February 5, 2019—The Centers for Medicare & Medicaid Services (CMS) announced the expiration of the Medicare Provider Enrollment Moratoria on Jan. 30, 2019. The announcement includes states where a moratorium had been issued for new home health agencies (HHAs).
The goal of the moratorium was to combat fraud, waste and abuse in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). The Social Security Act gives CMS the authority to impose temporary moratorium on the enrollment of new providers and suppliers in order to combat fraud, waste and abuse in health care areas of concern. CMS issued the first moratoria for HHAs for Miami-Dade Counties, Florida and Cook, County, Illinois as well as surrounding counties in July 2013. Extensions and expansions to additional counties in Illinois, Florida and counties in Michigan and Texas have been issued every six months since that time. On Aug. 3, 2016, CMS expanded the moratoria statewide for enrollment of new HHAs in these states.
On lifting the moratorium, CMS explained, “Consistent with the statutory authority, the moratoria were intended to be a “temporary” tool used to combat fraud, waste and abuse in Medicare, Medicaid, and CHIP. CMS’s implementation of additional and new safeguard measures in place of the moratoria, will continue the agency’s commitment and focus on protecting beneficiaries from harm and ensuring taxpayer funding is used appropriately to protect resources from fraud, waste, abuse, and avoid other improper payments in both Medicare and Medicaid.”
NAHC’s president, William A. Dombi offered this analysis in a statement provided to HomeCare magazine, “CMS has not indicated whether it has any plans to reinstate the moratoria in the future. However, CMS did reference NAHC to the pending proposed rule that modifies standards for moratoria when asked about risks of starting a new HHA and getting short of the point where Medicare certification is permitted when any new moratoria is imposed. 81 Fed. Reg. 10720 (March 21, 2016). In the past, many parties invested in creating an HHA only to be stopped from Medicare participation because CMS imposed a provider moratorium before the party fully completed the certification process.
NAHC’s assessment is that the near-term risk of a new moratorium is remote at most. That would mean the door is open for new HHAs in the previously targeted states or any new states. However, it would be prudent to move soon to submit an application and to stay attentive to advancing the certification process.”