Centers for Medicare & Medicaid Services

AuthorJeffrey Lehman, Shirelle Phelps

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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 Medicare+Choice 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

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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 low-income 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...

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