CENTERS FOR MEDICARE & MEDICAID SERVICES
On July 1, 2001, the Health Care Financing
Administration was reorganized and changed its
name to the Centers for Medicare & Medicaid
Services (CMS). CMS is an operating division of
the HEALTH AND HUMAN SERVICES DEPARTMENT.
It was established in 1977 to combine
under one administration the oversight of the
MEDICARE Program and the federal portion of
the MEDICAID Program (Reorg.Order of Mar. 9,
1977, 42 Fed. Reg. 13262).
As part of the 2001 reorganization, three
new business centers were developed: the Center
for Beneficiary Choices, the Center for Medicare
Management, and the Center for Medicaid and
State Operations. The Center for Beneficiary
Choices provides beneficiaries with information
about Medicare, Medicare Select, Medicare
Choice, and Medigap options. It also manages
the MedicareChoice plans, consumer research
and demonstrations, and grievances and appeals.
The Center for Medicare Management oversees
the traditional fee-for-service Medicare program.
This entails developing payment policies and managing Medicare fee-for-service contractors.
The Center for Medicaid and State Operations
oversees programs administered by the
states, including Medicaid, the State Children’s
Health Insurance Program (SCHIP), insurance
regulation functions, survey and certification,
and the Clinical Laboratory Improvements Act
(CLIA).
Medicare provides health insurance coverage
for U.S. citizens age 65 or older, for younger
people receiving SOCIAL SECURITY benefits, and
for persons needing dialysis or kidney transplants
for the treatment of end-stage renal disease
(42 U.S.C.A. § 1395 et seq.). Medicare
beneficiaries may receive medical care through
physicians of their own choosing or through
health maintenance organizations and other
medical plans that have contracts with
Medicare.
Medicaid is a medical assistance program
jointly financed by state and federal governments
for low-income individuals (42 U.S.C.A.
§ 1396 et seq.). Medicaid covers HEALTH CARE
expenses for recipients of Temporary Assistance
for Needy Families (formerly Aid to Families
with Dependent Children), as well as for lowincome
pregnant women and other individuals
whose medical bills qualify them as medically
needy. Most states also cover medical expenses
for older U.S. citizens who are needy, as well as
for individuals who are blind and disabled who
receive assistance under the Supplemental Security
Income Program. Coverage is further
extended to some INFANTS and low-income
pregnant women and, depending on the state, to
other low-income individuals with medical bills
that qualify them as medically needy.
The mission of the CMS is to promote the
timely delivery of quality health care to
Medicare and Medicaid beneficiaries and to
ensure that the Medicare and Medicaid Programs
are administered in an efficient manner.
The agency must also ensure that program
beneficiaries are aware of the services for
which they are eligible, that those services are
accessible and of high quality, and that agency
policies and actions promote efficiency and
quality within the total health care delivery system.
A quality assurance program administered
by the CMS is responsible for developing
health and safety standards for providers of
health care services authorized by Medicare
and Medicaid legislation. This program helps
to ensure that Medicare and Medicaid beneficiaries
receive quality health care services at a
reasonable cost.
FURTHER READINGS
Centers for Medicare & Medicaid Services. Available online
at (accessed July 23, 2003).
Medicare Resource Center. Available online at (accessed July 23, 2003).
U.S. Government ManualWebsite. Available online at (accessed November 10, 2003).
