The Structure of Centers for Medicare and Medicaid Services - Term Paper Example

Research: CMS Affiliation Research: CMS The Centers for Medicare and Medicaid Services formerly referred to as the HealthCare Financing (Allgov.com, 2014; Cms.gov, 2014) Administration is a central agency within the US Department of both Health as well as Human Services which the Medicare program (Allgov.com, 2014), administers and also the works in corporation with national governments to administer the children’s Health insurance program (Allgov.com, 2014), Medicaid as well as the standards of the health insurance portability. Apart from these programs (Allgov.com, 2014), Centers for Medicare has other responsibilities which include the standards for administrative simplification from the (Cms.gov, 2014) Accountability Act of 1996 and (Allgov.com, 2014) Health Insurance Portability. It also has another responsibility for worth standards in durable health care facilities through its certification process and survey (Cms.gov, 2014) process, quality standards for clinical laboratory under the Clinical Laboratory Improvement Amendments as well as oversight of HealthCare.gov. (Allgov.com, 2014) The Medicare together with Medicaid programs were contracted into law on 30th July 1965 (Cms.gov, 2014). LBJ who was the president by then is seen at the signing ceremony during independence at the Truman library in Missouri (Cms.gov, 2014). Truman who was the former president is also pictured seated beside him. President LBJ held the ceremony there in honor of the leadership of President Truman on health insurance. He had first proposed it in 1945. The most important legislative modification to Medicare referred to as the Medicare Modernization Act was as well signed into law by (Cms.gov, 2014) President George W. Bush (Cms.gov, 2014) from Texas, on 8th December 2003. This historic legislation is of significance to the outpatient as it adds the outpatient’s drug prescription advantage to Medicare and it also leads to many other significant changes (Cms.gov, 2014). A number of changes have been implemented (Cms.gov, 2014) to Center for Medical services programs since 1965 (Cms.gov, 2014). In addition, the agencies that are concerned with the implementation of these programs have also changed (Cms.gov, 2014).The head of the Center for Medical services programs is as well the Administrator of the Center for both the Medicaid and Medicare Services (Cms.gov, 2014). This position of leadership is appointed by the president and the Senate confirms it. The Center for Medicare Services hires a total of approximately 4,100 employees 2,700 (Cms.gov, 2014) of the employees are located in (Cms.gov, 2014) Woodlawn which is the headquarter (Cms.gov, 2014)of Maryland. The rest of the workers are found in Hubert H. Humphrey which is a building in Washington, D.C. (Cms.gov, 2014) The Centers for Medicare & Medicaid Services programs aims at providing their audiences with a steady communication (Cms.gov, 2014)as well as brand experience. Steady branding makes the Center (Cms.gov, 2014) for Medicare program services initiatives more operative by aiding CMS’ audiences in the understanding of how to take advantage of the programs of CMS and the way in which the (Cms.gov, 2014) program works in order to improve healthcare. By so doing, it will as well strengthen every audience’s comprehension of the (Cms.gov, 2014)purpose of CMS therefore strengthening the CMS brand. CMS is capable of interacting with various audiences in various ways (Cms.gov, 2014). The providers as well as other non–consumers who take part in their programs understand and are able to identify CMS as an Agency (Cms.gov, 2014). This leads to building the trust of the customers towards their health care programs. Customers are very appreciative for the access of the health care (Cms.gov, 2014) as well as the security their programs offer (Cms.gov, 2014). We talk out accurate, consistent and also operational information where, when and how consumers require to utilize the benefits of (Cms.gov, 2014) CMS program and observe the CMS rules (Cms.gov, 2014). Through our informations, messages, visual identity and adequate consumer services, the two sets of audiences are able to experience CMS together with its programs (Cms.gov, 2014). These guidelines assist in creating that consistent and positive experience. The non–consumer audiences are stakeholder (Cms.gov, 2014) individuals, key partner and sets who are already familiar with CMS. Among those programs include (Cms.gov, 2014): a. Insurance industry b. States (Cms.gov, 2014) c. Hospitals (Allgov.com, 2014), nursing homes (Cms.gov, 2014; (Allgov.com, 2014), and home health care organizations d. Patient advocates (Cms.gov, 2014) e. Many physicians and mid–level (Allgov.com, 2014) providers These audiences have primary theme which consist: expanded care coverage, better care, population and prevention health and lower Costs (Cms.gov, 2014). CMS brand strategy theme applies the CMS brand and incorporates the numerous programs that CMS designs in order to improve health (Cms.gov, 2014) care delivery which include value- based purchasing (Cms.gov, 2014), partnership for patients, bundled payments, accountable care organizations and demonstrations to incorporate care dual appropriate persons (Cms.gov, 2014). Though the audiences may seem to (Cms.gov, 2014) understand the population Health, Expanded coverage and Care and Costs theme more explanation still needs to be offered. It is not instantly instinctive how the programs offered by the CMS align with this theme even for the stakeholder audiences (Cms.gov, 2014). The theme of safety net which resonates with customers, is also seen to resonate with the producers and with other non–customers. In contrast, the Care and Costs, Expanded coverage and Population Health (Cms.gov, 2014) theme is not instinctive to the customers. Consumer audiences are persons as well as groups who benefit from the use of the CMS services (Cms.gov, 2014). Those audiences include: People with Medicare (Cms.gov, 2014), families and care givers, People with Medicaid or CHIP, people with no coverage, those with pre-existing conditions. The main theme for these audience is: New benefits, Safety Net and expanded coverage (Cms.gov, 2014). This theme symbolizes the solid bond individuals who profit from CMS programs have with the particular programs (Cms.gov, 2014). This is very true for the nearly 50 million individuals with Medicare as it is the most durable program brand (Cms.gov, 2014) Organization of CMS The Consortia The Centers for Medicare & (Cms.gov, 2014) Medicaid Services which comprise of ten Field offices was reorganized in the year 2007 moving to a consortia based structure. from the earlier geography-based structure, on the Organizations strategic lines of profession:, Medicare financial management, Medicare health (Cms.gov, 2014) plans, Medicaid, Medicare fee for service provision actions, and childrens health care, inspection and endorsement, and quality enhancement. The key reason of the consortia structure is to develop enactment through unvarying dispute managing, reliable communication and management fixated on attaining the Organizations strategic feat plan (Provider & Code, 2009). Each syndicate group is headed by a Consortium Administrator (Cms.gov, 2014)that attends as the Organizations countrywide focal point in the Ground for their trade lines and as is also accountable for steady enactment of (Cms.gov, 2014; Provider & Code, 2009)The Centers for Medicare & (Cms.gov, 2014) Medicaid Services programs, plan and management across all the ten sections for matters relating to the organization’s trade line.  Apart from the responsibility for managing the trade line, each and every Consortium Administrator also serves as the Organizations senior most managing official for about three Regional Offices, representing (Cms.gov, 2014) The Centers for Medicare & (Cms.gov, 2014; Provider & Code, 2009) Medicaid Services’ Administrator in peripheral dealings, other matters and managing administrative processes (Cms.gov, 2014). The trade lines, Consortium Administrator’s (Cms.gov, 2014), site of the confederations headquarters and the Regional Offices that the Consortium Administrator has accountability for administrative processes and local peripheral affairs are as follows (Provider & Code, 2009; Cms.gov, 2014):  Consortium/Trade Line Consortium Administrator Location Senior Management Official Consortium Administrator Consortium for Financial Management & Fee for Service Operations Kansas City Denver Kansas City San Francisco Nanette Foster Reilly Consortium for Medicare Health Plans Operations (Cms.gov, 2014) New York New York Boston Philadelphia James T.  Kerr Consortium for Medicaid & Childrens Health Operations Chicago Seattle Chicago Jackie Garner Consortium for Quality Improvement & Survey and Certification Operations (Cms.gov, 2014) Dallas Dallas Atlanta Randy Farris, M.D. The Local Managers in the 6 non-Consortium Manager local offices together with Seattle, Atlanta, Philadelphia, San Francisco (Cms.gov, 2014; Provider & Code, 2009), Denver, and Boston are accountable for preparation and applying all exterior affairs resourcefulness within the topographical area that they are associated with.  Each Regional Administrator (Cms.gov, 2014) reports to 1 of the 4 Consortium Administrators (Allgov.com, 2014; Provider & Code, 2009).  There are Associate Regional Administrators that are located all over the Turf that formerly reported to the Regional Administrators (Cms.gov, 2014), who now report straight to the Consortium Administrator that is responsible for that precise trade line /serviceable area that they are responsible for (Allgov.com, 2014). Role and Importance of the Centers for Medicare and Medicaid Services Field The Centers for (Allgov.com, 2014) Medicare and Medicaid Services central and their regional offices segment a mutual mission and vision as well as a communal obligation to the 5 key purposes defined in the Centers for Medicare (Cms.gov, 2014) & Medicaid Services (Allgov.com, 2014) Strategic Plan for the years 2008 – 2012 (Provider & Code, 2009): 1. Committed, Skilled, and Vastly Motivated Workforce, 2. High-Value Health Care (Allgov.com, 2014; Provider & Code, 2009), 3. Affordable Health Care System, 4.  Collaborative Partnerships and, 5. Confident, Informed Consumers (Allgov.com, 2014). The Turf offers an accomplished, regional presence essential to attain the Organizations purposes and meet the continuous encounters of attending to about (Cms.gov, 2014) 90 million recipients.  The role of the Centers for Medicare & (Cms.gov, 2014) Medicaid Services Field comprises of three key components (Provider & Code, 2009): 1. Monitoring, 2. Protection and (Allgov.com, 2014), 3. Representation. Monitoring To attain and uphold an inexpensive health care structure, it is domineering that observing of The Centers for Medicare and (Cms.gov, 2014) Medicaid Services programs and assessment of workers/grantees is accurate, timely (Allgov.com, 2014), and rigorous.  Through continuing observing of the State Medicaid Agency monetary appealing, Managed Care Plans (Allgov.com, 2014), state survey agencies, Medicare claims handling servicers and peer appraisal organizations, the Turf is the Organizations façade line in observation and the implementation of The Centers for Medicare & (Provider & Code, 2009) Medicaid Services policies and regulations (Allgov.com, 2014). Protection The Turf puts into exercise on a local, state and regional level the defensive policy, regulations, and program (Allgov.com, 2014; Provider & Code, 2009) regulation established in the central office.  The Turf ensures defenses are set up in place to ease the provision of high-quality health care that is effective, safe, efficient (Provider & Code, 2009), timely, patient centered, and equitable (Allgov.com, 2014).  Actions engaged by the Turf protect the health and welfare of their recipients and the trust reserve.  Through continuing client services (Provider & Code, 2009), patient’s professional relationships and advocacy, the Turf is a delinquent solver for recipients, workers and other Centers for Medicare (Cms.gov, 2014) & Medicaid Services’ stakeholders (Allgov.com, 2014). Representation By the nature of their vicinity to The Centers for Medicare & Medicaid Services’ beneficiaries and partners, the Turf (Allgov.com, 2014) acts a very crucial role in the representation of the Organization and in the delivery of key messages.  Maintenance and development of local, state and regional corporations (Provider & Code, 2009), containing those with recipient alliances, professional relations and legislative bodies together (Allgov.com, 2014) with an understanding of local and regional influences allows (Cms.gov, 2014) Turf offices to achieve access and form cooperative corporations that would otherwise prove to be impossible (Allgov.com, 2014).  The Centers for Medicare & (Cms.gov, 2014) Medicaid Services Turf offices also habitually cooperate (Allgov.com, 2014) with turf offices of some other Federal organizations to enable them in serving the human and health service requirements of the public more effectively.  The Centers for Medicare & (Cms.gov, 2014) Medicaid Services Turf is a channel of information. The Turf is continually skimming (Cms.gov, 2014) and scrutinizing the local, state and regional health care bazaar and distribute their visions with the central office.  The extended coverage and profits for some audiences remain to be upheld to enhance that relationship (Allgov.com, 2014). This theme incorporates necessities encompassed in the Affordable Care Act covering also the increasing (Cms.gov, 2014) family coverage to kids under the age of 26, PCIP (Provider & Code, 2009), extended deterrent profits, extra investments in the Part D donut hole as well as Health Care interchangeable programs (Cms.gov, 2014). The universal community and customer audiences relate to the programs of CMS that offer them with health care (Allgov.com, 2014). REFERECNE\ Allgov.com. (2014). AllGov - Departments. [online] Retrieved from: http://www.allgov.com/departments/department-of-health-and-human-services/centers-for-medicare-medicaid-services-cms?agencyid=7395 [Accessed: 1 Apr 2014]. Cms.gov. (2014). Historical - Centers for Medicare & Medicaid Services. [online] Retrieved from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html [Accessed: 1 Apr 2014]. Cms.gov. (2014). History - Centers for Medicare & Medicaid Services. [online] Retrieved from: http://www.cms.gov/About-CMS/Agency-Information/History/index.html?redirect=/history/ [Accessed: 1 Apr 2014]. Cms.gov. (2014). Center for Strategic Planning - Centers for Medicare & Medicaid Services. [online] Retrieved from: http://www.cms.gov/About-CMS/Agency-Information/CMSLeadership/Office_CSP.html [Accessed: 1 Apr 2014]. Medicaid.gov. (2014). About Us | Medicaid.gov. [online] Retrieved from: http://medicaid.gov/about-us/about-us.html [Accessed: 1 Apr 2014]. Provider, M. C., & Code, Z. (2009). Centers for Medicare & Medicaid Services. Read More