Moratorium Issued for Miami-Dade Florida and Chicago Area by HHS
Tuesday, July 30, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy




The Centers for Medicare and Medicaid Services (CMS) July 26 issuedits first temporary moratoria for Medicare, Medicaid, and Children's Health Insurance Program (CHIP) provider and supplier enrollments, this first moratorium will focus on home health. Existing providers and suppliers will be allowed to continue providing care.

VNAA has been a staunch advocate for a home health and hospice moratorium, recognizing the fraud and abuse in Medicare was hurting vulnerable populations and safety net providers. In an April 2012 letter to Secretary Sebelius, VNAA urged the Department of Health and Human Services to implement a home health and hospice moratorium. To read the full pre-publication notice, click here.

Effective July 30, new home health agencies will be barred from enrollment for six months in the following counties:

Florida: Miami-Dade and Monroe
Illinois: Cook, DuPage, Kane, Lake, McHenry, and Will counties
 
CMS notes in the announcement that these areas are considered at high risk of fraud as determined by Medicare Fraud Strike Forces. The CMS notice will be published in the July 31 Federal Register.
 
CMS has the option to either lift the moratoria at the end of the six-month period or extend it for another six months. CMS worked closely with state governments to carefully examine the impact of access for Medicare and Medicaid patients and determined the moratoria will not affect access to care. CMS and states will continuously monitor access to care during the moratoria period to ensure continued access for beneficiaries.

Section 6401(a) of the Affordable Care Act authorizes the secretary of health and human services to impose temporary moratoria to combat fraud, waste or abuse in federal health care programs. In February 2011, a final rule was published clarifying the authority. Members of the Senate have sent three letters to Health and Human Services Secretary Kathleen Sebelius requesting information on the use of the moratorium and reasons why it had not yet been implemented.
 
In consultation with the Office of Inspector General (OIG) and the Department of Justice, CMS determined the need of a moratorium based the on fraud data analyses trends in the affected counties. Both Florida and Illinois had considerably higher concentrations of home health agencies per beneficiaries. Miami-Dade averaged 38 home health agencies per 100,000 Medicare beneficiaries. In comparison, other counties with similar Medicare populations averaged two home health agencies per 100,000 beneficiaries.  Home health agencies in Miami-Dade also received average Medicare payments of $4,000 more per home health patient in 2012, compared with similar counties. The data also found that Miami-Dade contains 16 percent of Florida Medicaid home health beneficiaries but has 45 percent of all home health providers in the state.In Illinois, data on the six counties revealed Medicaid payments in those counties averaging $3,000 in for home health users in 2010, 57 percent more than the average expenditure per home health user in the state as a whole.
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