Summary: The reorganization of the Health Care Financing Administration (HCFA) within the Department of Health, Education, and Welfare (HEW), which has resulted in the placement of Medicaid, Medicare, and quality and standards primarily under the direction of one agency head, should result in improved management of the programs through better coordination of efforts and exchange of information. The organizational structure, including the authorization of specific supergrade positions, is still developing. HCFA requests for supergrade and executive-level staff have been cut in half since the initial proposal, and some reductions have occurred since the Subcommittee on Health questioned the matter. The continued split between the Public Health Service and HCFA can be expected to result in problems with respect to the administration and management of the health financing programs authorized by the Social Security Act. There is evidence of duplication and overlapping of staff activities in functional statements issued by HCFA and other elements of HEW. However, most of these duplications were in the area of planning or carrying out evaluations, studies, and research where the identification of precise duplication based on broad functional statements is difficult. The primary areas where real consolidation has occurred are in program integrity and the administration of standards and provider certifications. Little has occurred in other consolidation of Medicaid and Medicare functions presumably because of the major differences in the legislation for the two programs.
