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[Federal Register: July 1, 2008 (Volume 73, Number 127)]
[Notices]               
[Page 37463-37464]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr01jy08-45]                         

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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. 46, pp. 12451-12452, dated Friday, March 7, 2008) is amended to 
reflect a change in the name and updates to the functions for the 
Center for Beneficiary Choices.
    Part F. is described below:
     Section F. 20. (Functions) reads as follows:

Center for Drug and Health Plan Choice (FAE)

     Responsible for all national policies and operations 
necessary for the purchasing of Medicare Prescription Drug (Part D) and 
Medicare Advantage (Part C) health plan benefits. Designs, implements, 
and manages the procurement of prescription drug plans (PDPs) and 
Medicare Advantage plans (MA and MA-PD plans), including the 
solicitation and approval of applications, review of benefits and 
negotiation of competitive bids, the implementation of quality 
improvement and performance measures, review of fiscal solvency and 
contractor management activities.
     Develops and improves all bidding and payment policies 
related to the Medicare Prescription Drug Benefit and the Medicare 
Advantage (MA) program.
     Validates payments to the Part D prescription drug and MA 
plans, including routine annual risk adjustment data validation based 
on medical record review.
     Coordinates the development and management of business 
requirements for the national systems for enrollment, payment, and 
contractor management for the Prescription Drug Benefit and the 
Medicare Advantage (MA) programs.
     Develops and implements the national policy and oversees 
operational implementation for all issues related to the Retiree Drug 
Subsidy Program.
     Develops national policy for eligibility, enrollment and 
entitlement for Medicare Parts A, B, C, and D, including oversight of 
activities related to Part D auto-enrollment, low income subsidy, and 
creditable coverage.
     Develops national policy and oversees operational 
activities related to Medicare Part A, B, C, and D claims-related 
hearings, appeals, grievances and other beneficiary-centered dispute 
resolution processes.
     Serves as the focal point for issues related to a variety 
of Federal standards affecting private health insurance coverage, 
including those pertaining to its administration of the Medigap 
program, Title I of the Health Insurance Portability and Accountability 
Act and the Consolidated Omnibus Budget Reconciliation Act.
     Works closely with the regional Consortium for Medicare 
Health Plans Operations (CMHPO) on all operational aspects of the Part 
C and Part D programs.
     Develops and implements Part C and Part D contractor 
performance monitoring programs and Part C and Part D compliance and 
oversight programs and carries out these programs collaboratively with 
CMHPO.
     Develops surveys to measure consumer experiences with 
their health plans and health care providers; manages the Consumer 
Assessment of Health Care Provider and Systems (CAHPS) survey; develops 
and prepares performance measures for Part C sponsors; analyzes and 
reports Health Plan Employers Data and Information Set data for Part C 
performance measures and consumer reports; and

[[Page 37464]]

assesses the effectiveness of CMS' quality reporting activities.
     Effectively communicates program policies related to the 
Prescription Drug and Medicare Advantage (MA) programs to heath plans 
and drug plan contractors, employer group sponsors, beneficiary 
advocates and other stakeholders in the health care field.
     Develops new policies (e.g. health plan access, benefits, 
special needs plans) and programs to reflect changes in program 
objectives, the health care delivery system, beneficiary health care 
needs, and new plan types to support an appropriate range of choices 
for beneficiaries.
     Collaborates with our partners, such as industry, other 
government entities and advocacy groups, to understand their 
perspectives on Prescription Drug and Medicare Managed Care policies 
and procedures and to drive best practices in the health care industry.
     Develops and implements a comprehensive strategic plan, 
objectives and measures for overseeing an effective compliance and 
oversight program for all Part C (Medicare Advantage) and Part D 
(Medicare Prescription Drug) contractors in close collaboration with 
CMHPO, the Medicare Drug Benefit and C & D Data Group, the Medicare 
Drug and Health Plan Contract Administration Group and other Center for 
Drug and Health Plan Choice components.
     Develops and implements a comprehensive and effective 
audit program for all Part C (Medicare Advantage) and Part D (Medicare 
Prescription Drug) contractors.

    Dated: June 21, 2008.
James W. Weber,
Acting Director, Office of Operations Management, Centers for Medicare 
& Medicaid Services.
[FR Doc. E8-14896 Filed 6-30-08; 8:45 am]

BILLING CODE 4120-01-P

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