Centers for Medicare & Medicaid Services (CMS)
- Homepage: http://www.cms.hhs.gov/
August 2004: "The Centers for Medicare & Medicaid Services (CMS) is a Federal agency within the U.S. Department of Health and Human Services. Programs for which CMS is responsible include Medicare, Medicaid, State Children's Health Insurance Program (SCHIP), HIPAA, and CLIA."http://www.cms.hhs.gov/
September 2014: "The distinction between inpatient and outpatient status matters: Seniors must have three consecutive days as admitted patients to qualify for Medicare coverage for follow-up nursing home care, and observation time doesn’t count for that three-day tally. That leaves some observation patients with a tough choice: Pay the nursing home bill themselves – often tens of thousands of dollars – or go home without the care their doctor prescribed and recover as best they can."http://www.charlotteobserver.com/2014/09/15/5176579/hospital-observation-can-be-pricey.html
March 2014: "For years, efforts to curb fastrising Medicaid costs centered on welfare mothers and children, even though Medicaid spends more than five times as much on an aged or severely disabled person in longterm care as it does on a poor child."http://www.nytimes.com/2014/03/07/nyregion/pitfalls-seen-in-tennessees-turn-to-privately-run-long-term-care.html
August 2012: 'To some, HCA successfully pushed the envelope in its interpretation of existing Medicare rules. “If HCA can do it, why can’t we?” asked a hospital consulting firm, the Advisory Board Company, in a presentation to its clients.'http://www.nytimes.com/2012/08/15/business/hca-giant-hospital-chain-creates-a-windfall-for-private-equity.html
March 2010: 'START WITH THE DATA Every year the Centers for Medicare and Medicaid Services collect data on more than 15,000 nursing homes throughout the country. Health inspection data, staffing and quality measures are combined to come up with an overall ranking of one to five stars. To look up nursing homes in your area, go to medicare.gov and click on the “nursing home compare” tool.'http://www.nytimes.com/2010/03/20/health/20patient.html
September 2009: "Despite that heavy investment, federal law limits Medicare reimbursement for the immunosuppressant drugs that transplant recipients must take for life, at costs of $1,000 to $3,000 a month."http://www.nytimes.com/2009/09/14/health/policy/14kidney.html
June 2009: "It is natural to be skeptical. The largest existing public health programs — Medicare and Medicaid — are the main reason that the government’s long-term finances are in shambles. True, Medicare’s administrative costs are low, but it is easy to keep those costs contained when a system merely writes checks without expending the resources to control wasteful medical spending."http://www.nytimes.com/2009/06/28/business/economy/28view.html
May 2009: "...Medicare has decided not to pay for genetic tests intended to help doctors determine the best dose of the blood thinner warfarin for a particular patient....the Centers for Medicare and Medicaid Services said that there was not enough evidence that use of the tests improved patients’ health."http://www.nytimes.com/2009/05/05/health/05thinner.html
June 2009: "Proposal 1: Lower the annual rate of pay increases for Medicare"http://www.smartmoney.com/personal-finance/health-care/obamas-health-care-plan-what-it-means-for-you/
December 2008: "Medicare is pressing for quality improvements, using as leverage the $155 billion it spends on hospital care annually. But Herb Kuhn, deputy administrator of the Centers for Medicare and Medicaid Services, said hospitals would not make patient safety their top priority until Medicare changed its reimbursement system."http://www.nytimes.com/2008/12/08/business/08hospital.html
November 2008: "Since Medicaid is an entitlement, not a program everyone pays into like Social Security or Medicare, the Federal government defines eligibility. And Federal law prohibits state Medicaid programs from looking at the finances of anyone other than the applicant or the applicant’s spouse. When the elderly exhaust their assets, individually or as a couple, the government steps in and pays for their long-term care. Adult children are not part of the Medicaid eligibility equation."http://newoldage.blogs.nytimes.com/2008/11/20/unenforced-filial-responsibility-laws/index.html
November 2008: "Two decades have now passed, and not one of those solutions (which I call smiley-faced) has made much difference. The Medicare program cost $429 billion in 2007 and, with a 7 percent annual cost increase, will rise to $884 billion in 2017. At that point, the Trustees of the program have told us, it will in effect be bankrupt."http://newoldage.blogs.nytimes.com/2008/11/13/heart-surgery-how-old-is-too-old/index.html
August 2008: "Medicare’s top officials said in 2006 that they had reduced the number of fraudulent and improper claims paid by the agency, keeping billions of dollars out of the hands of people trying to game the system."http://www.nytimes.com/2008/08/21/business/21medicare.html
May 2008: "Government officials have been complaining for two decades that the medical-device lobby has managed to keep reimbursements for that service too high. Last year, the Democratic-controlled House passed a bill that would have slashed oxygen payments, but the Senate did not act. Kerry Weems, acting administrator of the Centers for Medicare and Medicaid Services, said Congress could lower payments sharply and still provide profit to the companies and full service to patients."http://www.washingtonpost.com/wp-dyn/content/article/2008/05/05/AR2008050502302.html
December 2007: 'The Bush administration, responding to earlier reports of [private Medicare health plan] deceptive marketing, has tried to crack down on such practices. "There are substantially fewer violations, and those violations are of substantially lower severity than in previous marketing periods,” said Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services."'http://www.nytimes.com/2007/12/17/us/17medicare.html
November 2007: "Herb B. Kuhn, the deputy director of the Center for Medicare and Medicaid Services, said that finding was attracting attention at the center, which is eager to keep the hospice care benefit from morphing into a long-term care entitlement. “Well over nine out of 10 hospices seem to be managing well, including the ones in higher-wage areas, so it does raise an issue of management,” Mr. Kuhn said. Mr. Kuhn said it remained a question whether hospice care saved money, but called it “a wonderful benefit” that “probably needs refinement” after nearly 25 years."http://www.nytimes.com/2007/11/27/us/27hospice.html
October 2007: An additional 22,110 poor children had not received dental care in at least two years, according to a review of dental records requested from United Healthcare, a managed-care organization serving Maryland Medicaid beneficiaries. The congressional subcommittee requested billing and service records from United as part of an investigation into gaps in Medicaid care for poor children.http://www.washingtonpost.com/wp-dyn/content/article/2007/10/03/AR2007100302348.html
October 2007: Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of scores of federal audits has found.http://www.nytimes.com/2007/10/07/us/07medicare.html
October 2007: The New Jersey lawsuit, filed yesterday in U.S. District Court, contends that the federal Centers for Medicare and Medicaid Services (CMS) violated the law by not going through a formal rulemaking process when it announced the new regulations. That process would require CMS to publish a notice in the Federal Register and provide the public an opportunity to comment.http://www.washingtonpost.com/wp-dyn/content/article/2007/10/01/AR2007100101450.html
July 2007: The site, http://www.hospitalcompare.hhs.gov, now rates the level of cardiac care provided by more than 4,000 hospitals nationwide based on mortality statistics, the first time the federal Centers for Medicare & Medicaid Services (CMS) has posted hospital information based on outcomes.http://www.washingtonpost.com/wp-dyn/content/article/2007/06/29/AR2007062902056.html
April 2007: “Some of these homes repeatedly harmed residents over a six-year period and yet remain in the Medicare and Medicaid programs,” said the report, to be issued next week by the Government Accountability Office, an investigative arm of Congress.http://www.nytimes.com/2007/04/22/health/22nursing.html
January 2007: Leavitt and other Republicans countered that the year-old program is working, with the Centers for Medicare and Medicaid Services (CMS) reporting overall costs coming in billions of dollars lower than expected and average plan premiums being lower this year than in 2006. Moreover, polls conducted last fall by the Henry J. Kaiser Family Foundation and other nonpartisan groups found that the overwhelming majority of seniors were satisfied with their drug plans.http://www.washingtonpost.com/wp-dyn/content/article/2007/01/12/AR2007011201399.html
December 2006: States base their programs on a 1993 federal law mandating that they recover what Medicaid spends on a beneficiary's long-term care. Congress approved the law to prevent states from forcing the sale of beneficiaries' homes while they were still living, in case their conditions improve and they can return home, says Mary Kahn, spokeswoman for the Centers for Medicare and Medicaid Services.http://www.csmonitor.com/2006/1226/p03s03-ussc.html
November 2006: WASHINGTON, Nov. 2 — Under a new federal policy, children born in the United States to illegal immigrants with low incomes will no longer be automatically entitled to health insurance through Medicaid, Bush administration officials said Thursday.http://www.nytimes.com/2006/11/03/washington/03medicaid.html
May 2006: The Bush administration, which has argued strenuously for keeping both the deadline and the late fees, refused to respond yesterday to the Republicans' concern about the penalties. 'We've not been focused on it. We've really been focused on getting to May 15,' said Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services (CMS), who was stumping through New England yesterday encouraging older people to sign up. He said he planned to hit five more states before the end of the weekend.http://www.washingtonpost.com/wp-dyn/content/article/2006/05/12/AR2006051202081.html
July 2006: Among the groups exempted will be seniors and people with disabilities who have Medicare or SSI, as Supplemental Security Income is commonly called. Because they have provided documentation as required in those programs, the Centers for Medicare and Medicaid Services agreed that they should be excluded from a new citizenship rule.http://www.washingtonpost.com/wp-dyn/content/article/2006/07/06/AR2006070601734.html
June 2006: The U.S. Centers for Medicare and Medicaid Services has allowed 48 heart, liver and lung transplant centers to continue operating despite sometimes glaring and repeated lapses, the newspaper's review found. There are 236 approved centers nationwide.http://www.latimes.com/news/local/la-me-transplant29jun29,1,4034696.story
February 2006: The mentally ill are nearly a third of the 'dual eligibles' who qualify for both Medicare and Medicaid because of income and disability or age. Mark B. McClellan, head of the Centers for Medicare and Medicaid Services, told a Senate committee hearing Thursday that a prime focus is resolving the 'remaining transition issues' for this extremely vulnerable population.http://www.washingtonpost.com/wp-dyn/content/article/2006/02/05/AR2006020501163.html
January 2006: Administration officials, already racing to fix other glitches in the new drug program, yesterday pointed the finger back at drugmakers, saying there are a variety of legal ways to assist low-income patients. If a drug company's patient assistance program ends, 'that's the manufacturer's decision,' said Mark McClellan, administrator of the Centers for Medicare and Medicaid Services. He said drugmakers could continue their patient assistance programs as long as they remain separate from Medicare or contribute money to charities that help poor patients.http://www.washingtonpost.com/wp-dyn/content/article/2006/01/26/AR2006012602061.html
January 2006: Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services, said on Saturday that he was working closely with states to address their concerns and to help individual patients. 'We are filling close to a million prescriptions a day, including hundreds of thousands for low-income beneficiaries,' Dr. McClellan said. 'Many, many people are getting the prescriptions they need.'http://www.nytimes.com/2006/01/08/national/08medicare.html
March 2005: Mr. Grassley, the chairman of the Finance Committee, which has authority over Medicaid, said: 'The drug program has been badly mismanaged. The Centers for Medicare and Medicaid Services, which administers the program, has been negligent. For 15 years, drug companies have been profiting from a system that costs taxpayers untold hundreds of millions, if not billions, of dollars annually.'http://nytimes.com/2005/03/08/politics/08drug.html
January 2005: So it was that in May the GAO said the Centers for Medicare Centers for Medicare & Medicaid Services Medicaid Services violated "publicity and propaganda" prohibitions by producing a "video news release" regarding changes to Medicare benefits. The video package, complete with lead-in scripts, did not identify CMS as the source, resembled a television news story and was used by some TV stations as if it were independently reported news.http://www.washingtonpost.com/wp-dyn/articles/A49757-2005Jan30.html
Role Name Type Last Updated Owner of (partial or full, past or present) Center for Consumer Information and Insurance Oversight (CCIIO) Organization Jul 9, 2012 Owned by (partial or full, past or present) Department of Health and Human Services (HHS) Organization Aug 5, 2004 Owned by (partial or full, past or present) US Federal Government - Independent Agencies Organization May 4, 2005 Organization Executive (past or present) Prof. Cindy Mann Esq. Person Jul 1, 2006 Organization Head/Leader (past or present) Dr. Mark B. McClellan Person Jan 8, 2006 Organization Head/Leader (past or present) Organization Executive (past or present) Leslie V. Norwalk Esq. Person Nov 6, 2006 Organization Head/Leader (past or present) Marilyn B. Tavenner Person Aug 15, 2012 Organization Head/Leader (past or present) Kerry Weems Person Jun 5, 2008
Articles and Resources
Date Fairness.com Resource Read it at: Sep 15, 2014 Medical costs: Hospital observation can be pricey
QUOTE: The distinction between inpatient and outpatient status matters: Seniors must have three consecutive days as admitted patients to qualify for Medicare coverage for follow-up nursing home care, and observation time doesn’t count for that three-day tally.
Charlotte Observer Mar 06, 2014 Pitfalls Seen in a Turn to Privately Run Long-Term Care
QUOTE: a closer look at Tennessee, widely cited as a model, reveals hidden pitfalls as the system of caring for the frail comes under the twin pressures of cost containment and profit motive. In many cases, care was denied after needs grew costlier — including care that people would have received under the old system. “The notion of prevention saving money in the long run only works if you actually provide care in the long run,”
New York Times Aug 14, 2012 A Giant Hospital Chain Is Blazing a Profit Trail
QUOTE: HCA’s emergence as a powerful leader in the hospital industry is all the more remarkable because only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion. Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff, a move that sometimes led to conflicts with doctors and nurses over concerns about patient care.
New York Times Mar 23, 2010 In Health Care Bill, Obama Attacks Wealth Inequality
QUOTE: [over the past three decades] government policy and market forces have been moving in the same direction, both increasing inequality. The pretax incomes of the wealthy have soared since the late 1970s, while their tax rates have fallen more than rates for the middle class and poor. Nearly every major aspect of the health bill pushes in the other direction.
New York Times Mar 18, 2010 Stressful but Vital: Picking a Nursing Home (Patient Money)
QUOTE: Finding a good nursing home takes research and perseverance...Unfortunately, the typical search for a nursing home is made under duress.
New York Times Sep 14, 2009 Insurers Fight Speech-Impairment Remedy
QUOTE: Medicare and private health insurers decline to cover cheap devices like iPhones and netbook PCs that can help the speech-impaired, despite their usefulness and lower cost.
New York Times Sep 13, 2009 U.S. Cost-Saving Policy Forces New Kidney Transplant
QUOTE: Although the government regularly pays $100,000 or more for kidney transplants, it stops paying for anti-rejection drugs after only 36 months.
New York Times Sep 02, 2009 The Fix Is In: The hidden public-private cartel that sets health care prices.
QUOTE: Fundamentally, the entire payment model of American health care drives medical centers, doctors, and hospital managers to push for more fancy procedures at the expense of primary care doctors.
Slate Jul 24, 2009 Buying a Hearing Aid? You’ve Got a Lot to Learn (Patient Money)
QUOTE: “Unfortunately, hearing aids are seen as one of those medical costs, like vision and dental, that doesn’t deserve full coverage,” said Gyl A. Kasewurm, an audiologist in St. Joseph, Mich.
New York Times Jun 27, 2009 Economic View: The Pitfalls of the Public Option
QUOTE: IN the debate over health care reform, one issue looms large: whether to have a public option. Should all Americans have the opportunity to sign up for government-run health insurance?....Even if one accepts the president’s broader goals of wider access to health care and cost containment, his economic logic regarding the public option is hard to follow. Consumer choice and honest competition are indeed the foundation of a successful market system, but they are usually achieved without a public provider.
New York Times Jun 25, 2009 Family Caregiving on Contract (The New Old Age: Caring and Coping)
QUOTE: Elder lawyers have been discussing care contracts [where a family member is paid to care for the elderly relative] or caregiver agreements for years, but interest has picked up since 2006, when Medicaid eligibility requirements tightened.
New York Times Jun 16, 2009 Obama's Health-Care Plan: What It Means for You
QUOTE: More than $1 trillion will be needed to pay for the Obama administration's ambitious health-care reform plan. To come up with the money, the president has pledged to trim fat from the Medicare and Medicaid programs. But when all is said and done, it may be consumers who end up paying the price.
Smart Money Jun 03, 2009 Slump Pushing Cost of Drugs Out of Reach
QUOTE: Even with the Medicare drug benefit, even with the prevalence of low-cost generics, even with loss-leader discounting by big chains, many Americans still find themselves unable to afford the prescription medications that manage their life-threatening conditions....the recession has heightened the struggle.
New York Times May 04, 2009 Gene Test for Dosage of Warfarin Is Rebuffed
QUOTE: In a proposed decision posted on its Web site Monday, the Centers for Medicare and Medicaid Services said that there was not enough evidence that use of the tests improved patients’ health. But the agency said it would pay for the tests as part of clinical trials to gather such evidence.
New York Times Mar 09, 2009 Money Stimulates Debate in States Over Plan's Goals
QUOTE: states and federal agencies are gripped by disputes over whether the money [from the Recovery Act] is being used in ways that violate the letter or spirit of the legislation,
Washington Post Dec 08, 2008 The Evidence Gap: Weak Patchwork of Oversight Lets Bad Hospitals Stay Open
QUOTE: in late 2006 a state commission recommended that it be scaled back and merged with another hospital. The state’s inability to follow through on that plan for University provides a stark example of how hard it can be — not just in New York, but around the nation — to close or shrink hospitals, even when there is evidence they are providing costly and below-average care.
New York Times Nov 20, 2008 The New Old Age: Legally Responsible for Care
QUOTE: When the elderly exhaust their assets, individually or as a couple, the government steps in and pays for their long-term care. Adult children are not part of the Medicaid eligibility equation. But Medicaid is in big trouble — cutting here, squeezing there — and will be inundated when baby boomers reach old age. The staggering cost of long-term care and the explosion in the number of people who will need it has prompted a second look at filial responsibility laws as a way to deal with the impending crisis.
New York Times Nov 13, 2008 The New Old Age: Rationing Health Care
QUOTE: The biggest change in the last 40 years, Mr. Callahan said to me, is that there are no limits. There's nothing we can't do for an old person, and there's a lot of pressure to do it. This is considered progress, and its considered ageism to be skeptical. But we can't go on this way. It's unaffordable. And it's the hardest dilemma in our society because theres no good way to deal with it other than saying no.
New York Times Oct 26, 2008 Quickly Vetted, Treatment Is Offered to Patients
QUOTE: "F.D.A. officials defend the quick-review process as a way to promote innovation. Because most new products are simply an improvement on an existing device, they say, there is rarely need for a full review.... Critics say the F.D.A.’s process for reviewing medical technology, under which medical devices have become a $75 billion-a-year industry in this country, is often too lax."
New York Times Aug 21, 2008 Report Rejects Medicare Boast of Paring Fraud
QUOTE: Medicare’s top officials said in 2006 that they had reduced the number of fraudulent and improper claims paid by the agency, keeping billions of dollars out of the hands of people trying to game the system. But according to a confidential draft of a federal inspector general’s report, those claims of success, which earned Medicare wide praise from lawmakers, were misleading.
New York Times
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