Home Health & Hospice Week

Medicare has shot down 18 waiver requests.

What will the future hold for the home health community that was in Hurricane Harvey’s path? No one is sure, but it’s complicated by the fact that Medicare continues to enforce a ban on new home health agencies in the entire state.

Reminder: The Centers for Medicare & Medicaid Services first implemented a moratoria on new HHAs in select Texas counties in 2014. Then last August it took the moratorium statewide in Texas and Florida to thwart agencies trying to get around the ban by setting up shop in adjacent counties. CMS recently renewed the moratoria for another six months (see Eli’s HCW, Vol. XXVI, No. 29).

However, in the wake of Hurricane Harvey, CMS has lifted its moratoria in Texas for Part B nonemergency ambulance suppliers. “CMS has authority … to lift a moratorium at any time if the President declares an area a disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act. On August 25, 2017, the President of the United States signed the Presidential Disaster Declaration for several counties in the State of Texas,” CMS notes in a newly revised MLN Matters article on Harvey relief. “As a result of the President’s declaration CMS has carefully reviewed the potential impact of continued moratorium in Texas and is lifting the temporary enrollment moratoria on Part B nonemergency ambulance suppliers in Texas in order to aid in the disaster response. This lifting applies to Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) and became effective on September 1, 2017.”

Detail: “Providers and suppliers that were unable to enroll because of the moratorium will be designated to CMS’ high screening level … to the extent these providers and suppliers enroll in Medicare in the future,” CMS adds in the article.

But don’t get your hopes up that CMS will do the same for home health agencies, advises William Dombi, VP for Law and President of the National Association for Home Care & Hospice. Dombi doesn’t expect to see CMS lift the moratorium for HHAs.

Why? Many reasons likely contribute to HHAs’ exclusion from the moratoria lift. “During the ‘emergency’ phase, I don’t know how much care home health will be providing,” observes attorney Robert Markette Jr. with Hall Render in Indianapolis. “I suspect many patients no longer have homes.”

For patients who weren’t flooded out or who are able to return quickly, “the agencies that were there serving their patients would have executed emergency plans,” Markette reasons. “They would, to the extent they are able, continue to serve patients who did not relocate.”

Anyway, “it would be difficult to get an agency started and enrolled in time to make much of a difference in the next few months,” Markette adds. “Medicare enrollment is not a fast process.” That same fact is also true for ambulances, however, he acknowledges. That doesn’t seem to have stopped CMS from lifting its ban for that provider segment.

Bottom line: The most important factor may be the home health industry’s fraud reputation, especially in Houston. “OIG’s suspicion of home health is sufficiently strong that even this disaster will not lead them to lift the statewide moratorium,” Markette predicts. “I have not seen anything from CMS to conclude they have changed their mind that there are too many HHAs in Texas and elsewhere.”

While scrapping the Texas moratorium may be out, Harvey-affected HHAs will face significant hardships, Markette expects. “These agencies may be facing difficulties due to staff relocating, dealing with the aftermath, etc.,” he notes.

“For home health, there may not be an increased need until the recovery is farther along,” he says. “We may find that the moratorium needs to be lifted, because a significant number of agencies are not able to recover from the disaster and they need to allow new enrollments to facilitate caring for patients whose agencies did not survive the hurricane and its aftermath.”

If that dynamic occurs, it may give agencies some ammunition for successfully applying for an individual moratorium waiver.

Reminder: In the moratoria extension notice last year for the statewide expansion, CMS said it would offer exceptions through a “Provider Enrollment Moratoria Access Waiver Demonstration.” But the application form is still in the Paperwork Reduction Act process and awaits Office of Management and Budget approval, a CMS spokesperson recently told Eli (see Eli’s HCW, Vol. XXVI, No. 30). The waiver is supposed to afford “possible exceptions to the moratoria to ensure that beneficiary access to care is not adversely impacted,” CMS says on its waiver demo site. “Authorization of an exception would be based primarily on beneficiary access to care but would also depend upon passing the enhanced screening measures.”

New stats: As of last month, 18 HHAs had tried applying for such a waiver and been shot down, the CMS rep says.

Houston and the other affected areas “will recover and patients will return,” Markette says. “This may lead to a gap that requires new providers. I could see that leading to approval of individual waiver applications, if they are in the right geographic area.”

“I doubt, however, they would lift the entire statewide moratorium,” Markette cautions.

Note: Information on applying for the waiver is at www.cms.gov/Medicare/Provider-Enrollmentand-Certification/MedicareProviderSupEnroll/ProviderEnrollmentMoratorium.html.