Home Health & Hospice Week

If you thought the Centers for Medicare & Medicaid Services might ease up on moratoria areas for home health agency enrollment, the opposite is actually happening.

Background: CMS implemented the HHA moratoria in July 2013 in the Miami and Chicago areas. Then in February 2014, CMS added Ft. Lauderdale, Detroit, Dallas, and Houston and has extended the moratoria every six months since then.

Now CMS is expanding the moratoria to be state-wide in the four affected states — Florida, Illinois, Michigan and Texas. “CMS is also increasing its oversight efforts through the use of heightened screening and investigative tools for new providers in the moratoria areas,” CMS deputy administrator for program integrity Shantanu Agrawal says in a release.

Exception: But with the wider moratoria area comes a chance for agencies to bypass the restriction. CMS will implement the Provider Enrollment Moratoria Access Waiver Demonstration (PEWD), “which gives CMS the ability to allow for provider and 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,” according to the release.

The National Association for Home Care & Hospice “has long supported CMS using their authority to impose a moratorium on new HHAs in areas where there is evidence of fraud and abuse,” the trade group says. But it calls for CMS to follow through on its proposal to exempt agencies that are already in the enrollment process.

The changes took effect July 29, CMS notes. However, the paperwork for the PEWD program is not yet approved by the Office for Management and Budget, NAHC notes.