[Federal Register Volume 60, Number 162 (Tuesday, August 22, 1995)]
[Notices]
[Pages 43602-43606]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-20692]
Health Care Financing Administration
Health Standards and Quality Bureau; 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, Health
Care Financing Administration (HCFA), (Federal Registers, Vol. 59, No.
60, pp. 14659-14662, dated Tuesday, March 29, 1994, and Vol. 59, No.
187, pp. 49406-49407, dated Wednesday, September 28, 1994) is amended
to reflect changes in the organizational structure of the Health
Standards and Quality Bureau (HSQB), Associate Administrator for
Operations and Resource Management. The HSQB functional statement has
not been changed; however, it is being republished to reflect the new
administrative code.
The specific amendments to part F are as follows:
Section F.10.D.7. (Organization) is amended to read as
follows:
7. Health Standards and Quality Bureau (FLH)
a. Survey Training Improvement Team (FLH1)
b. Center for Information Systems (FLH2)
c. Center for Operations Management (FLH3)
d. Center for Laboratories (FLH4)
e. Center for Hospital and Community Care (FLH5)
f. Center for Long Term Care (FLH6)
g. Center for Health Education and Promotion (FLH7)
h. Center for Clinical Measurement and Improvement (FLH8)
Section F.20.D.7. (Functions) is amended by deleting all
functional statements in their entirety and replacing them with the
following:
7. Health Standards and Quality Bureau (FLH)
Provides leadership and overall programmatic direction for
implementation and enforcement of health quality and safety standards
for providers and suppliers of health care services and evaluates their
impact on the utilization, quality and cost of health care services.
Plans, develops, and establishes procedures and guidelines
for administering and evaluating the nationwide Medicare and Medicaid
survey and certification program.
Monitors and validates the process for certifying that
participating
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providers and suppliers are in compliance with established conditions
and standards.
Responsible for implementation and operation of
professional review and other medical review programs.
Administers a comprehensive system for assessment of
individual professional and medical review organizations to determine
compliance with program requirements and to document the effectiveness
and impact of their activities.
Establishes specifications for information and data
reporting, collection and systems requirements for the survey and
certification, professional review and other medical review activities.
a. Survey Training Improvement Team (FLH1)
Responsible for the national surveyor training system.
Directs and coordinates development, measurement and
improvement of an integrated surveyor training program for HCFA
regional office and State agency personnel on interpretation of
regulations, surveyor protocols, procedures, techniques and
certification issues.
In conjunction with the specific program groups, insures
that training materials and techniques are current and comprehensive
and meet the needs of the HCFA regional office and State survey
agencies.
Evaluates program-related data and develops approaches for
improvements to program management and operations.
Evaluates customer service and systems performance data
and develops approaches for improvement to the training programs.
Serves as the focal point for the operation of all
training including scheduling, logistical support, enrollment, etc.
Coordinates, as necessary, with State agencies, regional offices, and
other HCFA organizations, provider and supplier groups and other
stakeholder groups who may require the program training.
Communicates with professional groups, providers, and
consumers to obtain information for the development and implementation
of training initiatives.
Serves as focal point for administering the certification
of Continuing Education Units under the auspices of the International
Association for Continuing Education and Training.
b. Center for Information Systems (FLH2)
Manages day-to-day operations of the Bureau's data
systems, including the Peer Review Organization, End-Stage Renal
Disease Network, Health Care Quality Improvement Program, On-line
Survey and Certification and Reporting and Clinical Laboratory
Improvement Amendment activities.
In conjunction with other Centers, designs, operates,
documents, and maintains system applications used in the administration
of Bureau programs, and/or provides technical assistance in
implementing and maintaining program-related ADP systems.
Designs, develops, and produces management reports to
support effective and efficient operation of Bureau program systems.
Provides expert technical support to the Bureau's
information technology infrastructure; i.e., local area network end-
users, telecommunications, personal computers, etc.
Develops and implements Bureau-wide information technology
policies and procedures to support the Bureau's information technology
objectives.
Prepares specifications for programming the On-line Survey
and Certification and Reporting system to include changes to
interpretive guidelines, survey procedures and forms.
Coordinates and monitors the transmission of data to and
from proficiency testing organizations, accrediting programs, common
working files and Medicaid State Agencies.
Directs and monitors the Bureau's system security and LAN
administration programs.
Provides technical support in development and evaluation
of ADP sections of contractor proposals; establishes procedures
regarding systems operations and security.
Maintains liaison with the Bureau of Data Management and
Strategy, user groups, and workgroups within and outside of the Agency.
Maintains liaison with internal and external customers and
stakeholders to assess needs and satisfaction and to coordinate
development of IRM strategies, budget, and implementation plans.
Oversees systems support contracts.
Participates in meetings with data standards
organizations.
Develops and/or evaluates program-related data, including
approaches and recommendations for improvements to program management
and operations.
Evaluates customer service and system performance data and
develops approaches for improvement.
c. Center for Operations Management (FLH3)
Develops, coordinates, manages, and evaluates Bureau
budget, procurement, contract, personnel management, correspondence,
and administrative support systems.
Develops and implements a Bureau staff development plan to
ensure that the current and future training needs of all employees is
addressed. Coordinates all internal and external training and staff
development initiatives.
Directs and manages the Bureau's management and
administrative operations including the administrative budget and
information collection budget. Coordinates Bureau responses to GAO and
OIG reports.
Manages the Bureau's correspondence, printing, manual
issuance, and regulation management processes, including managing a
bureau-wide automated library and other communication systems.
Responds to program-related public and congressional
inquiries and to freedom of information and privacy act requests
related to bureau programs.
Coordinates contract development, evaluation of contract
proposals, and negotiation for Bureau contracts. Acts as project
officer for contracts affecting multiple bureau components.
In partnership with central and regional office staff,
coordinates and oversees systems for assessing contractor performance.
Administers the State grants process for Medicare and
Medicaid State certification and CLIA program payments. Reviews
periodic State agency expenditure reports and estimates to evaluate
budget execution and determine allowability of costs.
Prepares annual operating plans for States to assure
sufficient resources are available for program operations on a
quarterly basis.
Develops justifications for program operating requirements
for Medicare State certification, Medicaid State certification, Peer
Review Organization, End-Stage Renal Disease Networks, CLIA, and
support contracts.
Establishes and maintains systems to control program funds
and ensure that the Anti-Deficiency Act is not violated.
Manages the Bureau procurement plan.
Coordinates with HCFA central and regional office staff,
state agencies, and the contractor community concerning contract and
financial management and issues.
Evaluates budget, contract, correspondence, and
administrative
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data, including approaches and recommendations for improvements to
their management and operations.
Evaluates customer service and performance data and
develops approaches for improvement.
d. Center for Laboratories (FLH4)
Directs and coordinates development, measurement and
improvement of program strategies that implement, enforce, and monitor
the Clinical Laboratory Improvement Program. Scope of the program
administered includes all clinical laboratories, conducting testing of
human specimens for the purpose of diagnosis and/or treatment for
residents of the United States.
Prepares regulation specifications and evaluates comments.
Serves as the HCFA liaison with the Public Health Service,
Centers for Disease Control and Prevention (CDC) and the Food and Drug
Administration, professional groups, standards setting organizations,
and consumer and advocate groups, in the development and administration
of laboratory standards.
Prepares and implements interpretive guidelines, survey
procedures, and forms.
Develops, implements, and monitors quality indicators for
the assessment of quality of laboratory services.
Directs and coordinates development, implementation, and
improvement of the CLIA User Fee Plan, including the administration of
the collection process.
Reviews and approves applications by States for
``exemption'' and private accrediting bodies for deemed status.
Develops and administers proficiency testing programs and
monitors their performance.
In conjunction with CDC, develops and administers the
cytology proficiency testing program.
Develops and/or evaluates program-related data, including
approaches and recommendations for improvements to program management
and operations.
Evaluates customer service and system performance data and
develops approaches for improvement.
Contributes to/participates in budget development,
direction, execution, and review.
Provides support to and communicates with other HCFA and
HHS components, and other governmental agencies such as the Veterans'
Administration and the Department of Defense on program-related issues.
Represents HCFA in presentations and meetings with public
and professional organizations and CLIAC on matters involving
laboratory standards, enforcement and performance. Provides public
education as needed.
Assists in the development of functional requirements and
specifications required for the design of information systems and
evaluates the effectiveness of information systems.
Through communication with the regional offices, assists
in the review of State agency performance, in these program areas, by
developing appropriate assessment techniques and protocols.
Assumes primary responsibility for assessing training
needs, developing instructional material, and training State Agency and
regional office staff in these program areas.
Develops assessment techniques and protocols for the
evaluation and improvement of established policy by State survey
agencies, exempt States and accrediting organizations whose standards
are deemed to meet Federal requirements for clinical laboratories.
Manages mission specific contracts.
e. Center for Hospital and Community Care (FLH5)
Directs and coordinates development, measurement and
improvement of program strategies that implement, enforce, and monitor
health quality and safety standards and other health care procedures
for other than CLIA and Long Term Care providers and suppliers under
Medicare and Medicaid, e.g., Hospitals, Psychiatric Hospitals,
Ambulatory Surgical Centers, End-Stage Renal Disease Facilities, Home
Health Agencies, etc.
Develops and implements provider and supplier specific
quality indicators and outcome measures in order to improve care
provided to beneficiaries. Directs program efforts to assure the
improvement of health care delivery in all settings.
Develops and implements program strategies to improve the
quality of health care delivery through the education of the
beneficiary, public, providers, suppliers and other concerned parties
about the standards and methods for delivery of quality health care;
e.g., education about standards or care, publication of monographs,
etc.
Manages mission specific contracts.
Develops and/or evaluates program-related data, including
approaches and recommendations for improvements to program management
and operations.
Evaluates customer service and system performance data and
develops approaches for improvement.
Contributes to/participates in budget development,
direction, execution, and review.
Communicates with professional groups, consumer and
advocate groups, and standards setting organizations and serves as the
HCFA focal point for implementation of compliance, enforcement, health
quality and safety procedures relative to these providers and
suppliers.
Prepares regulation specifications and evaluates comments.
In partnership with the Bureau of Policy Development,
reviews and analyzes existing health and safety standards to determine
their initial and continued effectiveness and impact on utilization,
quality, and cost of provider and supplier services.
Prepares and implements interpretive guidelines, survey
procedures, forms, and related sections of the Regional Office, State
Medicaid and State Operations Manuals.
Through communication with the regional offices, assists
in the review of State agency performance, in these program areas, by
developing appropriate assessment techniques and protocols.
Assumes primary responsibility for assessing training
needs, developing instructional material, and training State Agency and
regional office staff in these program areas.
Develops assessment techniques and protocols for the
evaluation and improvement of established policy by State survey
agencies and accrediting organizations whose standards are deemed to
meet Federal requirements for the Medicare Programs.
Serves as HCFA liaison with other government
organizations, professional groups, and standards setting
organizations, consumer and advocate groups and beneficiaries.
Serves as the focal point for responding to regional
office, State agency, Congressional, organizational, and individual
inquiries related to the application of health and safety requirements
and certification procedures for participating providers.
Assists in the development of functional requirements and
specifications required for the design of information systems and
evaluates the effectiveness of information systems.
f. Center for Long Term Care (FLH6)
Directs and coordinates development, measurement and
improvement of program strategies that implement, enforce and monitor
health quality and safety standards and other health care procedures
for long-term care facilities under Medicare and
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Medicaid. These facilities include skilled nursing facilities/nursing
facilities (including swing beds) and intermediate care facilities for
the mentally retarded.
Develops and implements provider specific quality
indicators and outcome measures in order to improve care provided to
beneficiaries. Directs program efforts to assure the improvement of
health care delivery in all settings.
Coordinates the development of the Resident Assessment
Instrument that includes the Minimum Data Set (MDS).
Develops and implements program strategies to improve the
quality of health care delivery through the education of the
beneficiary, public, providers, suppliers and other concerned parties
about the standards and methods for delivery of quality health care.
Develops and/or evaluates program-related data, including
approaches and recommendations for improvements to program management
and operations.
Evaluates customer service and system performance data and
develops approaches for improvement.
Contributes to/participates in budget development,
direction, execution, and review.
Communicates with professional groups, consumer and
advocate groups, and standards setting organizations and serves as the
HCFA focal point for implementation of compliance, enforcement, health
quality and safety procedures relative to these facilities.
Prepares regulation specifications and evaluates comments.
In partnership with the Bureau of Policy Development,
reviews and analyzes existing standards to determine their initial and
continued effectiveness and impact on utilization, quality, and cost of
provider and supplier services.
Manages mission specific contracts.
Leads/oversees surveyor minimum qualifications testing
program.
In partnership with the Medicaid Bureau reviews and
analyses existing standards for ICFs/MR to determine their continue
effectiveness and prepares regulation specifications addressing changes
to those requirements.
Leads in the development and implementation of clinical
data information for improving the coordination of care between health
care settings.
Prepares and implements interpretive guidelines, survey
procedures, forms, and related sections of the Regional Office, State
Medicaid and State Operations Manual.
Through communication with the regional offices and the
Medicaid Bureau, assists in the review of State agency performance, in
these program areas, by developing appropriate assessment techniques
and protocols.
Assumes primary responsibility for assessing training
needs, developing instructional material, and training State Agency and
regional office staff in these program areas.
Develops assessment techniques and protocols for the
evaluation and improvement of State survey agencies and accrediting
organizations whose standards are deemed to meet Federal requirements
for the Medicare Programs.
Serves as HCFA liaison with other government
organizations, professional groups, and standards setting
organizations, consumer and advocate groups and beneficiaries.
Serves as the focal point for responding to regional
office, State agency, Congressional, organizational, and individual
inquiries related to the application of health and safety requirements
and certification procedures for participating providers.
Develops and coordinates procedures and guidelines for
implementing and evaluating inspection of care under Medicaid.
Through communications with the regional offices, develops
appropriate assessment techniques and protocols to determine the
effectiveness of Medicaid State agency performance in the area of
utilization control.
Provides the documentation and analyses necessary to
initiate and support actions on disallowances, sanctions, and
corrective action requirements, and on adjudication of appeals of
disallowances and sanctions resulting from national quality control
programs that determines the effectiveness of Medicaid State agency
performance in the area of utilization control.
Assists in the development of functional requirements and
specifications required for the design of information systems and
evaluates the effectiveness of information systems.
g. Center for Health Education and Promotion (FLH7)
Undertakes communications and quality improvement
activities to support the Medicare Peer Review and End-Stage Renal
Disease programs, and HCFA's Consumer Information Strategy.
Coordinates development and measurement of Health Care
Quality Improvement Program (HCQIP) communication strategies and
implementation approaches to promote behavior changes which result in
improved health care quality.
Serves as the HCQIP communications focal point with
internal and external customers and stakeholders including beneficiary
and provider groups, regional offices, Peer Review Organizations, ESRD
Networks, and other contractors and State entities.
Coordinates development of quality improvement
communications and information dissemination guidelines and mechanisms
and implementing instructions for HCQIP contractors.
Plans, develops; and issues operating policy,
specifications, procedural requirements, and other materials to
implement, maintain, and oversee the HCQIP communication process.
Manages mission specific contracts.
Coordinates HCFA Consumer Information Strategy.
Develops, implements and interprets data driven
performance measurement and quality improvement efforts to assess/
improve quality of care provided to Medicare beneficiaries. Areas of
concentration include prevention, consumer choice, and beneficiary
education about health care options and healthy behavior.
Coordinates and promotes participation of public and
private sector individuals, and groups within HCFA in the development
of performance measures and quality improvement strategies of mutual
benefit and interest.
Coordinates the preparation of manuals and other policy
issuances required to meet the PRO and ESRD-related instructional and
informational needs of providers, contractors, State agencies, regional
offices, Peer Review Organizations, ESRD Network organizations, managed
care organizations, Social Security Administration and other audiences
directly involved in the administration of HCFA quality improvement/
management programs.
In partnership with central and regional office staff,
coordinates and oversees systems for assessing contractor performance.
Maintains an ongoing review system, including clearance of
instructions, to ensure clarity and consistency. Identifies
instructional needs and initiates development of instructions by HCFA
components.
Maintains liaison with the regional offices, and other
internal and external HCQIP customers and stakeholders to assess needs
and satisfaction and to coordinate development of HCQIP program policy,
regulations, legislative
[[Page 43606]]
proposals and communication strategy and implementation.
Develops, implements, and interprets program policy and
guidance pertaining to the implementation of the HCQIP and other Peer
Review Organizations and End-Stage Renal Disease program statutory and
regulatory responsibilities.
Monitors legislative, regulatory and operational
developments related to the HCQIP, and coordinates development of
related regulations and legislative proposals.
Develops and/or evaluates program-related data, including
approaches and recommendations for improvements to program management
and operations.
Evaluates local project related data and develops
communication strategies and tools for improvements to program
management and operations (e.g., benchmarking and best practices.
Evaluates customer service and system performance data and
develops approaches for improvement.
Assists in the development of functional requirements and
specifications required for the design of information systems and
evaluates the effectiveness of information systems.
h. Center for Clinical Measurement and Improvement (FLH8)
Undertakes quality monitoring and improvement activities,
studies and projects to support the Medicare Peer Review and End-Stage
Renal Disease programs.
Coordinates the development and measurement of improvement
strategies and implementation approaches for the Health Care Quality
Improvement Program (HCQIP) including the development, assessment,
compilation, preparation, and dissemination of information on the
quality and efficiency of care.
Coordinates development of quality improvement project
guidelines and mechanisms and implementing instructions for HCQIP
contractors. Areas of concentration for the project process include
identifying opportunities for improvement, developing project plans,
and evaluating the effectiveness, efficiency, and appropriateness of
projects.
In partnership with central and regional office staff,
coordinates and oversees systems for assessing contractor performance.
Develops, implements, interprets, and oversees data driven
performance measurement and quality improvement efforts to assess/
improve quality of care provided to Medicare beneficiaries in all
populations. Areas of concentration include clinically-oriented
projects in the areas of managed care, acute care, ambulatory care, and
ESRD.
Collaborates with customers and stakeholders, public and
private sector individuals, and groups in the development of
performance measures and quality improvement strategies of mutual
benefit and interest.
Manages the Clinical Data Abstraction Centers and other
mission-specific contracts.
Manages the Medicare Quality Indicator System.
Maintains liaison with the regional offices, and other
internal and external HCQIP customers and stakeholders to assess needs
and satisfaction and to coordinate development of HCQIP program policy,
regulations, legislative proposals and quality measurement and
improvement plans.
Assists in the development of functional requirements and
specifications required for the design of information systems and
evaluates the effectiveness of information systems.
Develops and implements quality monitoring and improvement
studies/projects. Serves as content experts within the Bureau and
partners with other Bureaus and regional office components to ensure
full completion of all aspects of these studies/projects, including
evaluation, follow-up, communication, marketing and intervention
strategies.
Develops, implements, and interprets program policy and
guidance pertaining to the implementation of the HCQIP.
Develops and/or evaluates program-related data, including
approaches and recommendations for improvements to program management
and operations.
Evaluates customer service and system performance data and
develops approaches for improvement.
Dated: July 31, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 95-20692 Filed 8-21-95; 8:45 am]
BILLING CODE 4120-01-P