CMS to Ease HHA, Ambulance Enrollment Restrictions

The Centers for Medicare & Medicaid Services (CMS) will ease restrictions it imposed on the enrollment of new home health and non-emergency ambulance providers in six states.

In a notice that appeared in the Aug. 20 issue of the Federal Register, CMS announced that providers will be able to apply for a waiver to the temporary moratorium initially imposed in 2013 and extended every six months thereafter.

However, the eligibility requirements are limited to the following: The provider applying must prove that an access to care problem exists in a particular geographic area. And, the provider or supplier also must show that it had submitted an enrollment application prior to the implementation of the moratorium on July 29, 2016 or later, and that it was denied as a result of that moratorium. The waivers will be decided on a case-by-case basis.

CMS noted that if it receives more than one application for a particular geographical area, and the acceptance factor is based on access to care, the applications will be prioritized by order of receipt until the access to care concern is alleviated. The same goes for applications that were submitted prior to the moratorium. The agency noted that there is a heightened screening requirement that includes:

  • License verification
  • Background investigations including evaluation of affiliations
  • Federal debt review
  • Credit history review
  • Fingerprint-based criminal background checks (FCBC) of persons with a 5 percent or greater direct or indirect ownership interest, partners, and managing employees
  • Enhanced site visits
  • Ownership interest verification
  • Evaluation of past behavior in other public programs

CMS first imposed the moratorium on July 30, 2013 to prevent the enrollment of new HHAs in Chicago and Miami, as well as Part B ground ambulance suppliers in Houston. That moratorium was later expanded to other cities in those states, and later to entire states, impacting HHAs in Florida, Illinois, Michigan, and Texas, along with ambulance suppliers in New Jersey and Pennsylvania.

The moratorium was imposed in an effort to reduce fraud, waste and abuse. As we previously wrote about, home healthcare agencies and home healthcare aides topped the list of providers with the largest number of healthcare fraud convictions in 2014, according to a report released by the HHS Office of the Inspector General.

Citing problems with fraud and abuse, CMS also launched a pre-claim review demonstration in 2016 for HHAs in five states, but put an end to the program in April 2017 following concerns that the demonstration would impact access to care.

In addition to the Medicare program, the waiver also will apply to Medicaid and CHIP. The states will administer the Medicaid and CHIP waivers and will, independent of CMS, evaluate access to care. The states will make recommendations to CMS regarding when a provider should be enrolled based on access to care issues, and must wait for CMS concurrence prior to enrolling a provider.

CMS noted that it will continue to review the moratorium every six months as it has been and may lift it at any time.

The Health Law Offices of Anthony C. Vitale represents home health agencies in a number of different matters including fraud and abuse defense. If you have any questions relating to this, or other healthcare related, matters contact us at 305-358-4500 or send an email to info@vitalehealthlaw.com.

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