The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services (HHS) responsible for administering Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace. CMS oversees health insurance coverage for more than 160 million Americans and is the single largest payer of health care services in the United States.
CMS sets the rules for connected care. Every billing code, reimbursement rate, documentation requirement, supervision standard, and program eligibility criterion for CCM, RPM, PCM, BHI, and APCM is defined by CMS through the annual rulemaking process. The agency publishes a proposed rule each summer (typically July), accepts public comments, and issues a final rule each fall (typically November) that takes effect January 1 of the following year. This annual cycle is the Medicare Physician Fee Schedule (PFS), and it governs the vast majority of connected care reimbursement.
Key CMS Divisions Relevant to Connected Care:
Center for Medicare (CM):
Administers fee-for-service Medicare (Parts A and B), including the Physician Fee
Center for Medicare and Medicaid Innovation (CMMI):
Tests new payment models, including value-based and technology-enabled care models.
Center for Clinical Standards and Quality (CCSQ):
Oversees quality measurement programs, including the Merit-based Incentive Payment System (MIPS) and the Quality Payment Program.
Sources:
CMS.gov organizational overview; 42 U.S.C. § 1395; Social Security Act § 1115A.
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