CMS Extends Enrollment Moratoria in Fraud-ridden States
- By Renee Dustman
- In Billing
- January 29, 2018
- No Comments
Continuing the effort to prevent and combat healthcare fraud, waste, and abuse where it occurs most, the Centers for Medicare & Medicaid Services (CMS) has extended the statewide temporary moratoria on the enrollment of new Medicare Part B, Medicaid, and Children’s Health Insurance Program (CHIP) non-emergency ground ambulance providers and suppliers and home health agencies, sub-units, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey.
CMS published this action, applicable immediately, in the Jan. 29, 2018, Federal Register.
You May Be Exempt
Network providers participating in one or more Medicaid managed care organizations prior to Jan. 1, 2018, will not be considered “newly enrolling” when they are required to enroll with the state Medicaid agency, and will not be subject to the moratoria.
A temporary moratorium does not apply to providers or suppliers who are enrolled but have:
- Changes in practice location
- Changes in provider or supplier information
- Changes in ownership
- Enrollment applications already approved but not yet entered into PECOS
You Can Appeal
A provider or supplier may use the existing appeal procedures (42 CFR part 498) to administratively appeal a denial of billing privileges based on the imposition of a temporary moratorium.
“Temporary” Moratoria Has a Track Record
CMS initially imposed a moratoria in Miami-Dade County, Fla., and Cook County, Ill., and surrounding counties and Medicare part B ground ambulance suppliers in Harris County, Texas, and surrounding counties in a notice issued on July 31, 2013. Since then, CMS has extended the moratoria every six months, expanding its application to other states based on recommendations from the Office of Inspector General.
On Aug. 3, 2016, CMS lifted the temporary moratoria for all Part B emergency ambulance suppliers, only to reissue the moratoria on Jan. 9 2017, and again on July 28, 2017. On Sept. 1, 2017, CMS lifted the statewide temporary moratoria on the enrollment of new Medicare Part B, Medicaid, and CHIP non-emergency ground ambulance suppliers in Texas in response to Hurricane Harvey.
CMS is reinstating the enrollment moratoria to include Texas and will revisit the moratoria in six months.
Renee Dustman
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