by Hannah Wolfson
October 18, 2019

A proposed rule from the Centers for Medicaid & Medicare (CMS) would give the agency broad power to deny or revoke a home health agency’s or home medical equipment provider’s Medicare enrollment or application for enrollment if they are found to have an improper relationship.

However, even though the Program Integrity Enhancements to the Provider Enrollment Process rule is scheduled to go into effect Nov. 4, 2019, that will very likely not be the reality of the situation, said Paul Giles, the director of Home Health Finance for Dignity Health.

That’s because, even though CMS has outlined what information it will require providers to turn over, it has not yet revised the form that will be used—CMS Form 855—and which needs significant alterations. That, Giles said, will take some time.

“It could take up to two years to do this—so quite a long time,” he said at the National Association for Health Care & Hospice’s 2019 Home Care and Hospice Conference and Expo in Seattle. Giles led an educational session on the new rule, which institutes new provider disclosure requirements under the enrollment and revalidation processes for Medicare, Medicaid and the Children's Health Insurance Program.

“They also recognize that there’s a massive burden to collect this information, but they’re basically giving us notice as providers,” he said. “They are going to have a phased-in approach for collecting this information.”

That’s good news, he said, because the list of documentation required is very long and will strain agency resources to collect.

In fact, it could cost $937,000 in each of the first three years in terms of estimated burden for collecting and providing the information, or $2.8 million total cost to home health providers. And once the process is fully enacted, CMS expects total compliance, he said.

The rule centers on documenting companies’ affiliations in order to avoid fraud. It would require providers and agencies to report any affiliations—from board members to employees to some bank debts—in detail and covering the previous five years. If CMS asks for the information, providers would have 30 days to answer their request.

“Basically, it’s everything. They just need to know everything…you can see how ominous this information is that’s going to be required,” Giles said.

He said that NAHC will be very involved in advocating for adjustments to the rule and will also seek clarification on what will be considered a reasonable attempt to gather information if requested.

"CMS right here is not saying how providers need to do that, they’re just saying you the provider have the responsibility to do it,” he said “They’re basically saying ‘you figure it out.”