[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