In 1997, HHS made significant strides toward ensuring that Americans have the tools they need to lead healthy and productive lives. Through targeted investments, we helped continue the important progress we've made since 1993 toward creating a stronger and healthier nation. And through better management, we streamlined and strengthened our services.
In particular, we took important steps toward improving health care access and quality. Under the Balanced Budget Act of 1997, we launched an historic expansion of health care for our nation's children. We also strengthened the Medicare and Medicaid programs, adding important new benefits and extending the life of the Medicare Trust Fund without raising premiums.
President Clinton also appointed a new advisory commission to improve health care quality, which proposed a new Consumer Bill of Rights. And we began implementation of the landmark Health Insurance Portability and Accountability Act of 1996, which includes important new protections for an estimated 25 million Americans who move from one job to another, who are self-employed, or who have pre-existing medical conditions. We also initiated a new effort to ensure privacy of personal health records, and achieved unprecedented levels of recoveries and prosecutions under our expanded effort to fight health care fraud and abuse.
In addition, HHS again reported significant gains in key indicators of our nation's health. AIDS deaths declined for the first time in the history of the epidemic, and teen birth rates declined for the fifth straight year. Infant mortality rates reached a new record low, and more women than ever before received prenatal care. Childhood immunization rates reached a record high, meeting the goals we set in 1993, and rates of vaccine preventable childhood disease fell to all-time lows.
HHS also announced new signs of progress in combating teen drug use with two comprehensive studies showing the first leveling off of drug use among young teens since 1992. And we achieved the largest decline in welfare caseloads in history.
In the coming year, we will continue to build on these accomplishments and prepare HHS -- and the nation -- for the 21st century. As part of this effort, we will work with Congress to craft bipartisan legislation to enact the Consumer Bill of Rights for health care, protect the privacy of health records, and dramatically reduce youth tobacco use.
Guide to HHS Progress Toward Goals
BUILDING STRONG FOUNDATIONS FOR INFANTS AND YOUNG CHILDREN
New Children's Health Insurance Program
Improving Child Care
Head Start Expansion Initiative
Record Vaccination Levels
Record Progress In Preventing Infant Mortality
Increasing Availability of Pediatric Use Information for Prescription Drugs
ENSURING SAFE PASSAGES TO ADULTHOOD FOR ADOLESCENTS
National Strategy to Prevent Teen Pregnancy
New Signs of Progress in Combating Youth Drug Use
First Provisions of the President's Plan to Reduce Youth Tobacco Use Become Effective
IMPROVING HEALTH CARE QUALITY
HHS Takes First Steps Toward Implementing Landmark Health Insurance Legislation
Advisory Commission on Consumer Protection and Quality in the Health Care Industry
Consumer Bill of Rights
Ban on Time Limits for Breast Cancer Surgery
New Patient Appeals Rights
Physician Incentive Rules
Standardizing Health Plan Performance Measurement
Medicare Managed Care Marketing Guidelines Released
FIGHTING HEALTH CARE FRAUD, WASTE, AND ABUSE
Record Recoveries and Prosecutions
Expanding Operation Restore Trust
Tightening Standards for Health Care Providers Participating in Medicare and Medicaid
New Resources for Fraud and Abuse Control
Medicare Fraud Hotline Improved and Expanded
Medicare Secondary Payer Initiatives Produce Significant Savings
PROGRESS IN THE FIGHT AGAINST HIV/AIDS
First Ever Decline in AIDS Deaths
IDS Vaccine Initiative
New Treatment Guidelines
Increased Access to AIDS Drugs
IMPROVING DEPARTMENT MANAGEMENT
Increasing On-Line Access to Health Information
Streamlining and Modernizing the FDA
MOVING FORWARD ON THE PROMISE OF WELFARE REFORM
Largest Caseload Decline in History
Overhauling the Welfare System Nationwide
Record Child Support Enforcement
New Proposal to Improve State Child Support State Incentive Payments
OTHER SIGNIFICANT ACCOMPLISHMENTS
Ensuring Food Safety
Improving Guidance on Mammography
First Biotechnology Product to Treat Cancer
Increasing Organ Donation
BUILDING STRONG FOUNDATIONS FOR INFANTS AND YOUNG CHILDREN
New Children's Health Insurance Program. At President Clinton's urging, the Balanced Budget Act of 1997, signed into law by the President on August 5, 1997, provides the largest increase in funds available for health insurance for low-income children since the creation of Medicaid in 1965. The $24 billion set-aside for children, administered by HHS, will allow states to extend health coverage to millions of uninsured children by expanding their current Medicaid programs or by creating new health insurance plans.
Increasing Adoptions. On February 14, 1997, HHS submitted to President Clinton Adoption 2002, a new action plan to help states set and meet urgent new adoption targets. The report, developed under a Presidential directive signed by President Clinton in December 1996, takes its name from the President's goal to at least double by the year 2002 the number of children adopted or permanently placed each year. Specific recommendations contained in the report included changing federal law to clarify reasonable efforts to reunite families, offering financial incentives to states to increase adoptions and permanent placements, and providing technical assistance to states, courts, and communities to move children more rapidly from foster care to permanent homes. In November 1997, President Clinton signed into law the Adoption and Safe Families Act of 1997, enacting a key part of the President's plan by changing federal law to require that children in foster care receive permanent placements within 12 months. As part of the President's initiative, HHS also awarded 40 demonstration grants in October 1997 for programs aimed at increasing adoptions and reducing the number of children in foster care. In 1997, HHS also awarded child welfare waivers to six states to allow them to test innovative strategies to improve child welfare systems.
Improving Child Care. On October 23, 1997, President Clinton hosted the first-ever White House Conference on Child Care to focus the nation's attention on the importance of addressing the need for safe, affordable, quality child care. This Conference underscores and builds upon the Clinton Administration's commitment to strengthening the American family by giving parents the tools they need to fulfill their responsibilities and giving children the ability to reach their full potential. At the Conference, HHS proposed a National Child Care Provider Scholarship Fund that will increase child care providers' incentives to complete child care-related course work.
Head Start Expansion Initiative. In March 1997, HHS announced a new Head Start initiative that will expand Head Start services for children while also helping parents on welfare move to work. Under the new initiative, Head Start expansion funds are being used for the first time to build partnerships with child care providers to deliver full-day and full-year Head Start services. Full-day and full-year services, in turn, can help parents attain full-time work. Through the Head Start-child care partnerships, Head Start and child care agencies combine staff and funds to provide high quality services. Children stay in one place all day, rather than attending Head Start for half a day and then moving to child care for the remainder of the day. Since taking office, the Clinton Administration has nearly doubled funding for Head Start, increased the number of children and families served by approximately 35 percent to about 836,000, and expanded the number of children age 0-3 in Head Start to over 37,000.
Record Vaccination Levels. In July 1997, HHS announced that childhood immunization rates reached a new all-time high of 78 percent in 1996 for the complete series of recommended vaccinations. In addition, HHS announced that the nation had exceeded its childhood vaccination goals for 1996, with 90 percent or more of America's toddlers receiving the most critical doses of the most routinely recommended vaccines for children by age two. Also in 1996, reported levels of preventable childhood diseases were at near or record lows, and three diseases reached the elimination targets. The 1996 goals were set in 1993 when President Clinton launched the comprehensive Childhood Immunization Initiative (CII), led by the CDC, in response to low vaccination rates among preschool children.
Record Progress In Preventing Infant Mortality. In 1997, HHS announced that the nation had again reached a record low infant mortality rate. Driving the overall decline in infant mortality was a 15 percent decline in infant deaths attributed to Sudden Infant Death Syndrome (SIDS) between 1995 and 1996. This decline is largely attributed to the increase in awareness produced by the Department's Back to Sleep campaign, which spreads the message that infant caregivers can reduce the risk of SIDS by placing babies on their backs to sleep. In addition, HHS announced in 1997 that a record number of women are receiving prenatal care in their first trimester of pregnancy. To help build on this progress, HHS in February 1997 announced the nation's first toll-free referral and information service to help women obtain proper prenatal care throughout their pregnancies. Callers in all 50 states can now call 1-800-311-BABY (2229) for pregnancy and prenatal care information, including referral to local clinics and physicians. A separate phone number is available for Spanish speakers: 1-800-504-7081. The service is supported by HRSA's Healthy Start program.
Increasing Availability of Pediatric Use Information for Prescription Drugs. On August 13, 1997, President Clinton unveiled a new FDA regulation that will protect children by requiring drug manufacturers to study the safety and appropriate dosage levels of medications for pediatric populations. The regulation also requires proper labeling of drugs for use by children. Even though many drugs affect children differently than adults, most drugs have not been tested on pediatric populations. Under this rule, manufacturers of prescription drugs likely to be used by children will be required to complete studies and place information on drug labels to help pediatricians and other health care providers make scientifically-based treatment decisions when prescribing drugs to children.
ENSURING SAFE PASSAGES TO ADULTHOOD FOR ADOLESCENTS
National Strategy to Prevent Teen Pregnancy. HHS announced in 1997 that the birth rate for teens aged 15-19 has declined five straight years in row, decreasing by 12 percent between 1991 and 1996. To build on this success, the Clinton Administration in January 1997 launched a comprehensive effort to prevent teen pregnancy and encourage adolescents to remain abstinent. The new initiative, led by HHS, builds on the variety of efforts already underway at HHS and in communities across the country. The initiative also responds to a call from the President and Congress for a national strategy to prevent out-of-wedlock teen pregnancies and to a directive, under the new welfare law, to assure that at least 25 percent of communities in this country have teen pregnancy prevention programs in place. To supplement this effort, HRSA in 1997 began awarding $50 million a year in new funding for state abstinence education activities, provided for under the new welfare law. And in May 1997, HHS announced the availability of two new $1 million grant programs for communities to develop innovative approaches to prevent teen pregnancy -- one targeted to girls and the other to boys.
New Signs of Progress in Combating Youth Drug Use. In 1997, HHS released data showing that illicit drug use among younger teens has leveled off for the first time since 1992. The data, taken from the 1996 National Household Survey on Drug Abuse and the 1997 Monitoring the Future Survey, also shows that after doubling from 1992 to 1995, marijuana use is leveling off among younger teens, and shows signs of beginning to level off among older teens as well. The surveys also found signs of improvement in drug-related attitudes, with disapproval of substance abuse increasing among younger teens. To bolster efforts to prevent youth substance abuse, HHS in October 1997 awarded a total of $15 million in grants to Governors' offices in five states to support statewide planning for coordinated youth substance abuse prevention services. Another $5 million was awarded to five regional centers, which will help the states implement well grounded, research-based substance abuse prevention strategies. HHS also released the first research-based guide to preventing young people from using drugs, and approved the first non-prescription test system for drugs of abuse.
First Provisions of the President's Plan to Reduce Youth Tobacco Use Become Effective. On February 27, 1997, the first provisions of the FDA's comprehensive rule to prevent the sale of tobacco products to children went into effect. In February, the FDA launched a nationwide outreach effort to educate retailers, parents and community leaders about the provisions of the FDA rule to protect children from tobacco products, and on August 1, 1997, the FDA joined with 20 national retailer, consumer and health professional organizations to launch a major poster campaign to assist retailers in enforcing age and photo ID provisions. In September 1997, President Clinton called for comprehensive national legislation to build on the FDA rule and significantly reduce children's use of tobacco products.
IMPROVING HEALTH CARE QUALITY
HHS Takes First Steps Toward Implementing Landmark Health Insurance Legislation. On April 1, 1997, HHS announced new regulations as the first step in implementing key provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), signed into law by President Clinton on August 21, 1996. The regulations focus on limiting exclusions for pre-existing medical conditions, prohibiting discrimination against employees and dependents based on their health status, guaranteeing availability of health insurance to small employers, and guaranteeing renewability of insurance to all employers regardless of size. In addition, Secretary Shalala on September 11, 1997 submitted to Congress recommendations for Federal health record confidentiality legislation as called for in the Act. The recommended legislation would guarantee rights for patients and define responsibilities for record keepers, so that there will be clear guidance and real incentives for confidential, fair, and respectful treatment of personal health information, and penalties for its misuse. Using these recommendations as a guide, HHS will work with Congress to enact bipartisan legislation to guarantee these protections.
Advisory Commission on Consumer Protection and Quality in the Health Care Industry. In March 1997, President Clinton announced the members of the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, created through an Executive Order signed by President Clinton to build on his Administration's commitment to improving the quality of the nation's health care system. The 32-member Commission will review rapid changes in the health care financing and delivery systems and make recommendations, where appropriate, on how best to preserve and improve the quality of the nation's health care system. Co-chaired by the Secretaries of Health and Human Services and Labor, the Advisory Commission has broad-based representation from consumers, businesses, labor, health care providers, insurers, and quality and financing experts.
Consumer Bill of Rights. In November 1997, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry announced their recommendation for a "Consumer Bill of Rights" to promote and assure patient protections and health care quality. The three goals of the Consumer Bill of Rights are: (1) to strengthen consumer confidence that the health care system is fair and responsive to consumer needs; (2) to reaffirm the importance of a strong relationship between patients and their health care providers; and (3) to reaffirm the critical role consumers play in safeguarding their own health. The President has asked all federal agencies to develop plans for applying the "Consumer Bill of Rights" to their workforce, and challenged private health care plans to adopt the standards. The Clinton Administration will work with Congress in the coming year to craft bipartisan legislation to enact the Commission's recommendations. The full text of the Consumer Bill of Rights [www.hcqualitycommission.gov/cborr] is available on the Internet at www.hcqualitycommission.gov.
Ban on Time Limits for Breast Cancer Surgery. In February 1997, HHS announced steps to ensure that Medicare beneficiaries are protected from any requirements by health plans that would place time limits on hospital stays for mastectomies. In letters to 350 managed care plans contracting with Medicare, HHS said outpatient surgery or limitation on hospital stays may not be required by plans for beneficiaries undergoing surgery for the treatment of breast cancer. Medicare paid for more than 84,000 mastectomies last year, or about a third of all mastectomies in the U.S. This action coincides with a call by President Clinton for bipartisan legislation to guarantee that a woman can stay in the hospital for 48 hours following a mastectomy. New Patient Appeals Rights. Response within 72 hours to appeals of care denials is required for Medicare beneficiaries under regulations enacted by HHS in April 1997. This regulation covers decisions that could jeopardize life, health or ability to regain maximum function, and terminations of care, such as skilled nursing facility discharge.
Physician Incentive Rules. As of January 1997, health plans are required to disclose financial incentives and pay for stop-loss insurance for physicians so they can lose no more than 25 percent of their income if the cost of care for their patients exceeds what they are paid by the plan. The regulations also ban any incentive arrangements that include payments to doctors to limit or reduce medically necessary services. These rules are designed to make sure incentives to discourage unnecessary services do not jeodardize quality patient care.
Standardizing Health Plan Performance Measurement. In January 1997, HCFA formally launched the Medicare Health Plan Employer Data Information Set (HEDIS), a partnership with the Kaiser Family Foundation to establish a performance measurement system that will minimize reporting burdens on managed care plans serving Medicare beneficiaries. The new measures will help plans to improve the quality of their care and support efforts to improve the health status of beneficiaries.
Medicare Managed Care Marketing Guidelines Released. On September 8, 1997, HHS issued marketing guidelines to help Medicare beneficiaries make informed choices about managed care plans. The guidelines will inform health plans serving Medicare what is, and is not, allowed under Medicare managed care regulations on advertising, enrollment, and required notifications to Medicare beneficiaries. The guidelines will also help expedite review of marketing materials by the Health Care Financing Administration, which runs the Medicare program.
FIGHTING HEALTH CARE FRAUD, WASTE, AND ABUSE
Record Recoveries and Prosecutions. On September 29, 1997, HHS announced that the Department's expanded efforts to fight fraud and abuse in health care are paying off, with unprecedented levels of recoveries and prosecutions. In FY 1997, HHS identified $1.2 billion for collection in total fines, restitutions, settlements, and recoveries -- the most ever identified in one year. The FY 1997 total was six times higher than recoveries for FY 1996, and over three times higher than the previous best year for recoveries. In addition, criminal and civil prosecutions totaled 1,340 cases in FY 1997 -- double the number for FY 1996, and more than five times the total number in FY 1995. Over 2,700 health care providers and entities were excluded from doing business with Medicare, Medicaid, and other federal and state health care programs for engaging in fraud or abuse of the programs -- an 86 percent increase from the 1,400 exclusions in FY 1996. Since 1993, actions affecting HHS programs alone have saved taxpayers more than $20 billion and increased health care fraud convictions by 240 percent.
Expanding Operation Restore Trust. In May 1997, Secretary Shalala announced a new, nationwide expansion of Operation Restore Trust (ORT), the Department's comprehensive anti-fraud initiative. ORT was started in 1995 as a two-year, five state pilot program to test the success of several innovations in fighting fraud and abuse in the Medicare and Medicaid programs. During the demonstration, ORT identified $23 in overpayments for every $1 spent looking at the fast-growing areas of Medicare, including home health care, skilled nursing facilities, and providers of durable medical equipment.
Tightening Standards for Health Care Providers Participating in Medicare and Medicaid. On September 15, 1997, President Clinton announced three new weapons to fight fraud and abuse in the home health care industry, the fastest growing part of the Medicare program. The President announced: (1) an immediate moratorium on all new home health providers coming into the Medicare program while HHS implements new regulations to prevent risky providers from entering the program; (2) a new renewal process for home health agencies currently in the program to help weed out fraudulent providers; and (3) a doubling of audits to help increase detection of fraud and abuse. In addition, the Clinton Administration in March 1997 proposed a new regulation that would revise the federal standards, called Conditions of Participation, that health care providers must meet in order to participate in the Medicare program. The new rule, included at the President's urging in the Balanced Budget Act of 1997, requires applicants to provide their social security numbers and employer identification numbers so HCFA can check for past fraudulent activity, and to conduct criminal background investigations on the staff they hire. The Balanced Budget Act will further reduce fraud and abuse in home health care by establishing a prospective payment system for home health services, tightening eligibility, and developing guidelines for use of home health services.
New Resources for Fraud and Abuse Control. In FY 1997, the HHS Office of the Inspector General (OIG) received $70 million from the new Health Care Fraud and Abuse Control Account created under the Health Insurance Portability and Accountability Act of 1996. The landmark Act, signed into law by President Clinton in August 1996, created a stable source of funding for health care fraud control efforts for the first time. The new funding has enabled the OIG to open six new field offices to facilitate enforcement actions, increasing from 26 to 31 the number of states in which the OIG is present. In addition, HHS in August 1997 awarded more than $2.25 million in grants funded by HIPAA through HCFA and the Administration on Aging for new programs to aid in the fight against health care fraud and abuse. Provisions under HIPAA will also establish a fraud and abuse database to identify health care providers who have been the subject of adverse actions as a result of illegal or abusive practices, and award grants to partner agencies engaged in investigations, prosecutions, and audits of health care fraud and abuse.
Medicare Fraud Hotline Improved and Expanded. In July 1997, HHS expanded the Medicare fraud hotline started in 1995 to report fraud and abuse in Medicare and Medicaid programs. Over 32,000 complaints that warranted follow-up action have been received since it began service. The hotline is staffed Monday through Friday, 8 a.m. to 5:30 p.m. Eastern Standard Time, and assistance is available in both English and Spanish. The toll-free Hotline number is 1-800-HHS-TIPS (1-800-447-8477). The TTY number for the hearing impaired is 1-800-377-4950 and the fax number is 1-800-223-8164.
Medicare Secondary Payer Initiatives Produce Significant Savings. In 1997, HCFA saved more than $1.1 billion because of new initiatives that help Medicare avoid paying bills that should be paid by other insurers. The Initial Enrollment Questionnaire and Prospective Data Sharing initiatives are both identifying Medicare beneficiaries who have other health insurance coverage. Under Medicare Secondary Payer (MSP) laws, other insurers covering Medicare beneficiaries often must pay claims before Medicare. This applies, for example, to beneficiaries with coverage through current employment.
PROGRESS IN THE FIGHT AGAINST HIV/AIDS
First Ever Decline in AIDS Deaths. In September 1997, HHS reported that, for the first time in the history of the epidemic, the number of Americans diagnosed with AIDS declined, falling six percent for Americans over age 12 between 1995 and 1996. In addition, HHS reported that HIV/AIDS mortality declined 26 percent between 1995 and 1996, falling from the leading cause of death among 25-44 year olds to the second leading cause of death in that age group. The CDC also reported a slowing in the epidemic overall and a 43 percent decline in perinatally acquired AIDS cases between 1995 and 1996.
AIDS Vaccine Initiative. On May 18, 1997, President Clinton challenged the nation to commit itself to the goal of developing an AIDS vaccine within the next ten years. The President also announced a number of important initiatives to help fulfill this commitment, including high-level international collaboration, a dedicated research center for AIDS vaccine research at NIH, and outreach to scientists, pharmaceutical companies, and patient advocates to maximize the involvement of both private and public sectors in the development of an AIDS vaccine. As part of this effort, the National Institute of Allergy and Infectious Diseases at NIH in September 1997 announced the first grant recipients in its new program to foster innovative research on AIDS vaccines.
New Treatment Guidelines. In 1997, HHS released draft guidelines for treating HIV with antiretroviral drugs. The guidelines, developed by panels of AIDS clinicians and researchers, reflect the current state of knowledge about HIV disease and antiretroviral drugs, and will help standardize and improve the quality of care for HIV-infected persons in the United States.
Increased Access to AIDS Drugs. In 1997, HHS dramatically increased funding for the AIDS Drug Assistance Program, significantly increasing access to promising treatments for HIV and AIDS. ADAP funding increased by 70 percent, and nearly 80,000 people benefited from the program in 1997. In addition, the FDA approved four new AIDS drugs and two drugs for AIDS related conditions in 1997. In March 1997, the FDA approved the first protease inhibitor with labeling for use in children.
IMPROVING DEPARTMENT MANAGEMENT
Increasing On-Line Access to Health Information. In April 1997, HHS launched Healthfinder, a new government gateway site on the Internet that brings together under one umbrella the broad range of consumer health information resources produced by the federal government and its many partners. Its current resources include hyperlinks to more than 1,000 Web sites and nearly 1,200 selected online documents. The address for Healthfinder is http://www.healthfinder.gov. To provide better access to research information, the National Library of Medicine at the NIH in June 1997 launched a new service to provide all Americans free access to MEDLINE -- the world's most extensive collection of published medical information -- over the World Wide Web. Prior to this announcement, users have had to register and pay to search MEDLINE and other NLM databases. MEDLINE can be accessed at: http://www.nlm.nih.gov. Also in June 1997, HHS announced a new "Computers for Seniors" program designed to help give older Americans access to the Internet and help them make better use of Medicare, Medicaid and other HHS programs.
Streamlining and Modernizing the FDA. In 1997, the FDA made significant progress in streamlining operations to improve consumer access to drug information, cut red tape, and speed approval of new medical products and devices. To date, the agency has cut new drug approval times nearly in half, while the number of new drugs approved in a year has doubled. In recognition of its innovations of the U.S. drug approval process, the FDA was named a 1997 winner of the prestigious Innovations in American Government Awards Program, sponsored by the Ford Foundation and Harvard University's John F. Kennedy School of Government. To build on this progress, President Clinton signed into law the FDA Modernization Act of 1997 on November 21, 1997, improving the regulation of food, medical products and cosmetics. In 1997, the FDA proposed a "new use initiative" to speed up the development of new and supplemental uses of medications; announced new, easier to understand labels for over-the-counter drugs; and launched an initiative to provide consumers with better, easier to understand information about prescription drugs. In addition, the FDA announced a plan to reinvent the regulation of human tissue, the FDA's sixth reinvention effort as part of the Clinton Administration's Reinventing Government Initiative.
MOVING FORWARD ON THE PROMISE OF WELFARE REFORM
Largest Caseload Decline in History. In 1997, HHS announced that the welfare caseload fell by 3.4 million recipients, from 14.1 million in January 1993 to 10.7 million in May 1997, a drop of 24 percent since the Clinton Administration took office. Forty-eight out of fifty states have seen their caseloads decline, with ten states reducing their rolls by 40 percent or more in the last four years. This is the largest welfare caseload decline in history and represents the lowest percentage of the population on welfare since 1970. According to an analysis released in 1997 by the Council of Economic Advisors (CEA), the reduction in the welfare rolls can be attributed to the strong economic growth during the Clinton Administration, the waivers granted to states to test innovative strategies to move people from welfare to work, and other factors, such as the Administration's expansion of the Earned Income Tax Credit.
Overhauling the Welfare System Nationwide. On July 1, 1997, the historic welfare law that the President signed last August went in to effect in every state, making work and responsibility the law of the land. HHS has certified welfare plans for each state. In accordance with the welfare law, all plans require and reward work, impose time limits, and demand personal responsibility. The balanced budget that the President signed on August 5, 1997 delivered on the President's pledge to fulfill the promise of welfare reform by investing in moving people from welfare to work and fixing the provisions in the law that had nothing to do with welfare reform, including restoring disability and health benefits to legal immigrants who are currently receiving benefits or become disabled in the future, and continuing Medicaid coverage for currently disabled children receiving SSI. On November 17, 1997, HHS proposed regulations under the new law which are intended to help all welfare recipients who can work go to work, and to encourage states to work with all families.
Record Child Support Enforcement. Due to the President's unprecedented and sustained campaign to make noncustodial parents pay the child support they owe, HHS announced in 1997 that it had collected a record $12 billion in child support in 1996, an increase of 50 percent since 1992. In addition, HHS announced that paternity establishment almost doubled to nearly 1 million cases in FY 1996, from 516,000 in 1992. And the number of families actually receiving child support rose to 4 million cases with collections, an increase of 43 percent over 1992. To build on this progress, the new welfare law includes tough child support measures long-supported by the President, including: a national new hire reporting system; streamlined paternity establishment; uniform interstate child support laws; computerized state-wide collections; and tough new penalties. These measures are projected to increase child support collections to more than $24 billion in the next ten years.
New Proposal to Improve State Child Support State Incentive Payments. On March 13, 1997, Secretary Shalala submitted to Congress a proposal designed to further improve the performance of state child support enforcement programs by linking federal incentive payments to states to their performance in five key areas: establishment of paternities, establishment of child support orders, collections on current child support owed, collections on previously or past due child support owed, and cost-effectiveness. The five areas are intended to better measure the performance of states in fostering parental support for children and family self-sufficiency. Current law provides for HHS to make incentive payments to states for their child support enforcement systems, but these payments are based only on cost-effectiveness. Under the new welfare reform law, HHS was authorized to prepare an alternative plan. On September 16, 1997, Secretary Shalala joined Reps. Clay Shaw and Sandy Levin in announcing bipartisan legislation drawn from the HHS proposal. The legislation would provide incentive funds to states which deliver real results for children who need child support payments from non-custodial parents. To reinforce the goal of achieving self-sufficiency, states will be rewarded for collection in all child support cases, but with a stronger emphasis on welfare and former welfare cases. The House passed this legislation in 1997, and action on the bill is pending in the Senate.
OTHER SIGNIFICANT ACCOMPLISHMENTS
Ensuring Food Safety. In 1997, HHS dramatically increased attention on food safety. In January, President Clinton announced a comprehensive new food safety initiative to help detect and respond to outbreaks of foodborne illness earlier, and to give us the data we need to prevent future outbreaks. The CDC and the FDA play a key role in this new initiative. Key components of the new initiative include: building a national Early Warning System to identify infectious agents and their sources and rapidly communicate these findings nationwide; developing new methods for monitoring the food supply; strengthening intergovernmental coordination to reduce and improve responses to outbreaks of foodborne illnesses; and improving awareness of food safety practices. Building on the President's initiative, the FDA in August 1997 announced new measures to reduce the risk of illness from disease-causing microbes in unpasteurized fruit and vegetable juices, and in October announced an initiative to upgrade domestic food safety standards and to ensure that fruits and vegetables coming from overseas are as safe as those produced in the United States. In addition, the FDA in December 1997 approved the irradiation of meat products to control disease-causing micro-organisms.
Improving Guidance on Mammography. In March 1997, NIH issued a recommendation that women age 40 and over be screened with mammography every one to two years. In addition, NIH recommended that women at higher risk of breast cancer get expert medical advice even before the age of 40 about when to begin screening and about the frequency of their screening. To support this new recommendation, President Clinton proposed and Congress adopted an expansion of Medicare coverage which will help pay for annual mammograms for all Medicare beneficiaries age 40 and over. The new benefit will be available starting January 1, 1998. In addition, the FDA in October 1997 announced final regulations that significantly improve the quality and performance of equipment and personnel at all U.S mammography facilities. The regulations implement the Mammography Quality Standards Act (MQSA) passed by Congress in 1992. The MQSA requires that all mammography facilities meet stringent quality standards, be accredited by an FDA-approved accreditation body, and be inspected annually.
First Biotechnology Product to Treat Cancer. On November 26, FDA approved Rituxan, the first biotechnology product to treat cancer. The drug is used to treat a type of non-Hodgkin's lymphoma. Rituxan targets and destroys white blood cells involved in the disease. Because specific cells are targeted, rather than all fast-growing cells, as is the case for most chemotherapy, tumor shrinkage is accomplished with fewer toxic side effects than other cancer treatments.
Increasing Organ Donation. In December 1997, HHS launched a National Organ and Tissue Donation Initiative aimed at increasing the number of organ donations and reducing the number of Americans who die each year while waiting for organ transplantation. The initiative builds on more than a decade of experience gained from government, private, and volunteer efforts. Focusing on known barriers to donation, it will: (1) create a broad partnership of public, private, and volunteer organizations to encourage Americans to agree to organ and tissue donation; (2) emphasize the need to share personal decisions on organ donation with one's family; (3) work with health care providers, consumers, and physicians to ensure that deaths are reported to organ procurement organizations whenever there is potential for donation; and (4) learn more about what works to bring about donation, through research and evaluation, including an HHS conference on best practices next spring. # # #