CMS has announced a number of changes to its temporary Medicare enrollment moratoria for certain provider types in select geographic areas as a mechanism to address fraud, waste, and abuse. First, CMS is extending for six months and expanding statewide its current moratoria on the enrollment of new Medicare Part B nonemergency ground ambulance suppliers in New Jersey, Pennsylvania, and Texas, and enrollment of new Medicare home health agencies (HHAs) in Florida, Illinois, Michigan, and Texas. CMS states that the statewide expansion is intended to address situations in which providers circumvent a moratorium by enrolling in counties outside a moratorium and servicing beneficiaries within the moratorium area. Second, CMS is expanding these moratoria to Medicaid and Children’s Health Insurance Program (CHIP) enrollment. Third, CMS is lifting its current temporary moratoria on Part B emergency ground ambulance suppliers. These policies are effective July 29, 2016.
Finally, CMS is implementing a demonstration project – the “Provider Enrollment Moratoria Access Waiver Demonstration” (PEWD) — to allow CMS to grant enrollment moratoria waivers on a case-by-case basis in response to demonstrated access to care issues (which CMS notes could arise due to the new statewide moratoria). To qualify for a waiver, a provider or supplier would be subject to heightened screening measures, including fingerprint-based criminal background checks, enhanced site visits, credit history review, and other measures. If the provider or supplier receives a waiver, the provider’s or supplier’s service area would be limited to the area with care access issues to “prevent it from furnishing services in locations that are already oversaturated with that provider or supplier type.”