centers-for-medicaid-and-medicare-services-and-snf-regulation
TRANSCRIPT
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
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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
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Overview of Skilled Nursing Facilities (SNF)
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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
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Advantages of CMS Control to the Consumer
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Advantages of CMS Control to the Provider
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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
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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