[Federal Register: December 28, 2007 (Volume 72, Number 248)]
[Notices]
[Page 73847-73850]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr28de07-116]
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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. 72, No.
123, pp. 35246-35247, dated Wednesday, June 27, 2007) is amended to
reflect the abolishment of the 10 Regional Offices and the
establishment of the Consortium for Medicare Health Plans Operations,
the Consortium for Financial Management and Fee for Service Operations,
the Consortium for Medicaid and Children's Health Operations, and the
Consortium for Quality Improvement and Survey and Certification
Operations.
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. Consortium for Medicare Health Plans Operations (FAU)
11. Consortium for Financial Management and Fee for Service Operations
(FAV)
12. Consortium for Medicaid and Children's Health Operations (FAW)
13. Consortium for Quality Improvement and Survey and Certification
Operations (FAX)
14. Office of Operations Management (FAY)
[[Page 73848]]
15. Office of Information Services (FBB)
16. Office of Financial Management (FBC)
17. Office of Strategic Operations and Regulatory Affairs (FGA)
18. Office of E-Health Standards and Services (FHA)
19. Office of Acquisition and Grants Management (FKA)
20. Office of Policy (FLA)
21. Office of Beneficiary Information Services (FMA)
Section F. 20. (Functions) reads as follows:
10. Consortium for Medicare Health Plans Operations (FAU)
Serves as the Field focal point for all interactions with
managed health care organizations, Medicare Advantage (MA) plans,
Medicare prescription drug plans (PDPs) and Medicare Advantage
Prescription Drug (Part D) plans for issues relating to Agency
programs, policy and operations.
Serves as the Field's 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
their retirees.
Serves as the Field focal point for all interactions with
beneficiaries, their families, care givers, health care providers, and
others operating on their behalf concerning improving beneficiaries'
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.
Implements national policy for Medicare Parts C and D
beneficiary eligibility, enrollment, entitlement, premium billing and
collection, coordination of benefits, rights and protections, and
dispute resolution process, as well as policy for managed care
enrollment and disenrollment to assure the effective administration of
the Medicare program.
Participates in the development of 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.
In conjunction with the Center for Beneficiary Choices
(CBC), handles all phases of contracts with managed health care
organizations eligible to provide care to Medicare beneficiaries.
Responds to inquiries regarding Parts C and D coverage and
payment policies.
Implements 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.
In conjunction with CBC, implements regulations,
guidelines, and instructions required for the dissemination of appeals
policies to Medicare beneficiaries, MA plans, PDPs, CMS Consortia,
beneficiary advocacy groups and other interested parties.
Assures, in coordination with other Consortium
Administrators and Central Office Centers and Offices, that the
activities of Medicare managed care plans, agents, and State Agencies
meet the Agency's requirements on matters concerning beneficiaries and
other consumers.
In partnership with appropriate Central Office components,
administers the contracts and grants related to beneficiary and
customer service, including the State Health Insurance Assistance
Program grants.
Participates in the formulation of strategies to advance
overall beneficiary communications goals and coordinates the Field
implementation of 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 Consortium focal point for emergency
preparedness for the Field.
Provides oversight in the areas of human resource
procurement and logistics.
Ensures the effective management of the Agency's
information technology and information systems and resources in the
Field.
Implements the privacy and confidentiality policies
pertaining to the collection, use, and release of individually
identifiable data.
Proactively establishes, manages, and fosters partnerships
within the Consortium with State and Local governments, providers and
provider associations, beneficiaries and their representatives, and the
media that are focused on CMS' goals and objectives.
Serves as the primary point of contact to appropriate
members of Congress, Federal, State, and Local officials and Tribal
governments on matters concerning the Medicare program.
Oversees the coordination and integration of CMS'
activities with other Federal, State, Local, and private health care
agencies and organizations.
Counsels, advises, and collaborates with top Agency
officials on policy matters and major considerations in developing,
implementing, and coordinating CMS' programs as they interrelate in
addressing national and regional strategies.
Advises the Office of the Administrator (OA) on special
programs as they relate to national initiatives and as they impact
major constituents or their key representatives.
Promotes accountability, communication, coordination and
facilitation of cooperative corporate decision-making among CMS' top
senior staff on management, operational and programmatic issues cross-
cutting organizational components with diverse functions and
activities.
11. Consortium for Financial Management & Fee for Service Operations
(FAV)
Serves as the Field focal point for all interactions with
the Office of Financial Management and assists in its overall
responsibility for the fiscal integrity of all Agency programs.
Implements all benefit integrity policies and operations
in coordination with other Agency components in the Field. Assists in
the management of the Medicare program integrity contractors.
Performs the Field's activities regarding Medicare
Secondary Payer.
Implements all civil money penalty policies in all CMS'
programs.
Oversees and coordinates the Field's preparation of
certification statements for the Federal Managers Financial Integrity
Act and Government Performance and Results Act.
Serves as the Field focal point for all Agency
interactions between health care providers and fee-for-service (FFS)
contractors for issues relating to Part A and Part B FFS policies and
operations.
Coordinates provider and physician-centered Part A and
Part B FFS information, education, and service initiatives in the
Field.
Responds to inquiries regarding Part A and Part B coverage
and payment policies.
Provides the Center for Medicare Managementwith comments
on FFS current/proposed legislation in order to determine impact on
providers.
[[Page 73849]]
Performs activities related to the Medicare Part A and
Part 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
Program for All-Inclusive Care for the Elderly (PACE) for claims-
related hearings, appeals, grievances and other dispute resolution
processes that are beneficiary-centered.
Implements national policy for Medicare Parts A and B
beneficiary eligibility, enrollment, entitlement; premium billing and
collection; coordination of benefits; rights and protections; dispute
resolution process to assure the effective administration of the
Medicare program.
Serves as the Consortium focal point for emergency
preparedness for the Field.
Provides oversight in the areas of human resource
procurement and logistics.
Ensures the effective management of the Agency's
information technology and information systems and resources in the
Field.
Implements the privacy and confidentiality policies
pertaining to the collection, use, and release of individually
identifiable data.
Proactively establishes, manages, and fosters partnerships
within the Consortium with State and Local governments, providers and
provider associations, beneficiaries and their representatives, and the
media that are focused on CMS' goals and objectives.
Serves as the primary point of contact to appropriate
members of Congress, Federal, State, and Local officials and Tribal
governments on matters concerning the Medicare program.
Oversees the coordination and integration of CMS'
activities with other Federal, State, Local, and private health care
agencies and organizations.
Counsels, advises, and collaborates with top Agency
officials on policy matters and major considerations in developing,
implementing, and coordinating CMS' programs as they interrelate in
addressing national and regional strategies.
Advises OA on special problems as they relate to national
initiatives and programs and as they impact major constituents or their
key representatives.
Promotes accountability, communication, coordination and
facilitation of cooperative corporate decision-making among CMS top
senior staff on management, operational and programmatic issues cross-
cutting organizational components with diverse functions and
activities.
12. Consortium for Medicaid & Children's Health Operations (FAW)
Serves as the Field focal point for all CMS activities
relating to Medicaid and the State Children's Health Insurance Program
(SCHIP) with States and Local governments (including the Territories).
Implements national Medicaid program and fiscal 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.
Implements, 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.
Reviews, approves and conducts oversight of Medicaid
managed care waiver programs. Provides assistance to States and
external customers on all Medicaid managed care issues.
Implements national policies and procedures on Medicaid
automated claims/encounter processing and information retrieval systems
such as the Medicaid Management Information System and integrated
eligibility determination systems.
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.
Coordinates with and provides input into the Medicaid
Integrity Program (MIP). Develops strategies to prevent and detect
improper payments, including fraud and abuse by providers and others,
from Medicaid and SCHIP. Offers support and assistance to the States to
combat provider fraud, waste, and abuse. Provides guidance and
direction to State Medicaid programs based on the insights gained
through MIP's efforts.
Serves as the Consortium focal point for emergency
preparedness for the Field.
Provides oversight in the areas of human resource
procurement and logistics.
Ensures the effective management of the Agency's
information technology and information systems and resources in the
Field.
Implements the privacy and confidentiality policies
pertaining to the collection, use, and release of individually
identifiable data.
Proactively establishes, manages, and fosters partnerships
within the Consortium with State and Local governments, providers and
provider associations, beneficiaries and their representatives, and the
media that are focused on CMS' goals and objectives.
Serves as the primary point of contact to appropriate
members of Congress, State Governors, Federal, State, and Local
officials and Tribal governments on matters concerning the Medicaid
program.
Oversees the coordination and integration of CMS'
activities with other Federal, State, Local, and private health care
agencies and organizations.
Counsels, advises, and collaborates with top Agency
officials on policy matters and major considerations in developing,
implementing, and coordinating CMS' programs as they interrelate in
addressing national and regional strategies.
Advises OA on special problems as they relate to national
initiatives and programs and as they impact major constituents or their
key representatives.
Promotes accountability, communication, coordination and
facilitation of cooperative corporate decision-making among CMS' top
senior staff on management, operational and programmatic issues cross-
cutting organizational components with diverse functions and
activities.
13. Consortium for Quality Improvement & Survey & Certification
Operations (FAX)
Serves as the Field 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
the Clinical Laboratory Improvement Amendments (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
[[Page 73850]]
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 in the Field. Carries out the Health Care
Quality Improvement Program for the Medicare, Medicaid, and CLIA
programs.
Assists 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.
Enforces the requirements of participation for providers
and plans in the Medicare, Medicaid, and CLIA programs. Recommends
revisions of the requirements based on statutory change and input from
other components.
Operates the Medicare Quality Improvement Organization and
End Stage Renal Disease Network program, 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; and
collaborates with other components to develop comparative provider and
plan performance information for consumer choices.
Assists in the preparation of the scientific, clinical and
procedural basis for, and recommends to the Administrator decisions
regarding, coverage of new and established technologies and services.
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 contractors and payment
policies.
Serves as the focal point for all CMS Field activities
relating to CLIA and the survey and certification of health facilities
with States and Local governments (including the Territories).
Implements, evaluates and refines standardized provider
performance measures used within provider certification programs.
Supports States in their use of standardized measures for provider
feedback and quality improvement activities. Implements and supports
the data collection and analysis systems needed by States to administer
the certification program.
Serves as the Consortium focal point for emergency
preparedness for the Field.
Provides oversight in the areas of human resource
procurement and logistics.
Ensures the effective management of the Agency's
information technology and information systems and resources in the
Field.
Implements the privacy and confidentiality policies
pertaining to the collection, use, and release of individually
identifiable data.
Proactively establishes, manages, and fosters partnerships
within the Consortium with State and Local governments, providers and
provider associations, beneficiaries and their representatives, and the
media that are focused on CMS' goals and objectives.
Serves as the primary point of contact to appropriate
members of Congress, State Governors, Federal, State, and Local
officials and Tribal governments on matters concerning the Medicare and
Medicaid programs.
Oversees the coordination and integration of CMS'
activities with other Federal, State, Local, and private health care
agencies and organizations.
Counsels, advises, and collaborates with top Agency
officials on policy matters and major considerations in developing,
implementing, and coordinating CMS' programs as they interrelate in
addressing national and regional strategies.
Advises OA on special problems as they relate to national
initiatives and programs and as they impact major constituents or their
key representatives.
Promotes accountability, communication, coordination and
facilitation of cooperative corporate decision-making among CMS top
senior staff on management, operational and programmatic issues cross-
cutting organizational components with diverse functions and
activities.
Dated: November 23, 2007.
Charlene Frizzera,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
[FR Doc. E7-25305 Filed 12-27-07; 8:45 am]
BILLING CODE 4120-01-P