Which federal agency develops rules for Medicare and Medicaid programs?

• A. Center for Medicare and Medicaid Services (CMS)
• B. Occupational Safety and Health Administration
• C. National Committee for Quality Assurance
• D. Joint Commission

Answer: (A)

The agency that sets the rules for Medicare and Medicaid is the Centers for Medicare & Medicaid Services. This federal agency administers both programs and creates the policies that govern coverage, payment, and enrollment. Medicare rules include national coverage determinations that decide what services are reimbursable, while Medicaid involves federal guidelines plus state administration under CMS oversight. The other organizations listed aren’t federal regulators for these programs: OSHA handles workplace safety rules, NCQA is a private group that accredits health plans and providers, and the Joint Commission provides accreditation but is not a federal regulatory body.