Centre for Medicare and Medicaid

Centre for Medicare and Medicaid Services (CMS)

The CMS is a federal agency that falls within the United States Department f Health and Human Services (DHHS). It is charged with the administering Medicare and also works with the state governments in providing Medicaid. The Medicare includes involves the federal health insurance for the seniors while the Medicaid basically deals with the needs-based programs. The CMS is also charged with overseeing the Health Insurance Portability and Accountability Act otherwise known as (HIPAA) the Children's Health Insurance Program also known as (CHIP) as well as the Clinical Laboratory Improvement Amendments (CLIA) as the main areas of concentration among several other areas of commitments (Techtarget, 2011).

It is also worth noting that CMS has also been charged with the responsibility of advancing health IT which includes the implementation of the EHR or electronic health record program. It was also entrusted to come up with definition for the meaningful use of the HER technology asn well as the determining of the standards for the certification of the electronic health record technology and the security and privacy of the technology under the HIPAA.

CMS through its Medicare also caters for the insurance of the elderly people who are of the age 65 years and beyond and people with certain disabilities.

The CMS and the programs that it runs have proven to be quite expensive in the recent years and are projected to continue in the same trend over the next few years. Currently, the numbers of citizens who require medical care from the program get far much more form the program than they contribute through taxes. This is in sight of the baby-boomer generation that is now retiring in drives. An instance at hand is the case of a wage earner who paid his taxes from 1966 and retired in 1998 will have contributed on average $16, 800 yet the present value of future Part A benefits is estimated at $109,000 which outstrips by far the contribution that the individual made.

The main point of worry for the program has to do with the financial solvency that is occasioned by the baby Boomer generation maturation towards retirement age. According to financial analysts if the health insurance programs coordinated by CMS fail to change with the prevailing trend it is possible that they will end financial solvency hence seeing an end to Medicare and Medicaid. It is projected that the Medicare program could possibly consume more than half of the federal income tax by the year 2042, this will also drive up the real cost of drugs. The main reason behind the continued rise in the Medicare cost is the fact that the medical insurances has vastly expanded over the last 40 years as observed in Congressional Budget Office (2011). People will adopt the new technology freely with the thought that insurance will pay for it.

Despite the fact that CMS has widely succeeded in ensuring that the Medicare and Medicaid are implemented effectively in a manner that benefits Americans, it is faced with quite a number of challenges. One very significant concern was raised by AARP regarding the administrative functioning of the agency. There were some ambiguities noted between the CMS and it regional offices. Bearing that Medicare is a national program that issues uniform benefits, there should be uniform information issued throughout the system. There has been however cases of CMS's ten regional offices and the contractors making decisions about contract management, coverage and certification of facilities. This has led to some providers and beneficiaries complaining that they have severally received conflicting information from national and regional offices.

The other inefficiency of the CMS has to do with the areas that it leaves out in the health coverage yet very significant. It is worth noting that with both Part A and B. Of the policy of the CMS present, there are still a significant number of health care services that still are uncovered and AARP mentions them as prescription drugs, long-term care, some preventive care, hearing aids, eyeglasses or optical aids, dental care as well as service obtained outside the U.S.A. It is worth noting that some of these parts that are left out can be very expensive at times particularly when the beneficiary has to pay the out-of-pocket premiums and deductibles as well, and these services could be inevitable like seeking medical services outside the U.S.A. Some of the services left out by the cover at times can be more expensive and life threatening that those covered hence this serves to negate the whole purpose of the CMS health care services.

In order to cover the above mentioned areas that the CMS leaves out, there is the Medicare part C which is also referred to as Medicare + Choice program which allows the beneficiary to select a private health plan provider such as the Health Maintenance Organization (HMO) who will then contract with the Medicare in order to provide all the covered health services. This is the other undoing of the CMS plan since the private companies are required to cover all of the services while receiving only fixed monthly due from CMS, not taking into account the cost of care that was received by the patient. The effect of this is that the HMO may sound cheaper for the clients but it provides leaner options with most people going only for the primary care, hence effectively remaining not sufficiently covered (Steven J. Lonchyna, 2011).

With the adoption of the Obama Health care plan, there is hope that the situation will be amicably solved ultimately. One of the very central things that the health care plan will provide to resolve the current problem is the Emergency Medical Services (EMS) which are emergency services dedicated to providing care to patients with injuries or illnesses that the medical personnel or the patient believes are emergencies. These services are mostly provided out of the hospital and in some cases it constitutes providing transportation to emergency patients from one hospital to another. The primary aim of the EMS is to readily avail treatment to those in acute need for it with the aim of putting under control the prevailing symptoms, as well as arranging for a prompt transportation of the patients to the closest place of definitive care which is mostly the emergency department in a hospital or a place with qualified physicians, all these without considering the extent to which one is insured first.