NAHC Discusses Moratoria with the CMS Program Integrity Group
May 1, 2014 02:33 PM
The National Association for Home Care & Hospice (NAHC) recently participated in a conference call with officials from the Centers for Medicare & Medicaid Services (CMS) Program Integrity Group to discuses the implementation of the moratorium on new home health agencies in designated areas. NAHC sought clarification in the following areas:
Approved enrollment record
CMS confirmed that any enrollment application that has not have been approved will be denied. An approved enrollment application means that all the steps required for enrollment must be completed. CMS stated that even after the tie-in notice has been issued additional steps take place to assure the provider is eligible to be enrolled in Medicare. NAHC expressed concern for those providers who are very far along in the process but had not completed the enrollment process when the moratorium takes effect. These providers may have invested large sums of money and years preparing for Medicare enrollment only to be told that they will not be approved. Although CMS appreciated NAHC’s concern they believed that is was necessary for any provider in an area where a moratorium has been issued to have a complete and approved enrollment record in the system prior to the effective date of the moratorium.
Additionally, CMS will begin requiring fingerprint-based background checks on individuals with a 5 percent or greater ownership interest in newly enrolling home health agencies. This added requirement will likely extend the time it takes to process enrollment applications to completion - causing delays in approving new enrollees.
In addition to new providers, CMS will deny a branch application in an area affected by the moratorium. NAHC questioned CMS’ rational to subject branches to the moratorium since they are not enrolling as a new provider. Branches submit claims and operate under the parent agency provider number and serve the same geographic service area. CMS stated they view the extension of a branch into a moratorium area as a new practice location which they consider the same as a new agency. However, the officials completed the discussion on branches with an agreement to review their decision in applying the moratorium to branches.
Change of location
CMS will permit an agency that is currently located within an area where a moratorium has been issued to change their location within the moratorium area. However, CMS will not permit an agency to move a practice location into the moratorium area, even if it is within the agency’s geographic service area. The CMS Program Integrity Group does not recognize the CMS Survey and Certification Group’s geographic service areas. The moratorium applies to specific zip codes, therefore, even if an agency’s service area crosses into a moratorium area the agency would be prohibited from moving it’s office into the zip code where the moratorium has been issued.
NAHC reiterated to the CMS officials its general support for placing a moratorium on new home health agencies in areas where there continues to be high rates of fraud and abuse. However, NAHC wants to ensure reasonable policies are in place for implementing moratoriums and will continue to work with CMS as issues arise.