announced by HHS last week included folding five offices into one entity: the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), the National Institute for Occupational Safety and Health (NIOSH), the Agency for Toxic Substances and Disease Registry (ATSDR), and the Office of the Assistant Secretary for Health (OASH).
The new Administration for a Healthy America (AHA) will aim to "more efficiently coordinate chronic care and disease prevention programs and harmonize health resources to low-income Americans," HHS stated. Divisions of the AHA will include primary care, maternal and child health, mental health, environmental health, HIV/AIDS, and workforce, and will be supported by the U.S. Surgeon General and policy team.
Though experts acknowledged there may have been redundancies in the consolidated entities, they also expressed concerns, such as the swift and sprawling nature of workforce cuts, and the potential for fewer resources to negatively affect important services.
Former CMS Administrator Tom Scully, JD, told MedPage Today that although he believes HHS has grown too large and that some areas "could be trimmed back," he also feels workforce cuts being reported across HHS could have been undertaken more gradually and with greater consideration of individual experience and expertise.
Here is a look at the key functions of each entity set to be consolidated under the new AHA.
SAMHSA
The agency -- organized into various offices and centers with 10 regional offices -- aims to improve the delivery of behavioral health services through grants.
A key function of SAMHSA is supporting the 988 suicide and crisis lifeline. Other centers are focused on behavioral health statistics, mental health services, and substance abuse prevention and treatment.
Brian Hurley, MD, MBA, president of the American Society of Addiction Medicine (ASAM), said in a statement that his organization is "deeply concerned about the possible domino effects of SAMHSA's restructuring and its potential to deprioritize addiction care services nationwide."
"Any weakening of centralized substance use disorder (SUD) expertise within HHS would be cause for alarm, especially amidst the ongoing deadly addiction and overdose crisis," the statement continued.
ASAM further implored HHS Secretary Robert F. Kennedy Jr. "to appoint a dedicated leader within AHA to helm SUD initiatives, coordinate across these divisions, and importantly, work directly with CMS on improving coverage and reimbursement for addiction treatment."
SAMHSA's budget request for fiscal year 2025 was $8.1 billion.
HRSA
HRSA programs are aimed at providing healthcare to individuals facing geographic challenges and who are financially or medically vulnerable.
Notably, HRSA oversees the 340B drug pricing program that provides discounts on prescription drugs to safety net providers. Additional areas of focus include organ transplantation, compensation for individuals injured by vaccination, and data on medical malpractice payments.
The administration proclaims to "support health infrastructure, including through training of health professionals and distributing them to areas where they are needed most, providing financial support to healthcare providers, and advancing telehealth."
Indeed, some of HRSA's offices include those for the advancement of telehealth, special health initiatives, and women's health. And bureaus include those focused on health workforce, HIV/AIDS, maternal and child health, health systems, and provider relief.
Awards from HRSA have reached billions of dollars in grants -- including those given to health centers -- as well as loans and scholarships.
HRSA's budget request for fiscal year 2025 was a substantial $16.3 billion.
NIOSH
Earlier this week, it was reported that layoffs tied to the HHS restructuring have hit NIOSH especially hard.
NIOSH -- which, like ATSDR, is part of CDC -- focuses on research and recommendations for the prevention of work-related injury and illness.
It has nine centers that assist with collaboration and research across NIOSH and its partners. These centers include those for direct reading and sensor technologies, maritime and motor vehicle safety, and nanotechnology and occupational robotics research.
NIOSH also has management offices and a variety of divisions and branches, including a health effects laboratory division, respiratory health division, compensation analysis and support division, and the World Health Center Trade Program.
ATSDR
For ATSDR, the focus is on determining and thwarting human health effects of exposure to hazardous substances. It claims to be the "only federal health agency that works directly with concerned citizens to address environmental hazards and responds to requests for assistance from communities across the nation."
Its staff respond to threats from emergencies, such as natural disasters and chemical spills. Specific health hazards that are addressed by the agency include dioxins/furans, per- and polyfluoroalkyl substances, radiation, lead, and trichloroethylene exposure.
ATSDR is headquartered in Atlanta -- along with CDC, under which it resides -- and also has regional offices within the Environmental Protection Agency's 10 regional offices and headquarters in Washington, D.C.
OASH
This HHS office is known for housing the Office of the Surgeon General, but it also has other offices for disease prevention and health promotion, infectious disease and HIV/AIDS policy, population affairs, research integrity, and minority and women's health.
Specific programs and initiatives within OASH encompass areas like behavioral health, kidney disease, long COVID, vector-borne diseases, the mother-infant dyad, and Parkinson's disease.
Additionally, its Office of Regional Health Operations focuses on approaches to "address health disparities to improve access to healthcare and human services, to increase the capacity of the public health infrastructure and workforce, and to provide resources that address the needs of our state, Tribal, local, and territorial partners."
OASH offers grants, contracts, and other agreements for certain services under its purview.
https://www.medpagetoday.com/special-reports/features/114953
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