SMQT- Survey & Certification Background
1. Social Security It was signed into law by President Johnson on July 30, 1965. The law established
Act of 1965 both Medicare, the health insurance program for Americans over 65 and Medicaid,
the health insurance program for low-income Americans.
2. Health Care Fi- Created in 1977 to combine, under one administration, the oversight of Medicare
nancing Adminis- and Medicaid under the HCFA (the predecessor of CMS).
tration (HCFA)
3. 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)
4. 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
, SMQT- Survey & Certification Background
- 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.
5. Clinical Labora- Signed into law in 1988, CLIA regulations include federal standards applicable to all
tory Improve- U.S. laboratory facilities or sites that test human specimens for health assessment
ment Amend- or to diagnose, prevent, or treat disease. The CDC, in partnership with the CMS
ments (CLIA) 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 spec-
imens 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
, SMQT- Survey & Certification Background
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 regis-
tration, fee collection, certificate generation, surveys, surveyor guidelines devel-
opment & training, enforcement, financial management, & finally, approvals of
proficiency testing providers, accrediting organizations & exempt states.
6. Title XVIII of Title XVIII (18) established regulations for the Medicare program. The Chapter also
the Social Securi- provides insurance coverage for hospital, post-hospital, home health services, and
ty Act hospice care for the aged and disabled. regardless of income or health status.
7. Title XIX (Medic- Title XIX (19) of the Social Security Act established regulations for the Medicaid
aid) of the Act 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.
8. Title XVIII (18) + Both titles mandate the establishment of minimum health and safety standards
Title XIX (19) of that must be met by providers and suppliers participating in the Medicare and
the Social Securi- Medicaid programs.
ty Act
9. 42 CFR Part Provides Medicaid recipients with free choice of providers. On a statutory basis, 42
431.51 CFR Part 431.51 provides that beneficiaries may obtain services from any qualified
Medicaid provider that undertakes to provide the services to them.
10. In Medicare terminology, providers are resident care institutions such as hospitals,
hospices, nursing homes, and home health agencies.
1. Social Security It was signed into law by President Johnson on July 30, 1965. The law established
Act of 1965 both Medicare, the health insurance program for Americans over 65 and Medicaid,
the health insurance program for low-income Americans.
2. Health Care Fi- Created in 1977 to combine, under one administration, the oversight of Medicare
nancing Adminis- and Medicaid under the HCFA (the predecessor of CMS).
tration (HCFA)
3. 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)
4. 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
, SMQT- Survey & Certification Background
- 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.
5. Clinical Labora- Signed into law in 1988, CLIA regulations include federal standards applicable to all
tory Improve- U.S. laboratory facilities or sites that test human specimens for health assessment
ment Amend- or to diagnose, prevent, or treat disease. The CDC, in partnership with the CMS
ments (CLIA) 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 spec-
imens 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
, SMQT- Survey & Certification Background
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 regis-
tration, fee collection, certificate generation, surveys, surveyor guidelines devel-
opment & training, enforcement, financial management, & finally, approvals of
proficiency testing providers, accrediting organizations & exempt states.
6. Title XVIII of Title XVIII (18) established regulations for the Medicare program. The Chapter also
the Social Securi- provides insurance coverage for hospital, post-hospital, home health services, and
ty Act hospice care for the aged and disabled. regardless of income or health status.
7. Title XIX (Medic- Title XIX (19) of the Social Security Act established regulations for the Medicaid
aid) of the Act 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.
8. Title XVIII (18) + Both titles mandate the establishment of minimum health and safety standards
Title XIX (19) of that must be met by providers and suppliers participating in the Medicare and
the Social Securi- Medicaid programs.
ty Act
9. 42 CFR Part Provides Medicaid recipients with free choice of providers. On a statutory basis, 42
431.51 CFR Part 431.51 provides that beneficiaries may obtain services from any qualified
Medicaid provider that undertakes to provide the services to them.
10. In Medicare terminology, providers are resident care institutions such as hospitals,
hospices, nursing homes, and home health agencies.
