Paul Spitalnic is the Chief Actuary for CMS. Paul joined CMS in 2003 and led the actuarial efforts to implement the new Part D program. Since 2006, Paul has held the position of Director of the Parts C & D Actuarial Group, where he has responsibility for the review of Medicare Advantage and Part D plan bids, preparing budget and cost estimates for the Parts C and D programs and calculating the Medicare Advantage benchmark rates. Prior to joining CMS, he worked as a Consulting Actuary focusing on retiree health insurance issues. Paul is an Associate of the Society of Actuaries, a Member of the American Academy of Actuaries and has a B.A. in Mathematics from Binghamton University.
OA Functional Statement
- Conducts and directs the actuarial program for CMS and directs the development of and methodologies for macroeconomic analysis of health care financing issues.
- Performs actuarial, economic and demographic studies to estimate CMS program expenditures under current law and under proposed modifications to current law.
- Provides program estimates for use in the President's budget and for reports required by Congress.
- Studies questions concerned with financing present and future health programs, evaluates operations of the Federal Hospital Insurance Trust Fund and Supplementary Medical Insurance Trust Fund and performs microanalyses for the purpose of assessing the impact of various health care financing factors upon the costs of Federal programs.
- Estimates the financial effects of proposals to create national health insurance systems or other national or incremental health insurance reform.
- Develops and conducts studies to estimate and project national and area health expenditures.
- Develops, maintains, and updates provider market basket input price indexes and the Medicare Economic Index.
- Analyzes data on physicians' costs and charges to develop payment indices and monitors expansion of service and inflation of costs in the health care sector.
- Performs actuarial reviews and audits of employee benefit expenses charged to Medicare by fiscal intermediaries and carriers.
- Publishes cost projections and economic analyses, and provides actuarial, technical advice and consultation to CMS components, governmental components, Congress, and outside organizations.