Centers for Medicare and Medicaid Services
|Centers for Medicare & Medicaid Services|
|Preceding||Health Care Financing Administration (1977-2001)|
|Headquarters||Woodlawn, Baltimore County, Maryland|
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 managing the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), developing quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, developing and enforcing its clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments (CLIA) program, and overseeing the Healthcare.gov site.
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 1977, the Health Care Financing Administration (HCFA) was established 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.
The CMS has developed and used several systems to classify Medicare cases. Hospital cases are classified using the Diagnosis-related Group (DRG); outpatient cases are classified using the Ambulatory Patient Group (APG). These systems are used to determine how much Medicare pays the hospital or provider for each service or product.
The CMS employs approximately 4,100 employees, of which 2,700 are located at its headquarters in Woodlawn, Maryland. The remaining employees are located in the Hubert H. Humphrey Building in Washington, D.C., its 10 regional offices, and in various field offices located throughout the United States.
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.
- "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.
- "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.
- "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.
- "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.
- "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.
- 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.