[Federal Register Volume 76, Number 49 (Monday, March 14, 2011)]
[Notices]
[Pages 13618-13619]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-5779]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary


Delegation of Authority; Centers for Medicare & Medicaid Services

    Notice is hereby given that I have delegated to the Administrator, 
Centers for Medicare & Medicaid Services (CMS), or his or her 
successor, the authorities vested in the Secretary for the following 
provisions of Part A (42 U.S.C. 1301 et seq., as amended) and Part B 
(42 U.S.C. 1320c et seq., as amended) of Title XI of the Social 
Security Act (the Act) (42 U.S.C. 1301 et seq., as amended) insofar as 
such parts pertain to CMS' mission, as described in Section F.00 of 
CMS' Statement of Organization, Functions, and Delegations of 
Authority, last published at 55 FR 9363 (March 13, 1990).

Part A (General Provisions) of Title XI of the Act

     Section 1106--The authority under Section 1106, as 
amended, pertaining to disclosure of information in possession of CMS.
     Section 1110--The authority under Section 1110, as 
amended, to make grants to States and public and other organizations 
and agencies for paying part of the cost of research or demonstration 
projects such as those relating to the prevention and reduction of 
dependency, or which will aid in effecting coordination of planning 
between private and public welfare agencies or which will help improve 
the administration and effectiveness of programs carried on or assisted 
under the Act and programs related thereto, and to make contracts or 
jointly financed cooperative arrangements with States and public and 
other organizations and agencies for the conduct of research or 
demonstration projects relating to such matters. Refer to F.50.1.a.
     Section 1112--The authority under Section 1112, as 
amended, to develop and revise from time to time guides or recommended 
standards regarding the level, content, and quality of medical care and 
medical services for the use of the States in evaluating and improving 
public assistance medical care programs and the State programs of 
medical assistance.
     Section 1116--The authority under Section 1116, as 
amended, pertaining to State plans thereto under Title XIX of the Act. 
Refer to F.50.1.b.
     Section 1121--The authority under Section 1121, as 
amended, pertaining to uniform reporting systems for health services 
facilities and organizations.
     Section 1122(d), (e) and (f)--The authority under Section 
1122(d) and (e), as amended, to identify and deny unnecessary capital 
expenditure payment amounts to be excluded from reimbursement to health 
care facilities under Titles XVIII and XIX of the Act when such 
exclusions have been found necessary and Section 1122(f), as amended, 
to reconsider determinations made under Section 1122 of the Act.
     Section 1124--The authority under Section 1124, as 
amended, pertaining to disclosure of ownership and related information 
by providers, carriers, intermediaries, and similar organizations.
     Section 1124A--The authority under Section 1124A, as 
amended, pertaining to disclosure requirements for other providers 
under Part B of Title XVIII of the Act.
     Section 1126--The authority under Section 1126, as 
amended, pertaining to disclosure by institutions, organizations, and 
agencies of owners and certain other individuals who have been 
convicted of certain offenses.
     Section 1128(c)(3)(B)--The authority under Section 
1128(c)(3)(B), as amended, to request a waiver of program exclusion 
from the Office of Inspector General of the Department of Health and 
Human Services.
     Section 1132--The authority under Section 1132, as 
amended, pertaining to claims submitted by States for payment with 
respect to expenditures that affect only programs for which the 
Administrator, CMS, has delegated authority, including Titles XIX and 
XXI of the Act. Refer to F.50.1.e.
     Section 1134--The authority under Section 1134, as 
amended, pertaining to determinations of whether the reasonable costs 
of services provided to nonprofit hospitals or critical access 
hospitals are to be deducted from the operating costs of such hospitals 
or critical access hospitals.
     Section 1137--The authority under Section 1137, as 
amended, pertaining to income and eligibility verification system for 
the Medicaid program under Title XIX of the Act.
     Section 1138--The authority under Section 1138, as 
amended, pertaining to hospital protocols for organ procurement and 
standards for organ procurement agencies.
     Section 1139--The authority under Section 1139, as 
amended, pertaining to improving access to, and delivery of, health 
care for Indians under Titles XIX and XXI of the Act.
     Section 1139A--The authority under Section 1139A, as 
amended, pertaining to child health quality measures for children 
enrolled in Medicaid or the Children's Health Insurance Program.
     Section 1144(c)--The authority under Section 1144(c), as 
amended, pertaining to assistance with Medicare savings program and 
low-income subsidy program applications.
     Section 1146--The authority under Section 1146, as 
amended, pertaining to public disclosure of certain information on 
hospital financial interest and referral patterns.

Part B (Peer Review of the Utilization and Quality of Health Care 
Services) of Title XI of the Act

     Section 1152--The authority under Section 1152, as 
amended, pertaining to utilization and quality control peer review 
organizations.
     Section 1153--The authority under Section 1153, as 
amended, to contract with utilization and quality control peer review 
organizations.
     Section 1154--The authority under Section 1154, as 
amended, pertaining to the functions of the peer review organizations.
     Section 1155--The authority under Section 1155, as 
amended, pertaining to the right of a beneficiary, provider, or 
practitioner to request that a utilization and quality control peer 
review organization reconsider a determination made by that 
organization. Refer to F.50.1.f.
     Section 1157--The authority under Section 1157, as 
amended, pertaining to violations of law, limitations on liability and 
payment for certain legal expenses.
     Section 1158--The authority under Section 1158, as 
amended, pertaining to utilization and quality control peer review 
organizations performing certain functions described in Part B of Title 
XI of the Act under contracts with State programs receiving Federal 
financial assistance under Title XIX of the Act.
     Section 1159--The authority under Section 1159, as 
amended, to authorize use of certain funds to administer the provisions 
of Part B of Title XI of the Act.
     Section 1160--The authority under Section 1160, as 
amended, to prohibit

[[Page 13619]]

against disclosure of information pursuant to a contract under Part B 
of Title XI of the Act, except that authorities for controlling fraud 
and abuse under Section 1160(b) of the Act shall be exercised by the 
Office of Inspector General.
    This delegation of authority supersedes the authorities delegated 
under Part A (42 U.S.C. 1301 et seq.) of Title XI of the Act and Part B 
(42 U.S.C. 1320c et seq.) of Title XI of the Act that were published in 
the Federal Register notice on September 6, 1984, including the 
authorities contained in paragraphs C.1.--15., and D. of Section F.30--
Delegations of Authority; and includes F.40.--Reservations of 
Authority, 1.--Under Part B of Title XI of the Social Security Act (42 
U.S.C. 1320(c) et. seq.); 3.--General Reservations, paragraphs a. and 
b. Section F.50.--Limitations of Authority, 1.--Under Parts A and B of 
Title XI of the Social Security Act (42 U.S.C. 1320 et. seq), is 
deleted in its entirety and replaced with the following:
    a. Disputes regarding the determinations listed in 45 CFR Part 16, 
Appendix A, pertaining to discretionary grants, such as grants for 
research or demonstration projects under section 1110 (42 U.S.C. 1310) 
of the Act or for special demonstration projects under Section 1115 (42 
U.S.C. 1315) of the Act, are heard by the Chair and Members of the 
Departmental Appeals Board, Office of the Secretary, who issue the 
final HHS decision. See 42 CFR 430.3 and 457.206; 46 FR 43816.
    b. The authority to hear appeals and issue final HHS decisions 
under Section 1116(e) (42 U.S.C. 1316(e)) of the Act with respect to 
disallowances or reconsidered disallowances under Title XIX of the Act 
shall be exercised only by the Chair and Members of the Departmental 
Appeals Board, Office of the Secretary, pursuant to Section 1116(e)(2) 
(42 U.S.C. 1316(e)(2)) of the Act. This includes an appeal of a Title 
XIX disallowance based on a State's failure to meet the timely claims 
requirements of Section 1132 (42 U.S.C. 1320b-2) of the Act.
    c. The authorities under Sections 1128 (42 U.S.C. 1320a-7), 1128A 
(42 U.S.C. 1320a-7a), 1128B (42 U.S.C. 1320a-7b), 1128D (42 U.S.C. 
1320a-7d), 1128E(b)(6) (42 U.S.C. 1320a-7e(b)(6)), 1140 (42 U.S.C. 
1320b-10), 1156(b) (42 U.S.C. 1320c-5(b)), and 1160(b) (42 U.S.C. 
1320c-9(b)) of the Act for controlling fraud and abuse in healthcare 
programs shall be exercised by the Office of Inspector General.
    d. The hearings to which the procedures in section 1128A(c) (42 
U.S.C. 1320a-7a(c)) of the Act apply, as well as the hearings under any 
other section of the Act authorizing the Secretary to impose a civil 
remedy, including a civil money penalty, exclusion, or assessment, for 
which the Secretary has delegated authority to the Administrator, CMS, 
or to the Office of Inspector General to impose the remedy, shall be 
conducted by Administrative Law Judges at the Departmental Appeals 
Board, Office of the Secretary, who issue initial decisions subject to 
review and final determinations made by the Chair and Members of the 
Departmental Appeals Board. See 59 FR 52967; 42 CFR Parts 402 and 1002-
1004, incorporating the procedures at 42 CFR Part 1005; 42 CFR Part 
422, Subpart T; 42 CFR Part 423, Subpart T; and 45 CFR Part 160.
    e. Disallowances under Title XXI of the Act, including 
disallowances based on State's failure to meet the timely claims 
requirements of Section 1132 (42 U.S.C. 1320b-2) of the Act, are 
subject to reconsideration by the Chair and Members of the Departmental 
Appeals Board, Office of the Secretary, under section 1116(d) (42 
U.S.C. 1316(d)) of the Act, made applicable to Title XXI by Section 
2107(e) (42 U.S.C. 1397gg(e)) of the Act. See 42 CFR 457.206.
    f. The hearings under Section 1155 (42 U.S.C. 1320c-4) of the Act, 
which incorporates by reference Section 205(b) (42 U.S.C. 405(b)) of 
the Act, shall be conducted by Administrative Law Judges in the Office 
of Medicare Hearings and Appeals, Office of the Secretary, with review 
by the Medicare Appeals Council at the Departmental Appeals Board, 
Office of the Secretary. See 42 CFR Part 478, Subpart B and 42 CFR Part 
405, Subpart J.
    g. The hearings under Section 1156(b)(4) (42 U.S.C. and1320c-
5(b)(4)) of the Act, which incorporates section 205(b) (42 U.S.C. 
405(b)) of the Act, shall be conducted by the Administrative Law Judges 
at the Departmental Appeals Board, Office of the Secretary, who issue 
initial decisions subject to review and final determinations made by 
the Chair and Members of the Departmental Appeals Board. See 42 CFR 
Part 1004, incorporating the procedures at 42 CFR Part 1005; 59 FR 
52967.
    This delegation of authority is effective immediately.
    These authorities may be re-delegated.
    These authorities shall be exercised under the Department's policy 
on regulations and the existing delegation of authority to approve and 
issue regulations.
    I hereby affirm and ratify any actions taken by the Administrator, 
CMS, or his or her subordinates, which involved the exercise of the 
authorities under Part A (42 U.S.C. 1301 et seq.) of Title XI of the 
Act and Part B (42 U.S.C. 1320c et seq.) of Title XI of the Act 
delegated herein prior to the effective date of this delegation of 
authority.

    Authority: 44 U.S.C. 3101

    Dated: March 4, 2011.
Kathleen Sebelius,
Secretary.
[FR Doc. 2011-5779 Filed 3-11-11; 8:45 am]
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