Home Health & Hospice Week

Existing agencies may get a boost from the prolonged restriction.

The so-called “temporary” moratoria on new home health agency enrollees in six metro areas are looking anything but short-term as CMS renews the restrictions.

Background: Back in July 2013, the Cen-ters for Medicare & Medicaid Services placed a moratorium on new HHAs enrolling in Medicare in the Miami and Chicago areas (see Eli’s HCW, Vol. XXII, No. 27). Then in February of this year, CMS added Ft. Lauderdale, Detroit, Dallas, and Houston to the list and extended the moratoria in the original two cities (see Eli’s HCW, Vol. XXIII, No. 6).

Now, CMS had renewed the moratoria in all six locations, CMS says in a notice scheduled for publication in the Aug. 1 Federal Register. Under regulations, the moratoria may last only six months, so CMS has to renew them as they expire.

“Both [the HHS Office of Inspector Gene-ral and the Department of Justice] agree that a significant potential for fraud, waste, and abuse continues to exist in these geographic areas,” CMS says in the notice. “The circumstances warranting the imposition of the moratoria have not yet abated, and CMS has determined that the moratoria are still needed as we monitor the indicators and continue with administrative actions such as payment suspensions and revocations of provider/supplier numbers.”

“I am not surprised they have been extended,” says Chicago-based regulatory consultant Re-becca Friedman Zuber.

“It is too easy for them to maintain,” comments attorney Troy Brooks with Brooks Acevedo in Houston, Texas. “While providers are negatively impacted by the moratoria, it does not create an additional workload for CMS or its contractors to enforce it,” Brooks tells Eli.

The OIG continues to churn out releases about indicting and arresting home health-related suspects in the HEAT Medicare Fraud Strike Forces in these cities, points out attorney Robert Markette Jr. with Hall Render in Indianapolis. Until that stops, you can expect to see the moratoria continued when it comes time for them to expire.

Consider the moratoria “more or less permanent,” agrees Washington, D.C.-based attorney Eliz-abeth Hogue. The sheer volume of agencies operating in the moratorium locations all but guarantee extensions for the foreseeable future, she believes.

“I don’t expect the moratorium in Illinois to be lifted for many years,” Zuber predicts. “There truly is an oversupply of providers here.”

Impact Felt By Existing Agencies

On one hand, current agencies and their reps favor the moratoria. The National Association for Home Care & Hospice “has supported the use of targeted moratoria and supports the extension announced by CMS,” NAHC says in a message to members.

Practically speaking, the moratoria makes existing agencies more valuable and reduces incoming competition, Markette observes.

However, the restriction can have unintended consequences, Zuber cautions. “If they kill off the compliant providers with the budget cuts and excessive regulation, the less scrupulous providers may survive in their place,” Zuber worries. 

Note: The notice is at https://federalregister.gov/a/2014-18174 .