United States Department of Health and Human Services

The **United States Department of Health and Human Services** (**HHS**) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of the U.S. people and providing essential human services. Its motto is "Improving the health, safety, and well-being of America". Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).

HHS is administered by the Secretary of Health and Human Services, who is appointed by the president with the advice and consent of the United States Senate. The position is currently held by Xavier Becerra.

The United States Public Health Service Commissioned Corps, the uniformed service of the PHS, is led by the Surgeon General who is responsible for addressing matters concerning public health as authorized by the secretary or by the assistant secretary for Health in addition to his or her primary mission of administering the Commissioned Corps.

## History

### Federal Security Agency

The Federal Security Agency (FSA) was established on July 1, 1939, under the Reorganization Act of 1939, P.L. 76–19. The objective was to bring together in one agency all federal programs in the fields of health, education, and social security. The first Federal Security Administrator was Paul V. McNutt. The new agency originally consisted of the following major components: (1) Office of the Administrator, (2) Public Health Service (PHS), (3) Office of Education, (4) Civilian Conservation Corps, and (5) Social Security Board.

### Department of Health, Education, and Welfare

The Department of Health, Education, and Welfare (HEW) was created on April 11, 1953, when Reorganization Plan No. 1 of 1953 became effective. HEW thus became the first new Cabinet-level department since the Department of Labor was created in 1913. The Reorganization Plan abolished the FSA and transferred all of its functions to the secretary of HEW and all components of the agency to the department. The first secretary of HEW was Oveta Culp Hobby, a native of Texas, who had served as commander of the Women's Army Corps in World War II and was editor and publisher of the *Houston Post*. Sworn in on April 11, 1953, as secretary, she had been FSA administrator since January 21, 1953.

The six major program-operating components of the new department were the Public Health Service, the Office of Education, the Food and Drug Administration, the Social Security Administration, the Office of Vocational Rehabilitation, and St. Elizabeth's Hospital. The department was also responsible for three federally aided corporations: Howard University, the American Printing House for the Blind, and the Columbia Institution for the Deaf (Gallaudet College since 1954).

### Department of Health & Human Services

The Department of Health, Education, and Welfare was renamed the Department of Health & Human Services (HHS) on October 17, 1979, when its education functions were transferred to the newly created United States Department of Education under the Department of Education Organization Act. HHS was left in charge of the Social Security Administration, agencies constituting the Public Health Service, and Family Support Administration.

In 1995, the Social Security Administration was removed from the Department of Health & Human Services, and established as an independent agency of the executive branch of the United States Government.

The 2010 United States federal budget established a reserve fund of more than $630 billion over 10 years to finance fundamental reform of the health care system.

## Organization

### Internal structure

The Department of Health & Human Services is led by the United States Secretary of Health and Human Services, a member of the United States Cabinet appointed by the President of the United States with the consent of the United States Senate. The secretary is assisted in managing the department by the Deputy Secretary of Health and Human Services, who is also appointed by the president. The secretary and deputy secretary are further assisted by seven assistant secretaries, who serve as top departmental administrators.

As of January 20, 2018, this is the top level of the organizational chart. HHS provides further organizational detail on its website.

Several agencies within HHS are components of the U.S. Public Health Service (PHS), as noted below.

### Immediate Office of the Secretary

The **Immediate Office of the Secretary** (**IOS**) is the top-level unit that directly reports to the Secretary of Health and Human Services. They assist in the administration of HHS and include the following components:

* **Office of the Deputy Secretary** (**DS**) – an Executive Schedule, Level II Position. This role is responsible for all departmental operations.
* **Office of the Chief of Staff** (**COS**) – This role is responsible for staff coordination and support.
* **Office of the General Counsel** (**OGC**)
* **Executive Secretariat** (**ES** or ***ExecSec***) – Develops and reviews rules, regulations, correspondences, Reports to Congress, and other policy-related documents and decisions. Headed by the Executive Secretary to the Department and assisted by the Deputy Executive Secretary.
* **Office of Health Reform** – Oversees the implementation of new policies and legislation.
* **Office of the Chief Technology Officer** (**CTO**) – Oversees the use of Data and Technology implementations in HHS.
* **Office of National Security** (**ONS**) – A department-wide office that provides oversight, policy direction, standards, and performance assessments on all intelligence and national security related programs within HHS.

### Office of the Secretary

The **Office of the Secretary** (**OS**) is the unit directly below the Immediate Office of the Secretary, but still directly reports to the Secretary. This unit consists of the offices of assistant secretaries including:

* **Office of the Assistant Secretary of Health and Human Services for Financial Resources** (**ASFR**)
* Office of the National Coordinator for Health Information Technology (**ONC**)
* **Office of the Assistant Secretary of Health and Human Services for Public Affairs** (**ASPA**)
* **Office of the Assistant Secretary for Legislation** (**ASL**)
* **Office of the Assistant Secretary of Health and Human Services for Planning and Evaluation** (**ASPE**)

### Office of Intergovernmental and External Affairs

The **Office of Intergovernmental and External Affairs** (**IEA**) serves as the liaison to state, local and tribal governments as well as NGOs. Through the IEA, HHS directs oversees current federal health programs at the regional and tribal level.

* **Headquarters Staff** – assists the **HHS** Secretary in developing policies related to state and local government relations.
* **Tribal Affairs** – serves as the point of contact for **HHS** regarding **HHS** programs on Indian reservations.
* **Center for Faith-based and Neighborhood Partnerships** (a.k.a. the *Partnership Center*) – works to create partnerships with faith-based and community organizations at the local level.
* **Office of Human Resources** – the department-wide office for **HR** related issues.
* **Regional Offices** – Work with the subordinated state governments to institute **HHS** policy in the respective regions. Each office is led by a presidential-appointed regional director. The following

### U.S. Public Health Service

Within HHS is a collection of agencies and offices that fall under the Public Health Service. The PHS also is home to the Public Health Service Commissioned Corps (**PHSCC**).

* Office of the Assistant Secretary for Health (OASH) and the U.S. Surgeon General
* Office of Global Affairs

The subordinate operating agencies under the Public Health Service:

* National Institutes of Health (NIH)
* Centers for Disease Control and Prevention (CDC)
* Indian Health Service (IHS)
* Food and Drug Administration (FDA)
* Agency for Toxic Substances and Disease Registry (ATSDR)
* Health Resources and Services Administration (HRSA)
* Agency for Healthcare Research and Quality (AHRQ)
* Substance Abuse and Mental Health Services Administration (SAMHSA)
* Administration for Strategic Preparedness and Response (ASPR)

### Human Services agencies

This list includes the subordinate agencies that do not fall under the Public Health Service, but are under HHS:

* Administration for Children and Families (ACF)
* Administration for Community Living (ACL)
* Centers for Medicare & Medicaid Services (CMS) – formerly the Health Care Financing Administration.

### Office of Inspector General

The Office of Inspector General, U.S. Department of Health and Human Services (OIG) investigates criminal activity for HHS. The special agents who work for OIG have the same title series "1811" as other federal criminal investigators, such as the FBI, HSI, ATF, DEA and Secret Service. They receive their law enforcement training at the U.S. Department of Homeland Security's Federal Law Enforcement Training Center in Glynco, Georgia. OIG Special Agents have special skills in investigating white collar crime related to Medicare and Medicaid fraud and abuse. Organized crime has dominated the criminal activity relative to this type of fraud.

HHS-OIG investigates tens of millions of dollars in Medicare fraud each year. In addition, OIG will continue its coverage of all 50 states and the District of Columbia by its multi-agency task forces (PSOC Task Forces) that identify, investigate, and prosecute individuals who willfully avoid payment of their child support obligations under the Child Support Recovery Act.

HHS-OIG agents also provide protective services to the Secretary of HHS, and other department executives as necessary.

In 2002, the department released Healthy People 2010, a national strategic initiative for improving the health of Americans.

With the passage of the Fraud Enforcement and Recovery Act of 2009, and the Affordable Care Act of 2010, the Office of the Inspector General has taken an emboldened stance against healthcare related non-compliance, most notably for violations of Law and the Anti-Kickback Statute.

In 2015, the OIG issued a fraud alert as a warning to hospitals and healthcare systems to monitor and comply with their physician compensation arrangements.

Recent years have seen dramatic increases in both the number and the amounts of Stark Law violation settlements, prompting healthcare experts to identify a need for automated solutions that manage physician arrangements by centralizing necessary information with regard to physician–hospital integration. Contract management software companies such as **Meditract**provide options for health systems to organize and store physician contracts. Ludi Inc introduced DocTime Log®, an SaaS solution that specifically addresses this growing concern, automating physician time logging in compliance with contract terms to eliminate Stark Law and Anti-Kickback Statute violations.

According to a report released by the OIG in July 2019, more than 80 percent of the 4,563 U.S. hospice centers that provide care to Medicare beneficiaries surveyed from 2012 to 2016 have at least one deficiency and 20 percent have at least one "serious deficiency".

From January 2020, Christi Grimm became the principal deputy inspector general. She assumed the duties of an acting inspector general, because the inspector general post was empty. In April 2020, Grimm released a report which surveyed the state of hospitals in late March during the COVID-19 pandemic in the United States. The hospitals reported "severe shortages of testing supplies", "frequently waiting 7 days or longer for test results", which extended the length of patient stays and strained resources, and "widespread shortages of PPE". President Trump called the report "wrong" and questioned Grimm's motives. Later he called the report "Another Fake Dossier!" In May 2020, Trump nominated Jason Weida to be the permanent inspector general, pending confirmation by the U.S. Senate. According to a department spokeswoman, Grimm will remain as principal deputy inspector general.

### Former operating divisions and agencies

* Social Security Administration, made independent in 1995.

## Budget and finances

The Department of Health and Human Services was authorized a budget for fiscal year 2020 of $1.293 trillion. The budget authorization is broken down as follows:

The FY2020 budget included a $1.276 billion budget decrease for the Centers for Disease Control, and a $4.533 billion budget decrease for the National Institutes of Health. These budget cuts, along with other changes since 2019, comprised a total decrease of over $24 billion in revised discretionary budget authority across the entire Department of Health and Human Services for Fiscal Year 2020.

Additional details of the budgeted outlays, budget authority, and detailed budgets for other years, can be found at the HHS Budget website.

## Programs

The Department of Health & Human Services' administers 115 programs across its 11 operating divisions. The United States Department of Health & Human Services (HHS) aims to "protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves." These federal programs consist of social service programs, civil rights and healthcare privacy programs, disaster preparedness programs, and health related research. HHS offers a variety of social service programs geared toward persons with low income, disabilities, military families, and senior citizens. Healthcare rights are defined under HHS in the Health Insurance Portability and Accountability Act (HIPAA) which protect patient's privacy in regards to medical information, protects workers health insurance when unemployed, and sets guidelines surrounding some health insurance. HHS collaborates with the Office of the Assistant Secretary for Preparedness and Response and Office of Emergency Management to prepare and respond to health emergencies. A broad array of health related research is supported or completed under the HHS; secondarily under HHS, the Health Resources & Service Administration houses data warehouses and makes health data available surrounding a multitude of topics. HHS also has vast offering of health related resources and tools to help educate the public on health policies and pertinent population healthinformation. Some examples of available resources include disease prevention, wellness, health insurance information, as well as links to healthcare providers and facilities, meaningful health related materials, public health and safety information.

Some highlights include:

* AI in health and social science research
* Preventing disease, including immunization services
* ARPA-H
* Assuring food and drug safety
* Medicare (health insurance for elderly and disabled Americans) and Medicaid (health insurance for low-income people)
* Health information technology
* Financial assistance and services for low-income families
* Improving maternal and infant health, including a Nurse Home Visitation to support first-time mothers
* Head Start (pre-school education and services)
* Faith-based and community initiatives
* Preventing child abuse and domestic violence
* Substance abuse treatment and prevention
* Services for older Americans, including home-delivered meals
* Comprehensive health services for Native Americans
* Assets for Independence
* Medical preparedness for emergencies, including potential terrorism
* Child support enforcement

### The Health Insurance Portability and Accountability Act (HIPAA)

This program is to ensure the accountability of medical professionals to respect and carry-out basic human health rights, under the act of the same name. In the United States, the government feels that it is essential for the American people to understand their civil duty and rights to all of their medical information. That includes: health insurance policies or medical records from every doctor or emergency visit in one's life. Through Health & Human services one is able to file a complaint that their HIPAA rights have been violated or a consultant that will be able to decide if their rights were violated.

### Social Services

This branch has everything to do with the social justice, wellness, and care of all people throughout the United States. This includes but is not limited to people who need government assistance, foster care, unaccompanied alien children, daycares (headstart included), adoption, senior citizens, and disability programs. Social services is one of (if not) the largest branch of programs underneath it that has a wide variety throughout the United States at a state and local level.

### Prevention and Wellness

The prevention and wellness program's main idea is to give the American people the ability to live the healthiest and best lifestyle physically that they can. They are the ones who deal with vaccines and immunizations, which fight from common diseases to deadly ones. The nutrition & fitness program that are the basics of healthy eating and regular exercise. Health screenings & family health history which are crucial in the knowledge of each individual's health and body. A severely important one especially in today's society is mental health and substance abuse in where they help people with mental illness and drug abuse. Lastly, they help with environmental health where people are researching and studying how our environments both physical and metaphorically have a short- and long-term effect on our health and wellness.

### Strengthening Communities Fund

In June 2010, the Department of Health & Human Services created the Strengthening Communities Fund as part of the American Recovery and Reinvestment Act. The fund was appropriated $50 million to be given as grants to organizations in the United States who were engaged in Capacity Building programs. The grants were given to two different types of capacity builders:

* State, Local and Tribal governments engaged in capacity building: grants will go to state local and tribal governments to equip them with the capacity to more effectively partner with faith-based or non-faith based nonprofit organizations.Capacity building in this program will involve education and outreach that catalyzes more involvement of nonprofit organizations in economic recovery and building up nonprofit organization's abilities to tackle economic problems. State, Local and Tribal governments can receive up to $250,000 in two year grants
* Nonprofit Social Service Providers engaged in capacity building: they will make grants available to nonprofit organizations who can assist other nonprofit organizations in organizational development, program development, leadership, and evaluations. Nonprofits can receive up to $1 million in two year grants

### Biodefense

HHS plays a role in protecting the United States against bioterrorism events. In 2018, HHS released a new National Biodefense Strategy required by passage of the 2016 Biodefense Strategy Act. The Biodefense Strategy required implementation of a biodefense strategy after a 2015 Blue Ribbon Study Panel on Biodefense report found that the 2009 National Strategy for Countering Biological Threats was inadequate in protecting the U.S. The strategy adopted these five central recommendations: creating a single centralized approach to biodefense; implementing an interdisciplinary approach to biodefense that brings together policy makers, scientists, health experts, and academics; drawing up a comprehensive strategy to address human, plant, and animal health; creating a defense against global and domestic biological threats; and creating a proactive policy to combat the misuse and abuse of advanced biotechnology.

HHS also runs the Biodefense Steering Committee, which works with other federal agencies including the U.S. Department of State, U.S. Department of Defense, U.S. Food and Drug Administration, U.S. Department of Homeland Security, and the Environmental Protection Agency. HHS specifically oversees Project BioShield, established in 2003 and operating since 2004, and its development and production of genetically based bio-weapons and vaccines. HHS together with DHS are authorized under the Homeland Security Act of 2002 to deploy the weapons and vaccines produced by Project BioShield on the US general public under martial law during "emerging terrorist threats" or public health emergencies. Both HHS and DHS have similar authorities through state-based legislation adopted from Model State Emergency Health Powers Act provisions.