Department of Health and Human Services Agency-Wide Plan

Note: Implementation plan formats have recently been updated, but all content remains as submitted to OMB.

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Table of Contents

• Department of Health and Human Services Broad Recovery Goals
• List of Recovery Programs within HHS
• Funding Table
• Competition of contracts (excludes contracts under grants)
• Contract Type (excludes contracts under grants)
• Description of Agency Accountability Mechanisms

Broad Recovery Goals

HHS Recovery Act activities increase access to health care, protect those in greatest need, create jobs, expand educational opportunities, lay the groundwork for successful Health Reform, and provide immediate relief to states and local communities. HHS has been entrusted with carefully investing $167 billion of taxpayer’s funds for these purposes, and is committed to making every dollar count.

HHS is moving quickly and carefully to award Recovery Act funds in an open and transparent manner that will achieve the objectives of each Recovery Act program. A Recovery Act Implementation Team, comprised of the heads of the Department’s Operating Divisions and Staff Divisions, meets on a regular basis to review specific program plans and Recovery Act policies being implemented in HHS.

To coordinate and manage the complexity of HHS’ role in the Recovery Act, HHS established an Office of Recovery Act Coordination. This Office will ensure that HHS fully implements the Act’s requirements and OMB’s guidance. This includes ensuring that programs are designed to best meet the Recovery Act’s objectives, reporting due dates are met, performance outcomes are established and tracked, risks of fraud and abuse are mitigated, and the public is kept informed through the Web and other means of communication.

HHS Recovery Act activities touch the lives of Americans, lay a solid foundation for Health Reform, and make a down payment on the President’s “Zero to Five” plan of early care and education of children by:

• Promoting access to health insurance and increasing the number of health care professionals through additional grants to healthcare workforce training institutions;
• Computerizing Americans’ health records, which will improve the quality of health care, reduce medical errors, and prevent unnecessary health care spending;
• Advancing scientific and biomedical research and development related to health and human services;
• Promoting economic and social well-being of individuals, families, and communities;
• Strengthening necessary healthcare services for medically underserved individuals and as part of the unique relationship between Tribes and the Federal government, providing healthcare services to American Indians and Alaska Natives;
• Providing information on the relative strengths and weaknesses of various medical interventions, so clinicians and patients have valid information to make decisions, which will improve the performance of the health care system;
• Expanding access to vaccines and vaccination services, preventing healthcare associated infections, and promoting prevention of disease through a large-scale community-oriented prevention intervention using proven techniques to reduce rates of chronic disease;
• Ensuring that all Recovery Act funds achieve the goals of the Act and the specific programmatic goals by designing Recovery Act programs so risks of fraud and abuse are mitigated up-front, and then reporting, auditing, and investigating for fraud and abuse once programs are underway; and protecting the confidentiality and integrity of HHS data systems.

Examples of performance measures include:

• Number of new patients served at health centers.
• Number of additional Head Start children served by Recovery Act funds.
• Number of home delivered meals served.
• Reduction in Healthcare Associated Infections

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List of Recovery Programs within HHS:

  Improving and Preserving Health Care

• Temporary Increase in Medicaid Federal Medical Assistance Percentage (FMAP)
• Medicaid FMAP Implementation (PDF - 38.80 KB)
• Transitional Medical Assistance (TMA) Extension (PDF - 28.40 KB)
• Temporary Increase in Disproportionate Share Hospital (DSH) Allotments (PDF - 26.29 KB)
• Qualified Individuals (QI) Program Extension (PDF - 32.68 KB)
• Protections for Indians Under Medicaid and the Children’s Health Insurance Program (CHIP) (PDF - 33.66 KB)
• Health Professions Training Programs (PDF - 102.12 KB)

  Accelerating the Adoption of Health Information Technology

• Health Information Technology (HIT) (Medicare and Medicaid) (PDF - 66 KB)
• The Office of the National Coordinator

  Strengthening Scientific Research and Facilities

• Scientific Research (PDF - 122.36 KB)
• Extramural Lab Construction and Renovation (PDF - 90 KB)
• Buildings and Facilities (PDF - 80 KB)
• Shared Instrumentation – (PDF - 80.35 KB)

  Improving Children and Community Services

• TANF - Emergency Fund (PDF - 65.34 KB)
• TANF - Supplemental Grants (PDF - 80.68 KB)
• Child Support Enforcement (PDF - 78.28 KB)
• Temporary Increase in Foster Care Permanency (FMAP) (PDF - 87.67 KB)
• Child Care and Development Block Grant (CCDBG) (PDF - 86.14 KB)
• Early Head Start (PDF - 67.2 KB)
• Head Start (PDF - 78.84 KB)
• Community Services Block Grant (PDF - 56 KB)
• Strengthening Communities Fund (PDF - 82.05 KB)
• Congregate Nutrition Services (PDF - 63.5 KB)
• Home-Delivered Nutrition Services (PDF - 69.93 KB)
• Native American Nutrition Services (PDF - 66.56 KB)

  Strengthening Community Healthcare Services

• Health Centers - Construction, Renovation and Equipment, and Health Information Technology (PDF - 186.97 KB)
• Health Centers - Services (PDF - 172.63 KB)
• Health Professions Training Programs - National Health Service Corps (PDF - 182.98 KB)
• Indian Health Service - Health Care Facilities Construction (PDF - 210 KB)
• Indian Health Service - Sanitation (PDF - 222 KB)
• Indian Health Service - Facilities Maintenance and Improvement (PDF - 213 KB)
• Indian Health Service - Equipment (PDF - 225 KB)
  • Pre-Award List - Construction, Sanitation, Maintenance, and Equipment Projects
    This supplemental document provides additional project details for the following Indian Health Service Plans: Health Care Facilities Construction; Sanitation; Facilities, Maintenance, and Improvement, and Equipment.
• Indian Health Service - Health Information Technology (PDF - 225 KB)
  • Pre-Award List of Non-localized Funding
    This supplemental document provides additional details about the IHS Recovery Act Implementation Plan for Health Information Technology.

  Supporting Comparative Effectiveness Research

• NIH
• AHRQ
• Office of the Secretary

  Promoting Prevention and Wellness

• Evidence-based Clinical and Community-based Prevention Strategies (PDF - 27.83 KB)
• Section 317 Imunization Program (PDF - 118.57 KB)
• Healthcare Associated Infection Reduction Strategies in States (PDF - 321.79 KB)

  Improving Accountability and Information Technology Security

• HHS Information Technology Security (PDF - 85.1 KB)

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Funding Table:

* Includes $202 million for implementation of Section 4301 of Division B of the Recovery Act.

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Competition of Contracts (excludes contracts under grants):

Baseline Competition Performance: HHS has achieved great success awarding its contract actions competitively. In fiscal years 2007 and 2008, of the contract dollars available for competition, HHS awarded 80% and 84% of its available dollars competitively. The funds that were not available for competition, were obligated through statutorily exempt processes, such as the SBA 8(a) Business Development Program and Indian Self-Determination and Education Assistance Act (Section 638).

Recovery Act Competition Projection: Currently, 84 percent of the Operating Divisions’ (OPDIVs) spending plans are approved or awaiting approval. However, in many cases, the OPDIVs are still early in their acquisition planning processes and our data is incomplete and subject to change. Based on data available on April 17, 2009 from those OPDIVs with approved spending plans, HHS plans to award 98% of its Recovery Act funded contract actions competitively. This compares favorably to our baseline performance. Again, these data are preliminary, but they reflect the efforts already taken to encourage competition and to reinforce the importance of proper acquisition planning. HHS issued Department-wide guidance emphasizing HHS’ commitment to using competitive procedures to award Recovery Act-funded acquisitions and its intention to strengthen internal quality controls to maximize competition. Representatives from HHS’ contracting community meet weekly to share information and lessons, to reinforce the need for contracting officials to be business advisors to their program offices, and to reemphasize the need to steward public funds responsibly.

Increased Scrutiny of Non-Competitive Recovery Act Contracts: For actions that will not be competed, program and contracting officials have been put on notice that their justifications for other than full and open competition must demonstrate the soundness of limiting competition and withstand public scrutiny. In addition, HHS is developing a standard template to further document the decision process and provide a higher level of scrutiny than is currently required for noncompetitive actions using Recovery Act funds.

Periodic Updates: This plan will be updated quarterly to reflect changes to the planned level of competition, information from the remaining OPDIVs, achievements against plans, and issuance of additional competition-related policy.

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Contract Type (excludes contracts under grants):

Baseline Contract Type: For fiscal years 2007 and 2008, HHS has successfully awarded 45% and 38%, respectively, of its contract actions on a fixed price basis.

Recovery Act Contract Type Projection: Currently, 84 percent of the OPDIVs spending plans are approved or awaiting approval. However, in many cases, the OPDIVs are still early in their acquisition planning processes and our data is incomplete and subject to change. Based on data available as of April 17, 2009 from those OPDIVs with approved spending plans, HHS plans to award 67% of its Recovery Act funded contract actions on a fixed price basis. This compares favorably to our baseline performance. Again, these data are preliminary, but they reflect the efforts already taken to encourage fixed price and to reinforce the importance of proper acquisition planning and requirements definition. The Acting Senior Procurement Executive issued, through the Office of Recovery Act Coordination, Department-wide guidance emphasizing HHS’ commitment to using fixed price type contracts to award Recovery Act-funded acquisitions. Representatives from HHS’ contracting community meet weekly to share information and lessons, to reinforce the need for contracting officials to be business advisors to their program offices, and to reemphasize the need to steward public funds responsibly.

Increased Scrutiny of Other Than Fixed Price Recovery Act Contracts: For actions that will not be fixed price, program and contracting officials have been put on notice that they must demonstrate the basis for determining the contract type. Accordingly, HHS is developing a standard template to specifically document the basis for determining that a contract using Recovery Act funds could not be fixed price.

Periodic Updates: This plan will be updated quarterly to reflect changes to the planned contract type, information from the remaining OPDIVs, achievements against plans, and issuance of additional contract type-related policy.

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Description of Agency Accountability Mechanisms:

Ensuring accountability has been a key HHS objective from the very beginning of implementation of the Recovery Act. HHS is establishing new policy and technical processes to implement the Recovery Act’s transparency and accountability requirements. A Recovery Act Implementation Team comprised of the Department’s top leadership meets on a regular basis to discuss program specific plans and implementation issues that impact across HHS Recovery Act activities. The Department also created a Recovery Act Technical Council consisting of senior management officials from the Department’s Operating Divisions and the heads of business functions across the Department that meet regularly to address operational issues. The Office of Recovery Act Coordination (the Office) was established in March 2009 to ensure that HHS fully implements the Act’s requirements and OMB’s guidance, and provides staff support to these groups. This Office will work with senior program managers to establish project management plans to ensure that reporting due dates are met, performance measures are established and tracked, risks of fraud and abuse are mitigated, and the public is kept informed through the web and other means of communication. The Office will convene quarterly meetings with senior program managers, the Department’s Senior Accountable Official, and other Department policy leadership to discuss the status of the more than 40 programs supported by the Recovery Act and ensure that programs are:

• on track to meet their program goals,
• assessing and mitigating risks,
• ensuring transparency, and
• incorporating corrective actions.

In addition, the Office will convene quarterly status meetings with the Secretary.

Examples of ongoing activities to minimize risk and ensure accountability:

• Focusing, from the very beginning, on designing our programs to identify and mitigate the risks of non-performance and waste, fraud, and abuse in each step of program implementation.
• Working proactively with the Office of Inspector General on the design of our programs to prevent fraud, waste, and abuse.
• Incorporating accountability measures for Recovery Act programs in personnel performance appraisal systems.
• Conducting risk assessments, establishing risk mitigation strategies, and monitoring results.
• Conducting program and financial reviews.

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