Are Temporary Medicare Moratoriums Hurting Providers?


 

When your kids are misbehaving, you put them in a timeout, which is essentially what Medicare has done with certain provider groups through its temporary enrollment moratoriums. However, the temporary moratoriums, designed to prevent fraud, abuse, and overuse, may actually be hurting some innocent providers.

Brian Werfel, a Medicare consultant with the American Ambulance Association, told me that the AAA supported the original moratoriums, which were limited to select counties, but said a state-level expansion raised the burden on providers.

The initial temporary moratoriums were imposed in July 2013 and targeted newly enrolling home health agencies ambulance providers in certain counties. The moratoriums were expanded to the state level in July 2016, and there are moratoriums in place on newly enrolling ambulance providers in New Jersey, Pennsylvania, and Texas, and newly enrolling home health agencies in Florida, Illinois, Michigan, and Texas.

Expanding the scope of the moratoriums from county to state level swept up many providers that were in the midst of enrolling in Medicare, Werfel said. The enrollment process can take up to five months, so providers that wanted to enroll near the original targeted areas were suddenly blocked from enrolling, he said.

The Affordable Care Act gave the Centers for Medicare & Medicaid Services the authority to impose a temporary moratorium on the enrollment of new Medicare, Medicaid, or Children’s Health Insurance Program providers and suppliers if the CMS determined that it was necessary to prevent or fight fraud, waste, or abuse.

Werfel said the CMS should make more use of waivers, which can allow individual providers to enroll in Medicare despite the existence of the moratorium. He also said the CMS should grandfather in all pending Medicare enrollment applications that were blocked when the moratoriums were expanded to the state level.

Read my full article here.

Stay on top of new developments in health law and regulation with a free trial to the Health Law Resource Center.

Learn more about Bloomberg Law and sign up for a free trial.