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‘SMQT- Survey & Certification Background 2024/2025 (100% verified) A+ grade assured
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SMQT- Survey & Certification‘
Background
Social Security Act of 1965
It was signed into law by President Johnson on July 30, 1965. The law established both
Medicare, the health insurance program for Americans over 65 and Medicaid, the health
insurance program for low-income Americans.
Health Care Financing Administration (HCFA)
Created in 1977 to combine, under one administration, the oversight of Medicare and
Medicaid under the HCFA (the predecessor of CMS).
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Medicare
Signed into law in 1965, Medicare is a Health Insurance Program for the following groups:
- People age 65 or older
- People under age 65 with certain disabilities
- People of all ages with End-Stage Renal Disease (permanent kidney failure requiring
dialysis or a kidney transplant)
Medicaid
Medicaid is a medical assistance program jointly financed by State and Federal
governments for eligible low-income individuals. The program covers a variety of groups,
including the following:
,- The needy elderly
- Blind
- Disabled individuals receiving cash assistance under the Supplemental Security Income
Program
- Certain infants and low-income pregnant women
- At the option of the State, other low-income individuals with medical bills that qualify them
as categorically or medically needy.
Medicaid is a state program that provides medical services to clients of the state public
assistance program and, at the State's option, other needy individuals.
Medicaid also augments the hospital and nursing facility (NF) services mandated under
Medicaid.
States may decide on the amount, duration, and scope of additional services, except that
care in institutions primarily for the care and treatment of mental health issues, may not be
included for persons over age 21 and under age 65.
Clinical Laboratory Improvement Amendments (CLIA)
Signed into law in 1988, CLIA regulations include federal standards applicable to all U.S.
laboratory facilities or sites that test human specimens for health assessment or to diagnose,
prevent, or treat disease. The CDC, in partnership with the CMS and FDA, supports the
CLIA program and clinical laboratory quality.
- The Centers for Disease Control & Prevention is responsible for the CLIA studies,
convening the Clinical Laboratory Improvement Amendments Committee (CLIAC) &
provides scientific & technical support to CMS.
- A laboratory is defined as any facility that performs laboratory testing on specimens derived
from humans for the purpose of providing information for the diagnosis, prevention,
treatment of disease, or impairment of, or assessment of health.
- CLIA covers approximately 175,000 laboratory entities.
- The Food & Drug Administration (FDA) is responsible for test categorization.
- The Division of Laboratory Services, within the Survey & Certification Group, under the
Center for Medicaid, CHIP and Survey & Certification have the responsibility for
implementing the CLIA Program.
- CMS is charged with the implementation of CLIA, including laboratory registration, fee
collection, certificate generation, surveys, surveyor guidelines development & training,
enforcement, financial management, & finally, approvals of proficiency testing providers,
accrediting organizations & exempt states.
, Title XVIII of the Social Security Act
Title XVIII (18) established regulations for the Medicare program. The Chapter also provides
insurance coverage for hospital, post-hospital, home health services, and hospice care for
the aged and disabled. regardless of income or health status.
Title XIX (Medicaid) of the Act
Title XIX (19) of the Social Security Act established regulations for the Medicaid program,
specifically, the Chapter appropriates money to States for families with dependent children
and for aged, blind, or disabled individuals, whose income and resources are insufficient to
meet the costs of necessary medical services.
Title XVIII (18) + Title XIX (19) of the Social Security Act
Both titles mandate the establishment of minimum health and safety standards that must be
met by providers and suppliers participating in the Medicare and Medicaid programs.
42 CFR Part 431.51
Provides Medicaid recipients with free choice of providers. On a statutory basis, 42 CFR Part
431.51 provides that beneficiaries may obtain services from any qualified Medicaid provider
that undertakes to provide the services to them.
PROVIDERS (Medicare Terminology)
In Medicare terminology, providers are resident care institutions such as hospitals, hospices,
nursing homes, and home health agencies.
SUPPLIERS
Suppliers are agencies for diagnosis and therapy rather than sustained resident care, such
as laboratories, clinics, & physical therapist (PT) offices.
The Act designates those providers & suppliers that are subject to Federal health care
quality standards.
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