Page 1 GAO-13-377R Center for Strategic Planning

United States Government Accountability Office

Washington, DC 20548

April 1, 2013

The Honorable Orrin G. Hatch

Ranking Member

Committee on Finance

United States Senate

The Honorable Tom Coburn

Ranking Member

Committee on Homeland Security and Governmental Affairs

United States Senate

The Honorable Michael B. Enzi

United States Senate

Subject: CMS: Activities, Staffing, and Funding for the Center for Strategic Planning

The Centers for Medicare & Medicaid Services (CMS)—an agency within the U.S. 

Department of Health and Human Services (HHS)—is responsible for overseeing

Medicare, Medicaid, and the State Children’s Health Insurance Program.1

With its programs playing a central role in the financing of the nation’s health care for 

the foreseeable future, CMS has taken steps to make the agency’s strategic 

Together, 

these programs provide health insurance coverage for over 100 million men, 

women, and children and account for a significant share of national health care 

spending. Medicare and Medicaid expenditures accounted for 36 percent of national 

health care spending in 2011 and are expected to increase as a share of national 

health care spending, driven in part by increases in Medicare enrollment and 

expanded Medicaid coverage.

 

1

Medicare is the federally financed health insurance program for persons aged 65 or over, individuals 

under the age of 65 with certain disabilities, and individuals with end-stage renal disease. Medicaid is 

a joint federal-state program that finances health care for certain categories of low-income individuals. 

The State Children’s Health Insurance Program is another federal-state program that provides health 

care coverage to children under 19 years of age living in low-income families whose incomes exceed 

the eligibility requirement for Medicaid. 
Page 2 GAO-13-377R Center for Strategic Planning

planning a priority.2

To develop this report, we reviewed documentation from CMS, including 

organizational charts, descriptions of functions and activities, guidance documents 

on strategic planning processes, and planning reports. We also reviewed data from 

fiscal years 2010, 2011, and 2012 on CSP’s staffing and funds obligated.

In 2010, as part of an internal reorganization, CMS established 

the Center for Strategic Planning (CSP) to facilitate the agency’s strategic planning 

efforts. You expressed an interest in learning more about the activities CSP 

conducts to facilitate CMS’s strategic planning. This report describes CSP’s current 

activities and staffing, as well as CSP’s funding for the most recent full fiscal year.

3

Results in Brief

In 

addition, we interviewed CMS officials about CSP’s activities, staffing, and funds 

obligated. Our work for this performance audit was conducted from October 2012 

through March 2013 in accordance with generally accepted government auditing 

standards. Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our findings and 

conclusions based on our audit objectives. We believe that the evidence obtained 

provides a reasonable basis for our findings and conclusions based on our audit 

objectives.

CSP’s activities, staff, and funding support strategic planning by individual CMS 

offices and centers as well as the agency itself. CMS officials told us that CSP 

assists individual offices and centers in developing strategic plans for their units, 

leads the agency’s senior-level strategic planning meetings, and is helping to 

develop a centralized approach to monitor the implementation of CMS’s agencywide strategic plan. As of January 2013, CSP had 11 staff and it had $1.9 million in 

funds obligated for fiscal year 2012. Staff size and funding for CSP’s most recent 

fiscal year represent a decrease compared to prior years, in part because CSP’s 

activities have been narrowed in scope since the office was established in 2010, 

according to CMS officials. We provided a draft of this report to HHS for comment.

After its review, HHS indicated that it did not have any comments.

CSP Activities, Staffing, and Funding

According to CMS officials and agency documents, CSP engages in a range of 

activities to facilitate CMS’s long-term strategic planning. Among the range of CSP 

activities that support CMS’s strategic planning, one of the center’s key functions is 

to consult with staff in individual CMS offices and centers. Specifically, CSP staff 

educate other staff about CMS’s strategic planning approach and help them conduct 

 

2

In general, strategic planning is used to define an organization’s missions, establish measurable 

goals in support of those missions, and implement strategies to achieve the goals and align resources 

in support of these efforts. HHS, like all federal departments, is required to develop a strategic plan 

under the Government Performance and Results Act (GPRA). Pub. L. No. 103-62, § 3, 107 Stat. 285 

(codified, as amended, at 5 U.S.C. § 306) (1993). While federal agencies such as CMS that exist 

within departments are not required to conduct strategic planning, they may choose to do so. In 

September 2012, CMS issued its Strategic Roadmap, which sets out the agency’s mission and goals. 

In addition, individual centers and offices within CMS may choose to conduct strategic planning.

3

The term “funds obligated” refers to a definite commitment by a federal agency that creates a legal 

liability to make payments immediately or in the future.
Page 3 GAO-13-377R Center for Strategic Planning

strategic planning for their office or center.4 Officials told us that when helping CMS 

centers or offices develop their own strategic plans, CSP staff seek to ensure that 

such plans are consistent with the agency’s overall strategic approach and with 

activities in other parts of the agency. As an example of CSP’s efforts, CMS officials 

described CSP’s work with the Center for Medicare to help the center conduct 

strategic planning for its Medicare Advantage Program.5 The officials told us that 

CSP staff helped the Center for Medicare form a planning team, facilitated the 

team’s meetings, and guided the team through the steps of the planning process.6

CMS officials said that in addition to working with individual centers and offices, CSP 

facilitates CMS’s agency-wide planning by leading the monthly meetings of CMS’s 

Strategic Planning and Management Council (SPMC), which serves as the agency’s 

governing board. The SPMC comprises senior staff from each of CMS’s centers and 

offices and determines the agency’s overall direction and priorities, including CMS’s 

strategic planning objectives.7

CSP had 11 staff as of January 2013 and $1.9 million in funds obligated for fiscal 

year 2012. Six CSP staff are at the top levels of the federal “General Schedule” of 

employment categories—grades 14 and 15—while no staff are at the Senior 

Executive Service level, which ranks above the General Schedule categories.

CSP officials also told us that CSP works with CMS’s 

Office of Enterprise Management (OEM), the office responsible for establishing 

project management tools and for developing the agency’s performance measures. 

The officials told us that CSP is assisting OEM in developing the performance 

measures that will be used to monitor the implementation of CMS’s strategic plan 

and supporting OEM in developing a centralized approach for tracking the agency’s 

progress on those measures.

8

CMS’s Deputy Chief Operating Officer in the Office of the Administrator serves as 

the Acting Deputy Administrator and Director of CSP. According to CMS officials, 

CSP staff include individuals with professional backgrounds in strategic planning and 

process improvement, including experience in strategic planning with other federal 

agencies. Of CSP’s fiscal year 2012 funds obligated of $1.9 million, 82.9 percent 

was for salaries and benefits, and 17.1 percent was for research expenses and for 

other administrative costs that year such as travel and supplies.

 

4

CMS’s strategic planning process is documented in CMS’s Strategy Management Toolkit. The 

Strategy Management Toolkit was developed by CMS with the assistance of a strategic planning 

contractor.

5

The Medicare Advantage program provides health coverage to Medicare beneficiaries through 

private health plans offered by organizations under contract with CMS.

6

According to CMS officials, examples of other CMS divisions that CSP has assisted in strategic 

planning are the Office of Acquisition and Grants Management, the Office of Public Engagement, the 

Office of Minority Health, the Center for Medicaid and CHIP Services, the Office of Equal Opportunity 

and Civil Rights, and the Center for Clinical Standards and Quality.

7

CMS officials said they expect to distribute a strategic plan internally within the agency in March 

2013. 

8

The General Schedule is a classification and pay system for the majority of civilian federal 

employees. The General Schedule has 15 grades—GS-1 (lowest) to GS-15 (highest). Senior 

Executive Service positions are federal employee positions that are classified above GS-15.
Page 4 GAO-13-377R Center for Strategic Planning

CMS officials said that CSP’s staff size and funding for the most recent full fiscal 

year (2012) represent a decrease compared to prior years, in part because CSP’s 

activities have narrowed in scope since the office was established in 2010. CSP’s 

staff and funds obligated declined in each year from fiscal years 2010 through 2012.

In fiscal year 2010 CSP had 179 staff and funds obligated of $151.5 million; in fiscal 

year 2011 it had 83 staff and funds obligated of $51.2 million; by fiscal year 2012 it 

had 12 staff and funds obligated of $1.9 million. The reduction in CSP’s staffing and 

funding occurred in part because CMS transferred responsibility for some of CSP’s 

activities and associated staff to other CMS centers or offices. For example: in 

November 2010 some CSP staff were moved to the newly established Center for 

Medicare and Medicaid Innovation (CMMI); in December 2010 some CSP staff were 

moved to the newly established Federal Coordinated Health Care Office (FCHCO); 

in March 2011 certain research and development functions and staff were moved 

from CSP into CMMI; and in April 2012, responsibility for certain data functions and 

associated staff were transferred from CSP to the Office of Enterprise Management.9

Agency Comments

HHS reviewed a draft of this report and indicated that it did not have any comments.

– – – – – 

As we agreed with your offices, unless you publicly announce the contents of this 

report earlier, we plan no further distribution until 30 days from its date. At that time 

we will send copies of this report to the Secretary of Health and Human Services. In 

addition, the report will be available at no charge on our website at 

http://www.gao.gov. 

If you or your staff have any questions regarding this report, please contact me at 

(202) 512-7114 or kohnl@gao.gov. Contact points for our offices of Congressional 

Relations and Public Affairs may be found on the last page of this report. GAO staff 

making key contributions to this report include Kristi Peterson, Assistant Director; 

Mary Giffin; and Krister Friday.

Linda T. Kohn

Director, Health Care

(291091) 

 

9

The Secretary of Health and Human Services was required to establish CMMI and FCHCO within 

CMS under the Patient Protection and Affordable Care Act (PPACA). See Pub. L. No. 111-148, 

§ 2602, 3021, 124 Stat. 119, 315, 389. The purpose of CMMI is to test new models for delivering and 

paying for health services under Medicare and Medicaid, and the purpose of FCHCO is to more 

effectively integrate benefits under Medicare and Medicaid for individuals eligible for both programs.
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