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News & Updates: National Updates

CMS Issues Moratoria Waiver Demonstration

Wednesday, August 3, 2016  
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Courtesy of The National Association for Home Care and Hospice (www.nahc.org)

The Centers for Medicare & Medicaid Services (CMS) has issued a notice announcing the Provider Enrollment Moratoria Access Waiver Demonstration (PEWD) of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies (HHAs) in six states. The demonstration gives CMS the authority to grant waivers to the statewide enrollment moratoria on a case-by-case basis in response to access to care issues, and to subject providers and suppliers enrolling via such waivers to heightened screening, oversight, and investigations.

Concurrent with this announcement CMS issued a notice for a statewide expansion of the temporary moratorium on the enrollment of non-emergency ambulance suppliers and HHAs in Medicare, Medicaid, and the Children’s Health Insurance Program in six states. For HHAs, the moratorium includes the states of Florida, Texas, Illinois, and Michigan. 

Since the moratorium extends statewide, CMS has concerns regarding beneficiary access to care in areas where there is not an oversaturation of HHAs. However, CMS does not have the regulatory authority to implement an exception process for a moratorium. The PEWD will allow CMS to implement an access of care–based exception to the moratoria in limited circumstances. 

In order to qualify for a waiver, a provider must demonstrate that an access to care issue exists, and will be subject to heightened screening measures. The waiver will limit an agency’s service area to the area with access to care issues and prevent it from furnishing services in locations that are already oversaturated with HHAs.

The CMS Center for Program Integrity will review all PEWD applications. The primary determining factor for approval will be a determination regarding beneficiary access to care based on:

  • provider saturation;
  • provider to beneficiary ratios; and
  • claims data.

The PEWD went into effect July 29, 2016; however, the application form for the demonstration is subject to approval by the Office of Management and Budget under the Paper Work Reduction Act. Therefore, the form will not be available until that process is completed.

Although it is unclear whether waivers under this demonstration will be necessary, the National Association for Home Care & Hospice supports the waiver demonstration. The PEWD will be necessary if beneficiaries who reside in the moratoria states begin to have difficulty accessing home health care.



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