CMS’ Role

1006 - CMS’ Role (Rev. 1, 05-21-04) The primary mission of CMS is to administer the Medicare program and certain related provisions of the Act in a manner which: • Promotes the timely and economic delivery of appropriate quality of care to eligible beneficiaries; • Promotes beneficiary awareness of the services for which they are eligible; and • Promotes efficiency and quality within the total health care delivery system. Overall policy-making responsibility is centralized in CMS' Baltimore headquarters (CO), where all aspects of the Medicare program, CLIA program, and oversight of the State Medicaid programs are coordinated. CMS CO is responsible for: • Monitoring, surveillance, and overall administrative control of the certification process, including its financial and surveyor training aspects; • Establishing operational policy for the certification process; • Conveying operational instructions and official interpretations of policy to the SAs and CMS’ regional offices (ROs); and • Implementation of the CLIA program. The CMS ROs have been delegated the authority by the Secretary for assuring that health care providers and suppliers participating in the Medicare, Medicaid, and CLIA programs meet applicable Federal requirements. This is accomplished through various activities. The ROs are responsible for: • Making final determinations of provider and supplier eligibility for participation in the Medicare and CLIA programs; assembling information on all determinants of eligibility; approving, denying, or terminating provider agreements and supplier participation; CLIA certification; imposing nursing home sanctions and arranging for FI tie-in with new providers; • Evaluating the performance of SAs in interpreting and applying health and safety standards, their assessments of providers and suppliers for compliance with standards, and their use of appropriate administrative procedures; • Providing liaison, direction, and technical assistance to SAs in the day-to-day management of the certification process; • Interpreting CMS guidelines, policies, and procedures applicable to certification activities; • Analyzing and negotiating State Medicare certification budgets; analyzing State spending patterns to assure that funds are economically and appropriately used; and allocating SA funds for conducting certification activities; • Alerting CMS CO to potential or actual health care crises resulting from terminations, natural disasters, and strikes among other occurrences; • Conducting surveillance and assessments of SA operations and assisting SAs in developing the capability to provide direct assistance to providers and suppliers; reviewing SA certification actions; and providing feedback to States; • Preparing data based on SA survey findings for input into CMS' Automated Survey Processing Environment (ASPEN), Online Data Input and Edit (ODIE) system, which is a subsystem of the Online Survey Certification and Reporting (OSCAR) system, a database and retrieval program; analyzing OSCAR data, and providing feedback to SAs on certification information tracked by the system; and • Conducting Federal surveys of providers and suppliers to ensure that standards and procedures are being applied in a uniform and consistent manner.