CMS Final Rule on Moratoria for the Enrollment of New Home Health Agencies and Ambulance Suppliers and Providers

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On February 4, 2014, the Centers for Medicare and Medicaid Services (CMS) issued in the Federal Register a notice of temporary moratoria on enrollment of new home health agencies (HHA) and ambulance suppliers and providers in certain geographic locations across the U.S. The moratoria were effective on January 30, 2014. CMS also extended existing moratoria noticed on July 31, 2013.

All moratoria apply not only to Medicare, but also to enrollment in Medicaid and the Children’s Health Insurance Program (CHIP). The Affordable Care Act authorizes CMS to impose these moratoria. The moratoria last for six-months, but may be extended in subsequent six-month increments following notice in the Federal Register. Judicial review is unavailable to applicants without an already-approved enrollment application.

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 and State Departments of Emergency Medical Services. The counties subject to moratoria are those that have been identified as high risk for fraud, or that surround such an area.

New moratoria were issued for these counties:

County (City)

-Surrounding Counties

Type of Moratorium

Data

(1. Medicare ’12 / 2. Medicaid ‘11)

Broward (Ft. Lauderdale)

HHA

1.  Ratio of HHAs to Medicare FFS Beneficiaries was 92 percent higher than Comparison Counties.

2.  HHAs were paid 95 percent more per year  compared to the rest of the state.

Wayne (Detroit)-Macomb

-Monroe

-Oakland

-Washtenaw

HHA

1.  Compounded annual growth was almost double the   national average.

2.  Spent 35 percent more per home health user   compared to the rest of the state.

Dallas   (Dallas)-Collin

-Denton

-Ellis

-Kaufman

-Rockwall

-Tarrant

HHA

1.  Ratio of HHAs to Medicare FFS   Beneficiaries was 365 percent higher than Comparison Counties.

2.  Spent 35 percent more per home health user   compared to the rest of the state.

Harris   (Houston)-Brazoria

-Chambers

-Fort Bend

-Galveston

-Liberty

-Montgomery

-Waller

HHA

1.  Ratio of HHAs to Medicare FFS   Beneficiaries was 276 percent higher than Comparison Counties.

2.  Spent 83 percent more per home health user compared   to the rest of the state.

Philadelphia   (Philadelphia)-Bucks

-Delaware

-Montgomery

-Burlington   (NJ)

-Camden (NJ)

-Gloucester   (NJ)

Ambulance

1.  Ratio of Ambulance Suppliers to Medicare FFS Beneficiaries was 232 percent higher than Comparison Counties.

2.  Ambulances paid 130 percent more per year   compared to the rest of the state.

Moratoria were extended for these counties:

Counties—State

 

Type of Moratorium

Miami-Dade & Monroe—FL

HHA

Cook, DuPage, Kane, Lake, McHenry & Will—IL

HHA

Harris, Brazoria, Chambers, Fort Bend, Galveston, Liberty, Montgomery & Waller—TX

Ambulance

The Final Rule is available at: http://www.gpo.gov/fdsys/pkg/FR-2014-02-04/pdf/2014-02166.pdf.