[Federal Register Volume 84, Number 227 (Monday, November 25, 2019)]
[Notices]
[Pages 64899-64902]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-25426]


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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) (last amended at Federal 
Register, Vol. 75, No. 56, pp. 14176-14178, dated March 24, 2010; Vol. 
76, No. 203, pp. 65197-65199, dated October 20, 2011; Vol. 78, No. 86, 
p. 26051, dated May 3, 2013; Vol. 79, No. 2, pp. 397-398, dated January 
3, 2014; and Vol. 84, No. 32, p. 4470, dated February 15, 2019) is 
amended reflect the establishment of the Office of Program Operations 
and Local Engagement (OPOLE), and the abolishment of the Consortium for 
Medicare Health Plan Operations (CMHPO), the Consortium for Financial 
Management and Fee for Service Operations (CFMFFSO), and the Consortium 
for Quality Improvement and Survey and Certification Operations 
(CQISCO) to improve business alignment of the regional locations with 
the program components and improve local engagement with external 
stakeholders. The Center for Clinical Standards and Quality (CCSQ), 
Center for Medicaid and CHIP Services (CMCS), Chief Operating Officer 
(COO), Office of Communications (OC), Office of Financial Management 
(OFM), and the Office of Human Capital (OHC) were restructured to align 
audit management activities; change the reporting relationship of the 
Emergency Preparedness and Response Operations, and modernize CMS's 
approach to public and internal communications.
    In the current structure, CMHPO and CFMFFSO serve as the local 
focal points for Medicare (both original Medicare and the Medicare 
Advantage and Part D Health Plans) and for the federally-facilitated 
exchanges, have been well-aligned with several program areas. The 
combination of the CMHPO and CFMFFSO functions under the new OPOLE 
structure will improve coordination across Medicare program lines and 
integrates communication and local engagement activities into a single 
structure that reports directly to the CMS Administrator, in alignment 
with the CMS program centers themselves.
    CCSQ administers all quality, clinical, and medical science issues 
and survey and certification policies for CMS's programs. The regional 
employees who conduct the quality and safety surveys of facilities and 
oversee the enforcement of the quality and safety standards, as well as 
those who manage the quality improvement organizations will be fully 
integrated into CCSQ. The changes will improve business processes, 
leadership alignment, and customer focus, enabling CMS to unify its 
quality improvement, survey and enforcement activities while preserving 
its ability to consider local and state requirements. With this 
integration, CCSQ will be the agency's single point of contact for this 
work.
    CMCS serves as CMS's focal point for assistance with formulation, 
coordination, integration, and implementation of all national program 
policies and operations relating to Medicaid, CHIP, and the Basic 
Health Program. The regional employees who work on Medicaid and CHIP 
were integrated into CMCS as a single operating unit. It has become 
clear that additional integration is needed to be successful. The new 
structure will improve efficiency, alignment, and coordination of 
Medicaid and CHIP policy and operational activities throughout the 
regional locations, and create a leaner, more integrated structure that 
aligns key areas requiring a higher degree of specialization, 
significantly improving stakeholder experiences. It will also allow for 
a tighter coordination between financial policy and operations and 
bolster a national approach to prioritizing efforts across the 
portfolio of Medicaid and CHIP activities.
    The COO facilitates the coordination, integration and execution of 
CMS policies and activities across CMS components, including new 
program initiatives. The Emergency Preparedness and Response Operations 
function that currently reports into the regional organizational 
component, will report to the COO.
    OC serves as CMS's focal point for internal and external strategic 
and tactical communications providing leadership for CMS in the areas 
of customer service; website operations; traditional and new media 
including web initiatives such as social media supported by innovative, 
increasingly mobile technologies; media relations; call center 
operations, consumer materials; public information campaigns; and, 
public engagement. The regional public affairs officers will report to 
OC to improve consistency of media engagement. Other parts of this 
component were restructured to successfully leverage technology and to 
strengthen the Agency commitment to advocates and professional 
partners.

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The internal communications' work is moving from OHC to OC.
    OFM serves as the Chief Financial Officer (CFO) and Comptroller for 
CMS. It manages the preparation and audit of CMS financial statements, 
and issues the annual Agency Financial Report, in accordance with the 
requirements of the CFO Act. The external audit management function is 
being realigned from the regional component that currently serves as 
the local focal point for original Medicare operations to OFM. This 
change will integrate agency-wide responsibility and management of both 
external and internal audits under the responsibility of the CMS CFO.
    OHC administers CMS's special hiring authorities, diversity hiring 
initiatives, Delegated Examining authority and internal Merit Promotion 
program, and recruitment and retention programs, including negotiating 
base salary and any appropriate special hiring incentives.
    Part F, Section FC. 10 (Organization) is revised as follows:

Office of the Administrator (FC)
Office of Program Operations and Local Engagement (FCY)
Office of Enterprise Data and Analytics (FCW)
Office of Human Capital (FCX)
Office of Equal Opportunity and Civil Rights (FCA)
Office of Communications (FCT)
Office of Legislation (FCC)
Federal Coordinated Health Care Office (FCQ)
Office of Minority Health (FCN)
Office of the Actuary (FCE)
Office of Strategic Operations and Regulatory Affairs (FCF)
Office of Financial Management (FCV)
Chief Operating Officer (FCM)
Center for Clinical Standards and Quality (FCG)
Center for Medicare and Medicaid Innovation (FCP)
Center for Medicare (FCH)
Center for Medicaid and CHIP Services (FCJ)
Center for Program Integrity (FCL)
Center for Consumer Information and Insurance Oversight (FCR)

    Part F, Section FC. 20 (Functions) for each organization is as 
follows:

Office of Program Operations and Local Engagement

     Serves as the senior level point of contact within each 
Region for counterparts in CMS, Department leadership (including the 
HHS Regional Director), as well as external stakeholders. Creates and 
maintains regional location cohesion and leads regional efforts to 
improve employee engagement.
     Responsible for consistently and effectively implementing 
the Agency's local outreach strategy and messaging.
     Serves as the regional lead for environmental scanning and 
issue identification, systematically providing a regional perspective 
in advising the Office of the Administrator on national initiatives and 
their impact on program beneficiaries, consumers, key partners, and 
major constituents.
     Responsible for providing the regional voice in the Agency 
rural health strategy, advising on effective goals, tactics, and 
success metrics, and implementing the strategy at a local level.
     Serves as the regional focal point for emergency response 
management for employees in regional locations as well as coordinating 
the local response to emergencies in accordance with Agency Continuity 
of Operations, Disaster Recovery, and Emergency Response and 
Preparedness Operations protocols.
     Implements 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.
     Provides Medicare health and drug plans with technical 
assistance to comply with program requirements, monitoring plan 
compliance with applicable statutes, regulations, and sub-regulatory 
guidance.
     Serves as the regional partner in the monitoring and 
oversight of Qualified Health Plans and Stand Alone Dental Plans 
operating in the federally-facilitated exchanges.
     Responds, handles and oversees resolution of inquiries and 
casework concerning Medicare beneficiary and federally-facilitated 
exchange consumer rights and protections, enrollment, eligibility, 
coverage and costs.
     Serves as the regional focal point for CMS interactions 
with Medicare Shared Savings Program Accountable Care Organizations 
(ACO) and innovation models.
     Serves as the regional focal point for CMS oversight of 
the Medicare Administrative Contractors' program and fiscal integrity 
function.
     Implements national policy for Medicare Parts A and B 
beneficiaries and health care providers.

Center for Clinical Standards and Quality

     Serves as the focal point for all quality, clinical, 
medical science issues, survey and certification, and policies for 
CMS's programs. Provides leadership and coordination for the 
development and implementation of a cohesive, CMS-wide approach to 
measuring and promoting quality and leads CMS's priority-setting 
process for clinical quality improvement. Coordinates quality-related 
activities with outside organizations. Monitors quality of Medicare, 
Medicaid, and the Clinical Laboratory and Improvement Amendments 
(CLIA). Evaluates the success of interventions.
     Identifies and develops best practices and techniques in 
quality improvement; implementation of these techniques will be 
overseen by appropriate components. Collaborates on demonstration 
projects to test and promote quality measurement and improvement.
     Develops, tests, evaluates, adopts and supports 
performance measurement systems (i.e., quality measures) to evaluate 
care provided to CMS beneficiaries except for demonstration projects 
residing in other components.
     Assures that CMS's quality-related activities (survey and 
certification, technical assistance, beneficiary information, payment 
policies and provider/plan incentives) are fully and effectively 
integrated. Carries out the Health Care Quality Improvement Program for 
the Medicare, Medicaid, and CLIA programs.
     Oversees the planning, policy, 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 CLIA.
     Serves as CMS's lead for management, oversight, budget, 
and performance issues relating to the survey and certification program 
and the related interactions with the States.
     Leads in the specification and operational refinement of 
an integrated CMS quality information system, which includes tools for 
measuring the coordination of care between health care settings; 
analyzes data supplied by that system to identify opportunities to 
improve care and assess success of improvement interventions.
     Develops requirements of participation for providers and 
plans in the Medicare, Medicaid, and CLIA programs. Revises 
requirements based on statutory change and input from other components.
     Operates the Quality Improvement Organization and End-
Stage Renal Disease Network program in conjunction with Regional 
Offices, providing policies and procedures, contract design, program 
coordination, and leadership in selected projects.
     Identifies, prioritizes and develops content for clinical 
and health related

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aspects of CMS's Consumer Information Strategy; collaborates with other 
components to develop comparative provider and plan performance 
information for consumer choices.
     Prepares the scientific, clinical, and procedural basis 
for coverage of new and established technologies and services and 
provides coverage recommendations to the CMS Administrator. Coordinates 
activities of CMS's Technology Advisory Committee and maintains liaison 
with other departmental components regarding the safety and 
effectiveness of technologies and services; prepares the scientific and 
clinical basis for, and recommends approaches to, quality-related 
medical review activities of carriers and payment policies.
     Identifies new and innovative approaches and tests for 
improving quality programs and lowering costs.

Center for Medicaid and CHIP Services

     Serves as CMS's focal point for assistance with 
formulation, coordination, integration, and implementation of all 
national program policies and operations relating to Medicaid, CHIP, 
and the Basic Health Program (BHP).
     In partnership with States, assists State agencies in 
successfully carrying out their responsibilities for effective program 
administration and beneficiary protection, and, as necessary, supports 
States in correcting problems and improving the quality of their 
operations.
     Identifies and proposes modifications to Medicaid, CHIP, 
and BHP program measures, regulations, laws, and policies to reflect 
changes or trends in the health care industry, program objectives, and 
the needs of Medicaid, CHIP, and BHP beneficiaries. Collaborates with 
the Office of Legislation on the development and advancement of new 
legislative initiatives and improvements.
     Serves as CMS's lead for management, oversight, budget, 
and performance issues relating to Medicaid, CHIP, BHP and the related 
interactions with States and the stakeholder community.
     Coordinates with the Center for Program Integrity on the 
identification of program vulnerabilities and implementation of 
strategies to eliminate fraud, waste, and abuse.
     Leads and supports all CMS interactions and collaboration 
relating to Medicaid, CHIP, and BHP with States and local governments, 
territories, Indian tribes and tribal healthcare providers, key 
stakeholders (e.g., consumer and policy organizations and the health 
care provider community) and other Federal government entities. 
Facilitates communication and disseminates policy and operational 
guidance and materials to all stakeholders and works to understand and 
consider their perspectives, support their efforts, and to develop best 
practices for beneficiaries across the country and throughout the 
health care system.
     Develops and implements a comprehensive strategic plan, 
objectives, and measures to carry out CMS's Medicaid, CHIP, and BHP 
mission and goals and positions the organization to meet future 
challenges with Medicaid, CHIP, and BHP.

Chief Operating Officer

     Overall responsibility for facilitating the coordination, 
integration and execution of CMS policies and activities across CMS 
components, including new program initiatives.
     Promotes accountability, communication, coordination, and 
facilitation of cooperative corporate decision-making among CMS senior 
leadership on management, operational and programmatic cross-cutting 
issues.
     Tracks and monitors CMS performance and intervenes, as 
appropriate, to ensure key milestones/deliverables are successfully 
achieved. Keeps the Administrator and Principal Deputy Administrator 
advised of the status of significant national initiatives and programs 
that affect beneficiaries and/or the health care industry and makes 
recommendations regarding necessary corrective actions.
     Oversees all planning, implementation and evaluation of 
administrative and operational activities for CMS, including 
enterprise-wide information systems and services, acquisition and 
grants, financial management, electronic health standards, facilities, 
and human resources.

Office of Communications

     Serves as CMS's focal point for internal and external 
strategic and tactical communications providing leadership for CMS in 
the areas of customer service; website operations; traditional and new 
media including web initiatives such as social media supported by 
innovative, increasingly mobile technologies; media relations; call 
center operations, consumer materials; public information campaigns; 
and, public engagement.
     Serves as senior advisor to the Administrator in all 
activities related to the media. Provides consultation, advice, and 
training to CMS's senior staff with respect to relations with the news 
media.
     Coordinates with external partners including the 
Department of Health and Human Services (HHS) and the White House on 
key communication and public engagement initiatives, leveraging CMS 
resources to strategically support these activities.
     Contributes to the formulation of policies, programs, and 
systems as related to strategic and tactical communications.
     Coordinates with the Office of Legislation on the 
development and advancement of new legislative initiatives and 
improvements.
     Oversees communications research, design and development, 
evaluation and continuous improvement activities for improving internal 
and external communication tools, including but not limited to 
brochures, public information campaigns, handbooks, websites, reports, 
presentations/briefings.
     Identifies communication best practices for the benefit of 
CMS beneficiaries (i.e., of the Medicare and Medicaid programs) and 
other CMS customers.
     Formulates and implements a customer service plan that 
serves as a roadmap for the effective treatment and advocacy of 
customers and the quality of information provided to them.
     Oversees beneficiary and consumer call centers and 
provides leadership for CMS in the area of call center operations.
     Oversees all CMS interactions and collaborations with key 
stakeholders (external advocacy groups, contractors, local and State 
governments, HHS, the White House, other CMS components, and other 
Federal entities) related to the Medicare and Medicaid and other Agency 
programs.
     Coordinates stakeholder relations, community outreach, and 
public engagement with the CMS Regional Offices.

Office of Financial Management

     Serves as the Chief Financial Officer and Comptroller for 
CMS. Manages the preparation and audit of CMS financial statements, and 
issues the annual Agency Financial Report, in accordance with the 
requirements of the CFO Act.
     Formulates, presents and executes all CMS budget accounts; 
develops outlay plans and tracks contract and grant award amounts; acts 
as liaison with the Congressional Budget Office on budget estimates; 
reviews demonstration waivers (except 1115) for revenue neutrality. Is 
responsible for ensuring that the budget is formulated

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in accordance with CMS's strategic plan and the Government Performance 
and Results Act (GPRA) goals and performance measures.
     Acts as liaison to the Department of Health and Human 
Services (HHS), Assistant Secretary for Financial Resources, Office of 
Management and Budget (OMB), and the Congressional appropriations 
committees for all matters concerning CMS's operating budget.
     Manages the Medicare financial management system, the 
Medicare contractors' budgets, Quality Improvement Organizations' 
budgets, research budgets, managed care payments, the issuance of State 
Medicaid grants, and the funding of the State survey/certification and 
the Clinical Laboratory and Improvement Act programs. Is responsible 
for all CMS disbursements.
     Maintains CMS financial data and prepares external reports 
to other agencies such as HHS, Treasury, OMB, Internal Revenue Service, 
General Services Administration, related to CMS's obligations, 
expenditures, prompt payment activities, debt and cash management, and 
other administrative functions.
     Performs cash management activities and establishes and 
maintains systems to control the obligation of funds and ensure that 
the Anti-Deficiency Act is not violated.
     Manages the Medicare Secondary Payer Program and Medicare 
Debt Resolution activities.
     Develops CMS policies governing both Medicare Secondary 
Payer and Medicaid Third Party Liability.
     Oversees the Medicare fee-for-service and the Medicaid and 
CHIP improper payment measurement programs to measure payment accuracy.
     Develops and publishes the Medicare Fee-For-Service, 
Medicaid, and Children's Health Insurance Error Rate. Develops improper 
payment measurement methodologies to report related Marketplaces and 
related programs.
     Manages, develops, and enhances CMS's core financial 
management system, the Healthcare Integrated General Ledger Accounting 
System (HIGLAS), which tracks the financial activity and transactions 
of all of CMS's programs.
     Manages the development to maintain information technology 
program systems that support accounting operations, for the Medicare 
Benefits, Medicare Secondary Payer, Marketplace, Medicaid, CHIP Grants, 
and Administrative Program Accounting lines of business.
     Coordinates the development and monitoring of all audit 
corrective action plans and the Office of the Inspector General (OIG) 
clearance documents that address each OIG and the Government 
Accountability Office agreed upon recommendations.
     Develops an enterprise risk assessment program to better 
support CMS programs.
     Works collaboratively with components and contracting 
officials to review contract language and contract cost estimates in 
order to develop contract-specific performance and financial 
information.
     Coordinates performance management and promotes the use of 
Agency performance measures to foster a more results-orientated 
performance culture through CMS.
     Ensures compliance with a number of agency performance 
requirements such as GPRA and the GPRA Modernization Act, OMB program 
analysis and the Department strategic plan priorities.

Office of Human Capital

     Administers CMS's special hiring authorities, diversity 
hiring initiatives, Delegated Examining authority and internal Merit 
Promotion program, and recruitment and retention programs, including 
negotiating base salary and any appropriate special hiring incentives.
     Collects, analyzes and coordinates strategic planning data 
for use by CMS for recruitment purposes. Uses data to focus recruitment 
efforts.
     Provides leadership for the development and implementation 
of CMS Leadership and Management Development Programs. Coordinates 
management development activities with the Leadership Development and 
Recognition Board.
     Manages and oversees CMS learning management systems and 
coordinates with DHHS on department-wide courses.
     Administers plans, develops, directs, coordinates and 
evaluates Agency-wide management programs, performance management, 
delegations of authority, and position management. Ensures program 
operations are compliant with federal regulations and Departmental 
requirements and guidance, and develops and implements guidance and 
educational tools to support successful administration of these 
programs.
     Provides oversight of collective bargaining agreements and 
provision of advisory services to CMS managers. Conducts negotiations 
on behalf of management and/or advises management on the conduct of 
labor-management negotiations. Coordinates and develops CMS-wide policy 
regarding the development, implementation, and evaluation of labor 
relations' activities.
     Provides managers and senior Agency officials (in 
accordance with Federal Service Labor-Management Relations statue(s), 
and Master Labor Agreement) with advice and assistance on activities 
associated with labor management relations, including but not limited 
to bargaining unit status determinations, unfair labor practices, 
negotiability issues, workplace changes affecting bargaining unit 
employees, and case work associated with labor relations activities, 
(e.g., grievances).
     Develops and coordinates the policies and procedures 
necessary to implement the CMS Ethics Program. Provides advice and 
guidance to the CMS Deputy Ethics Counselor (DEC) concerning all issues 
that must be considered by the DEC.

    Authority: 44 U.S.C. 3101.

    Dated: November 18, 2019.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2019-25426 Filed 11-20-19; 4:15 pm]
 BILLING CODE 4120-01-P