Moratoria on Home Health, Ambulance Enrollment Extended Six Months

Nine moratoria on enrollment of new suppliers of home health and ambulance services in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) will be extended for an additional six months, CMS has announced. The Notice of the extension will appear in the Federal Register on Friday, August 1, 2014. Specifically, the moratoria on enrollment of new home health agencies will continue in: (1) Chicago, Illinois; (2) Miami, Florida; (3) Dallas, Texas; (4) Houston, Texas; (5) Detroit, Michigan; (6) Philadelphia, Pennsylvania, including suburban New Jersey; and (7) Fort Lauderdale, Florida. No new suppliers of ambulance services will be enrolled in the metropolitan areas of Philadelphia and Houston.

Legal Basis

Section 6401 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) gave CMS the authority to impose temporary moratoria on the enrollment of new providers or suppliers when it determines that there is a high risk of fraud, waste, or abuse. The moratoria are targeted to specific types of suppliers or providers and specific geographic areas where the incidence of fraud or abuse is especially high. CMS implemented the statute by adopting 42 CFR sec. 424.570.

The first moratoria were imposed on July 31, 2013; they applied to enrollment of home health agencies in the Miami and Chicago metropolitan areas and to enrollment of ambulance services in the Houston, Texas area. These moratoria were extended, and the remaining moratoria were added, by publication in the Federal Register on February 4, 2014. In order to impose or extend a moratorium, CMS must determine that, in addition to the high risk of fraud, waste, or abuse, beneficiaries’ access to care will not be impaired. CMS made the determinations in consultation with state and local Medicaid agencies and law enforcement.