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CMS Exercises New Authority Under ACA

Aug 02, 2013

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.