Medicaid Medicare program

Its mission is to ensure effective, up-to-date health care coverage and quality care for beneficiaries of Medicare and Medicaid, two programs that provide prescription drug benefits. 

Medicare is a government-administered insurance program that is offered to people who are older than 65 years of age, have specific disabilities, or have kidney failure (DHHS, 2002a). The Centers for Medicare and Medicaid Services (CMS) oversees the Medicare program. For services provided in the outpatient setting,... 

Centers for Medicare and Medicaid Services (CMS). 2007d. Medicare Program—General Information, Medicare Part B. Available at www.cms.hhs.gov/Medicare GenInfo/03 Part%20B.asp accessed on May 2007. 

Medicare is a federal health care program, and its recipients include people over the age of 65, the disabled, and those with end-stage renal disease. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration. The Medicare program consists of two parts (parts A and B), but is funded by four different sources (1) general tax revenues, (2) beneficiaries premiums, (3) mandatory contributions from employers and employees, and (4) deducf-ibles and copayments paid by patients. ... 

Medicaid is a federal-state entitlement program for low-income Americans who meef cerfain criferia.i Even though Medicaid is administered by CMS as well, it has very little in common with the U.S. Medicare program. Medicaid primarily covers three groups of individuals fhe elderly, the disabled, and parents and their dependent children. ... 

The Medicare and Medicaid programs have had a significant impact on the prachce of pharmacy. The Medicare program stimulated the growth of the hospital pharmacy profession. Only those hospitals with a pharmacy department that was directed by a pharmacist and met a minimum set of federal sfandards could receive federal funding for Medicare reimbursement. °... 

The OIG must exclude any person or corporation convicted of a felony relating to health care fraud from the Medicare program. The law mandates minimum periods of exclusion from 1 to 3 years, depending on the basis for exclusion. For many corporations, it is this debarment from federal programs (more so than any criminal fine) that causes the most fear, as the loss of Medicare and Medicaid patients could ultimately cause the business to fail. 

Many companies, in their internal training, include information about the anti-kickback statute. The Office of the Inspector General in the Department of Health and Human Services (HHS) enforces the antikickback law. HHS administers the Medicaid and Medicare programs. Any serious violations are referred for potential criminal prosecution to the Department of Justice administrative sanctions also are possible. 

Historically, a lack of public insurance programs created obstacles to health care services. For those who could not afford to pay for private insurance, the costs associated with health care were larger than most could afford. After lengthy debate, the U.S. Congress passed legislation in 1965 that established Medicare and Medicaid. Medicare covers over 95% of the elderly in the United States as well as many individuals who are disabled. Coverage for the disabled began in 1973 and is divided in two parts 1) hospital insurance and 2) supplementary medical insurance. The total disbursement for Medicare in 1997 was 213,575 billion, and there were 36,460,143 enrollees, of which 32,164,416 were elderly. 

Been excluded from participation in a Medicaid or Medicare program. 

The Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003 produced the largest overhaul of the Medicare program in 38 years. The Centers for Medicare and Medicaid Services (CMS) are responsible for developing and supervising MMA. 

URL http //www.os.dhhs.gov/ about/opdivs/hcfa.html Phone (410) 966-3000 200 Independence Avenue SW Washington, DC 20201 An agency within the Department of Health and Human Services that oversees Medicare, the federal portion of Medicaid, and quality assurance for federal health care programs. 

CMS (Center for Medicare Sc Medicaid Services). 2005. CLIA Approved Proficiency Testing Programs 2005 [online]. Available http //63.241.27.79/clia/ptlist.pdf. [accessed April 14,2006]. 

The proposed consensus committee should consider whether the CLIA program should become more active in ensuring the quality of environmental and occupational biomonitoring data by, for example, establishing a chemistry subspecialty in environmental and occupational medicine or expanding the array of biomonitoring-relevant proficiency tests available from the Center for Medicare and Medicaid Services-approved providers. 

With worsening of the economy, both the federal and state governments may cut back on Medicare and Medicaid reimbursement to nursing homes. Thus these facilities may go out of business or have insufficient funds to reimburse us for the services of the program. 

Many third parties hire pharmacy benefit managers (PBMs) to provide prescription claims processing and other services. Examples of third parties that hire PBMs are insurance companies, employers, Medicare prescription drug plans, and state Medicaid programs. PBMs establish pharmacy networks as part of their claims management services, so many pharmacy third-party contracts are with PBMs. Examples of other ser-... 

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