Statement of Organization, Functions, and Delegations of Authority, 73847-73850 [E7-25305]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 72, Number 248 (Friday, December 28, 2007)]
[Notices]
[Pages 73847-73850]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-25305]


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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