Centers for Medicare and Medicaid Services

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Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services logo.png
Agency overview
Formed June 20, 1977
Preceding agency Health Care Financing Administration (1977-2001)
Headquarters Woodlawn, Baltimore County, Maryland
Agency executive Marilyn Tavenner, Administrator, Centers for Medicare and Medicaid Services
Parent agency Department of Health and Human Services
Website
cms.gov

The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP)[1], and health insurance portability standards.[2]

In addition to these programs, CMS has other responsibilities, including managing the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA)[3], developing quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process[4], developing and enforcing its clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments (CLIA) program[5], and overseeing the Healthcare.gov site.

History

President Lyndon B. Johnson signed the Social Security Amendments on July 30, 1965, establishing both Medicare and Medicaid. The Social Security Administration (SSA) became responsible for the administration of Medicare, and the Social and Rehabilitation Service (SRS) became responsible for the administration of Medicaid. Both agencies were organized under what was then known as the Department of Health, Education, and Welfare (HEW).

In March 1977, HEW secretary Joseph A. Califano, Jr. announced a reorganization of HEW to improve its operations and delivery of service. This reorganization included the creation of the Health Care Financing Administration (HCFA), which would suddenly "be responsible for administering both Medicare and Medicaid and most of the activities which support these two programs."[6] On June 20, 1977, the HCFA began operating under HEW. HCFA became responsible for the coordination of Medicare and Medicaid; however, responsibility for enrolling beneficiaries into Medicare and processing premium payments remained with SSA.[6][7]

By early 1995, the HCFA was providing services for nearly 37 million Medicare beneficiaries and another 36 million Medicaid beneficiaries. The agency was also in the process of pushing for improved services to beneficiaries and providers via an integrated, national system that would replace the nine existing claims processing systems in use.[8]

On June 14, 2001, the U.S. Department of Health and Human Services announced it would be changing the HCFA's name[9]:

Changing the agency's name is the first, visible sign of the many steps being taken to change the agency and drive it to be [the] responsive and effective agency that it should be. The new name of the Centers for Medicare & Medicaid Services reflects the scope of the agency's mission — to serve Medicare and Medicaid beneficiaries. It will help consumers identify the agency that administers their health insurance and will help to develop a more consumer-friendly association. In addition, the agency will be restructured to focus more clearly on its distinct lines of business.

That restructuring led to the creation of three centers to handle traditional fee-for-service Medicare, Medicare+Choice, and state-administered programs like Medicaid and SCHIP:

  1. The Center for Medicare Management - fee-for-service Medicare program, including the development of payment policy and oversight of fee-for-service contractors
  2. The Center for Beneficiary Choices - Medicare, Medicare Select, Medicare+Choice and Medigap options, including management of consumer research and demonstrations, as well as grievance and appeals functions
  3. The Center for Medicaid and State Operations - programs administered by states, including Medicaid, the State Children's Health Insurance Program (SCHIP), the Clinical Laboratory Improvements Act (CLIA) program, and additional insurance regulation and certification functions

Workforce

As of September 2013 the CMS employs approximately 5,800 employees at its headquarters in Woodlawn, Maryland, the Hubert H. Humphrey Building in Washington, D.C., its 10 regional offices, and in various field offices located throughout the United States.[10]

The head of the CMS is the Administrator of the Center for Medicare & Medicaid Services. The position is appointed by the president and confirmed by the Senate.[11]

External links

References

  1. ↑ "Children's Health Insurance Program (CHIP)". Medicaid.gov. Centers for Medicare & Medicaid Services. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Childrens-Health-Insurance-Program-CHIP/Childrens-Health-Insurance-Program-CHIP.html. Retrieved 23 March 2014. 
  2. ↑ "HI 00208.010 Role of the Centers for Medicare & Medicaid Services (CMS)". Program Operations Manual System (POMS). U.S. Social Security Administration. 12 September 2003. http://policy.ssa.gov/poms.nsf/lnx/0600208010. Retrieved 23 March 2014. 
  3. ↑ "HIPAA - General Information". CMS.gov. Centers for Medicare & Medicaid Services. http://cms.hhs.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/index.html. Retrieved 23 March 2014. 
  4. ↑ "Skilled Nursing Facility Center". CMS.gov. Centers for Medicare & Medicaid Services. http://cms.hhs.gov/Center/Provider-Type/Skilled-Nursing-Facility-Center.html. Retrieved 23 March 2014. 
  5. ↑ "Clinical Laboratory Improvement Amendments (CLIA)". CMS.gov. Centers for Medicare & Medicaid Services. http://cms.hhs.gov/Regulations-and-Guidance/Legislation/CLIA/index.html. Retrieved 23 March 2014. 
  6. ↑ 6.0 6.1 Ahart, Gregory J. (21 July 1977). "Development and Organization of the Health Care Financing Administration" (PDF). Government Accountability Office. http://archive.gao.gov/f1102b/102852.pdf. Retrieved 23 March 2014. 
  7. ↑ "Social Security History - Organizational History". U.S. Social Security Administration. http://www.ssa.gov/history/orghist.html. Retrieved 23 March 2014. 
  8. ↑ National Performance Review (21 February 1995). "Health Care Financing Administration (HCFA)". National Partnership for Reinventing Government. University of North Texas Libraries, Government Documents Dept. http://govinfo.library.unt.edu/npr/library/rsreport/220e.html. Retrieved 23 March 2014. 
  9. ↑ "The New Centers for Medicare & Medicaid Services (CMS)" (PDF). U.S. Department of Health and Human Services. 14 June 2001. http://cdn.ca9.uscourts.gov/datastore/library/2013/02/26/Providence_pressrelease.pdf. Retrieved 23 March 2014. 
  10. ↑ "FedScope - Employment Cubes - September 2013". U.S. Office of Personnel Management. September 2013. http://www.fedscope.opm.gov/employment.asp. Retrieved 23 March 2014. "Cabinet Level Agencies > Department of Health and Human Services > Centers for Medicare and Medicaid Services" 
  11. ↑ Kliff, Sarah (23 November 2011). "Medicare administrator Donald Berwick resigns in the face of Republican opposition". The Washington Post. http://www.washingtonpost.com/national/health-science/medicare-administrator-donald-berwick-resigns-in-the-face-of-republican-opposition/2011/11/23/gIQA5S7mpN_story.html. Retrieved 23 March 2014. 
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