What Does the Center of Medicare and Medicaid Services Do?

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The Centers of Medicare and Medicaid Services (CMS) is the governing body that sets the rules regarding care for the senior population and those with severe disabilities or end stage renal disease in the United States. It determines what I as an agent can and cannot say at a Medicare appointment. Medical treatment rendered by a physician must be approved by CMS before Medicare will pay for the treatment. How much the hospital will receive for a procedure is also approved by CMS prior to payment. But is that all CMS does? In an article written by Seema Verma, Administrator, Centers for Medicare & Medicaid Services, Verma points out that CMS is charged with developing and enforcing quality and safety standards across the nation’s health care system. This duty is especially important when it comes to the care provided for some of the most vulnerable in our society, Americans residing in nursing homes.

Basic human dignity and respect for our nursing home residents is always a core value we all should maintain. Abuse and neglect should never be subjects in question with the care given to our loved ones. Complacency is not accepted by CMS regarding the kind of treatment our Seniors are receiving in the nation’s health care system. Verma says, “CMS is not waiting, and not settling for the status quo.”

Verma lists five ways CMS is keeping its eyes on future improvements in nursing homes:

Strengthen Oversight - CMS works in partnership with State Survey Agencies (SSAs) to oversee nursing homes, since these agencies are generally also responsible for state licensure. CMS is examining the way surveyors identify issues such as abuse, facility staffing levels, and dementia care.

Enhance Enforcement - CMS enforces the compliance of basic health and safety standards for nursing homes to ensure patient safety and quality care.

Increase Transparency - CMS is empowering consumers, their families, and their caregivers by giving them the resources they need to make informed decisions, and key to their effort is their Nursing Home Compare website.

Improve Quality - While CMS is holding nursing homes accountable through oversight and enforcement measures, it is also actively keeping patients safe by helping nursing homes improve.

Put Patients Over Paperwork – When administrative burden increases with little or no benefit, patients suffer because mountains of unnecessary paperwork keep providers from patients. 

The Centers of Medicare and Medicaid are actively looking for ways to improve the quality of care our senior population receives in nursing homes across the nation. This is a never-ending pursuit, and one that requires challenges at the highest of standards.