CMS has announced a temporary six-month moratoria on Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) enrollment of new home health providers in the Miami and Chicago metropolitan areas and ground ambulance supplier enrollments in the Houston metropolitan area. The affected counties in each of the three metropolitan areas are: Miami (Miami-Dade and Monroe); Chicago (Cook, DuPage, Kane, Lake, McHenry and Will); and Houston (Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller). A Federal Register notice announcing the moratoria published on July 31, 2013 (78 FR 46339).
The temporary moratoria, which began July 30, is being imposed to fight fraud, waste and abuse, while continuing to ensure patient access to care. Existing home health providers and ground ambulance suppliers in these affected counties can continue to deliver and bill for services under the moratoria. CMS may lift the moratoria early or extend it another six months by issuing another Federal Register notice.
PPACA Authority
Section 6401(a) of the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) added a new section 1866(j)(7) to the Social Security Act to provide the Secretary of HHS with authority to impose a temporary moratorium on the enrollment of new fee-for-service 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. Section 6401(b) of PPACA added specific moratorium language applicable to Medicaid at section 1902(kk)(4) of the Soc. Sec. Act, requiring states to comply with any moratorium imposed by the Secretary unless the state later determines that the imposition of such moratorium would adversely impact Medicaid beneficiaries’ access to care.
Basis
CMS determined, in consultation with the HHS Office of Inspector General (OIG) and the Department of Justice that fraud trends in these three geographical areas warranted a moratorium on home health providers and ground ambulance suppliers. Key factors which CMS considered included a disproportionate number of providers and suppliers relative to beneficiaries, a rapid increase in enrollment applications from providers and suppliers, and extremely high utilization. Federal law enforcement agencies have also pursued and prosecuted a large number of cases of health care fraud in each of these areas.
Senate Support
U.S. Senators Orrin Hatch (R-Utah), Chuck Grassley (R-Iowa), and Tom Coburn (R-Okla.) issued a press release welcoming the CMS action. Over the past three years, reports from HHS-OIG and letters from the senators have urged the use of the enrollment moratoria tool to help stop Medicare fraud.