organized. The secretary has discretion to assign the administration of those programs to whatever entity within the department he may choose or create and to designate the official he chooses to be in charge of those programs. Likewise, there are no statutory directions or limitations on the internal organization of whatever unit he specifies to administer those programs. As we have seen, no statutory provision directs that Medicare and Medicaid, or any of the components thereof, be administered by the same organizational unit within the department.

The only statutory provisions we have found that appear to affect the organization of CMS are in section 1117 of the SSA. Subsection (a) thereof requires that the administrator of the Health Care Financing Administration (HCFA) shall be appointed by the President with the advice and consent of the Senate. Subsection (b) establishes within the administration the position of chief actuary, requires that he be in direct line authority to the administrator, and specifies that he may be removed only for cause. Interestingly, section 1117 does not create the position of administrator; it merely requires that it be an advice and consent position. That provision did not prevent the secretary from renaming HCFA as the Centers for Medicare and Medicaid Services in 2001, nor would it seem to prevent the secretary from eliminating that position and/or reorganizing the functions thereof.

Agency for Healthcare Research and Quality

Section 901 of the PHSA establishes within PHS the Agency for Healthcare Research and Quality (AHRQ) and specifies that it be headed by a director appointed by the secretary. The statute requires that the functions of the agency specified in title IX of the PHSA shall be carried out through the director.

Title IX contains no other organizational directions or limitations on AHRQ. However, other parts of the PHSA contain a number of provisions directing the secretary to carry out certain functions through AHRQ (e.g., the conduct of studies to support organ donation and organ recovery, preservation, and transportation [sec. 377C]; the conduct of a research, evaluation, and assessment program on the impact and cost-effectiveness of HIV treatments [sec. 2673]). (The appendix to this paper contains a list of the provisions.) There are other provisions requiring or encouraging consultation with AHRQ by the secretary and other officials



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