By Robert B. Barnett Jr., J.D.
CMS again extended for six months the temporary provider moratoria on new home health agencies (HHAs) in Florida, Illinois, Michigan, and Texas, and on new Part B non-emergency ground ambulance suppliers in Pennsylvania and New Jersey. The enrollment moratoria—using data from civil, criminal, and administrative investigations—target areas believed to be at high risk of fraud, waste, or abuse (Notice, 83 FR 4147, January 30, 2018).
History. The original six-month moratoria (78 FR 46339, July 31, 2013), enacted pursuant to power given to CMS under Sec. 6401(a) of the Patient Protection and Affordable Care Act (P.L. 111-148), targeted new HHAs in Miami-Dade County, Florida (and other counties surrounding Miami), and Cook County, Illinois (and other counties surrounding Chicago), as well as Part B ground ambulance suppliers in Harris County, Texas (and other counties surrounding Houston). Over the years, the moratoria have been dutifully renewed every six months, with certain alterations, such as extending the county moratoria to entire states (see Home health, non-emergency ambulance moratoria expanded to cover entire states, August 1, 2016).
Moratoria proof. Prior to extending the moratoria, CMS used qualitative and quantitative factors to confirm that the affected areas continue to pose a high risk of fraud, waste, and abuse. CMS was also required to confirm that extension of the moratoria would not limit access to HHAs or ground ambulance suppliers for Medicare, Medicaid, and CHIP beneficiaries. In this case, CMS, after consulting with state Medicaid agencies and with the appropriate federal agencies, concluded that no access-to-care issues would be created by extending the moratoria.
Additional conditions. The moratoria apply to new applications (see Some new providers still unable to enroll in high-risk fraud areas, February 1, 2016). For those entities that have already been approved, the following change in conditions will not subject them to the temporary moratoria: (1) change in practice location, (2) change in provider or supplier information, such as a new phone number, or (3) change in most types of ownership. Furthermore, the moratoria may be lifted in extreme circumstances. For example, the Part B ambulance supplier moratorium had applied to Texas but, in 2017, CMS lifted the moratorium as a result of the Presidential Disaster Declaration to aid in the disaster response to Hurricane Harvey.
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