CMS Blocking Reimbursements for some Home Health Agencies
January 31, 2014 10:49 AM
Modern Healthcare recently reported that CMS is, “temporarily blocking several home health agencies and ground ambulance suppliers located around the country from enrolling in and receiving reimbursement from the Medicare, Medicaid and Children's Health Insurance (CHIP) programs.
The article continues, stating that:
The affected entities are located in Chicago, Fort Lauderdale, FL, Miami, Detroit, Dallas, Houston and the Greater Philadelphia area. The freezes are allowed under a provision in the Patient Protection and Affordable Care Act that aims to move the CMS beyond a “pay and chase” fraud model to one that's focused on prevention, CMS Administrator Marilyn Tavenner said in a statement…
The CMS chose to focus on these areas following consultation with HHS' Office of Inspector General and the Justice Department, which found a disproportionate number of providers and suppliers relative to beneficiaries along with extremely high utilization in these areas.
The hold is expected to last for six months starting January 31. However, the CMS said it may lift the moratorium earlier or extend it another six months by issuing another notice in the Federal Register.
Earlier in the year, CMS announced a temporary and targeted moratorium on new home health agencies- also in the Chicago and Miami metropolitan areas. NAHC fully supported the moratorium as a necessary program integrity measure.
After the moratorium on new home health agencies was announced in July – see NAHC Report, July 30, 2013 – NAHC President Val J. Halamandaris said:
“We fully support the action taken by CMS. NAHC has long supported program integrity measures such as this and strongly recommended that Congress give CMS the authority to issue a moratorium as part of the Affordable Care Act. We look forward to continue working with CMS as it considers other areas of the country where a moratorium may be needed.”