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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.

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Presentation on theme: "INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential."— Presentation transcript:

1 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. 1 Nurses at The Centers for Medicare & Medicaid Services (CMS) Anitra Johnson, DHSc, RN CDR, USPHS Nurse Consultant May 3, 2013

2 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. 2 Overview  CMS  Experiences at CMS  Current roles and responsibilities  Useful experience/education

3 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. 3 CMS The Centers for Medicare & Medicaid Services is responsible for administration of several key federal health care programs. These programs include:  Medicare  Medicaid  Children’s Health Insurance Program (CHIP)  Health Insurance Portability and Accountability Act (HIPAA)  Clinical Laboratory Improvement Amendments (CLIA) For additional information please visit

4 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. 4 Experiences at CMS Developed quality measures Medicaid fraud, waste, and abuse Ombudsman Program of All Inclusive Care for the Elderly (PACE)

5 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. 5 Experiences at CMS (cont’d) PACE allows nursing home eligible beneficiaries to stay at home and receive comprehensive services and support Services include:  Primary care  Home care  Physical, occupational, and recreational therapy  Meals and nutritional counseling  Social services  Transportation  Personal care and supportive services

6 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. 6 Current Roles and Responsibilities Lead Clinician for PACE 92 PACE Organizations Point of contact to all CMS staff, PACE Organizations, and State agencies Provide consultative and authoritative advice to Agency officials and external stakeholder on clinical and quality improvement issues

7 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. 7 Current Roles and Responsibilities (cont’d) Promote collaboration and communication with key stakeholders, both internal and external to CMS Responsible for writing technical guidance documents and revising federal regulations Developing quality measures Monitoring and auditing of PACE Organizations Represent CMS at National conferences and programs

8 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. 8 Useful Experience/Education Preferred and required experience varies across the agency Nurse Consultant and Health Insurance Specialist are generic titles at CMS Education progression Training and certifications

9 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law. 9 Contact Information Anitra Johnson, DHSc, RN CDR, USPHS Nurse Consultant Division of Medicare Advantage Operations (DMAO)


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