CMS Extends Freeze On New Home Health Agencies and Ambulances

On July 29, 2014, the Centers for Medicare and Medicaid Services (CMS) announced an extension on the temporary moratoria on new provider enrollment applications as well as on applications adding additional practice locations for Home Health Agencies (and related sub-units) and Part B ambulance suppliers. The temporary moratoria is for an additional six months.

The current extension represents the second time CMS is temporarily freezing enrollment for HHAs and ambulance providers.  Many of the regions impacted under the current moratoria are in cities already facing scrutiny from the government’s Medicare Fraud Strike Force (HEAT).

Moratoria on newly enrolling or expanding Home Health Agencies are in three counties in Florida (Broward County, Miami-Dade and Monroe), five counties in Michigan (Macomb, Monroe, Oakland, Washtenaw and Wayne), seven counties in Dallas, Texas (Collin, Dallas, Denton, Ellis, Kaufman, Rockwall and Tarrant), and eight counties in Houston, Texas (Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller). Similarly, six counties in Chicago, IL are also facing the temporary ban (Cook, DuPage, Kane, Lake, McHenry and Will).

Ambulance suppliers in three New Jersey counties are subjected to the temporary ban (Burlington County, Camden County and Gloucester), as well as four counties in Pennsylvania (Bucks, Delaware, Montgomery and Philadelphia) and seven counties in Houston, Texas (Harris, Brazoria, Chambers, Fort Bend, Galveston, Liberty, Montgomery and Waller).

Why The Temporary Freeze?

CMS may impose a temporary ban if CMS determines that there is a significant potential for fraud, waste or abuse with respect to a particular provider or supplier type or particular geographic area or both.  This CMS determination is based on the agency’s analysis of existing data, which, among other factors, identifies trends that appear to be associated with a high risk of fraud, waste or abuse. Such trends may include, for example, highly disproportionate number of providers or suppliers in a category relative to the number of beneficiaries or a rapid increase in enrollment applications within a category.

Other reasons for CMS to impose moratoria include State determination to impose moratoria on enrollment in a particular geographic area or on a particular provider or supplier type or both. Similarly, CMS may determine the need for a moratoria when, after consultation with the Office of Inspector General at the Department of Health and Human Services or the Department of Justice, CMS identifies a particular provider or supplier type and/or any particular geographic area as having a significant potential for fraud, waste or abuse in the Medicare program.

Impact of The Temporary Freeze

Medicare contractors are required by regulation to deny enrollment applications of providers subject to the temporary moratoria.

If you have questions about the Medicare moratoria, enrollment, revalidation and exclusion questions, or have other legal questions, please contact us here.