The moratorium on Medicare home health enrollment has blocked 250 agencies that applied from gaining approval, according to Kim Brandt, the deputy administrator and chief operating officer of the Centers for Medicare & Medicaid Services (CMS).
The moratorium on hospice enrollment, meanwhile, has blocked 50 hospices from enrolling, she added, saying that she was surprised at the proportion of home health versus hospice enrollment attempts. The moratoria have led to large drops in billing rates in certain areas, Brandt said at the National Alliance for Care at Home’s (the Alliance) Annual Meeting & Expo in Washington on Wednesday.
“That was money that was taking away from the good providers,” Brandt said on a panel. “What we’ve been able to do, and what we’ll hopefully be able to show, is that thanks to the efforts we did there, we are now hopefully extending the life of the trust fund. And that’s why I think you saw the more favorable payment rates that you were able to see in this year’s rule.”
The moratorium was the only way to protect Medicare beneficiaries and keep the program from being ripped off, she said.
While some of the largest home health providers have said the moratorium has no impact on their growth plans, others have warned that the enrollment ban will curb growth for compliant providers and limit access to care, especially in rural areas.
The Alliance has supported CMS’ focus on rooting out fraud, waste and abuse, but has argued that the nationwide moratorium is overly broad and that targeted tools are better suited to fight fraud.
“I think one of the things that I hear a lot from the members is their concern about access to care,” Denis Fleming Jr., the Alliance’s chief government affairs officer, said on the panel. “With the breadth of the moratorium being nationwide, there are some areas that could develop gaps of care, particularly in rural areas.”
Access to home health services has been particularly constrained, he added.
CMS’ chief concern is ensuring beneficiaries know which services they are enrolled in, Brandt said. To that end, the agency sent letters to beneficiaries in California asking whether they knew they were enrolled to receive services, she said.
While CMS is not trying to implicate compliant providers, some will inevitably be caught up in the program integrity net, Brandt said.
“Of the people that have been, we’ve had a very high success rate of getting them untangled,” Brandt said. “Then a few people didn’t know they were affiliated with some bad people, and that’s unfortunate. But then they learn, and they figure that out, and hopefully move on.”
The home health and hospice industries have offered a slew of creative solutions to mitigate the moratoria’s negative side effects, Brandt said, some of which have been “a little too creative.”
The agency has considered approaches including geographic limitations and a “gold card” program, which would provide exceptions for existing providers with strong compliance track records.
The agency is working closely with its counsel office to identify a balanced solution, she said.
“The one thing I will say about duration: we are statutorily required to do six months,” Brandt said. “We do not have the flexibility to say we’re only going to do it for two more months or three more months. If we do extend either or both, it has to be for a six-month period of time. So I just want to level set expectations on that.”
Brandt said that CMS leadership feels that the moratoria are necessary in order to sustain the Medicare program, pay compliant providers fairly and prevent improper payments to bad actors.
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