Health Standards and Quality Bureau; Statement of Organization, Functions, and Delegations of Authority

[Federal Register Volume 60, Number 162 (Tuesday, August 22, 1995)]

[Notices]

[Pages 43602-43606]

From the Federal Register Online via the Government Publishing Office [www.gpo.gov]

[FR Doc No: 95-20692]

Health Care Financing Administration

Health Standards and Quality Bureau; 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, Health

Care Financing Administration (HCFA), (Federal Registers, Vol. 59, No.

60, pp. 14659-14662, dated Tuesday, March 29, 1994, and Vol. 59, No.

187, pp. 49406-49407, dated Wednesday, September 28, 1994) is amended

to reflect changes in the organizational structure of the Health

Standards and Quality Bureau (HSQB), Associate Administrator for

Operations and Resource Management. The HSQB functional statement has

not been changed; however, it is being republished to reflect the new

administrative code.

The specific amendments to part F are as follows:

Section F.10.D.7. (Organization) is amended to read as

follows:

7. Health Standards and Quality Bureau (FLH)

a. Survey Training Improvement Team (FLH1)

b. Center for Information Systems (FLH2)

c. Center for Operations Management (FLH3)

d. Center for Laboratories (FLH4)

e. Center for Hospital and Community Care (FLH5)

f. Center for Long Term Care (FLH6)

g. Center for Health Education and Promotion (FLH7)

h. Center for Clinical Measurement and Improvement (FLH8)

Section F.20.D.7. (Functions) is amended by deleting all

functional statements in their entirety and replacing them with the

following:

7. Health Standards and Quality Bureau (FLH)

Provides leadership and overall programmatic direction for

implementation and enforcement of health quality and safety standards

for providers and suppliers of health care services and evaluates their

impact on the utilization, quality and cost of health care services.

Plans, develops, and establishes procedures and guidelines

for administering and evaluating the nationwide Medicare and Medicaid

survey and certification program.

Monitors and validates the process for certifying that

participating

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providers and suppliers are in compliance with established conditions

and standards.

Responsible for implementation and operation of

professional review and other medical review programs.

Administers a comprehensive system for assessment of

individual professional and medical review organizations to determine

compliance with program requirements and to document the effectiveness

and impact of their activities.

Establishes specifications for information and data

reporting, collection and systems requirements for the survey and

certification, professional review and other medical review activities.

a. Survey Training Improvement Team (FLH1)

Responsible for the national surveyor training system.

Directs and coordinates development, measurement and

improvement of an integrated surveyor training program for HCFA

regional office and State agency personnel on interpretation of

regulations, surveyor protocols, procedures, techniques and

certification issues.

In conjunction with the specific program groups, insures

that training materials and techniques are current and comprehensive

and meet the needs of the HCFA regional office and State survey

agencies.

Evaluates program-related data and develops approaches for

improvements to program management and operations.

Evaluates customer service and systems performance data

and develops approaches for improvement to the training programs.

Serves as the focal point for the operation of all

training including scheduling, logistical support, enrollment, etc.

Coordinates, as necessary, with State agencies, regional offices, and

other HCFA organizations, provider and supplier groups and other

stakeholder groups who may require the program training.

Communicates with professional groups, providers, and

consumers to obtain information for the development and implementation

of training initiatives.

Serves as focal point for administering the certification

of Continuing Education Units under the auspices of the International

Association for Continuing Education and Training.

b. Center for Information Systems (FLH2)

Manages day-to-day operations of the Bureau's data

systems, including the Peer Review Organization, End-Stage Renal

Disease Network, Health Care Quality Improvement Program, On-line

Survey and Certification and Reporting and Clinical Laboratory

Improvement Amendment activities.

In conjunction with other Centers, designs, operates,

documents, and maintains system applications used in the administration

of Bureau programs, and/or provides technical assistance in

implementing and maintaining program-related ADP systems.

Designs, develops, and produces management reports to

support effective and efficient operation of Bureau program systems.

Provides expert technical support to the Bureau's

information technology infrastructure; i.e., local area network end-

users, telecommunications, personal computers, etc.

Develops and implements Bureau-wide information technology

policies and procedures to support the Bureau's information technology

objectives.

Prepares specifications for programming the On-line Survey

and Certification and Reporting system to include changes to

interpretive guidelines, survey procedures and forms.

Coordinates and monitors the transmission of data to and

from proficiency testing organizations, accrediting programs, common

working files and Medicaid State Agencies.

Directs and monitors the Bureau's system security and LAN

administration programs.

Provides technical support in development and evaluation

of ADP sections of contractor proposals; establishes procedures

regarding systems operations and security.

Maintains liaison with the Bureau of Data Management and

Strategy, user groups, and workgroups within and outside of the Agency.

Maintains liaison with internal and external customers and

stakeholders to assess needs and satisfaction and to coordinate

development of IRM strategies, budget, and implementation plans.

Oversees systems support contracts.

Participates in meetings with data standards

organizations.

Develops and/or evaluates program-related data, including

approaches and recommendations for improvements to program management

and operations.

Evaluates customer service and system performance data and

develops approaches for improvement.

c. Center for Operations Management (FLH3)

Develops, coordinates, manages, and evaluates Bureau

budget, procurement, contract, personnel management, correspondence,

and administrative support systems.

Develops and implements a Bureau staff development plan to

ensure that the current and future training needs of all employees is

addressed. Coordinates all internal and external training and staff

development initiatives.

Directs and manages the Bureau's management and

administrative operations including the administrative budget and

information collection budget. Coordinates Bureau responses to GAO and

OIG reports.

Manages the Bureau's correspondence, printing, manual

issuance, and regulation management processes, including managing a

bureau-wide automated library and other communication systems.

Responds to program-related public and congressional

inquiries and to freedom of information and privacy act requests

related to bureau programs.

Coordinates contract development, evaluation of contract

proposals, and negotiation for Bureau contracts. Acts as project

officer for contracts affecting multiple bureau components.

In partnership with central and regional office staff,

coordinates and oversees systems for assessing contractor performance.

Administers the State grants process for Medicare and

Medicaid State certification and CLIA program payments. Reviews

periodic State agency expenditure reports and estimates to evaluate

budget execution and determine allowability of costs.

Prepares annual operating plans for States to assure

sufficient resources are available for program operations on a

quarterly basis.

Develops justifications for program operating requirements

for Medicare State certification, Medicaid State certification, Peer

Review Organization, End-Stage Renal Disease Networks, CLIA, and

support contracts.

Establishes and maintains systems to control program funds

and ensure that the Anti-Deficiency Act is not violated.

Manages the Bureau procurement plan.

Coordinates with HCFA central and regional office staff,

state agencies, and the contractor community concerning contract and

financial management and issues.

Evaluates budget, contract, correspondence, and

administrative

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data, including approaches and recommendations for improvements to

their management and operations.

Evaluates customer service and performance data and

develops approaches for improvement.

d. Center for Laboratories (FLH4)

Directs and coordinates development, measurement and

improvement of program strategies that implement, enforce, and monitor

the Clinical Laboratory Improvement Program. Scope of the program

administered includes all clinical laboratories, conducting testing of

human specimens for the purpose of diagnosis and/or treatment for

residents of the United States.

Prepares regulation specifications and evaluates comments.

Serves as the HCFA liaison with the Public Health Service,

Centers for Disease Control and Prevention (CDC) and the Food and Drug

Administration, professional groups, standards setting organizations,

and consumer and advocate groups, in the development and administration

of laboratory standards.

Prepares and implements interpretive guidelines, survey

procedures, and forms.

Develops, implements, and monitors quality indicators for

the assessment of quality of laboratory services.

Directs and coordinates development, implementation, and

improvement of the CLIA User Fee Plan, including the administration of

the collection process.

Reviews and approves applications by States for

``exemption'' and private accrediting bodies for deemed status.

Develops and administers proficiency testing programs and

monitors their performance.

In conjunction with CDC, develops and administers the

cytology proficiency testing program.

Develops and/or evaluates program-related data, including

approaches and recommendations for improvements to program management

and operations.

Evaluates customer service and system performance data and

develops approaches for improvement.

Contributes to/participates in budget development,

direction, execution, and review.

Provides support to and communicates with other HCFA and

HHS components, and other governmental agencies such as the Veterans'

Administration and the Department of Defense on program-related issues.

Represents HCFA in presentations and meetings with public

and professional organizations and CLIAC on matters involving

laboratory standards, enforcement and performance. Provides public

education as needed.

Assists in the development of functional requirements and

specifications required for the design of information systems and

evaluates the effectiveness of information systems.

Through communication with the regional offices, assists

in the review of State agency performance, in these program areas, by

developing appropriate assessment techniques and protocols.

Assumes primary responsibility for assessing training

needs, developing instructional material, and training State Agency and

regional office staff in these program areas.

Develops assessment techniques and protocols for the

evaluation and improvement of established policy by State survey

agencies, exempt States and accrediting organizations whose standards

are deemed to meet Federal requirements for clinical laboratories.

Manages mission specific contracts.

e. Center for Hospital and Community Care (FLH5)

Directs and coordinates development, measurement and

improvement of program strategies that implement, enforce, and monitor

health quality and safety standards and other health care procedures

for other than CLIA and Long Term Care providers and suppliers under

Medicare and Medicaid, e.g., Hospitals, Psychiatric Hospitals,

Ambulatory Surgical Centers, End-Stage Renal Disease Facilities, Home

Health Agencies, etc.

Develops and implements provider and supplier specific

quality indicators and outcome measures in order to improve care

provided to beneficiaries. Directs program efforts to assure the

improvement of health care delivery in all settings.

Develops and implements program strategies to improve the

quality of health care delivery through the education of the

beneficiary, public, providers, suppliers and other concerned parties

about the standards and methods for delivery of quality health care;

e.g., education about standards or care, publication of monographs,

etc.

Manages mission specific contracts.

Develops and/or evaluates program-related data, including

approaches and recommendations for improvements to program management

and operations.

Evaluates customer service and system performance data and

develops approaches for improvement.

Contributes to/participates in budget development,

direction, execution, and review.

Communicates with professional groups, consumer and

advocate groups, and standards setting organizations and serves as the

HCFA focal point for implementation of compliance, enforcement, health

quality and safety procedures relative to these providers and

suppliers.

Prepares regulation specifications and evaluates comments.

In partnership with the Bureau of Policy Development,

reviews and analyzes existing health and safety standards to determine

their initial and continued effectiveness and impact on utilization,

quality, and cost of provider and supplier services.

Prepares and implements interpretive guidelines, survey

procedures, forms, and related sections of the Regional Office, State

Medicaid and State Operations Manuals.

Through communication with the regional offices, assists

in the review of State agency performance, in these program areas, by

developing appropriate assessment techniques and protocols.

Assumes primary responsibility for assessing training

needs, developing instructional material, and training State Agency and

regional office staff in these program areas.

Develops assessment techniques and protocols for the

evaluation and improvement of established policy by State survey

agencies and accrediting organizations whose standards are deemed to

meet Federal requirements for the Medicare Programs.

Serves as HCFA liaison with other government

organizations, professional groups, and standards setting

organizations, consumer and advocate groups and beneficiaries.

Serves as the focal point for responding to regional

office, State agency, Congressional, organizational, and individual

inquiries related to the application of health and safety requirements

and certification procedures for participating providers.

Assists in the development of functional requirements and

specifications required for the design of information systems and

evaluates the effectiveness of information systems.

f. Center for Long Term Care (FLH6)

Directs and coordinates development, measurement and

improvement of program strategies that implement, enforce and monitor

health quality and safety standards and other health care procedures

for long-term care facilities under Medicare and

[[Page 43605]]

Medicaid. These facilities include skilled nursing facilities/nursing

facilities (including swing beds) and intermediate care facilities for

the mentally retarded.

Develops and implements provider specific quality

indicators and outcome measures in order to improve care provided to

beneficiaries. Directs program efforts to assure the improvement of

health care delivery in all settings.

Coordinates the development of the Resident Assessment

Instrument that includes the Minimum Data Set (MDS).

Develops and implements program strategies to improve the

quality of health care delivery through the education of the

beneficiary, public, providers, suppliers and other concerned parties

about the standards and methods for delivery of quality health care.

Develops and/or evaluates program-related data, including

approaches and recommendations for improvements to program management

and operations.

Evaluates customer service and system performance data and

develops approaches for improvement.

Contributes to/participates in budget development,

direction, execution, and review.

Communicates with professional groups, consumer and

advocate groups, and standards setting organizations and serves as the

HCFA focal point for implementation of compliance, enforcement, health

quality and safety procedures relative to these facilities.

Prepares regulation specifications and evaluates comments.

In partnership with the Bureau of Policy Development,

reviews and analyzes existing standards to determine their initial and

continued effectiveness and impact on utilization, quality, and cost of

provider and supplier services.

Manages mission specific contracts.

Leads/oversees surveyor minimum qualifications testing

program.

In partnership with the Medicaid Bureau reviews and

analyses existing standards for ICFs/MR to determine their continue

effectiveness and prepares regulation specifications addressing changes

to those requirements.

Leads in the development and implementation of clinical

data information for improving the coordination of care between health

care settings.

Prepares and implements interpretive guidelines, survey

procedures, forms, and related sections of the Regional Office, State

Medicaid and State Operations Manual.

Through communication with the regional offices and the

Medicaid Bureau, assists in the review of State agency performance, in

these program areas, by developing appropriate assessment techniques

and protocols.

Assumes primary responsibility for assessing training

needs, developing instructional material, and training State Agency and

regional office staff in these program areas.

Develops assessment techniques and protocols for the

evaluation and improvement of State survey agencies and accrediting

organizations whose standards are deemed to meet Federal requirements

for the Medicare Programs.

Serves as HCFA liaison with other government

organizations, professional groups, and standards setting

organizations, consumer and advocate groups and beneficiaries.

Serves as the focal point for responding to regional

office, State agency, Congressional, organizational, and individual

inquiries related to the application of health and safety requirements

and certification procedures for participating providers.

Develops and coordinates procedures and guidelines for

implementing and evaluating inspection of care under Medicaid.

Through communications with the regional offices, develops

appropriate assessment techniques and protocols to determine the

effectiveness of Medicaid State agency performance in the area of

utilization control.

Provides the documentation and analyses necessary to

initiate and support actions on disallowances, sanctions, and

corrective action requirements, and on adjudication of appeals of

disallowances and sanctions resulting from national quality control

programs that determines the effectiveness of Medicaid State agency

performance in the area of utilization control.

Assists in the development of functional requirements and

specifications required for the design of information systems and

evaluates the effectiveness of information systems.

g. Center for Health Education and Promotion (FLH7)

Undertakes communications and quality improvement

activities to support the Medicare Peer Review and End-Stage Renal

Disease programs, and HCFA's Consumer Information Strategy.

Coordinates development and measurement of Health Care

Quality Improvement Program (HCQIP) communication strategies and

implementation approaches to promote behavior changes which result in

improved health care quality.

Serves as the HCQIP communications focal point with

internal and external customers and stakeholders including beneficiary

and provider groups, regional offices, Peer Review Organizations, ESRD

Networks, and other contractors and State entities.

Coordinates development of quality improvement

communications and information dissemination guidelines and mechanisms

and implementing instructions for HCQIP contractors.

Plans, develops; and issues operating policy,

specifications, procedural requirements, and other materials to

implement, maintain, and oversee the HCQIP communication process.

Manages mission specific contracts.

Coordinates HCFA Consumer Information Strategy.

Develops, implements and interprets data driven

performance measurement and quality improvement efforts to assess/

improve quality of care provided to Medicare beneficiaries. Areas of

concentration include prevention, consumer choice, and beneficiary

education about health care options and healthy behavior.

Coordinates and promotes participation of public and

private sector individuals, and groups within HCFA in the development

of performance measures and quality improvement strategies of mutual

benefit and interest.

Coordinates the preparation of manuals and other policy

issuances required to meet the PRO and ESRD-related instructional and

informational needs of providers, contractors, State agencies, regional

offices, Peer Review Organizations, ESRD Network organizations, managed

care organizations, Social Security Administration and other audiences

directly involved in the administration of HCFA quality improvement/

management programs.

In partnership with central and regional office staff,

coordinates and oversees systems for assessing contractor performance.

Maintains an ongoing review system, including clearance of

instructions, to ensure clarity and consistency. Identifies

instructional needs and initiates development of instructions by HCFA

components.

Maintains liaison with the regional offices, and other

internal and external HCQIP customers and stakeholders to assess needs

and satisfaction and to coordinate development of HCQIP program policy,

regulations, legislative

[[Page 43606]]

proposals and communication strategy and implementation.

Develops, implements, and interprets program policy and

guidance pertaining to the implementation of the HCQIP and other Peer

Review Organizations and End-Stage Renal Disease program statutory and

regulatory responsibilities.

Monitors legislative, regulatory and operational

developments related to the HCQIP, and coordinates development of

related regulations and legislative proposals.

Develops and/or evaluates program-related data, including

approaches and recommendations for improvements to program management

and operations.

Evaluates local project related data and develops

communication strategies and tools for improvements to program

management and operations (e.g., benchmarking and best practices.

Evaluates customer service and system performance data and

develops approaches for improvement.

Assists in the development of functional requirements and

specifications required for the design of information systems and

evaluates the effectiveness of information systems.

h. Center for Clinical Measurement and Improvement (FLH8)

Undertakes quality monitoring and improvement activities,

studies and projects to support the Medicare Peer Review and End-Stage

Renal Disease programs.

Coordinates the development and measurement of improvement

strategies and implementation approaches for the Health Care Quality

Improvement Program (HCQIP) including the development, assessment,

compilation, preparation, and dissemination of information on the

quality and efficiency of care.

Coordinates development of quality improvement project

guidelines and mechanisms and implementing instructions for HCQIP

contractors. Areas of concentration for the project process include

identifying opportunities for improvement, developing project plans,

and evaluating the effectiveness, efficiency, and appropriateness of

projects.

In partnership with central and regional office staff,

coordinates and oversees systems for assessing contractor performance.

Develops, implements, interprets, and oversees data driven

performance measurement and quality improvement efforts to assess/

improve quality of care provided to Medicare beneficiaries in all

populations. Areas of concentration include clinically-oriented

projects in the areas of managed care, acute care, ambulatory care, and

ESRD.

Collaborates with customers and stakeholders, public and

private sector individuals, and groups in the development of

performance measures and quality improvement strategies of mutual

benefit and interest.

Manages the Clinical Data Abstraction Centers and other

mission-specific contracts.

Manages the Medicare Quality Indicator System.

Maintains liaison with the regional offices, and other

internal and external HCQIP customers and stakeholders to assess needs

and satisfaction and to coordinate development of HCQIP program policy,

regulations, legislative proposals and quality measurement and

improvement plans.

Assists in the development of functional requirements and

specifications required for the design of information systems and

evaluates the effectiveness of information systems.

Develops and implements quality monitoring and improvement

studies/projects. Serves as content experts within the Bureau and

partners with other Bureaus and regional office components to ensure

full completion of all aspects of these studies/projects, including

evaluation, follow-up, communication, marketing and intervention

strategies.

Develops, implements, and interprets program policy and

guidance pertaining to the implementation of the HCQIP.

Develops and/or evaluates program-related data, including

approaches and recommendations for improvements to program management

and operations.

Evaluates customer service and system performance data and

develops approaches for improvement.

Dated: July 31, 1995.

Bruce C. Vladeck,

Administrator, Health Care Financing Administration.

[FR Doc. 95-20692 Filed 8-21-95; 8:45 am]

BILLING CODE 4120-01-P