question archive A US Public Health Agency Review Introduction The main emphasis of HHS is promoting the health and wellbeing of all the people staying within the borders of the US

A US Public Health Agency Review Introduction The main emphasis of HHS is promoting the health and wellbeing of all the people staying within the borders of the US

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A US Public Health Agency Review

Introduction

The main emphasis of HHS is promoting the health and wellbeing of all the people staying within the borders of the US. This same department is tasked with promoting research in areas of interest including social services, medicine, and public. Based on the variety of tasks performed by HHS, it works in collaboration with 11 agencies to manage all the programs under this department. One of the agencies working under the HHS is the Centers for Medicare and Medicaid Services (CMS). CMS is an agency that oversees the activities of the programs like Medicare program, the Medicaid program especially that portion where the federal government is needed, the State Children’s Health Insurance program, the market place of health insurance, and also all activities related to quality assurance particularly in these areas of interest. Through the CMS, patients are given the necessary information regarding quality and costs to enable them make appropriate health care decisions.

Key Phases in the History and Development

CMS was originally formed in 1977 although the name Center for Medicare and Medicaid Services was not used until 2001. A body referred to as Health Care Financing Administration (HCFA) was formed in 1977 and tasked with coordinating the Medicare and Medicaid programs. It is HCFA that enrolled beneficiaries to Medicare although the Social Security Administration (SSA) continued to process premium payments for those who qualified to enrolled to the program. HFCA continued to operate until 2001 when its name was changed to CMS.

It is critical to note that CMS came into existence after the formation of Medicare and Medicaid among other programs. However, the programs needed coordination from a central body. It is the policy that required the Medicare and Medicaid services to be coordinated that led to the creation of CMS (CMS.GOV, 2020a). Thus, the body that overshow the functions of Medicare and Medicaid was renamed to CMS. Likewise, the Affordable Care Act (ACA) was enacted to enhance health insurance services to more people. ACA wanted more people to have access to health insurance thereby making care more accessible. This impacted CMS in the sense that this agency revised its eligibility reforms to make more people access the insurance services (The Commonwealth Fund, 2018). The policies were expanded to include even the working population of adults. Presently, Medicaid is the largest source of insurance in the US courtesy of the ACA.

Major Features CMS

The main departments of CMS is the Medicare and Medicaid/CHIP. Medicare is a federal program responsible for providing coverage for individuals aged 65 years and above or those below this age but living with defined disabilities. Medicaid is both a state and federal program. It provides health coverage for those citizens with very low levels of income as defined by the laws governing this. However, for Medicaid, the federal is only responsible for a portion that relates to it while the state takes charge of the other part.

The services covered by CMS are those that Medicare and Medicare covers. While Medicare and Medicaid cover different services, it is the responsibility of CMS to coordinate the services performed by the two. It is the responsibility of CMS to ensure that the services of Medicare and Medicaid are well coordinated and meet the quality desired to serve the intended purpose.

The eligible population for the CMS depends on the eligibility criteria of Medicare and Medicaid. However, it is possible for an individual to benefit from both programs if they meet the conditions. To benefit for Medicare, the requirements include 65 years of age and above, below 65 years of age living with a disability, and is a voluntary enrollee who has paid the Part A monthly premium in full. Likewise, for Medicaid, ACA made it possible to benefit from the program through income eligibility criteria which is based in modified adjusted gross income (MAGI). This has made more people to benefit from the program. The beneficiaries need to be citizen residents of a specified state or non-citizens who qualify as lawful residents. Once the individual meets this criterion, they qualify for consideration in CMS agency.

CMS works under a well-defined leadership. There are several offices in the CMS right from the office of the administrator who is the head of the agency to the IT office. Employees work according to the departments. There are more than 6,200 employees in the CMS where 4,000 are within its headquarters (CMS, 2019). The total budget appropriation for CMA in 2020 was $3,965.796 million while the amount that was enacted in 2020 was $3,974.744. From the president’s budget the amount is slightly expected to decline in 2021 to #3,693.548 million (HHS, 2021). Further, the efficiency of CMS comes from its focus on high quality services at the lowest possible costs. It is after ensuring that providers get high-quality service where resources are maximized.

Policy Process Supporting CMS

CMS is an entitlement because it runs mandatory federal programs which include Medicare and Medicaid. CMS is usually funded by the Medicare Trust Funds which comes from either Hospital Insurance (HI) Trust Fund or Supplementary Medical Insurance (SMI) Trust Fund. HI is funded by the payroll taxes whereas the SMI is funded by the funds authorize by the Congress as well as the premiums from Medicare.

The Senate Finance Committee has jurisdiction over the services of CMS (AOTA, 2021). It is the same committee that handles all the issues surrounding CMS. Medicare is a federal program and thus it is fully funded by the federal. For Medicaid, it is partly funded by the federal and partly by the state. There is a section of the Medicaid where the federal takes responsibility.

It is the role of the federal to ensure that quality of services is guaranteed through CMS. States and local authorities are also engaged in conducting surveys regarding activities of CMS to ensure that they meet the intended purpose. Failure by the CMS to follow the rules laid down should be reported by the state and local governments. Likewise, the groups with an interest in CMS include federal, state, and local governments, health care representatives, CMS contractors, community groups, patients and caregivers. CMS is an agency operating under the HHS to run federal agencies. Thus, it has no or minimal groups that advocate against it. It is after improving the quality of the services that people enrolled to the programs receive from the Medicare and Medicaid.

Activities and Funding CMS IN Region 4

CMS has offices in various regions. In region 4, the regional office is located in Atlanta. The states served in this region include Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee (CMS.GOV, 2020). No particular activity or funding done by the CMS in any of these states. However, the role of regional offices is to make residents feel the presence of CMS at the state and local level. Nevertheless, sates like Kentucky was among the 33 states that benefited from the new federal funding by CMS to help it transition its citizens from nursing homes to the community (CMS.GOV, 2021).

Sustainability and Future Outlook of CMS

CMS can be sustained if the Medicare and Medicaid programs continue to run normally. From one year to the other, the number of people enrolled to the programs has been increasing given the new guidelines provided by ACA. This is shows that the number of people funded by Medicare and Medicaid will continue to increase. Similarly, the CMS has a growth potential from if the enrollees will increase in future.

Some of the challenges CMS is facing includes the possible emergence of other health insurance programs. Such programs may take a given number of the current members subscribed under the CMS. Insufficient funding also makes most of the operations by CMS impossible. However, with improvement in technology, it is an opportunity for CMS to streamline its services, focus on quality improvement and minimize costs as much as possible. Personally, I believe that provided the Medicare and Medicaid programs are properly run and funded, the responsibility of collaboration by CMS will be very simple.

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