By Deborah Hammonds, J.D.
CMS announced the extension of temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance suppliers and home health agencies for six states. Finding the circumstances which warranted the moratoria had not yet abated, the agency concluded it was still necessary to monitor and continue its actions to combat fraud and abuse (Notice, 82 FR 35122, July 28, 2017).
Moratoria. Section 6401(a) of the Affordable Care Act added a new section 1866(j)(7) to the Social Security Act to provide CMS with authority to impose a temporary moratorium on the enrollment of new Medicare, Medicaid or Children’s Health Insurance Program (CHIP) providers and suppliers, including categories of providers and suppliers, if the agency determined a moratorium was necessary to prevent or combat fraud, waste, or abuse under these programs. In 2013, CMS initially imposed a moratoria to prevent enrollment of new home health agencies, subunits, and branch locations (HHAs) in Miami-Dade County, Florida and Cook County, Illinois, as well as surrounding counties, and Medicare Part B ground ambulance suppliers in Harris County, Texas and surrounding counties. The moratoria was extended and expanded several times until the current listing of statewide locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey. This extension also applies to the enrollment of new nonemergency ground ambulance suppliers and home health agencies, subunits, and branch locations in Medicaid and the Children’s Health Insurance Program in those states.
Extension. CMS extended the temporary moratoria after finding the circumstances warranting the moratoria’s imposition have not yet abated and that the moratoria was still needed as the agency monitors the indicators and continues its administrative actions to combat fraud and abuse such as payment suspensions and revocations of provider/supplier numbers. While there may be exceptions, CMS believes that a category of providers or suppliers that pose a risk to the Medicare program also pose a similar risk to Medicaid and CHIP. CMS has applied the moratoria to the enrollment of HHAs and non-emergency ground ambulance providers and suppliers in Medicaid and CHIP in those locations.
The extension of the moratoria is not expected to create an access to care issue for Medicaid or CHIP beneficiaries in the affected states at this time. CMS also reviewed Medicare data for these states and found there are no current problems with access to HHAs or ground ambulance providers or suppliers. Nevertheless, the agency will continue to monitor these locations to make sure that no access to care issues arise in the future.
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