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From Health Law Daily, November 20, 2015

Expanded health care access, opioid abuse control among HHS’ 2015 accomplishments

By Mary Damitio, J.D.

Looking back on fiscal year (FY) 2015, HHS points to several areas of accomplishments, including the continued expansion of access to health care for millions of Americans under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), and its increased efforts at combating opioid abuse and antibiotic-resistant bacteria and infections. However, in its FY 2015 Agency Financial Report (AFR), HHS also identified significant areas for improvement, including health insurance marketplace oversight and data security (HHS FY 2015 Agency Financial Report, November 19, 2015).

FY 2015 AFR. HHS’ FY 2015 AFR provides the Department’s fiscal and summary performance results for its accomplishments during the reporting period of October 1, 2014, through September 30, 2015.

Access to care. HHS estimates that one in every three Americans is now covered by Medicare and Medicaid and the ACA is continuing to expand health coverage to millions of individuals. The Department noted that a recent analysis showed that 17.6 million have gained coverage since the law was passed and the rate of uninsured individuals has dropped to the lowest ever recorded. The ACA also provides support for community health centers to remain a continued source of primary care for uninsured and the medically underserved population, with over 1,300 health centers serving 23 million people. Additionally, section 10503 of the ACA provided additional funding to help new centers to reach an additional 1.4 million people.

Opioid abuse. Over the past ten years, the number of overdose deaths caused by prescription opioid pain relievers and heroin has grown significantly, and HHS is working with state and federal leaders to coordinate a comprehensive approach to address the problem. The approach focuses on preventing overdose and opioid use disorder, which includes addressing prescribing practices, increasing access drugs that reverse overdoses, and expanding medication-assisted treatment options. HHS points out that Medication-assisted treatment is a comprehensive approach that combines the use of medication with counseling and behavioral therapies to treat substance abuse. HHS is also revising regulations regarding prescribing FDA-approved drugs to treat opioid dependence.

Antibiotic-resistant bacteria. HHS appointed experts to the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria to provide advice and recommendations on HHS policies for combating antibiotic-resistant bacteria, which is responsible for over two million infections and 23,000 deaths in the U.S. each year. The Department is also working on implementing a National Plan for Combating Antibiotic-Resistant Bacteria to identify and coordinate action to prevent and control outbreaks. Additionally, it is coordinating with international partners to preserve the effectiveness of antibiotics and to prevent the transmission of the antibiotic-resistant bacteria.

Fraud and abuse. HHS has invested in program integrity initiatives to crack down on fraud and abuse, which are projected to save $22 billion over the next decade. In 2015, the Medicare Fraud Strike Force led a national fraud takedown in 17 districts that resulted in charges being brought against 243 individuals involving over $712 million in false billing. Additionally, HHS has suspended various providers under authority given to it by Section 6401 of the ACA.

Resource management. HHS received an unmodified opinion relating to the Consolidated Balance Sheets, Statement of Net Cost, Statement of Changes in Net Position, and the Combined Statement of Budgetary Resources. The HHS’ auditors “disclaimed” providing an opinion on the Statement of Social Insurance and the Statement of Changes in Social Insurance Amounts due to uncertainties arising from the ACA’s provisions and potential changes in law that could impact financial projections. The Department also evaluated its internal controls and financial management systems and identified one material weakness, which was nonconformance relating to Information System Controls and Security. It also identified a material noncompliance relating to Error Rate Measurement. HHS management is continuing to efforts to improve its financial reports and systems.

Challenges. HHS worked with the Office of the Inspector General (OIG), which identified 10 areas that presented opportunities for improvement, including oversight of the health insurance marketplace; privacy and data security; and fraud, waste, and abuse avoidance in HHS grants and contract funds. The OIG also noted that ensuring the safety of food, drugs, and medical devices was another area that presented a challenge for HHS in FY 2015.

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