The
Centers for Medicare and 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 ServicesThe United States Department of Health and Human Services is a Cabinet department of the United States 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"...
(DHHS) that administers the
MedicareMedicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over, or who meet other special criteria. The medicare program also funds residency training programs for the vast majority of physicians in the...
program and works in partnership with state governments to administer
Medicaid Medicaid is the United States health program for eligible individuals and families with low incomes and resources. It is a means-tested program that is jointly funded by the states and federal government, and is managed by the states. Among the groups of people served by Medicaid are certain...
, the
State Children's Health Insurance ProgramThe State Children's Health Insurance Program – later known more simply as the Children's Health Insurance Program – is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to families with children...
(SCHIP), and
health insuranceHealth insurance is insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies...
portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the
Health Insurance Portability and Accountability ActThe Health Insurance Portability and Accountability Act was enacted by the U.S. Congress in 1996. According to the Centers for Medicare and Medicaid Services website, Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs...
of 1996 (HIPAA), quality standards in
long-term careLong-term care is a variety of services which help meet both the medical and non-medical need of people with a chronic illness or disability who cannot care for themselves for long periods of time....
facilities (more commonly referred to as
nursing homeA nursing home, convalescent home, Skilled Nursing Unit , care home or rest home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living. Residents include the elderly and younger...
s) through its survey and certification process, and clinical laboratory quality standards under the
Clinical Laboratory Improvement AmendmentsClinical Laboratory Improvement Amendments of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research.-CLIA Program:...
.
History
President
Lyndon B. JohnsonLyndon Baines Johnson , served as the 36th President of the United States from 1963 to 1969 after his service as the Vice President of the United States from 1961 to 1963...
signed the Social Security Act on July 30, 1965, establishing both Medicare and Medicaid. The
Social Security AdministrationThe United States Social Security Administration is an independent agency of the United States federal government that administers Social Security, a social insurance program consisting of retirement, disability, and survivors' benefits...
(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. The responsibility for enrolling beneficiaries into Medicare and processing premium payments remained with SSA.
In 1980, HEW was split into two agencies: the
Department of EducationThe United States Department of Education, also referred to as ED or the ED for Education Department, is a Cabinet-level department of the United States government...
and the Department of Health and Human Services (HHS). HCFA became an agency under the Department of Health and Human Services.
In 1999, CMS created the PSC (Program Safeguard Contractor) program to support the Medicare Integrity Program (MIP). MIP was created as part of HIPAA.
On July 1, 2001, HHS Secretary
Tommy ThompsonTommy George Thompson , a United States politician, was the 42nd Governor of Wisconsin and the 19th U.S. Secretary of Health and Human Services. Thompson was a candidate for the 2008 U.S...
renamed HCFA the Centers for Medicare & Medicaid Services (CMS). Secretary Thompson explained that in order "to give the agency a new direction, a new spirit, it is necessary that we give it a new name - one that truly reflects the agency's vital mission to serve millions of Medicare and Medicaid beneficiaries across America."
The previous CMS Administrator,
Mark McClellanMark Barr McClellan is currently the Director of the Engelberg Center for Health Care Reform, Senior Fellow in Economic Studies and Leonard D. Schaeffer Director's Chair in Health Policy Studies at the Brookings Institution in Washington, DC. McClellan served as Commissioner of the United States...
, MD, PhD, was sworn in on March 25, 2004. On September 5, 2006, McClellan announced his resignation from the post. The current Acting Administrator as of March 26, 2009 is Charlene Frizzera.
Workforce
The CMS employs approximately 4,100 employees, of which 2,700 are located at its headquarters in
Woodlawn, MarylandWoodlawn is an unincorporated community and a census-designated place in Baltimore County, Maryland, United States. The population was 36,079 at the 2000 census. It is home to both the headquarters of the Social Security Administration as well as the Centers for Medicare and Medicaid Services...
. The remaining employees are located in the Hubert H. Humphrey Building in
Washington, D.C.Washington, D.C. , formally the District of Columbia and commonly referred to as Washington, the District, or simply D.C., is the capital of the United States, founded on July 16, 1790...
, the 10 regional offices listed below, and in various field offices located throughout the United States.
Regional offices
CMS has its headquarters in
Woodlawn, MarylandWoodlawn is an unincorporated community and a census-designated place in Baltimore County, Maryland, United States. The population was 36,079 at the 2000 census. It is home to both the headquarters of the Social Security Administration as well as the Centers for Medicare and Medicaid Services...
, with 10 regional offices located throughout the United States:
- Region I - Boston
Boston is the capital and largest city of the Commonwealth of Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is considered the economic and cultural center of the region and is sometimes regarded as the unofficial "Capital of New England"...
- Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island and Vermont.
- Region II - New York
New York is a state in the Mid-Atlantic and Northeastern regions of the United States and is the nation's third most populous. The state is bordered by New Jersey and Pennsylvania to the south, and Connecticut, Massachusetts and Vermont to the east...
- New Jersey, New York as well as the U.S. Virgin Islands and Puerto Rico.
- Region III - Philadelphia
- Delaware, Maryland, Pennsylvania, Virginia, West Virginia and the District of Columbia.
- Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee.
- Region V - Chicago
Chicago is the largest city in the U.S. state of Illinois, and with more than 2.8 million people, the 3rd largest city in the United States...
- Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin.
- Arkansas, Louisiana, New Mexico, Oklahoma and Texas.
- Region VII - Kansas City
Kansas City is the largest city in the U.S. state of Missouri. It encompasses in parts of Jackson, Clay, Cass, and Platte counties. It is one of two county seats of Jackson County, the other being Independence, just to the city's east...
- Iowa, Kansas, Missouri and Nebraska.
- Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming.
- Region IX - San Francisco
- Arizona, California, Hawaii, Nevada and the Territories of American Samoa, Guam and the Commonwealth of the Northern Mariana Islands.
- Alaska, Idaho, Oregon and Washington.
See also
- Administration on Aging
The Administration on Aging is an agency of the United States Department of Health and Human Services. AoA awards annual grants to State government agencies on aging and Native American tribal organizations to support programs mandated by the Congress in the Older Americans Act...
- Medicare (Australia)
Medicare is Australia's publicly-funded universal health care system, operated by the government authority Medicare Australia. Medicare is intended to provide affordable treatment by doctors and in public hospitals for all resident citizens and permanent residents except for those on Norfolk Island...
- Medicare (Canada)
Medicare is the unofficial name for Canada's publicly funded universal health insurance system. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.Under the terms of the Canada Health...
- National Health Service
The National Health Service is the name commonly used to refer to the publicly-funded health care services in Great Britain. In England the name National Health Service is used without further qualification whereas the services in Scotland and Wales are known as NHS Scotland and NHS Wales...
(United Kingdom)
- Quality improvement organizations
Quality Improvement Organizations monitor the appropriateness, effectiveness, and quality of care provided to Medicare beneficiaries. They are private contractor extensions of the federal government that work under the auspices of the U.S...
- Stark Law
Stark law, actually three separate provisions, governs physician self-referral for Medicare and Medicaid patients. The law is named for United States Congressman Pete Stark, who sponsored the initial bill.- Physician self-referral :...
- Medical billing
- Health Insurance Portability and Accountability Act
The Health Insurance Portability and Accountability Act was enacted by the U.S. Congress in 1996. According to the Centers for Medicare and Medicaid Services website, Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs...
- Emergency Medical Treatment and Active Labor Act
The Emergency Medical Treatment and Active Labor Act is a United States Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act. It requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of...
- Thomas A. Scully
Thomas A. Scully was the Administrator of the Centers for Medicare and Medicaid Services from 2001-2003 under President George W. Bush. Scully currently is Senior Counsel at Alston & Bird LLP, a law and lobbying firm, where he focuses on health care regulatory and legislative matters, as well as...
External links