Home Health & Hospice Week

Covering whole states inhibits fraudsters’ endruns around the ban, CMS contends.

The move to statewide moratoria on new home health agencies that the Centers for Medicare & Medicaid Services put into place last August continues. CMS’s “temporary moratoria” in Florida, Illinois, Michigan, and Texas are renewed another six months, the agency says in a July 28 Federal Register notice.

“While the National Association for Home Care & Hospice supports a moratorium in areas where Medicare fraud and abuse by HHAs is occurring, NAHC does not support CMS’ approach of applying the moratorium to the entire state,” the trade group says in its member newsletter. “CMS should restrict the moratorium to high-risk service areas rather than unfairly applying it statewide,” NAHC urges.

History: CMS first implemented the moratoria in July 2013 in Miami-Dade and Chicago (see Eli’s HCW, Vol. XXII, No. 27), two years after the moratorium authority was enacted. Then in February 2014, it added Ft. Lauderdale and counties in Texas and Michigan (see Eli’s HCW, Vol. XXIII, No. 6).

Industry observers had long thought CMS might spread the moratoria to other high-profile fraud hot spots such as Ohio and Las Vegas. But instead, last August it expanded the moratoria areas statewide in the locations where they already existed (see Eli’s HCW, Vol. XXV, No. 30).

Why? Because the former moratoria areas were “geographically defined by county,” they did not prohibit providers and suppliers from opening new locations or creating a new enrollment and moving it into a moratorium area, CMS explains on its moratoria website. “Moreover, CMS is unable to prevent existing providers and suppliers from outside of a moratoria area from servicing beneficiaries within that area. In fact, CMS has analyzed data showing that providers and suppliers who are located several hundred miles outside of a moratorium area are billing for services provided to beneficiaries located within that moratorium area. The ability of providers and suppliers to circumvent the moratoria undermines the effectiveness of the moratoria in protecting the integrity of the Medicare, Medicaid, and CHIP programs.” Thus, CMS went with a statewide ban.

On its moratoria website last updated in March, CMS notes its “Provider Enrollment Moratoria Access Waiver Demonstration,” but says the application form is still in the Paperwork Reduction Act process. Theoretically, the waiver is supposed to afford “possible exceptions to the moratoria to ensure that beneficiary access to care is not adversely impacted. Authorization of an exception would be based primarily on beneficiary access to care but would also depend upon passing the enhanced screening measures. The demonstration includes a provision that will restrict the billing of newly enrolling providers to a specific county-based geographical area, based on beneficiary need.”

No HHAs have reported using the waiver successfully to the National Association for Home Care & Hospice, NAHC’s William Dombi tells Eli.

See the moratoria waiver website at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/ProviderEnrollmentMoratorium.html.