By: Dave Davidson
In July 2013, CMS issued a moratorium on enrolling new home health providers in Medicare, Medicaid and the Children’s Health Insurance Program in specific counties in Florida and Illinois. The moratorium was subsequently expanded to counties in Texas and Michigan. And in August 2016, the moratorium was expanded to cover those entire states. The stated purpose of the moratorium was to allow CMS to address the “fraud, waste and abuse” it had identified in those states, and it was consistently renewed by CMS every six months for the past five years.
That renewal cycle finally ended on January 30, 2019 when CMS allowed the home health moratorium to expire. CMS explained, “Consistent with the statutory authority, the moratoria were intended to be a “temporary” tool used to combat fraud, waste and abuse in Medicare, Medicaid, and CHIP. CMS’s implementation of additional and new safeguard measures in place of the moratoria, will continue the agency’s commitment and focus on protecting beneficiaries from harm and ensuring taxpayer funding is used appropriately to protect resources from fraud, waste, abuse, and avoid other improper payments in both Medicare and Medicaid.”
CMS believes that the recent safeguards it has implemented will help it minimize the instances of abuse and improper payments. While some of those efforts, such as the Review Choice Demonstration, have yet to be fully implemented, CMS has stated that it does not intend to reinstate the moratorium in the near future.
It is too early to tell whether the end of the moratorium will have much of an impact in the Florida market. It will open the door for new providers to obtain Medicare certification, and the impact of increased competition will benefit the industry. However, with the increased level of regulatory review in place for home health agencies and a new payment structure proposed for 2020, there may still not be many agencies who decide to walk through that door.