CMS stands for Centers for Medicare and Medicaid Services, an operating division of the Department of Health and Human Services. This agency manages several large medical care programs including Medicare, Medicaid and the Health Insurance Marketplace as well as policies and procedures designed to ensure smooth operations of each. CMS also collects data to detect fraudulent practices in healthcare as well as to provide reports to Congress and other government bodies.
CMS strives to ensure Medicare recipients have access to high-quality healthcare services, and provides incentives to encourage top facilities to deliver high-quality treatments, while penalizing poor performing providers by lowering reimbursement rates – helping improve care quality across the board while simultaneously decreasing overall healthcare costs.
CMS furthers its mission by increasing transparency in the health insurance marketplace and informing Americans about their options. To this end, the agency regularly releases premiums and deductibles information for Medicare and the Health Insurance Marketplace; furthermore it oversees compliance with federal requirements related to consumer protection such as prohibition of denial for preexisting conditions; annual or lifetime dollar limits on essential benefits; as well as rating rules which mandate insurers spend certain percentage of premiums on clinical services and quality improvement initiatives.
CMS invests heavily in employee professional development to foster a healthy and sustainable workforce, offering training on various healthcare topics as well as management and leadership skills. Furthermore, CMS has initiated numerous employee recognition and wellness initiatives designed to create a positive work environment – for instance Diversity and Inclusion courses (DEI), robust mentoring programs and providing resources that support health and wellbeing are just some of these measures.
CMS ensures the programs it administers are staffed with qualified healthcare professionals by mandating that any health care organization that wishes to receive payments from Medicare or Medicaid must first undergo an accreditation process by an independent organization approved by CMS. This certification process takes place through an accreditation program overseen by CMS itself.
Additionally, CMS certification program establishes criteria for accrediting organizations (AOs) and conducts surveys to confirm they meet all necessary standards.
CMS works closely with states and other partners to ensure people who need assistance gaining affordable, quality health coverage can access it. In doing so, millions of individuals receive better, more tailored healthcare that suits them personally. As terminations of Medicaid enrollment end and regular eligibility and enrollment operations resume, CMS employs every tool available to it in order to fulfill this important mission.