[Federal Register Volume 66, Number 177 (Wednesday, September 12, 2001)]
[Notices]
[Pages 47497-47499]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-22821]


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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. 62, No. 
85, pp. 24120-24126 dated Friday, May 2, 1997) is amended to reflect 
changes to the organizational structure of CMS by replacing the Center 
for Beneficiary Services and the Center for Health Plans and Providers 
with the Center for Beneficiary Choices and the Center for Medicare 
Management. Also, it transfers managed care audit responsibility from 
the Office of Financial Management to the Center for Beneficiary 
Choices, and

[[Page 47498]]

also transfers the Quality Measurement and Health Assessment Group from 
the Office of Clinical Standards and Quality to the Center for 
Beneficiary Choices.
    The specific amendments to part F are described below:
     Section F.10. (Organization) is amended to read as 
follows:

1. Press Office (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 Strategic Planning (FAK)
7. Office of Communications and Operations Support (FAL)
8. Office of Clinical Standards and Quality (FAM)
9. Office of the Actuary (FAN)
10. Center for Medicaid and State Operations (FAS)
11. Northeastern Consortium (FAU)
12. Southern Consortium (FAV)
13. Midwestern Consortium (FAW)
14. Western Consortium (FAX)
15. Office of Internal Customer Support (FBA)
16. Office of Information Services (FBB)
17. Office of Financial Management (FBC)

     Section F.20. (Functions) is amended by deleting the 
functional statements in their entirety for the Center for Beneficiary 
Services, Center for Health Plans and Providers, and the Quality 
Measurement and Health Assessment Group within the Office of Clinical 
Standards and Quality. The new functional statements read as follows:

2. Center for Beneficiary Choices (FAE)

     Serves 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 beneficiary 
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, and 
C beneficiary eligibility, enrollment, and entitlement; rights and 
protections; dispute resolution process; as well as policy for managed 
care enrollment and disenrollment to ensure 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.
     Ensures that, 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 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 ensure 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 
ensure appropriate focus on long-term care, where applicable, and 
assumes responsibility for the operational and demonstration efforts 
related to the payment aspects of long-term care and post-acute care 
services.
     Designs and conducts payment, purchasing, and benefits 
demonstrations.

4. Center for Medicare Management (FAH)

     Serves as the focal point for all Agency interactions with 
health care providers, intermediaries, and carriers for issues relating 
to Agency fee-for-service (FFS) policies and operations.
     Monitors providers' and other entities' conformance with 
quality standards (other than those directly related to survey and 
certification); 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 services under FFS.
     Writes payment and benefit-related instructions for 
Medicare contractors.
     Defines the scope of Medicare benefits and develops 
national FFS payment policies, as necessary, to ensure the effective 
administration of the Agency's programs, including the development of 
related statutory proposals.
     Develops Agency medical coding policies related to FFS 
payments.
     Provides administrative support to the Practicing 
Physician Advisory Council.
     Coordinates provider, physician, and contractor centered 
information, education, and service initiatives.
     Serves as the CMS lead for Medicare carrier and fiscal 
intermediary (FI) management, oversight, budget, and performance 
issues.
     Functions as CMS liaison for all Medicare carrier and FI 
program issues and, in close collaboration with the regional offices 
and other CMS components, coordinates the agency-wide contractor 
activities.
     Manages contractor instructions, workload, and change 
management process.

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     Collaborates with other CMS components to establish 
ongoing performance expectations for Medicare contractors (carriers and 
FIs) consistent with the agency's goals; interprets, evaluates, and 
provides information on Medicare contractors in terms of ongoing 
compliance with performance requirements and expectations; evaluates 
compliance with issued instructions; evaluates contractor-specific 
performance and/or integrity issues; and evaluates/monitors corrective 
action, if necessary.
     Manages, monitors, and provides oversight of contractor 
(carriers and FIs) transition activities including replacement of 
departing contractors and the resulting transfer of workload, 
functional realignments, and geographic workload carveouts.
     Maintains and provides accurate contractor specific 
information. Develops and implements long-term FFS contractor strategy, 
tactical plans, and other planning documents.
     Serves as lead on current/proposed legislation in order to 
determine impact on provider and contractor operations.
     Develops national policy and implementation of all 
Medicare Part A, Part B, and Part C premium billing and collection 
activities and coordination of benefits to assure effective 
administration of FFS aspects of the Medicare program.

    Dated: September 6, 2001.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 01-22821 Filed 9-11-01; 8:45 am]
BILLING CODE 4120-01-P