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Provider Enrollment Moratorium

NOTICE: PLEASE SEE THE FOLLOWING REGARDING HURRICANE HARVEY

CMS has authority under 42 C.F.R. § 424.570(d) to lift a moratorium at any time if the President declares an area a disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act. On August 25, 2017, the President of the United States signed the Presidential Disaster Declaration for several counties in the State of Texas. As a result of the President’s declaration CMS has carefully reviewed the potential impact of continued moratorium in Texas and is lifting the temporary enrollment moratoria on Part B non-emergency ambulance suppliers in Texas in order to aid in the disaster response. This lifting applies to Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) and became effective on September 1, 2017. CMS will also publish a document in the Federal Register to announce that the moratoria on Part B non-emergency ambulance suppliers has been lifted. Providers and suppliers that were unable to enroll because of the moratorium will be designated to CMS' high screening level under 42 CFR § 424.518(c)(3)(iii) to the extent these providers and suppliers enroll in Medicare in the future.


Temporary Enrollment Moratoria on Home Health Agency Providers and Non-Emergency Ground Ambulance Suppliers and the Provider Enrollment Moratoria Access Waiver Demonstration


Temporary Moratoria


On July 30, 2013, CMS implemented moratoria to prevent enrollment of new home health agencies (HHAs) in the Chicago, Illinois and Miami, Florida areas, as well as Part B ground ambulance suppliers in the Houston, Texas area.  CMS exercised this authority again on January 30, 2014, to extend the existing moratoria and expand them to include HHAs in the metropolitan areas of Fort Lauderdale, Florida; Detroit, Michigan; Houston, Texas; and Dallas, Texas, as well as Part B ground ambulance suppliers in Philadelphia, Pennsylvania and nearby New Jersey counties.  The moratoria have since been extended at 6 month intervals and to date, remain in place in all of the above-mentioned locations.

Since implementation of the moratoria, CMS has been able to evaluate the moratoria and identified several operational concerns.  Because the current moratoria are geographically defined by county, they do not prohibit providers and suppliers from opening new locations or creating a new enrollment and moving it into a moratorium area.  Moreover, CMS is unable to prevent existing providers and suppliers from outside of a moratoria area from servicing beneficiaries within that area.  In fact, CMS has analyzed data showing that providers and suppliers who are located several hundred miles outside of a moratorium area are billing for services provided to beneficiaries located within that moratorium area.  The ability of providers and suppliers to circumvent the moratoria undermines the effectiveness of the moratoria in protecting the integrity of the Medicare, Medicaid, and CHIP programs.

In order to mitigate the vulnerabilities that have been observed in the current moratoria, CMS expanded the moratoria on Medicare Part B, Medicaid, and CHIP non-emergency ambulance suppliers and Medicare, Medicaid, and CHIP HHA providers to statewide as announced in a Federal Register document which posted on July 29, 2016. On January 29, 2017, CMS extended the Moratoria for an additional six months.  The moratoria was again extended for a six month period on July 29, 2017, and again on January 29, 2018. Most currently, CMS extended the Moratoria for a six month period on July 29, 2018.

Please click here for more information regarding the Temporary Moratorium from the Federal Register.


Provider Enrollment Moratoria Access Waiver Demonstration Revisions

 

CMS is implementing revisions to the “The Provider Enrollment Moratoria Access Waiver Demonstration” (PEWD), which CMS established under section 402(a)(1)(J) of the Social Security Amendments of 1967. The revision will waive the requirements of section 17004 of the Cures Act, which prevents Medicare, Medicaid, and/or CHIP payments to newly enrolling provider’s and supplier’s in a moratoria area. Approved providers and suppliers enrolled under the Demonstration will be able to receive Medicare, Medicaid, and/or CHIP payment for items and services furnished within the provider’s or supplier’s service area for the Demonstration. Authorization of an exception would be based on beneficiary access to care or the new option requiring that the provider or supplier establish that it had submitted an enrollment application prior to implementation of the state-wide moratoria on July 29, 2016 that was denied as a result of implementation of such moratoria. Providers and suppliers who meet either criteria will be subject to the heightened screening, oversight, and restrictions of the revised demonstration. The demonstration includes a provision that may restrict the billing of newly enrolling providers to a specific county-based geographical area.  Under the demonstration, and 1879(a)(2) and (b) of the Social Security Act, claims outside of the provider’s or supplier’s service area will be denied and the provider or supplier may not bill beneficiaries for services outside of the approved service area.  This will limit financial liability of Medicare beneficiaries and protect them from costs associated with claims submitted by providers and suppliers who are not eligible to provide services in that geographic location.  

The Provider Enrollment Moratoria Access Waiver Application, named the “Waiver Application for Providers and Suppliers Subject to an Enrollment Moratorium”, currently in the Paperwork Reduction Act process, has been created to collect that data, which will be completed by providers and suppliers to apply for a waiver in Moratoria locations along with the completed CMS-855 enrollment form to providerenrollmentmoratoria@cms.hhs.gov

Please click here to access the Moratoria Waiver Application, Form CMS-10629.

CMS Provider Enrollment Waiver Demonstration Fact Sheet

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