Centers for Medicare & Medicaid Services

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. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001.

CMS actively inspects and reports on every nursing home in the United States. This includes maintaining the 5-Star Quality Rating System.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

History

Originally, the name "Medicare" in the United States referred to a program providing medical care for families of people serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956.<ref>Robinson, P. I. (1957). Medicare: Uniformed Services Program for Dependents. Social Security Bulletin, 20(7), 9–16.</ref> President Dwight D. Eisenhower held the first White House Conference on Aging in January 1961, in which creating a health care program for social security beneficiaries was proposed.<ref>Tibbits C. "The 1961 White House Conference on Aging: it's rationale, objectives, and procedures". J Am Geriatr Soc. 1960 May. 8:373–77</ref><ref>Mcnamara PAT, Dirksen EM, Church F, Muskie ES. The 1961 White House Conference on Aging: basic policy statements and recommendations / prepared for the Special Committee on Aging, United States Senate 87th Congress, 1st Session, Committee Print, May 15, 1961.</ref>

President Lyndon B. Johnson signed the Social Security Amendments on July 30, 1965, establishing both Medicare and Medicaid.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Arthur E. Hess, a deputy commissioner of the Social Security Administration, was named as first director of the Bureau of Health Insurance in 1965, placing him as the first executive in charge of the Medicare program.<ref name=":1">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> At the time, the program provided health insurance to 19 million Americans.<ref name=":1" /><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The Social Security Administration (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 1965. Since then, HEW, has been reorganized as the Department of Health and Human Services (HHS) in 1980. This consequently brought Medicare and Medicaid under the jurisdiction of the HHS. <ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

In March 1977, the Health Care Financing Administration (HCFA) was established under HEW.<ref name=":0">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> HCFA became responsible for the coordination of Medicare and Medicaid.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The responsibility for enrolling beneficiaries into Medicare and processing premium payments remained with SSA.

HCFA was renamed the Centers for Medicare and Medicaid Services on July 1, 2001.<ref name=":0" /><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

In 2013, a report by the inspector general found that CMS had paid $23 million in benefits to deceased beneficiaries in 2011.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

In April 2014, CMS released raw claims data from 2012 that gave a look into what types of doctors billed Medicare the most.<ref>Template:Cite news</ref>

In January 2018, CMS released guidelines for states to use to require Medicaid beneficiaries to continue receiving coverage.<ref>Template:Cite news</ref> These guidelines came in response to then-President Trump's announcement that he would allow states to impose work requirements in Medicaid.<ref>Template:Cite news</ref> In October, CMS reported a data breach of 75,000 people's personal data due to a hack.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

In February 2018, CMS removed a notice from its website that informed insurance companies they were not allowed to charge physicians a fee when the companies paid the doctors for their work. This has resulted in doctors being charged up to a 5% fee on their compensation, adding up to billions of dollars annually.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

In January 2021, CMS passed a rule that would cover "breakthrough technology" for four years after they received FDA approval.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> In September 2021, CMS submitted a proposal to repeal the rule based on safety concerns.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

On September 19, 2023, the Subcommittee on Health held a hearing titled "Examining Policies to Improve Seniors’ Access to Innovative Drugs, Medical Devices, and Technology." Dora Hughes, the acting director of the Center for Clinical Standards and Quality at the U.S. Centers for Medicare and Medicaid Services (CMS), defended the proposed Transitional Coverage for Emerging Technologies (TCET) pathway, which aims to restrict coverage for breakthrough medical devices to five reviews a year. Some lawmakers and medtech trade groups called for expanding the pathway to include diagnostics. Various other legislative proposals were discussed during the hearing, including bills related to Medicare coverage, drug pricing, and transparency in healthcare.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Workforce

CMS employs over 6,000 people, of whom about 4,000 are located at its headquarters in Woodlawn, Maryland.<ref>Template:Cite journal</ref> The remaining employees are located in the Hubert H. Humphrey Building in Washington, D.C., the 10 regional offices listed below, and in various field offices located throughout the United States.

The head of CMS is the administrator of the Centers for Medicare & Medicaid Services. The position is appointed by the president and confirmed by the Senate.<ref name=kliff2011>Template:Citation</ref> On May 27, 2021, Chiquita Brooks-LaSure was sworn in as administrator, the first black woman to serve in the role.<ref>Template:Cite news</ref>

Regional offices

CMS has its headquarters in Woodlawn, Maryland, with 10 regional offices located throughout the United States: Template:Col-begin Template:Col-2

• Region I <ref>{{#invoke:citation/CS1|citation

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Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island and Vermont

• Region II <ref>{{#invoke:citation/CS1|citation

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New York State, New Jersey, U.S. Virgin Islands and Puerto Rico

• Region III <ref>{{#invoke:citation/CS1|citation

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Delaware, Maryland, Pennsylvania, Virginia, West Virginia and the District of Columbia

• Region IV <ref>{{#invoke:citation/CS1|citation

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Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee

• Region V <ref>{{#invoke:citation/CS1|citation

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Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin

• Region VI <ref>{{#invoke:citation/CS1|citation

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Arkansas, Louisiana, New Mexico, Oklahoma and Texas

• Region VII <ref>{{#invoke:citation/CS1|citation

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Iowa, Kansas, Missouri, and Nebraska

• Region VIII <ref>{{#invoke:citation/CS1|citation

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Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming

• Region IX <ref>{{#invoke:citation/CS1|citation

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Arizona, California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands

• Region X <ref>{{#invoke:citation/CS1|citation

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Alaska, Idaho, Oregon, and Washington

List of administrators

No.	Image	Name	Took office	Left office	President served under
1	File:Arthur Hess.jpg	Arthur E. Hess<ref name=":0"/>	1965	1967	Lyndon B. Johnson
2	File:No image.svg	Thomas M. Tierney<ref name=":0"/>	1967	1978	Lyndon B. Johnson Richard Nixon Gerald Ford Jimmy Carter
3	File:No image.svg	Robert Derzon<ref name=":0"/>	June 1977	November 1978	Jimmy Carter
4	File:No image.svg	Leonard Schaeffer<ref name=":0"/>	November 1978	June 1980
5	File:No image.svg	Howard N. Newman<ref name=":0"/>	July 1980	January 1981
6	File:No image.svg	Carolyne Davis<ref name=":0"/>	March 1981	August 1985	Ronald Reagan
7	File:William L Roper.jpg	William L. Roper<ref name=":0"/>	May 1986	February 1989	Ronald Reagan George H. W. Bush
8	File:Gail Wilensky official photo.jpg	Gail Wilensky<ref name=":0"/>	February 1990	March 1992	George H. W. Bush
9	File:No image.svg	Bruce Vladeck<ref name=":0"/>	May 1993	September 1997	Bill Clinton
10	File:Nancy-Ann DeParle official portrait.jpg	Nancy-Ann DeParle<ref name=":0"/>	November 1997	September 29, 2000
11	File:Thomas A. Scully (2017).jpg	Thomas A. Scully<ref name=":0"/>	May 2001	December 3, 2003	George W. Bush
12	File:MarkMcClellan.jpg	Mark McClellan<ref name=":0"/>	March 25, 2004	October 14, 2006
13	File:Donald Berwick CMS Administrator.jpg	Donald Berwick<ref name=":0"/>	July 7, 2010	December 2, 2011	Barack Obama
14	File:Marilyn-Tavenner.jpg	Marilyn Tavenner<ref name=":0"/>	December 2, 2011	March 18, 2015
–	File:Andy Slavitt official portrait.jpg	Andy Slavitt Acting	March 18, 2015	January 20, 2017
15	File:Seema Verma official photo.jpg	Seema Verma	March 14, 2017	January 20, 2021	Donald Trump
–	File:Liz Richter.png	Elizabeth Richter Acting	January 20, 2021	May 27, 2021	Joe Biden
16	File:Chiquita Brooks-LaSure, CMS Administrator 2.png	Chiquita Brooks-LaSure	May 27, 2021	January 20, 2025
–	File:No image.svg	Jeff Wu<ref>{{#invoke:citation/CS1|citation	CitationClass=web }}</ref> Acting	January 20, 2025	January 31, 2025	Donald Trump
–	File:No image.svg	Stephanie Carlton<ref>{{#invoke:citation/CS1|citation	CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation	CitationClass=web }}</ref> Acting	January 31, 2025		April 8, 2025
17	File:CMS Admin Dr Mehmet Oz.png	Mehmet Oz	April 8, 2025	Incumbent

See also

• Center for Medicare and Medicaid Innovation
• Zone Program Integrity Contractor

References

Template:Reflist Robinson, P. I. (July 1957). "Medicare: Uniformed Services Program for Dependents". Social Security Bulletin, 20(7), 9–16.

External links

• Template:Official website
• Centers for Medicare and Medicaid Services in the Federal Register
• Centers for Medicare & Medicaid Services in the Code of Federal Regulations
• Centers for Medicare & Medicaid Services reports and recommendations from the Government Accountability Office
• Grants to States for Medicaid account on USAspending.gov
• Centers for Medicare and Medicaid Innovation account on USAspending.gov
• State Grants and Demonstration account on USAspending.gov
• Centers for Medicare and Medicaid Services apportionments on OpenOMB
• GitHub Repositories
• GitHub Repositories for Digital Service at CMS