[Federal Register Volume 88, Number 107 (Monday, June 5, 2023)]
[Notices]
[Pages 36586-36587]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-11901]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Statement of Organization, Functions, and Delegations of 
Authority

AGENCY: Centers for Medicare & Medicaid Services.

ACTION: Notice.

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SUMMARY: The Centers for Medicare and Medicaid Services, Center for 
Medicaid and CHIP Services has modified its organizational structure.

SUPPLEMENTARY INFORMATION: Part F of the Statement of Organization, 
Functions, and Delegations of Authority for the Department of Health 
and Human Services, Centers for Medicare &

[[Page 36587]]

Medicaid Services (CMS) (last amended at Federal Register, Vol. 87, No. 
205, pp. 64492-64494, dated March 27, 2023) is amended to reflect the 
establishment of the Managed Care Group and rename the Disabled and 
Elderly Health Programs Group to Medicaid Benefits and Health Programs 
Group within the Center for Medicaid and CHIP Services (CMCS).
    Part F, Section FC. 10 (Organization) is revised as follows:

Center for Medicaid and CHIP Services, Managed Care Group
Managed Care Group, Division of Managed Care Policy
Managed Care Group, Division of Managed Care Operations
Division of Managed Care Operations, Branch A through D
Center for Medicaid and CHIP Services, Medicaid Benefits and Health 
Programs Group

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

Managed Care Group

     Provides national leadership in the development and 
management of Medicaid program policy and operations regarding managed 
care programs and provides technical assistance to States and other 
stakeholders.
     Establishes Medicaid program policy around access, and 
accountability for all managed care programs regardless of authority 
used and including all populations (e.g., Temporary Assistance for 
Needy Families, dually eligible, foster care children, individuals who 
need long-term services and supports).
     Provides Medicaid managed care policy and operational 
guidance to States as well as internal and external stakeholders to 
ensure appropriate application of the policy.
     Provides subject matter expertise and technical support/
assistance in the review, approval, and oversight of managed care in 
Section 1115 demonstrations.
     Supports delivery systems reform through the development 
and implementation of policy around state directed payments including 
technical assistance to states, review and approval of 438.6(c) 
preprints, and responding to external inquires related to the 438.6(c) 
approval process.
     Establishes and reviews policy and performs operations 
related to 1915(b) waivers and 1932(a) SPAs, including the review and 
approval of new managed care programs, renewals and amendments to 
ensure appropriate application of Medicaid managed care policy in state 
Medicaid programs.
     Leads reviews of state contracts and amendments with 
managed care organizations, prepaid inpatient health plans, prepaid 
ambulatory health plans, primary care case management entities, 
enrollment brokers and external quality review organizations to confirm 
that contracts and capitation rates, when applicable, satisfy federal 
laws and regulations and are consistent with the Federal managed care 
authority(ies) approved by CMS.
     Reviews at-risk capitation rates for consistency between 
the rate certification, the contract provisions, and the Federal 
managed care authority (ies) approved by CMS.
     Reviews and approves state plan amendments and capitation 
rates for Programs of All-Inclusive Care of the Elderly.
     Reviews States' risk mitigation strategies for consistency 
between the contract and the rate certification and tracks the status 
of risk mitigation reconciliation activities.
     Conducts readiness assessment reviews and ongoing 
monitoring and oversight of Medicaid managed care programs.
     Collaborates with States in their implementation of 
approved managed care programs.
     Serve as the policy lead and liaison with the Office of 
the Actuary in the review and approval of effective and efficient rate 
methodologies.
     The primary point of contact for policy questions on 
Mental Health Parity and the application of that policy in the review 
of documents provided by States.

    Authority: 44 U.S.C. 3101.

Xavier Becerra,
Secretary of Health and Human Services.
[FR Doc. 2023-11901 Filed 6-2-23; 8:45 am]
BILLING CODE 4150-28-P