Editing Medicare (United States) (section)

==Administration==
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The [[Centers for Medicare and Medicaid Services]] (CMS), a component of the [[United States Department of Health and Human Services|U.S. Department of Health and Human Services]] (HHS), administers Medicare, [[Medicaid]], the [[Children's Health Insurance Program]] (CHIP), the [[Clinical Laboratory Improvement Amendments]] (CLIA), and parts of the [[Patient Protection and Affordable Care Act|Affordable Care Act]] (ACA) ("Obamacare").<ref>{{cite web|title=About CMS|url=http://www.cms.gov/About-CMS/About-CMS.html|website=CMS.gov|access-date=July 27, 2015}}</ref> Along with the [[United States Department of Labor|Departments of Labor]] and [[United States Department of the Treasury|Treasury]], the CMS also implements the insurance reform provisions of the [[Health Insurance Portability and Accountability Act]] of 1996 (HIPAA) and most aspects of the Patient Protection and Affordable Care Act of 2010 as amended. The [[Social Security Administration]] is responsible for determining Medicare eligibility, eligibility for and payment of Extra Help/Low Income Subsidy payments related to Parts C and D of Medicare, and collecting most premium payments for the Medicare program.

The Chief Actuary of the CMS must provide accounting information and cost-projections to the Medicare Board of Trustees to assist them in assessing the program's financial health. The Trustees are required by law to issue annual reports on the financial status of the Medicare Trust Funds, and those reports are required to contain a statement of actuarial opinion by the Chief Actuary.<ref>[http://www.actuary.org/pdf/medicare/medicare_actuary_jan02.pdf "What Is the Role of the Federal Medicare Actuary?"], [[American Academy of Actuaries]], January 2002.</ref><ref>[http://www.actuarialstandardsboard.org/pdf/asops/asop032_062.pdf "Social Insurance"], Actuarial Standard of Practice No. 32, Actuarial Standards Board, January 1998</ref>

The [[Specialty Society Relative Value Scale Update Committee]] (or Relative Value Update Committee; RUC), composed of [[physician]]s associated with the [[American Medical Association]], advises the government about pay standards for Medicare patient procedures performed by doctors and other professionals under Medicare Part B.<ref name="NYT-20150531">{{cite news |last=Pear |first=Robert |author-link=Robert Pear |title=Federal Investigators Fault Medicare's Reliance on Doctors for Pay Standards |url=https://www.nytimes.com/2015/06/01/us/federal-investigators-fault-medicares-reliance-on-doctors-for-pay-standards.html |date=May 31, 2015 |work=[[The New York Times]] |access-date=June 1, 2015 }}</ref> A similar but different CMS process determines the rates paid for acute care and other hospitals—including skilled nursing facilities—under Medicare Part A. The rates paid for both Part A and Part B type services under Part C are whatever is agreed upon between the sponsor and the provider. The amounts paid for mostly self-administered drugs under Part D are whatever is agreed upon between the sponsor (almost always through a pharmacy benefit manager also used in commercial insurance) and pharmaceutical distributors and/or manufacturers.