[Federal Register Volume 73, Number 188 (Friday, September 26, 2008)]
[Notices]
[Pages 55850-55851]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-22690]
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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. 73, No.
127, pp. 37463-37464, dated Tuesday, July 1, 2008) is amended to
reflect an update to the functions for the Center for Medicare
Management.
Part F. is described below:
Section F. 20. (Functions) reads as follows:
Center for Medicare Management (FAH)
Serves as the focal point for all Agency interactions with
health care providers, intermediaries, carriers, and Medicare
Administrative Contractors (MACs) for issues relating to Agency fee-
for-service (FFS) policies and operations.
Responsible for 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 items and services under Medicare FFS.
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Develops, evaluates and maintains policies, regulations,
and instructions that define the scope of benefits and payment amounts
for:
1. Hospitals for inpatient services under the inpatient prospective
payment system and the long-term care hospital prospective payment
system;
2. Inpatient services in hospitals and units excluded from the
prospective payment systems;
3. Physicians and non-physician practitioners;
4. Hospital outpatient departments, comprehensive outpatient
rehabilitation facilities and ambulatory surgical centers;
5. Clinical laboratory services;
6. Ambulance services;
7. Prescription drugs and blood, blood products and hemophilia
clotting factor; and
8. Telemedicine services, rural health clinics, and federally-
qualified health centers.
Formulates CMS policy for development, analysis, and
maintenance of new and revised medical codes and medical classification
systems (including ICD-9-CM, Healthcare Common Procedure Coding System,
Diagnosis Related Groups, and Ambulatory Payment Classifications) and
develops common medical coding standards and policy.
Participates in the development and evaluation of proposed
legislation pertaining to assigned subject areas.
Coordinates with the Office of Clinical Standards and
Quality on coverage issues in assigned areas.
Develops, evaluates, and reviews regulations, manuals,
program guidelines, and instructions required for the dissemination of
program policies to program contractors and the health care field.
Identifies, studies and makes recommendations for
modifying Medicare policies to reflect changes in beneficiary health
care needs, program objectives, and the health care delivery system.
Develops, evaluates and maintains policies, regulations,
and instructions that define the scope of benefits and payment amounts
for skilled nursing facilities, home health agencies, hospice, durable
medical equipment, orthotics, prosthetics and supplies.
Develops and evaluates national Medicare policies and
principles for applying limitations to the costs of skilled nursing
facilities and home health agencies. Develops criteria for exceptions
to the cost limitations for skilled nursing facilities. Reviews and
makes decisions on requests for such exceptions.
Analyzes payment data, develops, maintains and updates
payments rates for End Stage Renal Disease services and Program of All-
Inclusive Care for the Elderly sites.
Manages designation process for Medicare organ transplant
centers, organ procurement organizations and for hospitals seeking out-
of-service-area waivers.
Develops, issues and administers the specifications,
requirements, methods, standards, policies, procedures and budget
guidelines for Medicare claims processing related activities, including
detailed definitions of the relative responsibilities of providers,
contractors, CMS, other third-party payers and the beneficiaries of the
Medicare program.
Develops and releases the coding and pricing databases and
software for physician, laboratory, Skilled Nursing Facility, Home
Health, Inpatient, Outpatient and supplier services in the Medicare
claims processing standard systems.
Develops policies related to the integration of health
care services, including policies on ownership and referral
arrangements, business relationships and conflict of interest.
Serves as the CMS lead for management, oversight, budget
and performance issues relating to Medicare carriers, fiscal
intermediaries, and MACs.
Functions as CMS liaison for all Medicare carrier, fiscal
intermediary, and MAC program issues and, in close collaboration with
the regional offices and other CMS components, coordinates Agency-wide
contractor activities.
Manages contractor instructions, workload, and change
management process.
Manages and oversees Medicare contractor provider inquiry,
outreach, and education activities including specifying Budget
Performance Requirements, allocating and managing budget dollars across
contractors, evaluating supplemental budget requests, issuing program
instructions and participating in contractor performance evaluation
activities.
In conjunction with the CMS program area experts, develops
training programs and materials, and training tools to educate
providers, physicians, suppliers and Medicare contractor provider
education staff on new initiatives and changes to the Medicare program.
Develops national provider/supplier education products and
training tools for Medicare contractors as well as for provider
education provided directly by CMS.
Supports communication between CMS and the provider/
supplier community through facilitation of ``open door'' and
Participating Physician Advisory Committee meetings, other listening
sessions and promotes awareness of Agency initiatives by sponsoring
exhibit programs at industry conferences.
Develops system requirements and computer software for
select portions of Medicare FFS claims processing systems.
Develops and implements Medicare FFS program requirements
for provider billing and for claims processing systems.
Implements the Medicare Health Support Program.
Dated: September 18, 2008.
James W. Weber,
Acting Director, Office of Operations Management, Centers for Medicare
& Medicaid Services.
[FR Doc. E8-22690 Filed 9-25-08; 8:45 am]
BILLING CODE 4120-01-P