HCFA implements major restructuring

Shift to centers reflects agencies’ broader efforts

Taking a major step toward its stated goal to become a "beneficiary-centered purchaser" of health care services, the Health Care Financing Administration (HCFA) recently implemented an agencywide restructuring. The new structure, which took effect in July, is built around three large units, called "centers," one for each of HCFA’s primary clients: beneficiaries, health plans and providers, and states. (See chart, at right.)

According to HCFA, the three centers will provide "one-stop shopping" for individuals and organizations interacting with the agency. Other units with specialized expertise, such as clinical, financial, information systems, communication, and legislation, will support the three centers.

The agency says the new focus will enable HCFA to use purchasing strategies, including market presence, to acquire high-quality health care for beneficiaries at an affordable price.

The restructuring includes a new Office of Strategic Planning that will bring together research, actuarial analysis, and environmental scanning to provide analytical support to HCFA’s senior leadership on long-term agency and program direction. Also, for the first time, four field executives called Consortium Administrators will join the agency’s top deliberative body, bringing a local perspective to issues. The three centers are as follows:

• The Center for Beneficiary Services serves as the focal point for all of HCFA’s interactions with beneficiaries, their families and caregivers, and other representatives. The Center has policy and operational responsibility for Medicare enrollment and eligibility activities within the agency.

• The Center for Health Plans and Providers is responsible for purchasing health care under the Medicare program. This Center has policy responsibility for defining the Medicare benefit and establishing the prices to be paid under Medicare for all services.

• Center for Medicaid and State Operations deals with states and local governments (and territories), as well as Native American and Alaskan Native tribes. It will house all Medicaid program police and operations activities including Medicaid 1115 waiver projects and 1915(b) waivers.