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| December 31, 2000 | Contact: | HHS Press Office (202) 690-6343 |
In 2000, the Department of Health and Human Services (HHS) continued to improve the health and welfare of American families. We increased access to care, and we provided greater assurances of its quality and safety. And we continued to make major investments in the health of our nation's children. New child welfare regulations, finalized in January, will better protect abused and neglected children, while promoting the placement of children in safe, permanent homes. And in October, the President signed new legislation to promote the research, prevention and treatment of childhood disease.
We also achieved significant new research accomplishments this year. The HHS-supported Human Genome Project assembled the first working draft of the genetic blueprint for a human being, a discovery that holds tremendous promise for enhancing our understanding of genetics and disease. Overall, the National Institutes of Health (NIH) budget increased to $20.3 billion in fiscal year 2001, the largest increase ever and nearly double the $10.3 billion spent in 1993. The President also signed legislation creating a new National Center on Minority Health and Health Disparities to further our efforts to eliminate health disparities across racial and ethnic groups.
To protect consumers and patients, we established historic new medical privacy protections that will ensure that Americans' medical records and personal health information are protected. We also pushed ahead on major initiatives to reduce medical errors, improve the allocation of organs for transplants and reduce tobacco use. And we created a new Office for Human Research Protections to lead efforts to streamline and strengthen our system for ensuring responsible conduct of human research and protecting research subjects.
This year, we also implemented new rules to allow people with disabilities to return to work without losing essential medical coverage. HHS and the Health Care Financing Administration (HCFA) obtained clean opinions from independent auditors. And Medicare celebrated its 35th anniversary with its strongest financial outlook in decades, as strong management, financial controls and a good economy extended the solvency of the hospital insurance trust fund until 2025. President Clinton also signed legislation to reauthorize and expand the Older Americans Act, which provides essential home and community-based services, such as Meals on Wheels, transportation services, and legal assistance to millions of older Americans across the country. The legislation also established the National Family Caregiver Support Program to help hundreds of thousands of family members who are struggling to care for their older loved ones who are chronically ill or who have disabilities.
For the past eight years, we've worked hard on these and other essential issues. People now have new and better treatment options for cancer, AIDS and other diseases, which not only extend their lives, but also improve their quality of life. More children and families now have access to affordable health care. And our efforts in the past will continue to bear fruit in the future, continuing to make a real difference in the health and welfare of all Americans.
PROMOTING A SAFE AND HEALTHY CHILDHOOD. In 2000, the Clinton administration continued to make providing a safe and healthy childhood a top priority. The President signed new legislation to ensure coordinated, intensified efforts for the research, prevention and treatment of childhood diseases such as asthma, autism, diabetes and epilepsy. Immunization rates against childhood diseases remained at a record high of 80 percent. Increased Head Start funding allowed the program to expand and stay on track for serving 1 million children by 2002. Fewer young people used illegal drugs, suffered from abuse or neglect, or had children of their own. HHS also issued new child welfare standards and approved a new vaccine to prevent a potential cause of childhood meningitis, brain damage and hearing loss.
The Children's Health Act of 2000. Building on eight years of improving the quality of health care for America's children, President Clinton in October signed the Children's Health Act of 2000. The law expands, intensifies and coordinates research, prevention and treatment activities for diseases and conditions that affect children, including autism, diabetes, asthma, hearing loss, epilepsy, traumatic brain injuries, infant mortality, lead poisoning and oral health. The law reauthorizes HHS' substance abuse prevention, addiction treatment and mental health services programs for Americans of all ages, including critical programs aimed at our nation's youth. The law also reauthorizes both the Mental Health Block Grant and the Substance Abuse and Prevention Block Grant. It also provides states with more flexibility in the use of block grant funds in exchange for accountability based on performance.
Record child immunization rates. In July, the Centers for Disease Control and Prevention (CDC) reported that overall immunization rates for pre-school children remained at a record high of 80 percent in 1999, while rates for four individual vaccines increased. The figures represent a dramatic increase from the 55 percent immunization rate in 1992. In February, the Food and Drug Administration (FDA) approved the first vaccine to prevent invasive pneumococcal diseases, which can cause brain damage and, in rare cases, death, in infants and toddlers. And in December, the President directed the Department of Agriculture to assess the immunization status of the five million children under the age of five participating in the Women, Infants, and Children (WIC) program and refer them to a healthcare provider when appropriate. The CDC will help develop a national strategic plan to ensure more accurate and cost-effective immunization assessment, referral, and follow-up for children at risk.
New funds for children's hospitals. In a new initiative, HHS' Health Resources and Services Administration (HRSA) provided nearly $40 million to 56 independent children's hospitals to give resident physicians the focused, advanced training they need to provide quality care to the nation's youngest citizens. The financial awards represent the first payments under a new program created by the President and Congress in the Healthcare Research Quality Act of 1999.
Youth drug use, smoking decreases. In 2000, HHS released new statistics showing continued progress in the department's efforts to combat drug use among young people. In August, the Substance Abuse and Mental Health Services Administration (SAMHSA) released new data showing a continued downward trend in illicit drug use among young people ages 12 to 17. Between 1997 and 1999, the National Household Survey of Drug Abuse found that illicit drug use among this group fell from 11.4 percent to 9 percent. For the first time, the SAHMSA survey included state-by-state estimates of illicit drug, alcohol and cigarette use by age group. In December, the 26th annual Monitoring the Future Survey of drug use among 8th, 10th, and 12th graders confirmed that illicit drug use, including the use of marijuana, generally remained unchanged in the last year. The survey marks the fourth year in a row that the use of any illicit drugs among teenagers has stayed level or declined in all categories: lifetime, past year and past month use.
New pediatric growth charts. In May, at an historic National Nutrition Summit, the CDC released new pediatric growth charts that are more representative of the United States population and include a new assessment for body mass index (BMI). This key tool will help identify weight problems in early childhood. Pediatricians, nurses and nutritionists use these charts to monitor children's growth.
Youth violence prevention grants. Working with the Departments of Education and Justice, HHS helped to expand the Safe Schools/Healthy Students Initiative to prevent school violence through a coordinated and comprehensive community-based partnership. In fiscal year 2000, more than $41 million in new grants were awarded to 23 additional local education authorities, bringing the total number of grantees to 77. As a result of these partnerships, comprehensive plans have been developed and implemented with the goal of promoting healthy development, fostering resilience in the face of adversity, and preventing violence. The Children's Health Act of 2000 authorized $100 million for fiscal year 2000 to combat youth violence.
Expanded Girl Power! campaign. As part of HHS's four-year-old Girl Power! campaign, HHS issued new community education kits in April to help coaches, teachers, business leaders and other caring adults help girls make the most of their lives. In November, HHS expanded the Girl Power! Web site and issued a new assignment book. Girl Power! is a national public education campaign to help encourage and motivate 9- to 14-year-old girls. Studies show that girls tend to lose self-confidence and self-worth during this pivotal time, become less physically active, perform less well in school, and neglect their own interests and aspirations. Across the country, national, state and local organizations have enthusiastically embraced the Girl Power! message by developing community-based programs and activities that assist girls in realizing their full potential.
Expanding and improving child care. HHS continued to expand and improve child care. The Children's Health Act of 2000, signed by the President in October, authorizes grants to states to improve the education and training of child-care workers; to strengthen child care standards and increase unannounced inspections and enforcement; to renovate child care facilities; to enhance services for children with disabilities; and to conduct criminal background checks on child care providers. In December, Congress approved HHS' request of an $817 million increase in federal child-care funding for fiscal year 2001, proving a total of $2 billion. Overall, HHS has more than doubled federal resources for child care since 1993.
Expanding Head Start. Head Start, the nation's premier early childhood development program for low-income children and families, expanded to reach about 860,000 children with a $5.3 billion budget in fiscal year 2000. For fiscal year 2001, the Administration won an $933 million increase for a total of $6.2 billion to serve 935,000 children. This is the largest ever one-year increase in Head Start. Since 1993, Head Start has more than doubled from $2.8 billion to $6.3 billion. The program has an unprecedented track record of preparing children to start school ready to learn.
Improving child welfare, foster care. In January, HHS issued new regulations to improve outcomes for abused and neglected children, children in foster care, and children awaiting adoption. The regulations will hold states accountable for services to at-risk children with a new, results-oriented approach in federal monitoring of state child welfare programs. States will also be subject to tough new penalties as well as being given the opportunity to undertake corrective action plans. In April, new national child abuse and neglect statistics reported by states showed a decline to an estimated 903,000 in 1998, the fifth year in a row of improvement since 1993. The incidence rate of children victimized by maltreatment also declined to 12.9 per 1,000 children, the lowest rate in more than 10 years.
Encouraging adoption. In September, HHS awarded nearly $20 million in bonuses to 42 states and the District of Columbia and Puerto Rico for increasing the number of children adopted from public foster care. First awarded in 1999, the adoption bonuses were proposed by the Clinton administration in its Adoption 2002 initiative and were included in the Adoption and Safe Families Act of 1997. The number of children adopted has increased 77 percent from 26,000 in 1995 to 46,000 in 1999.
Improving child support enforcement. In January, HHS announced that the federal and state child support enforcement program broke new records in nationwide collections in fiscal year 1999, reaching $15.5 billion - nearly double the amount collected in 1992. The federal government collected $1.3 billion in overdue child support from federal income tax refunds for 1998, an 18 percent increase over the previous year and a 99 percent increase since 1992. Nearly 1.4 million families benefited from these collections. In August, HHS and the Department of Labor forwarded a report to Congress with recommendations to address barriers to the effective enforcement of medical support by state agencies. An estimated 3 million of the 21 million children currently eligible for child support enforcement services are without any health care coverage. Also in August, HHS issued new regulations to allow direct child support enforcement funding to federally recognized Indian tribes and tribal organizations.
Teen birth rates decline. In August, HHS issued new statistics showing that the birth rate for teenagers declined 3 percent between 1998 and 1999, the lowest rate in the 60 years that data on teen births have been recorded. The birth rate for teens aged 15-19 has declined every year since 1992, falling from 60.7 per 1,000 teens to 49.6 per 1,000 teen in 1999. The latest statistics also showed a drop in the number of births to unmarried teens and record high levels of women receiving early prenatal care. The report presents data for the nation as well as key indicators by state.
ADVANCING MEDICAL SCIENCE AND IMPROVING PUBLIC HEALTH. This year marked a major milestone with great promise for the future, as scientists completed the first working draft of the human genetic blueprint. The achievement will lead to a new era of molecular medicine, an era that will bring new ways to prevent, diagnose, treat and cure disease. Because advances in science must always be accompanied by advances in medical ethics, HHS also created a new Office for Human Research Protections to further strengthen patient protections in clinical trials, as well as a new advisory committee to provide counsel on patient protection and research needs. With new resources sought by the President, the NIH now funds more biomedical research projects than ever before, increasing the potential for scientific advances that will improve prevention and treatment for a wide array of diseases. And in November, President Clinton signed legislation creating a new National Center on Minority Health and Health Disparities to further the department's efforts to achieve quality care and good health for all Americans.
Increased funding for biomedical research. President Clinton's 1998 proposal for a 21st Century Research Fund has resulted in a dramatic increase in biomedical research funding for the National Institutes for Health (NIH). Overall, the NIH budget increased to $20.3 billion in fiscal year 2001, a 14 percent increase over the previous year and nearly double the $10.3 billion spent in 1993. These new resources are resulting in record numbers of funded grants for essential biomedical research to prevent and combat diseases including Alzheimer's, AIDS and cancer.
Human genome sequenced. In June, the international Human Genome Project funded by HHS, the Department of Energy, and others, assembled a working draft of the sequence of the human genome, the genetic blueprint for a human being. Already, many tens of thousands of genes have been identified and dozens of disease genes pinpointed by access to the working draft. The human genome map will eventually allow scientists and doctors to alert patients that they are at risk for certain diseases; reliably predict the course of disease; precisely diagnose disease and ensure the most effective treatment is used; and develop new treatments at the molecular level.
Protecting research subjects. In 2000, HHS created a new Office for Human Research Protections (OHRP) and took other important steps to further strengthen protections for human research subjects in clinical trials, including those involving gene transfer. HHS launched an aggressive effort to improve the education and training of clinical investigators and review board members, moved to clarify guidance regarding conflict-of-interest requirements. HHS also created a new National Human Research Protections Advisory Committee to provide broad-based counsel on patient protection and research needs. In February, the NIH also launched a consumer-friendly Web site for information about ongoing clinical trials. The Web site, ClinicalTrials.gov, includes detailed information on more than 5,000 federal and private medical studies at more than 50,000 locations nationwide.
Assuring safe, effective drugs and medical technology. In 2000, the FDA also approved 106 new drug applications in a median time of less than 12 months - more than twice as fast as a decade ago. For 23 priority drugs - including Visudyne, which treats the leading cause of blindness in senior citizens, and Zyvox, a new antibiotic - the median approval time was six months. Since 1992, the number of drugs approved has increased from 86 to 106 a year, and the average approval time has decreased from more than 24 months to less than 12 months. The FDA also approved 3,600 new devices, including many that represented technology breakthroughs that will revolutionize health care for Americans.
Healthy People 2010. In January, HHS released "Healthy People 2010," the nation's health goals for this decade, which include a major focus on eliminating disparities in health status. Also unveiled were the first-ever leading health indicators, comprising 10 areas of health status, based upon Healthy People 2010 objectives. These new measures will allow Americans to easily assess the overall health of the nation, as well as that of their own communities, and make comparisons and improvements over time.
Eliminating racial and ethnic health disparities. In November, President Clinton signed legislation creating a new National Center on Minority Health and Health Disparities to fund relevant research. The center, which will be part of the NIH, will also support training researchers and provide educational loan relief for health professionals who commit to perform related research. The center promises to help all Americans who bear the burden of health disparities regardless of their race, ethnicity, gender, socioeconomic status or geographic location. It will expand and extend HHS' extensive, ongoing efforts to raise the health status of various groups, especially with regard to six specific areas - infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV infection and AIDS, and immunizations. In 2000, these efforts included:
Combating bioterrorism. In November, President Clinton signed the Public Health Improvement Act, which expanded the Department's authority to conduct activities to better prepare the nation for possible bioterrorist acts. Among other provisions to address emerging public health threat, the act authorizes HHS to work with other federal agencies and build on existing efforts to support research related to likely bioterrorism agents, to develop an unprecedented vaccine and therapeutics "stockpile," and to strengthen disease surveillance and public health networks. HHS budgeted nearly $278 million for bioterrorism-related activities in fiscal year 2000.
New dietary guidelines. In May, HHS and the U.S. Department of Agriculture held an historic National Nutrition Summit and jointly issued new, improved Dietary Guidelines for Americans to provide easily understood, science-based information on how Americans can choose diets that promote good health. The new guidelines are more consumer-friendly, contain more specific scientific recommendations, address the need for safe food handling to prevent illness, and emphasize physical activity as important for healthy living.
PROTECTING PATIENTS AND PROMOTING QUALITY HEALTH CARE. HHS took major steps to better protect patients and ensure that they receive quality health care in 2000. Following the guiding principles Secretary Shalala outlined three years ago, HHS issued the first national standards to protect the sensitive, personal information found in medical records. Significant strides were also made to reduce medical errors, improve organ allocations for transplants and reduce tobacco use.
Protecting personal medical records. In December, HHS issued the nation's first standards for protecting the privacy of Americans' personal health records. The new regulation will protect personal health records held by health care providers, hospitals, health plans and health care clearinghouses. Following the principles Secretary Shalala first outlined in her 1997 recommendations to Congress, the final rule applies to medical records and personal health information in any form - including paper, electronic and oral - and requires patient consent even for routine use of medical records for treatment, payment and health plan operations. The rule takes a common-sense approach reflecting what typically occurs today in physician offices and hospitals, while setting clear boundaries that protect patients from having their information used without specific authorization for marketing or other non-routine uses.
Reducing medical errors. In February, the Clinton administration's Quality Interagency Coordination Task Force issued a report on reducing medical errors, and HHS launched a series of activities to improve patient safety. AHRQ and the FDA developed materials to educate patients on how to prevent errors from happening to them and to make safer choices about their medical care. AHRQ also coordinated a national summit on medical errors and patient safety to review the needs of patients, clinicians, and others involved in reducing errors. To help improve the safety of delivery systems, HRSA has worked with the Veterans Administration to design a new program for credentialing providers in federal health programs; CDC has been involved in efforts to address how working conditions in health care facilities impact patient safety; and HCFA has solicited proposed for projects on medical errors and patient safety from its Peer Review Organizations. These and other HHS-wide activities will help create an environment in which providers, patients, and purchasers of care work to achieve the Institute of Medicine's goal of reducing preventable medical errors by 50 percent over five years. In December, the FDA also proposed a new, user- friendly format for prescription drug labeling designed to reduce errors in drug prescribing. The proposal will establish a clear, consistent, and readable format that is essential to proper prescribing practices.
Strengthening organ transplant programs. In March, HHS implemented improvements in the nation's organ transplant system aimed at enabling the transplant network to operate in the fairest and most medically effective way possible for the patients. Under a final transplant policy regulation, human organs donated for transplantation will be allocated to patients with the greatest medical need. In the past, organs have sometimes gone to those with less urgent need, while patients with more urgent need died waiting. More lives can be saved as the new allocation procedures are phased in. In November, the Organ Procurement and Transplant Network submitted a plan for developing an improved definition of medical need for patients awaiting liver transplantation. At the same time, HHS was forming a new Advisory Committee on Organ Transplantation, which will review the new proposed policies and advise the Secretary on their approval. During the first half of 2000, the number of organ donors rose nearly 4 percent compared to the first half of 1999 - from 2,875 to 2,978. The increase reflects ongoing efforts to encourage organ donations.
Ensuring access to care in HMOs. Based on recommendations from HHS and the President's Advisory Commission on Consumer Protection and Quality in Health Care, the U.S. Department of Labor in November issued new rules to ensure workers quick processing of health insurance claims. The rules, which also require timely decisions on appeals when claims are denied, cover an estimated 130 million Americans in health plans offered by employers and covered by the Employee Retirement Income Security Act. Already about 85 million Americans in federal health plans, such as Medicare, receive similar such rights and protections. HHS also has supported legislation to establish a patients' bill of rights for all Americans enrolled in managed health care plans.
National standards for electronic claims. As part of its efforts to streamline the processing of health-care claims and reduce paperwork, HHS in August established national uniform standards for electronic transmission of claims and other health care transactions information. By promoting the greater use of electronic transactions and the elimination of inefficient paper forms, the new standards are expected to provide a net savings to the health care industry of $29.9 billion over 10 years.
Continuing the fight against HIV/AIDS. In 2000, HHS devoted $8.5 billion to its initiatives to combat the epidemic of HIV/AIDS. AIDS no longer ranks among the top 15 causes of death in the U.S. thanks to the development of effective therapies. Overall, AIDS deaths have declined from more than 50,000 in 1995 to about 16,000 in 1999. In addition, anti-viral drug therapies developed through NIH-supported research have dramatically reduced HIV transmission from mother to child from about 1,000 cases in 1992 to fewer than 200 cases in 1999. In fiscal year 2000, the NIH alone funded $2 billion in AIDS research, including efforts to better understand HIV, develop effective therapies for it, and design interventions to prevent new infections. NIH has doubled its investment in HIV vaccine research since 1997.
In October, President Clinton signed legislation reauthorizing the Ryan White CARE Act, which provides services to nearly 500,000 people affected by HIV/AIDS around the country. In August, HHS began notifying the first eligible families that they will receive payments from the Ricky Ray Hemophilia Relief Fund as compensation to people who contracted HIV through contaminated anti-hemophilic blood products prior to 1988. HCFA also approved a new Medicaid demonstration in Maine to provide coverage, early intervention and treatment to people in need who are HIV-positive but not otherwise eligible for Medicaid. And on World AIDS Day in December, the NIH issued the first strategic plan for international AIDS research, a blueprint for establishing new funding approaches and research opportunities in over 50 countries.
Reducing tobacco use. In June, the U.S. Public Health Service issued new guidelines for clinicians containing evidence-based information about therapies to help smokers quit. Also in June, the Surgeon General and the Federal Trade Commission announced that the seven largest U.S. cigar companies agreed to include warnings about the health risks of cigar use in their advertising and packaging. In July, HCFA authorized a new demonstration project to help Medicare beneficiaries stop smoking. And in August, the Surgeon General issued a new report on strategies that could cut smoking rates among teens and adults in half within the decade. The report calls for the widespread use of approaches that have proven to be effective in substantially reducing the number of people who will become addicted to nicotine; increasing the success rate of young people and adults trying to quit tobacco use; decreasing nonsmokers' exposure to environmental tobacco smoke; reducing disparities among population groups related to tobacco use and its health effects; and decreasing the future health burden of tobacco-related disease and death.
First oral health report. In May, the Surgeon General issued the first-ever national report on oral health, identifying a "silent epidemic" of dental and oral diseases that burden some population groups and calling for a national effort to improve oral health among all Americans. The report urged broadened awareness and use of common preventive tactics, including personal daily oral hygiene habits such as brushing with a fluoride toothpaste and flossing daily, community programs such as community water fluoridation and tobacco cessation programs, and health care provider-based interventions.
EXPANDING ACCESS TO HEALTH CARE. In 2000, HHS expanded its efforts to broaden Americans' access to health care. These efforts have shown measurable results, as the Census Bureau reported in September that the number of uninsured Americans declined significantly in 1999 - the first decline in at least 12 years. HHS worked with states to improve outreach efforts for the State Children's Health Insurance Program (SCHIP), which now provides health coverage to some 2.5 million children. HHS also implemented new rules to allow people with disabilities to return to work without losing essential medical benefits. And the department invested in community health centers, rural hospitals and other providers of essential health care in underserved communities around the country.
Expanding insurance for children and families. In 2000, HHS continued to work with states to expand and strengthen SCHIP, created by the Balanced Budget Act of 1997 and the largest single expansion of health insurance coverage for children in more than 30 years. HCFA worked in 2000 with all 50 states, the District of Columbia and five U.S. territories on implementation of their SCHIP plans, which now provide coverage for an estimated 2.5 million children. Outreach efforts included a national toll-free hotline, which has logged more than 375,000 calls since its launch in February 1999, and a public awareness campaign to increase the number of eligible families. In December, Congress approved changes to enhance outreach and enrollement for children eligible for SCHIP. The law permits states to enroll uninsured but eligible children at schools, child-support enforcement agencies, program eligibility centers, and other sites.
Expanding Medicaid. In October, HHS proposed regulations to allow states to further "disregard" portions of an individual's income when determining their Medicaid eligibility. States are now able to provide Medicaid coverage to people who would not otherwise be eligible, and move people from institutions into the community by allowing them to retain additional income to pay for food, clothing, and shelter. In addition, the broader rules can be used to encourage people to return to work or continue to work by ensuring that they will not lose their health insurance coverage if their income increases slightly. In April, HHS asked all states to review their computer systems and eligibility processes to ensure that all families that are eligible for Medicaid benefits keep their benefits, and provided guidance on streamlining processes for reviewing eligibility to ensure continued coverage among eligible families. And in December, the Congress included key provisions in the HHS budget that extend for another year Medicaid coverage for people leaving welfare for work.
Expanding community health centers. In 2000, HRSA invested more than $1 billion in community health centers across the country -- centers that serve millions, including migrant workers, homeless people, and residents of public housing. New access sites were established in previously unserved areas and existing sites were expanded to include new services, particularly in the areas of oral health, mental health, outreach, respite care and pharmacy services. HRSA also put more than 2,500 primary care clinicians in health professional shortage areas through the National Health Service Corps.
Promoting services for the uninsured. In 2000, HHS awarded more than $13 million in grants to 11 states to promote innovations to provide uninsured citizens with access to affordable health insurance. These grants will help states determine the most effective methods to provide the uninsured with high-quality, affordable health insurance similar to plans that cover government employees or other benchmark plans. In a separate initiative, HHS awarded grants of up to $1 million each to 23 communities to build integrated health care systems among local partner organizations. This program will make it possible for residents without health insurance to receive coordinated services such as primary care, specialty care and mental health counseling. For fiscal year 2001, HHS received $140 million to continue its efforts to address the problem of uninsured individuals, including $125 million to expand the Community Access Program.
Supporting rural hospitals. In 2000, HRSA awarded additional grants under the Critical Access Hospital (CAH) program to help states expand and improve health care services in rural communities. The 5-year, $125 million program now includes 250 small rural hospitals designated as CAHs with a commitment to improve access to care, emergency medical services, and the overall quality of care.
ASSURING A HEALTHY, DIGNIFIED RETIREMENT. In 2000, Medicare celebrated its 35th anniversary by renewing its commitment to ensuring a healthy retirement for older Americans. With the number of seniors doubling by the year 2030, HHS took a series of steps designed to promote quality care and quality of life for older and disabled Americans. The Health Care Financing Administration continued to strengthen Medicare's management and, working with the HHS Inspector General, to aggressively prevent waste, fraud and abuse. In 2000, both HHS and HCFA for the first time received a clean audit opinion, demonstrating the enormous continuing progress toward strong, effective financial stewardship. These efforts, coupled with a strong economy, helped to extend the projected solvency of Medicare's Trust Fund until 2025 - well beyond the solvency date of 1999 when the Secretary took office, and the longest projection of solvency since 1974.
Medicare solvency extended to 2025. This spring, the Medicare Trustees reported that the hospital insurance trust fund will remain solvent until the year 2025 - 10 years beyond the previous year's projection based on the most probable economic and demographic assumptions. The new estimate is the longest projection of solvency since 1974. The Trustees credited the combination of the robust economy, as well as restrained expenditures due to HCFA's aggressive management of the system and structural reforms accomplished by the Balanced Budget Act, for extending the life of the trust fund and cutting the projected 75-year actuarial deficit by over three-fourths. Since 1993, the trust fund's solvency has been extended from 1999 to 2025.
. Combating health care waste, fraud and abuse. Since 1993, the Clinton administration has focused unprecedented attention on the fight against fraud, abuse and waste in health care, including the Medicare and Medicaid programs. Early in her tenure, Secretary Shalala launched Operation Restore Trust, a ground-breaking project aimed at coordinating federal, state, local and private resources and targeting them on areas most plagued by abuse. Today, the lessons learned in Operation Restore Trust are applied routinely in the government's anti-fraud activities. In fiscal year 2000, the HHS Inspector General recorded an estimated $1.2 billion in civil judgements, penalties and fines involving health care fraud, bringing the total recovered to more than $3 billion since 1996. In addition, in December, the Attorney General and Inspector General announced a record settlement of $840 million with Columbia/HCA Healthcare Corp. Since 1993, other efforts to prevent improper and wasteful spending have saved taxpayers an estimated $60 billion.
HHS receives "clean" audit. In March, HHS for the first time received an unqualified, or "clean," audit opinion for their fiscal year 1999 financial statements - one of only four federal departments to meet the new accounting standards under the Government Performance Reform Act. The independent opinion from the HHS Office of the Inspector General reflected the progress HHS, and HCFA in particular, made in tightening financial controls and cleaning up old accounts receivables. HCFA also maintained its progress toward reducing Medicare's payment-error rate.
Senior Medicare Patrol projects. As part of HHS' overall strategy to fighting Medicare waste, fraud and abuse, the Administration on Aging awarded $10 million in grants to 48 local Senior Medicare Patrol projects to educate citizens about identifying and stopping payment errors and reporting suspected Medicare fraud and abuse. These projects, together with AoA's related efforts, have trained about 30,000 senior volunteers and aging network staff and educated 650,000 beneficiaries to identify and report suspected cases of fraud and abuse.
New Medicare payment systems. HCFA implemented separate new prospective payment systems for outpatient hospital services and for home health services to promote efficient, quality care. Implemented Aug. 1, the outpatient system will reduce beneficiaries' out-of-pocket costs over time. The home health system, implemented Oct. 1, completes the transition from a cost-based system, which encouraged inefficiency, waste and abuse.
Medicare expands clinical trial coverage. Implementing President Clinton's order, HCFA in September issued a national coverage decision to pay for the "routine costs" of care for Medicare beneficiaries participating in clinical trials meeting federal standards. The decision will encourage greater participation in clinical trials by older Americans by ensuring that Medicare will continue to pay for covered health care services, including costs associated with providing items and services that would otherwise be covered by Medicare if they were not provided in the context of a clinical trial. Medicare also will pay for monitoring and evaluation, device implantation, and other costs, such as room and board as part of a hospital stay required as part of a clinical trial, for trials of importance to Medicare beneficiaries.
Covering preventive benefits through Medicare. In December, the President signed legislation that expands Medicare's preventive benefits to include new nutrition therapy and glaucoma screening, and provides greater access to colon and cervical cancer screening. In July, celebrating the 35th anniversary of the law creating Medicare, HHS launched a national outreach effort to remind beneficiaries to take advantage of the preventive benefits Medicare covers. Medicare's preventive benefits include annual screening mammograms, pap smears, colorectal cancer screenings, prostate cancer screenings, bone mass measurement, glucose monitoring and diabetes education programs, and flu, pneumonia and hepatitis B vaccinations, all added since 1992.
Expanded Medicare information for consumers. In 2000, HCFA added new and expanded features about Medicare benefits, nursing home staffing levels, health plan options and other topics to its two-year-old consumer Internet site, www.Medicare.gov. It is now easier for people with Medicare, as well as those who help them make health care decisions, to navigate through the Web site and find the information that is right for them. Updated databases enable visitors to find the most current information in their states on Medicare+Choice plans, Medigap policies, nursing homes, and other helpful data. These improvements to the design and content reflect consumer feedback as well as research and expert advice. The site averages 1.3 million page views each month. In addition, Medicare's toll-free information line, 1-800-MEDICARE, is helping provide additional information for thousands of beneficiaries and families each month.
Improving nursing home care. In August, HHS completed the first phase of a groundbreaking study that established a clear relationship between staffing levels and quality of care. The next phase will analyze the costs and feasibility of establishing national minimum staffing levels for nursing homes, and whether those levels should vary based on the health conditions of nursing-home residents. In addition, HHS continued and extended its initiative to further assure that nursing home residents receive quality care. As part of that initiative, HCFA launched a national awareness campaign to help certified nursing assistants protect nursing home residents at risk of unintended weight loss and dehydration. In addition, HCFA has given states expanded authority to notify nursing homes when they would be denied payments for new admissions and other sanctions for failing to meet health and safety requirements. And in December, President Clinton signed legislation investing approximately $30 billion in reimbursements for nursing homes, home health agencies, hospices, hospitals and other health-care providers.
Reauthorization of the Older Americans Act. In November, President Clinton signed legislation to reauthorize and expand the Older Americans Act, which provides essential home and community-based services, such as Meals on Wheels, transportation services, and legal assistance to millions of older Americans across the country. In addition, the legislation for the first time provides much needed support to families who are caring for their loved ones who are ill or have disabilities, as the President proposed in 1999 as part of his long-term care initiative. Once funded, the new program will provide information, assistance, counseling and support, as well as respite care, to hundreds of thousands of family members who are struggling to care for their older relatives at home. It also recognizes the important role of grandparents who provide care for their grandchildren, and for individuals caring for adult children who have disabilities.
Supporting family caregivers. As part of the newly reauthorized Older Americans Act, the National Family Caregiver Support Program was established to help hundreds of thousands of family members who are struggling to care for their older loved ones who are chronically ill or who have disabilities. The program will provide, for the first time, much needed support such as information, assistance, training, counseling and respite care to families across the United States. Congress authorized the full $125 million requested by HHS for this program in fiscal year 2001. The program was as part of the Clinton administration's long term care package designed to help America's families plan for their future long term care needs. And HHS funded 16 new Alzheimer's Disease Demonstration Grants to expand support for persons with Alzheimer's Disease and their caregivers. The program emphasizes outreach to under served populations and regions, program development, service delivery systems and information dissemination.
PROMOTING OPPORTUNITY FOR ALL AMERICANS. Since 1993, the Clinton administration has worked hard to create opportunity for all Americans, including those with disabilities. In 2000, the President signed new legislation to provide services and opportunities for people with developmental disabilities to help them achieve their maximum potential as independent, productive citizens. HHS also has continued to help states reform the welfare system with continued record results. New data in 2000 showed that all 50 states and the District of Columbia met the overall welfare-to-work participation goals required by law. Job retention rates and earnings increases demonstrate the promising strategies for helping low-income parents make the transition from dependency to self-sufficiency. Since 1993, the national welfare rolls have fallen by more than half - from 14 million to about 6.3 million - and poverty rates have declined to their lowest levels since 1979.
Rewarding states for welfare performance. In December, HHS awarded $200 million in bonuses to 28 states with the best records in moving parents on welfare into jobs and assuring their success in the workforce. It was the second year HHS paid such bonuses. Overall, 43 percent of welfare recipients entered the work force in 1999 in comparison to 39 percent in 1998. Retention rates were also high: of those who obtained jobs, 77 percent were still working in the next quarter. States also reported a rise in the average increase in earnings of 31 percent from $2,027 in the first quarter of employment to $2,647 in the third quarter. In addition, HHS in August issued final regulations to expand future high-performance bonuses to states to include measures reflecting critical support provided to eligible working families, including child care, Medicaid, SCHIP and Food Stamps. The new regulations also include a measure of family formation and stability.
Record results for welfare to work. HHS announced that all 50 states and the District of Columbia in 1999 met the overall welfare to work participation rates required by the new welfare reform law. It is the third year in a row that all states subject to the welfare reform law's work requirements met the all families rate. Since 1992, the percentage of welfare recipients who were working, including employment, work experience and community service, has increased nearly fivefold, from 7 percent in 1992 to 33 percent in 1999.
Supporting independent living for people with disabilities. In October, President Clinton signed the Developmental Disabilities Assistance and Bill of Rights Act of 2000, which reauthorized programs that support people with developmental disabilities and help them achieve their maximum potential through increased self-determination, independence, productivity, and integration in all facets of life. The law also adds important new authority to provide services and activities for families of individuals with developmental disabilities and the dedicated workers who assist them. It includes performance-based accountability requirements to ensure continued progress in self-determination and access for historically unserved and underserved populations. HHS also awarded $17 million in grants to help 24 states and the District of Columbia improve access to personal assistance and create Medicaid buy-in programs for employed persons with disabilities. These grants encourage states to help individuals with disabilities work without fear of losing health coverage.
Reauthorizing the Violence Against Women Act. In October, the President signed legislation reauthorizing and expanding the Violence Against Women Act (VAWA). As part of VAWA, which was enacted in 1994, HHS has undertaken a wide range of initiatives, such as establishing a national toll-free domestic violence hotline that has fielded more than 530,000 calls. In fiscal year 2000, HHS also allocated $101.1 million for grants to states for battered women's programs, $15 million for programs to reduce sexual abuse among runaway, homeless and street youth, $44.1 million for grants to states for rape prevention and educational programs, and $5.9 million for coordinated community responses to violence against women.
Promoting tribal self-governance in health care. In August, President Clinton signed the Tribal Self-Governance Amendments of 2000, which establishes a permanent authority for the Indian Health Service (IHS) to enter into compacts with tribal governments. Through compacts, American Indian and Alaska Native tribes have greater flexibility to administer federally funded Indian health care programs established for their benefit. Since 1992, organizations have negotiated 47 compacts with the IHS. Under the permanent legislation, compacts initiated under the demonstration program will continue, with up to 50 additional compacts awarded each year.
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