[Federal Register Volume 66, Number 213 (Friday, November 2, 2001)]
[Notices]
[Pages 55677-55679]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-27700]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-9012-NC]


Medicare and Medicaid Programs; Plan to Create an Open and 
Responsive Federal Agency

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice with comment period.

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SUMMARY: This notice announces our efforts to enhance our openness and 
responsiveness to all of our constituencies including Medicare and 
Medicaid beneficiaries and other individuals involved in their care, 
physicians, nurses, other health care providers, advocacy associations, 
and industry trade associations. We are making structural changes in 
the way we do business to build in processes that will enhance our 
ability to be responsive. This notice invites comments on our efforts 
to create an open and responsive agency.
    We are proposing to issue quarterly provider updates that list 
provider-oriented regulatory documents and program instructions. We 
plan to release the quarterly provider update to provider associations 
first as a pilot and, at a later time, publish subsequent provider 
updates on our Web site on the first business day of each calendar 
quarter.
    We are accepting comments about concerns or suggestions for 
improving our agency. We are particularly interested in specific 
suggestions on how we can improve our efforts to create an open 
responsiveness to better address the needs and concerns of all of our 
constituencies. We are not placing any time constraints for receipt of 
public comments.

ADDRESSES: In commenting, please refer to file code CMS-9012-NC. 
Because of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission. Mail written comments (one original and 
three copies) to the following address only: Centers for Medicare & 
Medicaid Services, Department of Health and Human Services, Attention: 
CMS-9012-NC, P.O. Box 8013, Baltimore, MD 21244-8013.
    If you prefer, you may deliver (by hand or courier) your written 
comments (one original and three copies) to one of the following 
addresses: Room 443-G, Hubert H. Humphrey Building, 200 Independence 
Avenue, SW., Washington, DC 20201, or Room C5-14-03, 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Anthony Mazzarella, (410) 786-7501.

SUPPLEMENTARY INFORMATION:
    Inspection of Public Comments: Comments will be available for 
public inspection as they are received, generally beginning 
approximately 3 weeks after publication of a document, at the 
headquarters of the Centers for Medicare & Medicaid Services, 7500 
Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of 
each week from 8:30 a.m. to 4 p.m. In order to review public comments, 
you must schedule an appointment by calling (410) 786-7197. To obtain 
entry to our facility, you must have a photo identification (preferably 
a driver's license).

I. Background

    Our mission is to serve Medicare and Medicaid beneficiaries by 
assuring quality health care security for beneficiaries. In keeping 
with our mission, we are committed to reforming and strengthening our 
agency by creating an open responsiveness to the needs and concerns of 
all of our constituencies including Medicare and Medicaid beneficiaries 
and individuals involved in their care, physicians, nurses, other 
health care providers, advocacy associations, and industry trade 
associations.

II. Plan To Create an Open, Responsive Agency

    We want to be a reliable Federal agency; one that is open and 
responsive to the needs of all of our constituencies. In our effort to 
enhance our responsiveness to Medicare and Medicaid beneficiaries and 
their health care providers, we are making structural changes in the 
way we do business to build in processes that enhance our ability to 
create an open and responsive Agency. We plan to focus on working 
openly with our stakeholders, soliciting their individual input and 
feedback, responding to requests for information in a more timely 
manner, and issuing a

[[Page 55678]]

quarterly provider update of all changes to Medicare regulations and 
instructions that affect providers.
    Because our agency focus is to be open and responsive, we are 
creating mechanisms that will give our employees a greater opportunity 
to receive and act on feedback from our constituencies. First, we are 
establishing a series of open listening forums across the country to be 
chaired by our senior staff, so that we can hear directly from our 
constituencies about the impact that our regulations, policies, and 
programs have on them. We want to hear the concerns and individual 
suggestions for improvement from physicians and other health care 
providers, from the people who deal with us in communities and 
facilities from day to day, and from seniors who rely upon Medicare and 
Medicaid for their health care needs.
    Second, we are creating open door listening forums chaired by our 
senior staff, and made up of our employees, to serve as principal 
points of contact for beneficiary and provider groups. Our goal in 
working with these groups is to build stronger relationships, improve 
their understanding of CMS, and generate ideas for program improvements 
and reform, as well as ideas about how we can better serve our 
beneficiaries. Individual senior staff members will serve as the 
primary contacts for the following stakeholders to bring issues and 
ideas about our programs and policies:
     Physicians.
     Hospitals.
     Rural providers.
     Nursing homes.
     Medicare+Choice organizations and other health plans.
     Nurses and allied healthcare professionals.
     Home health agencies and hospices.
     End-stage renal disease facilities and dialysis centers.
    Third, we will work with each State at both the regional and 
central office level. A Medicaid/State Children's Health Insurance 
Program contact person for each State will troubleshoot and resolve 
disputes for Governors, State Medicaid Directors, and other high-
ranking State officials. The contact person will be directly 
accountable to the Administrator and the Director of the Center for 
Medicaid and State Operations as they respond to State issues.
    Fourth, we will form in-house expert teams across program areas to 
develop new ways of conducting business that will reduce administrative 
burdens and simplify our policies and regulations. These teams will 
look to reduce administrative burden on providers, eliminate complexity 
when possible, augment some of the individual suggestions we hear in 
our listening forums, and make Medicare more ``user-friendly.'' These 
expert teams will be coordinated with the Secretary's Regulatory Reform 
Initiative and the Secretary's Advisory Committee on Regulatory Reform.
    Fifth, providers have advised us that it has become increasingly 
more difficult for them to stay abreast of the many new and changing 
instructions concerning our programs. We wish to make it easier for 
them to understand and comply with our regulatory documents and program 
instructions and to provide more predictability to program changes. 
Therefore, we are proposing to issue quarterly provider updates that 
list provider-oriented regulations we plan to publish in the coming 
quarter, as well as the Federal Register publication date and page 
reference for all regulations published in the previous quarter. The 
full text of our regulations is available from the Federal Register 
online database through GPO Access, a service of the U.S. Government 
Printing Office. The Web site address is http://www.access.gpo.gov/nara/index.html. 
    The first update serves as a pilot. In the pilot phase of this 
project, we have established several business objectives that we are 
testing with this release of the provider update. First, this update 
will be sent to provider groups and associations for their assessment 
as to its usefulness of content and format. Second, because of the 
complexity of the policy decisions associated with much of our 
regulatory work, we are taking an intermediate step towards enhancing 
the consistency of our regulatory publications. Specifically, we 
intend, to the extent practical, to publish regulations on a 
predictable cycle once a month. We plan to publish CMS business in the 
Federal Register on the fourth Friday of each month. In fact, each 
issue of the provider update will identify the specific days. We will 
work in good faith to follow the substance and timing of the provider 
update in the majority of cases. However, because some of our 
regulatory work has statutory publication dates that fall outside the 
fourth Friday of the month, we will continue to comply with the 
statutory requirements. For example, the public comment period for one 
of our major payment proposed rules closed the beginning of October. To 
effectively address the number of comments we anticipate and the 
complexity of the issues, the final rule titled, ``Medicare Program; 
Revisions to Payment Policies Under the Physician Fee Schedule for 
Calendar Year 2002 (CMS-1169-FC),'' will be published on November 1, 
2001.
    In addition, there may be other instances when it is not possible 
to follow the schedule. We will work hard to minimize these situations 
to the greatest extent possible.
    Also, the provider update will include all instructions (program 
memoranda, manual transmittals, and Operational Policy Letters) that 
affect health care providers. These provider-oriented Medicare 
instructions will be implemented at the beginning of the quarter 
following the quarter in which the provider update is published. We are 
proposing to published future provider updates on our Web site, 
http://www.cms.gov, the first business day of each calendar quarter to 
ensure wider access to this information. We also welcome comments 
relative to this approach.
    In many instances, the publication of the quarterly provider update 
will lengthen the advance notification period we presently give 
providers; we will generally create a uniform 90-day period of notice 
before implementation of coverage and payment changes. We believe the 
predictability and uniformity offered by set publication and 
implementation timeframes would significantly reduce the burden on the 
provider community that our current ``flow basis'' publication 
processes impose. Further, we believe the benefits gained from 
predictable publication and implementation timeframes would 
significantly outweigh the disadvantages of the delays in coverage and 
payment changes that may occur.
    Sixth, we are planning to enhance our system of provider training 
on new requirements and the resolution of problems through formal 
training, satellite broadcasts, and web-based information.
    Finally, we are revamping the process for developing, reviewing, 
and clearing all correspondence and, in particular, congressional 
correspondence. Our goal is to substantially reduce our response time 
to congressional inquiries by December 1, 2001; thus, greatly improving 
our responsiveness to our constituency.

III. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995.

[[Page 55679]]

IV. Response to Comments

    Because of the large number of items of correspondence we normally 
receive on Federal Register documents published for comment, we are not 
able to acknowledge or respond to them individually. We will consider 
all comments we receive, and, if we proceed with a subsequent document, 
we will respond to the major comments in the preamble to that document.

V. Regulatory Impact Statement

    This notice does not require an impact analysis because it does not 
have an economic impact on small entities, small rural hospitals, or 
State, local, or tribal governments.
    In accordance with the provisions of Executive Order 12866, this 
notice was not reviewed by the Office of Management and Budget.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: September 7, 2001.
Thomas A Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 01-27700 Filed 11-1-01; 8:45 am]
BILLING CODE 4120-01-P