CMS Official Says Medicare Enrollment Freeze Has Kept 250 Home Health Agencies Out

A Medicare enrollment moratorium for home health agencies has prevented 250 applicants from being approved, according to Kim Brandt, deputy administrator and chief operating officer of the Centers for Medicare & Medicaid Services (CMS).

The parallel hospice enrollment moratorium has stopped 50 hospices from enrolling, she said, adding that she was struck by how many more home health organizations than hospices had tried to enter the program. Brandt made the remarks at the National Alliance for Care at Home’s annual meeting and expo in Washington.

She said the restrictions have contributed to major drops in billing rates in some regions.

“That was money that was taking away from the good providers,” Brandt said during a panel discussion. “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.”

Brandt said the moratorium was the only way to protect Medicare beneficiaries and prevent the program from being exploited.

While some large home health companies say the ban does not affect their growth plans, others argue it will slow expansion for compliant providers and reduce access to care, particularly in rural communities.

The Alliance has backed CMS efforts to combat fraud, waste and abuse, but has argued that a nationwide moratorium is too broad and that more focused enforcement tools would work better.

“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.”

He added that access to home health services has been especially limited.

Brandt said CMS is most concerned with making sure beneficiaries understand which services they are actually enrolled in. To address that issue, the agency sent letters to beneficiaries in California asking whether they knew they were enrolled to receive services.

She said CMS is not trying to target compliant providers, though some will inevitably be caught in the broader program-integrity effort.

“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.”

Brandt said the home health and hospice sectors have предложed many creative ideas to reduce the moratoria’s downsides, though some proposals have been “a little too creative.”

CMS has looked at options such as geographic limits and a “gold card” program that would give exceptions to existing providers with strong compliance histories.

The agency is working with its counsel office to find a balanced approach, 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 CMS leadership believes the moratoria are needed to help sustain Medicare, pay compliant providers fairly and block improper payments to bad actors.