slug: cms-gov
provider: CMS — Centers for Medicare & Medicaid Services
generated_by: planning/capability-mapping/scripts/classify_capabilities.py
model: claude-opus-5
frame:
- Public Sector & Government
min_confidence: 0.7
capability_model:
  source: https://github.com/vincentmakes/turbo-ea-capabilities
  license: CC-BY-4.0
  attribution: Turbo EA Capabilities by Vincent Verdet — Turbo EA, https://github.com/vincentmakes/turbo-ea-capabilities,
    CC BY 4.0
  notice: NOTICE
edge_count: 3
edges:
- tag: ExplanationOfBenefit
  spec_file: cms-gov-explanationofbenefit-api-openapi.yml
  capability_id: BC-2160
  capability_id_l1: BC-2160
  capability_name: Insurance Claims Management
  confidence: 0.8
  evidence: 'GET /ExplanationOfBenefit searchExplanationOfBenefit Search Explanation Of Benefit Resources;
    schemas: Bundle, ExplanationOfBenefit'
  reason: FHIR ExplanationOfBenefit resources are adjudicated insurance claim records (Medicare claims
    data), so the surface plainly concerns insurance claims. Which sub-capability (adjudication vs settlement
    records) is unclear, so L1 only.
  recovered_from: vertical-insurance-edges.json
- tag: Plans
  spec_file: cms-gov-plans-api-openapi.yml
  capability_id: BC-2100.10
  capability_id_l1: BC-2100
  capability_name: Insurance Product Catalogue Management
  confidence: 0.8
  evidence: exposes Qualified Health Plan (QHP) and Stand-alone Dental Plan (SADP) data from healthcare.gov
    including plan finder, plan compare, plan rates, plan benefits
  reason: Search and retrieval of insurance plan master data including benefits and rates — an insurance
    product catalogue surface. Sub-capability ambiguity exists (rates could touch pricing configuration)
    but catalogue is the dominant reading.
  recovered_from: vertical-insurance-edges.json
- tag: Eligibility
  spec_file: cms-gov-eligibility-api-openapi.yml
  capability_id: BC-3230.20
  capability_id_l1: BC-3230
  capability_name: Eligibility Determination
  confidence: 0.7
  evidence: POST /forms/eligibility  checkEligibility  Check Subsidy Eligibility
  reason: The operation determines applicant eligibility for a government subsidy (APTC/CSR) in the Health
    Insurance Marketplace, which is eligibility determination for a public entitlement. Confidence held
    moderate because the surface is a single stateless calculation endpoint rather than full eligibility
    case processing.