[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