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From Health Law Daily, January 31, 2014

CMS expands moratoria on ambulances and home health agencies

By Trin Legaspi, JD, LLM

On January 31, 2014, CMS issued a new temporary moratorium on the enrollment of home health agencies for the following metropolitan areas: Fort Lauderdale, Detroit, Dallas and Houston, pursuant to powers granted to CMS under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). The new moratorium also includes the enrollment of new ground ambulance suppliers located in the Philadelphia, Pennsylvania area. CMS also decided to extend the current enrollment moratorium that affects home health agency enrollments in the Chicago and Miami areas and ground ambulance supplier enrollments in the Houston area, for six months. The moratoria affect enrollments for Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

Reasoning. CMS chose these geographic areas because they ranked extremely high for fraud risk factors such as having a disproportional number of providers and suppliers in comparison to the number of beneficiaries; and extremely high utilization rates for these services. CMS’ use of moratoria reflects its commitment to fight fraud while ensuring patients have uninterrupted access to care. CMS may end the moratoria earlier than the announced six months; however, it may also choose to extend it by another six months. CMS notes any changes will be made by a Notice or Rule published in the Federal Register. An advanced copy of the Rule implementing the new moratoria and extending the current moratoria was released on the January 31, 2014, and is expected to be officially published on February 4, 2014.

Geographic areas. The moratoria affecting new home health agency enrollments covers the following metropolitan areas and their surrounding counties: Fort Lauderdale, Florida, including Broward county; Detroit, Michigan, including Macomb, Monroe, Oakland, Washtenaw, and Wayne Counties; Dallas, Texas, including Collin, Dallas, Denton, Ellis, Kaufman, Rockwell, and Tarrant counties; and Houston, Texas, including Harris, Brazoria, Chambers, Fort Bend, Galveston, Liberty, Montgomery, and Waller counties. The six-month extension of the existing moratorium on home health agencies affects the following areas and their surrounding counties: Chicago, Illinois, consisting of Cook, DuPage, Kane, Lake, McHenry, and Will counties; and Miami, Florida, consisting of Miami-Dade and Monroe Counties. The extended ambulance moratorium applies to the Houston, Texas metro area consisting of Harris, Brazoria, Chambers, Fort Bend, Galveston, Liberty, Montgomery, and Waller counties.

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