CMS extends provider moratoria, but adds waiver process

The federal government announced an extension of its three-year moratoria on home health providers and non-emergency ground ambulance suppliers in six states, along with a new waiver process to combat concerns about access to care.

The ban on new home health providers will continue in Florida, Texas, Illinois and Michigan and non-emergency ground ambulance suppliers in New Jersey, Pennsylvania and Texas. However, the agency has agreed to lift the current moratoria on emergency ambulance suppliers.

Expanded variations of the moratoria have been in place since July 2013, when the Centers for Medicare & Medicaid Services barred new home health and ambulance providers from enrolling in Medicare, Medicaid and the Children’s Health Insurance Program in Miami, Chicago and Houston--three areas identified as fraud “hot spots" at that time. The program surfaced following years of pressure from lawmakers who were concerned about fraud.

Along with the moratoria extension, CMS will roll out a Provider Enrollment Moratoria Access Waiver Demonstration, allowing the federal agency to grant exceptions in specific areas where patient access to those services is a concern.

Federal officials have identified home health and ambulance services as targets for fraud, and in some cases, supplemented the moratoria with preauthorization requirements, which have raised ongoing concerns about access to care. Beginning in August, CMS will also conduct “pre-claim reviews” for home health providers in Illinois.

- read the CMS announcement