Centers for Medicare & Medicaid Services (CMS) Role

1025 - Centers for Medicare & Medicaid Services (CMS) Role (Rev. 19, Issued: 05-01-15, Effective: 05-01-15, Implementation: 05-01-15) CMS was established in March 1977 to combine healthcare financing and quality improvement programs into a single agency. CMS is responsible for the Medicare Program, federal participation in the Medicaid Program, the Quality Improvement Organization (QIO) Program, and a variety of other health care quality improvement programs. CMS's primary mission is to administer its programs in a manner that: • Promotes the timely delivery of appropriate, quality healthcare to beneficiaries • Ensures that beneficiaries are aware of the services for which they are eligible • Ensures that those services are accessible and of high quality • Promotes efficiency and quality within the total healthcare delivery system • Promotes the award and administration of all CMS contracts in accordance with the Federal Acquisition Regulations (48 CFR) Central Office Policy-making Responsibility: Overall policy-making responsibility for administration of the QIO Program is centralized in CMS’s Center for Clinical Standards and Quality. The CMS Central Office is responsible for: • Monitoring and overall administrative control of the QIO Program, including coordinating with CMS’s Office of Acquisition and Grants Management on contracts and financial aspects • Establishing operational policy for the QIO Program • Developing operational instructions and official interpretations of policy for QIOs and CMS Regional Offices (ROs) Regional Office Assistance to QIOs: CMS Regional Offices are responsible for assuring that QIOs meet applicable federal requirements under the provisions of their contracts through the duties of Contracting Officer’s Representatives. The Regional Offices: • Provide liaison, direction, and technical assistance to QIOs in the day-to-day management of their operations • Interpret CMS guidelines, policies, and procedures applicable to QIO activities • Analyze QIO budgets and spending patterns to assure that funds are economically and appropriately utilized • Recommend the allocation of funds for conducting additional activities • Conduct assessments of QIO operations • Review QIO actions • Provide feedback to each QIO