The Centers for Medicare and Medicaid Services (CMS) has imposed a moratorium on the Medicare and Medicaid enrollment of new home health agencies (HHAs) and new HHA branch locations in a five-county area in Southeast Michigan. CMS determined the moratorium was necessary to combat fraud, waste or abuse under Medicare and Medicaid. The moratorium will be in effect for at least six months beginning January 30, 2014. Metropolitan Detroit is one of seven geographic areas subject to a HHA enrollment freeze. In addition, ground ambulance enrollments in two areas have been halted. Key facts regarding the Michigan HHA moratorium:
- The moratorium was imposed because of patterns of fraudulent HHA activity and prosecutions in Wayne County, but also covers Macomb, Monroe, Oakland, and Washtenaw Counties.
- As a justification for the moratorium, CMS also cited evidence that the ratio of HHAs to Medicare beneficiaries was 19 percent greater in Wayne County than in other comparable areas, and Medicaid HHA expenditures per patient were 24 percent higher in Wayne County than in other areas of the State.
- All pending enrollment applications from HHAs located in the affected Counties will be denied unless the application was recorded as “approved” in the PECOS system on 12:00 a.m. on January 30, 2014. When the moratorium is lifted, the denied applicants must begin the entire application process anew if they want to seek Medicare/Medicaid participation.
- The moratorium does not apply to changes in existing practice locations, changes to provider or supplier information (such as phone number or address), or changes in ownership of a HHA.
- The moratorium does not prevent an existing HHA that is located in an affected County from enrolling a new branch location that is outside the affected Counties.
- CMS may end the moratorium early (although there is no indication this is likely) or renew the freeze for an additional 6-month period(s).
- An applicant may not circumvent the moratorium by using accreditation from a CMS-approved accrediting organization to establish Medicare participation via “deemed status.”
- Once the moratorium is lifted, the Medicare program will not expedite the process of HHA enrollment applications.