Alyssa Lane
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. The CMS seeks to strengthen and modernise the nation's healthcare system, providing access to high-quality care and improved health at lower costs for more than 100 million people.
| Characteristics | Values |
|---|---|
| What is CMS? | The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS). |
| What does CMS do? | CMS 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. |
| How many people does CMS cover? | CMS provides health coverage to more than 100 million people. Another source states that CMS covers roughly half of Americans. |
| What else does CMS do? | CMS regulates health insurance and sets policy that guides the prices that doctors, hospitals, and drug companies are paid for medical services. CMS also actively inspects and reports on every nursing home in the United States, maintaining the 5-Star Quality Rating System. |
| Where is CMS located? | CMS has over 6,000 employees, with about 4,000 located at its headquarters in Woodlawn, Maryland. The remaining employees are located in Washington, D.C., 10 regional offices, and various field offices throughout the United States. |
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What You'll Learn
The Centers for Medicare & Medicaid Services (CMS)
CMS employs over 6,000 people, of whom about 4,000 are located at its headquarters in Woodlawn, Maryland. The remaining employees are located in the Hubert H. Humphrey Building in Washington, D.C., 10 regional offices, and various field offices throughout the United States.
CMS actively inspects and reports on every nursing home in the United States, including maintaining the 5-Star Quality Rating System. It also has responsibilities related to administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities, and oversight of HealthCare.gov.
The CMS seeks to strengthen and modernize the nation's healthcare system, providing access to high-quality care and improved health at lower costs. It regulates health insurance and sets policies guiding the prices that doctors, hospitals, and drug companies are paid for medical services. For example, in 2023, CMS negotiated prices directly with drug companies to improve access to costly brand-name drugs for Medicare beneficiaries.
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Medicare and Medicaid history
On July 30, 1965, President Lyndon B. Johnson signed the Medicare and Medicaid Act, also known as the Social Security Amendments of 1965, into law. The Act established Medicare, a health insurance program for the elderly, and Medicaid, a health insurance program for people with limited income.
The 1950 census had revealed that the aged population in the United States had grown from 3 million in 1900 to 12 million in 1950. Two-thirds of older Americans had incomes of less than $1,000 annually, and only one in eight had health insurance. By 1963, the aged population had grown to 17.5 million, and the cost of hospital care was rising at a rate of about 6.7% per year, far outpacing the growth in the incomes of older Americans. As a result, private insurers considered this population a "bad risk."
The Social Security Amendments of 1965 created one basic program of health insurance for persons aged 65 and older, and another program providing health care services to low-income children deprived of parental support, their caretaker relatives, the elderly, the blind, and individuals with disabilities. Before Medicare was created, approximately 60% of people over the age of 65 had health insurance, with coverage often unavailable or unaffordable to many others.
Over the years, Congress has made changes to Medicare and Medicaid. For example, in 1972, Medicare eligibility was expanded to cover individuals under 65 with long-term disabilities and those with end-stage renal disease. In 1999, the Ticket to Work and Work Incentives Improvements Act expanded the availability of Medicare and Medicaid for certain disabled beneficiaries who return to work. The Children's Health Insurance Program (CHIP) was created in 1997 to give health insurance and preventive care to nearly 11 million uninsured American children. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 laid the groundwork for a prescription drug benefit for seniors and people with disabilities on Medicare.
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CMS responsibilities
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS). CMS provides health coverage to more than 100 million people through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace.
CMS has several responsibilities, including:
- Administering the Medicare program and working in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
- Ensuring the security and integrity of CMS human resources and physical resources through the CMS Security Management Group (SMG).
- Maintaining quality standards in long-term care facilities (commonly referred to as nursing homes) through its survey and certification process.
- Regulating health insurance and setting policies that guide the prices that doctors, hospitals, and drug companies charge for medical services.
- Overseeing the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
- Regulating all non-research laboratory testing performed on humans in the United States, including clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments.
- Providing oversight of HealthCare.gov and the Health Insurance Marketplace.
- CMS also actively inspects and reports on every nursing home in the United States, maintaining the 5-Star Quality Rating System.
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CMS data and guidelines
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that provides health coverage to more than 160 million people through Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). CMS works in partnership with state governments to administer these programs and is responsible for implementing laws passed by Congress related to them.
As part of its responsibilities, CMS issues various forms of guidance and regulations to explain how laws will be implemented and what states and other entities need to do to comply. These include sub-regulatory guidance, operational updates, and technical clarifications. CMS also publishes notices of proposed rule-making, solicits and considers public comments, and issues final rules. State Medicaid Director Letters and State Health Official Letters provide further clarification and communication on policies, guidance, and statutory and regulatory issues.
CMS actively inspects and reports on every nursing home in the United States, maintaining the 5-Star Quality Rating System. It also supports the development and testing of innovative healthcare payment and service delivery models, aiming to improve access to costly brand-name drugs and protect people from surprise medical bills.
In terms of data, CMS releases raw claims data, which provides insights into billing patterns, and guidelines for states to ensure continued Medicaid coverage. For instance, in 2018, CMS released guidelines in response to then-President Trump's announcement about work requirements in Medicaid. CMS also strives to make its electronic and information technologies accessible to people with disabilities, ensuring information quality and privacy.
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CMS leadership
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS). CMS is the federal agency that runs 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.
CMS employs over 6,000 people, of whom about 4,000 are located at its headquarters in Woodlawn, Maryland. The remaining employees are located in the Hubert H. Humphrey Building in Washington, D.C., 10 regional offices, and various field offices across the United States.
The head of CMS is the administrator of the Centers for Medicare & Medicaid Services. The current leadership team at CMS includes:
- Stephanie Carlton, Administrator
- John Brooks, Deputy Administrator and Chief of Staff
- Kimberly Brandt, Deputy Administrator and Chief Policy and Regulatory Officer
- John Czajkowski, Deputy Administrator and Chief Operating Officer
CMS actively inspects and reports on every nursing home in the United States, including maintaining the 5-Star Quality Rating System. The agency also has other responsibilities, such as administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities, and oversight of HealthCare.gov.
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Frequently asked questions
CMS stands for the Centers for Medicare & Medicaid Services. It is a federal agency within the United States Department of Health and Human Services (HHS). CMS employs over 6,000 people across the US and its headquarters are in Woodlawn, Maryland.
Medicare is a national healthcare program that provides health coverage to millions of Americans. It was established in 1965 by President Lyndon B. Johnson.
Medicaid is another national healthcare program administered by CMS in partnership with state governments. In 2023, the US government spent over $1 trillion on Medicaid and Medicare combined.
CMS administers the Medicare and Medicaid programs and works with state governments to implement the Children's Health Insurance Program (CHIP) and health insurance portability standards. CMS also regulates health insurance and sets policies that guide the prices paid to healthcare providers.
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