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2003 National Health Policy ✯Conference
January 22-23, 2003
J.W. Marriott
Washington, D.C.
Matching Problems &
Solutions
Improving Medicare’s
Governance and Management
Our Charge:
♦ Examine whether a different
governance structure might help CMS
be more effective; and
♦ Identify ways in which the current
Medicare management could be
improved.
Used three criteria to evaluate
Medicare’s governance and
management:
♦ Does it have the capacity to
accomplish its functions?
♦ Is it accountable for the decisions it
makes?
♦ Is the Medicare program
administration viewed as credible?
Examined four alternative
governance models:
♦ Independent agency
♦ Independent board
♦ Performance-based organization
♦ Government corporation
None of the models, in their purest form,
were found to be clearly superior to the
current governance of the program.
Identified two critical
components to many of CMS’
management problems:
♦ A pervasive and persistent shortage of
resources to meet the greatly increased
responsibilities Congress has given it;
and
♦ The extent of Congressional
involvement in Medicare.
Recommendation 1: Medicare
policymakers should act now to
address administrative and
management problems in CMS
regardless of whether Congress takes
action on broader Medicare reform.
Recommendation 2: A panel of
independent experts should be
appointed to prepare an analysis of the
impact on Social Security and its
stakeholders of its transition from an
operating agency within the
Department of Health and Human
Services to a free-standing agency.
Such a report should also include an
analysis of the implications of such a
change for CMS.
Recommendation 3: In order to enable
CMS to fulfill its responsibilities,
Congress should increase
administrative funding for the agency.
Recommendation 4: Congress should
consider removing from CMS some
functions not directly related to Medicare
or Medicaid so that the agency can focus
more on its core missions. Some functions
that might be removed from CMS include
oversight of the Clinical laboratory
Improvement Act (CLIA) and
responsibilities in the Health Insurance
Portability and Accountability Act for
oversight of private health insurance and
administrative simplification of health
business transactions.
Recommendation 5: Congress should
furnish CMS with new multi-year
funding to develop and implement
improved information systems. CMS
should seek expert guidance and
assistance in implementing these
systems.
Recommendation 6: Congress should
authorize the President to appoint,
subject to Congressional approval, the
Administrator of CMS to a fixed term
and furnish protection against
arbitrary removal.
Recommendation 7: Congress should
increase the salary of the
administrator to better reflect the
stature and responsibilities of the
position. The CMS’ administrator’s
salary should be commensurate with
the Commissioner of the Social
Security Administration.
Recommendation 8: Congress should
grant CMS some relief from both
limitations on salary and civil service
personnel rules to recruit and retain
staff with technical skills (such as
actuaries or information systems
experts) or highly sought after
expertise.
Recommendation 9: In order to recognize
Medicare’s economic, social and budgetary
impact, as well as its role in the nation’s
health care system, Congress should
establish a joint committee to serve as a
central source of information and analysis.
Membership on the committee should be
comprised of members from the House
Ways and Means Committee, the House
Energy and Commerce Committee, and the
Senate Committee on Finance.
Recommendation 10: Congress should
give CMS more flexibility to contract
with new organizations to process
Medicare claims. Additional
resources should be provided to
contractors. CMS should build
service standards for customer service
in contracts and devote more attention
to assuring that information provided
to health care providers is timely,
accurate and easily understandable.
Recommendation 11: Congress should
provide resources to CMS to provide
more real-time assistance to
beneficiaries with Medicare-related
problems. This assistance should
occur by telephone, via the internet, or
by establishing Medicare help desks in
Social Security field offices. In any
case, those helping beneficiaries
should have access to beneficiaries’
claims records.
Recommendation 12: To assure that
beneficiaries and their families have
the information they need to make
informed choices about Medicare,
Congress should provide adequate
funding for the National Medicare
Education Program.