December 9, 2019
On November 25, 2019, the Centers for Medicare & Medicaid Services (CMS) published a notice (the Notice) in the Federal Register (84 FR 64899) announcing several changes related to its internal oversight structure. Specifically, CMS created a new Office of Program Operations and Local Engagement (OPOLE), while abolishing 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. The Notice also announced restructuring with respect to 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). According to CMS, these changes are intended to “improve business alignment of the regional locations with the program components and improve local engagement with external stakeholders,” as well as “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.” These changes broadly comprise the following:
1. Combination of CMHPO and CFMFFSO functions under the new OPOLE.
Medicare health plan and fee for service matters are to be consolidated under OPOLE. OPOLE will serve as a regional focal point for matters related to Medicare national initiatives and innovation models, emergency response and preparedness, health insurance markets, the sale of health insurance policies that supplement Medicare, and consumer rights, among other areas.
2. Integration into CCSQ of regional employees who conduct facility quality and safety surveys and oversee standards enforcement.
Regional employees overseeing facility quality and safety surveys, as well as standards enforcement, will be integrated into CCSQ, which will in turn serve as a focal point for all quality, clinical, medical science, and survey and certification policies for CMS’s programs. Among other responsibilities, CCSQ will be responsible for oversight of 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. Consistent with this function, the CCSQ will develop requirements of participation for providers and plans in the Medicare, Medicaid, and CLIA programs and also prepare the scientific, clinical, and procedural basis for coverage of new and established technologies and services. The CCSQ will also provide coverage recommendations to the CMS Administrator.
3. Integration into CMCS of regional employees who oversee Medicaid and Children’s Health Insurance Program (CHIP).
Regional employees overseeing Medicaid, CHIP, and the Basic Health Program (BHP) will be integrated into CMCS, which will in turn serve as CMS’s focal point for assistance with formulation, coordination, integration, and implementation of all national program policies and operations relating to these programs. This responsibility includes leading and supporting 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.
4. Redirection of reporting relationship for Emergency Preparedness and Response Operations function from the regional organizational component directly to the COO.
The COO will be more broadly directed to oversee all planning, implementation, and evaluation of administrative and operational activities for CMS, including enterprise-wide information systems and services, acquisition, grants, financial management, electronic health standards, facilities, and human resources.
5. Redirection of reporting relationships for regional public affairs officers to OC.
The OC shall be CMS’s focal point for internal and external strategic and tactical communications providing leadership for CMS in the areas of customer service, website operations, and traditional and new media, including web initiatives and social media. Efforts with respect to public relations shall also involve media interactions, call center operations, development of consumer materials, public information campaigns, and more general public engagement.
6. Realignment of external audit management function from regional component to OFM.
The OFM shall continue to serve as Chief Financial Officer and Comptroller for CMS, including expanded oversight with respect to audits.
7. Expanded oversight of OHC for hiring, including with respect to diversity initiatives, recruitment, retention, and employee qualifications.
This update is consistent with the OHC’s role in administering plans and developing, directing, coordinating, and evaluating Agency-wide management programs, performance management, delegations of authority, and position management.
What These Changes Mean
The above changes represent an across-the-board effort on the part of CMS to exercise greater oversight of regional agencies acting on CMS’s behalf. This heightened oversight is the first part of a “five-part plan” referenced by CMS Director Seema Verma earlier this year in the context of long-term care (the other four parts of this plan include enhancing enforcement, increasing transparency, improving care quality, and putting patients over paperwork). Prior efforts in this area include implementing a single, computer-based survey process which provides CMS with comprehensive data related to facilities nation-wide, and refining guidance concerning the determination of “Immediate Jeopardy.” Future developments may include efforts to ensure greater consistency of enforcement remedies, including Civil Monetary Penalties, as well as a reduction in the frequency of surveys for nursing homes that exhibit lower risk to residents, a proposal that CMS included in President Trump’s 2020 proposed budget.
Beyond long-term care, it is anticipated that CMS’s efforts to exercise greater oversight will ensure consistency and predictability among CMS representative agencies. This will likely involve some elimination or curtailment of regional policies, procedures, and traditional approaches customized to address local issues in favor of addressing matters tied to national trends and concerns of national lawmakers in the U.S. Congress. These developments are ongoing, and Hancock Daniel anticipates further information to develop in this area in the coming months.
If you have any questions or need further guidance regarding the upcoming compliance and ethics program requirement, please contact Hancock Daniel’s Long-Term Care & Post-Acute Care team.
The information contained in this advisory is for general educational purposes only. It is presented with the understanding that neither the author nor Hancock, Daniel & Johnson, P.C., is offering any legal or other professional services. Since the law in many areas is complex and can change rapidly, this information may not apply to a given factual situation and can become outdated. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice. Under no circumstances will the author or Hancock, Daniel & Johnson, P.C. be liable for any direct, indirect, or consequential damages resulting from the use of this material.
