In a recent federal register publication the Centers for Medicare & Medicaid Services (CMS) announced the extension of temporary moratoria already in place on the enrollment of new Medicare Part B nonemergency ground ambulance suppliers and Medicare home health agencies (HHAs), subunits, and branch locations in specific locations within designated metropolitan areas in New Jersey, as well as Florida, Illinois, Michigan, Texas, and Pennsylvania. Additionally, a statewide ban for these providers and suppliers, which now also extends to not only Medicare but also Medicaid and Children’s Health Insurance Program (CHIP), was also announced.
Three years ago in July, CMS implemented a moratoria on enrollment of new home health agencies (HHAs) in the Chicago, Illinois and Miami, Florida areas, as well as Part B ground ambulance suppliers in the Houston, Texas area. Six months later CMS expanded the geographic scope of that ban on new enrollment of HHAs and Part B ambulance providers to include metropolitan areas of Fort Lauderdale, Florida; Detroit, Michigan; Houston and Dallas, Texas; as well as Part B ground ambulance suppliers in Philadelphia, Pennsylvania and nearby New Jersey counties. Since then the moratoria has been consistently renewed every six months as required by regulations.
CMS has now not only extended the moratoria already in place in the existing areas but also expanded the ban statewide. Pursuant to this new ban, no new HHAs will be enrolled in Medicare, Medicaid, or CHIP with a practice location in Florida, Illinois, Michigan, or Texas. Similarly, no new Part B non-emergency ground ambulance supplier will be enrolled into Medicare, Medicaid, or CHIP with a practice location in New Jersey, Texas, or Pennsylvania.
The ability to establish moratoria is part of a new set of tools available to the Secretary under the Affordable Care Act (Act). The Act permits the Secretary to impose a moratorium when it determines that a ban is necessary to prevent or combat fraud, waste, or abuse in the Medicare, Medicaid, and CHIP programs. According to CMS, the agency’s determination of a high risk of fraud, waste, or abuse for the named providers and supplier types within the identified geographic locations was confirmed by, among other things, CMS’ data analysis.
In the same federal register publication CMS announced that it has lifted temporary moratoria for new enrollment of emergency ambulance services in all geographic locations applying under Medicare, Medicaid or CHIP programs. This includes Texas counties of Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller; the Pennsylvania counties of Bucks, Delaware, Montgomery, and Philadelphia; and the New Jersey counties of Burlington, Camden, and Gloucester). New emergency ambulance suppliers that furnish both emergency and non-emergency services will only be able to bill for emergency transportation services.
If you have questions related to the new CMS moratoria, provider enrollment, revalidation, revocation, exclusion or have other health law related questions, please contact our office.