HEALTH AND HUMAN SERVICES DEPARTMENT

The Department of Health and Human Services (HHS) is the cabinet-level department of the executive branch of the federal government most involved with the health, safety, and welfare of the U.S. population. A wide variety of HHS agencies administer more than 300 programs, which focus on such initiatives as providing financial assistance, health care, and advocacy to those in need; conducting medical and social science research; assuring food and drug safety; and enforcing laws and regulations related to human services.

The HHS originated in the Department of Health, Education, and Welfare (HEW), which was created in 1953. In 1980, the Department of Education Organization Act (20 U.S.C.A. § 3508) redesignated HEW the Department of Health and Human Services.

The secretary of HHS advises the president of the United States on the federal government's health, welfare, and income security plans, policies, and programs. He or she directs HHS staff in carrying out department programs and activities and promotes public understanding of HHS goals, programs, and objectives. The secretary administers these functions through the Office of the Secretary and the individual agencies of the HHS: the Administration on Aging; Administration for Children and Families; the centers for medicare & medicaid services; the Agency for Healthcare Research and Quality; the Centers for Disease Control and Prevention; the Agency for Toxic Substances and Disease Registry; the food and drug administration; the Health Resources and Services Administration; the Indian Health Service; the National Institutes of Health; the substance abuse and mental health services administration; and the Program Support Center. The social security administration, once located within HHS, became an independent agency in 1995.

Office of the Secretary

The Office of the Secretary of the HHS includes the offices of the Assistant Secretaries, the Inspector General, and the General Counsel. Individuals in these offices, along with other senior officials at HHS, assist the secretary with the overall management responsibilities of the HHS and aid in the day-to-day operations of the department. For example, the Program Support Center (PSC), which is part of the Office of the Assistant Secretary for Administration and Management, offers support services in such areas as human resources and financial management.

In addition, the Office for Civil Rights administers and enforces laws that prohibit discrimination in federally assisted health and human services programs. These laws include Title VI of the civil rights act of 1964 (42 U.S.C.A. § 2000d et seq.), which prohibits discrimination with regard to race, color, or national origin in programs and activities receiving federal financial assistance; the Age Discrimination Act of 1975 (42 U.S.C.A. § 6101 et seq.); and the Americans with Disabilities Act of 1990 (42 U.S.C.A. § 12101 et seq.).

The secretary is accountable to Congress and to the public for departmental expenditures of taxpayers' money. Thus, the secretary and other members of the HHS staff spend a great deal of time testifying before congressional committees, making speeches before national organizations interested in and affected by HHS policy, and meeting with the press and the public to explain HHS actions. The secretary and the HHS staff also prepare special reports, sometimes at the request of the president, on national problems related to health and human services. In addition, the secretary is required by law to submit to the president and to Congress periodic reports that explain how tax money was spent to address

and solve a particular problem and whether progress on the problem was achieved.

The headquarters of the HHS department is located in Washington, D.C., and ten regional HHS offices are located throughout the United States. The regional directors of these offices represent the secretary in any official HHS dealings with state and local government organizations. They promote a general understanding of HHS programs, policies, and objectives; advise the secretary on the potential local effects of HHS policies and decisions; and provide administrative services and support to HHS programs and activities in the regions.

Administration on Aging

The Administration on Aging (AOA) is the principal agency of the HHS designated to carry out the provisions of the Older Americans Act of 1965, as amended (42 U.S.C.A. § 3001 et seq.). The Older Americans Act was enacted to promote the well-being of older U.S. citizens by providing services and programs designed to help them live independently in their homes and communities. The act also empowers the federal government to distribute funds to the states for supportive services for older people. The AOA advises the secretary and other federal departments and agencies on the characteristics, circumstances, and needs of older citizens; develops policies and programs to promote the welfare of older citizens and advocates for their needs in HHS policy development and planning; and administers to the states grants that establish at the state and local levels programs providing services to older citizens, such as group meals and nutrition education. The AOA also administers programs providing legal and protective services for older people.

Administration for Children and Families

The Administration for Children and Families (ACF) was created in 1991 and is headed by the assistant secretary for children and families, who reports to the secretary of the HHS. The ACF consists of several component administrations, including the Administration on Children, Youth, and Families (ACYF), which advises the secretary, through the assistant secretary, on matters relating to the welfare of children and families, and administers grant programs to help the states provide child welfare services as well as foster care and adoption assistance. The ACYF also administers state grant programs for the prevention of child abuse; the Head Start Program, which appropriates funds for health, education, nutrition, social, and other services to economically disadvantaged children and their families; and programs providing services to prevent drug abuse among youth. In addition, the ACYF supports and encourages in the private and voluntary sectors programs for children, youth, and families.

Other components of the ACF include the Administration on Developmental Disabilities (ADD) and the Administration for Native Americans (ANA). ADD advises the secretary of the HHS on matters relating to persons with developmental disabilities and their families, and helps provide services to such individuals. ADD also helps the states provide services at the local level through grants and other programs. ANA represents the concerns of Native Americans and serves as the focal point within the HHS for providing developmental, social, and economic strategies to support Native American self-determination and self-sufficiency. ANA administers grant programs to Indian tribes and other Native American organizations in both urban and rural areas and acts as a liaison with other federal agencies on Native American affairs.

Yet another component of the ACF is the Office of Child Support Enforcement (OCSE), which advises the secretary on matters relating to child support enforcement and provides direction and guidance to state offices for child enforcement programs. The OCSE helps states develop programs establishing and enforcing support obligations by locating absent parents, establishing paternity, and collecting child support payments.

Medicare and Medicaid

The Centers for Medicare & Medicaid Services (CMS) replaced the former Health Care Financing Administration in 2001. It was created to oversee the Medicare Program and the federal portion of the Medicaid Program. Medicare provides health insurance for U.S. citizens age 65 or older, for younger people receiving social security benefits, and for persons needing dialysis or kidney transplants. Medicaid covers health care expenses for recipients of Temporary Assistance for Needy Families (formerly Aid to Families with Dependent Children), as well as for low-income pregnant women and other individuals whose medical bills qualify them as medically needy. Through these programs, the HCFA serves 68 million older, disabled, and poor U.S. citizens. In addition, a quality assurance program administered by the CMS develops health and safety standards for providers of health care services authorized by Medicare and Medicaid legislation.

Public Health Service Agencies

The public health service was first established in 1798 to create hospitals to care for U.S. merchant seamen. Over time, legislation has substantially broadened the number and scope of agencies that fall under the Public Health Service Division of the HHS, including the Agency for Healthcare Research and Quality, which produces and disseminates information about the quality, medical effectiveness, and cost of health care, and the Centers for Disease Control and Prevention (CDC), which provides leadership in the prevention and control of disease outbreak and responds to public health emergencies.

Other agencies within the Public Health Service Division include the Agency for Toxic Substances and Disease Registry, which carries out the health-related responsibilities of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA) (42 U.S.C.A. § 9601 et seq.), as well as the Food and Drug Administration (FDA), which is charged with protecting the health of the nation against unsafe foods, drugs, cosmetics, and other hazards.

The Health Resources and Services Administration (HRSA) focuses on ensuring that people without resources, or living in underserved areas (e.g., rural areas), receive quality health care. There are more than three thousand HRSA-funded centers throughout the United States. The health status of Native Americans and Alaska Natives is the concern of the Indian Health Service. The Indian Health Service administers a comprehensive health care delivery system for these groups, developing and managing programs to meet their health needs.

The National Institutes of Health (NIH) is the principal biomedical research agency of the federal government. Included within the NIH are the National Cancer Institute; National Heart, Lung, and Blood Institute; National Institute of Child Health and Human Development; and other institutes conducting research in the areas of alcohol and drug abuse, mental health, communication and neurological disorders, and aging.

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides national leadership in the prevention and treatment of addictive and mental disorders, through programs and services for individuals who suffer from these disorders. Within SAMHSA are several component centers designated to carry out its purposes, including the Center for Substance Abuse Prevention, Center for Substance Abuse Treatment, and Center for Mental Health Services. SAMHSA is also served by the Office of Management, Planning, and Communications, which is responsible for the financial and administrative management of SAMHSA components, monitors and analyzes legislation affecting these components, and oversees SAMHSA public affairs activities.