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Centers for Medicare & Medicaid Services

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Centers for Medicare & Medicaid Services
Agency overview
FormedMarch 1977; 47 years ago (1977-03)
Preceding agency
  • Health Care Financing Administration (1977–2001)
HeadquartersWoodlawn, Baltimore County, Maryland, U.S.
Employees6,000
Agency executives
Parent agencyDepartment of Health and Human Services
Websitewww.cms.gov Edit this at Wikidata

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), 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. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001.

CMS actively inspects and reports on every nursing home in the United States. This includes maintaining the 5-Star Quality Rating System.[1]

History

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Originally, the name "Medicare" in the United States referred to a program providing medical care for families of people serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956.[2] President Dwight D. Eisenhower held the first White House Conference on Aging in January 1961, in which creating a health care program for social security beneficiaries was proposed.[3][4]

President Lyndon B. Johnson signed the Social Security Amendments on July 30, 1965, establishing both Medicare and Medicaid.[5] 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.[6] At the time, the program provided health insurance to 19 million Americans.[6][7] 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 1965. Since then, HEW, has been reorganized as the Department of Health and Human Services (HHS) in 1980. This consequently brought Medicare and Medicaid under the jurisdiction of the HHS. [8]

In March 1977, the Health Care Financing Administration (HCFA) was established under HEW.[9] HCFA became responsible for the coordination of Medicare and Medicaid.[10] The responsibility for enrolling beneficiaries into Medicare and processing premium payments remained with SSA.

HCFA was renamed the Centers for Medicare and Medicaid Services on July 1, 2001.[9][11]

In 2013, a report by the inspector general found that CMS had paid $23 million in benefits to deceased beneficiaries in 2011.[12]

In April 2014, CMS released raw claims data from 2012 that gave a look into what types of doctors billed Medicare the most.[13]

In January 2018, CMS released guidelines for states to use to require Medicaid beneficiaries to continue receiving coverage.[14] These guidelines came in response to then-President Trump's announcement that he would allow states to impose work requirements in Medicaid.[15] In October, CMS reported a data breach of 75,000 people's personal data due to a hack.[16]

In February 2018, CMS removed a notice from its website that informed insurance companies they were not allowed to charge physicians a fee when the companies paid the doctors for their work. This has resulted in doctors being charged up to a 5% fee on their compensation, adding up to billions of dollars annually.[17]

In January 2021, CMS passed a rule that would cover "breakthrough technology" for four years after they received FDA approval.[18] In September 2021, CMS submitted a proposal to repeal the rule based on safety concerns.[19]

On September 19, 2023, the Subcommittee on Health held a hearing titled "Examining Policies to Improve Seniors’ Access to Innovative Drugs, Medical Devices, and Technology." Dora Hughes, the acting director of the Center for Clinical Standards and Quality at the U.S. Centers for Medicare and Medicaid Services (CMS), defended the proposed Transitional Coverage for Emerging Technologies (TCET) pathway, which aims to restrict coverage for breakthrough medical devices to five reviews a year. Some lawmakers and medtech trade groups called for expanding the pathway to include diagnostics. Various other legislative proposals were discussed during the hearing, including bills related to Medicare coverage, drug pricing, and transparency in healthcare.[20][21]

Workforce

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CMS employs over 6,000 people, of whom about 4,000 are located at its headquarters in Woodlawn, Maryland.[22] 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.

The head of CMS is the administrator of the Centers for Medicare & Medicaid Services. The position is appointed by the president and confirmed by the Senate.[23] On May 27, 2021, Chiquita Brooks-LaSure was sworn in as administrator, the first black woman to serve in the role.[24]

Regional offices

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

List of administrators

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No. Image Name Took office Left office President served under
1 Arthur E. Hess[9] 1965 1967 Lyndon B. Johnson
2 Thomas M. Tierney[9] 1967 1978 Lyndon B. Johnson
Richard Nixon
Gerald Ford
Jimmy Carter
3 Robert Derzon[9] June 1977 November 1978 Jimmy Carter
4 Leonard Schaeffer[9] November 1978 June 1980
5 Howard N. Newman[9] July 1980 January 1981
6 Carolyne Davis[9] March 1981 August 1985 Ronald Reagan
7 William L. Roper[9] May 1986 February 1989 Ronald Reagan
George H. W. Bush
8 Gail Wilensky[9] February 1990 March 1992 George H. W. Bush
9 Bruce Vladeck[9] May 1993 September 1997 Bill Clinton
10 Nancy-Ann DeParle[9] November 1997 September 29, 2000
11 Thomas A. Scully[9] May 2001 December 3, 2003 George W. Bush
12 Mark McClellan[9] March 25, 2004 October 14, 2006
13 Donald Berwick[9] July 7, 2010 December 2, 2011 Barack Obama
14 Marilyn Tavenner[9] December 2, 2011 March 18, 2015
Acting Andy Slavitt March 18, 2015 January 20, 2017
15 Seema Verma March 14, 2017 January 20, 2021 Donald Trump
Acting Elizabeth Richter January 20, 2021 May 27, 2021 Joe Biden
16 Chiquita Brooks-LaSure May 27, 2021 Present

See also

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References

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  1. ^ "Five-Star Quality Rating System".
  2. ^ Robinson, P. I. (1957). Medicare: Uniformed Services Program for Dependents. Social Security Bulletin, 20(7), 9–16.
  3. ^ Tibbits C. "The 1961 White House Conference on Aging: it's rationale, objectives, and procedures". J Am Geriatr Soc. 1960 May. 8:373–77
  4. ^ Mcnamara PAT, Dirksen EM, Church F, Muskie ES. The 1961 White House Conference on Aging: basic policy statements and recommendations / prepared for the Special Committee on Aging, United States Senate 87th Congress, 1st Session, Committee Print, May 15, 1961.
  5. ^ "Today's Document from the National Archives". www.archives.gov. August 15, 2016. Retrieved October 5, 2021.
  6. ^ a b Fritze, John (November 21, 2005). "Arthur E. Hess, 89, lawyer, served as 1st director of Medicare program". baltimoresun.com. Archived from the original on June 21, 2021. Retrieved October 5, 2021.
  7. ^ Centers for Medicare and Medicaid Services. "Administrator Tenure Dates & Biographies" (PDF). Archived (PDF) from the original on May 1, 2017.
  8. ^ Digital Communications Division (DCD) (March 14, 2023). "HHS Historical Insights". US Department of Health and Human Services. Retrieved November 21, 2024.
  9. ^ a b c d e f g h i j k l m n o p "Administrator Tenure Dates & Biographies, 1965 — 2015" (PDF). U.S. Centers for Medicare and Medicaid Services. July 1, 2015. pp. 5, 13. Retrieved November 17, 2020.
  10. ^ "20TH ANNIVERSARY 1977;TIME CAPSULE". Modern Healthcare. October 6, 2006. Retrieved October 5, 2021.
  11. ^ "CNN.com - Medicare agency renamed as prelude to reforms - June 14, 2001". www.cnn.com. Retrieved October 5, 2021.
  12. ^ Ellis, Blake (November 1, 2013). "Fraud, dumb mistakes lead Medicare to pay $23 million to dead people". CNNMoney. Retrieved October 5, 2021.
  13. ^ Abelson, Reed; Cohen, Sarah (April 9, 2014). "Sliver of Medicare Doctors Get Big Share of Payouts". The New York Times. ISSN 0362-4331. Archived from the original on October 5, 2021. Retrieved October 5, 2021.
  14. ^ Sanger-Katz, Margot (January 11, 2018). "Can Requiring People to Work Make Them Healthier?". The New York Times. ISSN 0362-4331. Archived from the original on October 5, 2021. Retrieved October 5, 2021.
  15. ^ Pear, Robert (January 11, 2018). "Trump Administration Says States May Impose Work Requirements for Medicaid". The New York Times. ISSN 0362-4331. Archived from the original on October 5, 2021. Retrieved October 5, 2021.
  16. ^ Whittaker, Zack (October 20, 2018). "Hackers breach Healthcare.gov system, taking files on 75,000 people". TechCrunch. Archived from the original on October 6, 2021. Retrieved October 5, 2021.
  17. ^ Podkul, Cezary (August 14, 2023). "The Hidden Fee Costing Doctors Millions Every Year". ProPublica. Retrieved August 15, 2023.
  18. ^ Brady, Michael (January 12, 2021). "Medicare approves coverage of 'breakthrough' medical devices". Modern Healthcare. Archived from the original on May 14, 2024. Retrieved October 5, 2021.
  19. ^ Brady, Michael (September 13, 2021). "Biden to toss Medicare coverage for "breakthrough" technology". Modern Healthcare. Archived from the original on May 14, 2024. Retrieved October 5, 2021.
  20. ^ "Memorandum for September 19, 2023, Health Subcommittee Hearing" (PDF). Committee on Energy and Commerce. Archived (PDF) from the original on December 8, 2023.
  21. ^ Paul Taylor, Nick (September 21, 2023). "CMS leader defends breakthrough device reimbursement proposal at House hearing". MedTech Dive. Archived from the original on January 14, 2024.
  22. ^ Brooks-LaSure, Chiquita (November 2022). "CMS Financial Report FY 2022" (PDF). Centers for Medicare and Medicaid Services: 122.
  23. ^ Kliff, Sarah (November 23, 2011), "Medicare administrator Donald Berwick resigns in the face of Republican opposition", The Washington Post, archived from the original on March 11, 2016, retrieved November 24, 2011
  24. ^ Weiland, Noah; Sanger-Katz, Margot (May 25, 2021). "Chiquita Brooks-LaSure becomes the first Black administrator confirmed to lead Medicare and Medicaid". The New York Times. ISSN 0362-4331. Archived from the original on October 5, 2021. Retrieved October 5, 2021.
  25. ^ "Office of Program Operations and Local Engagement | CMS" (PDF). Archived (PDF) from the original on March 8, 2017. Retrieved March 13, 2017.
  26. ^ "Office of Program Operations and Local Engagement | CMS" (PDF). Archived (PDF) from the original on March 8, 2017. Retrieved March 13, 2017.
  27. ^ "Office of Program Operations and Local Engagement | CMS" (PDF). Archived (PDF) from the original on March 8, 2017. Retrieved March 13, 2017.
  28. ^ "Office of Program Operations and Local Engagement | CMS" (PDF). Archived (PDF) from the original on March 8, 2017. Retrieved March 13, 2017.
  29. ^ "Office of Program Operations and Local Engagement | CMS" (PDF). Archived (PDF) from the original on March 8, 2017. Retrieved March 13, 2017.
  30. ^ "Office of Program Operations and Local Engagement | CMS" (PDF). Archived (PDF) from the original on March 8, 2017. Retrieved March 13, 2017.
  31. ^ "Office of Program Operations and Local Engagement | CMS" (PDF). Archived (PDF) from the original on March 8, 2017. Retrieved March 13, 2017.
  32. ^ "Region 8 – Denver" (PDF). CMS. Archived from the original (PDF) on March 8, 2017. Retrieved March 13, 2017.
  33. ^ "Office of Program Operations and Local Engagement | CMS" (PDF). Archived (PDF) from the original on March 8, 2017. Retrieved March 13, 2017.
  34. ^ "Office of Program Operations and Local Engagement | CMS" (PDF). Archived (PDF) from the original on March 8, 2017. Retrieved March 13, 2017.

Robinson, P. I. (July 1957). "Medicare: Uniformed Services Program for Dependents". Social Security Bulletin, 20(7), 9–16.

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