoftheChildCare  3 programwillbeimpactedbyotherfactors  4 whichmayhelporhindertheachievement  5 ofperformancegoalsincluding:1)the  6 nationaleconomy;2)StateFiscal 7 conditions,and3)_TANF_Ԁcaseloadtrends. 8  D  : _(X@( #K9;7l|b^ `BdE b^ (9 (#(#          (#(##`X>XXX>/#X>XX`X>   '     /      7 (X@(#(#(ProgramBackgroundandContext  t   ThemissionofACFsChildSupport XL  Enforcement(_CSE_)programistoassurethat D8  assistanceinobtainingsupportisavailable 0$  tochildrenbylocatingparents,establishing   paternityandsupportobligations,and   modifyingandenforcingthoseobligations.   ACFsOfficeofChildSupportEnforcement   (_OCSE_)worksincooperationwithState  agenciestoaggressivelyimplementthe  programandassurethatperformancegoals  areachieved.Inaddition,_OCSE_Ԁisan  integralpartoftheDepartmentseffortto |p increaseparentalresponsibilityby h\ promotingfathersinvolvementinthelives TH oftheirchildren. @4  ProgramPerformancePlanning  !    TheACFPerformancePlanforFY " 2004includesfiveperformancemeasures # forChildSupportEnforcement.These $ measuresareconsistentwiththe % performancemeasuresusedinthenew & performancebasedincentiveformula,which '  rewardsStatesforachievingperformance x(l! targets.Thefollowingexamplesof_CSE_ d)X" measuresillustratetheprograms P*D # commitmenttoassessingprogramoutcomes <+0!$ andimprovingprogramperformance: (,"%   -#&  *,-./012(yx*,-./012"*3"  *3 \2H3  0 c   Increasethepaternityestablishment t&   percentage(PEP)to99percent.*3 \M\݌l`'cG"cG" Ќ   *,-./012(xy*,-./012[  *,-./012(yx*,-./012"*3"  *3T^2H3  0 c   IncreasetheTitleIVDcollectionrate TH( to60percent.*3T^^݌@4 )cG"cG" Ќ   *,-./012(xy*,-./012]   MeansandStrategies   +  c Thefollowingmeansandstrategies  - illustratehowtheprogramcontinually  . strivestowardsachievingperformance / measures: 0  *,-./012(2xx*,-./012"*3"  *3a223  0 c   TheincentivefundingtoStatesfor 1 performanceonfivemeasurescontinues |2 tobeinstrumentalindrivingthe_CSE_ th3 programtowardachievementofits `T4 performancetargets.Incentivefunding L@5 toStatesisbasedonthefollowing: 8,6 paternityestablishment,currentsupport $ 7 collection,arrearscasespaying,andcost !8 effectiveness.*3aa݌!9cG"cG" Ќ   *,-./012(2xx*,-./012"*3"  *3d223  0 c   DataReliabilityAuditsofperformance ": dataareconductedbyFederalauditors.*3dd݌#;cG"cG" Ќ   *,-./012(2xx*,-./012"*3"  *3Uf223  0 c   ACFpartnerswiththeTreasury $< DepartmentsFinancialManagement %= ServicetoimplementtheIRSTax &> RefundOffsetandAdministrative 'x? PaymentOffsetprogramstooffset p(d@ incometaxrefundsandselectedFederal \)PA paymentstodelinquentchildsupport H*< B obligations.*3Uff݌4+(!CcG"cG" Ќ  "*3"  *3h223  0 c   TheFederalParentLocatorService  ,"D helpstolocatenoncustodialparents,as  -#E wellastheiremployersandwages.*3hh݌ -#FcG"cG" Ќ  "*3"  *3i223  0    TheNationalDirectoryofNewHires   andtheFederalCaseRegistryhelpto   locateabsentparentsacrossStatelines.*3ij݌  Ќ  "*3"  *37k223  0    ACFpartnerswiththeStateDepartment   todenypassportstononcustodial   parentswhodonotfulfilltheirchild  supportobligations.*37kdk݌ Ќ  "*3"  *3l223  0    ACFoperatestheMultiStateFinancial t InstitutionDataMatch(_MSFIDM_)with l` financialpartners,whichassistsin XL  identifyingnoncustodialparentassets.*3ll݌D8  Ќ  "*3"  *3Yn223  0    ACFsProjectSaveOurChildren,isa 0$  partnershipwiththeDepartmentof   Justice,U.S.Attorneys,theFederal   BureauofInvestigation,theHHS   InspectorGeneralandnumerousState   andlocallawenforcementagenciesto  addresscriminalnonpaymentof  support.*3Ynn݌ Ќ  "*3"  *3p223  0    TheFY2004PresidentsBudget  containsproposalstoenhanceand |p expandtheexistingautomated h\ enforcementinfrastructure,whichis TH crucialformeetingperformancetargets. @4 Theproposalsalsoidentifynew ,  enforcementtools.*3pp݌!  Ќ   *,-./012(2xx*,-./012"*3"  *35s223  0    Resources: ThebudgetestimateforFY " 2004is$4,525million.*35sbs݌" Ќ  ExternalFactors  $   TheperformanceoftheChildSupport & Enforcementprogramwillbesignificantly '  impactedbyanumberoffactorswhichmay |(p! helporhinderperformancegoal h)\" achievementincluding:1)theeffectofState T*H # _TANF_Ԁprogramstructuresandpolicies;2) @+4!$ thefiveyeartimelimiton_TANF_Ԁbenefits, ,, "% whichmakeschildsupportevenmore - #& criticalforfamilyselfsufficiency;3)the .#' nationaleconomy;4)wageandemployment  ' rates;5)demographicandsocialtrendssuch  ( asdivorceandnonmaritalbirthrates.  )  c .  + Ї #K:;7l|o `BdEo ":           78787G"7G" 78787878 78787878 78787878 7G"7G"7878    #`X>XXX>̤S#X>XX`X>1XX`1ProgramBackgroundandContext     ACFadministersanarrayofChild l`  WelfareprogramsinpartnershipwithState XL  andlocalgovernments.Thepurposesof D8  ACFsChildWelfareprogramsaretoprevent 0$  maltreatmentofchildrenintroubledfamilies,   protectchildrenfromabuse,andfind   permanentplacementsforthosewhocannot   safelyreturntotheirhomes.Programssuch   asFosterCareandIndependentLiving  providesafeandstableenvironmentsfor  thosechildrenwhocannotremainsafelyin  theirownhomes.TheChildWelfareServices  andPromotingSafeandStableFamilies |p programsprovideservicestochildrenand h\ familieswithafocusonprotectingchildren TH andstrengtheningfamilies.Whenachild @4 cannotbereunifiedwithhis/herfamily, ,  programssuchasAdoptionAssistance, !  AdoptionIncentivesandAdoption " Opportunitiesstrivetoplacethechild " permanentlywithanadoptivefamily. # ! ProgramPerformancePlanning  %    ACFsFY2004PerformancePlan '" includessixperformancemeasuresfocusing x(l# onprogramoutcomes.Themeasuresarethe d)X$ sameasthoseusedintheChildandFamily P*D % Services(CFS)reviews.ACFsfocuson <+0!& outcomesinChildWelfareandtheexcellence (,"' oftheseperformancemeasureswas -#( recognizedbyHarvardUniversityin2001. .#) ACFwasoneof15finalistsoutof3,000 ) applicantsinHarvardUniversitysInnovation t* inAmericanGovernmentcompetition. l`+ Examplesoftheperformancemeasuresare XL, listedbelow: D8 -   *,-./012(yx*,-./012"*3"  *3-2H3  0    Increasethenumberofadoptionsof  / childreninthepublicfostercaresystem  0 to60,000.*3-Z݌ 1(#(# Ќ  sp ?/+b|"u> 5 `.}@E5 5 \6 ;s  2  "*3"  *32H3  0     Ofthechildrenwhoexitthefostercare  "3 systemthroughreunification,maintain "4 thepercentageofchildrenwhodothis #5 withinoneyearofplacementat67 $6 percent.*3$݌%7(#(# Ќ   *,-./012(xy*,-./012 #" MeansandStrategies  'x9   ACFisemployinganumberofstrategies \)P; toaffectenhancedprogramperformancein H*< < childwelfareasfollows: 4+(!=  *,-./012(2xx*,-./012"*3"  *3223  0    Thefinalimplementingregulationsforthe  -#? AdoptionandSafeFamiliesActof1997 -#@(#(# establishedproceduresforfostercare   eligibilityreviewsandStateplanreviews.*3و݌ OO Ќ   *,-./012(2xx*,-./012"*3"  *3Ί223  0    The10ChildResourceCentersprovide   trainingandtechnicalassistancetoState   andlocalagenciesonpermanency   planning,adoption,familycentered  practice,youthdevelopment,legalissues,  abandonedinfants,childmaltreatment, t communitybasedfamilyresource l` services,andinformationtechnology.*3Ί݌XL OO Ќ  "*3"  *3=223  0    ACFhasalsoestablishedanewapproach D8  tomonitoringStatechildwelfare 0$  programsbyestablishingtheCFSreview   process,whichfocusesonoutcomesfor   childrenandfamiliesintheareasof   safety,permanency,andchildandfamily   wellbeing;andsystematicfactorsthat  impacttheStatescapacitytodeliver  servicesleadingtoimprovedoutcomes.  ByFY2004,atleastoneCFSreviewwill  havebeencompletedineachState,anda |p secondreviewwillhavebegunforsome h\ States.*3=j݌THOO Ќ  "*3"  *3Ȑ223  0    IntheFY2004PresidentsBudgetthereis @4 aproposalforanewprogramoptionfor ,  FosterCare,whichwillhelptheprogram !  reachitsperformancemeasures.States " choosingtoparticipatewillreceivetheir " fostercarefundsintheformofflexible # grants,whichwillserveasanincentiveto $ createinnovativechildwelfareprograms % withanemphasisonprovidingservices & thatpreventchildrenfrombeingplacedin '  fostercareandonstrengtheningfamilies. x(l! Inaddition,Stateswillhaveincreased d)X" flexibilityinservicesprovidedand P*D # populationservedandwillfacefewer <+0!$ administrativeburdens.*3Ȑ݌(,"%OO Ќ   *,-./012(2xx*,-./012"*3"  *3p223  0    Resources: ThebudgetrequestforFY -#& 2004is$6,814millionforFoster.#'OO Care/AdoptionAssistanceand  ' IndependentLiving(mandatory),$339  ( millionforChildWelfarePrograms,$56  ) millionforAdoptionIncentives/Adoption  * Awareness,$505millionforPromoting  + SafeandStableFamilies(mandatoryand , discretionary)and$60millionfor - IndependentLiving(discretionary).*3p݌t.(#(# Ќ  ExternalFactors  D8 1     TheperformanceoftheChildWelfare  3 programswillbeimpactedbyotherfactors  4 whichmayhelporhindertheachievementof  5 performancegoalsincluding:1)theeconomy,  6 includingemploymentandwagerates;2)the 7 successofemploymentprograms 8 implementedunder_TANF_;3)thesuccessof 9 initiativeswhichpromotehealthymarriages : andenhancedinvolvementoffathersin |p; childrenslives;4)theavailabilityoflowcost h\< housing;5)theavailabilityofsubstanceabuse TH= treatment;and6)socialanddemographic @4> trendssuchasdivorceandnonmaritalbirths. , ?  "A (X@OO(' #K<;7l| ^ `BdEM ^ Z< (#(#          (#(# (#(#(#(# (X@(#(#(ProgramBackgroundandContext  t   ThisAdministrationhasdevelopedanumber XL  ofprograminitiativesemphasizingthe D8  involvementoffaithandcommunitybased 0$  organizationstostrengthenthenationsfamilies;   namely1)theCompassionCapitalFund,2)the   PromotionandSupportofResponsible   FatherhoodandHealthyMarriageprogram,3)   the_Mentoring_ԀChildrenofPrisonersprogramand  4)theMaternityGroupHomesprogram.  Additionally,underthe_TANF_Ԁreauthorization  proposal,theAdministrationhasaFamily  Formationinitiativeaswellassomeresearchand |p technicalassistancededicatedtothiseffort. h\   AspartoftheAdministrationsinitiativeto @4 provideincreasedsupporttofaithbasedand ,  communitybasedorganizationsandtobuild !  upontheeffortsofcharitableorganizations, " theCompassionCapitalFundprovidesfundsto " public/privatepartnershipstosupportcharitable # organizationsinexpandingoremulatingmodel $ socialserviceprograms. %      `     h     ThisAdministrationiscommittedtomaking '  responsiblefatherhoodandhealthymarriage x(l! nationalpriorities.Toreversetheriseoffather d)X" absenceanditssubsequentimpactonour P*D # Nationschildren,theAdministrationproposes <+0!$ targetingfundsforthePromotionandSupportof (,"% ResponsibleFatherhoodandHealthyMarriage -#& program.Thisprogramfundsactivitiesbypublic .#' entitiesandnonprofitcommunityentities, t' includingreligiousorganizationsandIndian l`( Tribesandtribalorganizations,for XL) demonstrationserviceprojectsdesignedto D8 * testpromisingapproachestopromoteand 0$ + supportinvolved,committedand  , responsiblefatherhood,andtoencourage  - andsupporthealthymarriagesbetween  . parentsraisingchildren,i.e.forthose  / coupleswhochoosemarriagefor 0 themselves,toprovidetheskillsand 1 knowledgenecessarytoformandsustain 2 healthymarriages. 3   Legislationwasenactedin2001to h\5 amendTitleIVBsubpart2oftheSocial TH6 SecurityActtocreateadiscretionary @47 program(_Mentoring_ԀChildrenofPrisoners) , 8 toprovidecompetitivegrantstoStateand ! 9 localgovernments,IndianTribesand ": consortia,andfaithandcommunitybased "; organizationstomentorchildrenofprisoners #< andthoserecentlyreleasedfromprison. $=   TheMaternityandGroupHomes &? Programhelpsprotectandsupportthose '@ youngpregnantmothersandtheirchildren x(lA wholacksafeandstableenvironmentsin d)XB whichtolive.Thesewomenarevulnerable P*D C toabuseandneglectandoftenendupon <+0!D welfare,infostercare,inhomelessshelters (,"E oronthestreetsandtheirchildrenareat -#F highriskofbeingteenparentsthemselves. .#G Tobreakthiscycle,fundswillbetargetedfor   communitybased,adultsupervisedgrouphomes   foryoungmothersandtheirchildren.     %## ProgramPerformancePlanning       Asnewprograminitiativesunderthis  Administration,thereis,asyet,nobaselinedata t tobeusedinthedevelopmentofperformance l` measures.Performancemeasureswillbe XL  developedafterprogramdatabecomesavailable. D8  ACFanticipatesfunding95grantsunderthe 0$  CompassionCapitalFund,30grantsunderthe   PromotionandSupportofResponsible   FatherhoodandHealthyMarriageprogram,10   grantsunderthe_Mentoring_ԀChildrenofPrisoners   programand45grantsundertheMaternity  GroupHomesprogram.   *,-./012(yx*,-./012 @s s s    *,-./012(xy*,-./012۱&%$MeansandStrategies  th      *,-./012(2xx*,-./012"*3"  *3223  0    ACFwillfundgrantsasdescribedabovewith L@ astrongemphasisontheinvolvementof 8, faithbasedandcommunitybased $  organizations.*3݌!77 Ќ   *,-./012(2xx*,-./012"*3"  *3223  0    Resources: The$180millionbudgetrequest ! forFY2004is$25millionmorethantheFY " 2003Presidentsbudgetrequestandincludes # $100millionfortheCompassionCapital $ Fund,$50millionfor_Mentoring_ԀChildrenof % Prisoners,$10millionforMaternityGroup & Homesand$20millionforthePromotion '|  andSupportofResponsibleFatherhoodand t(h! HealthyMarriages.*3݌`)T"77 Ќ  ExternalFactors  8+,!$ #`X>XXX>̳y#X>XX`X>   Numerousexternalfactorsmayimpactthe -#& futuresuccessofthese#`X>XXX>)#X>XX`X>programs.Examplesare -#' 1)theeconomy;2)societalattitudes;3)  ' trendsincharitablegiving;4)sentencingand  ( parolepolicies;5)themedia/publicopinion;  ) 6)financialincentives/disincentivestoward  * marriageincludingtaxpolicy;and7)trends  + inchildbearing.  , e1/ XX@1p    ?,X,` X ,X,` XDpX?P=@<l \'" 3V `@XddddE3VttKL=   ,----#M>=9l|3Yt ` dEM YtL o>          (&%1[X/ X@1  HHSiscommittedtoimprovingthe   efficiencyandeffectivenessofthe z  Departmentsprogramsandachievingthe f  goalsofthePresidentsManagement Ry  Agenda,bycreatinganorganizationthatis >e  citizencentered,marketbasedandresults *Q  oriented.Aspartofouroverallcommitment =  togoodmanagement,HHSisdedicatedto ) successfullymeetingthechallengesidentified  bytheOfficeofInspectorGeneral.Included  inHHSsmanyeffortsistheworktoreduce  erroneouspaymentsandthededicationto  maintainingcleanopinionsinHHSaudited  financialstatementscoupledwiththepushto  meetacceleratedreportingrequirements. v   TheDepartmentisdiligentlyworking b withbothCMSandACFtoreduceerroneous N u payments.AtCMS,throughHealthCare :!a FraudandAbuseControl(_HCFAC_)Program &"M efforts,HHShasimplementedaggressive #9 effortstoreduceerroneouspayments, #% includingfraudandabuseinboththe $ MedicareandMedicaidprograms.For % example,inMedicaid,CMSiscommittedto & assistinginterestedStatesindeveloping ' methodologiesandconductingpilotstudies (  tomeasureMedicaidpaymentaccuracyrates. )!! HHScurrentlyhas12statesparticipatingina r*"" MedicaidPaymentAccuracyMeasurement ^+## pilot.HHSanticipatesexpandingthispilotto J,q$$  25statesinFY2004.E% ,X,` XDpX0*X,X,` XE 6-]%%  D FY2001wasthefirsttimeHHSandall  %  ofitsoperatingdivisionsreceivedclean z & auditopinionsforauditedfinancial f ' statements.HHSwillcontinueitseffortsto Ry ( retaincleanauditopinions.Overthenext >e ) severalyears,HHSwillincreaseeffortsto *Q* expandandenhancethefinancialanalysis =+ alreadyperformed. ), N ,X,` XDpX ,X,` XDpX0*XN D HHSisimplementinganambitious - restructuringplanaimedatconsolidating . andautomatingadministrativefunctions,re / engineeringbusinessprocesses,delayering 0 organizationstospeeddecisionmakingand 1 reducingthenumberofmanagementlayers. 2 Onespecificissuebeingaddressedisthe v3 expectedsignificantnumbersofretirements b4 inFY2004andFY2005.However,the N u5 Departmentalrecruitmentandretention :!a6 strategydevelopedinFY2002willhelp &"M7 HHSmeetthechangesthatthissurgein #98 retirementswillprovide. #%9  D HHSbelievesthatthesehighlighted $: efforts,combinedwithallotherHHS %; initiativeswillallowHHStomaintain &< excellenceinitsmanagementpractices. '=   ( > pq e   ([X@  (*)*dd\RF\RF\R(#(#,\R,\R,I\R+  <VVV#' < HHSStrategicGoal    AVVV#,!"VVV# A#`X>XXX>ҹ#X>XX`X>Agencies/   Programs   AVVVV#,!p "VVV# AFY2004PerformanceMeasures#`X>XXX># TVVC, " VVVV# T` X`X>GOAL8:Achieve R  Excellencein P   Management N   Practices ` .#`  # ` #X>X -# NVV=2L " VV NЌXX>#`ЌЌ# OIG_HCFAC_ f   Program ?VVV,!*  "VV ?Ќ`Ќ#X>XЌ#ЌXX>ԄMedicare/Medicaidtotalexpectedrecoveriesandsavingsper f  dollarinvestedof$156:1inFY2004.* *   *,-./012(yx*,-./012ӄWorkinpartnershipwithCMStoreducetheMedicare  ` PaymentErrorRateastobedeterminedbyCMS#X>XЌ#.ЌXX>*  $ #X>XЌn# *,-./012(2xy*,-./012P#`X>XXX>c#`ЌX`X> OVV>'  VVV O 7VV&lVV 7#`X>X`Ќw#`ЌX`X>ACFandCMS l CleanAudits ?VVV,!0"VV ?#`X>X`Ќ?#`ЌX`X>ԄObtainacleanauditopinionforACFfor_FYs_Ԁ2002,2003and l 2004.[FY9901:Cleanauditopinion] 0  *,-./012(yx*,-./012ӄMaintainacleanunqualifiedopiniononCMSs_FYs_Ԁ2002, f 2003and2004financialstatements. #`X>X`Ќ#`ЌX`X> [FY9901:Cleanaudit *  opinion]  |   *,-./012(2xy*,-./012 OVV>'@  VVV O 7VV& VV 7CDC   Facilities D  Improvement ?VVV,! "VV ?  CompleteconstructionofInfectiousDiseaseLab,Building   109,toreplaceBuildings4,6,7,8and9onthe_Chamblee_ D  Campus.[FY03:PhaseIIconstructioncomplete]    *,-./012(yx*,-./012ӄDesignandconstructanEnvironmentalToxicologyLab, Z ! Building110,toreplaceBuildings17,25,31and32onthe " _Chamblee_ԀCampus.[FY03:Constructiononschedule] T#  *,-./012(2xy*,-./012Ќ`Ќ7-+$  VVV 7*Seeagencyperformanceplan/reportforadditionalinformation.  t$  ([X@(#(#(/NE #K?;7l| `BdE!!_?              X>XЌProgramBackgroundandContext      TheHealthInsurancePortabilityand   AccountabilityActof1996(_P.L._Ԁ104191, r  _HIPAA_ԀortheAct)createdthe_HCFAC_ ^  Program(atSection1128CoftheSocial J  SecurityAct)andspecificallyfundstheOIG 6  _HCFAC_ԀProgram.TheActcoordinateshealth "  carefraudenforcementactivitiesinasingle   program,ledbyHHSandtheDepartmentof l Justice(_DOJ_),andprovidespowerfulnew X criminalandcivilenforcementtoolsand D resourcestocombathealthcarefraud. 0   TheActappropriatesmoniesfromthe  MedicareTrustFundtothe_HCFAC_ԀAccount  inamountsthattheSecretaryandAttorney  Generaljointlycertifyarenecessaryto n financeantifraudactivities.Themaximum Z amountsavailablearespecifiedintheAct. F Certainofthesesumsaretobeavailableonly 2 fortheactivitiesoftheHHSOIG.     Theincreasedresourcesmadeavailable  !| under_HIPAA_ԀhaveenabledOIGtoenhance !h itseffortstobothdetectfraud,wasteand "T abuseandtopreventit.Equallyimportant, #@  OIGspreventionactivitiesreducethe $,! governmentsenforcementcostsandprogram %" losses. &# H ,X,` XDX ,X,` XDpXH  InadditiontofundingtheOIG_HCFAC_ ~'$ Program,theMedicareTrustFundalsofunds j( % theMedicareIntegrityProgrammanaged V)!& thoughCMSatafundinglevelof$720 B*"' millioninFY2003. .+#(  ProgramPerformancePlanning  -x%* H ,X,` XDpX ,X,` XDXH -d&+  cdcdcs#cs# cdcdcdcd cdcdcdcd cdcdcdcd cdcdcdcd cdcdcdcd cs#cs#cdcd D TheOIG_HCFAC_ԀProgramhasthe t2 followingmeasuresthatarerepresentativeof `3 theprogramandillustratekeyprogrammatic L4 missionandactivities: 8 5   *,-./012(yx*,-./012"*3"  *3q2H3  0 p    Medicare/Medicaidtotalexpected  7 recoveriesandsavingsperdollar  8 investedof$156:1inFY2004*3q݌r 9ps#ps# Ќ   *,-./012(xy*,-./012 *,-./012(yx*,-./012"*3"  *32H3  0 p   WorkinpartnershipwithCMSto Z : reducetheMedicarePaymentError F; RateastobedeterminedbyCMS *3݌.<ps#ps# Ќ   *,-./012(xy*,-./012:sp,? /+b|"FY[ ( `.#@Ec[ ( [ (  @s (#  t> /(& MeansandStrategies  )#?  D TheOIGrolefeaturescollaborationwith %sA otherDepartmentcomponents,otherFederal %_B unitssuchas_DOJ_ԀandStateandlocal &KC agenciessuchastheStateMedicaidFraud '7 D ControlUnits.OIGandits_HCFAC_Ԁpartners (#!E emphasizeaninterdisciplinaryand )"F intergovernmentalapproachtoimprovethe *"G governmentsabilitytoidentifyfraudulent u+#H andabusivehealthcareprovidersand a,$I correctsystemicproblems.Thecoordinated M-%J effortdrawsonthetalentsoflocalaging 9.&K organizationsandStatesurveyofficialsand  ombudsmeninidentifyingandreporting z fraudandabuse.The1800HHSTIPS f  Hotlineisanimportantpartoftheprogram. R  Inaddition,OIGcontinuestoform >  associationswiththehealthcareindustryto *  publicize bestpractices,promotevoluntary   complianceplansandconsultonprogram t integritystrategies. `  v(8x*,-./012 ExternalFactors  8    #`X>XXX>#EX>XX`X>Awidearrayofexternalinfluencescan   affectOIGs_HCFAC_Ԁeffortsforanyoneyear.   Trialsandappeals#`X>XXEX>M#EX>XX`X>Ԁmaytakeyears,with v  resolutionwellaftertheinvestigativeworkis b  completed.Thereafter,recoveriesmayoccur N overadditionalyearsunderstaggered : paymentschedules.Keyportionsofthe & enforcementprocessareoutsidethecontrol  ofOIGandaretheresponsibilityoftheir p partners(e.g.,prosecutionofcases, \ settlement,collectionofrecoveriesand H implementationofrecommended 4 improvements).Althoughthisfostersthe   collaborationenvisionedby_HIPAA_,italso   contributestosometimessignificantdelays  betweenOIGactionsandpositiveoutcomes. r  Becauseofthis,forexpectedrecoveriesOIG ^! isinstitutingacalculationofamoving J" average,basedonthepriorthreeyears.This 6# averagefigurewillbeusedtocalculatethe "$ targetfortheupcomingyearsrecoveries.For %  example,thegoalfor_HCFAC_Ԁrecoveriesfor %l! FY2004representsa10percenttarget &X" increaseovertheaverageannualexpected 'D # recoveriesforthepriorthreeyears,FY1999 (0!$ 2001. )"%   Numericalgoalshaveanadditional *#& drawback.OIGcannottieindividual +#' performancetoaspecificnumberofcriminal n,$( prosecutionsordollarsrecovered,sincetodo Z-%) soeither(1)conditionsemployee F.&* performanceonmatterspartlyoutsidetheir * control(e.g.,prosecutions)or(2)createsthe z+ appearanceofabountysystem.Bothrisk f , renderingtheperformanceplan R - unenforceable.However,aggregatenumbers > . relatingtoenforcementactionsremaina * / goodindicatorofthevitalityoftheprogram.  0 Thesenumbers,suchasnumbersof t1 exclusions,settlementsunderpatient `2 dumpingcases,criminalconvictionsandthe L3 like,arealltrackedandreportedinthe 8 4 annualreportof_HCFAC_Ԁaccomplishments $ 5 preparedbytheAttorneyGeneralandthe  6 Secretary.#`X>XXEX>A#  7  D Asapartofthe_HIPAA_Ԁlegislation,the v 8 Actprovidesforenhancedfundingforanti b 9 fraudefforts.Specifically,theAct N: automaticallyappropriatesmoniesfromthe :; TrustFundtoaFraudandAbuseControl &< AccountinamountsthattheSecretaryand = AttorneyGeneraljointlycertifyeachyearas p> necessarytofinanceantifraudactivities. \? Maximumamountsavailablefor H@ certificationarespecifiedintheAct.InFY 4A 2002,themaximumamountwas$209  B million,inFY2003itis$241million.  C FundingforallyearsafterFY2003isfixed D attheFY2003levelof241million. r E  D Thestatuteprovidesthatasignificant ^!F amountofthesefundsbemadedirectly J"G availabletoOIG.ForFY2002arangeof 6#H $140$150millionwasspecified.Theactual "$I amountprovidedtoOIGwas$145million. %J TherangespecifiedforFY2003is$150 %lK 160million.Liketheamountforthe &XL _HCFAC_Ԁprogramasawhole,thisrangeis 'D M fixedforallfutureyears. (0!N   )"O             #KA;7l|xs  `BdExs  "A *   cdcdcs#cs# cdcdcdcd cdcdcdcd cdcdcdcd cdcdcdcd cs#cs#cdcd *   ([X`  (([X@(#(#( X>XX`X>#ЌXX>̀#X>XЌProgramBackgroundandContext #`X>XXX>& # t    Properfinancialmanagementisessential L  fortheoperationofviablefederalandstate 8  administeredhealthcareprograms.HHSis $  committedtoensuringthatitsfederal   programsandthestateprogramsitoversees   utilizestrongfinancialmanagementpractices v  andtosupportingthePresident's b  ManagementAgenda.Inadditiontoother N efforts,oneparticularfinancialmanagement : practiceHHShasalreadystartedusingand & willexpandinthefutureisthemeasurement  ofpaymenterrorratesformanyofitslargest p programs. \  Medicare  4  X>XX`X>ProgramPerformancePlanning #`X>XXX>)#     CMSstartedmeasuringthepercentageof r  improperpaymentsmadeundertheMedicare ^! fee-for-serviceprogramin1996andcreateda J"  goaltoreducethispercentage.Thepurpose 6#! ofthisgoalistocontinuetoreducethe "$" percentageofimproperpaymentsmadeunder %# thefee-for-serviceprogram.OneofCMS's %l$ keygoalsistopayclaimsproperlythefirst &X% time.Thismeanspayingtherightamount,to 'D & legitimateproviders,forcovered,reasonable (0!' andnecessaryservicesprovidedtoeligible )"( beneficiaries.Payingrightthefirsttimesaves *#) resourcesrequiredtorecoverimproper +#* paymentsandensurestheproperexpenditure n,$+ ofvaluableMedicaretrustfunddollars. Z-%,  F.&-  X>XX`X>MeansandStrategies #`X>XXX>}# t-  D  D ThecomplexityofMedicarepayment 8 0 systemsandpoliciesandthenumberof $ 1 contractors,providersandinsurersinvolved  2 intheMedicarefee-for-serviceprogram  3 createvulnerabilities.CMShas v 4 implementedaCorrectiveActionPlan b 5 (CAP)designedtominimizethese N6 vulnerabilitiesandreducetheMedicare :7 claimspaymenterrorrate.Examplesofthe &8 positiveeffectsofCMS'scorrectiveactions 9 onreducingimproperpaymentsare p: illustratedinboththe1998and1999OIG \; reports. H<  D CMSexceededits_GPRA_Ԁtargetsfor1999 4= and2000.Ingeneral,thesubstantial  > reductionintheerrorratedemonstratesthat  ? theMedicarecontractorclaimsprocessing @ systemisworkingwell.Furthermore,during r A previousaudits,asignificantportionof ^!B improperpaymentsreportedwere J"C attributabletodocumentationerrors. 6#D However,inFY1998,documentationerrors "$E accountedforonly$2.1billion,asubstantial %F declinefromthe$8.7billionreportedinFY %lG 1996.OIGattributedmuchofthesubstantial &XH improvementinthiscategorytotheCMS 'D I CAP.CMSagreedtocontinuethese (0!J correctiveactionsinresponsetoboththeFY )"K 1998and1999audits. *#L  D InFY2001,CMSdidnotreachthetarget +#M ofsixpercent,howeverCMScontinuedits n,$N successbyreducingtheerrorrateto6.3 Z-%O percent.CMSwillfurtherreducetheerror F.&P ratebycontinuingtofocusitscorrective  actionsonareasofvulnerabilityidentifiedby z OIG.CMSbelievesthatbyaggressively f  addressingspecifichighriskareasitwill R  continuetobesuccessfulinreducingthe >  fee-for-serviceerrorrate. *  X>XX`X>  CMSisintheprocessofimprovingits   abilitytomeasureitsMedicarefeefor t serviceerrorratebydevelopingerrorratesfor ` eachspecificMedicarecontractorthat L  processesclaims.Thisimprovementwill 8  allowCMStodevelopcontractorspecific $  errorratesaswellasdeterminenationalerror   ratesforspecificproviderandclaimstypes.   ForadiscussionofCMS'snew v  ComprehensiveErrorRateTesting(CERT) b  program#`X>XXX>B#,thatCMSwillbeusinginFY2004 N toaidintheiranalysisoftheerrorrate,see : CMS'sFY2004_GPRA_Ԁplan. &  EX>XX`X>#`X>XXEX> #EX>XX`X>Medicaid#`X>XXEX>!#X>XX`X> p ProgramPerformancePlanning#`X>XXX>[!#EX>XX`X> H  #`X>XXEX>!#EX>XX`X>  ThroughthePaymentAccuracy   Measurement(PAM)program,CMSis   currentlydevelopingapaymentaccuracy  measurementmethodology.ThePAMproject r  isinthesecondyearofafiveyeartimeline.#`X>XXEX>0"# ^! EX>XX`X> #`X>XXEX>̢##X>XX`X>MeansandStrategies #`X>XXX>##EX>XX`X> 6#   InFY2002,theCenterforMedicaidand %  StateOperations(_CMSO_)workedwithnine %l! statestodevelopandpilottestvariousstate &X" specificpaymentaccuracymeasurement 'D # methodologies.InFY2003,_CMSO_Ԁis (0!$ workingwith12statestopilottestthePAM )"% Modelthat_CMSO_Ԁisdeveloping.#`X>XXEX>A$##`ЌX`X>h #`X>X`Ќ *#& EX>XX`X>  InFY2004,theprogressreportsand +#' findingsfromtheFY2002andFY2003pilot n,$( yearswillbeusedtoproduceadraftofthe Z-%) finalspecificationsfortheCMSPAMModel F.&* thatwillbepilottestedinupto25states. * ThesuccessfulpilottestoftheCMSPAM z+ Modelinthese25stateswillprovide f , CMS/_CMSO_Ԁwiththefinalspecificationsfor R - amethodologythatcanbeimplementedin > . allstatesinFY2005.Stateparticipationin * / thePAMpilotisstrictlyvoluntary,andthe  0 federalgovernmentispaying100percentof t1 pilotprojectcosts.Eveniffullfederal `2 fundingwasprovidedonanongoingbasis,a L3 federalstatutorymandateclearlywillbe 8 4 requiredtogetallstatestoinstitutea $ 5 standardizedPAMprocess.#`X>XXEX>&#EX>XX`X>#EЌXEX>̵&#EX>XEЌԀAfterfull  6 implementationofthemethodologyacross  7 allstates,thebaselinepaymentaccuracy v 8 datafortheMedicaidprogramatthe b 9 nationallevelwillbeavailable.#`X>XXEX>[+# N:  EX>XX`X>_SCHIP_ #`X>XXEX>,# &< EX>XX`X> #`X>XXEX>~-#X>XX`X>ProgramPerformancePlanning#`X>XXX>-# EX>XX`X> p>  D HHSwillsubmita_SCHIP_Ԁactionplanfor H@ thedevelopmentandimplementationofa 4A _SCHIP_Ԁpaymentaccuracymeasurement  B project.#`X>XXEX>+.#  C EX>XX`X> #`X>XXEX>̛/#X>XX`X>MeansandStrategies #`X>XXX>/#EX>XX`X> r E  D HHSrecommendsthatoftheFY2003 J"G $10million_HCFAC_ԀProgramwedgefund 6#H (moneynotdirectlyavailabletoOIG) "$I programintegritymoney,$3.7millionbe %J usedtofundthe_SCHIP_ԀPAMpilot.The %lK fundswillsupportstate_SCHIP_Ԁpilotprojects &XL andexpandedworkby_CMSO_stechnical 'D M consultants.#`X>XXEX>:0##`ЌX`X>̝+#`X>X`Ќ (0!N EX>XX`X> D HHSplanstosolicitstates,initially )"O targetingthe12statesparticipatinginthe *#P FY2003MedicaidPAMproject,totestthe +#Q MedicaidPAMmethodologyintheir_SCHIP_ n,$R programs.Ofthe12pilotstates,threehave Z-%S standalone_SCHIP_Ԁprograms,threehave F.&T Medicaidexpansion_SCHIP_Ԁprogramsandsix  operatebothtypesof_SCHIP_Ԁprograms.Most z states,includingthese12,arefacingsevere f  administrativebudgetandstaffingpressures. R  Asaresult,evenwith100percentfederal >  funding,itwillbeachallengeforHHSto *  enlistasmanyasadozenstatesinthe_SCHIP_   pilot.#`X>XXEX>!3##`ЌX`X>2#`X>X`Ќ t  ACF  L      ACFiscommittedtoimprovingthe $  financialperformanceofitsprograms,akey   elementofthePresident'sManagement   Agenda.Currently,HHSandACFare v  involvedindiscussionswithOMBonways b  toenhanceprogramintegrityandfinancial N managementpractices.HHSeffortsto : improveX>XX`X>financialmanagementinclude & developingerrorratesforsomeofitsmost  importantprograms.#`X>XXX>̈9#ԀPlanstomeasureerror p ratesinHeadStart,FosterCare,and_TANF_ \ areunderdevelopment. H   5@(#(#[X@  5_ #`ЌX`X>l7#   /Nw Xe   `X>X`Ќ(X@(#(#( #KB;7l|x `BdEx ]B       ProgramBackgroundandContext   `   Federalagenciesfinancialstatementsare 8  auditedtoreassurethepublicthatthose $  statementsfairlyandaccuratelyrepresentthe   agencysfinancialcondition.Acleanand }  timelyauditopiniononthesestatementsis i  essentialifdecisionmakerswithintheagency, U  theOfficeofManagementandBudgetand A Congressaretousethisinformation.The - AdministrationandSecretaryhavesetHHS  wideprioritiestoimprovefinancial  management.HHShascreatedastrategicplan p to,amongotherthings,supportthesepriorities \ throughachievingacleanauditopinionforthe H Departmentasawholeandforitsoperating 4 divisionsindividually.    ProgramPerformancePlanning  y   HHSisaddressingimprovementin Q financialreportingreflectiveofitsthird =  consecutiveyearofacleanopinionforthe )! Department.AlsoinFY2001,itachievedclean " opinionsforallofitsmajoroperatingdivisions. #  InFY2002,HHSisaddressingtheissueof #l! acceleratingitsfinancialauditandreporting $X" andimprovingitsfinancialanalysisprocessto %D # ensurehighqualityfinancialinformationis &0!$ availabletimely.Insupportofthiseffort,many '"% operatingdivisionshavecleanopinion (#& performancegoalsand/ormeasures.The u)#' followingarejusttwoexamplesthatare a*$( representativeoftheprograms: M+%)   *,-./012(y8v .(,  T$$T$$$$ T$$T$$T$$T$$ T$$T$$T$$T$$ T$$T$$T$$T$$ T$$T$$T$$T$$ T$$T$$T$$T$$ $$T$$T$$"*3"  *3~F2H3  0 p    Obtainacleanauditopinionforthe  t3 AdministrationforACFfor_FYs_Ԁ2002,  `4 2003and2004.*3~FF݌ H5p$p$ Ќ   v(8y*,-./012#E *,-./012(y8v"*3"  *3H2H3  0 p   Maintainacleanunqualifiedopinionon  7 CMSs_FYs_Ԁ2002,2003and2004  8 financialstatements.*3HI݌m 9p$p$ Ќ   v(8y*,-./012`H *,-./012(2x8v 2/' MeansandStrategies  A ;  D ACFreceivedacleanopinionfromauditors = forFY19992001amajoraccomplishment > thatcontributedsignificantlytothe p? Departmentscleanopinion.Nevertheless,this \@ isonlyonestep,albeitasignificantone, HA towardsfinancialaccountabilitytothepublic. 4B AlthoughACFhasachievedacleanopinionfor  C threeyears,improvementstoitsaccounting  D systemsandservicesarestillneeded,especially yE withOMBrequiredcompresseddeadlines eF beginningwiththeFY2002auditcycle. QG  D CMSsgoalistomaintainacleanopinion, =H whichindicatesthattheirfinancialstatements ) I fairlypresent,inallmaterialrespects,the !J financialposition,netcosts,changesinnet "K position,budgetaryresourcesandfinancingof "lL CMS.SinceFY1998,CMShasmade #XM significantimprovementsontheirfinancial $DN statements.Inaddition,theycontinueto %0 O developtheanalyticaltoolsnecessaryto &!P performmoreexpansivetrendanalysisof '"Q criticalfinancialdatatoidentifypotentialerrors u("R ormisstatements.Theirlongtermplanisto a)#S implementanintegratedgeneralledger M*$T accountingsystem. 9+%U   %,&V "*3"  *3Q223  0       OnFY1998statements,theyobtaineda  qualifiedopinionbecauseauditorsfound m deficienciesinseveralaspectsofthe Y Medicarecontractorsaccountsreceivable.*3Q#R݌E Ќ   *,-./012(2xx*,-./012"*3"  *3"T223  0    InFY1999,FY2000andFY2001CMS 1  receivedcleanopinions.*3"TOT݌  Ќ   *,-./012(2xx*,-./012"*3"  *3U223  0    DuringFY2001,theytestedfinancial   managementinternalcontrolsatthirteen  t Medicarecontractorsusingcertifiedpublic  ` accounting(CPA)firms,conducted  L  contractorperformanceevaluationreviews 8  offinancialmanagementissuesatsix $  Medicarecontractorsandreviewed   accountsreceivablebalancesattwelve }  MedicarecontractorsusingCPAfirms.*3UU݌i  Ќ   *,-./012(2xx*,-./012 ExternalFactors  A   ForFY2004,theauditcyclemustbe  completedbyNovember,morethantwo  monthsearlierthanpreviousyears.ACFis p workingcloselywiththeDepartmenttomeet \ theseincreasinglyshortenedauditdeadlines. H WhileACFiscommittedtoachievingfuture 4 cleanopinions,theabbreviatedcyclesare   creatingmajorresourcechallenges.ACFis   workingtoimprovethelinkageoffinancial y managementsystemsanddatatoprogram e performanceandresultsandprovidemore Q accurateandtimelydatatofinancial/program =  managerstofosterinformeddecisionmaking. )!    (X@(  # #`ЌX`X>;#`X>X`Ќ(X@(#(#( #KC;7l|^7 `BdE^7RC        ProgramBackgroundandContext   t   TheDepartmentsemployees!ourhuman  L  capital!areakeytoaccomplishingour 8  missionandgoals.Missionaccomplishment $  requiresthatwealignourhumancapitalwith   theDepartmentsstrategicdirection.This }  requiresworkforceplanning!havingtheright i  peoplewiththerightskillsdoingtherightjobs U  attherighttime.Italsomeansknowingwhat A thoseskillsare,howtherequirementsare - changingandhowourworkforceischanging,  sothatwecantakethestepstofind,recruit,  hireandkeeptheworkforcethatwewillneed. p  ProgramPerformancePlanning  H   HHShasassertivelymovedtoalignits   humancapitalprogramswiththeDepartments   mission.Theseinitiativestoimprovehuman y capitalmanagementarepartofoureffortsto e implementthePresidentsManagement Q Agenda,aimedatmakingHHSamorecitizen =  centeredDepartment.  )!   Oureffortsincludesystematically " eliminatingunnecessarymanagementlayers,so #  thattherewillbenomorethanfourlevelsfrom #l! thefrontlineworkertothetopdecision $X" makers.Aspartofitsrestructuringplan,HHS %D # isconsolidatingits40humanresourcesoffices &0!$ intofourDepartmentalHRservicingsitesby '"% theendofFY2003. (#&   TheDepartmentlevelHRconsolidationis u)#' mirroredbyeffortsinallHHSOperating a*$(  .(,  #$#$$$ $$#$#$Divisionstoconsolidateadministrative  t3 functions,eliminate_duplicative_Ԁofficesandre  `4 deploystafftomissionfunctions.Theseactions  L5 arejustpartoftheDepartmentseffortstoalign 8 6 itshumancapitaltoitsstrategicdirection. $ 7  D Workforceplanninghaspointedoutissuesof  8 growingretirementeligibilityand hotspots } 9 inresignationsandturnover.HHSscross i : cuttingRecruitmentandRetentionPlanhasput U ; inplaceinitiativestoaddresstheseissuesby A< recruiting,hiringandkeepingtheworkforcewe -= willneedinthefuture. >  D TheDepartmentsRecruitmentandRetention ? planhasfosteredseveralDepartmentalhuman p@ capitalinitiativesofnote,includingthe \A EmergingLeadersProgram,aninnovative HB careerinternprogramtodevelopfutureleaders; 4C theHHSCorporateUniversity,consolidating  D commonneedstraininginoneplace;anexit  E interviewprojecttoanalyzewhyemployees yF leave;andaretentionstudytodevelop eG informationonthefactorsthatinfluence QH employeestostaywithHHS.Takentogether, = I thesetargetedactionstofind,hire,place, )!J developandkeepemployeeswithcriticalskills "K arethecornerstoneofaligningHHSshuman #L capitaltomissionaccomplishment. #lM   32( MeansandStrategies  %D O  D TheseeffortscutacrossHHS.As '"Q Departmentalinitiatives,theyarereflectedand (#R supportedinthe_OPDIV_Ԁplans.The u)#S Departmentshumancapitalinitiativescanbe a*$T summedupinfivecrosscuttingefforts: M+%U "*3"  *3Bo223  0 p   ImplementDepartmentalrecruitmentand 9,&V  retentionstrategies;*3Booo݌ %-'Wp$p$ Ќ  _"*3"  *3cp223  0    Developandimplementstrategic workforce  planstorespondtoandeliminateskills m imbalances;*3cpp݌Y Ќ  "*3"  *3q223  0    Consolidateadministrativefunctionsto E eliminateduplicationandincrease 1  efficiencyandeffectiveness;*3qq݌  Ќ  "*3"  *3r223  0    Delayerorganizationstonomorethanfour   managementlayerstospeeddecision  t making;and*3rs݌ ` Ќ  "*3"  *3)t223  0    Deploystafftomissionrelatedfunctionsto  L  improveHHSasacitizencentered 8  Department.#`ЌX`X>̹\#*3)tVt݌$      U    U  Ќ  _ `X>X`Ќ1X@1ue #KD;7l|^ `BdE^)^D VV      VVProgramBackgroundandContext#`ЌX`X>u#   ` `X>X`Ќ  SubsequenttoitspostWorldWarII   origins,CDCgrewtorespondtonewpublic   healththreats.Asitgrew,theorganization y  spreadoutoverseverallocationsthroughout e  theAtlantametropolitanarea.Many Q  employeesworkin23leasedbuildings.Some =  CDCscientistsconductexperimentson ) infectiousmicroorganismsinwooden  buildingsthatwereconstructedastemporary p facilitiesalmost60yearsago. \   CDCundertookafacilityplanningeffort H toconsolidateitsAtlantaoperationsintotwo 4 securecampuses.Thehighestprioritiesinthis   effortincludecompletionoftheEmerging   InfectiousDiseaseLab,constructionofthe  ScientificCommunicationsCenter,designand u constructionoftheEastCampusConsolidated a LabProjectandstartofconstructionofthe M HeadquartersandEmergencyOperations 9 Center,allatthe_Roybal_ԀCampus.Thehighest %  prioritiesalsoincludecompletionofthe ! EnvironmentalToxicologyLabatthe !l _Chamblee_ԀCampusandannualrepairand "X  improvementstoCDCsnationwidefacilities. #D!  ProgramPerformancePlanning  % # CDChasnineperformancemeasuresthat &!$ addressdesign,constructionandcompletion '!% ofitsvariousfacilitiesprojects.Thefollowing q("& measuresarerepresentativeofthe ])#' projectsandprogrammaticactivities: I*$(  -h(,  ##      ##  *,-./012(yx*,-./012"*3"  *32H3  0 D   CompleteconstructionofInfectious  L5 DiseaseLab,Building109,toreplace 8 6 Buildings4,6,7,8and9onthe  7 _Chamblee_ԀCampus*3݌ 8D#D# Ќ   *,-./012(2xy*,-./012k  *,-./012(yx*,-./012"*3"  *32H3  0 D   DesignandconstructanEnvironmental  9 ToxicologyLab,Building110,toreplace m : Buildings17,25,31and32onthe U ; _Chamblee_ԀCampus*3݌=<D#D# Ќ   *,-./012(2xy*,-./012 MeansandStrategies  >  D Thefollowingmeansandstrategies X@ illustratehowtheCDCBuildingsand DA Facilitieseffortstrivestowardsachieving 0B performancemeasures. C "*3"  *3̆223  0 D   Resources: TheFY2004Budgetrequest D isfor$114million.Animportantresource E CDCisemployingisanewdirectorof uF facilitiesmanagementandplanningwho aG hasaPh.D.incivilengineering. *3̆݌MHD#D# Ќ  "*3"  *3223  0 D   TheconstructionofInfectiousDisease 9 I Lab,Building109,toreplaceBuildings4, %!J 6,7,8and9onthe_Chamblee_ԀCampushas "K beenconsistentlyonschedule.PhaseII "lL constructionisexpectedtobecompletein #XM FY2003andCDCstargetistooccupy $DN thenewlabinFY2004.*3҈݌%0 OD#D# Ќ  "*3"  *3223  0 D   Constructionhasbegunonthe &!P EnvironmentalToxicologyLab,Building '"Q 10,toreplaceBuildings17,25,31and32 ("R onthe_ChambleeCampus_.CDCs q)#S performancetargetistocomplete ]*$T constructionbyFY2004.*3.݌I+%UD#D# Ќ   D  p      x   .|(X  VV       VVVV)V  t  P##P#### P##P##P##P## P##P##P##P## P##P##P##P## P##P##P##P## P##P##P##P## P##P##P##P## ##P##P##  t (VV( VV(#(# Introduction   L  (#(#VV    HHSPerformancePlansandReports:GE73n|DDM `@EDDMtt\L|WEaddressanumberofimportantmanagementissuesthat $  canaffectoverallperformance,orarelinkedtofraud,wasteandabuse.Belowaresomeofthe   mostimportantchallengesidentifiedintheOIGslistofTopManagementChallenges,which   identifiestheissueandsummarizesprogress.FormoreinformationonOIGactivitiesand y  reports,visit4= "O  5  http://oig.hhs.gov.6D"OX  7  e  Inaddition,anotherperspectiveofoverallDepartmentmanagementissuesisdetailedinGAO = 01748,HealthandHumanServicesStatusofAchievingKeyOutcomesandAddressingMajor ) ManagementChallenges.   Bioterrorism Preparedness  H   EventsofandsinceSeptember11,2001haveunderscoredtheneedforthenecessary $ infrastructureandtoolstorespondtopotentialfutureterroristevents,includingbioterrorismand  otherpublichealthemergencies.HHSisresponsibleformuchofthenationsfederalhealthcare  resourcesandprograms.CDChasspecific,keyresponsibilitiestohelpprotectthenationfrom, y  andrespondto,actsofbioterrorism. e!   TheOIGsconcerncentersonHHSvulnerabilitiestooutsidethreats,andthereadinessand Q " capacityofrespondersatalllevelsofgovernmenttoprotectthepublichealth.TheOIGis =!# evaluatingtheeffectivenessofCDCsbioterrorismeffectivenessefforts,andplanstocontinue )"$ securityandhealthsystempreparednessstudies. #%   Federal,state,andlocalhealthdepartmentsareworkingcooperativelytoensurethat $p& _bioterrorist_Ԁattacksaredetectedearlyandrespondedtoappropriately.Aspartofthiseffort,CDC $\' hastakenstepstoincreasethesupplyofpharmaceuticalsneededintheeventofchemical, %H ( biological,orradiologicalattacks.>X>XX`X>CDChasfundedfivestateenvironmentalhealthlaboratories &4!) toprovideadditionalsurgecapacityintheeventofamajorchemicalterrorismincident.#`X>XX>X>ʙ#ԀCDC's ' "* has>X>XX`X>expandedtheexistingbioterrorismcooperativeagreementstofundallstates,fourlocalities, ( #+ andeightterritories.Alljurisdictionsnowreceivefundingforeachofthekeyelementsof )#, bioterrorismpreparednessandresponse,whichare:preparednessplanningandreadiness u*$- assessment,surveillanceandepidemiology,laboratorycapacity,communicationsand a+%. informationtechnology,healthriskcommunicationandinformationdissemination,and M,&/ educationandtraining.#`X>XX>X>Ԛ# 9-'0      `  %.(1 ЇX>XX`X> GrantsManagement U     Departmentaldiscretionarygrantswereestimatedtototalover$35billioninFY2002.Those -  discretionarygrantprogramsarenumerousanddiverse,andvigilanceisrequiredtoassurethat   monitoringsystemsareestablishedtoassesswhethergrantsareadministeredinaccordancewith  t applicablelaws,regulations,termsandconditions.Inaddition,monitoringsystemsmustbe  ` sufficienttoassessachievementoftargetedgoals,objectivesandoutcomes.  L    TheOIGhasinitiatedatwopartgrantmanagementreviewplan,andisstudyinggrant 8  makingandoversightprocessesinseveralHHSagencies.Reviewsarealsoassessingindividual $  granteeprogramactivitiesandstewardshipoffunds.     AwidevarietyofDepartmentalactivitiesarecurrentlyunderwaywhich#`X>XXX>̞#X>XX`X>Ԁfocusonassessing   granteeprogressinachievinggrantoutcomesandmonitoringgranteecompliancewithgrant y  requirements.#`X>XXX>ء#X>XX`X>ԀSpecifically,#`X>XXX>̽#X>XX`X>operatingdivisionsarecontinuingtheireffortstoestablish e  #`X>XXX># X>XX`X> performancegoals#`X>XXX>̦#X>XX`X>Ԁinvariousgrantprogramsbyrequiringapplicants,aspartoftheirgrant Q applicationproposals,toidentifyperformancetargets#`X>XXX>#DX>XX`X>Ԁtobeachievedbytheendofeachbudget = period.Inaddition,targetedreviews#`X>XXDX>Ӥ#DX>XX`X>ԀofspecificgrantoperationswithintheDepartmentare ) currentlyunderwayorbeingplanned.Thesereviews#`X>XXDX>y#DX>XX`X>Ԁexamineavarietyofpreawardandpost  awardactivitiesperformedbyanHHSawardingagency.#`X>XXDX>:#DX>XX`X>Ԁ#`X>XXDX>#X>XX`X>HHSoperatingdivisionsalso p administera#`X>XXX>3#X>XX`X>GrantsManagementBalancedScorecardenablingoperatingdivisionstoassess \ perceptionsofperformancebysolicitingfeedbackfromavarietyofinternalandexternal H users/customers.Theresultsprovideindicatorsastohowwellanoperatingdivisionis 4 performingavarietyofpreawardandpostawardgrantawardactivitiesenablingoperating   divisionstodevelopandimplementactionplanstoaddressareastargetedforimprovement#`X>XXX>̳#X>XX`X>.    #`X>XXX>#X>XX`X>  PricingPrescriptionDrugs  a   #`X>XXX>V#Becauseprescriptiondrugsaresuchasignificantpartof21stcenturymedicalcaretohelp 9! ensurepropertreatmentandmaximum_wellness_,itisimportantthatMedicareandMedicaid %" beneficiariesaccesstopharmaceuticalsisnothinderedbydisproportionateoverpricing.X>XX`X>Ԁ#`X>XXX>G# #    TheOIGX>XX`X>ԀhasfoundthatHHS#`X>XXX>̲#X>XX`X>paystoomuchforprescriptiondrugs#`X>XXX>#X>XX`X>forbothMedicareand #l! Medicaid.#`X>XXX>o#X>XX`X>Ԁ#`X>XXX>#X>XX`X>ԀForexample,Medicarepaymentsfor24leadingdrugsinCY2000were$887million $X" higherthanactualwholesalepricesavailabletophysiciansandsuppliers,and$1.9billionhigher %D # thanpricesavailablethroughtheFederalSupplySchedule.OIGreportshaveindicatedthatthe &0!$ averagewholesalepricethatMedicarehasusedtoestablishdrugpricesborelittleresemblanceto '"% actualpricesavailableelsewhere. (#&   CMScontinuescollectingandanalyzingdataondrugpricing.Forexample,CMSisstudying )#' nonMedicaredrugpricingofselecteddrugscoveredunderMedicarepartBtodeterminethe q*$( feasibilityofotherapproachestomoreaccuratelydetermineanAverageWholesalePrice.CMS ]+%) ispreparedtoutilizeasinglecontractortodeterminepaymentratestoeliminatethecurrent I,&* variationincontractorprices.#`X>XXX>'#X>XX`X>Ԁ#`X>XXX>V#X>XX`X> 5-'+      !.(, _ԇ ProtectionofCriticalInfrastructure  i   #`X>XXX>̚#EX>XX`X>HHSisaddressingInformationTechnologySecurityasoneofitstopmanagementpriorities. A  ITsecurityisaprominentpartoftheHHSEnterpriseInformationTechnologyStrategicPlan, -  whichestablishedanenterpriseapproachtoprojectplanningandimplementationforcritical   infrastructureservicesinHHS.Furthermore,providinghealthcaretotheelderlyandthe  t disabled,facilitatingresearch,preventingandcontrollingdisease,andothercriticalmissionsall  ` dependoninformationtechnology.  L    RecentOIGassessmentsfoundweaknessesinentitywidesecurity,accesscontrols,service 8  continuityandsegregationofduties.WhiletheOIGhasnotfoundanyevidencethatthese $  weaknesseshavebeenexploited,theyleavetheDepartmentpotentiallyvulnerableto   unauthorizedaccesstosensitiveinformation,maliciouschanges,improperpayments,and   disruptionofcriticaloperations. y    HHSisaddressinginformationsecurityasoneofitstoppriorities.ITsecurityisaprominent e  partoftheHHSEnterpriseInformationTechnologyStrategicPlan.Basedonplanpriorities, Q contractswereawardedinFY2002toinstallmultitiervirusprotectionacrossHHS;implement = vulnerabilityscansofcriticalHHSsystems;andtoprovideperimeterprotectionforallInternet ) accesspoints.ForFY2003,contractsareinplacetoestablishroundtheclockmonitoringof  securityalerts;toprovidecertificationandaccreditationforallCriticalInfrastructureProtection p assets;reduceGovernmentInformationSecurityReformActcorrectiveactionitemsand \ continuetheProjectMatrixprocessthroughtheimplementationofaPhase2AnalysesofCritical H Assets.#`X>XXEX>~#X>XX`X>ԀTheHHSCIOandCIOCouncilwillcontinuetoprovideDepartmentaloversightforthe 4 SecurityProgramtoensurethatallHHSsecurityandprivacyrequirementsaremet.   #`X>XXX>ӻ#X>XX`X> NursingFacilities  u  S#`X>XXX>#X>XX`X>  Nursingfacilitiesprovideresidentsskillednursingcareandrelatedservicesforthe M  rehabilitationofinjured,disabled,orsickpersons,oronaregularbasis,healthrelatedcare 9! servicesabovethelevelofcustodialcaretootherthanmentallyretardedindividuals S#`X>XXX>n#X>XX`X>. %"   TheOIGcontinuestoreviewfinancialcontrolsandqualityofcareprovidedinnursing #  homes.TheOIGhasfoundsomeservicesthatwerepaidfortwice,andhasexamined #l! overutilizationandunderutilizationofPartBtherapyinnursinghomes. $X"   CMShasmadesignificantgainsinassuringthatservicesbeingpaidundertheskillednursing %D # facilityprospectivepaymentsystem(_SNF_Ԁ_PPS_)byfiscalintermediariesarenotalsobilledtoand &0!$ paidbycarriers.InApril2002,CMSimplementedcommonworkingfile(_CWF_)editsthatwill '"% detect#`X>XXX>#X>XX`X>Ԁanddenycasesinwhichcarriersarebeingbilledforservicesthatthe_CWF_Ԁshowstobein (#& aMedicarecoveredPartAstayduringtheperiodinwhichthesupplierbilledthecarrierforthe )#' service.InJuly2002,CMSalsoimplementededitsthatwilldetectandmarkpaymentsthatwere q*$( madebycarriersforpersonsinthecourseofaMedicarecovered_SNF_Ԁstaywherethe_SNF_Ԁclaim ]+%) didnotposttothe_CWF_Ԁrecordbeforethecarrierclaimwaspaid,thusresultinginanincorrect I,&* payment.InJanuary2003,CMSplanstoimplement_CWF_Ԁeditsthatwilldetectsimilarincorrect 5-'+ casesinthefiscalintermediaryclaimsprocessingsystem.#`X>XXX>h#X>XX`X>Inaddition,CMShasdevelopeda !.(, websiteapplicationthatcanbeusedbyaphysician,practitionerorsuppliertodetermineifa  serviceattheCommonProcedureCodingSystem(_HCPCS_)levelshouldbebilledtothe_SNF_Ԁor } tothecarrier.Finally,#`X>XXX>:#X>XX`X>CMShasmadesignificantstridesinitsoversightofthe_SNF_Ԁ_PPS_Ԁthrough i aprogramsafeguardcontractthatexaminestheminimumdataset2.0residentassessmentdata, U includingsomeonsightreviewsatnursinghomes. A  #`X>XXX>#X>XX`X> MedicaidPaymentSystem  t    #`X>XXX>̇#AccuracyinthefederalshareofMedicaidcostsisimportanttohelpensurefairnessacrossall  L  stateMedicaidprogramsaswellasassurethesefederalhealthcaredollarsreachandachieve 8  theirmaximumintendedhealthcarepurposes.X>XX`X> $    TheOIGfoundthatsomeStatesinappropriatelyinflatedthefederalshareofMedicaidby   requiringpublicproviderstoreturnMedicaidpaymentstothestategovernmentsthrough   intergovernmentaltransfers.Oncethepaymentswerereturned,thestatesusedthefundsfor y  _toher_Ԁpurposes,someofwhichwereunrelatedtoMedicaid. e    #`X>XXX>#TocurbabusesandensurethatstateMedicaidpaymentsystemspromoteeconomyand Q efficiency,CMSissuedafinalrule,effectiveMarch13,2001,whichmodifiedupperpayment = limitregulationsinaccordancewiththeBenefitsImprovementandProtectionActof2000.The ) regulatoryactioncreatedthreeaggregateupperpaymentlimits"oneX>XX`X>Ԁ#`X>XXX>#eachforprivate,state,and  nonstategovernmentoperatedfacilities.Thenewregulationswillbegraduallyphasedinand p becomefullyeffectiveonOctober1,2008.TheCMSprojectedthattheserevisionswouldsave \ $55billioninfederalMedicaidfundsoverthenext10years.X>XX`X>Ԁ#`X>XXX>m#TheCMSintendstodevelop H regulationsthatwilloutlineaccountabilitystandardsthatstatesmustaddresswhenmaking 4 Medicaiddisproportionatesharehospitalexpenditures.X>XX`X>    AccuracyofMedicareFeeforServicePayments  u   #`X>XXX>̅#TohelpensurethefinancialintegrityoftheMedicareprogram,continuedaccesstoMedicare M  benefits,aswellasthelongtermviabilityoftheMedicaretrustfund,itcontinuestobeessential 9! thatdocumentedandaccuratebillsaresubmittedforcorrectpaymentforproperlyrendered %" healthcareservices.X>XX`X>Ԁ #    Basedonastatisticalsample,theOIGestimatedthatimproperMedicarebenefitpayments #l! madeduringFY2001totaled$12.1billion,orabout6.3percentofthe$191.8billionin $X" processedfeeforservicepaymentsreportedyCMS.Whileprogressisbeingmade,theOIGs %D # analysisindicatesthatproblemsremain. &0!$   CMSreportedthattheFY2001errorrateislessthanhalfofthe13.8percentreportedforFY '"% 1996.Correctiveactionsenhancedinternalpreandpostpaymentcontrols;targetedvulnerable (#& programareas;andeducatedprovidersregardingdocumentationguidelinesandcommonbilling )#' errors.#`X>XXX>̢# X>XX`X> InFY2003,CMSwillfullyimplementtheComprehensiveErrorRateTesting(CERT) q*$( program.TheCERTprogramwillproducenational,#`X>XXX>#X>XX`X>contractorspecific,and#`X>XXX>#X>XX`X>Ԁbenefitcategory a+%) specificfeeforservicepaidclaimserrorrates.With#`X>XXX><#  CERT,CMShassetatargettoreducethe M,&* nationalerrorrateto4percentbyFY2008anddevelopedtwonewperformancegoalsforFY 9-'+ 2004.ThegoalsareProviderComplianceRatetobereduced20percentperyearandthe %.(, MedicareContractorSpecificErrorRatesallwouldbeatorbelowthenationalerrorrateof4  percentbyFY2008.?Xz"*XX`X> } #`X>X*X?Xz"#X>XX`X>  #`X>XXX>#X>XX`X>#`X>XXX>0#X>XX`X> MedicareContractors  A    #`X>XXX>s#BecauseofthecrucialroleMedicarecontractorsplayinhelpingfacilitateefficientand   effectivehealthcaredeliveryto39.5millionMedicarebeneficiaries,itisimportantthattheybe  t heldaccountablefortheirroleinthehealthcarefinancinganddeliverysystem.X>XX`X>Ԁ  `   #`X>XXX>)#TheOIGexpressedanunqualifiedopinionontheCMSFY1999through2001financial  L  statementslargelybecauseCMScontinuedtocontractforvalidationanddocumentationof 8  accountsreceivable.However,OIGsFY2001financialstatementauditdisclosedthatthelack $  ofafullyintegratedfinancialmanagementsystemcontinuedtoimpairthereportingofaccurate   financialinformation.     Toaddresstheseproblems,CMShasmadesignificantimprovementsinthisareaoverthelast y  fewyears,asevidencedbytheunqualifiedopinionsonCMS1999,2000,2001,and2002 e  financialstatements.CMShasbeguntoimplementtheHealthcareIntegratedGeneralLedger Q AccountingSystem,expectedtobefullyoperationalattheendofFY2007.X>XX`X>ԀCMShasalso = continuedtoreviseandclarifyfinancialreportinganddebtcollectionpoliciesandprocedures ) basedonauditandreviewfindings.  #`X>XXX>#