The 2020 Reorganization of CMS

In November 2019, CMS announced its plan to reorganize its infrastructure. These changes and the rationale for the changes were published in the November 25, 2019 Federal Register. The operational changes are significant and expansive, our focus for this article will be a summary of the overarching changes and the duties of the newly announced Center for Clinical Standards and Quality (CCSQ).

These changes begin with the establishment of the CMS Office of Program Operations and Local Engagement (OPOLE) and the abolishment of the Consortium for Medicare Health Plan Operations, Consortium for Financial Management and Fee for Service Operations and the Consortium for Quality Improvement and Survey & Certification Operations. The Center for Clinical Standards and Quality, Center for Medicaid and CHIP Services, Chief Operating Officer, Office of Communications, Office of Financial Management and Office of Human Capital were restructured to better align all audit management services and modernize CMS’s approach to public and internal communications.

Of specific interest to our readers are the duties and role of the CCSQ:

• The Center for Clinical Standards and Quality (CCSQ) administers all quality, clinical and medical science issues and Survey and Certification policies for CMS’s programs. CMS regional employees will be fully integrated into the CCSQ. This restructuring will allow CMS to unify its quality improvement, survey and enforcement activities while allowing them to remain considerate to local and state requirements. This restructuring will result in the CCSQ being the single, focal point of contact within CMS for all Clinical Standards and Quality related work.

• The goal of the CCSQ is to provide a cohesive, CMS-wide approach to measuring and promoting quality and will be the point at which priorities for clinical quality improvement will be set.

• The CCSQ will also identify and develop best practices and techniques related to Quality Improvement. This team will collaborate on all demonstration projects and promote quality measurement and Improvement. This will include the coordination of care between health care settings.

• The evaluation, adoption and implementation of performance measurement systems will also be a responsibility of the CCSQ.

• Survey and Certification activities will be the responsibility of the CCSQ: Here they will oversee the planning, policy, coordination and implementation of the survey and certification programs in  addition to the enforcement programs for all Medicare and Medicaid providers, suppliers and CLIA -certified Laboratories.

• CCSQ leaders shall manage the oversight, budget and performance issues relating to all survey and certification programs in addition to the interactions with each State.

• The CCSQ will operate the Quality Improvement Organization and End-Stage Renal Disease Network. They will work closely with the Regional Office resources.

• CCSQ will also be a driver in identifying new and innovative approaches and tests for improving quality programs and lowering costs.

The ultimate goal of CMS appears to be to streamline their operations while ensuring consistency in mission and actions, alignment of all programs into one vision for Quality while reducing overall costs of operations and costs to the consumer.

CMS Statement of Organization, Functions & Delegations of Authority

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