[Federal Register Volume 70, Number 102 (Friday, May 27, 2005)]
[Notices]
[Pages 30735-30738]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-10262]
-----------------------------------------------------------------------
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. 68, No.
34, pp. 8297-8299, dated February 20, 2003) is amended to reflect
changes to the organizational structure of CMS. The changes include:
(1) Renaming the Public Affairs Office to the Office of External
Affairs, (2) restructuring the Center for Beneficiary Choices to
implement Titles I and II of the Medicare Prescription Drug,
Improvement and Modernization Act of 2003, (3) realigning functions of
the Center for Medicaid and State Operations, (4) renaming the Office
of Health Insurance Portability and Accountability Acts Standards to
the Office of E-Health Standards and Services, and (5) establishing the
Office of Acquisition and Grants Management.
The specific amendments to Part F. are described below:
Section F.10. (Organization) is amended to read 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. Office of Operations Management (FAY).
11. Office of Information Services (FBB).
12. Office of Financial Management (FBC).
13. Office of Strategic Operations and Regulatory Affairs (FGA).
14. Office of E-Health Standards and Services (FHA).
15. Office of Acquisition and Grants Management (FKA).
Section F. 20. (Functions) is amended by deleting the
functional statements in their entirety for the Public Affairs Office,
the Center for Beneficiary Choices, the Office of Health Insurance
Portability and Accountability Act Standards, and the Center for
Medicaid and State Operations. The new functional statements for the
Office of External Affairs, Center for Beneficiary Choices, Center for
Medicaid and State Operations, Office of E-Health Standards and
Services, and the Office of Acquisition and Grants Management read as
follows:
1. Office of External Affairs (FAC)
Serves as the focal point for the Agency to the news media
and provides leadership for the Agency in the area of
[[Page 30736]]
intergovernmental affairs. Advises the Administrator and other Agency
components in all activities related to the media and on matters that
affect other units and levels of government.
Coordinates CMS activities with the Office of the
Assistant Secretary for Public Affairs and the Secretary's
intergovernmental affairs officials.
Serves as senior counsel to the Administrator in all
activities related to the media. Provides consultation, advice, and
training to the Agency's senior staff with respect to relations with
the news media.
Develops and executes strategies to further the Agency's
relationship and dealings with the media. Maintains a broad based
knowledge of the Agency's structure, responsibilities, mission, goals,
programs, and initiatives in order to provide or arrange for rapid and
accurate response to news media needs.
Prepares and edits appropriate materials about the Agency,
its policies, actions and findings, and provides them to the public
through the print and broadcast media. Develops and directs media
relations strategies for the Agency.
Responds to inquiries from a broad variety of news media,
including major newspapers, national television and radio networks,
national news magazines, local newspapers and radio and television
stations, publications directed toward the Agency's beneficiary
populations, and newsletters serving the health care industry.
Manages press inquiries, coordinates sensitive press
issues, and develops policies and procedures for how press and media
inquiries are handled.
Arranges formal interviews for journalists with the
Agency's Administrator or other appropriate senior Agency staff;
identifies for interviewees the issues to be addressed, and prepares or
obtains background materials as needed.
For significant Agency initiatives, issues media
advisories and arranges press conferences as appropriate; coordinates
material and personnel as necessary.
Serves as liaison with the Department of Health and Human
Services and White House press offices.
Serves as focal point for all Agency interactions with
Native American and Alaskan Native tribes.
Coordinates State program issues/concerns (i.e., waiver
reviews, Medigap, Medicare-Select, survey and certification, Clinical
Laboratory Improvement Act (CLIA), tribal affairs) with program staff
and regional offices.
Serves as coordinator of State health care policy and as
liaison between CMS and State and local officials, and individual
lobbyists representing State and local officials and advocate groups.
Serves as coordinator of tribal affairs issues and liaison
between CMS and State and local officials representing tribal affairs
groups.
Responsible for handling highly sensitive and complex
correspondence from and to State and local elected officials. Reviews
proposed regulations affecting States.
Coordinates roll-out of waivers or other significant
announcements relating to States.
Manages CMS activities to better hear and interact with
those beneficiaries, providers, and other stakeholders interested in
the delivery of quality healthcare for our nation's seniors and
beneficiaries with disabilities. Leads and coordinates an ongoing
series of `Open Door Forums' that provide a dialogue about both the
many individual service areas and beneficiary needs within CMS.
Manages and coordinates the Physicians Regulatory Issues
Team (PRIT) consisting of CMS subject matter experts who work to reduce
the regulatory burden on physicians who participate with the Medicare
program.
Manages and operates CMS' video production studio and
satellite network to include product activities, design, development,
installation, and monitoring of technological aspects of video
broadcast and projection systems, and the development of policies and
procedures for production operations.
Administers CMS' identity and branding programs, develops
related communication policies, standards and procedures, and oversees,
executes and evaluates communication strategies.
Represents the Administrator and senior executive staff in
speaking engagements with Physician and Provider groups on the Agency's
expectations regarding ongoing patient care. Serves as an Agency
liaison with physician and provider groups on the development and
implementation of evaluation management guidelines.
In cooperation with senior executive staff, oversees and
implements an outreach strategy to physicians and other provider
organizations in order to educate them regarding the various options
available under the Medicare program and how to discuss those options
with patients.
2. 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 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.
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.
Oversees the development of privacy and confidentiality
policies pertaining to the collection, use, and release of individually
identifiable data.
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
[[Page 30737]]
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.
9. Center for Medicaid and State Operations (FAS)
Serves as the focal point for all Centers for Medicare &
Medicaid Services activities relating to Medicaid, the State Children's
Health Insurance Program, the Clinical Laboratory Improvement Act
(CLIA), the survey and certification of health facilities and all
interactions with States and local governments (including the
Territories).
Develops national Medicaid 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.
Develops, 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 and regional offices.
In coordination with other components, develops,
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. Develops, implements and supports the data
collection and analysis systems needed by States to administer the
certification program.
Reviews, approves and conducts oversight of Medicaid
managed care waiver programs. Provides assistance to States and
external customers on all Medicaid managed care issues.
Develops national policies and procedures on Medicaid
automated claims/encounter processing and information retrieval systems
such as the Medicaid Management Information System (MMIS) and
integrated eligibility determination systems.
In coordination with the Office of Financial Management
(OFM), directs, coordinates, and monitors program integrity efforts and
activities by States and regions. Works with OFM to provide input in
the development of program integrity policy.
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.
Directs the planning, coordination, and implementation of
the survey, certification, and enforcement programs for all Medicare
and Medicaid providers and suppliers, and for laboratories under the
auspices of the CLIA. Reviews and approves applications by States for
``exemption'' from CLIA and applications from private accreditation
organizations for deeming authority. Develops assessment techniques and
protocols for periodically evaluating the performance of these
entities. Monitors the performance of proficiency testing programs
under the auspices of CLIA.
14. 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
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
[[Page 30738]]
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.
15. Office of Acquisition and Grants Management (FKA)
Serves as the Agency's Head of the Contracting Activity.
Plans, organizes, coordinates and manages the activities required to
maintain an agency-wide acquisition program.
Serves as the Agency's Grants Management Office, with
responsibility for all CMS discretionary grants.
Ensures the effective management of the Agency's
acquisition and grant resources.
Serves as the lead for developing and overseeing the
Agency's acquisition planning efforts.
Develops policy and procedures for use by acquisition
staff and internal CMS staff necessary to maintain efficient and
effective acquisition and grant programs.
Advises and assists the Administrator, senior staff, and
Agency components on acquisition and grant related issues.
Plans, develops, and interprets comprehensive policies,
procedures, regulations, and directives for CMS acquisition functions.
Represents CMS at departmental acquisition and grant
forums and functions, such as the Executive Council on Acquisition and
the Executive Council for Grants Administration Policy.
Serves as the CMS contact point with HHS and other Federal
agencies relative to grant and cooperative agreement policy matters.
Coordinates and/or conducts training for contracts and
grant personnel, as well as project officers in CMS components.
Develops agency-specific procurement guidelines for the
utilization of small and disadvantaged business concerns in achieving
an equitable percentage of CMS' contracting requirements.
Provides cost/price analyses and evaluations required for
the review, negotiation, award, administration, and closeout of grants
and contracts. Provides support for field audit capability during the
pre-award and closeout phases of contract and grant activities.
Develops and maintains an automated procurement management
system. Manages procurement information activities (i.e., collecting,
reporting, and analyzing procurement data).
Dated: April 28, 2005.
Karen Pellham O'Steen,
Director, Office of Operations Management, Centers for Medicare &
Medicaid Services.
[FR Doc. 05-10262 Filed 5-26-05; 8:45 am]
BILLING CODE 4120-01-P