Last week, CMS announced that it has extended temporary moratoria on the enrollment of new ambulance suppliers and home health agencies within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey. The temporary moratoria will remain in effect for an additional six months.

The Affordable Care Act granted the Secretary of HHS authority to impose a temporary moratorium on the enrollment of new fee-for-service Medicare, Medicaid or CHIP providers and suppliers if the Secretary determines that a moratorium is necessary to prevent or combat fraud, waste, or abuse under these programs. Based on this authority, CMS has implemented three phases of the moratoria prior to this latest extension of the moratoria. First, in July 2013, CMS imposed moratoria on the enrollment of home health agencies in Miami-Dade County, Florida and Cook County, Illinois and surrounding counties and on the enrollment of ground ambulance suppliers in the Harris County, Texas area and surrounding counties. Second, in February 2014, CMS extended the initial moratoria and imposed moratoria on the enrollment of home health agencies in Broward County, Florida, Dallas County, Texas, Harris County, Texas and Wayne County, Michigan and surrounding counties and on the enrollment of ground ambulance suppliers in Philadelphia, PA and surrounding counties. Finally, in August 2014, CMS extended its previously issued moratoria. 

In extending these moratoria last week, CMS stated that it considered the “qualitative and quantitative factors suggesting a high risk of fraud, waste, or abuse” in these areas and that its “determination of a high risk of fraud, waste, or abuse in these provider and supplier types within these geographic locations was then confirmed by CMS’ data analysis, which relied on factors the agency identified as strong indicators of risk.” If CMS deems it necessary, the moratoria may be extended in additional six-month increments. CMS will evaluate whether to extend or lift the moratoria before issuing any subsequent moratoria periods. If one or more of the moratoria are extended or lifted, CMS will publish a document to that effect in the Federal Register.

A copy of CMS’s notice, which was published in today’s Federal Register, is available by clicking here.

Reporter, Ramsey Prather, Atlanta, + 1 404 572 4624, rprather@kslaw.com.