✯ ✯ 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.