In addition to broadening health care and long-term care coverage, HHS is committed to increasing the availability and accessibility of health care services. This commitment includes reaching out to vulnerable and underserved populations, such as American Indians and Alaska Natives, people with disabilities, and rural populations. In addition, the Department is committed to enhancing and expanding existing services, such as health centers, long-term care options, substance abuse and mental health treatment programs, and Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) programs. Among the operating and staff divisions contributing to the achievement of this objective are AoA, CMS, HRSA, IHS, OCR, OD, ONC, OPHS, and SAMHSA.
Selected HHS performance indicators that best capture the impact of the wide array of HHS services provided under this strategic objective follow:
- Key aspects of having regular access to a source of ongoing care for the entire population;
- Receipt of services by American Indians and Alaska Natives, with whom HHS has a special treaty relationship;
- Efforts to expand access to publicly funded health centers and substance abuse treatment programs; and
- Rates at which programs funded by Title XXVI of the Public Health Service Act as amended by the Ryan White HIV/AIDS Treatment Modernization Act (Ryan White HIV/AIDS Program) serve racial and ethnic minorities, disproportionately affected by HIV/AIDS.
The joint planning initiative, Empower Consumer Access to Health Care, Long-Term Care, and Behavioral Health Services, is responsible for development, implementation, and coordination of health care, long-term care, and behavioral health service policies and programs. Ten HHS divisions partner with the U.S. Departments of Agriculture, Education, and Interior, as well as with State and local health departments, Medicaid and SCHIP State agencies, State and area agencies on aging, child care providers, early education providers, and tribal governments.
American Indians and Alaska Natives
Health services are provided to American Indians and Alaska Natives through several means. In FY 2006, IHS provided health care services directly at 33 hospitals, 59 health centers, and 50 health stations and supports essential sanitation facilities (including water supply, sewage, and solid waste disposal) for American Indian/Alaska Native (AI/AN) homes and communities. IHS professional staff include approximately 2,700 nurses, 900 physicians, 400 engineers, 500 pharmacists, 300 dentists, and 150 sanitarians. IHS also employs various allied health professionals, such as nutritionists, health administrators, and medical records administrators. More than half of the IHS budget is now used to provide funding for American Indian Tribes, tribal organizations, and Alaska Native corporations that choose to contract or compact with IHS to provide health care under the Indian Self-Determination and Education Assistance Act of 1975 (Public Law 93-638), as amended. These entities administer 15 hospitals, 221 health centers, 9 residential treatment centers, 97 health stations, and 176 Alaska village clinics. Both IHS and tribal entities purchase additional health care services from private providers.x
HHS and the U.S. Department of Veterans Affairs (VA) have entered into a Memorandum of Understanding to encourage cooperation and resource sharing between IHS and the Veterans Health Administration. The goal is to use the expertise of both organizations to deliver quality health care services and enhance the health status of AI/AN veterans. An interagency advisory committee, involving IHS and the Office of Minority Health (OMH) in OPHS, identifies health disparities for American Indians and Alaska Natives compared to the general U.S. population.
People With Disabilities
The four goals included in The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities are as follows:
- Increase understanding nationwide that people with disabilities can lead long, healthy, and productive lives;
- Increase knowledge among health care professionals and provide them with tools to screen, diagnose, and treat the whole person with a disability with dignity;
- Increase awareness among people with disabilities of the steps they can take to develop and maintain a healthy lifestyle; and
- Increase accessible health care and support services to promote independence for people with disabilities.
Virtually every HHS operating and staff division has initiatives to support this critical effort, headed by OPHS’s Office of the Surgeon General (OSG) and OD. Moreover, a broad array of Federal agencies, including the U.S. Departments of Agriculture, Defense, Education, Housing and Urban Development, Interior, Justice, Labor, Veterans Affairs, and the National Science Foundation, the Office of National Drug Control Policy, and the Social Security Administration, as well as many non-Federal stakeholders, have committed to pursuing these goals.
Of particular note is HRSA’s effort to provide health and community resource information and peer support to families having children and youth with special health care needs. Family-to-Family Health Information Centers, funded under the Dylan Lee James Family Opportunity Act,3 will be family-run, statewide centers in every State and the District of Columbia and will be responsible for developing partnerships with those organizations serving these children and their families. They also will be charged with monitoring the progress of programs with responsibility for payment and direct services of this population through a statewide data collection system.
Through collaborative initiatives such as the HHS Rural Task Force and the National Advisory Committee on Rural Health and Human Services, HHS works to address the difficulties of providing health care in rural communities. A technical assistance Web site and targeted dissemination of information about innovative models for health services delivery in rural communities are part of HHS’s overall strategy.
The HHS Underserved Populations effort focuses on delivery of health care services for underserved populations in rural and urban areas and involves CMS, HRSA, IHS, OD, SAMHSA, State and local health departments, health care providers, and the Tribal Technical Advisory Group.
At the beginning of FY 2007, HRSA’s Consolidated Health Center Program was providing comprehensive primary and preventive health care in more than 3,800 sites across the country to an estimated 14.8 million people.xi Most Health Center patients have incomes at or below 200 percent of the FPL. Many Health Center patients have no health insurance, and most patients are racial or ethnic minorities.
Health Centers help to improve the availability of health services by providing a range of essential services. As new or expanded sites are funded in medically underserved communities, a major focus will be on poor rural and urban counties consistent with the President’s goal of establishing new Health Centers in the poorest counties in the Nation. Health Centers help to improve the availability of health services by providing a range of essential services, including pharmacy services onsite or by paid referral, preventive dental care, and mental health and substance abuse services at most centers.
The final report of the President’s New Freedom Commission on Mental Health (2003) called for a fundamental transformation of how mental health care is delivered in America. SAMHSA’s Center for Mental Health Services will continue to work to transform the mental health system so that Americans understand that mental health is essential to overall health; mental health care is consumer and family driven; disparities in mental health services are eliminated; early mental health screening, assessment, and referral to services are common practice; excellent mental health care is delivered and research is accelerated; and technology is used to help consumers access mental health care and information.
New Orleans Health System
Hurricane Katrina incapacitated the Greater New Orleans health care system, ravaged its health care infrastructure, and severely impacted health care delivery in a number of Louisiana parishes. Eighty percent of New Orleans Health Centers were destroyed; the teaching hospitals of New Orleans were devastated; and countless people lost all of their medical records.
The Louisiana Health Care Redesign Collaborative strives to build an efficient
21st century health care system implementing technology, transparency, emergency preparedness, and greater personal health care choices. HHS is supporting the Collaborative in its effort by helping to convene stakeholders, providing expert assistance and other HHS resources, removing barriers to progress, and reviewing Medicaid waiver and Medicare demonstration concepts submitted by the Louisiana Health Care Redesign Collaborative in accordance with the guiding principles.
The goal is to improve health care by providing every citizen with access to health care that is prevention centered, neighborhood located, and electronically connected. Health care providers could use electronic health records and meet certain quality measures in order to provide care. Success means that Louisiana and New Orleans will have health care systems that can serve as models for the Nation. More information about how HHS is promoting electronic health records is included later in this chapter, In the Spotlight: Advancing the Development and Use of Health Information Technology.
Ryan White HIV/AIDS Program
HRSA’s programs through the Ryan White HIV/AIDS Programcurrently provide services to approximately 531,000 individuals who have little or no insurance and are impacted by HIV/AIDS.xii Key pieces of this program include its efforts to prioritize lifesaving services, medications, and primary care for individuals living with HIV/AIDS. Providing more flexibility to target resources to areas that have the greatest needs is also a key piece of the Ryan White HIV/AIDS Program. The program also encourages the participation of any provider, including faith-based and other community organizations, that shows results, recognizes the need for State and local planning, and ensures accountability by measuring progress.
Substance Abuse Services
SAMHSA’s Center for Substance Abuse Treatment promotes the quality and availability of community-based substance abuse treatment services for individuals and families who need them. The Center for Substance Abuse Treatment works with States and community-based groups to improve and expand existing substance abuse treatment services under the Substance Abuse Prevention and Treatment Block Grant Program. The Center also supports SAMHSA’s free treatment referral service to link people with the community-based substance abuse services they need.
Among SAMHSA’s efforts to improve the health of the Nation by increasing access to effective alcohol and drug treatment is the Access to Recovery program. Access to Recovery is designed to accomplish three main objectives: to expand capacity by increasing the number and types of providers, including faith-based and community providers, who deliver clinical treatment and/or recovery support services; to require grantees to manage performance, based on patient outcomes; and to allow recovery to be pursued through many different and personal pathways. Vouchers, State flexibility, and executive discretion combine to create profound positive change in substance abuse treatment financing and service delivery. The innovative and unique Access to Recovery program is focused on consumer empowerment. Under Access to Recovery, consumers will continue to have the ability to choose the path that is personally best for them and to choose the provider that best meets their needs, whether physical, mental, emotional, or spiritual.
Nondiscrimination and Privacy Protection
OCR ensures compliance with the nondiscrimination requirements of Title VI of the Civil Rights Act of 1964 (Public Law 88-352), as amended, requiring recipients of HHS Federal financial assistance to ensure that their policies and procedures do not exclude or limit, or have the effect of excluding or limiting, the participation of beneficiaries on the basis of race, color, or national origin. These efforts, which reach beneficiaries of all health and human service programs that HHS funds, seek to achieve voluntary compliance and corrective efforts when violations are found. OCR has collaborated with the U.S. Departments of Agriculture and Justice to produce a video and informational brochure in multiple languages to advise service providers and consumers with limited English proficiency about their responsibilities and rights under Title VI. OCR also enforces the federal privacy protections for individually identifiable health information provided by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Privacy enforcement activities provide consumer confidence in the confidentiality of their health information so that privacy concerns are not a deterrent to accessing care and full and accurate information is provided at treatment and payment encounters.
OCR will continue to work with Federal and State partners and with providers and consumer groups, including faith-based and community organizations, to ensure nondiscriminatory access to health and human services, to eliminate health disparities, and to protect the privacy of identifiable health information.