Mission

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Performance and Accountability Report
Fiscal Year 2002

Mission and Organization

Introduction

This is the seventh annual accountability report for the U.S. Department of Health and Human Services (HHS), and the first to include the Department's official performance report. In this report to our "stockholders," the American public, we account for the return on the taxpayers' investment. We also provide this information for the wide array of decision-makers, including the Office of Management and Budget (OMB) and the Congress, who are interested in our performance.

The HHS FY 2002 Performance and Accountability Report is produced under the Reports Consolidation Act (RCA) of 2000. Prior to this act, it was developed under the auspices of the Government Management Reform Act (GMRA) of 1994.

This report covers the period of October 1, 2001 through September 30, 2002, Fiscal Year (FY) 2002, and contains a high level overview of

The Department's purposes and programs;
The nature of resources entrusted to HHS; and
HHS' management of and accountability for those resources.

The report contains a discussion of key program, management, financial, and performance information (Sections I and II). The report also includes the Department's FY 2002 financial statements that discuss our financial condition (Section III) and includes the auditors' opinion, which is an independent, objective assessment that provides reasonable assurance about whether the financial statements are free from material misstatements (Section IV). Also this comprehensive report contains other streamlined reports required under various statutes that demonstrate accountability for our management, financial, and program performance (Section V).

By synthesizing all of this information into a single report, we provide a more complete, accurate, and useful understanding of the Department. Most of our components are also issuing similar reports, which provide detailed program and financial information.

Mission and Strategic Goals

Healthy and productive individuals, families, and communities are the very foundation of the Nation's security and prosperity. Through its leadership, HHS impacts virtually all Americans and people around the world, whether through direct services, the benefits of advances in science, or information that helps them to live better and to make healthy choices.

In a society that is diverse in culture, language, and ethnicity, HHS also manages an array of programs that aim to close the gaps and eliminate disparities in health status and access to health services that increase opportunities for disadvantaged individuals to work and lead productive lives.

HHS' Mission:
"To enhance the health and well-being of Americans by providing for effective health and human services and by fostering strong, sustained advances in the sciences underlying medicine, public health, and social services."

Secretary Thompson has identified a number of high priority goals needing urgent attention, including preparedness for terrorism incidents, emphasis on healthy choices and disease prevention activities for Americans, and continued progress in helping all Americans become self-sufficient. He has also aimed at increased cooperation between HHS and its partners and stakeholders; encouraged states to be more innovative; and pushed for reform of unnecessarily burdensome HHS regulations. To carry out its mission, HHS articulates these priorities in its draft FY 2003-2008 strategic plan through eight strategic goals. In Section II and the GPRA summary presentation later in this section, we have aligned our performance measures with these revised goals in anticipation of their implementation.

HHS' Strategic Goals:

Reduce the Major Threats to the Health and Well-being of Americans;

Enhance the Ability of the Nation's Health Care System to Effectively Respond to Bioterrorism and Other Public Health Challenges;

Increase the Percentage of the Nation's Children and Adults Who Have Access to Health Care Services, and Expand Consumer Choices;

Enhance the Capacity and Productivity of the Nation's Health Science Research Enterprise;

Improve the Quality of Health Care Services;

Improve the Economic and Social Well-being of Individuals, Families, and Communities, Especially Those Most In Need;

Improve Stability and Healthy Development of our Nation's Children and Youth; and

Achieve Excellence in Management Practices.

Scope of Services

Through managing more than 300 programs, HHS works toward accomplishing these goals that cut across individual HHS components and programs. For example, HHS works directly and with its partners to:

Conduct and sponsor medical and social science research to improve Americans' health and well-being;
Guard against the outbreak of infectious diseases through immunization services and the elimination of environmental health hazards near people's homes and work places;
Assure the safety of food and drugs;
Provide health insurance for elderly and disabled Americans, low-income people, and children;
Promote the availability of home and community based services;
Provide financial assistance and employment support services for low-income families;
Facilitate child support enforcement;
Improve maternal and infant health;
Improve preschool development and learning readiness;
Prevent child abuse and domestic violence;
Prevent and treat substance abuse;
Provide mental health services; and
Provide services for older Americans.

One HHS

The over-arching central direction of the Department is to function as a single entity, as "One HHS". To ensure that HHS is "One Department" rather than a collection of disparate and unrelated agencies, we have taken a number of actions, and are planning more. We are reforming the management of the Department and improving the programs that our Department runs. Over the next few years we will be increasingly collaborating and coordinating significant activities among HHS agencies, such as work on HIV/AIDS, Medicare, Medicaid, delivery of health care services to children and families, privacy and confidentiality policies, and research on the effectiveness of HHS programs.

For the first time ever, the HHS Strategic Plan contains a Management Improvement Goal, including strategies to reduce the number of personnel offices; modernize and improve human, financial, and technological management at HHS; and reform regulations to reduce excessive paperwork and burden to doctors and hospitals. To provide accountability, as well as feedback and tracking of how we are doing, we are instituting performance contracts (tied to the strategic goals and objectives) for the Department's senior leadership which will cascade throughout the Department. This performance contract will institute explicit standards against which HHS officials' work will be measured.

HHS Partners: Working Together

The achievement of HHS' mission and goals, the success of HHS' programs, and the ability of HHS to meet the needs of clients are directly tied to the commitment, cooperation, and success generated by our employees and those of other federal agencies, state and local governments, tribal organizations, community-based organizations, faith-based organizations and others.

HHS provides direct services for the underserved populations of America, including American Indians and Alaska Natives. However, for many programs, HHS' partners provide direct services and have much discretion in how the programs are implemented. In those cases, HHS contributes to accomplishing the program goals through funding, technical assistance, information dissemination, education, training, research, and demonstration projects.

Often the needs of individuals and families go beyond individual HHS programs. Frequently, programs are only focused on one particular need of a recipient because of the specific authority and funding for the program. However, to meet all the needs of a person, an integrated and comprehensive approach must be crafted with other HHS programs, other federal agencies, and HHS' partners. HHS therefore works internally and with its many, diverse partners to plan and deliver services in a coordinated way that maximizes resources and provides an integrated approach to clients' needs.

For example:

HHS is the largest grant-making agency in the Federal government � providing more than $200 billion, including funds for the Medicaid and Temporary Assistance for Needy Families (TANF) programs, of the total estimated $360 billion in federal funds awarded to states and other entities in FY 2002;
HHS funds more than 50,000 research investigators affiliated with about 2,000 university, hospital, and other research facilities;
HHS helps fund and foster a nationwide network of more than 3,500 sites that provide needed primary and preventive care to 12.5 million medically underserved patients last year;
HHS partners with the Aging Network, which includes 56 state units on aging, 655 area agencies on aging, 241 tribal and native organizations representing more than 300 American Indian and Alaska Native tribal organizations, and two organizations serving Native Hawaiians, plus more than 29,000 service providers and innumerable caregivers and volunteers;
Networks of state and private agencies provide substance abuse and mental health services;
Medicare contractors process over 1 billion fee-for-service claims, answer 40 million inquiries, process nearly 8 million appeals, enroll and educate providers, and assist beneficiaries;
Approximately 18,700 centers and 49,800 classrooms help to provide comprehensive development services with HHS support under the Head Start program for more than 915,000 low-income pre-school children, ages birth to five, including approximately 62,000 children under the age of three served through Early Head Start; and
More than 45,000 health care providers are enrolled in the Vaccines for Children Program, furnishing free vaccines to more than one-third of our Nation's children.

HHS' Organization: Structured to Accomplish our Mission

HHS is made up of Operating Divisions (OPDIVs), and led by the Office of the Secretary (OS). The Program Support Center (PSC), which is part of OS, provides administrative support to the Department and other federal agencies. The PSC is a self-supporting component of HHS. It provides competitive services on a fee-for-service basis, through HHS' Service and Supply revolving fund, in three key areas: financial management, human resources, and administrative operations. PSC provides these services to HHS and approximately 30 other federal agencies.

PSC is located in Rockville, MD. PSC was established in 1995 as a business enterprise from various administrative support units of HHS. In 2001, the PSC became part of the OS. Because of its nature as a service provider, it continues to be audited as a financial reporting entity.

HHS' Operating Divisions are:

Administration for Children and Families (ACF);
Administration on Aging (AoA);
Agency for Healthcare Research and Quality (AHRQ);
Agency for Toxic Substances and Disease Registry (ATSDR);
Centers for Disease Control and Prevention (CDC);
Centers for Medicare & Medicaid Services (CMS);
Food and Drug Administration (FDA);
Health Resources and Services Administration (HRSA);
Indian Health Service (IHS);
National Institutes of Health (NIH); and
Substance Abuse and Mental Health Services Administration (SAMHSA)

Eight staff divisions, seven of which are headed by an Assistant Secretary, report to the HHS Secretary. The Assistant Secretary for Budget, Technology, and Finance (ASBTF), is responsible for producing this report. HHS also actively coordinates, in ten regions throughout the United States, the crosscutting and complementary efforts that are needed to accomplish our mission. HHS Headquarters is located at 200 Independence Avenue, SW, Washington, DC, 20201. The Offices of Inspector General (OIG), Intergovernmental Affairs, Office for Civil Rights, Center for Faith-Based and Community Initiatives, and Departmental Appeals Board also support this mission across the Department.

Administration for Children and Families (ACF)
ACF was established in 1991, bringing together several pre-existing programs. ACF is responsible for approximately 60 programs that promote the economic and social well-being of families, children, individuals, and communities. Major programs that ACF administers include Temporary Assistance to Needy Families (TANF), Child Support Enforcement, and Head Start for preschool children.

ACF provides funds to assist low-income families in paying for childcare, preventing child abuse and domestic violence, and supports state programs to provide for foster care and adoption assistance. ACF is organized into eight program offices and five staff offices that operate in Washington, DC and ten regional offices.

Administration on Aging (AoA)
AoA is the federal focal point for aging programs and services. Through policy and program development, planning, and service delivery, AoA seeks to address the needs and concerns of older people and their families and those persons in need. AoA funds are leveraged through a nationwide service infrastructure to deliver comprehensive in-home and community services, including meals for older individuals. AoA funds also make legal services, counseling and ombudsmen programs available to elderly Americans.

AoA was established in 1965. AoA accomplishes its mission in collaboration with its partners � state and area agencies on aging, Tribal organizations, and the providers of services that comprise the aging network. AoA headquarters are located in Washington, DC.

Agency for Healthcare Research and Quality (AHRQ)
AHRQ acts as the catalyst for improving the quality, effectiveness, accessibility, and cost of health care as a result of its research and sharing of information. AHRQ conducts and supports the research needed to guide decision-making and improvements in both clinical care and the organization and financing of health care. AHRQ also promotes the incorporation of its and other research-based information into effective choices and treatment in health care by developing tools for public and private decision-makers and by broadly disseminating the results of the research.

AHRQ was established in 1989 and is currently located in Rockville, MD. AHRQ operates six centers as well as its special policy and information offices.

Agency for Toxic Substances and Disease Registry (ATSDR)
ATSDR helps to prevent exposure and adverse human health effects and diminished quality of life associated with exposure to hazardous substances. ATSDR is a unique component of HHS because, prior to FY 2001, it had been funded through the Environmental Protection Agency (EPA) Superfund as an allocation of funds and, therefore, EPA was accountable for the funds. However, beginning in FY 2001, ATSDR is funded through the EPA Superfund through a transfer of the funds and, as a result, HHS is accountable for the funds. ATSDR reports to the Director of CDC because of its complementary functions. Because of this relationship, the CDC financial statements include those from ATSDR.

ATSDR was established in 1980. ATSDR conducts public health assessments, health studies, surveillance activities, and health education training in communities around waste sites on the EPA's National Priorities List. ATSDR also has developed toxicological profiles of hazardous chemicals found at these sites. CDC and ATSDR's headquarters are located in Atlanta, GA.

Centers for Disease Control and Prevention (CDC)
CDC is the "Nation's Prevention Agency"; it is the lead federal agency responsible for promoting health and quality of life by preventing and controlling disease, injury, and disability. CDC helps to save lives and health costs by working with partners throughout the nation and the world to monitor health, detect and investigate health problems, conduct research to enhance prevention, develop and advocate sound health policies, implement prevention strategies, promote healthy behaviors, foster safe and healthy environments, and provide public health leadership and training. CDC also provides immunization services and national health statistics. CDC is well known for its response to disease outbreaks and health crises worldwide.

CDC was established in 1946, as the Communicable Disease Center. CDC's personnel are stationed in its national headquarters in Atlanta, GA, 18 locations throughout the United States and territories, more than 37 foreign countries and 47 state health departments, and numerous local health agencies.

Centers for Medicare & Medicaid Services (CMS),
formerly Health Care Financing Administration
CMS is the largest purchaser of health care in the world. CMS administers the Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP). The Medicare, Medicaid, and SCHIP programs provide health care for one in four Americans. The outlays for Medicare, Medicaid, and SCHIP including state funding, represent more than 33 cents of every dollar spent on health care in the United States. Medicare provides health insurance for elderly and disabled Americans. Medicaid, a joint federal-state program, provides health coverage for low-income persons (almost 48 percent of enrollees are children). Medicaid also pays for nursing home coverage for low-income elderly, covering almost half of total national spending for nursing home care. SCHIP, a federal-state program, provides health insurance coverage for children who otherwise would be without coverage.

CMS was established in 1977, incorporating the pre-existing Medicare and Medicaid programs. CMS operates from Baltimore, MD, Washington, DC, and ten regional offices.

Food and Drug Administration (FDA)
The FDA, established in 1927, is a science-based regulatory agency whose mission is to promote and protect the public health and well-being by ensuring that safe and effective products reach the market in a timely way, and to monitor products for continued safety after they are in use. FDA is responsible for overseeing a regulated industry that produces over one trillion dollars worth of products. The average cost of this effort to the taxpayers is about $5.00 per person per year. The products include the vast majority of the nation's food supply; over-the-counter and prescription medications; blood products; vaccines; tissues for transplantation; medical equipment and implantable devices; devices that emit radiation; animal drugs and feed; and cosmetics. FDA operations are headquartered in Rockville, Maryland and are organized into six centers, two offices, and five regions throughout the United States.

To accomplish its mission, FDA is divided into six program areas: foods, drugs, biological products, veterinary medicine, medical devices, and toxicological research. Each program area, except for toxicological research, is responsible for ensuring the safety and, where applicable, the effectiveness of products through their entire life cycle - from initial research through manufacturing, distribution, and consumption. These programs, supported by a national field force of scientific investigators, also monitor the safety of more than seven million import shipments that arrive at our borders each year. The toxicological research program conducts peer-reviewed research that provides the basis for FDA to make sound, science-based regulatory decisions.

Health Resources and Services Administration (HRSA)
HRSA is an important component of the nation's health safety net; HRSA improves the nation's health by assuring equitable access to comprehensive, quality health care. HRSA and its state, local, and other partners work to eliminate barriers to care and eliminate health disparities for Americans who are underserved, vulnerable, and have special needs. It also works to assure that quality health care professionals and services are available.

HRSA was established in 1982, bringing together several pre-existing programs. Its headquarters are located in Rockville, MD. HRSA works to decrease infant mortality and improve maternal and child health. It provides services to people with Acquired Immune Deficiency Syndrome (AIDS) through the Ryan White Comprehensive AIDS Resources Emergency (Ryan White CARE) Act programs and oversees the organ transplantation and bone marrow donor systems. HRSA also works to build the health care workforce and maintains the National Health Service Corps. HRSA uses a structure of four bureaus and several offices to accomplish its mission.

Indian Health Service (IHS)
The IHS is the principal federal health care provider and health advocate for American Indian people, who experience the lowest life expectancies in the country for both men and women. In partnership with American Indians and Alaska Natives from more than 557 federally recognized tribes, IHS's mission is to raise the physical, mental, social, and spiritual health of American Indians and Alaskan Natives to the highest level. IHS and the Indian tribes serve 1.5 million American Indians and Alaskan Natives through direct delivery of local health services.

IHS was established in 1924 (mission transferred from the Department of Interior in 1955). The IHS funds hospitals, health centers, school health centers, and health stations, which are administered by Indian tribes or IHS itself. There are also 34 health programs operated by urban Indian Health Organizations that provide various services to American Indians and Alaskan Natives living in urban areas of the country. When unavailable from IHS or the Indian tribes, medical services are also purchased from other providers to ensure that needed care is received. IHS headquarters are in Rockville, MD, and its 12 area offices are further divided into service units for reservations or a population concentration.

National Institutes of Health (NIH)
NIH is the world's premier medical research organization supporting research projects nation-wide in diseases such as cancer, Alzheimer's, diabetes, arthritis, heart ailments, and AIDS. The NIH consists of Institutes and Centers that improve the health of all Americans by advancing medical knowledge and sustaining the nation's medical research capacity in disease diagnosis, treatment, and prevention. More than $8 out of every $10 appropriated to NIH flows out to the scientific community at large. NIH's research activities extend from basic research that explores the fundamental workings of biological systems, to studies that examine disease and treatments in clinical settings, to prevention, and to population-based analyses of health status and needs.

NIH was established in 1887, as the Hygienic Laboratory, in Staten Island, NY. To accomplish its mission, NIH provides scientific leadership and establishes research priorities, funds the best research in the scientific community at large, and conducts leading-edge research in NIH laboratories. NIH also disseminates scientific results and information, facilitates the development of health-related products, ensures a continuing supply of well-trained laboratory and clinical investigators, sustains the nation's research facilities, and collaborates with other federal agencies. NIH is located in Bethesda, MD.

Substance Abuse and Mental Health Services Administration (SAMHSA)
SAMHSA works to strengthen the capacity of the Nation's healthcare system to provide substance abuse prevention, addictions treatment, and mental health services for Americans experiencing or at risk for mental illness, substance abuse disorder, or co-occurring mental and addictive illnesses. SAMHSA provides funding through block grants to states for direct substance abuse and mental health services, including treatment for Americans with serious substance abuse problems, prevention intervention services, and services for adults and children with serious mental illnesses or emotional disturbances.

SAMHSA was established in 1992. (A predecessor agency, the Alcohol, Drug Abuse and Mental Health Administration, was established in 1974.) SAMHSA is organized into three centers (Center for Substance Abuse Prevention, Center for Substance Abuse Treatment, and Center for Mental Health Services) and three offices (Office of the Administrator, Office of Program Services, and Office of Applied Studies). SAMHSA is located in Rockville, MD.

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Performance and Accountability ReportFiscal Year 2002