Centers for Medicare & Medicaid Services. (CMS) — The federal agency under the United States Department of Health and Human Services responsible for administering the Medicare and Medicaid programs.
Centers for Medicare & Medicaid Services. (Federal CMS) means the agency within DHHS that is responsible for the administration of the Medicare program and, in partnership with the states, administers Medicaid, the State Children’s Health Insurance Program (SCHIP), and the Health Insurance Portability and Accountability Act (HIPAA).
Centers for Medicare & Medicaid Services. (CMS) - the federal agency under the Department of Health and Human Services responsible for administering the Medicare and Medicaid programs under Titles XVIII and XIX of the Social Security Act. Centralized Enrollee Record - centralized and comprehensive documentation, containing information relevant to maintaining and promoting each Enrollee's general health and well being, as well as clinical information concerning illnesses and chronic medical conditions. See Subsection 2.4(A)(8-10) of the Contract for more information about the contents of the Centralized Enrollee Record. Complaint - an Enrollee’s informal oral or written expression of grievance or dissatisfaction with any aspect of his or her care, in accordance with Subsection 2.8 of the Contract. Complex Care Need - any condition or situation that demonstrates the Enrollee's need for expert coordination of multiple services (see Subsection 2.4(A)(4) of the Contract), including, but not limited to: clinical eligibility for institutional long term care; and medical illness, psychiatric illness, or cognitive impairment that requires skilled nursing to manage essential unskilled services and care. Consumer – a MassHealth Member, aged 65 or older, or the spouse, sibling, child, or unpaid Primary Caregiver of a MassHealth Member who is aged 65 or older. Contract - the participation agreement that EOHHS has with a Contractor, setting forth the terms and conditions pursuant to which an organization may participate in the MassHealth Senior Care Options Program.
Centers for Medicare & Medicaid Services. COMMENTS In its written comments on the draft report, CMS agreed with our recommendations. CMS stated that future section 1115 demonstration project agreements with California would contain specific 4In addition to accumulating approximately $306.4 million during the first 4 years of the project extension, the County accumulated a surplus of approximately $262.3 million during the initial 5-year term of the project. At the end of State FY 2004, the balance of the Designation Fund was approximately $568.7 million. terms and conditions that require financial controls and documentation related to the funding and disbursement of expenditures. CMS pointed out that it had recently approved a section 1115 project agreement with California that replaced questionable financing mechanisms with documented permissible funding sources and an accountable and transparent financing system. CMS also detailed several financial safeguards included in the agreement. The complete text of CMS’s comments is included as Appendix D. APPENDIXES APPENDIX A SUMMARY OF AMBULATORY AND SUPPLEMENTAL EXPENDITURES BY STATE FISCAL YEAR (in millions) State Fiscal Year (FY) Expenditures 2001 2002 2003 2004 Total By component: Ambulatory $247.0 $240.3 $162.9 $133.0 $783.2 Supplemental 233.6 239.7 204.6 113.3 791.2 Total (A) $480.6 $480.0 $367.5 $246.3 $1,574.4 Certified public Claimed1 $247.0 $240.3 $162.9 $133.0 $783.2 Unclaimed2 63.2 61.2 62.9 54.1 241.4 Total (B) $310.2 $301.5 $225.8 $187.1 $1,024.6 Claimed amount not identified with specific costs [(A) – (B)] $170.4 $178.5 $141.7 $59.2 $549.8 1The State claimed these amounts under the Ambulatory component. 2These amounts were costs that the State did not claim under the Ambulatory component. We offset these unclaimed amounts against Supplemental amounts not identified with specific costs incurred. APPENDIX B AMBULATORY COMPONENT: FLOW OF FUNDS AND CERTIFIED PUBLIC EXPENDITURES State FYs 2001–2004 (in millions) COUNTY GENERAL FUND D - $404.3 C - $404.3 A - $1,024.6 CERTIFIED PUBLIC EXPENDITURES B - $404.3 CALIFORNIA FEDERAL GOVERNMENT DHS & DMH A The Los Angeles County (the County) Department of Health Services (DHS) certified that DHS and the Department of Mental Health (DMH) made expenditures of $1,024.6 million for outpatient clinic services to indigent patients. California claimed $783.2 million of the certified amounts as project extension expenditures eligible for Federal reimbursement.
Centers for Medicare & Medicaid Services. Any provision required to be in this agreement shall bind ESP whether or not set forth herein. No Assignment You cannot assign any benefits or payments due under this agreement to any person, corporation or other organization. Any assignment by you will be void. Assignment means the transfer to another person or organization of your right to the services provided under this plan or your right to collect money from us for those services. Notice Any notice, which we give you under this agreement, will be mailed to you at your address as it appears on our records. You should notify us promptly of any change of your address. When you have to give us any notice, it should be mailed to ESP of Cambridge Health Alliance, 000 Xxxx Xxxxxx, Cambridge, MA 02141. Notice of Certain Events We shall give you reasonable notice of any termination of, breach of, or inability to perform a contract by any of our contracted providers or facilities if you may be materially or adversely affected. This includes hospitals, physicians or any other person with whom we have a contract to provide services or benefits. We will arrange for the provision of any interrupted service by another provider.
Centers for Medicare & Medicaid Services. CMS Program Official The authorized program official, whose signatures appear below, accept and expressly agree to the terms and conditions expressed herein, confirm that no verbal agreements of any kind shall be binding or recognized, and hereby commit their respective organizations to the terms of this agreement.
Centers for Medicare & Medicaid Services. COMMENTS In its written comments on the draft report, CMS agreed with our recommendations. The complete text of CMS’s comments is included as Appendix D. TABLE OF CONTENTS Page INTRODUCTION 1 BACKGROUND 1 Los Angeles County Medicaid Demonstration Project 1 Demonstration Project Extension 1 OBJECTIVE, SCOPE, AND METHODOLOGY 2 Objective 2 Scope 2 Methodology 3 FINDINGS AND RECOMMENDATIONS 3 PROJECT EXTENSION REQUIREMENTS 4 AMBULATORY AND SUPPLEMENTAL EXPENDITURES 4 Ambulatory Expenditures Identified With Costs 4 Supplemental Expenditures Not Identified With Costs 4 RECOMMENDATIONS 5 CENTERS FOR MEDICARE & MEDICAID SERVICES COMMENTS 5 APPENDIXES A – SUMMARY OF AMBULATORY AND SUPPLEMENTAL EXPENDITURES BY STATE FISCAL YEAR B – AMBULATORY COMPONENT: FLOW OF FUNDS AND CERTIFIED PUBLIC EXPENDITURES C – SUPPLEMENTAL COMPONENT: FLOW OF FUNDS D – CENTERS FOR MEDICARE & MEDICAID SERVICES COMMENTS INTRODUCTION
Centers for Medicare & Medicaid Services. The authorized DIB official, whose signature appears below, accepts and expressly agrees to the terms and conditions expressed herein, confirm that no verbal Agreements of any kind shall be binding or recognized, and hereby commits their respective organization to the terms of this Agreement. Xxxxx X. Xxxxxx -S Digitally signed by Xxxxx X. Xxxxxx -S Date: 2021.03.09 13:25:59 -05'00' Date Xxxxx Xxxxxx Acting Chairperson, HHS Data Integrity Board U. S. Department of Health and Human Services Attachments:
Centers for Medicare & Medicaid Services. The authorized approving official, whose signature appears below, accepts and expressly agrees to the terms and conditions expressed herein, confirms that no verbal agreements of any kind shall be binding or recognized, and hereby commits their respective organization to the terms of this Agreement. Xxxxxxx X. Xxxxxx -S Digitally signed by Xxxxxxx Xxxxxx -S Date: 2022.01.13 11:06:58 -0 E. 5'00' Xxxxxxx Xxxxxx Date Director, Division of Security and Privacy Policy and Governance, and Senior Official for Privacy Information Security and Privacy Group Office of Information Technology Centers for Medicare & Medicaid Services
Centers for Medicare & Medicaid Services. The authorized program official, whose signature appears below, accepts and expressly agrees to the terms and conditions expressed herein, confirm that no verbal agreements of any kind shall be binding or recognized, and hereby commits their respective organization to the terms of this Agreement. JCOI' e Depu Director Center for Program Integrity Centers for Medicare & Medicaid Services _j':.ft/ /} Date
