|Formed||July 30, 1965|
|Headquarters||Woodlawn, Baltimore County, Maryland|
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.
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 is a national health insurance program in the United States, begun in 1966 under the Social Security Administration and now administered by the Centers for Medicare and Medicaid Services (CMS). It provides health insurance for Americans aged 65 and older. It also provides health insurance to younger people with some disability status as determined by the Social Security Administration, as well as people with end stage renal disease and amyotrophic lateral sclerosis. Medicare is funded by a combination of a payroll tax, beneficiary premiums and surtaxes from beneficiaries, and general U.S. Treasury revenue.
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.
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.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 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 of the United States 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.
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.
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 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.
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., 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, first President of the United States and Founding Father. As the seat of the United States federal government and several international organizations, Washington is an important world political capital. The city is also 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.Seema Verma has been confirmed by the US Senate as Administrator of CMS, a top healthcare position in the Trump administration.
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, now known as Health Management Associates (HMA).
CMS has its headquarters in Woodlawn, Maryland, with 10 regional offices located throughout the United States:
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.
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.
Mark Barr McClellan is the Director of the Robert J Margolis Center for Health Policy and the Margolis Professor of Business, Medicine and Health Policy at Duke University. Formerly, he was a senior fellow and director of the Health Care Innovation and Value Initiative at the Engelberg Center for Health Care Reform at The Brookings Institution, in Washington, D.C. McClellan served as Commissioner of the United States Food and Drug Administration under President George W. Bush from 2002 through 2004, and subsequently as administrator of the Centers for Medicare and Medicaid Services from 2004 through 2006.
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 A. 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.
Geographic Practice Cost Index is used along with Relative Value Units by Medicare to determine allowable payment amounts for medical procedures. There are multiple GPCIs: Cost of Living, Malpractice, and Practice Cost/Expense. These categories allow Medicare to adjust reimbursement rates to take into account regional and practice-specific factors.
Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance "is used to describe any form of insurance providing protection against the costs of medical services. This usage includes private insurance and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.
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.
An Accountable Care Organization (ACO) is a healthcare organization that ties payments to quality metrics and 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 its services. 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 health care and health insurance industry and has been on the cutting edge of numerous innovations over the last 30 years.
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.
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.
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.
The Federal Register is the official journal of the federal government of the United States that contains government agency rules, proposed rules, and public notices. It is published daily, except on federal holidays. The final rules promulgated by a federal agency and published in the Federal Register are ultimately reorganized by topic or subject matter and codified in the Code of Federal Regulations (CFR), which is updated annually.