The Centers for Medicare & Medicaid Services, CMS has the task of managing three of the state’s biggest health care schemes. The three health care schemes are Medicaid, Medicare and the CHIP (Children’s Health Insurance Program).
It also monitors new benefits for employers and consumers using the PCIP (Pre-existing Condition Insurance Program), State High-Risk Pools, the ERRP (Early Retirement Reinsurance Program) as well as State-based Health Insurance Exchanges. The CMS takes this role through implementation of new rights and better responsibility for providers and consumers.
This is always applicable to the health insurance in the private market (Bardach, 2008). CMS is also responsible for distribution of an unprecedented stage of consumer details concerning coverage alternatives.
CMS is the United States’ major purchaser of health care and anticipates serving millions of consumers and approximately 105 million beneficiaries in FY 2012. According to FY 2010, the expenditure of CMS is $828 billion on reimbursement and other costs.
The CMS is a major division, which operates under the Health and Human Services department (DHHS). The CMS that was formally the known as Health Care Financing Administration was established in 1977.
This brought together the two biggest Federal health care schemes at that time, which include the Medicaid and Medicare under joined leadership. There was the establishment of the CHIP (Children’s Health Insurance Program) in 1997 with the objective of addressing uninsured children’s health care obligations.
There are emerging laws in the past years that have significantly influenced the CMS’ responsibilities in decision-making and its day-to-day operations. For instance, the MMA (Medicare Modernization Act) of 2003 implemented a prescription drug gain. This was the most essential extension of the Medicare plan since its foundation in 1965.
The advantage of the inclusion was because more consumers were relieved from the burden of non-prescribed drugs that was rampant. In 2005, there was a creation of another Act called Deficit Reduction Act. This was a Medicaid Integrity Plan to oversee abuse and fraud in the Medicaid scheme. The policy was also very important because the cases of frauds and abuses were reduced substantially by a greater margin.
The 2006 TRHCA (Tax Relief and Health Care Act) recognized a physician quality-reporting plan as well as quality improvement schemes and improved CMS’ agenda integrity efforts. This was possible by employing a program called the RAC (Recovery Audit Contractor). This program assisted a greater deal because auditing provided assurance of integrity in the CMS.
The MMSEA (Medicaid, Medicare as well as State Children’s Health Insurance Program Extension Act of 2007) ensured physician value reporting and broaden the CHIP, TMA (Transitional Medical Assistance) together with other programs. The legislation policy implementation of 2008 under the MIPPA (Medicare Improvements for Patients and Providers Act) expanded and extended the physician quality-reporting plan.
It also led to the creation of an electronic prescribing enticement plan, which was very vital for consumer efficiency (Bardach, 2008). There was also initiation of value-based purchasing program geared towards services related with end-stage renal disease.
In addition, CHIPRA Act of 2009 was essential for boosting outreach, access and enrollment to reimbursement within the CHIP and Medicaid schemes. It also mandated improvement of quality measures concerning child health. It also enhanced children enrollement reporting in CHIP and Medicaid.
The Recovery Act of 2009 offered investments for scientific advances. This comprises of information technology related to health as well as utilization of electronic health accounts. It also included wellness and prevention activities. This is a timely law implementation given the global advancement in the information technology. The President signed the Affordable Care Act becoming a law in March 2010.
This legislation contains many provisions, which influence CMS’ established responsibilities as the Medicaid, Medicare and CHIP schemes overseer. These provisions comprise of a major extension of the Medicaid plan. There is also a two-year expansion of CHIP. Similarly, there is the creation of a new Health Care Office called FCHCO in CMS to advance care for eligible beneficiaries for both Medicaid and Medicare.
Another important aspect in this case is the gradual abolition of the prescription drug under Medicare “donut hole”. There is also the formation of a Center for Innovation to investigate different care distribution, as well as payment methods in Medicaid, Medicare, and CHIP.
In addition, the court system has also played a very important role by ensuring legislation of Affordable Care Act’s private health insurance and consumer protections provisions. These provisions offer a new compensation options for Americans who were formerly uninsured. It also ensures employers reimbursement to assist meeting partial cost of offering health reimbursement for early retirees.
This would also extend to their dependents and spouses. At the same time, it also provides new obligations concerning the market behavior of health care insurers in the private sector. There is also provision for the new consumer education efforts and outreach to assist consumers appraise their choices and decide on their eligibility free schemes.
There is anticipation that the CMS will participate with states to generate new, aggressive health insurance markets by 2014. This will function through interactions and supply many Americans with affordable and accessible coverage.
Bardach, E. (2008). Getting Agencies to Work Together. Washington, D.C.: Brookings Institution Press.