Policy CMS Center
Question :
What are some of the key points in the legislative history of the establishment and evolution of CMS?
Policy-making debates were alive and well during the formation of Medicare.
Describe the key functions of CMSs Center for Medicare AND the challenges CMS faces in managing the health insurance marketplaces.
Answer :
Establishment of CMS
Data is collected and analyzed by CMS producing research reports and eliminating instances of abuse and fraud in the healthcare system. In the year 1965 on 30th July, a bill was signed by the president named Lyndon B. Johnson for the establishment of the programs of Medicaid and Medicare (Wu et al., 2018). In the year 1977, Healthcare Financing Administration was established by the federal government as part for the Department of Health along with Education and Welfare (HEW).
Evolution of CMS
In 1960s, Medicare and Medicaid had been enacted by the Title of XVIII and XIX of the Social Security Act with the provision of hospitals, extended care after hospitals along with health coverage in homes for the population of America whose age is 65 or more. The states were provided the option to receive federal funding to provide health care facilities for the underprivileged children, the blind, people with disabilities and their care giver families (Cohen, 1985). In such period, the population of the seniors who used to live in the poverty; almost 50% of them had health insurance coverage.
In 1970s, the eligibility for Medicare was extended to the people under 65 years having disabilities of long-term and to the people having end-stage of renal disorder. Start-up loans and grants were provided by the Health Maintenance Organizations Act for developing HMO (Malpani, Hilibrand & Grauer, 2018). In 1977, the Health Care Financing Administration has been established for administering the program of Medicare and Medicaid.
In 1997, the CHIP was developed and new Medicaid care requirements and options were created for the states. In 1998, Medicare.gov has been launched for providing up-to-date information regarding Medicare. In 2000s, Medicare payments were increased by The Benefits Improvement and Protection Act (BIPA) for organizations and providers of health care reducing some beneficiary co-payments of Medicare. In 2003, the most important changes were made by The Medicare Prescription Drug, Improvement and Modernization Act (MMA) in Medicare since the beginning of the program (Longest, 2002). A new prescription of benefit of drug for outpatients was created by MMA, given by private health scheme that allow the competition between the health schemes for fostering flexibility and innovation in coverage. Again, new preventive advantages were covered and various other changes were made. The method of paying physicians of Medicare was changed in the year 2015 by The Medicare Access and CHIP Reauthorization Act (Darves-Bornoz & Resnick, 2017). The methodology of SGR (Sustainable Growth Rate) was replaced by a method which is very predictable speeding up the participation in the payment models alternatively. Efficiency and quality are improved by such models.
Functions of CMS-Types of Programs
CMS has many major roles to play in the state and federal marketplace of health insurance to help the implementation of the laws of Affordable Care Act regarding private health insurance and to provide educational materials to the people.
Medicare: It is a program funded by taxpayer for the elders of 65 years of more or more. Health coverage was also provided by the Medicare for individuals having long term disabilities and last stage disorders.
Medicaid: It is a program which is sponsored by government providing assistance for the coverage of health care to the individuals having less income (Tsujimura et al., 2019). Assistant payments for few things are received by the patients such as visits of the doctor, cost of medical for long term and custodial care stays in healthcare centers and so on.
The Children’s Health Insurance Program (CHIP): This program is offered to the guardian of children who are under 19 years and making a lot for quality for Medicaid and are not capable of affording health insurance regularly. The limits of the income differ as there are variety of programs run by the state having various names and eligibility criteria.
The CARES Act: The ability of Medicare is expanded in this act for covering services and treatment for the people suffering from COVID-19. Flexibility is increased for Medicare for covering tele-health services in this Act (Heng et al., 2018). Again, Medicare payments of stays in hospitals and durable equipments of medicals were also increased for the COVID-19 patients.
Challenges
Payments: To ensure good expenditure of taxpayer funds for planned purposes have a substantial challenge of management. It is important for the department for implementing payments systems and financial management which are capable of producing timely and accurate payments who issue advance payments of cost-sharing reduction money, premium tax credits.
Eligibility: It is critical to ensure eligibility determinants accurately. More than that, for the next period of open enrollment, functionality must be added by the marketplaces to process enrollments (Prajapati, 2018). Impactful inside controls and accurately and timely resolution of inconsistencies will continue to be important for ensuring that eligible customers get proper benefits along with the assurance that non-eligible are not getting enrollment.
Management and Administration: After 1st October, 2013, the requirement for the improvement of the management and oversight was acknowledge by the Department that include disciplined operations, clear leadership along with good communication in the Department. Challenges are to select capable contractors and to provide proper oversight for ensuring operation successfully of the federal Marketplace that include both administrative and public-facing systems. Questions have been prompted by the Marketplace about using Federal established grant funds.
Security: It is a paramount to protect and ensure the integrity and confidentiality of personal sensitive information of the consumers and the Marketplace systems of information. The requirements for impactful operation of the Marketplace are secure, accurate and rapid integration of information from various state and federal sources, consumers and issuers (Visoottiviseth et al., 2017). A large scale established method to communicate is also needed among various state and federal systems.
References
Heng, S., Liu, S., Xia, C., Tang, H., Xie, F., Fu, T., & Wan, Z. (2018). Morphological and genetic characterization of a new cytoplasmic male sterility system (oxa CMS) in stem mustard (Brassica juncea). Theoretical and applied genetics, 131(1), 59-66.
Li, W., Luo, X., Ulbricht, Y., Wagner, M., Piorkowski, C., El-Armouche, A., & Guan, K. (2019). Establishment of an automated patch-clamp platform for electrophysiological and pharmacological evaluation of hiPSC-CMs. Stem Cell Research, 41, 101662.
Malpani, R., Hilibrand, A. S., & Grauer, J. N. (2018). Evolution and use of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys and their application for spinal surgery patients. Contemporary Spine Surgery, 19(5), 1-6.
Prajapati, C. K. (2018). Study of Hypertrophic Cardiomyopathy Using Human Induced Pluripotent Stem Cell Derived Cardiomyocytes.
Tsujimura, M., Kaneko, T., Sakamoto, T., Kimura, S., Shigyo, M., Yamagishi, H., & Terachi, T. (2019). Multichromosomal structure of the onion mitochondrial genome and a transcript analysis. Mitochondrion, 46, 179-186.
Visoottiviseth, V., Akarasiriwong, P., Chaiyasart, S., & Chotivatunyu, S. (2017, November). PENTOS: Penetration testing tool for Internet of Thing devices. In TENCON 2017-2017 IEEE Region 10 Conference (pp. 2279-2284). IEEE.
Wu, M., Song, J., Lin, L. W. L., Aurelle, N., Liu, Y., Ding, B., ... & Moon, Y. B. (2018). Establishment of intrusion detection testbed for CyberManufacturing systems. Procedia Manufacturing, 26, 1053-1064.
