[Federal Register: December 29, 2005 (Volume 70, Number 249)]
[Notices]
[Page 77159-77168]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr29de05-54]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Statement of Organization, Functions, and Delegations of
Authority
Part F of the Statement of Organization, Functions, and Delegations
of Authority for the Department of Health and Human Services, Centers
for Medicare & Medicaid Services (CMS), (Federal Register, Vol. 62, No.
85, pp. 24120-24126, dated Friday, May 2, 1997, as amended thereafter)
is being republished to reflect the current organizational structure of
CMS in relation to meeting the Department's goal of having no more than
four management levels in the Agency and to also exercise leadership in
implementing the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA).
Part F is described below:
Section F.10. (Organization) reads as follows:
1. Office of External Affairs (FAC)
2. Center for Beneficiary Choices (FAE)
3. Office of Legislation (FAF)
4. Center for Medicare Management (FAH)
5. Office of Equal Opportunity and Civil Rights (FAJ)
6. Office of Research, Development, and Information (FAK)
7. Office of Clinical Standards and Quality (FAM)
8. Office of the Actuary (FAN)
9. Center for Medicaid and State Operations (FAS)
10. Office of the Boston Regional Administrator (FAU1)
11. Office of the New York Regional Administrator (FAU2)
12. Office of the Philadelphia Regional Administrator (FAU3)
13. Office of the Atlanta Regional Administrator (FAV4)
14. Office of the Chicago Regional Administrator (FAW5)
15. Office of the Dallas Regional Administrator (FAV6)
16. Office of the Kansas City Regional Administrator (FAW7)
17. Office of the Denver Regional Administrator (FAX8)
18. Office of the San Francisco Regional Administrator (FAX9)
19. Office of the Seattle Regional Administrator (FAXX)
20. Office of Operations Management (FAY)
21. Office of Information Services (FBB)
22. Office of Financial Management (FBC)
23. Office of Strategic Operations and Regulatory Affairs (FGA)
24. Office of E-Health Standards and Services (FHA)
25. Office of Acquisition and Grants Management (FKA)
26. Office of Policy (FLA)
Section F. 20. (Functions) reads as follows:
1. Office of External Affairs (FAC)
Serves as the focal point for the Agency to the news media
and provides leadership for the Agency in the area of intergovernmental
affairs. Advises the Administrator and other Agency components in all
activities related to the media and on matters that affect other units
and levels of government.
Coordinates CMS activities with the Office of the
Assistant Secretary for Public Affairs and the Secretary's
intergovernmental affairs officials.
Serves as senior counsel to the Administrator in all
activities related to the media. Provides consultation, advice, and
training to the Agency's
[[Page 77160]]
senior staff with respect to relations with the news media.
Develops and executes strategies to further the Agency's
relationship and dealings with the media. Maintains a broad based
knowledge of the Agency's structure, responsibilities, mission, goals,
programs, and initiatives in order to provide or arrange for rapid and
accurate response to news media needs.
Prepares and edits appropriate materials about the Agency,
its policies, actions and findings, and provides them to the public
through the print and broadcast media. Develops and directs media
relations strategies for the Agency.
Responds to inquiries from a broad variety of news media,
including major newspapers, national television and radio networks,
national news magazines, local newspapers and radio and television
stations, publications directed toward the Agency's beneficiary
populations, and newsletters serving the health care industry.
Manages press inquiries, coordinates sensitive press
issues, and develops policies and procedures for how press and media
inquiries are handled.
Arranges formal interviews for journalists with the
Agency's Administrator or other appropriate senior Agency staff;
identifies for interviewees the issues to be addressed, and prepares or
obtains background materials as needed.
For significant Agency initiatives, issues media
advisories and arranges press conferences as appropriate; coordinates
material and personnel as necessary.
Serves as liaison with the Department of Health and Human
Services and White House press offices.
2. Center for Beneficiary Choices (FAE)
Serves as Medicare Beneficiary Ombudsman, as well as the
focal point for all Agency interactions with beneficiaries, their
families, care givers, health care providers, and others operating on
their behalf concerning improving beneficiary's ability to make
informed decisions about their health and about program benefits
administered by the Agency. These activities include strategic and
implementation planning, execution, assessment and communications.
Assesses beneficiary and other consumer needs, develops
and oversees activities targeted to meet these needs, and documents and
disseminates results of these activities. These activities focus on
Agency beneficiary service goals and objectives and include:
Development of baseline and ongoing monitoring information concerning
populations affected by Agency programs; development of performance
measures and assessment programs; design and implementation of
beneficiary services initiatives; development of communications
channels and feedback mechanisms within the Agency and between the
Agency and its beneficiaries and their representatives; and close
collaboration with other Federal and State agencies and other
stakeholders with a shared interest in better serving our
beneficiaries.
Develops national policy for all Medicare Parts A, B, C
and D beneficiary eligibility, enrollment, entitlement; premium billing
and collection; coordination of benefits; rights and protections;
dispute resolution process; as well as policy for managed care
enrollment and disenrollment to assure the effective administration of
the Medicare program, including the development of related legislative
proposals.
Oversees the development of privacy and confidentiality
policies pertaining to the collection, use, and release of individually
identifiable data.
Coordinates beneficiary-centered information, education,
and service initiatives.
Develops and tests new and innovative methods to improve
beneficiary aspects of health care delivery systems through Title
XVIII, XIX, and XXI demonstrations and other creative approaches to
meeting the needs of Agency beneficiaries.
Assures, in coordination with other Centers and Offices,
the activities of Medicare contractors, including managed care plans,
agents, and State Agencies, meet the Agency's requirements on matters
concerning beneficiaries and other consumers.
Plans and administers the contracts and grants related to
beneficiary and customer service, including the State Health Insurance
Assistance Program grants.
Formulates strategies to advance overall beneficiary
communications goals and coordinates the design and publication process
for all beneficiary-centered information, education, and service
initiatives.
Builds a range of partnerships with other national
organizations for effective consumer outreach, awareness, and education
efforts in support of Agency programs.
Serves as the focal point for all Agency interactions with
managed health care organizations for issues relating to Agency
programs, policy and operations.
Develops national policies and procedures related to the
development, qualification and compliance of health maintenance
organizations, competitive medical plans and other health care delivery
systems and purchasing arrangements (such as prospective pay, case
management, differential payment, selective contracting, etc.)
necessary to assure the effective administration of the Agency's
programs, including the development of statutory proposals.
Handles all phases of contracts with managed health care
organizations eligible to provide care to Medicare beneficiaries.
Coordinates the administration of individual benefits to
assure appropriate focus on long term care, where applicable, and
assumes responsibility for the operational efforts related to the
payment aspects of long term care and post-acute care services.
Serves as the focal point for all Agency interactions with
employers, employees, retirees and others operating on their behalf
pertaining to issues related to Agency policies and operations
concerning employer sponsored prescription drug coverage for retirees.
Develops national policies and procedures to support and
assure appropriate State implementation of the rules and processes
governing group and individual health insurance markets and the sale of
health insurance policies that supplement Medicare coverage.
Primarily responsible for all operations related to
Medicare Prescription Drug Plans and Medicare Advantage Prescription
Drug (Part D) plans.
Performs activities related to the Medicare Parts A & B
processes (42 CFR part 405, subparts G and H), Part C (42 CFR part 422,
subpart M), Part D (42 CFR part 423, subpart M) and the PACE program
for claims-related hearings, appeals, grievances and other dispute
resolution processes that are beneficiary-centered.
Develops, evaluates, and reviews regulations, guidelines,
and instructions required for the dissemination of appeals policies to
Medicare beneficiaries, Medicare contractors, Medicare Advantage plans,
Prescription Drug Plans, CMS regional offices, beneficiary advocacy
groups and other interested parties.
3. Office of Legislation (FAF)
Provides leadership and executive direction within the
Agency for legislative planning to address the Administration's agenda.
Tracks, evaluates and develops provisions of annual
legislative
[[Page 77161]]
proposals for Medicare, Medicaid, Clinical Laboratory Improvement Act,
Health Insurance Portability and Accountability Act and related
statutes affecting health care financing quality and access in concert
with HCFA components, the Department and the Office of Management and
Budget.
Advances the legislative policy process through analysis,
review and development of health care initiatives and issues.
Develops the long-range legislative plans for the Agency
in collaboration with the CMS Centers and Offices.
Participates with other CMS components in the development
of Agency policy, including implementing regulations and administrative
actions.
Manages pro-actively the Agency's response in times of
heightened congressional oversight of CMS in collaboration with the
Centers and Offices. Manages, coordinates and develops policies for
responding to congressional inquiries.
Coordinates activities with the Office of the Assistant
Secretary for Legislation (ASL) and serves as the ASLs principal
contact point on legislative and congressional relations.
In collaboration with CMS Centers and Offices, provides
technical assistance, consultation and information services to
congressional committees and individual members of Congress on the
Medicare and Medicaid programs, new CMS initiatives and pertinent
legislation.
In collaboration with the CMS Centers and Offices,
provides technical, analytical, advisory and information services to
the Agency's components, the Department, the White House, OMB, other
government agencies, private organizations and the general public on
Agency legislation.
Tracks and reports on legislation relating to CMS programs
and maintains legislative reference library.
Coordinates the Agency's participation in congressional
hearings, including preparation of testimony and briefing materials,
and covers all other congressional hearings on matters of interest to
the Agency except Appropriations Committee hearings specifically on the
appropriation budget.
4. Center for Medicare Management (FAH)
Serves as the focal point for all Agency interactions with
health care providers, intermediaries and carriers for issues relating
to Agency fee-for-service policies and operations.
Monitors providers' and other entities' conformance with
quality standards (other than those directly related to survey and
certification); policies related to scope of benefits; and other
statutory, regulatory, and contractual provisions.
Based on program data, develops payment mechanisms,
administrative mechanisms, and regulations to ensure that CMS is
purchasing medically necessary services under fee-for-service.
Writes payment and benefit-related instructions for
Medicare contractors.
Defines the scope of Medicare benefits and develops
national fee-for-service payment policies, as necessary, to assure the
effective administration of the Agency's programs, including the
development of related statutory proposals.
Develops Agency medical coding policies related to fee-
for-service payments.
Provides administrative support to the Practicing
Physician Advisory Council.
Coordinates provider, physician and contractor centered
information, education, and service initiatives.
Serves as the CMS lead for Medicare carrier and fiscal
intermediary management, oversight, budget, and performance issues.
Functions as CMS liaison for all Medicare carrier and
fiscal intermediary program issues and, in close collaboration with the
regional offices and other CMS components, coordinates the agency-wide
contractor activities.
Manages contractor instructions, workload, and change
management process.
Collaborates with other CMS components to establish
ongoing performance expectations for Medicare contractors (carriers and
fiscal intermediaries) consistent with the agency's goals; interprets,
evaluates, and provides information on Medicare contractors in terms of
ongoing compliance with performance requirements and expectations;
evaluates compliance with issued instructions; evaluates contractor-
specific performance and/or integrity issues; and evaluates/monitors
corrective action, if necessary.
Manages, monitors, and provides oversight of contractor
(carriers and fiscal intermediaries) transition activities including
replacement of departing contractors and the resulting transfer of
workload, functional realignments, and geographic workload carveouts.
Maintains and provides accurate contractor specific
information. Develops and implements long-term fee-for-service
contractor strategy, tactical plans, and other planning documents.
Serves as lead on current/proposed legislation in order to
determine impact on provider and contractor operations.
Develops national policy and implementation of all
Medicare Part A, Part B, and Part C premium billing and collection
activities and coordination of benefits to assure effective
administration of fee-for-service aspects of the Medicare program.
5. Office of Equal Opportunity & Civil Rights (FAJ)
Provides agency-wide leadership and advice on issues of
diversity, civil rights, and promotion of a supportive work environment
for Agency employees.
Develops, implements and manages affirmative employment
programs. Provides principal advisory, advocacy, and liaison services
for the Administrator to Agency leadership and employees concerning
equality in employment related issues to ensure a diverse workforce.
Develops Equal Employment Opportunity (EEO) and civil
rights compliance policy for the Agency. Assesses the Agency's
compliance with applicable civil rights statutes, executive orders,
regulations, policies, and programs.
Identifies policy and operational issues and proposes
solutions for resolving these issues in partnership with management,
Office of the General Counsel, and other organizational entities.
Receives and evaluates complaints for procedural
sufficiency; investigates, adjudicates and resolves such complaints.
Promotes the representation of minority groups, women, and
individuals with disabilities through community outreach and other
activities.
Resolves informal discrimination complaints by means of
EEO counseling and/or Alternative Dispute Resolution.
Develops and analyzes data for internal and external
reports reflecting the diversity of the Agency workforce and fairness
in employment related actions. Makes recommendations to management on
changes needed to ensure equal employment opportunity in every respect.
Serves as the internal advocate for civil rights and
related principles. Provides training, seminars, and technical guidance
to Agency staff.
6. Office of Research, Development & Information (FAK)
Provides analytic support and information to the
Administrator and
[[Page 77162]]
the Executive Council needed to establish Agency goals and directions.
Performs environmental scanning, identifying, evaluating,
and reporting emerging trends in health care delivery and financing and
their interactions with Agency programs.
Manages strategic, crosscutting initiatives.
Designs and conducts research and evaluations of health
care programs, studying their impacts on beneficiaries, providers,
plans, States and other partners and customers, designing and assessing
potential improvements, and developing new measurement tools.
Coordinates all Agency demonstration activities, including
development of the research and demonstration annual plan, evaluation
of all Agency demonstrations, and assistance to other components in the
design of demonstrations and studies.
Manages assigned demonstrations, including Federal review,
approval, and oversight; coordinates and participates with departmental
components in experimental health care delivery projects.
Develops research, demonstration, and other publications
and papers related to health care issues.
Designs and conducts payment, purchasing, and benefits
demonstrations.
7. Office of Clinical Standards & Quality (FAM)
Serves as the focal point for all quality, clinical and
medical science issues and policies for the Agency's programs. Provides
leadership and coordination for the development and implementation of a
cohesive, agency-wide approach to measuring and promoting quality and
leads the Agency's priority-setting process for clinical quality
improvement. Coordinates quality-related activities with outside
organizations. Monitors quality of Medicare, Medicaid, and CLIA.
Evaluates the success of interventions.
Identifies and develops best practices and techniques in
quality improvement; implementation of these techniques will be
overseen by appropriate components. Develops and collaborates on
demonstration projects to test and promote quality measurement and
improvement.
Develops, tests and evaluates, adopts and supports
performance measurement systems (quality indicators) to evaluate care
provided to CMS beneficiaries except for demonstration projects
residing in other components.
Assures that the Agency's quality-related activities
(survey and certification, technical assistance, beneficiary
information, payment policies and provider/plan incentives) are fully
and effectively integrated. Carries out the Health Care Quality
Improvement Program (HCQIP) for the Medicare, Medicaid, and CLIA
programs.
Leads in the specification and operational refinement of
an integrated CMS quality information system, which includes tools for
measuring the coordination of care between health care settings;
analyzes data supplied by that system to identify opportunities to
improve care and assess success of improvement interventions.
Develops requirements of participation for providers and
plans in the Medicare, Medicaid, and CLIA programs. Revises
requirements based on statutory change and input from other components.
Operates the Medicare Peer Review Organization and End
Stage Renal Disease Network program in conjunction with regional
offices, providing policies and procedures, contract design, program
coordination, and leadership in selected projects.
Identifies, prioritizes and develops content for clinical
and health related aspects of CMS' Consumer Information Strategy;
collaborates with other components to develop comparative provider and
plan performance information for consumer choices.
Prepares the scientific, clinical, and procedural basis
for and recommends to the Administrator decisions regarding coverage of
new and established technologies and services. Coordinates activities
of the Agency's Technology Advisory Committee and maintains liaison
with other departmental components regarding the safety and
effectiveness of technologies and services; prepares the scientific and
clinical basis for, and recommends approaches to, quality-related
medical review activities of carriers and payment policies.
8. Office of the Actuary (FAN)
Conducts and directs the actuarial program for CMS and
directs the development of and methodologies for macroeconomic analysis
of health care financing issues.
Performs actuarial, economic and demographic studies to
estimate CMS program expenditures under current law and under proposed
modifications to current law.
Provides program estimates for use in the President's
budget and for reports required by Congress.
Studies questions concerned with financing present and
future health programs, evaluates operations of the Federal Hospital
Insurance Trust Fund and Supplementary Medical Insurance Trust Fund and
performs microanalyses for the purpose of assessing the impact of
various health care financing factors upon the costs of Federal
programs.
Estimates the financial effects of proposals to create
national health insurance systems or other national or incremental
health insurance reform.
Develops and conducts studies to estimate and project
national and area health expenditures.
Develops, maintains, and updates provider market basket
input price indexes and the Medicare Economic Index.
Analyzes data on physicians' costs and charges to develop
payment indices and monitors expansion of service and inflation of
costs in the health care sector.
Performs actuarial reviews and audits of employee benefit
expenses charged to Medicare by fiscal intermediaries and carriers.
Publishes cost projections and economic analyses, and
provides actuarial, technical advice and consultation to CMS
components, governmental components, Congress, and outside
organizations.
9. Center for Medicaid and State Operations (FAS)
Serves as the focal point for all Centers for Medicare &
Medicaid Services activities relating to Medicaid, the State Children's
Health Insurance Program, the Clinical Laboratory Improvement Act, the
survey and certification of health facilities and all interactions with
States and local governments (including the Territories).
Develops national Medicaid policies and procedures which
support and assure effective State program administration and
beneficiary protection. In partnership with States, evaluates the
success of State agencies in carrying out their responsibilities and,
as necessary, assists States in correcting problems and improving the
quality of their operations.
Develops, interprets, and applies specific laws,
regulations, and policies that directly govern the financial operation
and management of the Medicaid program and the related interactions
with States and regional offices.
In coordination with other components, develops,
implements, evaluates and refines standardized provider performance
measures used within provider certification programs.
[[Page 77163]]
Supports States in their use of standardized measures for provider
feedback and quality improvement activities. Develops, implements and
supports the data collection and analysis systems needed by States to
administer the certification program.
Reviews, approves and conducts oversight of Medicaid
managed care waiver programs. Provides assistance to States and
external customers on all Medicaid managed care issues.
Develops national policies and procedures on Medicaid
automated claims/encounter processing and information retrieval systems
such as the Medicaid Management Information System (MMIS) and
integrated eligibility determination systems.
In coordination with the Office of Financial Management
(OFM), directs, coordinates, and monitors program integrity efforts and
activities by States and regions. Works with OFM to provide input in
the development of program integrity policy.
Through administration of the home and community-based
services program and policy collaboration with other Agency components
and the States, promotes the appropriate choice and continuity of
quality services available to frail elderly, disabled and chronically
ill beneficiaries.
Develops and tests new and innovative methods to improve
the Medicaid program through demonstrations and best practices
including managing review, approval, and oversight of the Section 1115
demonstrations.
Directs the planning, coordination, and implementation of
the survey, certification, and enforcement programs for all Medicare
and Medicaid providers and suppliers, and for laboratories under the
auspices of the Clinical Laboratory Improvement Act (CLIA). Reviews and
approves applications by States for ``exemption'' from CLIA and
applications from private accreditation organizations for deeming
authority. Develops assessment techniques and protocols for
periodically evaluating the performance of these entities. Monitors the
performance of proficiency testing programs under the auspices of CLIA.
10. Office of the Boston Regional Administrator (FAU1)
Assures the effective administration of CMS programs and
implements national policy at the regional level.
Develops policy, participates in the formulation of new
policy and recommends changes in existing national policy for CMS
programs.
Monitors the regional administrative budget, including
oversight of the regional travel funding allocation.
Manages procurement and contracting activities, and
personnel administration for the region.
Serves as principal CMS contact for professional and
provider/supplier organizations in the region's service area.
Oversees workplanning, facilities and property management,
labor-management relations, and staff training for the region.
Initiates and directs the implementation of special
regional and national projects.
Assures effective relationships within the region with
State and local governments, beneficiaries and their representatives,
and the media.
Coordinates with the DHHS Regional Director to assure
effective relationships with Congressional representatives and State
and local governments.
11. Office of the New York Regional Administrator (FAU2)
Assures the effective administration of CMS programs and
implements national policy at the regional level.
Develops policy, participates in the formulation of new
policy and recommends changes in existing national policy for CMS
programs.
Monitors the regional administrative budget, including
oversight of the regional travel funding allocation.
Manages procurement and contracting activities, automated
data processing/local area network systems, and personnel
administration for the region.
Serves as principal CMS contact for professional and
provider/supplier organizations in the region's service area.
Oversees workplanning, facilities and property management,
labor-management relations, and staff training for the region.
Initiates and directs the implementation of special
regional and national projects.
Assures effective relationships within the region with
State and local governments, beneficiaries and their representatives,
and the media.
Coordinates with the Department of Health and Human
Services' Regional Director to assure effective relationships with
Congressional representatives and State and local governments.
12. Office of the Philadelphia Regional Administrator (FAU3)
Assures the effective administration of CMS programs and
implements national policy at the regional level.
Develops new policies and recommends changes in existing
national policies for CMS programs.
Monitors the regional administrative budget, including
oversight of the regional travel funding allocation.
Manages procurement and contracting activities and
personnel administration for the region.
Serves as principal CMS contact for professional and
provider/supplier organizations in the region's service area.
Oversees work planning, facilities and property
management, labor-management relations, and staff training for the
region.
Initiates and directs the implementation of special
regional and national projects. Assures effective relationships within
the region with State and local governments, beneficiaries and their
representatives, and the media.
Coordinates with the Department of Health and Human
Services' Regional Director to ensure effective relationships with
elected officials as well as State and local governments.
13. Office of the Atlanta Regional Administrator (FAV4)
Directs the planning, coordination, and implementation of
the programs under Titles XI, XVIII, and XIX of the Social Security Act
and related statutes within the Agency's regional/field offices that
comprise the Atlanta and Dallas Regional Offices.
Provides executive leadership and direction to the
Agency's Regional Administrator(s) in the Atlanta and Dallas Regional
Offices.
Assures that the Agency's programs are carried out in the
most effective and efficient manner within the Atlanta and Dallas
Regional Offices, and that they are coordinated both at the Atlanta and
Dallas level and with the Agency's headquarters' offices.
Provides an Atlanta and Dallas perspective to the Agency's
Administrator and other members of the Executive Council in such
activities as strategic planning, determining the effectiveness of the
Agency's programs and policies, budget formulation and execution,
legislation, and administrative management.
Assures that the Agency's national policies, programs and
special initiatives are implemented effectively throughout the Atlanta
and Dallas Regional Offices. Conducts local projects to improve the
quality of medical care provided to beneficiaries and to control fraud,
abuse and waste in the Agency's programs.
[[Page 77164]]
Evaluates progress in the administration of the Agency's
programs in the Atlanta and Dallas Regional Offices, ensuring that
required actions are taken to direct or redirect efforts and/or
resources to achieve program objectives.
Working with the Regional Administrator(s) in the Atlanta
and Dallas Regional Offices and the Agency's headquarters' leadership,
assures that the information needs of the Medicare and Medicaid
beneficiaries are fully understood and met, to the maximum degree
possible. In association with other Agency components, maintains an
understanding of the health care market that is operating in the
Atlanta and Dallas Regional Offices in order to allow the Agency to
adapt to changes in that market when appropriate.
Assures that the Regional Administrator(s) in the Atlanta
and Dallas Regional Offices fully coordinate the Agency's programs with
other Health and Human Services' components, other Federal agencies,
the Agency's contractors, State and local governments, professional
associations, other interested groups, and the Agency's beneficiaries
and/or representatives in their respective region.
Working with the Agency's headquarters, manages the
Atlanta and Dallas' administrative budget, to include the planning and
allocation of resources to the regional offices comprising the Atlanta
and Dallas Regional Offices.
Provides executive leadership and guidance on behalf of
the Atlanta and Dallas Regional Administrator to CMS components at the
regional level.
Serves on the Atlanta and Dallas Leadership Council, which
sets the overall direction for the Atlanta and Dallas Regional Offices,
and implements the Council's directions within the Region's service
area.
Effectively implements national policy, programs, and
special initiatives at the regional level. Conducts local projects to
improve the quality of medical care provided to beneficiaries and to
control fraud, abuse, and waste in the Agency's programs.
Assures that the information needs of the Medicare and
Medicaid beneficiaries are fully understood and met, to the maximum
degree possible. In association with other Agency components, maintains
an understanding of the health care market that is operating in the
Region in order to allow the Agency to adapt to changes in that market
when appropriate.
Participates in the formulation of new policy and
recommends changes in existing national policy for CMS programs.
Develops and implements a professional relations program
within the Region for all CMS programs and serves as the principal CMS
contact for all professional organizations such as hospital and medical
associations.
Fully coordinates the Agency's programs with other Health
and Human Services' components including the Department's Regional
Director, other Federal agencies, the Agency's contractors, State and
local governments, professional associations, other interested groups,
and the Agency's beneficiaries and/or representatives in the Region.
Manages procurement and contracting activities, ADP/LAN
systems, and personnel actions for the Region.
Provides regional perspective to the Administrator and the
Executive Council.
Monitors the regional administrative budget, including
oversight of the regional travel funding allocation.
14. Office of the Chicago Regional Administrator (FAW5)
Serves as the principal office for Regional operations of
CMS.
Directs the administration of all CMS programs within the
region.
Sets the overall direction for the Chicago and Kansas City
Regional Offices through the Midwest Consortium Advisory Board, and
implements Board directions within the Region's service area.
Monitors the Regional administrative budget, including
oversight of the Regional travel funding allocation.
Manages procurement and contracting activities, ADP/LAN
systems, and personnel actions for the Region.
Serves as principal CMS contact for professional and
provider/supplier organizations in the Region's service area.
Oversees work planning, facilities and property
management, labor-management relations, merit promotion principles,
EEO, and staff training for the Region.
Coordinates environmental scanning and strategic planning
for the Region. Pursues activities which enable the Regional staff to
become knowledgeable regarding developments and trends in health care
delivery within the States they serve.
Serves as focal point among Regional Office components for
special initiatives and broad cross-cutting issues.
15. Office of the Dallas Regional Administrator (FAV6)
Provides executive leadership and guidance on behalf of
the Atlanta and Dallas Regional Administrators to CMS components at the
regional level.
Serves on the Atlanta and Dallas Leadership Council, which
sets the overall direction for the Regions, and implements the
Council's directions within the Region's service area.
Effectively implements national policy, programs, and
special initiatives at the regional level. Conducts local projects to
improve the quality of medical care provided to beneficiaries and to
control fraud, abuse, and waste in the Agency's programs.
Assures that the information needs of the Medicare and
Medicaid beneficiaries are fully understood and met, to the maximum
degree possible. In association with other Agency components, maintains
an understanding of the health care market that is operating in the
Region in order to allow the Agency to adapt to changes in that market
when appropriate.
Participates in the formulation of new policy and
recommends changes in existing national policy for CMS programs.
Develops and implements a professional relations program
within the Region for all CMS programs and serves as the principal CMS
contact for all professional organizations such as hospital and medical
associations.
Fully coordinates the Agency's programs with other Health
and Human Services' components including the Department's Regional
Director, other Federal agencies, the Agency's contractors, State and
local governments, professional associations, other interested groups,
and the Agency's beneficiaries and/or representatives in the Region.
Manages procurement and contracting activities, ADP/LAN
systems, and personnel actions for the Region.
Provides regional perspective to the Administrator and the
Executive Council.
Monitors the regional administrative budget, including
oversight of the regional travel funding allocation.
16. Office of the Kansas City Regional Administrator (FAW7)
Serves as the principal official for regional operations
of CMS and directs the administration of all CMS programs within the
region.
[[Page 77165]]
Directs the Consortium Survey and Certification and
Consortium Contractor Management organizations.
Monitors the regional administrative budget, including
oversight of the regional travel funding allocation.
Develops and implements a media relations plan to market
CMS programs to the diverse populations of the region.
Manages procurement and contracting activities, ADP/LAN
systems, and personnel actions for the Region.
Oversees work planning, facilities and property
management, labor-management relations, merit promotion principles, EEO
and staff training for the region.
Coordinates environmental scanning and strategic planning
for the region. Pursues activities which enable the Chicago and Kansas
City regional staff to become knowledgeable regarding developments and
trends in health care delivery within the states they serve.
Serves as the focal point among regional office components
for special initiatives and broad cross-cutting issues.
Manages and executes the Health Insurance Portability and
Accountability Act's insurance portability enforcement process for the
nation.
17. Office of the Denver Regional Administrator (FAX8)
The Office of the Regional Administrator directs the
operations of programs administered by the CMS, including Medicare,
Medicaid, Clinical Laboratory Improvement Act, and Health Insurance
Portability and Accountability Act, in a distinct geographic area and
provides executive leadership to regional office staff on behalf of the
CMS Administrator.
Develops and implements an outreach plan which includes
media relations, community participation, speeches and presentations,
and local Congressional office liaison, to market CMS programs to the
diverse populations of the region.
Manages the human and dollar resources of the regional
office in an efficient and effective manner including work planning,
facilities and property management, human resource management
(recruitment, retention, training, development and performance
management), and labor-management relations.
Coordinates with the Department's Regional Director to
assure effective relations with State and local governments and with
other Departmental programs and offices.
Evaluates diverse needs of constituents in the region and
advises policy makers so that such needs are considered by CMS in
national policy development.
Develops expert opinion to advise national policy makers
on concerns of American Indians and Alaska Natives as they relate to
programs administered by HHS.
18. Office of the San Francisco Regional Administrator (FAX9)
The Office of the Regional Administrator directs the
operations of programs administered by the CMS, including Medicare,
Medicaid, Clinical Laboratory Improvement Act, and Health Insurance
Portability and Accountability Act, in a distinct geographic area and
provides executive leadership to regional office staff on behalf of the
CMS Administrator.
Develops and implements an outreach plan which includes
media relations, community participation, speeches and presentations,
and local Congressional office liaison, to market CMS programs to the
diverse populations of the region.
Manages the human and dollar resources of the regional
office in an efficient and effective manner including work planning,
facilities and property management, human resource management
(recruitment, retention, training, development and performance
management), and labor-management relations.
Coordinates with the Department's Regional Director to
assure effective relations with State and local governments and with
other Departmental programs and offices.
Evaluates diverse needs of constituents in the region and
advises policy makers so that such needs are considered by CMS in
national policy development.
19. Office of the Seattle Regional Administrator (FAXX)
The Office of the Regional Administrator directs the
operations of programs administered by the CMS, including Medicare,
Medicaid, Clinical Laboratory Improvement Act, and Health Insurance
Portability and Accountability Act, in a distinct geographic area and
provides executive leadership to regional office staff on behalf of the
CMS Administrator.
Develops and implements an outreach plan which includes
media relations, community participation, speeches and presentations,
and local Congressional office liaison, to market CMS programs to the
diverse populations of the region.
Manages the human and dollar resources of the regional
office in an efficient and effective manner including work planning,
facilities and property management, human resource management
(recruitment, retention, training, development and performance
management), and labor-management relations.
Coordinates with the Department's Regional Director to
assure effective relations with State and local governments and with
other Departmental programs and offices.
Evaluates diverse needs of constituents in the region and
advises policy makers so that such needs are considered by CMS in
national policy development.
Designs and implements health care quality improvement
projects and manages contracts of peer review organizations to improve
health care quality in 13 Western States.
20. Office of Operations Management (FAY)
Prepares and presents recommendations to the
Administrator, Deputy Administrator, Chief Operating Officer and other
high-level CMS and Department officials on planning, leadership,
implementation and policy issues concerning modifications to existing
and proposed operating policies that will improve the administration
and operations of programs and the Agency as a whole.
Provides consulting services internally to Agency
management and staff to identify processes that need improvement, to
develop improvement strategies, and to monitor processes and
improvements over time. Participates in agency-wide initiatives to
streamline operations, improve accountability and performance, and
implement management best practices.
Promotes project planning principles throughout the Agency
and provides technical guidance to the Agency on project planning and
management techniques. Prepares and presents recommendations to senior
officials regarding major projects.
Promotes and teaches risk assessment methods to business
owners throughout CMS. Promotes awareness of the importance of risk
analysis as a component of business planning and trains CMS staff in
specific techniques and their applicability in particular situations.
Identifies operational vulnerabilities within CMS and
develops and executes an operational review plan for each fiscal year,
subject to approval by the Deputy
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Administrator, Chief Operating Officer and other senior leadership of
CMS.
Plans and conducts targeted internal audits and makes
recommendations to strengthen internal audits and improve the
operations of the Agency.
Serves as the Agency focal point for emergency
preparedness.
Provides the Agency's internal customers (employees) with
support in human resource management, procurement management, and
logistics. Includes planning, organizing, coordinating, and evaluating
needed activities in each area.
Manages and directs the Agency's ethics and management
programs; provides policy direction, coordination and support for
administrative services including space, property, records, printing
and facilities management, safety and security, and a centralized
customer service desk.
Provides administrative support functions for the
Commissioned Corps.
Develops and maintains administrative systems for ethics,
awards, procurement, and property management.
Provides staff support to the Provider Reimbursement
Review Board (PRRB) and the Medicare Geographic Review Board (MGCRB).
Conducts Medicare and Medicaid Hearings on behalf of the
Secretary or the Administrator that are not within the jurisdiction of
the Department Appeals Board, the Social Security Administration's
Office of Hearings and Appeals, the PRRB, the MGCRB, or the States.
21. Office of Information Services (FBB)
Serves as the focal point for the responsibilities of the
Agency's Chief Information Officer in planning, organizing, and
coordinating the activities required to maintain an agency-wide
Information Resources Management (IRM) program.
Ensures the effective management of the Agency's
information technology, and information systems and resources (e.g.,
implementation and administration of a change management process).
Provides workstation, server, and local area network
support for CMS-wide activities. Works with customer components to
develop requirements, needs and cost benefit analysis in support of the
LAN infrastructure including hardware, software and office automation
services.
Serves as the lead for developing and enforcing the
Agency's information architecture, policies, standards, and practices
in all areas of information technology.
Develops and maintains enterprise-wide central databases,
statistical files, and general access paths, ensuring the quality of
information maintained in these data sources.
Directs Medicare claims payment systems activities,
including CWF operation, as well as systems conversion activities.
Develops ADP standards and policies for use by internal
CMS staff and contractor agents in such areas as applications
development and use of the infrastructure resources.
Manages and directs the operation of CMS hardware
infrastructure, including the Agency's Data Center, data communications
networks, enterprise infrastructure, voice/data switch, audio
conferencing and other data centers supporting CMS programs.
Leads the coordination, development, implementation and
maintenance of health care information standards in the health care
industry.
Provides Medicare and Medicaid information to the public,
within the parameters imposed by the Privacy Act.
Performs information collection analyses as necessary to
satisfy the requirements of the Paperwork Reduction Act.
Directs CMS' ADP systems security program with respect to
data, hardware, and software.
Directs and advises the Administrator, senior staff, and
components on the requirements, policies, and administration of the
Privacy Act.
22. Office of Financial Management (FBC)
Serves as the Chief Financial Officer and Comptroller for
the Agency.
Formulates, presents and executes all Agency budget
accounts; develops outlay plans and tracks contract and grant award
amounts; acts as liaison with the Congressional Budget Office (CBO) on
budget estimates; reviews demonstration waivers (except 1115) for
revenue neutrality. Is responsible for ensuring that the budget is
formulated in accordance with the Agency's strategic plan and the GPRA
goals and performance measures.
Acts as liaison with ASMB, OMB, and the Congressional
appropriations committees for all matters concerning the Agency's
operating budget.
Manages the Medicare financial management system, the
Medicare contractors' budgets, Peer Review Organizations' budgets,
research budgets, managed care payments, the issuance of State Medicaid
grants, and the funding of the State survey/certification and the CLIA
programs. Is responsible for all Agency disbursements.
Performs cash management activities and establishes and
maintains systems to control the obligation of funds and ensure that
the Anti-Deficiency Act is not violated.
Performs the Agency's debt management activities (e.g.,
accounts receivable, user fees, penalties, disallowances).
Reconciles all Agency financial data and prepares external
reports to other agencies such as HHS, Treasury, OMB, Internal Revenue
Service, General Services Administration, related to the Agency's
obligations, expenditures, prompt payment activities, debt and cash
management, and other administrative functions.
Has overall responsibility for the fiscal integrity of all
Agency programs. Develops and performs all benefit integrity policy and
operations in coordination with other Agency components. Manages the
Medicare program integrity contractors authorized by the HIPAA and
managed care financial audit and enforcement functions. In coordination
with the Center for Medicaid and State Operations, develops Medicaid
program integrity policy; and monitors Medicaid program integrity
activities.
Working with other CMS components, develops Agency
policies governing both Medicare Secondary Payer and Medicaid Third
Party Liability.
Develops and implements all civil money penalty policies
in all programs.
Prepares financial statements for Federal Managers
Financial Integrity Act and GPRA.
23. Office of Strategic Operations & Regulatory Affairs (FGA)
Manages the Agency's decision-making and regulatory
process.
Serves in a neutral broker coordination role which
includes: Scheduling meetings and briefings for the Administrator and
coordinating communications between and among central and regional
offices to ensure that emerging issues are identified early, all
concerned components are directly and fully involved in policy
development/decision making, and that all points of view are presented.
Provides leadership, direction, and advocacy, on behalf of
top CMS officials in connection with official policy matters for
presentation to the Administrator and Deputy Administrator/ Chief
Operating Officer to insure that all points of view and
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program interests of concern to the Administrator and Deputy
Administrator/Chief Operating Officer are developed and properly
presented for consideration. Reviews policy statements by component
Directors and others to anticipate potential problems or
inconsistencies with views of the Administrator, Deputy Administrator/
Chief Operating Officer, and the Administration. Assists in resolving
these matters to the satisfaction of the Agency and top management.
Manages meeting requests for or on behalf of the
Administrator, and Deputy Administrator/Chief Operating Officer.
Coordinates the preparation of briefing materials for the
Administrator, Deputy Administrator/Chief Operating Officer, and the
Department in advance of the Administrator and Deputy Administrator/
Chief Operating Officer's participation in meetings, appointments with
major groups, etc. Works with CMS components to assure that appropriate
briefing materials are presented to Senior Leadership. Senior officials
in CMS and the Department, as well as officials of other Federal
agencies, State and local governments, and outside interest groups
attend these meetings.
Coordinates the preparation of manuals and other policy
instructions to ensure accurate and consistent implementation of the
Agency's programs.
Manages the Agency's system for developing, clearing and
tracking regulations, setting regulation priorities and corresponding
work agendas; coordinates the review of regulations received for
concurrence from departmental and other government agencies, and
develops routine and special reports on the Agency's regulatory
activities.
Manages the regulations development process to ensure
timely decision making by the Administrator and Deputy Administrator/
Chief Operating Officer on CMS regulations.
Provides leadership and management of the Agency's
Executive Correspondence system. Operates the agency-wide
correspondence tracking and control system and provides guidance and
technical assistance on standards for content of correspondence and
memoranda.
Manages the agency-wide clearance system to ensure
appropriate involvement from Agency components and serves as a primary
focal point for liaison with the Executive Secretariat in the Office of
the Secretary.
Provides management and administrative support to the
Office of the Attorney Advisor and staff.
Acts as audit liaison with the General Accounting Office
(GAO) and the HHS Office of Inspector General (OIG).
Monitors and coordinates major CMS legislative initiatives
such as tracking the status of the Agency's implementation of Balance
Budget Act, Balanced Budget Refinement Act, and the Benefits
Improvement and Protection Act provisions.
Coordinates and prepares the advance planning reports for
the Secretary and the Administrator (Secretary's Forecast Report).
Acts as the liaison with the Office of the Secretary for
Reports to the Congress and maintains a tracking system to monitor
status. Also serves as the CMS liaison with the Small Business
Administration's Office of the National Ombudsman.
Develops standard processes for all CMS FACA committees
and provides operational and logistical support to CMS components for
conferences and on all matters relating to Federal Advisory Committees.
Conducts activities necessary to the receipt, management,
response, and reporting requirements of the Department under the
Freedom of Information Act (FOIA) regarding all requests received by
CMS.
Maintains a log of all FOIA requests received by the
central office, refers requests to the appropriate components within
headquarters, the regions or among carriers and intermediaries for the
collection of the documents requested. Makes recommendations and
prepares replies to requesters, including denials of information as
permitted under FOIA, and drafts briefing materials and responses in
connection with appeals of denial decisions.
Directs the maintaining and amending of CMS-wide records
for confidentiality and disclosure to the Privacy Act to include:
Planning, organizing, initiating and controlling privacy matching
assignments.
Provides direct services and develops policy, standards,
and procedures for CMS' records, management and vital records program
for all CMS Central and Regional Offices.
24. Office of E-Health Standards and Services (FHA)
Develops and coordinates implementation of a comprehensive
e-health strategy for CMS. Coordinates and supports internal and
external technical activities related to e-health services and ensures
that individual initiatives tie to the overall agency and Federal e-
health goals strategies.