PROGRAM MANAGEMENT on them. To accomplish the goal of a clean and timely opinion, HHS and CMS will work with and rely on the Office of Inspector General and certified public accounting firms to conduct the audits. יוייד 3 10 יון Performance Goal MO4-04 – Maintain CMS's Improved Rating on Financial Statements Changes Related to Managed Care: $10.0 million The BBA requires that an independent contractor review Medicare managed care appeals. This FY 2004 request includes funding for managed care reconsiderations. In addition, the settlement agreement of the Grijalva lawsuit shifts the burden of adjudicating certain managed care appeals, i.e., discharges from skilled nursing facilities (SNFs), home health agencies (HHAs), and comprehensive outpatient rehabilitation facilities (CORFs), from Medicare managed care organizations (MCOs) to an independent review entity (IRE) under contract with CMS. Under this new appeals process, an MCO would be required to give a beneficiary notice prior to terminating SNF, HHA, or CORF services. The beneficiary may file for an expedited review with the IRE. This request is based on CMS's experience with the IRE that currently processes its Medicare managed care appeals workload. This request is $2.7 million less than the FY 2003 President's budget request. PROGRAM IMPROVEMENTS: $17.3 million This category, which decreases $1.7 million from the FY 2003 President's budget level, includes projects that improve the Medicare program, increase efficiency, and enhance relations with our stakeholders. These activities include: Medicare-Endorsed Prescription Drug Card: $5.0 million CMS is requesting funding for start-up costs in FY 2004 for the Medicare-endorsed prescription drug card. Activities would include: technical support for the start-up of the consortium, such as developing a design for the enrollment exclusivity system and for the price comparison web site (which will reduce implementation time by 6 months); development of marketing guidelines for program sponsors to follow in producing marketing materials; review of program-sponsor marketing materials; initial development of a complaints tracking system; technical support for starting up a corrective actions process; and social marketing research to understand beneficiary attitudes and behaviors toward drug discount card programs under Medicare's PROGRAM MANAGEMENT endorsement to inform our education and assistance efforts. This is a new activity not included in the FY 2003 President's budget request. Physician Regulatory Issues Team (PRIT): $5.0 million CMS developed the Physician Regulatory Issues Team (PRIT) in response to physician complaints about the Medicare regulatory burden. CMS's plans include the following activities to investigate and address physicians' concerns: improve physician understanding of the Medicare program, including collect issues and develop solutions to regulatory obstacles or unnecessary continue to obtain input from practicing physicians by querying them about their This request is the same as the FY 2003 President's budget request. Medicare Learning Network Support (MedLearn): $4.0 million MedLearn is a comprehensive program that communicates with health care professionals via mass media, including print, Internet, videos, and satellite network resources, as well as face-to-face instructions. It also includes coordination of feedback mechanisms to ensure that CMS is giving the provider community the information it wants and needs. This request is the same as the FY 2003 President's budget request. Investments in Information Technology: $2.3 million This category includes funding for strengthening information technology security compliance at the Medicare contractors and several smaller activities. This request is $2.7 million less than the FY 2003 President's budget request. Improve Medicare Contractor Oversight: $1.0 million CMS remains focused on continuing this comprehensive initiative to improve contractor oversight. In FY 2004, CMS will develop, refine, and improve the methodology for populating review teams, make overall improvements to the Contractor Performance Evaluation (CPE) review protocols, and identify a methodology for drawing CPE review samples. This request also funds the Contractor Management Information System (CMIS). This request is the same as the FY 2003 President's budget request. גייד PROGRAM MANAGEMENT WW 121 Performance Goal MO5-04- Improve CMS Oversight of Medicare Fee-for-Service INFORMATION TECHNOLOGY ENTERPRISE INFRASTRUCTURE FUND: $11.0 million CMS's request includes $11.0 million to support Departmental efforts to improve the HHS information technology (IT) enterprise infrastructure. This funding will support an enterprise approach to investing in key IT infrastructure, such as security and network modernization, investments which will enable HHS programs to carry out their missions more securely and at a lower cost. Agency funds will be combined with resources in the IT Security and Innovation Fund to promote collaboration in planning and project management and to achieve common goals, such as secure and reliable communication and lower costs for the purchase and maintenance of hardware and software. This request is the same as the FY 2003 President's budget request. UNIFIED FINANCIAL MANAGEMENT SYSTEM (UFMS): $3.0 million The UFMS will be implemented to replace five legacy accounting systems currently used across the Operating Divisions. The UFMS will integrate the Department's financial management structure and provide HHS leaders with a more timely and coordinated view of critical financial management information. It will also promote the consolidation of accounting operations and thereby reduce substantially the cost of providing accounting services throughout HHS. Similarly, UFMS, by generating timely, reliable and consistent financial information, will enable HHS senior managers and program administrators to make more timely and informed decisions regarding their operations. CMS is requesting $3.0 million to support this effort in FY 2004. PROGRAM MANAGEMENT APPROPRIATIONS HISTORY: The table below displays Medicare Operations funding levels for the past 5 years. CMS's FY 2004 budget request for Medicare Operations is $1,776.9 million which will enable CMS's Medicare contractors to fulfill their growing contractual responsibilities and expectations, including paying claims, handling appeals, responding to inquiries, enrolling providers and suppliers, educating providers and beneficiaries, along with many other activities. In addition, it will allow CMS to address the significant increase in activities required by legislation. This level of funding will enable CMS to continue serving approximately 41 million Americans who depend on the Medicare program for their health care coverage. 1/ This column reflects the current estimate for FY 2003. Budget authority requested in the FY 2003 President's budget was $587,199,000. The current estimate does not reflect $30.4 million for the proposed accrual payment for retirement and health benefits included in the FY 2003 President's budget. It also restores $5.7 million in funding for legislative and public affairs staff to remain at CMS. 2/ Funding for additional FTEs is described in the following sections: Medicare Operations, HCFAC and CLIA. Staff resources resulting from the transfer of appeals activities from the Social Security Administration are not included in the FY 2004 estimate. PURPOSE AND METHOD OF OPERATIONS In FY 2004, approximately 4,486 CMS employees working in Baltimore, Maryland; Washington, DC; and 10 regional offices nationwide will perform many essential activities, including: providing funds to Medicare contractors; developing operating systems used to oversee our programs; managing programs to fight fraud, waste, and abuse; developing cost-effective health care purchasing approaches; monitoring contractor performance; and assisting States with Medicaid and SCHIP issues. |