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CMS Announces Moratorium on Enrollment of Home Health Agencies

By Peter J. Domas / Aug 01, 2013
For the first time since being given the authority by the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) instituted an immediate six month moratorium on the enrollment of home health agencies in the communities surrounding Cook County, Illinois and Miami-Dade County, Florida.  While the ban on enrolling home health agencies does not affect existing providers and suppliers, new providers and suppliers will not be allowed to bill CMS for services rendered in these areas until the moratorium is lifted.

In the Federal Register notice publishing the moratorium, CMS cited the high risk in these communities for fraud, waste, and abuse as evidenced by: 1) a disproportionate number of providers to beneficiaries (at times 1,960% greater than the national average); 2) a rapid increase in the number of enrollment applications (Cook County had a 280% greater number of applications than the national average); and 3) extremely high utilization (17% higher utilization than other comparable counties).

While this temporary moratorium is scheduled to last only six months, CMS also announced that it may extend the ban on enrolling new home health agencies for an additional undetermined period of time.

The enactment of an enrollment moratorium has implications beyond home health agencies in the Chicago and Miami-Dade Communities.  CMS stated "it is important to note that all of the moratoria target areas identified in this notice - Miami, Houston, and Chicago - are all Strike Force cities, and each of these areas has experienced intense, sustained criminal prosecution activity with respect to provider and supplier types subject to these moratoria."  Furthermore, as part of the same notice, CMS also announced a moratorium on the enrollment of ambulance suppliers in the communities surrounding Houston, Texas. Since the Department of Health and Human Services and the Department of Justice 's Strike Force is also targeting the cities of Baton Rouge, Brooklyn, Dallas, Detroit, Los Angeles, and Tampa Bay, it is likely that additional moratoria may be on the horizon for other types of providers in these c ities .

The Federal Register Notice can be found at:

https://www.federalregister.gov/articles/2013/07/31/2013-18394/medicare-medicaid-and-childrens-health-insurance-programs-announcement-of-temporary-moratoria-on

If you have questions regarding this or any other provider enrollment matter, please contact the Clark Hill Healthcare Practice Group at 248-988-8542.