Herb Kuhn,  Acting Director

Bill Lasowski, Deputy Director

Policy Coordination & Planning Group - Shellie Rogers, Director

Family & Children's Health Programs Group - Dianne Heffron, Acting Director
Division of State Demonstrations & Waivers - Clarke Cagey, Director
Division of State Children's Health Insurance Programs - Kathleen Farrell, Director
Division of Quality, Evaluation & Health Outcomes - John Young, Acting Director
Division of Benefits, Eligibility and Managed Care - Christine Gerhardt, Director

Disabled & Elderly Health Programs Group - Gale Arden, Director
Division of Coverage and Integration - Linda Peltz, Director
Division of Eligibility, Enrollment & Outreach - Ginni Hain, Director
Division of Community and Institutional Services - Suzanne Bosstick, Director
Division of Advocacy & Special Issues - Melissa Hulbert, Director
Division of Pharmacy - Deirdre Duzor, Director

Survey and Certification Group - Thomas Hamilton, Director
Training Staff, George Karahalis, Director
Division of Acute Care Services - Marilyn Dahl, Director
Division of Laboratory Services - Judith Yost, Director
Division of Nursing Homes - Cindy Graunke, Director
Division of Continuing Care Providers - Jan Tarantino, Director

Finance, Systems, and Budget Group - Edward Gendron, Director
Survey & Administrative Budget Staff - Dave Escobedo, Director
Division of National Systems - Jack Williams, Director
Division of State Systems - Rick Friedman
Division of Information Analysis & Technical Assistance - Roger Buchanan, Director

Medicaid Integrity Group - David Frank, Director
Division of Medicaid Integrity Contracting - Barbara Rufo, Director
Division of Field Operations - Robb Miller, Director
Division of Fraud Research & Detection - James Gorman, Director

Financial Management Group - Jim Frizzera, Director
Division of Financial Operations - Jay Gavens, Acting Director
Division of Reimbursement & State Financing - Janet Freeze, Acting Director

Functional Statement

• Serves as the focal point for all Centers for Medicare & Medicaid Services activities relating to Medicaid, the State Children's Health Insurance Program, the Clinical Laboratory Improvement Act (CLIA), the survey and certification of health facilities and all interactions with States and local governments (including the Territories).
• Develops national Medicaid policies and procedures which support and assure effective State program administration and beneficiary protection. In partnership with States, evaluates the success of State agencies in carrying out their responsibilities and, as necessary, assists States in correcting problems and improving the quality of their operations.
• Develops, interprets, and applies specific laws, regulations, and policies that directly govern the financial operation and management of the Medicaid program and the related interactions with States and regional offices.
• In coordination with other components, develops, implements, evaluates and refines standardized provider performance measures used within provider certification programs. Supports States in their use of standardized measures for provider feedback and quality improvement activities. Develops, implements and supports the data collection and analysis systems needed by States to administer the certification program.
• Reviews, approves and conducts oversight of Medicaid managed care waiver programs. Provides assistance to States and external customers on all Medicaid managed care issues.
• Develops national policies and procedures on Medicaid automated claims/encounter processing and information retrieval systems such as the Medicaid Management Information System and integrated eligibility determination systems.
• In coordination with the Office of Financial Management (OFM), directs, coordinates, and monitors program integrity efforts and activities by States and regions. Works with OFM to provide input in the development of program integrity policy.
• Through administration of the home and community-based services program and policy collaboration with other Agency components and the States, promotes the appropriate choice and continuity of quality services available to frail elderly, disabled and chronically ill beneficiaries.
• Develops and tests new and innovative methods to improve the Medicaid program through demonstrations and best practices including managing review, approval, and oversight of the Section 1115 demonstrations.
• Directs the planning, 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. Reviews and approves applications by States for "exemption" from CLIA and applications from private accreditation organizations for deeming authority. Develops assessment techniques and protocols for periodically evaluating the performance of these entities. Monitors the performance of proficiency testing programs under the auspices of CLIA.
• Provides leadership to the Medicaid Integrity Program (MIP). Develops strategies to prevent and earlier detect improper payments, including fraud and abuse by providers and others, from Medicaid and SCHIP. Offers support and assistance to the States to combat provider fraud, waste, and abuse. Provides guidance and direction to State Medicaid programs based on the insights gained through MIP's efforts.
  

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Page Last Modified: 08/06/2008 7:44:40 AM
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