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1991.03.14 :  HCFA Reorganization

Contact:  Bob Hardy (202) 245-6145
March 14, 1991

       The planning, promotion and oversight of coordinated care
activities under Medicare and Medicaid will be strengthened under
a reorganization plan approved by HHS Secretary Louis W. Sullivan,
M.D.
       The plan was submitted by Gail R. Wilensky, Ph.D.,
administrator of the Health Care Financing Administration.  It
creates two new offices under HCFA: one for coordinated care policy
and planning, and the other for the oversight of managed care
operations and quality assurance.
       "Dr. Wilensky's proposal reflects her long-standing concern
with the organization of HCFA's managed care activities," 
Dr. Sullivan said.  "The plan updates HCFA's organizational
structure to reflect the changing nature and growth of coordinated
care initiatives within the Medicare program."
       The Office of Coordinated Care Policy and Planning will be
headed by Ed Moy, the current director of the Office of Prepaid
Health Care.  Moy will continue to be HCFA's lead spokesman for the
planning and promotion of coordinated care activities, and will
report directly to the administrator.
       The Office of Prepaid Health Care Operations and Oversight
will be under the administrative management of David Butler, who
also oversees HCFA's regional offices and quality control
activities as deputy associate administrator for operations.  The
office will be responsible for ensuring that managed care providers
fulfill their contractual responsibilities to the Medicare program.
       According to Dr. Wilensky, HCFA's Office of Prepaid Health
Care was the appropriate office to design, develop and implement
the managed care program during its early years.
       "Now that HMOs are an established part of the Medicare
program, however, HCFA needs a structure that can promote the
Bush administration's broader vision of coordinated care, while
ensuring even stronger oversight of existing programs," 
Dr. Wilensky said.
       The reorganization plan will place HMO operational
authority and HCFA's regional offices, which oversee HMO
operations, under the same administrative command for the first
time.  It will also heighten the special nature of coordinated
care by streamlining the planning, policy and promotion functions
that report directly to the administrator.  The plan will also
retain the managed care industry's direct communications link to
the administrator and strengthen the relationship between managed
care and peer review.
       Finally, Dr. Wilensky's plan, which takes effect
immediately, reactivates and strengthens HCFA's nine-member
Coordinated Care Management Council, to be headed by Moy.  Dave
Butler will serve as vice chairman of the group, which will
ensure the integration of all coordinated care activities within
the agency.  The council will report to Dr. Wilensky on a regular
basis.


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