Centers for Medicare and Medicaid Services

Last updated
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services logo.svg
Agency overview
FormedJuly 30, 1965;54 years ago (1965-07-30)
Preceding
  • Health Care Financing Administration (1977-2001)
Headquarters Woodlawn, Baltimore County, Maryland
Employees4,100
Agency executive
Website www.cms.gov

The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), 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), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov.

United States Department of Health and Human Services Department of the US federal government

The United States Department of Health & Human Services (HHS), also known as the Health Department, is a cabinet-level department of the U.S. federal government with the goal of protecting the health of all Americans and providing essential human services. Its motto is "Improving the health, safety, and well-being of America". Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).

Medicare (United States) United States single-payer national social insurance program

Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the Social Security Administration, as well as people with end stage renal disease and amyotrophic lateral sclerosis.

Medicaid United States social health care program for families and individuals with limited resources

Medicaid in the United States is a federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The Health Insurance Association of America describes Medicaid as "a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care." Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people as of 2017. It is a means-tested program that is jointly funded by the state and federal governments and managed by the states, with each state currently having broad leeway to determine who is eligible for its implementation of the program. States are not required to participate in the program, although all have since 1982. Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities. Poverty alone does not necessarily qualify someone for Medicaid.

Contents

History

President Lyndon B. Johnson signed the Social Security Amendments on July 30, 1965, establishing both Medicare and Medicaid. Arthur E. Hess, a deputy commissioner of the Social Security Administration, was named as first director of the Bureau of Health Insurance in 1965, placing him as the first executive in charge of the Medicare program. At the time, the program provided health insurance to 19 million Americans. [2] 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).

Lyndon B. Johnson 36th president of the United States

Lyndon Baines Johnson, often referred to as LBJ, was an American politician who served as the 36th president of the United States from 1963 to 1969. Formerly the 37th vice president from 1961 to 1963, he assumed the presidency following the assassination of President John F. Kennedy. A Democrat from Texas, Johnson also served as a United States Representative and as the Majority Leader in the United States Senate. Johnson is one of only four people who have served in all four federal elected positions.

Social Security Amendments of 1965

The Social Security Amendments of 1965, Pub.L. 89–97, 79 Stat. 286, enacted July 30, 1965, was legislation in the United States whose most important provisions resulted in creation of two programs: Medicare and Medicaid. The legislation initially provided federal health insurance for the elderly and for poor families.

Arthur E. Hess, former acting commissioner of the Social Security Administration, was born in Reading, Pennsylvania. Hess graduated from Princeton University in 1939 and received a law degree from the University of Maryland in 1948. Shortly after graduating from Princeton, he took his first government job as a field representative for the Social Security Administration.

In 1977, the Health Care Financing Administration (HCFA) was established under HEW. HCFA became responsible for the coordination of Medicare and Medicaid. The responsibility for enrolling beneficiaries into Medicare and processing premium payments remained with SSA.

Workforce

The CMS employs over 6,000 people, of whom about 4,000 are located at its headquarters in Woodlawn, Maryland. The remaining employees are located in the Hubert H. Humphrey Building in Washington, D.C., the 10 regional offices listed below, and in various field offices located throughout the United States.

Woodlawn, Baltimore County, Maryland Place in Maryland, United States

Woodlawn is an unincorporated community and census-designated place in Baltimore County, Maryland, United States. The population was 37,879 at the 2010 census. It is home to the headquarters of the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS). It is bordered by Catonsville on the south, by the Patapsco River and Howard County on the west, by Randallstown and Lochearn to the north, and by the City of Baltimore to the east. Parts of Woodlawn are sometimes informally referred to as Security, Maryland, due to the importance of the SSA's headquarters as well as nearby Security Boulevard and Security Square Mall.

Hubert H. Humphrey Building

The Hubert H. Humphrey Building is a low-rise Brutalist office building located in Washington, D.C., in the United States. Originally known as the South Portal Building, the Hubert H. Humphrey Building was dedicated on November 1, 1977. It became the headquarters of the United States Department of Health, Education, and Welfare (HEW). After the department's education component was given to the newly created United States Department of Education in 1979, the newly named United States Department of Health and Human Services (HHS) continued to occupy the structure.

Washington, D.C. Capital of the United States

Washington, D.C., formally the District of Columbia and commonly referred to as Washington or D.C., is the capital of the United States. Founded after the American Revolution as the seat of government of the newly independent country, Washington was named after George Washington, the first president of the United States and a Founding Father. As the seat of the United States federal government and several international organizations, Washington is an important world political capital. The city, located on the Potomac River bordering Maryland and Virginia, is one of the most visited cities in the world, with more than 20 million tourists annually.

The head of the CMS is the Administrator of the Centers for Medicare & Medicaid Services. The position is appointed by the president and confirmed by the Senate. [3] On March 13, 2017, Seema Verma was confirmed by the US Senate as Administrator of CMS. [4]

Seema Verma American health policy consultant and the current administrator of the Centers for Medicare and Medicaid Services

Seema Verma is an American health policy consultant and the current Administrator of the Centers for Medicare and Medicaid Services, serving in the Trump Administration. She is the founder and previous CEO of SVC Inc., a health policy consulting firm, which was acquired by Health Management Associates (HMA) just prior to Verma's nomination to head CMS.

Regional offices

CMS has its headquarters in Woodlawn, Maryland, with 10 regional offices located throughout the United States:

See also

The Center for Medicare and Medicaid Innovation is an organization of the United States government under the Centers for Medicare and Medicaid Services (CMS). It was created by the Patient Protection and Affordable Care Act, the 2010 U.S. health care reform legislation. "The center is to test innovative payment and delivery system models that show important promise for maintaining or improving the quality of care in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP), while slowing the rate of growth in program costs". The center "is to give priority to twenty models specified in the law, including medical homes, all-payer payment reform, and arrangements that transition from fee-for-service reimbursement to global fees and salary-based payment". It is "intended to overcome antireform inertia by creating a mechanism for the diffusion of successful pilot programs" without requiring Congressional approval.

The Zone Program Integrity Contractor (ZPIC) is an entity established in the United States by the Centers for Medicare & Medicaid Services (CMS) to combat fraud, waste and abuse in the Medicare program. As a result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which established seven zones throughout the United States for the purpose of processing Medicare claims, CMS created ZPICs to more effectively protect the Medicare program. ZPICs replaced Program Safeguard Contractors (PSC), which had been established by the Health Insurance Portability and Accountability Act of 1996.

Related Research Articles

Socialized medicine is a term used in the United States to describe and discuss systems of universal health care: medical and hospital care for all by means of government regulation of health care and subsidies derived from taxation. Because of historically negative associations with socialism in American culture, the term is usually used pejoratively in American political discourse. The term was first widely used in the United States by advocates of the American Medical Association in opposition to President Harry S. Truman's 1947 health-care initiative. It was later used in opposition to Medicare.

Diagnosis-related group (DRG) is a system to classify hospital cases into one of originally 467 groups, with the last group being "Ungroupable". This system of classification was developed as a collaborative project by Robert B Fetter, PhD, of the Yale School of Management, and John D. Thompson, MPH, of the Yale School of Public Health. The system is also referred to as "the DRGs", and its intent was to identify the "products" that a hospital provides. One example of a "product" is an appendectomy. The system was developed in anticipation of convincing Congress to use it for reimbursement, to replace "cost based" reimbursement that had been used up to that point. DRGs are assigned by a "grouper" program based on ICD diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used in the US since 1982 to determine how much Medicare pays the hospital for each "product", since patients within each category are clinically similar and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs). DRGs are also standard practice for establishing reimbursements for other Medicare related reimbursements such as to home healthcare providers.

Health Net

Health Net, Inc., a Centene company, is an American health care insurance provider. HMO, POS, insured PPO and government contracts subsidiaries provide health benefits to approximately 5.9 million individuals in all 50 states and the District of Columbia through group, individual, Medicare, Medicaid, Tricare and Veterans Affairs programs. Health Net's behavioral health services subsidiary, MHN, provides behavioral health, substance abuse and employee assistance programs (EAPs) to approximately 7.3 million individuals in various states, including the company's own health plan members. The company's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs. In July 2015, Centene announced its intention to acquire Health Net for $6.8 billion. St. Louis-based Centene completed its acquisition of Health Net in March 2016.

The Arizona Health Care Cost Containment System (AHCCCS) is the name of the Medicaid program in the state of Arizona. As with all Medicaid programs, it is a joint program between the state and the Centers for Medicare and Medicaid Services (CMS). It became the final such state Medicaid program to implemented under Title XIX when it began in October 1982 as a section 1115 demonstration project. The program acronym AHCCCS is frequently pronounced like the word "access."

Thomas Andrew Scully was the Administrator of the Centers for Medicare and Medicaid Services (CMS) from 2001 to 2004 under President George W. Bush. Scully currently is a Principal at Lincoln Policy Group and a partner at its affiliated law firm Scully, Roskey & Missmar, where he focuses on health care regulatory and legislative matters, as well as on advising clients on health policy and strategies for health care delivery. Scully is also a general partner at Welsh, Carson, Anderson & Stowe, a private equity investment firm, where he focuses on health care investments.

Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.

Robert Alan Derzon was an American health care professional who served as the first director of the Health Care Financing Administration (HCFA), the arm of the US federal government responsible for administering Medicare and Medicaid.

The Albany Health and Human Services Corporation (AHHSC) is a proposed public benefit corporation (PBC) of Albany County, New York, and New York State. On May 11, 2009, Albany County Comptroller Michael Conners in his "2009 State of Fisc" proposed a PBC for health in Albany County. On June 9, 2009, the Albany County, Legislature adopted Resolution 205, which directs the County Executive to develop a plan for the long-term care of the elderly in Albany County.

CareStar, Inc. (CareStar) is a private, Ohio-based healthcare corporation which provides home and community-based case management services in government, agency and residential operations. CareStar is the contracted case management administrator of the Ohio Home Care Program and HOME Choice through the Ohio Department of Job and Family Services (ODJFS). CareStar spends about $2 million a year on health benefits for more than 300 employees and their families. Based on Better Business Bureau (BBB) files comparing multiple criteria in several categories, CareStar has a BBB Rating of A+ on a scale from A+ to F.

An Accountable Care Organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to patients and third-party payers for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services, an ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it".

The Healthcare Common Procedure Coding System is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT).

Jerrold Jacob Hercenberg, JD, MPA, is a subject-matter expert for the healthcare and health insurance industry and has been on the cutting edge of numerous innovations over the last 30 years.

Marilyn Tavenner American administrator

Marilyn Barbour Tavenner is the former Administrator of the Centers for Medicare and Medicaid Services, an agency of the United States Department of Health and Human Services. She became Acting Administrator following the resignation of Dr. Donald M. Berwick in December 2011, after serving as the agency's Principal Deputy Administrator. Prior to her original appointment to the Centers for Medicare and Medicaid Services, she served as Secretary of Health and Human Resources in the Cabinet of Virginia Governor Tim Kaine from 2006 to 2010. From 1981 to 2005, she was employed by Hospital Corporation of America, beginning as a nurse at Richmond, Virginia-based Johnston-Willis Hospital eventually becoming Chief Executive Officer of the hospital in 1993. In 2001, she became President of HCA's Central Atlantic Division, and was later appointed Group President of Outpatient Services before resigning from HCA in 2005. She earned B.S. in nursing and M.H.A. degrees from Virginia Commonwealth University.

Following the signing of the Children’s Health Insurance Program (CHIP) into law on August 5, 1997 as Title XXI of the Social Security Act, Utah started looking at how to implement the Federal program under the Center for Medicare and Medicaid Services.

Don I. Wortman

Don I. Wortman is a retired U.S. federal government administrator who served 27 years in senior-level executive positions in many federal government agencies. He was Acting Commissioner of the Social Security Administration (SSA) from December 13, 1977 to October 4, 1978. In early 1977, while working at the Department of Health, Education and Welfare (HEW)—precursor to the Department of Health and Human Services—he was Chairman of the task force for implementing the reorganization of HEW. This reorganization included the merging of the Medicare and Medicaid programs into a new agency; this agency was named the Health Care Financing Administration. He became the first Administrator of the Health Care Financing Administration. On two occasions—6 months in 1975 and the first 3 months of 1977—he was Acting Administrator of the Social and Rehabilitation Services, the agency which, at that time, administered the Medicaid program and the Aid to Families with Dependent Children program.

References

  1. ↑ "Administrator". www.cms.gov. 24 April 2018. Archived from the original on 2 May 2018. Retrieved 9 May 2018.
  2. ↑ Centers for Medicare and Medicaid Services. "Administrator Tenure Dates & Biographies" (PDF). Archived (PDF) from the original on 2017-05-01.
  3. ↑ Kliff, Sarah (23 Nov 2011), "Medicare administrator Donald Berwick resigns in the face of Republican opposition", The Washington Post , archived from the original on 2016-03-11, retrieved 24 Nov 2011
  4. ↑ "Indian-American Seema Verma to head Medicare and Medicaid, confirms Senate". www.connectedtoindia.com. Archived from the original on 15 March 2017. Retrieved 9 May 2018.
  5. ↑ "Archived copy" (PDF). Archived (PDF) from the original on 2017-03-08. Retrieved 2017-03-13.CS1 maint: archived copy as title (link)
  6. ↑ "Archived copy" (PDF). Archived (PDF) from the original on 2017-03-08. Retrieved 2017-03-13.CS1 maint: archived copy as title (link)
  7. ↑ "Archived copy" (PDF). Archived (PDF) from the original on 2017-03-08. Retrieved 2017-03-13.CS1 maint: archived copy as title (link)
  8. ↑ "Archived copy" (PDF). Archived (PDF) from the original on 2017-03-08. Retrieved 2017-03-13.CS1 maint: archived copy as title (link)
  9. ↑ "Archived copy" (PDF). Archived (PDF) from the original on 2017-03-08. Retrieved 2017-03-13.CS1 maint: archived copy as title (link)
  10. ↑ "Archived copy" (PDF). Archived (PDF) from the original on 2017-03-08. Retrieved 2017-03-13.CS1 maint: archived copy as title (link)
  11. ↑ "Archived copy" (PDF). Archived (PDF) from the original on 2017-03-08. Retrieved 2017-03-13.CS1 maint: archived copy as title (link)
  12. ↑ "Archived copy" (PDF). Archived (PDF) from the original on 2017-03-08. Retrieved 2017-03-13.CS1 maint: archived copy as title (link)
  13. ↑ "Archived copy" (PDF). Archived (PDF) from the original on 2017-03-08. Retrieved 2017-03-13.CS1 maint: archived copy as title (link)
  14. ↑ "Archived copy" (PDF). Archived (PDF) from the original on 2017-03-08. Retrieved 2017-03-13.CS1 maint: archived copy as title (link)
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