CMS Extends and Expands Medicare Enrollment Moratoria for HHAs
August 3, 2016 12:04 PM
The Centers for Medicare & Medicaid Services (CMS) has announced a six-month extension of the temporary moratoria on the new Medicare home health agencies (HHAs), subunits, and branch locations within the states of Florida, Illinois, Michigan, and Texas. This announcement expands the moratoria from specific counties within each state to a statewide application.
CMS has extended the temporary moratoria for HHAs several times since it was initially imposed for Miami-Dade County, Florida, and Cook County, Illinois, in July 2013. The moratoria were extended in February 2014 for an additional six months and expanded to locations including Broward County, Florida; Dallas County, Texas; Harris County, Texas; and Wayne County, Michigan. The six-month moratorium was extended again on August 2014, February 2015, July 2015, and February 2016.
The moratoria will also apply to Medicaid and the Children’s Health Insurance Program (CHIP) in each state, although states continue to have the ability to opt out if they determine that the imposition of such moratorium would adversely impact Medicaid beneficiaries’ access to care
CMS has determined that the factors initially evaluated to implement the temporary moratoria show that a high risk of fraud, waste, and abuse exists beyond the current moratoria areas, and believes that a high risk of fraud, waste, or abuse exists largely due to circumvention of the moratoria by some providers. The primary means of circumvention includes enrolling a new practice location outside of a moratorium area and servicing beneficiaries within the moratorium area. Additionally, CMS has continued to see areas of saturation that exceed the national average in the moratoria states.
CMS maintains its policy that the temporary moratorium does not apply to changes in practice locations, changes to provider or supplier information such as phone number, address, or changes in ownership, except changes in ownership of HHAs that require initial enrollments. Also, the moratorium does not apply to an enrollment application that a CMS contractor has already approved, but has not yet entered into the Provider Enrollment Chain and Ownership System (PECOS) at the time the moratorium is imposed.
The National Association for Home Care & Hospice (NAHC) has long supported CMS using their authority to impose a moratorium on new HHAs in areas where there is evidence of fraud and abuse. However, NAHC objects to applying the moratoria to new enrollees that have not completed the enrollment application to approval. NAHC has advocated to exclude from a moratoria HHAs that are anywhere along the application process. The Medicare enrollment process can take years from application submission to enrollment approval. When additional areas are included in a moratoria new enrollee applicants are at risk for significant losses. We are aware of providers that have invested years of hard work and many thousands of dollars preparing for Medicare enrollment only to have the application denied because of the sudden imposition of a moratorium.
This policy position is particularly disheartening since CMS proposed to change when a moratoria would apply to new enrollment applicants in the March 1, 2016, proposed rule (81 FR 10720) titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process.” In that proposed rule CMS stated the following:
“Section 424.570(a) (1)(iv) currently states that a temporary enrollment moratorium does not apply to any enrollment application that has been approved by the enrollment contractor but not yet entered into PECOS at the time the moratorium is imposed. We propose to revise this paragraph to state that a temporary moratorium does not apply to any enrollment application that has been received by the Medicare contractor prior to the date the moratorium is imposed.”
NAHC will continue to work with CMS to establish a balanced approach when imposing moratoriums to ensure a fair process for new enrollee applicants.