Overview of CMS

CMS Headquarters

DHHS Secretary Kathleen Sebelius

CMS Administrator Dr. Donald Berwick

Proposed Vision CMS is a major force and a trustworthy partner for the continual improvement of health and health care for all Americans. 6

The “Three Part Aim” Better Health for the Population Better Care for Individuals Lower Cost through Improvement Safe Effective Patient-Centered Timely Efficient Equitable Risk Factors Vitality Government All Payers 7

Serving almost 105 million through Medicare, Medicaid and Children’s Health Insurance Programs Budget approx. $800 billion dollars CMS – Largest Purchaser of Health Care in the United States 8

Medicare – The Beginning Medicare and Medicaid enacted in 1965 Implemented in 1966 Over 19 million enrolled on July 1, 1966

Medicare & Medicaid Statistics Medicare enrollees –19.1 million in 1966 –45.9 million in million Medicaid enrollees in 2009 –Almost half, 24.9 million, are children 130% increase

Drug Coverage Statistics 90% (40 million) have drug coverage –Medicare –Another source 26.6 million have Part D coverage –Growth of 1.5 million in one year 9.6 million get extra help –80% of those eligible

U.S. Health Care Expenditures National health expenditures in 2007 –$2.2 trillion –16.2% of gross domestic product Per person health care expenditures –$211 in 1965 –$7,421 in 2007 –$13,101 expected in 2017

Region IV States Alabama Florida Georgia Kentucky Mississippi North Carolina South Carolina Tennessee 13 A Map of the Regions

Atlanta Regional Office The Atlanta Regional Office serves eight states – Alabama Florida Georgia Kentucky Mississippi North Carolina South Carolina Tennessee

CMS Provides health care security for over 18 million people –8.9 million Medicare beneficiaries –9 million Medicaid recipients (including 1.6 million dual eligible) –725,000 CHIP kids

Program Basics Medicare Medicaid Children’s Health Insurance Program

Medicare Medicare is the health insurance program for: –People age 65 and older –Certain people under age 65 with disabilities –People with all ages with End Stage Renal Disease (ESRD)

Medicare Coverage Part A – Hospital Insurance Part B – Medical Insurance Part C – Medicare Advantage Plans Part D – Medicare Prescription Drug Coverage

Medicare Part A Inpatient Hospital Stays Home Health Care Skilled Nursing Care Hospice Blood

Medicare Part B Doctor’s services Outpatient Hospital Services Home Health Services Preventive Services Durable Medical Equipment

Medicare Part C Live in plan’s service area Entitled to Medicare Part A Enrolled in Medicare Part B –Continue to pay Part B premiums –May also pay monthly premium to plan Don’t have ESRD at enrollment –Some exceptions

Medicare Part C Usually get all Part A and B services through plan –May have to use providers in plan’s network –Generally must still pay Part B premium May get extra benefits –Vision, hearing, dental –Prescription drug coverage Still in Medicare program –Get all Part A and Part B services –Have Medicare rights and protections

Medicare Part D Medicare Prescription Drug Coverage Began January 1, 2006 Provided through –Prescription drug plans –Medicare Advantage plans –Some employers and unions

Medicaid

Federal and State program –For some with limited income and resources If eligible, most health care costs covered Each state decides –Who is eligible –How people apply Office names vary –Social services –Public Assistance

Children’s Health Insurance Program

Families who earn too much to qualify for Medicaid and who cannot afford private insurance may be able to qualify for CHIP For little or no cost, this insurance pays for: doctor’s visits; immunizations; hospitalizations, and emergency room visits Insure Kids Now (877-KIDS-NOW) or

PATIENT PROTECTION AND AFFORDABLE CARE ACT

Patient Protection & Affordable Care Act (ACA) Large number of changes Many changes effective this year and next year Only some of these are for CMS to implement

Medicare changes from ACA Some provisions begin right away: 50% reduction for brand name drugs for individuals in the “donut hole” and 7% discount for generics – eff. 1/1/11 Makes preventative care free under Medicare – effective 1/1/11 Moves open season out of the Christmas holiday period – effective 2011 (Oct 15 – Dec. 7)

Other changes you may have read about HHS has created a new office to work with the insurance industry called the Office of Consumer Information & Insurance Oversight, or OCIIO You can see what they are working on at: public information at

OCIIO tasks Children with Pre-existing conditions- effective 6 months after enactment Interim High Risk Pools – effective in 2010 Preventing Rescissions if someone gets sick - effective 6 months after enactment Coverage for young people up to 26 th birthday - effective 6 months after enactment Early Retirees – effective 2010 Lifetime Limits - effective 6 months after enactment Restrictive annual limits on coverage - effective 6 months after enactment

Pre-existing Condition Insurance Plan Must be a US citizen or reside here legally; Have been without health insurance for at least 6 months before applying Have a pre-existing condition or denied coverage because of a health condition

Pre-existing Condition Insurance Plan For more information, please visit: – –

Helpful Resources medicare / Medicare.gov Cms.gov Medicare & You Handbook GeorgiaCares – the State Health Insurance Assistance Program Healthcare.gov Pcip.gov

Contact Information Centers for Medicare and Medicaid Services Sam Nunn Federal Center 61 Forsyth Street, Suite 4-T-20 Atlanta, Georgia