Providers face numerous challenges on a daily basis, from unruly patients to overwhelming paperwork. For a select few providers, life just got a little harder, thanks to Medicare’s recent extension and expansion of temporary enrollment moratoria in six states.
Under the moratoria extension, new home health agencies will be blocked from Medicare enrollment in Florida, Illinois, Texas and Michigan, while new non-emergency ambulance providers will be blocked from Medicare enrollment in New Jersey, Pennsylvania and Texas. The moratoria, which were extended for six months as of July 30, were previously confined to several counties within the six states.
Medicare said the extension and statewide expansion were necessary due to ongoing fraud and abuse concerns. Fraud and abuse risks were extending beyond the counties where the moratoria were originally imposed, Medicare said, due largely to providers moving their practices outside of the affected counties but still serving patients within the counties. In some case, Medicare has uncovered providers who are treating patients who live more than 300 miles away.
In addition to the moratoria extensions and expansions, Medicare rolled out the Provider Enrollment Moratoria Access Waiver Demonstration, which allows individual providers to challenge the statewide moratoria if an access to care issue exists. Waivers will be granted on a case-by-case basis. Medicare said it’ll conduct extensive claims reviews for any providers that get a waiver.
Some providers did catch a break, however, as Medicare lifted temporary moratoria for emergency ambulance providers in several counties in New Jersey, Pennsylvania and Texas. The moratoria were lifted after Medicare uncovered some access to care issues.
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