1. Merle Cunningham, MD MPH Connecting the Dots: Interagency & Intergovernmental Collaborations Related to Health Care

2. Learning Objectives At the end of this session, participants will be able to: 1.Better understand the key Federal players and collaboration among Federal Executive Branch agencies with respect to health care & CHCs 2.Better appreciate the role of key State and Local government players who relate to health care & CHCs and their collaboration with Federal agencies

3. Session Overview Federal level: Executive Branch –Administrative agencies related to health care State and local (county/city) level –Administrative agencies related to health care Examples of collaboration among key players

4. Collaboration among Key Players Childhood & Adolescent life cycles –Early childhood development-Asthma –Immunization registries-Obesity Women’s Health life cycles –Family planning & prenatal care (reproductive health) –Screening & prevention (breast & cervical CA, HTN) Adult life cycles –Diabetes-Obesity –Heart disease-Cancer –Depression

5. Federal Executive Branch Key Powers related to Health Care –Agenda setting –Interact with legislative & budget process –Issue/promulgate regulations within statutes –Provide oversight and monitoring –Financing – grants, contracts, health insurance

6. Federal Executive Branch Key Health Care Players (Cabinet level) –Administrative Agencies (Direct healthcare roles) DHHS (HRSA, CDC, SAMHSA, AHRQ, ONC, NIH, AoA, FDA, OGC, CMS) –Administrative Agencies (Indirect healthcare roles) USDA (WIC, Food Stamps, Coop Extension Service) Education (Health Educ Curriculum, School Health) DVA (Veterans Health Administration) Defense (Tri-Care: Military Health Service) Note: for underlined agencies Organizational Chart provided

7. HHS Organizational Chart

8. CDC

12. Bureau of Primary Health Care Administers Health Center programs Policies: Policy Information Notices (PINs) and Program Assistance Letters (PALs) Program requirements, grants management Technical Assistance UDS data FTCA deeming

13. State Government Key Health Care Players –Variable agency structure & authority related to State constitutions –Typical players in some variation or combination: State Health Department State Mental Health Department State Medicaid Office State Office: licensing & regulation of insurance companies State Office: licensing & regulation of facilities (CON, etc) State Education Department (staff licensing) Complex relationship with Federal Agencies –Varying levels of federal intervention over time

14. Local Government (County or City) Local Public Health Agencies (LPHA): –Created by referendum or legislation –Part of state network with shared responsibilities –Usually formed and managed by local government –May share oversight or directly operate health services Typical Players/Structures –County health and or mental health departments –City health or mental health departments

15. Collaboration among Key Players Childhood & Adolescent life cycles –Early childhood development-Asthma –Immunization registries-Obesity Women’s Health life cycles –Family planning & prenatal care (reproductive health) –Screening & prevention (breast & cervical CA, HTN) Adult life cycles –Diabetes-Obesity –Heart disease-Cancer –Depression

16. Questions?