CMS Expands Home Health Agency Moratoria In Several States
Amends Ambulance Supplier Moratoria
Entire States Affected
Centers for Medicare & Medicaid Services (CMS) has issued the announcement of its extension, implementation and lifting of temporary moratoria, affecting Florida, Illinois, Michigan, Texas, Pennsylvania and New Jersey. 81 Fed. Reg. 51120 (Aug. 3, 2016).
Background
Under the Affordable Care Act, Congress provided the Secretary of Health and Human Services with authority to impose a temporary moratorium on the enrollment of new Medicare, Medicaid and CHIP providers and suppliers, if the Secretary determines a moratorium is necessary to prevent or combat fraud, waste or abuse under these programs. Moratoria previously have been in effect in certain states or portions of states for home health and ambulance providers and suppliers, which periodically have been extended. CMS is now lifting, extending and expanding the moratoria, as further described below. Moratoria are reviewed every six months.
Lifting of Moratoria on New Part B Emergency Ambulance Suppliers
In 2013, CMS imposed moratoria on the enrollment of Medicare Part B ground ambulance suppliers in certain counties in the states of Texas, Pennsylvania and New Jersey, which were extended a number of times. During the moratoria period, CMS evaluated program risk and determined the primary risk comes from the non-emergency ambulance supplier category.
As such, CMS has announced it is not extending the temporary moratoria on the enrollment of Part B emergency ground ambulance suppliers in any geographic locations in the states of New Jersey, Pennsylvania or Texas. The lifting of the moratoria also applies to Medicaid and Children’s Health Insurance Program (CHIP).
New Part B suppliers of emergency ambulance services will be permitted to enroll as of July 29, 2016. New emergency ambulance suppliers that furnish both emergency and non-emergency services will be able to bill only for emergency transportation services.
Extension of Home Health and Non-Emergency Ambulance Moratoria
Also in 2013, CMS imposed moratoria on the enrollment of new home health agencies in certain counties in the states of Florida, Illinois, Michigan and Texas, which were extended a number of times. CMS is continuing the moratoria on the Medicare enrollment of home health agencies in these locations. The moratoria also apply to Medicaid and CHIP enrollment.
CMS also imposed in 2013 moratoria on the enrollment of new ground ambulance suppliers in certain counties of Texas, Pennsylvania and New Jersey, as discussed above, which were also extended a number of times. CMS is extending the moratoria on the Medicare Part B enrollment of non-emergency ground ambulance suppliers in these geographic areas. The moratoria also apply to Medicaid and CHIP enrollment.
New Home Health and Non-Emergency Ambulance Moratoria
CMS has determined that the factors initially evaluated to implement the temporary moratoria show a high risk of fraud, waste and abuse exists beyond the current moratoria areas. According to CMS, this is due largely to circumvention of the moratoria by providers and suppliers who enroll a new practice location outside a moratorium area but service beneficiaries within a moratorium area.
As such, CMS has determined, in consultation with the Office of Inspector General of the U.S. Department of Health & Human Services, it is necessary to expand the moratoria on a state-wide basis. New moratoria, therefore, are established on all newly-enrolling Medicare home health agencies in the remaining counties of Florida, Illinois, Michigan and Texas, making the moratoria state-side in these states.
Further, the moratoria on Part B enrollment of non-emergency ground ambulance suppliers have been expanded state-wide in Texas, Pennsylvania and New Jersey.
The moratoria apply also to Medicaid and CHIP, but states may choose to opt out if they determine the imposition of such moratoria will adversely impact Medicaid beneficiaries’ access to care.
When Moratoria Do Not Apply
A temporary moratorium does not apply to changes in practice locations, changes to provider or supplier information such as phone number or address, or changes in ownership (except changes in ownership of home health agencies that require initial enrollments under applicable law).
Further, a 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 (in this case, July 29, 2016).
Provider Enrollment Moratoria Access Waiver Demonstration (PEWD)
CMS also announced the PEWD, which gives CMS the ability to allow for provider or supplier enrollment exceptions in the moratoria areas if access to care issues are identified and for the development and improvement of methods of investigating and prosecuting fraud in Medicare, Medicaid and CHIP. This will allow enrollment of a provider or supplier after a heightened review of that provider or supplier has been conducted.
Should you need assistance in understanding and applying the new requirements, please contact one of the Members of our health law team below.
Health Law Practice Group
Members
John D. Fanburg, Chair
973.403.3156 • jfanburg@bracheichler.com
Riza I. Dagli
973.403.3103 • rdagli@bracheichler.com
Lani M. Dornfeld
973.403.3136 • ldornfeld@bracheichler.com
Joseph M. Gorrell
973.403.3112 • jgorrell@bracheichler.com
Carol Grelecki
973.403.3140 • cgrelecki@bracheichler.com
Debra Lienhardt
973.364.5203 • dlienhardt@bracheichler.com
Mark Manigan
973.403.3132 • mmanigan@bracheichler.com
Keith J. Roberts
973.364.5201 • kroberts@bracheichler.com
