Center for Clinical Standards and Quality

Functional Statement

• Serves as the focal point for all quality, clinical, medical science issues, survey and certification, and policies for CMS' programs. Provides leadership and coordination for the development and implementation of a cohesive, CMS-wide approach to measuring and promoting quality and leads CMS's priority-setting process for clinical quality improvement. Coordinates quality-related activities with outside organizations. Monitors the quality of Medicare, Medicaid, and the Clinical Laboratory and Improvement Amendments (CLIA). Evaluates the success of interventions.
• Identifies and develops best practices and techniques in quality improvement; implementation of these techniques will be overseen by appropriate components. Collaborates on demonstration projects to test and promote quality measurement and improvement.
• Develops, tests evaluate, adopts, and supports performance measurement systems (i.e., quality measures) to evaluate the care provided to CMS beneficiaries except for demonstration projects residing in other components.
• Assures that CMS's quality-related activities (survey and certification, technical assistance, beneficiary information, payment policies, and provider/plan incentives) are fully and effectively integrated. Carries out the Health Care Quality Improvement Program for the Medicare, Medicaid, and CLIA programs.
• Oversees the planning, policy, coordination, and implementation of the survey, certification and enforcement programs for all Medicare and Medicaid providers and suppliers, and for laboratories under the auspices of CLIA.
• Serves as CMS's lead for management, oversight, budget, and performance issues relating to the survey and certification program and the related interactions with the States.
• Leads in the specification and operational refinement of an integrated CMS quality information system, which includes tools for measuring the coordination of care between health care settings; analyzes data supplied by that system to identify opportunities to improve care and assess the success of improvement interventions.
• Develops requirements of participation for providers and plans in the Medicare, Medicaid, and CLIA programs. Revises requirements based on statutory change and input from other components.
• Operates the Quality Improvement Organization and End-Stage Renal Disease Network program in conjunction with Regional Offices, providing policies and procedures, contract design, program coordination, and leadership in selected projects.
• Identifies, prioritizes, and develops content for clinical and health-related aspects of CMS's Consumer Information Strategy; collaborates with other components to develop comparative providers and plan performance information for consumer choices.
• Prepares the scientific, clinical, and procedural basis for coverage of new and established technologies and services and provides coverage recommendations to the CMS Administrator. Coordinates activities of CMS's Technology Advisory Committee and maintains liaison with other departmental components regarding the safety and effectiveness of technologies and services; prepares the scientific and clinical basis for, and recommends approaches to, quality-related medical review activities of carriers and payment policies.
• Identifies new and innovative approaches and tests for improving quality programs and lowering costs.