What is CMS ?

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.^[1]

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.^[2] 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.^[3][4]

President Lyndon B. Johnson signed the Social Security Amendments on July 30, 1965, establishing both Medicare and Medicaid.^[5] 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.^[6] At the time, the program provided health insurance to 19 million Americans.^[6][7] 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. ^[8]

In March 1977, the Health Care Financing Administration (HCFA) was established under HEW.^[9] HCFA became responsible for the coordination of Medicare and Medicaid.^[10] 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.^[9][11]

In 2013, a report by the inspector general found that CMS had paid $23 million in benefits to deceased beneficiaries in 2011.^[12]

In April 2014, CMS released raw claims data from 2012 that gave a look into what types of doctors billed Medicare the most.^[13]

In January 2018, CMS released guidelines for states to use to require Medicaid beneficiaries to continue receiving coverage.^[14] These guidelines came in response to then-President Trump’s announcement that he would allow states to impose work requirements in Medicaid.^[15] In October, CMS reported a data breach of 75,000 people’s personal data due to a hack.^[16]

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.^[17]

In January 2021, CMS passed a rule that would cover “breakthrough technology” for four years after they received FDA approval.^[18] In September 2021, CMS submitted a proposal to repeal the rule based on safety concerns.^[19]

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.^[20][21]

CMS employs over 6,000 people, of whom about 4,000 are located at its headquarters in Woodlawn, Maryland.^[22] 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.^[23] On May 27, 2021, Chiquita Brooks-LaSure was sworn in as Administrator, the first black woman to serve in the role.^[24]

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

No.	Image	Name	Took office	Left office	President served under
1		Arthur E. Hess[9]	1965	1967	Lyndon B. Johnson
2		Thomas M. Tierney[9]	1967	1978	Lyndon B. Johnson Richard Nixon Gerald Ford Jimmy Carter
3		Robert Derzon[9]	June 1977	November 1978	Jimmy Carter
4		Leonard Schaeffer[9]	November 1978	June 1980
5		Howard N. Newman[9]	July 1980	January 1981
6		Carolyne Davis[9]	March 1981	August 1985	Ronald Reagan
7		William L. Roper[9]	May 1986	February 1989	Ronald Reagan George H. W. Bush
8		Gail Wilensky[9]	February 1990	March 1992	George H. W. Bush
9		Bruce Vladeck[9]	May 1993	September 1997	Bill Clinton
10		Nancy-Ann DeParle[9]	November 1997	September 29, 2000
11		Thomas A. Scully[9]	May 2001	December 3, 2003	George W. Bush
12		Mark McClellan[9]	March 25, 2004	October 14, 2006
13		Donald Berwick[9]	July 7, 2010	December 2, 2011	Barack Obama
14		Marilyn Tavenner[9]	December 2, 2011	March 18, 2015
Acting		Andy Slavitt	March 18, 2015	January 20, 2017
15		Seema Verma	March 14, 2017	January 20, 2021	Donald Trump
Acting		Elizabeth Richter	January 20, 2021	May 27, 2021	Joe Biden
16		Chiquita Brooks-LaSure	May 27, 2021	Present

• Center for Medicare and Medicaid Innovation
• Zone Program Integrity Contractor

Robinson, P. I. (July 1957). “Medicare: Uniformed Services Program for Dependents“. Social Security Bulletin, 20(7), 9–16.

• Official website 
• Centers for Medicare and Medicaid Services in the Federal Register
• Centers for Medicare & Medicaid Services in the Code of Federal Regulations
• Centers for Medicare & Medicaid Services reports and recommendations from the Government Accountability Office
• Grants to States for Medicaid account on USAspending.gov
• Centers for Medicare and Medicaid Innovation account on USAspending.gov
• State Grants and Demonstration account on USAspending.gov
• Centers for Medicare and Medicaid Services apportionments on OpenOMB