| Major Management Challenge |
Specific Performance Goal(s) |
|
Y2K readiness.
| 100% of HHS information systems will function properly into the year 2000.
Business continuity and contingency plans will be available for 100% of critical business processes and mission-critical systems. |
|
Information security. |
Achieve, for both central office and Medicare contractor systems, zero material weaknesses on the electronic data processing (EDP) portion of the Health Care Financing Administration (HCFA) FY 2000 Chief Financial Officer report, and achieve at least a 50% reduction compared to the baseline in reportable conditions on the EDP portion.
Enhance the Centers for Disease Control (CDC) information security program. Performance indicators: No serious losses, alteration, or releases of data or information occur that are critical, highly sensitive, or are covered by privacy or confidentiality requirements. |
|
Medicare payment errors, in general. |
Reduce improper Medicare fee-for-service payments to 7% by 2000 and 5% by 2002 . |
|
Improper Medicare payments for mental health services. |
No specific goal on reducing improper payments for mental health services, but see previously cited goal to reduce overall percentage of improper fee-for-service payments. |
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Inadequate controls over Medicare managed care, including improper payments made after beneficiaries disenroll from an HMO and dissatisfaction of vulnerable beneficiaries. |
Enroll beneficiaries into managed care plans timely. For 98% of clean Medicare+Choice transactions received in compliance with monthly processing schedule, the system will activate plan benefits in the same month.
Improve Medicare managed care plans’ administration of the appeals process, through targeted improvements in the average length for plans to issue a determination of coverage, average length of time to issue a reconsideration, percentage of reconsiderations not handled within 30 days, and other measures. (Data system is not yet available to measure progress for this goal; developing a data system is an additional goal.)
Increase percentage of health plans where more than a specified percentage of beneficiaries report satisfaction related to getting needed care and several other aspects of care. (Data to set target for goal is not yet available.)
In FY 2000, 80% of Medicare beneficiaries will have at least one managed care choice. |
|
Inadequate controls over Medicare home health benefits. |
Reduce percentage of home health services for which improper payment is made from 35% to 10% in California, Illinois, New York, and Texas. |
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Implementation of payment reforms for nursing facilities in Balanced Budget Act of 1997. |
Develop new Medicare payment systems for fee-for-service and Medicare+Choice care, including care provided by skilled nursing facilities, home health agencies, outpatient hospital departments. |
|
Implementation of other Balanced Budget Act provisions. |
None. |
|
Child support enforcement. |
Establish paternity for 96% of children born out-of-wedlock.
Establish support orders for 76% of cases.
Collect 71% of current support due for all cases.
Collect some past due support for 46% of cases. Achieve program cost-effectiveness ratio (dollars collected per $1 expense) of $5.00. |
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Additional Medicare reforms needed. |
None. |
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Scope and complexity of HHS programs create coordination, oversight, and performance measurement challenges. |
HHS-wide: None
Health Resources and Services Administration: Increase to 50 the number of State Offices of Rural Health that have implemented performance outcome measurement indicators and reported a summary of their outcomes.
HCFA: Develop a performance standard concerning the effectiveness of the Health Insurance Portability and Accountability Act in resolving complaints against insurers, states, or plans. |
|
Lack of reliable and comprehensive performance data and data systems. |
HHS-wide: None.
Food and Drug Administration (FDA): Develop Sentinel Surveillance System for device injury reporting.
FDA: Establish an electronic data system to facilitate error and accident reporting for unlicenced blood facilities.
CDC: Encourage state health departments to develop efficient and comprehensive public health information and surveillance systems by promoting use of the Internet and by focusing on development of standards for data elements. (The plan states that the number of states with a plan for a comprehensive information network will increase to 22 and the number who have implemented a comprehensive network will increase to 4. However, there is no information to allow measurement of systems’ efficiency or comprehensiveness and there is no information on data standards.) |
| Lack of reliable and timely financial statements. |
HHS and its operating divisions will receive unqualified opinions on their FY 2000 financial statement audits.
The number of material weaknesses identified in HHS financial statement audits will be reduced from 22 in FY 97 to 3 in FY 2000.
All HHS operating divisions will be in substantial compliance with the Federal Financial Management Improvement Act. |
|
Other program integrity. |
HHS’ FY 2000 debt collections will be 10% higher than those for FY 99.
Improve the efficiency of medical claims review to permit a 10 % increase in the number of claims otherwise projected to be reviewed in FY 2000—from 91 million to about 100 million.
Increase the ratio of HCFA recoveries to audit dollars spent, from $12.30 for each dollar spent to $13.00.
Increase Medicare Secondary Payer (MSP) liability and no-fault recoveries by 5 percent. (In FY 1998, MSP liability and no-fault recoveries were $364 million.) |
