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CMS Extends HHA Enrollment Moratoria

CMS has extended the HHA enrollment moratoria for new agencies.(August 6, 2014):  The Centers for Medicare & Medicaid Services (CMS) has extended its year-long HHA enrollment moratoria on the enrollment of new home health agencies and ground ambulance suppliers in several major metropolitan areas. Furthermore, CMS has broadened its temporary enrollment moratoria so that it applies not only to Medicare, but also to enrollment in Medicaid and the Children’s Health Insurance Program (CHIP).

This announcement is just the latest maneuver in CMS’ ongoing efforts to prevent and combat fraud, waste, and abuse in these health care programs while safeguarding taxpayer dollars and ensuring patient access to care is not interrupted.

I.  Initial HHA Enrollment Moratoria:

On July 31, 2013, CMS imposed a moratoria[1] on the enrollment of HHAs in Miami-Dade County, Florida, and Cook County, Illinois (Chicago), as well as selected surrounding counties.  The moratoria also included the enrollment of ground ambulance suppliers and providers in the Harris County, Texas (Houston), area and its surrounding counties.  CMS indicated that its purpose for imposing this moratoria was to prevent and combat fraud, waste, and abuse in Medicare, Medicaid, and CHIP.

II.  CMS Extends Initial Moratoria, Includes Additional Counties Nationwide:

As we highlighted previously, CMS extended for six-months that initial enrollment moratoria.  Moreover, the agency also broadened that moratoria to include the enrollment of HHAs in Broward County, Florida (Ft. Lauderdale); Wayne County, Michigan (Detroit); and Dallas County, Texas, and the surrounding counties. Additionally, CMS has set forth a temporary moratorium on the enrollment of new ground ambulance suppliers and providers in the Greater Philadelphia, Pennsylvania area.

III.  CMS Extends Moratoria For An Additional Six Months:

On August 1, 2014, CMS announced that it would extend those moratoria for an additional six months. Again, this temporary moratoria affects the enrollment of new ambulance suppliers and providers and HHAs in specific geographic locations within the greater metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey.

In extending these enrollment moratoria, CMS states that it considered both qualitative and quantitative factors that suggests a high risk of fraud, waste, or abuse. The agency relied on reports and consultation with the Department of Health and Human Services’ Office of Inspector General and the Department of Justice, both of whom have longstanding experience with ongoing and emerging fraud trends and activities through civil, criminal, and administrative investigations and prosecutions.

IV.  Final Remarks:

This latest moratoria will last for only six months.  However, HHAs and ground ambulance suppliers and providers should recognize that it will likely be extended for an additional six-month period, at the least.  In fact, in our previous assessment following the first extension, we concluded that additional extensions were more than likely. Providers in these affected metropolitan areas – including those surrounding counties, which are outlined here – should take risk into consideration.

Moreover, as noted above, CMS’ temporary enrollment moratoria affects these providers who not only participate in Medicare, but also in the Medicaid and CHIP programs.

Is this latest extension as significant as the first one? Maybe not.  Many of the HHAs and ground ambulance suppliers were caught unaware by the first extension.  One of our attorneys, Jennifer Papapanagiotou, spoke with an authority at the CMS-Dallas Regional Office and that individual reported that over 100 applications in Texas alone had been affected by the first extension. Interestingly, the individual at CMS reported that the CMS-Dallas Regional office had no prior notice of the moratorium and that it is being driven largely by the HEAT task force.

Nevertheless, HHAs and ground ambulance suppliers and providers – which, as noted above, includes that who not only participate in Medicare, but also in the Medicaid and CHIP programs – may not have an excuse any longer.  Our firm has worked with a number of HHAs in the past and we understand the complexities with setting up a new practice or ensuring that your current HHA meets all of the relevant Federal and State regulations. Our firm also has significant experience ensuring that you understand the medical necessity, documentation, coverage, coding and billing requirements applicable to HHA claims.  If you need assistance with dealing with the new CMS moratoria or any HHA compliance issues, give us a call today.

Saltaformaggio, RobertRobert Saltaformaggio, Esq., serves as an Associate at Liles Parker, Attorneys & Counselors at Law.  Liles Parker attorneys represent health care providers and suppliers around the country in connection with Medicare audits by ZPICs and other CMS program integrity contractors.  The firm also represents health care providers in HIPAA Omnibus Rule risk assessments, privacy breach matters, State Medical Board inquiries and regulatory compliance reviews.  For a free consultation, call Robert at:  1 (800) 475-1906

[1] CMS has the regulatory authority to establish temporary moratoria on the enrollment of certain providers and suppliers pursuant to 42 U.S.C. § 1395cc(j)(7) and 42 CFR § 424.570.

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