On July 31st, CMS posted a Notice in the Federal Register outlining a
Temporary Moratorium on Enrollment of Ambulance Suppliers in the Houston, TX
area. A CMS Fact Sheet (dated July 26th) also
helped explain the details of how the moratorium specifically impacts the
ambulance industry. This is the first temporary enrollment moratorium
under Section 6401 of the Affordable Care Act, which grants CMS the authority
to impose a moratorium to help fight fraud in Medicare, Medicaid and the
Children's Health Insurance Program ("CHIP").
As of July 30, 2013, no new
ambulance suppliers will be enrolled into Medicare Part B (and no new ambulance
providers will be enrolled in Medicaid or CHIP) with a practice location in the Texas Counties of Harris (which includes Houston),
Brazoria, Chambers, Fort Bend, Galveston, Liberty, Montgomery, or Waller unless the enrollment application has already been approved, but not
yet entered into PECOS or the State Enrollment System.
The ambulance moratorium does
NOT apply
to:
- Air ambulance service
suppliers and providers attempting to enroll in Medicare, Medicaid and
CHIP.
- Provider-based Medicare
ambulances, which are owned and/or operated by a Medicare provider (or
furnished under arrangement with a provider) such as a hospital, critical access
hospital, skilled nursing facility, comprehensive outpatient
rehabilitation facility, home health agency, or hospice program, and are
not required to enroll separately as a supplier in Medicare Part B.
- Changes made
by existing suppliers through a CMS 855 form submission such as change
in practice location, demographic information or ownership (except where
such an ownership change requires a new initial enrollment).
The
moratorium lasts for 6 months; and, if deemed necessary by CMS, may be
extended in 6-month increments. CMS must publish another Notice in the Federal
Register when it extends a moratorium. CMS decided that this
temporary moratorium would not affect patient care, and CMS pledges to monitor
access to care among Medicare, Medicaid and CHIP patients.
Because of the high rate of
Medicare fraud in the Houston area, as documented through prior enforcement
actions in the area (i.e. 6 cases since April 2012 totaling $9.5 million in
alleged health care fraud in the Houston area alone), CMS believes this
moratorium is needed to help combat further fraud, abuse and waste.