centers-for-medicaid-and-medicare-services-and-snf-regulation

Government Regulatory Agencies and the Impact on Consumer Choices

Team “C”

HCS/490

Dan Crawley

Centers for Medicare & Medicaid Services

This Presentation Will Examine The Following:•Roles and Responsibilities •The Health Care Products & Services the Agency is Accountable for Managing or Regulating.•Overview of Skilled Nursing Facilities (SNF)•How the Agency Oversees, Governs, & Regulates Skilled Nursing Facilities.

•Advantages of this Control to the Consumer•Advantages of this Control to the Provider•The Role of the Agency and it’s Regulation of Skilled Nursing Facilities, & the Affect of Consumer Choice in the Health Care Marketplace.•Consumer Health Care Costs•Related factors that Contribute to the Consumer’s Choice of Providers.

Centers for Medicare & Medicaid ServicesRoles, Responsibilities, & Regulations

Image Credit: www.eventbrite.com

CMS covers 100 million people through Medicare & Medicaid.

CMS Strives to increase the health of Americans while reducing costs.

CMS enforces and implements health care legislation

CMS reduces fraud, waste, and abuse of federal health programs.

The Health Care Products & Services the CMS is Accountable for Managing or Regulating

Image Credit:www.medicare.gov

Image Credit:blogs.browardpalmbeach.com

Overview of Skilled Nursing Facilities (SNF)

Image Credit: Bayoupines.com

A Skilled Nursing Facility (SNF) is a 24 hour health care facility that provides skilled nursing care to patients in need.

How CMS Regulates Skilled Nursing Facilities

Image obtained from: www.chandler-glendale.com

Advantages of CMS Control to the Consumer

Image 1 obtained from: xeloq.wordpress.comImage 2 obtained from: www.goldsmithinsurance.comImage 3 obtained from: aumpt.co

Advantages of CMS Control to the Provider

Image 1 obtained from: manifestedharmony.com Image 2 obtained from: www.newhopebaptistchurch-wc.comi Image 3 obtained from: www.montecookgames.com

CMS Skilled Nursing Facility Regulation & The effect of Consumer Choice in the Health Care

Marketplace.

In the event a provider’s loses CMS certification it significantly reduces their potential consumer base and removes the potential 100 million Medicare and Medicaid beneficiaries from its desired demographic.

Overall, CMS’s regulation of SNF providers increases provider efforts and performance therefore bettering the quality of care delivered.

Consumer Health Care Costs

Related factors that Contribute to the Consumer’s Choice of Providers.

Conclusion

Image obtained from: www.piperreport.com

Reference

Bowers, L. (2013). Long Term Living. Medicare.gov. Retrieved from

http://www.ltlmagazine.com/news-item/private-snf-care-tops-94k-year-insurance-

survey-says

Center for Medicare & Medicaid Services (n.d.). Criteria for Long-term Care Services:

Skilled Nursing Facility Services. Retrieved from

http://www.dhos.ca.gov/services/medi-cal/Documents/ManCriteria_26_LTC.htm

Center for Medicare & Medicaid Service (2013). Details for Title: New resources

available to

Help consumers navigate the health insurance marketplace

Retrieved from http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-

Release/2013-Press-Release-Itmes/2013-08-15.htm

Centers for Medicaid & Medicare Service. (2010). Medicare and Home Health Care.

Retrieved from http://www.medicare.gov/pubs/pdf/10969.pdf

Reference

Center for Medicare and Medicaid Services. (n.d). Skilled Nursing Facility PPS .

Retrieved from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/SNFPPS/index.html

Center for Medicare & Medicaid Services (2012). Skilled Nursing Facility Prospective

Payment System: Payment System Facts Sheet Series. Retrieved from

http://www.cms.gov.Outreach-and-Education/Medicare-Learning-Network-

MNL/MNLProducts/downloads/snfpropaymtfctsht.pdf

Illinois Department of Public Health. (n.d.). Nursing Homes in Illinois. Retrieved from

http://www.idph.state.il.us/healthca/nhregulate.htm

Kotler, P., Shalowitz, J., & Stevens, R. J. (2008). Strategic marketing for health care

organizations: Building a customer-driven health system. San Francisco, CA:

Jossey-Bass.

Medicare.gov. (2013). Medicare.gov The Official U.S. Government site for Medicare.

Retrieved from http://www.medicare.gov/coverage/skilled-nursing-facility-

care.html