Home Health Agency Provider Enrollment Moratoria Expires

The Centers for Medicare & Medicaid Services (CMS) posted the following on its web site announcing the expiration the Medicare Provider Enrollment Moratoria, which includes those states where a moratorium had been issued for new home health agencies (HHAs).

“As of January 30, 2019, there are no active Medicare Provider Enrollment Moratoria in any State or U.S. territories.

The Provider Enrollment Moratoria Waiver Demonstration will end when the moratoria expires.

Temporary Moratoria

The Social Security Act (the Act) provides the Secretary with tools and resources to combat fraud, waste, and abuse in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). In particular, section 1866(j)(7) of the Act provides the Secretary with authority to impose a temporary moratorium on the enrollment of new Medicare, Medicaid, or CHIP providers and suppliers, including categories of providers and suppliers, if the Secretary determines a moratorium is necessary to prevent or combat fraud, waste, or abuse under these programs. Regarding Medicaid, section 1902(kk)(4) of the Act requires States to comply with any moratorium imposed by the Secretary unless the State determines that the imposition of such moratorium would adversely impact Medicaid beneficiaries’ access to care. In addition, section 2107(e)(1)(F) of the Act provides that the Medicaid provisions in section 1902(kk) are also applicable to CHIP.”

CMS issued the first moratoria for HHAs for Miami-Dade County, Florida and Cook County, Illinois, as well as surrounding counties, in July 2103. 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 August 3, 2016 CMS expanded the moratoria statewide for enrollment of new HHAs in Florida, Illinois, Michigan, and Texas. CMS continued the moratoria extension every six months citing concerns regarding fraud, waste, and abuse in the selected geographic areas.

The National Association for Home Care & Hospice (NAHC) sought more information from CMS regarding the announcement and received the following response:

“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 the Children’s Health Insurance Program (CHIP).  CMS’ 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.”

Therefore the moratorium on new HHAs in states of Florida, Illinois, Michigan, and Texas has expired with no immediate plans to be reinstated.

___Home Care Association of Florida

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