CMS Imposes First New Enrollment Moratoria Under Affordable Care Act

For the first time, the Centers for Medicare & Medicaid Services (CMS) is exercising its authority under the Affordable Care Act to impose temporary moratoria on new enrollments in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Affected by the moratoria are home health agencies and ambulance providers and suppliers located in several Miami, Chicago, and Houston counties.

Specifically, these moratoria apply to new enrollments for home health agencies located in:

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Miami, Fla. – Miami-Dade and Monroe counties
Chicago, Ill. – Cook, Dupage, Kane, Lake, McHenry, and Will counties

And new enrollments for ground ambulance suppliers and providers located in:

Houston, Texas – Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller counties

These metropolitan areas are known to be “hot spots” for fraud based on the ratio of applicable entities to Medicare fee-for-service beneficiaries compared to other counties with similar beneficiary populations. For example, in 2012, the ratio of ambulance suppliers to Medicare beneficiaries in the Houston, Texas counties was 1,065 percent (yes, one thousand and sixty-five percent) higher than in comparable counties.

According to a notice CMS published in the July 31 Federal Register, the moratoria began July 30 and will be in effect for six months. CMS has the authority, however, to shorten or extend a moratorium as it sees fit.

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