[Federal Register Volume 61, Number 25 (Tuesday, February 6, 1996)]
[Notices]
[Pages 4443-4444]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-2373]



-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration


Bureau of Program Operations, 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), (60 FR 42888, 42889, 42898, and 
42899, Aug. 17, 1995) is amended to reflect a reorganization in the 
Bureau of Program Operations (BPO).
    BPO is moving the Medicare Transaction System (MTS) functions from 
the MTS Initiative Task Force to the Office of Analysis and Systems 
(OAS). Expanding OAS's functions to include MTS is necessary because 
HCFA is transitioning to a new phase in the development of MTS. This 
phase requires a different management strategy to align the initial 
planning decisions with the organizational component that will bear 
responsibility for implementing MTS and ultimately strengthen the 
overall management of MTS.
    The specific amendments to part F are described below:
    Section F.10.D., Health Care Financing Administration, Associate 
Administrator for Operations and Resource Management (FL) 
(Organization), paragraph 4.b. is amended by adding subparagraphs (5) 
through (7). Paragraph 4.g. and all the associated subparagraphs are 
deleted in their entirety.
b. Office of Analysis and Systems (FLG1)

    (5) Medicare Transaction System Quality Assurance (FLG15)
    (6) Medicare Transaction System Development (FLG16)
    (7) Medicare Transaction System Program Planning & Needs Analysis 
(FLG17)

    Section F.20.D, Health Care Financing Administration Associate 
Administrator for Operations and Resource Management (FL) (Functions), 
paragraph 4.b. is deleted and replaced with the following new 
functional statement. In addition, paragraph 4.b. is further amended by 
adding subparagraphs (5) through (7). Paragraph 4.g. and subparagraphs 
(1) through (3) are deleted in their entirety.

b. Office of Analysis and Systems (FLG1)

     Provides requirements and specifications for the design, 
development, and maintenance of reporting and information management 
systems that generate data reflecting on Medicare program operations.
     Serves as the Agency focal point for the management and 
coordination of the Medicare Transaction System Initiative (MTSI). 
Represents HCFA to the Department, other Federal Agencies, and outside 
organizations.
     Provides direction and technical guidance for the design, 
development, implementation, verification and validation, and 
maintenance of the Medicare Transaction System (MTS) to integrate 
Medicare Part A and Part B claims processing systems.
     Identifies reporting and information needs for data 
relating to Medicare contractor operations and initiates appropriate 
action for establishing or modifying the reporting and information 
systems to satisfy these needs.
     Analyzes a broad range of information, including computer 
stored data, on operations performed in support of the Medicare 
program; prepares interpretive reports and recommendations on findings 
to internal bureau components for purposes of conducting program and 
performance evaluations.
     Provides overall support to other staff in analyzing and 
interpreting program and operational data to better understand the 
program.
     Provides requirements and specifications for the design, 
development, and management at the national level, activities required 
to enhance systems for improvement of the Medicare eligibility systems, 
Part A and Part B claims processing systems, and the Medicare program 
database.
     Provides direction and guidance to HCFA staff (central 
office and regional) on improving contractor systems.
     Prepares systems plans and develops policies for the 
design, implementation, and evaluation of shared systems and 
standardized modules for use by Medicare carriers, intermediaries, and 
hosts.
     Directs the design, development testing, and 
implementation of innovative system enhancements to the Common Working 
File (CWF) shared claims processing systems resulting in improvements 
to the national Medicare claims payment process.
     Provides requirements and specifications for the 
development, implementation, execution, and monitoring of a procedure 
to provide ongoing testing of national claims processing and 
information system to detect flaws in the operation of software, 
hardware, and related operations.
     Provides requirements and specifications for the 
development and implementation of systems that provide for the creation 
and maintenance of databases and test files that are required to 
conduct comprehensive system acceptance testing of a national claims 
processing and information system.

(5) Medicare Transaction System Quality Assurance (FLG15)

     Develops, implements, directs, and operates activities to 
assure the quality of Medicare Transaction System (MTS) development 
throughout the system development life cycle.
     Provides technical management, oversight, coordination and 
day-to-day monitoring of contract(s) for the independent verification 
and validation of MTS analysis, design, development, validation, 
implementation, and maintenance activities.
     Reviews and evaluates the effectiveness of the processes 
and procedures used to analyze, design, develop, implement, and 
maintain the MTS.
     Provides the documentation and analysis necessary to 
initiate and support corrective action resulting from findings of the 
MTS quality assurance activities.
     Reviews and evaluates quality assurance programs 
maintained by the MTS design contractor, the independent verification 
and validation contractor and HCFA to ensure integration of quality 
assurance activities throughout the MTS development process.
     Recommends alternatives to proposed methodologies for the 
analysis, design, development, validation, implementation and 
maintenance of the MTS.

(6) Medicare Transaction System Development (FLG16)

     Develops, implements, and directs activities to assure the 
development of the Medicare Transaction System (MTS) throughout the 
system development life cycle.
     Provides technical management, oversight and coordination 
and day-to-day monitoring of the contract(s) for performing the 
Medicare Transaction System (MTS) analysis, design, development, 
validation, implementation, and maintenance activities.
     Provides the inter- and intra-component coordination 
required to insure appropriate and timely review 

[[Page 4444]]
and dissemination of the contract work products and other pertinent 
information.
     Reviews and evaluates the effectiveness of the processes 
and procedures used to coordinate and facilitate the review of the 
contract work products.
     Develops, conducts, and coordinates modifications to 
existing operational procedures, contracts, reporting mechanisms and 
related materials as required.
     Provides the documentation and analysis necessary to 
initiate and support corrective action resulting from the findings of 
the MTS development activities.

(7) Medicare Transaction System Program Planning and Needs Analysis 
(FLG17)

     Recommends alternatives to existing requirements, 
operational priorities, processes, procedures, and methods for 
improvement which will enhance the quality and cost-effectiveness of 
Medicare operational and administrative procedures and meet the needs 
of HCFA's internal and external customers.
     Develops, implements, and directs project planning, 
control and administration procedures, processes, and methods used to 
determine Medicare Transaction System Initiative (MTSI) program status, 
assess performance, report progress, and implement changes.
     Maintains the MTSI program schedule and MTSI program 
management plan and various program management databases.
     Provides advisory and consultative services on project 
planning to HCFA central and regional office staff and key officials 
responsible for planning and implementing projects in support of the 
development and implementation of the Medicare Transaction System.
     Conducts project planning training to HCFA staff 
responsible for MTSI projects.

    Dated: December 21, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 96-2373 Filed 2-5-96; 8:45 am]
BILLING CODE 4120-01-P