Statement of Organization, Functions, and Delegations of Authority, 12451-12452 [E8-4585]

Agencies

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

[Federal Register Volume 73, Number 46 (Friday, March 7, 2008)]
[Notices]
[Pages 12451-12452]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-4585]


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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. 
248, pp. 73847-73850, dated Friday, December 28, 2007) is amended to 
reflect updates to the functions for the Center for Beneficiary Choices 
and the Office of E-Health Standards and Services.
    Part F. is described below:
     Section F. 20. (Functions) reads as follows:

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.
     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 their 
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 (MA) 
plans, Prescription Drug Plans (PDPs), CMS regional offices, 
beneficiary advocacy groups and other interested parties.

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.
     Promotes and leverages innovative component initiatives. 
Facilitates cross-component awareness of various e-health projects.
     Develops regulations and guidance materials, and provides 
technical assistance on the Administrative Simplification provisions of 
the Health Insurance Portability and Accountability Act of 1996 
(HIPAA), including transactions, code sets, identifiers, and security.
     Develops and implements the enforcement program for HIPAA

[[Page 12452]]

Administrative Simplification provisions.
     Develops and implements an outreach program for HIPAA 
Administrative Simplification provisions. Formulates and coordinates a 
public relations campaign, prepares and delivers presentations and 
speeches, responds to inquiries on HIPAA issues, and maintains liaison 
with industry representatives.
     Adopts and maintains messaging and vocabulary standards 
supporting electronic prescribing under Medicare Part D.
     Serves as agency point of reference on Federal and private 
sector e-health initiatives. Works with Federal departments and 
agencies to identify and adopt universal messaging and clinical health 
data standards, and represents CMS and HHS in national projects 
supporting the national health enterprise architecture and the national 
health information infrastructure.
     Coordinates and provides guidance on legislative and 
regulatory issues related to e-health standards and services.
     Collaborates with HHS on policy issues related to e-health 
standards, and serves as the central point of contact for the Office of 
the National Coordinator for Health Information Technology.
     Oversees the development of privacy and confidentiality 
policies pertaining to the collection, use, and release of individually 
identifiable data.

     Dated: October 19, 2007.
Karen Pelham O'Steen,
Director, Office of Operations Management, Centers for Medicare & 
Medicaid Services.

    Editorial Note: This document was received at the Office of the 
Federal Register on Tuesday, March 4, 2008.

[FR Doc. E8-4585 Filed 3-6-08; 8:45 am]
BILLING CODE 4120-01-P