A. Health Standards and Quality Bureau (HSQB)

1. Develops, interprets and implements health quality and safety standards and evaluates their impact on the utilization, quality, and cost of health care services;

2. Develops, interprets, implements, and evaluates the conditions and standards of participation by and monitors and validates certification activities for providers and suppliers of health services under the Medicare and Medicaid programs;

3. Develops, interprets, implements, and evaluates policies for professional standards review, related peer review, utilization review, and utilization control programs under Medicare and Medicaid;

4. Develops and manages grants with PSRO’s and contacts with statewide Professional Standards Review Councils and develops policies regarding operational aspects of peer and utilization review programs, including their monitoring and evaluation;

5. Develops and evaluates health care and health-related policies related to implementation of the End Stage Renal Disease (ESRD) provision and coordinates with Medicare the implementation and monitoring of their policies;

6. Determines information and data reporting, collection and systems requirements for the PSRO and provider certification programs;

7. Serves as the CMS focal point in the agency’s interface with the Assistant Secretary for Health and the Public Health Service on Medical Care Standards Quality Assurance, and other health-related matters.