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CMS Consortia

Introduction

The Centers for Medicare & Medicaid Services (CMS) ten Field offices reorganized in February 2007 moving from a geography-based structure to a Consortia structure based on the Agency's key lines of business: Medicare health plans, Medicare financial management, Medicare fee for service operations, Medicaid and children's health, survey & certification and quality improvement. The intent of the new structure is to improve performance through uniform issue management, consistent communication and leadership focused on achieving the Agency's strategic action plan. Over the past year, the Field has made progress in these areas and more. 

The Four Consortia

Each consortium is led by a Consortium Administrator (CA) who serves as the Agency's national focal point in the Field for their business line(s) and as such is responsible for consistent implementation of CMS programs, policy and guidance across all ten regions for matters pertaining to their business line.  In addition to responsibility for a business line, each CA also serves as the Agency's senior management official for two or three Regional Offices (ROs), representing the CMS Administrator in external affairs matters and overseeing administrative operations.

The business lines, CAs, location of the consortium's headquarters and the ROs for which the CA has responsibility for administrative operations and regional external affairs (REA) are as follows: 

Consortium/Business Line

Consortium Administrator

(CA)

CA LocationSenior Management Official
Consortium for Medicare Health Plans Operations (CMHPO)James T.  KerrNew York

Boston

New York

Philadelphia

Consortium for Financial Management and Fee for Service Operations (CFMFFSO)Nanette Foster ReillyKansas City

Kansas City

Denver

San Francisco

Consortium for Medicaid and Children's Health Operations (CMCHO)Jackie GarnerChicago

Chicago

Seattle

Consortium for Quality Improvement and Survey & Certification Operations (CQISCO)Randy Farris, M.D.Dallas

Atlanta

Dallas

The Regional Administrators (RAs) in the six non-CA regional offices including Boston, Philadelphia, Atlanta, Denver, San Francisco and Seattle are responsible for planning and implementing all external affairs initiatives within the geographic area with which they are affiliated.  Each RA reports to one of the four CAs. 

The Associate Regional Administrators (ARAs) located throughout the Field, who previously reported to the RAs, now report directly to the CA responsible for the specific business line/functional area for which they are responsible (see organization charts).

Role and Significance of the CMS Field

CMS central and regional offices share a common vision and mission as well as a shared commitment to the five key objectives outlined in the CMS Strategic Plan 2008 - 2012:

  1. Skilled, Committed, and Highly Motivated Workforce,
  2. Affordable Health Care System,
  3. High-Value Health Care,
  4.  Confident, Informed Consumers and
  5. Collaborative Partnerships.

The Field provides a capable, local presence necessary to achieve the Agency's objectives and meet the constant challenges of serving approximately 90 million beneficiaries.  The role of the CMS Field includes three key components:

  1. Representation,
  2. Protection, and
  3.  Monitoring.

Representation

By the very nature of our proximity to CMS beneficiaries and partners, the Field plays a key role in representing the Agency and delivering key messages.  Development and maintenance of regional, state and local partnerships, including those with beneficiary coalitions, professional associations and governmental entities as well as an understanding of local influences enable Field offices to gain access and build collaborative partnerships that might otherwise be impossible.  CMS Field offices also routinely collaborate with field offices of other Federal agencies to serve the health and human service needs of the public. 

The CMS Field is a conduit of information.  The Field is constantly scanning and analyzing the regional, state and local health care marketplace and sharing their insights with central office.  So not only do we represent the Agency on a grassroots level, we represent the grassroots to the Agency.  Information and data from the Field contributes to informed policymaking and solutions that make sense inside and outside the beltway. 

Protection

The Field puts into practice on a regional, state and local level the protective regulations, policy and program guidance developed in central office.  The Field ensures protections are in place to facilitate the delivery of high-value health care that is safe, effective, efficient, patient centered, timely and equitable. 

Actions taken by the Field safeguard the health and well-being of our beneficiaries and the trust fund.  Through ongoing customer service, patient advocacy and professional relations, the Field is a problem solver for beneficiaries, providers and other CMS stakeholders.

Monitoring

To achieve and maintain an affordable health care system, it is imperative that monitoring of CMS' programs and evaluation of contractors/grantees is rigorous, accurate and timely.  Through ongoing monitoring of State Medicaid Agency financial claiming, state survey agencies, Managed Care Plans, Medicare claims processing contractors and peer review organizations, the Field is the Agency's front line in monitoring the implementation of CMS policies and regulations.