[Federal Register Volume 59, Number 51 (Wednesday, March 16, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-6008]


[[Page Unknown]]

[Federal Register: March 16, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration

 

Statement of Organization, Functions, and Delegations of 
Authority

Reorganization of the Health Care Financing Administration

    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) (49 FR 3547, September 6, 1984, as 
amended most recently at 58 FR 42079, August 6, 1993) is amended to 
reflect a major reorganization of HCFA. The Administration's 
``reinventing government'' initiative has been considered in developing 
this reorganization. In addition, the reorganization is also designed 
to improve the efficiency of HCFA's total operation and to provide 
increased responsiveness to the needs of the Administration, 
beneficiaries, the States, and the health care industry.
    The specific amendments to Part F are:
     Section F.10., Health Care Financing Administration 
(Organization) is amended to read as follows:

Section F.10., Health Care Financing Administration (Organization)

    The Health Care Financing Administration (HCFA) is an Operating 
Division of the Department. It is headed by an Administrator, HCFA, who 
is appointed by the President and reports to the Secretary. It consists 
of the following organizational elements:

A. Office of the Administrator (FA).
    1. Provider Reimbursement Review Board (FA-1).
    2. Equal Employment Opportunity Staff (FA-3).
    3. Executive Secretariat (FA-4).
    4. Office of Legislative and Inter-Governmental Affairs (FAA).
    5. Medicaid Bureau (FAB).
    6. Office of Managed Care (FAC).
B. Office of the Associate Administrator for Customer Relations and 
Communications (FF).
    1. Office of Beneficiary Services (FFA).
    2. Office of Public Affairs (FFB).
    3. Office of Public Liaison (FFC).
C. Office of the Associate Administrator for Policy (FK).
    1. Special Analysis Staff (FK-1).
    2. Bureau of Policy Development (FKA).
    3. Office of Research and Demonstrations (FKB).
    4. Office of the Actuary (FKC).
D. Office of the Associate Administrator for Operations and Resource 
Management (FL).
    1. Office of the Attorney Advisor (FL-1).
    2. Office of Financial & Human Resources (FLA).
    3. Bureau of Program Operations (FLB).
    4. Bureau of Data Management and Strategy (FLC).
    5. Office of the Regional Administrators (FLD(1-X)).
    6. Health Standards and Quality Bureau (FLE).

     Section F.20., Health Care Financing Administration 
(Functions) is amended by deleting the statement in its entirety and 
replacing it with the following statements. The statements that follow 
provide the organizational structure of the Health Care Financing 
Administration to the Bureau and Primary Office level. The remainder of 
the organizational substructure will be published at a later date. The 
new HCFA organizational structure is described as follows:

A. Office of the Administrator (FA)

    The Administrator, Health Care Financing Administration, directs 
the planning, coordination and implementation of the programs under 
titles XI, VIII, and XIX of the Social Security Act, and related 
statutes, as amended, and directs the development of effective 
relationships between these programs and private and federally 
supported health-related programs. The Administrator works with the 
States, other Federal agencies and other concerned nongovernmental 
organizations in administering health care financing programs.

1. Provider Reimbursement Review Board (FA-1)

    The Provider Reimbursement Review Board (Board) is organizationally 
assigned to the HCFA for administrative support. The Board, after 
determining that it has jurisdiction, conducts hearings to resolve 
disputes on cost and prospective payment submitted by Medicare 
providers under Section 1878 of the Social Security Act. Upon the 
completion of these hearings, the Board renders impartial decisions on 
these appeals. This is the initial step in the judicial review process. 
Provides staff support to the Medicare Geographic Classification Review 
Board (MGCRB) and conducts Medicare and Medicaid hearings on behalf of 
the Secretary or the Administrator that are not within the jurisdiction 
of the Department Appeals Board, the Social Security Administrations' 
Office of Hearings and Appeals, or the States.

2. Equal Employment Opportunity Staff (FA-3)

    Provides principal advisory services to the Administrator 
concerning equal employment opportunity (EEO) and civil rights policies 
and programs. Develops EEO and voluntary civil rights compliance policy 
for HCFA and assesses the Agency's compliance with applicable equal 
opportunity statutes, executive orders, regulations and policies. 
Identifies policy and operational issues and proposes solutions for 
resolving these issues. Serves as the central liaison point with the 
Department on EEO and civil rights issues. Coordinates the development 
of HCFA affirmative EEO plans and evaluates their implementation by 
HCFA components. Promotes EEO special emphasis programs and activities 
affecting the concerns of minority groups, women and individuals with 
disabilities. Provides for conciliation and adjudication of informal 
and formal discrimination complaints by means of EEO counseling, formal 
hearings, issuance of final decisions, etc. Manages, coordinates and 
monitors HCFA's equal employment opportunity activities working 
directly with bureau and office personnel.

3. Executive Secretariat (FA-4)

    Assists the HCFA Administrator in the resolution of agency program 
and administrative policy matters through memoranda, actions documents, 
or correspondence. Monitors HCFA performance in developing necessary 
documents for the Administrator's review. Manages the clearance system 
and reviews documents for consistency with the Administrator's and 
Secretary's assignments, previous decisions on related matters, and 
editorial standards. Facilitates the resolution of issues connected 
with matters forwarded to the Administrator. Operates the agency-wide 
correspondence tracking and control system, and provides guidance and 
technical assistance on standards for content of correspondence and 
memoranda. Serves as a primary focal point for liaison with the 
Executive Secretariat in the Office of the Secretary on HCFA 
correspondence and special administrative matters.

4. Office of Legislative and Inter-Governmental Affairs (FAA)

    The Office of Legislative and Inter-Governmental Affairs provides 
leadership and executive direction within HCFA for legislative planning 
and congressional and intergovernmental affairs. Develops and evaluates 
recommendations concerning legislative proposals for changes in health 
care financing. Develops the long-range HCFA legislative plans. 
Coordinates activities with the Office of the Assistant Secretary for 
Legislation (ASL) and serves as the ASL's principal contact point on 
legislative and congressional relations, and intergovernmental affairs. 
Manages HCFA involvement in congressional hearings. Provides technical, 
analytical, and advisory services to HCFA components, to the 
Department, to other elements of the Executive Branch, and other 
government agencies interested in health care financing legislation, 
congressional relations, and intergovernmental affairs. In conjunction 
with the ASL, provides information services to congressional 
committees, individual Congressmen, and private organizations on health 
care financing legislation. Provides leadership for HCFA in the area of 
intergovernmental affairs. Advises the Administrator on program matters 
which affect other units and levels of government. In coordination with 
the Department's Inter-Governmental Affairs office, the Regional 
Directors, and other HCFA offices, meets with key State and local 
officials in order to strengthen HCFA's relationships with other 
governmental jurisdictions and to resolve sensitive intergovernmental 
problems and issues. Reviews and consults with State and local 
officials regarding proposed HCFA policy and operational issuances. 
Assists States and localities in requesting and obtaining technical 
materials, assistance, and support for appropriate HCFA components. 
Upon State requests, coordinates the exchange of HCFA staff with State 
and local agencies. Develops and provides briefings on 
intergovernmental affairs issues for HCFA staff. Briefs State and local 
agencies on HCFA's mission, organization, and functions.

5. Medicaid Bureau (FAB)

    Directs the planning, coordination, and implementation of the 
Medicaid program under title XIX of the Social Security Act and related 
statutes, as amended, except for Medicaid managed health care. 
Formulates, evaluates, and prepares policies, specifications for 
regulations, instructions, preprints and procedures related to Medicaid 
eligibility, coverage, and payment activities; makes recommendations 
for legislative changes; and, reviews State plan amendments and make 
recommendations on approvals/disapprovals. Oversees, coordinates, 
processes and assesses the operation of State Medicaid Home and 
Community-Based Services Waivers. Administers the State grants process 
for administrative and program payments, including budget preparation 
by States. Provides Medicaid payment policy for administrative costs, 
availability of Federal Financial Participation (FFP) and designation 
of appropriate FFP rates. Develops and monitors planning, development 
and implementation of Medicaid program operations in regional offices 
and State Medicaid agencies. Develops and promulgates policies and 
procedures for the proper maintenance, review, and approval of State 
plans and their amendments. Monitors State compliance with State plan 
and oversees the compliance process. Develops requirements, standards, 
procedures, guidelines, and methodologies pertaining to the review and 
evaluation of State agencies' automated systems. Develops, operates, 
and manages a program for the performance evaluation of Medicaid State 
agencies and fiscal agents. Implements Medicaid maternal and infant 
health initiative and the Early and Periodic Screening, Diagnostic, and 
Treatment program through coordination of HCFA resources and activities 
with those of the Public Health Service and other national 
organizations, monitoring program performance, effective interagency 
and interprogram liaison, guidance, and technical assistance. Provides 
technical assistance to States, regional offices, and other interested 
groups in all special Medicaid initiatives. Coordinates with HCFA's 
Office of Legislative and Inter-Governmental Affairs on all issues that 
affect States. Coordinates with the Office of Research and 
Demonstrations HCFA review and management of State waiver requests and 
projects.

6. Office of Managed Care (FAC)

    Provides national direction and executive leadership for managed 
health care operations, including health maintenance organizations 
(HMOs), prepaid health plans (PHPs), primary care case management 
programs, competitive medical plans (CMPs), and other capitated health 
organizations. Serves as the departmental focal point in the areas of 
managed health care plan qualification, including quality assurance, 
ongoing regulation, State and employer compliance efforts, Medicare and 
Medicaid HMO, Medicare CMP contracting and Medicaid freedom of choice 
waivers. Develops national managed care policies and objectives for the 
development, qualification, and ongoing compliance of HMOs and CMPs. 
Plans, coordinates, and directs the development and preparation of 
related legislative proposals, regulatory proposals, and policy 
documents. Formulates, evaluates, and prepares policies, specifications 
for regulations, instructions, preprints, and procedures related to 
managed health care. Makes recommendations for legislative changes to 
improve managed health care program policy.

B. Office of the Associate Administrator for Customer Relations and 
Communications (FF)

    The Associate Administrator for Customer Relations and 
Communications is responsible for the effective direction and 
implementation of HCFA policies, rules, and procedures in the areas of: 
advising the Administrator, HCFA, and HCFA components concerning the 
services, requirements, and initiatives relating to HCFA beneficiaries; 
liaison with external medical, dental, and allied health practitioners, 
institutional providers of health services, and academic institutions 
responsible for the education of health care professionals; and 
directing the public affairs activities of HCFA.

1. Office of Beneficiary Services (FFA)

    Provides advisory services to the Associate Administrator for 
Customer Relations and Communications and HCFA components concerning 
the services for, needs of, and initiatives relating to HCFA 
beneficiaries. Promotes an awareness of the concerns of children, the 
elderly, and needy among the HCFA components responsible for developing 
program policies, regulations, and legislative proposals. Analyzes the 
impact of proposed HCFA policies, regulations, and instructions on 
beneficiaries. Maintains close working relationships with HCFA central 
and regional components, the Social Security Administration District 
Offices, the Public Health Service, other Federal agencies, State 
agencies, and beneficiary consumer groups to identify and assess the 
need for information, benefits and services; the impact of proposed 
HCFA actions; and the effects that operating systems and programs have 
on the health care system programs and current and future 
beneficiaries. Presents the overall HCFA mission and promotes its 
acceptance by beneficiaries and representatives of the constituent 
organizations. Participates with other HCFA components in the 
development and implementation of program objectives and strategies 
pertaining to beneficiary services. Through direct contact with 
children, the elderly, the needy and/or their representative groups 
determines their understanding of HCFA's programs and services and 
conveys this information to HCFA components. Responds to beneficiary 
referrals concerning accessing and utilizing the Agency's health care 
financing programs. Plans, directs, and coordinates the production of 
radio, television, and film products, and the preparation of general-
purpose publications. Reviews and clears all print, audiovisual, and 
exhibit plans and material intended for external dissemination and 
serves as clearance liaison with the Office of the Secretary, Office of 
the Assistant Secretary for Public Affairs.

2. Office of Public Affairs (FFB)

    Plans, directs and coordinates the public affairs activities of 
HCFA including: Speech writing, public appearances, Administrator's 
meetings, special Associate Administrator for Customer Relations and 
Communications (AACR&C) projects as well as conducting evaluations and 
analyses. Provides advice and counsel from a public affairs perspective 
to the AACR&C and all HCFA components. Administers the Freedom of 
Information Act and Privacy Act responsibilities for HCFA.

3. Office of Public Liaison (FFC)

    Directs and implements HCFA policies, rules, and procedures in the 
areas of liaison with external medical, dental, and allied health 
practitioners, institutional providers of health services, and business 
and academic institutions responsible for the education of health care 
professionals. Also, plans, directs and coordinates media relations.

C. Office of the Associate Administrator for Policy (FK)

    The Associate Administrator for Policy is responsible for the 
effective direction and implementation of the development and review of 
policies and regulations pertaining to all HCFA programs including 
HCFA's research and demonstrations activities. Conducts research and 
develops legislative proposals designed to make improvements in the 
health care delivery system and develops the technical specifications 
for such legislation. Performs actuarial, economic and demographic 
studies to predict HCFA program expenditures under current law and 
under proposed modifications to current law.

1. Special Analysis Staff (FK-1)

    Conducts legislative, economic and policy analyses related to the 
private health insurance industry and the overall structure of health 
care financing and reform. Analyzes and reviews current literature 
regarding the state of the Nation's health policy in order to develop 
national trend analyses for future HCFA program directions. Plans and 
develops future HCFA program policy in order to assist in the 
development of legislative strategies that will enhance the 
Department's legislative program. Coordinates policy development and 
research relating to legislative proposals designed to reform and make 
improvements in the health care delivery system including the technical 
specifications for such legislation.

2. Bureau of Policy Development (FKA)

    Establishes national program policy on all issues of Medicare 
payment including provider payment policy, provider accounting and 
audit policy, and physician and medical services payment policy. 
Develops, evaluates, and reviews national policies and standards 
concerning the coverage and utilization effectiveness of items and 
services under the Medicare program provided by hospitals, long-term 
care facilities, hospices, End Stage Renal Disease facilities, home 
health agencies, alternative health care organizations, comprehensive 
outpatient rehabilitation facilities, physicians, health practitioners, 
clinics, laboratories, and other health care providers and suppliers. 
Serves as the principal organization within HCFA for evaluating the 
medical aspects of Medicare coverage issues and for developing provider 
conditions of participation. Develops, evaluates, and reviews national 
Medicare and Medicaid coverage issues concerning reasonableness and 
necessity for medical and related services. Develops, interprets, and 
evaluates program policies pertaining to Medicare eligibility, Medicare 
secondary payer policies and other technical issues. Develops 
regulations for the Medicare and Medicaid programs. Manages the HCFA 
system for developing regulations, setting regulations priorities, and 
corresponding work agenda. In cooperation with the Office of the 
General Counsel, coordinates litigation affecting the Medicare program.

3. Office of Research and Demonstrations (FKB)

    Provides leadership and executive direction within HCFA for a wide 
range of health care financing research and demonstration activities. 
Develops, tests and evaluates new payment methods, coverage policies 
and delivery mechanisms in Medicare, Medicaid and other health care 
programs. Has primary responsibility for managing HCFA's Medicare and 
Medicaid demonstration waiver authorities including the Federal review, 
approval, and oversight of State health reform waivers. Develops new 
and innovative ways to reform the quality, efficiency, and cost 
effectiveness of Federal, State and private health care financing 
programs. Works closely with the Associate Administrator for Policy, 
other Bureau/Office Directors, and high level staff outside HCFA to 
insure that the Agency's objectives and long range planning in these 
areas are accomplished. Participates with departmental components in a 
wide range of experimental health care delivery projects. Performs 
claims adjudication, payment, and data collection for demonstration 
projects. Undertakes research to facilitate informed program and policy 
decisions designed to make improvements in the health care delivery 
system.

4. Office of the Actuary (FKC)

    Conducts and directs the actuarial program for HCFA and directs the 
development of and methodologies for macroeconomic analysis of health 
care financing issues. Performs actuarial, economic and demographic 
studies to predict HCFA program expenditures under current law and 
under proposed modifications to current law. Provides program estimates 
for use in the President's budget and for reports required by Congress. 
Studies questions concerned with financing present and future health 
programs, evaluates operations of the Federal Hospital Insurance Trust 
Fund and Supplementary Medical Insurance Trust Fund and performs 
macroanalyses for the purpose of assessing the impact of various health 
care financing factors upon the costs of Federal programs. Develops and 
conducts studies to estimate and project national and area health 
expenditures. Analyzes trend data sources such as the Consumer Price 
Index to develop projections of health care costs. Analyzes data on 
physicians' costs and charges to develop payment indices and monitors 
expansion of service and inflation of costs in the health care sector. 
Publishes cost projections and economic analyses, and provides 
actuarial, technical advice and consultation to HCFA components, 
governmental components, Congress and outside organizations.

D. Office of the Associate Administrator for Operations and Resource 
Management (FL)

    The Associate Administrator for Operations and Resource Management 
(AAORM) is responsible for the effective direction, coordination and 
implementation of all aspects of headquarters and regional program 
operations and resource management activities. The program operational 
functions include the Medicare financial management systems; the 
development, negotiation, execution and management of contracts with 
Medicare contractors; enforcement of health quality and safety 
standards for providers and suppliers of health care services; the 
administration of professional review and other medical review 
programs; the evaluation of contractors and State agencies against 
performance standards; and the statistically based quality control 
programs which measure the financial integrity of Medicare. The 10 
Regional Administrators report to the AAORM through the Deputy 
Associate Administrator for Operations and Resource Management. The 
resource management responsibilities include developing and 
implementing HCFA's policies, rules and procedures in the areas of 
financial, personnel and contracts management, project grant 
administration, management evaluation and analysis and administrative 
services; the nationwide operation of a centralized Automated Data 
Processing (ADP) and telecommunications facility; establishing and 
maintaining computerized records supporting HCFA programs; developing 
and coordinating information and statistical plans and policies; and 
maintaining a statistical data system which will provide program 
accountability data to the Administrator, HCFA, Congress, and the 
public.

1. Office of the Attorney Advisor (FL-1)

    The Office of the Attorney Advisor is attached to AAORM for 
administrative issues but continues to report to the Administrator, 
HCFA, for substantive issues. The Supervisory Attorney Advisor 
recommends initiation of ``own motion review'' of Provider 
Reimbursement Review Board decisions and of Medicare Geographical 
Classification Review Board (MGCRB) decisions. Evaluates cases under 
``own motion review'' and recommends the disposition of such cases by 
the Administrator. Evaluates and makes recommendations for disposition 
of MGCRB decisions appealed to the Administrator.

2. Office of Financial and Human Resources (FLA)

    Provides HCFA-wide policy direction, coordination and control in 
the areas of budget, financial and accounting operations, personnel, 
management evaluation and analysis, administrative services, project 
grants, contracting and procurement, audit resolution, and 
workplanning. Develops and promulgates HCFA policy in these areas and 
executes these policies throughout HCFA; also assures consistency with 
departmental policy. Designs systems support for personnel management, 
financial management, procurement, and facilities management programs 
within HCFA. The Director serves as the Chief Financial Officer and the 
Deputy Ethics Counselor for the Agency.

3. Bureau of Program Operations (FLB)

    Provides direction and technical guidance for the nationwide 
administration of the Medicare health care financing programs. 
Develops, negotiates, executes, and manages contracts with Medicare 
contractors. Manages the Medicare financial management system and 
national budgets for Medicare contractors. Establishes national 
policies and procedures for the procurement of claims processing and 
related services from the private sector. Defines the relative 
responsibilities of all parties in the health care financing operations 
and designs the operational systems which link these parties. Directs 
the establishment of standards of performance for contractors. Compiles 
operational and performance data for recurring and special reports to 
reflect status and trends in program operations effectiveness. Prepares 
recommendations regarding terminations, awards, penalties, non-
renewals, or other appropriate contract actions. Establishes national 
policy and procedures for the recovery of overpayments. Directs the 
processing of Part A beneficiary appeals and issues instructions and 
guidance for resolving beneficiary overpayments. Following coordination 
with pertinent HCFA components, notifies carriers and fiscal 
intermediaries of findings resulting from quality control programs.
    Makes recommendations to the Associate Administrator for Operations 
and Resource Management regarding financial penalties authorized and 
determined appropriate under regulations. Assists Medicare contractors 
in improving the management of Federally required quality control 
programs. Identifies significant trends and priority problems through 
comprehensive analyses and program operations and performance and 
evaluates findings surfaced through various assessment programs. 
Develops and conducts comprehensive analyses and studies of selected 
areas of policy and operations to evaluate the appropriateness, cost 
effectiveness, or other impact resulting from the implementation of 
law, regulations, policies or operational procedures and systems. 
Develops recommendations for specific policy or operational 
improvements based on assessment findings. Coordinates, monitors, and 
evaluates all corrective action initiatives resulting from program 
assessment findings. Develops programwide policies, regulations, 
procedures, guidelines, and studies dealing with program oversight and 
improvement. Coordinates the preparation of manuals and other policy 
issuances required to meet the instructional and informational needs of 
providers, contractors, State Agencies, Regional Offices, Peer Review 
Organizations, the Social Security Administration, and other audiences 
directly involved in the administration of HCFA programs.

4. Bureau of Data Management and Strategy (FLC)

    Serves as the focal point for the management of HCFA's information 
resources. Provides Agency-wide information management, decision 
support, automated data processing (ADP), and data communication 
services essential to the management and administration of HCFA 
programs. Provides technical information planning and developmental 
review of HCFA data collection initiatives. Collects, analyzes, and 
disseminates data on beneficiary eligibility, enrollment entitlement, 
and medical utilization. Collects and maintains data on Medicare 
contractor claims processing workloads and maintains contractor quality 
assurance and performance evaluation systems. Manages statistical data 
systems on HCFA programs to support policy and program decisions. 
Coordinates the development of special purpose statistical data bases 
and tabulations required for assessing (1) the impact of proposals 
which change health care financing programs, (2) the characteristics of 
HCFA beneficiaries and (3) the utilization and cost of program 
benefits. Provides applications software support to HCFA headquarters 
and Regional Offices in administrative/program management systems.
    The Director serves as HCFA's Principal Information and Resource 
Management (IRM) Official and is responsible for overseeing the 
Agency's IRM programs including those of the Medicare contractors, Peer 
Review Organizations, and End Stage Renal Disease Networks. Directs the 
HCFA ADP systems security program including its application to Medicare 
contractors. Develops common coding standards and quality assurance 
monitoring mechanisms. Negotiates and administers agreements and 
provides ADP liaison between HCFA users and other external 
organizations for the provisions of ADP capacity and support services. 
Provides support and data handling capability to control/examine, 
audit, investigate, and process/release a variety of provider billing, 
query, enrollment, and premium billing correspondence and transactions.

5. Office of the Regional Administrators (FLD (I-X))

    The Office of the Regional Administrator manages regional operation 
in each of the Health Care Financing Administration's 10 regions. The 
Regional Administrators provide executive leadership and guidance on 
behalf of the Associate Administrator for Operations and Resource 
Management to HCFA components at the regional level. Implements 
national policy at the regional level. Assures the effective 
administration of HCFA programs including Medicare, Medicaid, Peer 
Review Organizations (PROs), HMOs/CMPs, quality control, and 
certification of institutional providers in a major geographical area. 
Participates in the formulation of new policy and recommends changes in 
existing national policy for HCFA programs. Develops and implements a 
professional relations program within the region for all HCFA programs 
and serves as the principal HCFA contact for all professional 
organizations such as hospital and medical associations. At the 
regional level, takes action to implement HCFA national initiatives 
undertaken to integrate HCFA program operations and is responsible for 
coordination of HCFA programs with other departmental components and 
Federal agencies. Coordinates with the Department's Regional Director 
to assure effective relationships with State and local governments. 
Manages all administrative activities for HCFA components and 
coordinates such activities with the Regional Administrative Support 
Center. Initiates and directs the implementation of special regional 
and headquarters projects affecting HCFA programs. Directs regional 
responsibilities relating to experimental and demonstration projects. 
Oversees a beneficiary services program within the region for HCFA 
programs. Provides regional perspective to the Administrator, Associate 
Administrators, Bureau Directors, and Staff Office Directors in the 
development of HCFA policies, programs and objectives.

6. Health Standards and Quality Bureau (FLE)

    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 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.

    Dated: March 8, 1994.
Donna E. Shalala,
Secretary, Department of Health and Human Services.
[FR Doc. 94-6008 Filed 3-15-94; 8:45 am]
BILLING CODE 4120-01-M