Statement of Organization, Functions, and Delegations of Authority, 55850-55851 [E8-22690]

Agencies

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

[Federal Register Volume 73, Number 188 (Friday, September 26, 2008)]
[Notices]
[Pages 55850-55851]
From the Federal Register Online via the Government Printing 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.

[[Page 55851]]

     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