What does CMS stand for? What is the difference between Medicare and Medicaid?
CMS = Centers for Medicare and Medicaid. Medicare is the federal program
... [Show More] run by the Department of Health and Human Services and Medicaid is managed more at the state level.
Describe the history of Medicare
On July 30, 1965, President Lyndon Johnson signed law that lead to both Medicare and Medicaid programs. This was a federal health care plan for the poor - seniors were the population most likely to be living in poverty. The federal agency became The Centers for Medicare and Medicaid Services (CMS).
When was Medicare coverage expanded? Who was it expanded to?
Medicare coverage was expanded in 1972 to cover individuals under age 65 with long-term disabilities and people with ESRD.
Who is the CMS Administrator appointed by?
The CMS administrator is appointed by the President of the United States.
What are the responsibilities of the CMS administrator?
The CMS administrator oversees $1 trillion budget, which is 26% of the total federal budget. Responsibilities include directing planning, coordination, and implementation of programs; overseeing establishment of program goals and objectives; overseeing development of policies, standards, and guidelines; evaluating progress in administration of CMS programs; and ensuring required actions are taken to achieve program objectives
Who was the CMS Administrator under the Trump Administration and when did she resign?
Seema Verma - she resigned on January 15, 2021.
Who will be the CMS administrator under the Biden administration?
Elizabeth Richter is the interim administrator. Chiquita Brooks-LaSure and Mandy Cohen are currently the leading candidates for CMS administrator.
What criteria does an individual need to meet to be eligible for Medicare at age 65 or older?
To receive full Medicare benefits at age 65 or older, and individual needs to meet the following requirements: U.S. citizen or permanent legal resident who lived in the U.S. for at least five years; and an individual or spouse has worked long enough to be eligible for SS or railroad retirement benefits (usually having earned 40 credits over 10 years of work; or individual or spouse is a government employee or retiree who has not paid SS but paid Medicare payroll taxes while working.
What does earning 40 credits through payroll taxes guarantee?
Earning 40 credits through payroll taxes guarantees that the individual will not have to pay premiums for Part A benefits.
What criteria does an individual need to meet to be eligible for Medicare under age 65?
To receive full Medicare benefits under age 65, an individual needs to meet the following requirements: entitled to SS disability benefits for at least 24 months that need not be consecutive; or receive disability pension from Railroad Retirement board and meet certain conditions; or have Lou Gehrig's disease (ALS); or have permanent kidney failure requiring regular dialysis or kidney transplant, and individual or spouse had paid SS taxes for specified length of time depending on the person's age.
What is the National Quality Strategy (NQS)?
The National Quality Strategy (NQS) was first published in March 2011 as a National Strategy for Quality Improvement in Health Care. It was led by the Agency for Healthcare Research and Quality on behalf of the U.S. Department of Human Health Services (HHS). It is updated annually in a report to congress. The report articulates the broad aims and priorities that guide development of CMS programs, regulations, and strategic plans for new initiatives.
(Within the Medicare system, we started looking at what we need to do from a national strategy standpoint on improving quality within healthcare. Medicare created NQS, and NQS defines what they feel like they need to do to improve U.S. healthcare quality. This report is submitted to congress for review).
What was one of the objectives of CMS?
"CMS, in collaboration with public and private partners, is transforming how we conduct business and operations, connect providers, and empower consumers and beneficiaries. We are working to build a health care delivery system that is better, smarter, and healthier - a system that delivers improved care, spends health care dollars more wisely, and one that makes our communities healthier."
What is the CMS Quality strategy?
The CMS quality strategy includes aims to provide better, more affordable care, and priorities to guide efforts to improve health and health care quality.
What are the three aims of the CMS Quality Strategy?
1. Better Care: Improve the overall quality of care by making healthcare more person-centered, reliable, accessible, and safe.
2. Healthier People, Healthier Communities: Improve the health of Americans by supporting proven interventions to address behavioral, social, and environmental determinants of health, and deliver higher-quality care.
3. Smarter Spending: Reduce the cost of quality healthcare for individuals, families, employers, government, and communities.
What are the six priorities of the CMS Quality Strategy?
1. Make Care Safer by Reducing Harm Caused in the Delivery of Care
2. Strengthen Person and Family Engagement as Partners in Their Care
3. Promote Effective Communication and Coordination of Care
4. Promote Effective Prevention and Treatment of Chronic Disease
5. Work with Communities to Promote Best Practices of Healthy Living
6. Make Care Affordable
What are the four parts to Medicare? What is included in each part?
Part A: inpatient hospital care, skilled nursing services, hospice care (acute care)
Part B: doctor's visits, outpatient hospital services, durable medical equipment, physician administered drugs
Part C: Medicare advantage plans, which combine parts A & B; may cover vision, dental and hearing (many people are starting to opt into this - even big commercial insurance companies are opting into Medicare advantage plans)
Part D: prescription drug coverage
What is included under hospital coverage for Medicare Part A?
Inpatient/acute hospital care, surgery, skilled nursing services (i.e. SNFs), laboratory tests, home health visits, and hospice services
What is the yearly deductible for Medicare Part A?
$1,484 for 2021. This deductible covers share of costs for the first 60 days of the Medicare-covered inpatient hospital stay. The beneficiary requires a supplemental health insurance policy to assist with payments starting at day 61.
Medicare cost sharing [Show Less]