In an attempt to better position itself to respond to the changing healthcare environment -- and to the needs of beneficiaries -- the Health Care Financing Administration (HCFA) announced a restructuring Nov. 7.
"It is built around HCFA’s three primary audiences: our beneficiaries, the plans and providers who care for them, and the states. There will be separate divisions at HCFA focusing on the needs of each of these three groups," HCFA Administrator Bruce Vladeck said.
The restructuring has been in the works for the past eight months and is expected to be implemented by mid-July.
Currently the agency’s patient operations are divided into three areas. One division is responsible for fee-for-service Medicare enrollees; a second handles operations involving Medicare enrollees in managed care plans; and a third is responsible for most Medicaid operations.
A new unit, known as Beneficiary Services and Operations, will be responsible for assisting people with all types of health coverage provided by HCFA -- Medicare fee-for-service, Medicare HMOs, and a limited number of Medicaid programs. This unit will help beneficiaries with such things as receiving reimbursements and filing appeals with HMOs and will assist people who are having problems enrolling in Medicare.
"We will eliminate outdated distinctions. For example, managed care is no longer a sideline but an integral and rapidly growing part of our operations. It makes more sense to integrate managed care and fee-for-service operations throughout the agency than to maintain a separate Office of Managed Care," Vladeck said. HMOs, home health agencies, and other suppliers of health services to Medicare will work with the Health Plan and Provider Operations unit, which will address quality of care issues, business operations, and mass purchasing programs undertaken by HCFA.A third unit, to be called State Operations, will work with states on Medicaid issues. The agency is "combining the Medicaid Bureau, survey and certification operations, insurance regulation, clinical laboratory regulation, and intergovernmental affairs into this unit," Vladeck said.
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