CMS and Healthcare Reform: What’s the Connection?

The Centers for Medicare and Medicaid Services (CMS) is a section of the United States Department of Health and Human Services (HHS).

The Centers for Medicare and Medicaid Services (CMS) is a section of the United States Department of Health and Human Services (HHS). It is the largest administrator of health insurance benefits with its health care programs providing services to more than 100 million people, or a bit less than 1/3 of the United States Population. The programs administered by CMS include Medicare, Medicaid, and the Children’s Health Insurance Program.

Historically, rules created by CMS for Medicare were often copied by private insurers. For instance, new tests for screening and/or diagnosing diseases were considered experimental until Medicare approved them for reimbursement. Most times private insurance companies would follow rather than lead in implementing payments for new diagnostics and medicines.

The role of The Centers for Medicare and Medicaid in implementing the Affordable Care Act (ACA) is quite important. They are the agency within HHS that is underwriting the reimbursement rules for implementing the ACA.

They are also the primary federal agency that is informing and educating the public about what to expect in the way of changes from implementation of the Affordable Care Act. Opponents to the ACA derisively call it “Obamacare,” but the president and his supporters have said that is a nickname they are proud of.

Whether you support the ACA or not, it is the most significant change in health care since the implementation of Medicare and Medicaid fifty years ago.

The Centers for Medicare and Medicaid Services is concerned with three key components of the Affordable Care Act implantation. They are:

1. Availability of health insurance
2. Affordability of health insurance
3. Reducing the cost of health care in the United States

They have developed programs to encourage all medical care facilities to computerize their medical record systems. The high dollar savings initially predicted have not yet materialized, although improved patient care due to electronic medical availability has been anecdotally reported.

It is no longer legal to bar someone from health insurance because they have a “pre-existing” condition.

The lifetime caps (total amount of health insurance available to you) were done away with and no matter how expensive your care is you will receive it for as long as it is needed.

Children under age 26 living at home are also eligible for coverage.

CMS is tasked with making regulations to implement the ACA which is not yet popular with the majority of Americans. Even after the legislation passed, many are opposed to it.  The law is being phased in over several years, with 2014 seen as the target date for full implementation.

While CMS is outstanding in its role of administrator for the plans of the Federal Government with very low administrative expenses it remains to be seen if they are up to the task of implementing the most sweeping reforms in health care insurance since Medicare. 

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