AFFORDABLE CARE ACT TAX CREDITS STILL AVAILABLE AFTER SUPREME COURT RULING ACCORDING TO HHS SECRETARY BURWELL'S STATEMENT

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOR IMMEDIATE RELEASE
June 25, 2015

Statement by HHS Secretary Sylvia M. Burwell on the Affordable Care Act
Today’s Supreme Court decision confirms that the Affordable Care Act’s tax credits are available to all eligible Americans no matter where they live. Americans in all 50 states and the District of Columbia can continue to rely on the security and peace of mind that come with affordable, quality health care coverage.

Over six million Americans and their families will sleep easier knowing they will still be able to afford health coverage. Millions more won’t have to worry about an upward spiral in their premiums because of today’s decision, even if they didn’t buy their insurance through the Marketplace. And the law’s financial assistance will be available in the next open enrollment so that others can benefit as well.

The Affordable Care Act is working to improve access, affordability and quality.
That is the story I hear as I travel across this country. People’s lives have been changed and even saved because they have health insurance—many for the first time. They have coverage that can keep them healthy and provide quality care when they are sick.

The Affordable Care Act also strengthens protections for almost every American with health insurance. People with pre-existing conditions can no longer be denied coverage or charged higher premiums. Critical preventive services, like immunizations and certain cancer screenings, are available at no additional cost. Since parents can keep their children on their health insurance policies up to age 26, young Americans can stay in school or find their first job without worrying about their coverage. And your health premiums can no longer be higher just because you are a woman.

I hope that this positive decision will do what the American people want us to do -- focus on the substance and turn to building on the progress we have made. They want us to move forward to provide more Americans with affordable access to quality coverage and create a health care system that improves the quality of care and spends our dollars more wisely.

HHS, USDA, DOD SECRETARIES DISCUSS COMBATING ANTIBIOTIC-RESISTANT BACTERIA

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Our Plan to Combat and Prevent Antibiotic-Resistant Bacteria
Mar 27, 2015
By: Sylvia Mathews Burwell, HHS Secretary
Co-Authored by: USDA Secretary Tom Vilsack, Defense Secretary Ash Carter.

Antibiotics save millions of lives every year. Today, however, the emergence of drug resistance in bacteria is undermining the effectiveness of current antibiotics and our ability to treat and prevent disease. The Centers for Disease Control and Prevention (CDC) estimates that drug-resistant bacteria cause two million illnesses and approximately 23,000 deaths each year in the United States alone. Antibiotic resistance also limits our ability to perform a range of modern medical procedures, such as chemotherapy, surgery, and organ transplants. That’s why fighting antibiotic resistance is a national priority.

Over the past year, the Administration has taken important steps to address the threat of antibiotic resistance. In September 2014, the President issued Executive Order (EO) 13676: Combating Antibiotic-Resistant Bacteria, which outlines steps for implementing the National Strategy on Combating Antibiotic-Resistant Bacteria and addressing the policy recommendations of the President’s Council of Advisors on Science and Technology (PCAST)’s report on Combating Antibiotic Resistance. Furthermore, the President’s FY 2016 Budget released earlier this year proposed nearly doubling the amount of Federal funding for combating and preventing antibiotic resistance to more than $1.2 billion.

Combating and preventing antibiotic resistance, however, will be a long-term effort. That’s why, today, the Administration is releasing the National Action Plan for Combating Antibiotic Resistant Bacteria (NAP). The NAP outlines a whole-of-government approach over the next five years targeted at addressing this threat:

1. Slow the emergence of resistant bacteria and prevent the spread of resistant infections

The judicious use of antibiotics in health care and agriculture settings is essential to combating the rise in antibiotic resistance. We can help slow the emergence of resistant bacteria by being smarter about prescribing practices across all human and animal health care settings, and by continuing to eliminate the use of medically-important antibiotics for growth promotion in animals.

2. Strengthen national "One-Health" surveillance efforts

A “One-Health” approach to disease surveillance will improve detection and control of antibiotic resistance by integrating data from multiple monitoring networks, and by providing high-quality information, such as detailed genomic data, necessary to tracking resistant bacteria in diverse settings in a timely fashion.

3. Advance development and use of rapid and innovative diagnostic tests
The development of rapid “point-of-need” diagnostic tests could significantly reduce unnecessary antibiotic use by allowing health care providers to distinguish between viral and bacterial infections, and identify bacterial drug susceptibilities during a single health care visit making it easier for providers to recommend appropriate, targeted treatment.

4. Accelerate basic and applied research and development

New antibiotics and alternative treatments for both humans and animals are critical to maintaining our capacity to treat and prevent disease. This involves supporting and streamlining the drug development process, as well as increasing the number of candidate drugs at all stages of the development pipeline. Additionally, boosting basic research to better understand the ecology of antibiotic resistance will help us develop effective mitigation strategies.
5. Improve international collaboration and capacities

Antibiotic resistance is a global problem that requires global solutions. The United States will engage with foreign ministries and institutions to strengthen national and international capacities to detect, monitor, analyze, and report antibiotic resistance; provide resources and incentives to spur the development of therapeutics and diagnostics for use in humans and animals; and strengthen regional networks and global partnerships that help prevent and control the emergence and spread of resistance.

The NAP is a comprehensive effort that will require the coordinated and complementary efforts of individuals and groups around the world, including public- and private-sector partners, health care providers, health care leaders, veterinarians, agriculture industry leaders, manufacturers, policymakers, and patients. Working together, we can turn the tide against the rise in antibiotic resistance and make the world a healthier and safer place for the next generation.
Sylvia Mathews Burwell is the Secretary of the Department of Health and Human Services. Tom Vilsack is the Secretary of the Department of Agriculture. Ash Carter is the Secretary of the Department of Defense.

DOJ, HHS, ANNOUNCE OVER $27.8 BILLION RECOVERED COMBATING HEALTH CARE FRAUD

FROM:  U.S. JUSTICE DEPARTMENT
Thursday, March 19, 2015
Departments of Justice and Health and Human Services Announce Over $27.8 Billion in Returns from Joint Efforts to Combat Health Care Fraud
Administration Recovers $7.70 for Every Dollar Spent on Health Care-Related Fraud and Abuse

More than $27.8 billion has been returned to the Medicare Trust Fund over the life of the Health Care Fraud and Abuse Control (HCFAC) Program, Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell announced today.  The government’s health care fraud prevention and enforcement efforts recovered $3.3 billion in taxpayer dollars in Fiscal Year (FY) 2014 from individuals and companies who attempted to defraud federal health programs, including programs serving seniors, persons with disabilities or those with low incomes.  For every dollar spent on health care-related fraud and abuse investigations in the last three years, the administration recovered $7.70.  This is about $2 higher than the average return on investment in the HCFAC program since it was created in 1997.  It is also the third highest return on investment in the life of the program.

“As the innovative and collaborative work of the Health Care Fraud and Abuse Control Program proceeds, more taxpayer money is being recovered, more criminals are facing justice, and more fraud is being punished, prevented and deterred,” said Attorney General Eric Holder.  “The extraordinary return on investment we've obtained speaks to the skill, the tenacity, and the inspiring success of the hardworking men and women fighting on behalf of the American people.  And with these outstanding results, we are sending the unmistakable message that we will not waver in our mission to pursue fraud, to protect vulnerable communities, and to preserve the public trust.”

“Eliminating fraud, waste and abuse is a top priority for the Department of Health and Human Services,” said HHS Secretary Sylvia Burwell.  “These impressive recoveries for the American taxpayer demonstrate our continued commitment to this goal and highlight our efforts to prosecute the most egregious instances of health care fraud and prevent future fraud and abuse.  New enrollment screening techniques and computer analytics are preventing fraud before money ever goes out the door.  And together with the continued support of Congress and our partners at the Department of Justice, we’ve cracked down on tens of thousands health care providers suspected of Medicare fraud – all of which are helping to extend the life of the Medicare Trust Fund.”

The recoveries announced today reflect a two-pronged strategy to combat fraud and abuse.  Under new authorities granted by the Affordable Care Act, the administration continues to implement programs that move away from “pay and chase” to preventing health care fraud and abuse in the first place.  In addition, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), run jointly by the HHS Office of the Inspector General and the Justice Department, is changing how the federal government fights certain types of health care fraud.  These cases are being investigated through "real-time" data analysis in lieu of a prolonged subpoena and account analyses, resulting in significantly shorter periods of time between fraud identification, arrest and prosecution.

Increased funding from the administration and Congress has allowed HHS and the Justice Department to build on early successes of the Medicare Strike Force by expanding into nine geographic territories – Miami, Los Angeles, Detroit, Houston, Brooklyn, New York, Southern Louisiana, Tampa, Florida, Chicago and Dallas.  Since its inception, Strike Force prosecutors filed more than 963 cases charging more than 2,097 defendants who collectively billed the Medicare program more than $6.5 billion; 1,443 defendants pleaded guilty and 191 others were convicted in jury trials; and 1,197 defendants were sentenced to imprisonment for an average term of approximately 47 months.  Through the Strike Force and other efforts, in FY 2014 alone, the Justice Department opened 924 new criminal health care fraud investigations.  Federal prosecutors filed criminal charges in 496 cases involving 805 defendants.  A total of 734 defendants were convicted of health care fraud‑related crimes during the year.

Another powerful tool in the effort to combat health care fraud is the federal False Claims Act.  In 2014, the Justice Department’s Civil Division and the U.S. Attorneys’ Offices obtained $2.3 billion in settlements and judgments from civil cases involving fraud and false claims against federal health care programs such as Medicare and Medicaid.  Since January 2009, the Justice Department has recovered more than $15.2 billion in cases involving health care fraud.  These amounts reflect federal losses only.  In many of these cases, the department was instrumental in recovering additional billions of dollars for state health care programs.  In FY 2014, the department continued its enforcement of the civil False Claims Act and the Federal Food, Drug and Cosmetic Act, and opened 782 new civil health care fraud investigations.

The Centers for Medicare & Medicaid Services (CMS) is also adopting a number of preventive measures to combat fraud and abuse.  Provider enrollment is the gateway to billing the Medicare program, and CMS has put critical safeguards in place to make sure that only legitimate providers are enrolling in the program.  The Affordable Care Act required a CMS revalidation of all existing 1.5 million Medicare suppliers and providers under new screening requirements.  CMS will have requested revalidations by March 2015.  As a result of this and other proactive initiatives, CMS has deactivated 450,000 enrollments and revoked nearly 27,000 enrollments to prevent certain providers from re-enrolling and billing the Medicare program.  Both of these actions immediately stop billing.  A provider with deactivated billing privileges can reactivate at any time, and a revoked provider is barred from re-entry into Medicare for a period ranging from one to three years.  CMS has also issued a regulation requiring prescribers of Part D drugs to enroll in Medicare and undergo screening.

CMS also continued the fiscal 2014 temporary moratoria on the enrollment of new home health or ambulance service providers in six fraud hot spots: Miami, Chicago, Dallas, Houston, Detroit and Philadelphia (which includes some counties in New Jersey).  This extension will allow CMS to continue its actions to suspend payments or remove providers from the program before allowing new providers into potentially over-supplied markets.

Similar to the technology used by credit card companies, CMS is using its Fraud Prevention System to apply advanced analytics to all Medicare fee-for-service claims on a streaming, national basis.  The Fraud Prevention System identifies aberrant and suspicious billing patterns which in turn trigger actions that can be implemented swiftly to prevent payment of fraudulent claims.  In the second year, the system saved $210.7 million, almost double the amount identified during the first year of the program.

$840 MILLION INITIATIVE ANNOUNCED BY HHS SECRETARY BURWELL

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

FOR IMMEDIATE RELEASE

October 23, 2014

HHS Secretary announces $840 million initiative to improve patient care and lower costs

New initiative will support networks that help doctors access information and improve health outcomes

Health and Human Services Secretary Sylvia M. Burwell today announced an initiative that will fund successful applicants who work directly with medical providers to rethink and redesign their practices, moving from systems driven by quantity of care to ones focused on patients’ health outcomes, and coordinated health care systems. These applicants could include group practices, health care systems, medical provider associations and others. This effort will help clinicians develop strategies to share, adapt and further improve the quality of care they provide, while holding down costs. Strategies could include:
Giving doctors better access to patient information, such as information on prescription drug use to help patients take their medications properly;
Expanding the number of ways patients are able communicate with the team of clinicians taking care of them;
Improving the coordination of patient care by primary care providers, specialists, and the broader medical community; and
Using electronic health records on a daily basis to examine data on quality and efficiency.

“The administration is partnering with clinicians to find better ways to deliver care, pay providers and distribute information to improve the quality of care we receive and spend our nation’s dollars more wisely,” said Secretary Burwell.  “We all have a stake in achieving these goals and delivering for patients, providers and taxpayers alike.”

Through the Transforming Clinical Practice Initiative, HHS will invest $840 million over the next four years to support 150,000 clinicians. With a combination of incentives, tools, and information, the initiative will encourage doctors to team with their peers and others to move from volume-driven systems to value-based, patient-centered, and coordinated health care services. Successful applicants will demonstrate the ability to achieve progress toward measurable goals, such as improving clinical outcomes, reducing unnecessary testing, achieving cost savings and avoiding unnecessary hospitalizations.

The initiative is one part of a strategy advanced by the Affordable Care Act to strengthen the quality of patient care and spend health care dollars more wisely. For example, the Affordable Care Act has helped reduce hospital readmissions in Medicare by nearly 10 percent between 2007 and 2013 – translating into 150,000 fewer readmissions – and quality improvements have resulted in saving 15,000 lives and $4 billion in health spending during 2011 and 2012.

Building upon successful models and programs, such as the Quality Improvement Organization Program, Partnership for Patients with Hospital Engagement Networks, and Accountable Care Organizations, the initiative provides opportunities for participating clinicians to collaborate and disseminate information. Through a multi-pronged approach to technical assistance, it will identify existing health care delivery models that work and rapidly spread these models to other health care providers and clinicians.

“This model will support and build partnerships with doctors and other clinicians across the country to provide better care to their patients. Clinicians want to spend time with their patients, coordinate care, and improve patient outcomes, and the Centers for Medicare & Medicaid Services wants to be a collaborative partner helping clinicians achieve those goals and spread best practices across the nation,” said Patrick Conway, M.D., deputy administrator for innovation and quality and CMS chief medical officer.

Practice Transformation Networks. CMS will award cooperative agreements to group practices, health care systems, and others that join together to serve as trusted partners in providing clinician practices with quality improvement expertise, best practices, coaching and assistance. These practices have successfully achieved measurable improvements in care by implementing electronic health records, coordinating among patients and their families, and performing timely monitoring and interventions of high-risk patients to prevent unnecessary hospitalization and readmissions. Practice Transformation Networks will work with a diverse range of practices, including those in rural communities and those that provide care for the medically underserved.

Support and Alignment Networks. CMS will award cooperative agreements to networks formed by medical professional associations and others who would align their memberships, communication channels, continuing medical education credits and other work to support the Practice Transformation Networks and clinician practices. These Support and Alignment Networks would create an infrastructure to help identify evidence-based practices and policies and disseminate them nationwide, in a scalable, sustainable approach to improved care delivery.

By participating in the initiative, practices will be able to receive the technical assistance and peer-level support they need to deliver care in a patient-centric and efficient manner, which is increasingly being demanded by health care payers and purchasers as part of a transformed care delivery system. Participating clinicians will thus be better positioned for success in the health care market of the future - one that rewards value and outcomes rather than volume.

HHS VIDEO: SECRETARY BURWELL: LEADING & MAMAGING FOR IMPACT

STEPS ANNOUNCED TO FURTHER STRENGTHEN HHS MANAGEMETN TEAM

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN RESOURCES
Secretary Burwell announces steps to further strengthen HHS management team
Leslie Dach to join HHS as Senior Counselor

Today, Health and Human Services Secretary Sylvia M. Burwell has named Leslie Dach to a newly-created Senior Counselor position, to further strengthen the HHS leadership team and enhance the Department’s ability to deliver impact for the American people.

Dach joins HHS with more than 25 years of business, policy, communications and executive management experience.  He has delivered impact in complex organizations, created highly innovative public-private partnerships, and successfully worked with a wide spectrum of political and community voices to make a difference on complex issues.

“We have a strong leadership team at HHS,” said Secretary Burwell. “Leslie’s experience, which spans the business, government, and civil society sectors, will further enhance our ability to deliver impact for the American people. We want to not only retain, but also recruit, talented individuals to our mission of ensuring every American has access to the building blocks of a healthy, productive life.”

As a senior counselor, Dach will work closely with the Department’s senior staff on key policy challenges, strategic initiatives, and engagement with external partners. Dach will also work with the team on the successful execution of the second Open Enrollment period for the Health Insurance Marketplace.

From 2006 to 2013, Dach served as Executive Vice President of Corporate Affairs for Walmart Stores Inc.  Dach’s efforts at Walmart have been credited with developing a new model of public, private, and civil society partnerships that deliver meaningful impact. Under his leadership, Walmart partnered with First Lady Michelle Obama’s Let’s Move! campaign on a series of initiatives to make food healthier and more affordable, and launched a $2 billion program to help end hunger.

He will report directly to the Secretary.

HHS SECRETARY ANNOUNCES NEW COLLABORATION WITH STATES TO IMPROVE MEDICAID BENEFICIARY CARE

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

New resources improve states’ abilities to advance Medicaid payment and delivery system reform

Monday, Health and Human Services Secretary Sylvia M. Burwell announced a new innovative collaboration with states to improve care for Medicaid beneficiaries by accelerating efforts in reforming their health care systems to improve health and care while reducing costs.  The goals and activities of the Medicaid Innovation Accelerator Program build on many of the recent recommendations made by the National Governors Association’s (NGA) Health Care Sustainability Task Force.

This initiative is consistent with states’ recommendation that the Centers for Medicare & Medicaid Services (CMS) identify opportunities for care improvement and addressing high priority areas such as mental health and emergency department utilization.  Through the Medicaid Innovation Accelerator Program, HHS is investing over $100 million in technical support to help states in their efforts to improve health, improve care and decrease costs for their Medicaid beneficiaries.  While complementing other federal-state delivery system reform efforts such as the State Innovation Models initiative, this new initiative will help jumpstart innovation by providing federal tools and resources to support states in advancing Medicaid-specific delivery system reform.

“Medicaid innovation is moving forward, and the new Medicaid Innovation Accelerator Program, announced in response to recommendations from Governors, will give states the opportunity to even further strengthen their great work,” said Secretary Burwell.  “HHS will provide strategically targeted resources that states can leverage to enhance the impact of their efforts to transform health care.”

“We are very pleased by this new effort to develop performance partnerships with states that can deliver better health outcomes at a cost we can afford,” said Oregon Gov. John Kitzhaber. “Using the reform principles developed by a bipartisan NGA Health Care Sustainability Task Force that I co-chaired with Governor Haslam, Oregon has begun to prove these principles can deliver. We look forward to working with HHS, NGA and other states to scale this work.”

“The Task Force's recommendations highlighted many key areas that needed reform, and I appreciate the continued conversations CMS has had with us about these areas," said Tennessee Gov. Bill Haslam. "This new initiative and investment demonstrate that there is great benefit to state-federal collaboration.”

The Medicaid Innovation Accelerator Program will develop Medicaid specific resources to support state-based innovative health care reform efforts by identifying and advancing new Medicaid service delivery and financing models to improve patient care by providing data analytics, improving quality measurement and rapid cycle evaluation capabilities, and advancing effective and timely dissemination of best practices and learning among states.

HHS SAYS $100 MILLION AVAILABLE TO SUPPORT NEW HEALTH CENTER SITES

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HHS announces the availability of $100 million in Affordable Care Act funding to expand access to primary care through new community health centers
HHS Secretary Sylvia Mathews Burwell announced today the availability of $100 million from the Affordable Care Act to support an estimated 150 new health center sites across the country in 2015. New health center sites will increase access to comprehensive, affordable, high quality primary health care services in the communities that need it most.  Later today, Secretary Burwell will also visit a Community Health Center in Decatur, Georgia to talk with its health care professionals about the important work they are doing to connect the community with high quality primary care.

“In communities across the country, Americans turn to their local Community Health Center for vital health care services that help them lead healthy, productive lives,” said Secretary Burwell.  “That’s why it’s so important that the Affordable Care Act is supporting the expansion of health centers.”

The investment announced today will add to the more than 550 new health center sites that have opened in the last three years as a result of the Affordable Care Act.  Today, nearly 1,300 health centers operate more than 9,200 service delivery sites that provide care to more than 21 million patients in every State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin.  Health centers are also playing a critical role in helping the public learn about new coverage opportunities under the Affordable Care Act, by conducting outreach and enrollment activities that link individuals to affordable coverage options available through the Health Insurance Marketplace.

“Since last fall, health centers have provided enrollment assistance to more than 4.7 million people across the country,” said HRSA Administrator Mary K. Wakefield, Ph.D., R.N. “We are pleased that the Affordable Care Act is supporting the establishment of additional health center sites to provide expanded opportunities for the newly insured to receive care.”