TL;DR
Turn quiet afternoons into listening time
- Thousands of audiobooks, podcasts and originals
- Listen on your phone, tablet or Echo — also offline
- Cancel anytime
CMS deputy administrator and COO Kim Brandt said a federal moratorium has prevented 250 home health agencies from enrolling in Medicare, while a separate hospice moratorium has blocked 50 hospices. CMS says the restrictions address fraud and improper payments; industry representatives warn the nationwide policy may limit access, especially in rural areas. The duration and any changes to the moratoria remain uncertain.
Medicare enrollment moratoria have blocked 250 home health agencies and 50 hospices from enrolling in the program, Centers for Medicare & Medicaid Services deputy administrator and COO Kim Brandt said Wednesday at an industry meeting in Washington. The figures quantify the effect of restrictions CMS says are intended to prevent fraud and improper payments, while providers have raised concerns about access to care, particularly in rural areas.
Brandt shared the figures during a panel at the National Alliance for Care at Home’s annual meeting and expo. She said she was surprised by the proportion of blocked applications coming from home health agencies compared with hospices. The source report did not specify when the applications were submitted, how many were denied versus otherwise prevented from proceeding, or how CMS determined the figures.
Brandt said the moratoria have contributed to large drops in billing rates in certain areas. She argued that the restrictions helped protect Medicare funds and compliant providers. “That was money that was taking away from the good providers,” she said, adding that CMS hoped its efforts would help extend the life of the Medicare trust fund. Brandt also connected the effort to more favorable payment rates in the current year’s rule, though the report did not provide a detailed calculation linking the moratoria to those rates.
CMS has also sent letters to beneficiaries in California asking whether they knew they were enrolled to receive services, Brandt said. She described beneficiary awareness of enrolled services as a central concern for the agency. Brandt acknowledged that providers acting appropriately may still be caught up in program-integrity reviews, but said CMS had been successful in resolving cases involving people who were “untangled.”
Enrollment Limits and Care Access
The blocked applications show that the moratoria are affecting the supply of organizations seeking to participate in Medicare, not only the providers CMS may suspect of wrongdoing. For patients and families, the practical concern is whether restrictions on new enrollment could make it harder to find home health services, especially in places with fewer providers.
Rural access is a particular concern raised by the industry. Denis Fleming Jr., the Alliance’s chief government affairs officer, said a nationwide policy could create gaps in some areas. He said access to home health services was already constrained. Those are concerns voiced by the industry, not evidence in the source report that specific communities have lost services because of the moratorium.
The dispute also involves how CMS balances program integrity against provider participation. Brandt said CMS leadership believes the restrictions are needed to prevent improper payments and support fair payment to compliant providers. The Alliance supports efforts to address fraud, waste and abuse, but argues that a nationwide moratorium is broader than necessary and that targeted tools would be more appropriate.
Products Worth Considering
EVERECO Polycarbonate Greenhouse Panels, 8 ft × 4 ft × 0.24 in, 6-Pack
Husqvarna 525P4S Gas-Powered Pole Saw with 12-Inch Bar
EGO Power+ 16 Cordless Chainsaw (CS1611) with 56V 2.5Ah Battery and Charger
As an affiliate, we earn on qualifying purchases.
CMS Weighs Changes to the Moratoria
The moratoria apply to enrollment in Medicare for home health agencies and hospices. The source report does not give the original start date or describe the full legal and operational terms of each restriction. It does report that CMS has considered changes, including limiting restrictions geographically and creating a “gold card” program that could grant exceptions to existing providers with strong compliance records.
Brandt said CMS is working with its counsel office to identify a balanced approach. She also cautioned that the agency has limited flexibility on duration: “We are statutorily required to do six months,” she said. If CMS extends either moratorium, she said, an extension would have to be for six months rather than a shorter period.
Industry responses have varied. The report says some large home health providers have said the moratorium does not affect their growth plans, while other providers have warned it could restrain growth by compliant organizations and limit care access. The Alliance has proposed alternatives, though the source does not detail those proposals.
“That was money that was taking away from the good providers.”
— Kim Brandt, CMS deputy administrator and COO
Scope and Local Effects Remain Unclear
The figures Brandt cited do not establish how many of the 250 home health agencies or 50 hospices were found to have violated rules, nor whether all were rejected or remain unable to complete enrollment. The report provides no geographic breakdown, application timeline or count of providers that later gained approval.
It is also unclear whether the moratoria have caused service gaps in particular communities. Fleming warned of that possibility, especially in rural areas, but the source does not identify locations where care has been lost or quantify the effect on patients. CMS’s proposed geographic limits and compliance-based exceptions are options under consideration, not announced policy changes.
Brandt’s comments about billing rates and payment policy reflect her account of the moratoria’s effects. The report does not include underlying data or an independent analysis of how much the restrictions affected rates or the Medicare trust fund.
CMS Reviews Duration and Exceptions
CMS is working with its counsel office to evaluate possible changes, Brandt said. The options discussed include geographic limits and a “gold card” approach for established providers with strong compliance histories. The agency has not announced whether it will adopt either proposal, change the moratoria’s scope or extend the restrictions.
The next key development will be CMS’s decision on whether to maintain, modify or extend the enrollment limits. Brandt said any extension must last six months under the statutory requirement she described. Until the agency provides a decision and further details, the number of affected providers, local access effects and timing of any policy changes remain open questions.
Key Questions
How many providers have been blocked from Medicare enrollment?
CMS COO Kim Brandt said the moratoria blocked 250 home health agencies and 50 hospices from enrolling. The report does not provide a geographic breakdown or application dates.
Why does CMS say it imposed the moratoria?
Brandt said CMS considers the restrictions necessary to protect beneficiaries and Medicare from fraud and improper payments, and to support fair payment to compliant providers.
Could the moratoria affect access to home health care?
The Alliance has warned that a nationwide policy could contribute to care gaps, particularly in rural areas. The report does not confirm specific service losses or quantify the effect on patients.
What changes is CMS considering?
Brandt said CMS has considered geographic limits and a “gold card” program that could provide exceptions for existing providers with strong compliance records. No change has been announced.
How long could an extension last?
Brandt said CMS is statutorily required to use six-month periods and cannot extend a moratorium for only two or three months. The agency has not said whether it will extend either restriction.
Source: homehealthcarenews.com
