Abby Block, Director

C. Mark Loper, Deputy Director

Functional Statements for the Center for Beneficiary Choices (CBC):

• Develops national policy for all Medicare Parts A, B, C and D beneficiary eligibility, enrollment, entitlement; premium billing and collection; coordination of benefits; rights and protections; dispute resolution process; as well as policy for managed care enrollment and disenrollment to assure the effective administration of the Medicare program, including the development of related legislative proposals.
• Develops and tests new and innovative methods to improve beneficiary aspects of health care delivery systems through Titles XVIII, XIX, and XXI demonstrations and other creative approaches to meeting the needs of Agency beneficiaries.
• Assures, in coordination with other Centers and Offices, the activities of Medicare contractors, including managed care plans, agents, and State agencies meet the Agency's requirements on matters concerning beneficiaries and other consumers.
• Serves as the focal point for all Agency interactions with managed health care organizations for issues relating to Agency programs, policy and operations.
• Develops national policies and procedures related to the development, qualification and compliance of health maintenance organizations, competitive medical plans and other health care delivery systems and purchasing arrangements (such as prospective pay, case management, differential payment, selective contracting, etc.) necessary to assure the effective administration of the Agency's programs, including the development of statutory proposals.
• Handles all phases of contracts with managed health care organizations eligible to provide care to Medicare beneficiaries.
• Coordinates the administration of individual benefits to assure appropriate focus on long term care, where applicable, and assumes responsibility for the operational efforts related to the payment aspects of long term care and post-acute care services.
• Serves as the focal point for all Agency interactions with employers, employees, retirees and others operating on their behalf pertaining to issues related to Agency policies and operations concerning employer sponsored prescription drug coverage for their retirees.
• Develops national policies and procedures to support and assure appropriate State implementation of the rules and processes governing group and individual health insurance markets and the sale of health insurance policies that supplement Medicare coverage.
• Primarily responsible for all operations related to Medicare Prescription Drug Plans and Medicare Advantage (MA) Prescription Drug (Part D) plans.
• Performs activities related to the Medicare Parts A & B processes (42 CFR Part 405, Subparts G and H), Part C (42 CFR Part 422, Subpart M), Part D (42 CFR Part 423, Subpart M) and the Programs of All Inclusive Care for the Elderly program for claims-related hearings, appeals, grievances and other dispute resolution processes that are beneficiary-centered.
• Develops, evaluates, and reviews regulations, guidelines, and instructions required for the dissemination of appeals policies to Medicare beneficiaries, Medicare contractors, MA plans, Prescription Drug Plans, CMS regional offices, beneficiary advocacy groups and others interested parties.
  

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Page Last Modified: 05/04/2007 10:44:45 AM
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