Centers for Medicare & Medicaid Services

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| formed = {{Start date and age|1977|3}}

| preceding1 = Health Care Financing Administration (1977–2001)

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| headquarters = Woodlawn, Baltimore County, Maryland, U.S.

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| employees = 6,000

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| chief1_name = Mehmet Oz

| chief1_position = Administrator

| chief2_name = Stephanie Carlton

| chief2_position = Deputy Administrator

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| parent_agency = Department of Health and Human Services

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| website = {{Official URL}}

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The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov.

CMS was previously known as the Health Care Financing Administration (HCFA) until 2001.

CMS actively inspects and reports on every nursing home in the United States. This includes maintaining the 5-Star Quality Rating System.{{Cite web|title=Five-Star Quality Rating System|url=https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS}}

History

Originally, the name "Medicare" in the United States referred to a program providing medical care for families of people serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956.Robinson, P. I. (1957). Medicare: Uniformed Services Program for Dependents. Social Security Bulletin, 20(7), 9–16. President Dwight D. Eisenhower held the first White House Conference on Aging in January 1961, in which creating a health care program for social security beneficiaries was proposed.Tibbits C. "The 1961 White House Conference on Aging: it's rationale, objectives, and procedures". J Am Geriatr Soc. 1960 May. 8:373–77Mcnamara PAT, Dirksen EM, Church F, Muskie ES. The 1961 White House Conference on Aging: basic policy statements and recommendations / prepared for the Special Committee on Aging, United States Senate 87th Congress, 1st Session, Committee Print, May 15, 1961.

President Lyndon B. Johnson signed the Social Security Amendments on July 30, 1965, establishing both Medicare and Medicaid.{{Cite web|title=Today's Document from the National Archives|url=https://www.archives.gov/historical-docs/todays-doc/index.html?dod-date=730|access-date=2021-10-05|website=www.archives.gov| date=15 August 2016 }} Arthur E. Hess, a deputy commissioner of the Social Security Administration, was named as first director of the Bureau of Health Insurance in 1965, placing him as the first executive in charge of the Medicare program.{{Cite web|last=Fritze|first=John|title=Arthur E. Hess, 89, lawyer, served as 1st director of Medicare program|url=https://www.baltimoresun.com/news/bs-xpm-2005-11-21-0511210002-story.html|url-status=live|access-date=2021-10-05|website=baltimoresun.com|date=21 November 2005 |language=en-US|archive-url=https://web.archive.org/web/20210621214712/https://www.baltimoresun.com/news/bs-xpm-2005-11-21-0511210002-story.html |archive-date=2021-06-21 }} At the time, the program provided health insurance to 19 million Americans.{{Cite web|url=https://www.cms.gov/About-CMS/Agency-Information/History/Downloads/Administrator-Tenure-Dates-and-Biographies-1965-%E2%80%94-2015.pdf|title=Administrator Tenure Dates & Biographies|last=Centers for Medicare and Medicaid Services|archive-url=https://web.archive.org/web/20170501033505/https://www.cms.gov/About-CMS/Agency-Information/History/Downloads/Administrator-Tenure-Dates-and-Biographies-1965-%E2%80%94-2015.pdf|archive-date=2017-05-01|url-status=live}} The Social Security Administration (SSA) became responsible for the administration of Medicare and the Social and Rehabilitation Service (SRS) became responsible for the administration of Medicaid. Both agencies were organized under what was then known as the Department of Health, Education, and Welfare (HEW), in 1965. Since then, HEW, has been reorganized as the Department of Health and Human Services (HHS) in 1980. This consequently brought Medicare and Medicaid under the jurisdiction of the HHS. {{Cite web |last=Digital Communications Division (DCD) |date=March 14, 2023 |title=HHS Historical Insights |url=https://www.hhs.gov/about/historical-highlights/index.html?utm_source=chatgpt.com |access-date=November 21, 2024 |website=US Department of Health and Human Services}}

In March 1977, the Health Care Financing Administration (HCFA) was established under HEW.{{Cite web|date=2015-07-01|title=Administrator Tenure Dates & Biographies, 1965 — 2015|url=https://www.cms.gov/About-CMS/Agency-Information/History/Downloads/Administrator-Tenure-Dates-and-Biographies-1965-%E2%80%94-2015.pdf|access-date=2020-11-17|website=U.S. Centers for Medicare and Medicaid Services|pages=5, 13}} HCFA became responsible for the coordination of Medicare and Medicaid.{{Cite web|date=2006-10-06|title=20TH ANNIVERSARY 1977;TIME CAPSULE|url=https://www.modernhealthcare.com/article/19960826/NEWS/608260322/20th-anniversary-1977-time-capsule|access-date=2021-10-05|website=Modern Healthcare|language=en}} The responsibility for enrolling beneficiaries into Medicare and processing premium payments remained with SSA.

HCFA was renamed the Centers for Medicare and Medicaid Services on July 1, 2001.{{Cite web|title=CNN.com - Medicare agency renamed as prelude to reforms - June 14, 2001|url=http://www.cnn.com/2001/HEALTH/06/14/hcfa.changes/|access-date=2021-10-05|website=www.cnn.com}}

In 2013, a report by the inspector general found that CMS had paid $23 million in benefits to deceased beneficiaries in 2011.{{Cite web|last=Ellis|first=Blake|date=2013-11-01|title=Fraud, dumb mistakes lead Medicare to pay $23 million to dead people|url=https://money.cnn.com/2013/11/01/pf/medicare-deceased/index.html|access-date=2021-10-05|website=CNNMoney}}

In April 2014, CMS released raw claims data from 2012 that gave a look into what types of doctors billed Medicare the most.{{Cite news|last1=Abelson|first1=Reed|last2=Cohen|first2=Sarah|date=2014-04-09|title=Sliver of Medicare Doctors Get Big Share of Payouts|language=en-US|work=The New York Times|url=https://www.nytimes.com/2014/04/09/business/sliver-of-medicare-doctors-get-big-share-of-payouts.html |url-access=subscription |access-date=2021-10-05 |issn=0362-4331 |url-status=live |archive-url=https://web.archive.org/web/20211005202507/https://www.nytimes.com/2014/04/09/business/sliver-of-medicare-doctors-get-big-share-of-payouts.html |archive-date=2021-10-05 }}

In January 2018, CMS released guidelines for states to use to require Medicaid beneficiaries to continue receiving coverage.{{Cite news|last=Sanger-Katz|first=Margot|date=2018-01-11|title=Can Requiring People to Work Make Them Healthier?|language=en-US|work=The New York Times|url=https://www.nytimes.com/2018/01/11/upshot/medicaid-work-requirements-trump.html |url-access=subscription |access-date=2021-10-05 |issn=0362-4331 |url-status=live |archive-url=https://web.archive.org/web/20211005192816/https://www.nytimes.com/2018/01/11/upshot/medicaid-work-requirements-trump.html |archive-date= 2021-10-05 }} These guidelines came in response to then-President Trump's announcement that he would allow states to impose work requirements in Medicaid.{{Cite news|last=Pear|first=Robert|date=2018-01-11|title=Trump Administration Says States May Impose Work Requirements for Medicaid|language=en-US|work=The New York Times|url=https://www.nytimes.com/2018/01/11/us/politics/medicaid-work-requirements.html |url-access=subscription |access-date=2021-10-05 |issn=0362-4331 |url-status=live |archive-url= https://web.archive.org/web/20211005192817/https://www.nytimes.com/2018/01/11/us/politics/medicaid-work-requirements.html |archive-date=2021-10-05 }} In October, CMS reported a data breach of 75,000 people's personal data due to a hack.{{Cite web|title=Hackers breach Healthcare.gov system, taking files on 75,000 people|url=https://techcrunch.com/2018/10/20/hackers-stole-files-from-healthcare-gov-system/ |date=October 20, 2018 |first1=Zack |last1=Whittaker |access-date=2021-10-05 |website=TechCrunch|language=en-US |url-status=live |archive-url=https://web.archive.org/web/20211006023531/https://techcrunch.com/2018/10/20/hackers-stole-files-from-healthcare-gov-system/ |archive-date= 2021-10-06 }}

In February 2018, CMS removed a notice from its website that informed insurance companies they were not allowed to charge physicians a fee when the companies paid the doctors for their work. This has resulted in doctors being charged up to a 5% fee on their compensation, adding up to billions of dollars annually.{{Cite web|title=The Hidden Fee Costing Doctors Millions Every Year|url=https://www.propublica.org/article/the-hidden-fee-costing-doctors-millions-every-year |first1=Cezary |last1=Podkul |access-date=2023-08-15|website=ProPublica|date=14 August 2023 |language=en-US}}

In January 2021, CMS passed a rule that would cover "breakthrough technology" for four years after they received FDA approval.{{Cite web|date=2021-01-12|title=Medicare approves coverage of 'breakthrough' medical devices|url=https://www.modernhealthcare.com/medical-devices/medicare-approves-coverage-breakthrough-medical-devices |url-access=subscription |first1=Michael |last1=Brady |access-date=2021-10-05|website=Modern Healthcare|language=en |url-status=live |archive-url=https://archive.today/20240514213245/https://www.modernhealthcare.com/medical-devices/medicare-approves-coverage-breakthrough-medical-devices |archive-date= 14 May 2024 }} In September 2021, CMS submitted a proposal to repeal the rule based on safety concerns.{{Cite web|date=2021-09-13|title=Biden to toss Medicare coverage for "breakthrough" technology|url=https://www.modernhealthcare.com/payment/biden-toss-medicare-coverage-breakthrough-technology |url-access=subscription |first1=Michael |last1=Brady |access-date=2021-10-05 |website=Modern Healthcare|language=en |url-status=live |archive-url=https://archive.today/20240514225228/https://www.modernhealthcare.com/payment/biden-toss-medicare-coverage-breakthrough-technology |archive-date= 14 May 2024 }}

On September 19, 2023, the Subcommittee on Health held a hearing titled "Examining Policies to Improve Seniors’ Access to Innovative Drugs, Medical Devices, and Technology." Dora Hughes, the acting director of the Center for Clinical Standards and Quality at the U.S. Centers for Medicare and Medicaid Services (CMS), defended the proposed Transitional Coverage for Emerging Technologies (TCET) pathway, which aims to restrict coverage for breakthrough medical devices to five reviews a year. Some lawmakers and medtech trade groups called for expanding the pathway to include diagnostics. Various other legislative proposals were discussed during the hearing, including bills related to Medicare coverage, drug pricing, and transparency in healthcare.{{Cite web |url=https://d1dth6e84htgma.cloudfront.net/09_19_23_Public_Memo_HE_Hearing_0cef398da9.pdf |title=Memorandum for September 19, 2023, Health Subcommittee Hearing |publisher=Committee on Energy and Commerce |url-status=live |archive-url=https://web.archive.org/web/20231208154339/https://d1dth6e84htgma.cloudfront.net/09_19_23_Public_Memo_HE_Hearing_0cef398da9.pdf |archive-date= Dec 8, 2023 }}{{Cite web |url=https://www.medtechdive.com/news/cms-tcet-hearing-house-breakthrough-device-reimbursement/694178/ |title=CMS leader defends breakthrough device reimbursement proposal at House hearing |date=2023-09-21 |last=Paul Taylor |first=Nick |website=MedTech Dive |url-status=live |archive-url= https://web.archive.org/web/20240114041640/https://www.medtechdive.com/news/cms-tcet-hearing-house-breakthrough-device-reimbursement/694178/ |archive-date= Jan 14, 2024 }}

Workforce

CMS employs over 6,000 people, of whom about 4,000 are located at its headquarters in Woodlawn, Maryland.{{Cite journal |last=Brooks-LaSure |first=Chiquita |date=November 2022 |title=CMS Financial Report FY 2022 |url=https://www.cms.gov/files/document/cms-financial-report-fiscal-year-2022.pdf |journal=Centers for Medicare and Medicaid Services |pages=122}} The remaining employees are located in the Hubert H. Humphrey Building in Washington, D.C., the 10 regional offices listed below, and in various field offices located throughout the United States.

The head of CMS is the administrator of the Centers for Medicare & Medicaid Services. The position is appointed by the president and confirmed by the Senate.{{Citation|author=Kliff, Sarah|date=23 Nov 2011|newspaper=The Washington Post|access-date=24 Nov 2011 |title=Medicare administrator Donald Berwick resigns in the face of Republican opposition |url=https://www.washingtonpost.com/national/health-science/medicare-administrator-donald-berwick-resigns-in-the-face-of-republican-opposition/2011/11/23/gIQA5S7mpN_story.html |url-access=subscription |url-status=live |archive-url=https://web.archive.org/web/20160311070037/https://www.washingtonpost.com/national/health-science/medicare-administrator-donald-berwick-resigns-in-the-face-of-republican-opposition/2011/11/23/gIQA5S7mpN_story.html?wpisrc=nl_headlines|archive-date=2016-03-11}} On May 27, 2021, Chiquita Brooks-LaSure was sworn in as administrator, the first black woman to serve in the role.{{Cite news|last1=Weiland|first1=Noah|last2=Sanger-Katz|first2=Margot|date=2021-05-25|title=Chiquita Brooks-LaSure becomes the first Black administrator confirmed to lead Medicare and Medicaid.|language=en-US|work=The New York Times|url=https://www.nytimes.com/2021/05/25/us/politics/chiquita-brooks-lasure-medicare-medicaid.html |url-access=subscription |access-date=2021-10-05 |issn=0362-4331 |url-status=live |archive-url=https://web.archive.org/web/20211005193848/https://www.nytimes.com/2021/05/25/us/politics/chiquita-brooks-lasure-medicare-medicaid.html |archive-date=2021-10-05 }}

Regional offices

CMS has its headquarters in Woodlawn, Maryland, with 10 regional offices located throughout the United States:

Region I {{cite web |url=https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/downloads/BostonRegionalOffice.pdf |title=Office of Program Operations and Local Engagement | website=CMS |access-date=2017-03-13 |url-status=live |archive-url=https://web.archive.org/web/20170308132924/https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloads/BostonRegionalOffice.pdf |archive-date=2017-03-08 }} – Boston, Massachusetts

:Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island and Vermont

Region II {{cite web |url=https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/downloads/NewYorkRegionalOffice.pdf |title=Office of Program Operations and Local Engagement | website=CMS |access-date=2017-03-13 |url-status=live |archive-url=https://web.archive.org/web/20170308132925/https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloads/NewYorkRegionalOffice.pdf |archive-date=2017-03-08 }} – New York, New York

:New York State, New Jersey, U.S. Virgin Islands and Puerto Rico

Region III {{cite web |url=https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/downloads/PhiladelphiaRegionalOffice.pdf |title=Office of Program Operations and Local Engagement | website=CMS |access-date=2017-03-13 |url-status=live |archive-url=https://web.archive.org/web/20170308132926/https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloads/PhiladelphiaRegionalOffice.pdf |archive-date=2017-03-08 }} – Philadelphia, Pennsylvania

:Delaware, Maryland, Pennsylvania, Virginia, West Virginia and the District of Columbia

Region IV {{cite web |url=https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloads/AtlantaRegionalOffice.pdf |title=Office of Program Operations and Local Engagement | website=CMS |access-date=2017-03-13 |url-status=live |archive-url=https://web.archive.org/web/20170308132927/https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloads/AtlantaRegionalOffice.pdf |archive-date=2017-03-08 }} – Atlanta, Georgia

:Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee

Region V {{cite web |url=https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/downloads/ChicagoRegionalOffice.pdf |title=Office of Program Operations and Local Engagement | website=CMS |access-date=2017-03-13 |url-status=live |archive-url=https://web.archive.org/web/20170308132927/https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloads/ChicagoRegionalOffice.pdf |archive-date=2017-03-08 }} – Chicago, Illinois

:Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin

Region VI {{cite web |url=https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/downloads/DallasRegionalOffice.pdf |title=Office of Program Operations and Local Engagement | website=CMS |access-date=2017-03-13 |url-status=live |archive-url=https://web.archive.org/web/20170308132928/https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloads/DallasRegionalOffice.pdf |archive-date=2017-03-08 }} – Dallas, Texas

:Arkansas, Louisiana, New Mexico, Oklahoma and Texas

Region VII {{cite web |url=https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/downloads/KansasCityRegionalOffice.pdf |title=Office of Program Operations and Local Engagement | website=CMS |access-date=2017-03-13 |url-status=live |archive-url=https://web.archive.org/web/20170308132929/https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloads/KansasCityRegionalOffice.pdf |archive-date=2017-03-08 }} – Kansas City, Missouri

:Iowa, Kansas, Missouri, and Nebraska

Region VIII {{cite web |url=https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/downloads/DenverRegionalOffice.pdf |title=Region 8 – Denver |website=CMS |access-date=2017-03-13 |url-status=dead |archive-url=https://web.archive.org/web/20170308132930/https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloads/DenverRegionalOffice.pdf |archive-date=2017-03-08 }} – Denver, Colorado

:Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming

Region IX {{cite web |url=https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/downloads/SanFranciscoRegionalOffice.pdf |title=Office of Program Operations and Local Engagement | website=CMS |access-date=2017-03-13 |url-status=live |archive-url=https://web.archive.org/web/20170308132931/https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloads/SanFranciscoRegionalOffice.pdf |archive-date=2017-03-08 }} – San Francisco, California

:Arizona, California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands

Region X {{cite web |url=https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/downloads/SeattleRegionalOffice.pdf |title=Office of Program Operations and Local Engagement | website=CMS |access-date=2017-03-13 |url-status=live |archive-url=https://web.archive.org/web/20170308132932/https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/Downloads/SeattleRegionalOffice.pdf |archive-date=2017-03-08 }} – Seattle, Washington

:Alaska, Idaho, Oregon, and Washington

List of administrators

class="wikitable" style="text-align:center"
No. !Image !Name !Took office !Left office !President served under
1 \|60px \|Arthur E. Hess \|1965 \|1967 \|Lyndon B. Johnson
2 \|60px \|Thomas M. Tierney \|1967 \|1978 \|Lyndon B. Johnson Richard Nixon Gerald Ford Jimmy Carter
3 \|60px \|Robert Derzon \|June 1977 \|November 1978 \|rowspan=3\|Jimmy Carter
4 \|60px \|Leonard Schaeffer \|November 1978 \|June 1980
5 \|60px \|Howard N. Newman \|July 1980 \|January 1981
6 \|60px \|Carolyne Davis \|March 1981 \|August 1985 \|Ronald Reagan
7 \|60px \|William L. Roper \|May 1986 \|February 1989 \|Ronald Reagan George H. W. Bush
8 \|60px \|Gail Wilensky \|February 1990 \|March 1992 \|George H. W. Bush
9 \|60px \|Bruce Vladeck \|May 1993 \|September 1997 \|rowspan=2\|Bill Clinton
10 \|60px \|Nancy-Ann DeParle \|November 1997 \|September 29, 2000
11 \|60px \|Thomas A. Scully \|May 2001 \|December 3, 2003 \|rowspan=2\|George W. Bush
12 \|60px \|Mark McClellan \|March 25, 2004 \|October 14, 2006
13 \|60px \|Donald Berwick \|July 7, 2010 \|December 2, 2011 \|rowspan=3\|Barack Obama
14 \|60px \|Marilyn Tavenner \|December 2, 2011 \|March 18, 2015
bgcolor="#E6E6AA" \|– \|bgcolor="#E6E6AA" \|60px \|bgcolor="#E6E6AA" \|Andy Slavitt Acting \|bgcolor="#E6E6AA" \|March 18, 2015 \|bgcolor="#E6E6AA" \|January 20, 2017
15 \|60px \|Seema Verma \|March 14, 2017 \|January 20, 2021 \|Donald Trump
bgcolor="#E6E6AA" \|– \|bgcolor="#E6E6AA" \|60px \|bgcolor="#E6E6AA" \|Elizabeth Richter Acting \|bgcolor="#E6E6AA" \|January 20, 2021 \|bgcolor="#E6E6AA" \|May 27, 2021 \|rowspan=2\|Joe Biden
16 \|60px \|Chiquita Brooks-LaSure \|May 27, 2021 \|January 20, 2025
bgcolor="#E6E6AA" \|– \|bgcolor="#E6E6AA" \|60px \|bgcolor="#E6E6AA" \|Jeff Wu{{cite web \|url=https://www.cms.gov/about-cms/who-we-are/leadership \|title=Administrator {{!}} CMS \|last= \|first= \|author= \|date=January 22, 2025 \|website=CMS \|publisher= \|language= \|url-status= \|archive-url=https://web.archive.org/web/20250122091804/https://www.cms.gov/about-cms/who-we-are/leadership \|archive-date=January 22, 2025 \|quote=}} Acting \|bgcolor="#E6E6AA" \|January 20, 2025 \|bgcolor="#E6E6AA" \|January 31, 2025 \| rowspan="3" \|Donald Trump
bgcolor="#E6E6AA" \|– \|bgcolor="#E6E6AA" \|60px \|bgcolor="#E6E6AA" \|Stephanie Carlton{{cite web \|url=https://www.cms.gov/about-cms/who-we-are/leadership \|title=Administrator {{!}} CMS \|last= \|first= \|author= \|date=January 31, 2025 \|website=CMS \|publisher= \|language= \|url-status= \|archive-url=https://web.archive.org/web/20250131232745/https://www.cms.gov/about-cms/who-we-are/leadership \|archive-date=January 31, 2025 \|quote=}}{{cite web \|url=https://www.cms.gov/about-cms/who-we-are/leadership \|title=Administrator {{!}} CMS \|last= \|first= \|author= \|date=February 8, 2025 \|website=CMS \|publisher= \|language= \|url-status= \|archive-url=https://web.archive.org/web/20250208152918/https://www.cms.gov/about-cms/who-we-are/leadership \|archive-date=February 8, 2025 \|quote=}} Acting \|bgcolor="#E6E6AA" \|January 31, 2025 \|bgcolor="#E6E6AA" \|April 8, 2025
17 \|84x84px \|Mehmet Oz \|April 8, 2025 \|Incumbent

class="wikitable" style="text-align:center"

No.

!Image

!Name

!Took office

!Left office

!President served under

Centers for Medicare & Medicaid Services

History

Workforce

Regional offices

List of administrators

See also

References

External links