DEPARTMENT OF HEALTH SERVICES - CMS

DEPARTMENT OF HEALTH

AND HUMAN SERVICES

FISCAL YEAR

2021

Centers for Medicare & Medicaid Services

Justification of Estimates for

Appropriations Committees

DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850

Message from the Administrator

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I am pleased to present the Centers for Medicare & Medicaid Services' (CMS) Fiscal Year (FY) 2021 performance budget. In FY 2021, over 145 million Americans will rely on the programs CMS administers including Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Exchanges. To accomplish this mission, we must empower patients to work with their doctors and make healthcare decisions that are best for them. Our beneficiaries and consumers need to be equipped with meaningful information about quality and costs in order to be active health care consumers.

CMS' vision for the year ahead is progressively focused on a more competitive American health care system that delivers affordable, high quality care, at a sustainable cost, with less burdensome regulations. Supporting this vision, CMS has established an agency-wide objective to 'Improve the nation's health and quality of life'.

This CMS agency-wide objective will be achieved through our continued focus on advancing our 16 Strategic Initiatives:

1. Strengthening Medicare 2. Transforming Medicaid 3. Marketplace Choice and Affordability 4. Lowering Drug Prices 5. Price Transparency 6. Rethinking Rural Health 7. Protecting Taxpayer Dollars

8. eMedicare

9. Ensuring Safety & Quality 10. Patients Over Paperwork 11. Fostering Innovation 12. MyHealthEData 13. Fighting The Opioid Epidemic 14. Better Care for Dual Eligibles 15. Innovative Payment Models 16. Modernizing CMS

This performance budget reflects CMS' vision by investing in our people, processes, structure, and capabilities. CMS will continue to build on successes of previous years focusing all of its authority and programs on one objective: transforming the health care system to deliver better value and results for patients through competition and innovation. CMS is holding the entire health care system-health plans, states, contractors, providers, clinicians-accountable by encouraging choice and competition to develop new tools and solutions that will allow the system to deliver value to patients.

We take our role seriously in leading efforts to improve the quality and affordability of health care for all Americans; drive American health care towards payment for value, not volume, and, lower the rate of growth in America's health care spending.

The investments proposed in FY 2021 will keep CMS on the leading edge of providing high quality healthcare that all Americans deserve, while also pursuing program integrity methods to "Pay it Right" and better prevent fraudulent or improper payments.

On behalf of all those we serve, I thank you for your continued support of CMS and it FY 2021 performance budget.

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OFFICE OF PROGRAM OPERATIONS & LOCAL ENGAGEMENT Nancy O'Connor, Dir*

Nancy O'Connor, Dep. Dir. Of Drug Health Plan Opers. Gregory Dill, Dep. Dir. For Innovation & Fin. Mgmt.

John Hammarlund, Dep. Dir. For Local Eng. & Admin. Ray Hurd, Dep. Dir. For Strategy & Bus. Opers.

OFFICE OF ENTERPRISE DATA AND ANALYTICS

Allison Oelschlaeger, Dir. & CMS Chief Data Officer Andy Shatto, Dep. Dir.

OFFICE OF HUMAN CAPITAL Scott Giberson, Director* Craig Gillespie, Dep. Dir.*

OFFICE OF EQUAL OPPORTUNITY AND CIVIL RIGHTS Anita Pinder, Director

Alaina Jenkins, Dep. Dir.

OFFICE OF COMMUNICATIONS Tom Corry, Director

Mary Wallace, Dep. Dir. Karen Aldana, Dep. Dir.

OFFICE OF LEGISLATION Alec Aramanda, Director

Jennifer Boulanger, Dep. Dir.

FEDERAL COORDINATED HEALTH CARE OFFICE

Tim Engelhardt, Director Sara Vitolo, Dep. Dir.

OFFICE OF MINORITY HEALTH Cara V. James, Director

Capt. Wanda Finch, Dep. Dir.

OFFICE OF THE ACTUARY Paul Spitalnic

Director and CMS Chief Actuary

OFFICE OF STRATEGIC OPERATIONS AND REGULATORY AFFAIRS Kathleen Cantwell, Director Olen Clybourn, Dep. Dir.

OFFICE OF FINANCIAL MANAGEMENT Megan Worstell, Director & CMS Chief Financial Officer

Maria Montilla, Dep. Dir.*

DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR MEDICARE & MEDICAID SERVICES

Seema Verma

ADMINISTRATOR

Vacant CHIEF PRINCIPAL DEPUTY ADMINISTRATOR AND CHIEF OF STAFF

Brady Brookes DEPUTY ADMINISTRATOR AND DEPUTY CHIEF OF STAFF

Kimberly Brandt PRINCIPAL DEPUTY ADMINISTRATOR FOR POLICY AND OPERATIONS

Demetrios Kouzoukas PRINCIPAL DEPUTY ADMINISTRATOR FOR MEDICARE

& DIRECTOR, CENTER FOR MEDICARE

Brad Smith DEPUTY ADMINISTRATOR AND DIRECTOR

Jennifer Main, CHIEF OPERATING OFFICER Karen Jackson, DEPUTY CHIEF OPERATING OFFICER

CONTINUOUS IMPROVEMENT & STRAT. PLAN. STAFF Andrea Chapman, Director*

DIGITAL SERVICE @ CMS Misu Tasnim, Director

OPERATIONS

HEALTH INFORMATICS OFFICE

Vacant, Dir. & Chief Health Informatics Officer

Alex Mugge, Deputy Chief Health Informatics Officer

EMERGENCY PREPAREDNESS & RESPONSE OPERATIONS Bobby Saxon, Dir.*

OFFICE OF ACQUISITION AND GRANTS MANAGEMENT

Melissa Starinsky, Director Derrick Heard, Dep. Dir.

OFFICE OF INFORMATION TECHNOLOGY Rajiv Uppal, Dir. & CMS Chief Information Officer (CIO)

Mark Hogle, Dep. Dir. George Hoffmann, Dep. Dir. & Dep. CIO George Linares, CMS Chief Technology Officer

OFFICE OF SUPPORT SERVICES AND OPERATIONS Jim Weber, Director

Elizabeth Mack, Dep. Dir.

OFFICES OF HEARINGS AND INQUIRIES Randy Brauer, Director James Slade, Dep. Dir.

APPROVED as of February 3, 2020 * Acting

CENTER FOR CLINICAL STANDARDS AND QUALITY

Kate Goodrich, Director and CMS Chief Medical Officer Jean Moody-Williams, Dep. Dir. Jeneen Iwugo, Dep. Dir.

Shari Ling,, M.D., CMS Dep. Chief Medical Officer --------------------------------

OFFICE OF CLINICIAN ENGAGEMENT Barry Marx, M.D., Dir.

CENTER FOR MEDICARE AND MEDICAID INNOVATION Brad Smith, Deputy Administrator and Director

Amy Bassano, Dep. Dir. Arrah Tabe-Bedward, Dep. Dir.

CENTER FOR MEDICARE Demetrios Kouzoukas, Principal Deputy Administrator for Medicare and Director John Brooks, Principal Deputy Director

Elizabeth Richter, Dep. Dir. Cheri Rice, Dep. Dir.

CENTER FOR MEDICAID AND CHIP SERVICES Calder Lynch, Deputy Administrator and Director

Karen Shields, Dep. Dir. Vacant, Dep. Dir.

CENTER FOR PROGRAM INTEGRITY Alec Alexander, Deputy Administrator and Director

Bradley Hart, Dep. Dir. George Mills, Jr., Dep. Dir..

CENTER FOR CONSUMER INFORMATION AND INSURANCE OVERSIGHT

Randy Pate, Deputy Administrator and Director Jeff Grant, Dep. Dir. for Operations Jeff Wu, Dep. Dir. for Policy

Bobby Saxon, Center Chief Technology Officer

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Table of Contents

EXECUTIVE SUMMARY & BUDGET OVERVIEW Executive Summary and Overview of Performance Program Management All Purpose Table

NARRATIVES BY ACTIVITY Discretionary Appropriations CMS Program Management

Budget Exhibits Program Management Appropriation Language Program Management Language Analysis Amounts Available for Obligation Summary of Changes Budget Authority by Activity Authorizing Legislation Appropriation History Table Appropriations Not Authorized by Law

Narrative by Activity Program Operations Federal Administration Medicare Survey & Certification Program

Mandatory Appropriations Medicaid Payments to the Health Care Trust Funds

Other Accounts Health Care Fraud and Abuse Control (HCFAC) Children's Health Insurance Program (CHIP) State Grants and Demonstrations Information Technology Federal Exchanges

OFFICE OF NATIONAL DRUG CONTROL POLICY Information on Drug Control Programs Summary Table and Narrative

SUPPLEMENTARY TABLES Budget Authority by Object Class Salaries and Expenses Detail of Full-Time Equivalent Employment (FTE) Detail of Positions Programs Proposed for Elimination FTE Funded by the Affordable Care Act Physician's Comparability Allowance (PCA) Worksheet

Page

1 9

12 13 16 17 18 19 20 23

25 63 69

85 107

121 151 161 181 195

203

213 214 215 218 219 220 224

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Table of Contents

SIGNIFICANT ITEMS Significant Items in Appropriation Committee Reports

CMS SPECIFIC ITEMS Proposed Law Summary Proposed Law Table Modernization of the Public-Facing Digital Services ? Integrated Digital Experience Act

CMS PERFORMANCE APPENDIX Program Operations Medicare Survey & Certification Program Medicaid HCFAC Medicare Quality Improvement Organizations (QIO) Medicare Benefits CHIP Center for Medicare and Medicaid Innovation (CMMI) CMS Discontinued Performance Measures

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