Over the past year, the Centers for Medicare & Medicaid Services (CMS) flexed its regulatory muscle to establish temporary moratoria on the enrollment of certain providers and suppliers under its recent authority pursuant to 42 U.S.C. § 1395cc(j)(7) and 42 CFR § 424.570.
Back in its Federal Register notice on July 31, 2013 (78 FR 46339), CMS imposed moratoria on the enrollment of home health agencies in Miami-Dade County, Florida; Cook County, Illinois; and surrounding counties, as well as on the enrollment of ground ambulance suppliers in the Harris County, Texas, area and surrounding counties. Then, in a Federal Register notice published on February 4, 2014 (79 FR 6475), it imposed moratoria on the enrollment of home health agencies in Broward County, Florida; Dallas County, Texas; and Wayne County, Michigan; and surrounding counties, in addition to the enrollment of ground ambulance suppliers in Philadelphia, Pennsylvania, and surrounding counties.
CMS is now extending those moratoria in a new notice, published in the Federal Register on August 1, 2014. In the notice, CMS explains that it continues to see risk in the areas affected by the moratoria, and it has also confirmed its findings with the Office of Inspector General.
A list of counties and providers affected can be found in the Public Inspection Rule.
CMS's temporary enrollment moratoria apply not only to Medicare, but also to enrollment in Medicaid and the Children's Health Insurance Program (CHIP). The moratoria last for six months, and may be extended in subsequent six-month increments, as CMS is now doing. Moratoria are issued to prevent and combat fraud, waste and abuse of Medicare, Medicaid and CHIP resources. CMS determines whether to issue moratoria by reviewing data and trends identified by federal agencies and consulting with state Medicaid agencies.