Center for Medicare and Medicaid Services

Medicare and Medicaid were first proposed in 1945 and signed into law in 1965. Since then, major changes have been made to CMS. The Center for Medicare and Medicaid Services is a consortium based on the Agency’s major line of business namely: Medicare financial management, Medicare health plans, Medicaid and child health, Medicare fee for service operations among others.
There are four main consortium’s namely:

1. The health care operations consortium: Functions as the main stop for all businesses done with health care firms, Medicare Advantage Plans, Medicare prescription plans among others. It also operates as the main stop for all agency relations done with employers, employees, retired persons and any other person working on their behalf concerning the Agency’s policies and services and any matter relating to sponsored drug cover. It also serves as the main base for any connections with beneficiaries and their families, care takers, health care providers and any person working on behalf of the beneficiaries regarding educating the beneficiaries on making sound decisions relating to the program.

2. Financial management & fee for service operations: Functions as the centre for all businesses relating to the Office of Financial Management. Takes charge of all field operations relating to Medicare Secondary Payer. It serves as the main station for all the Agency’s operations between health care providers and fee for service contractors in regards to matters concerning some areas of the fee for service policies. It acts as the main center for comments relating fee for service legislation to find out its impact.

3. The Medicaid and Children’s health operations Consortium: It functions as the main center for all Center for Medicare and Medicaid Services activities in regards to Medicaid and children’s health Insurance Program and operations. This consortium is responsible for providing overall supervision and technical aid to the state’s CHIP. It is mainly responsible for putting into place the National Medicaid program as well as supportive procedures to ensure an effective program is administered, and recipient protection. This consortium partners with corresponding states in the evaluation of the success of agencies in their duties as well as promoting quality operations. It is also responsible for the implementation, interpretation and application of various laws and policies that are directly involved in the governance of the financial procedure, as well as the management of the Medicaid program. The consortium is responsible for the initiation and implementation of special regional projects. It directs and monitors the integrity and efforts of states in running activities.

4. Quality improvement and survey & certification operations consortium: Its main functions are: it is the centre for all medical and clinical issues and it is responsible for the management of quality activities with other organizations. It is responsible for the supervision of Medicare and Medicaid to ensure quality and success are attained. It employs quality practices and methods for quality advancement. It ensures that all activities relating to the Agency such as payment policies, provider plans and beneficiary awareness as well as any technical assistance are effectively incorporated.

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