Miami-Dade, Broward Counties in Florida; Harris County, Texas Affected by HHS Ruling
A Notice by the
Publication Date:
Agencies:
Entry Type: Notice
Action: Extension of temporary moratoria.
Document Citation: 80 FR 44967
Page: 44967 -44970 (4 pages)
Agency/Docket Number: CMS-6059-N3
Document Number: 2015-18327
Shorter URL: https://federalregister.gov/a/2015-18327
Action
Extension Of Temporary Moratoria.
Summary
This document announces the extension of temporary moratoria on the enrollment of new ambulance suppliers and home health agencies, subunits, and branch locations in specific locations within designated metropolitan areas in
DATES:
Effective Date:
FOR FURTHER INFORMATION CONTACT:
News media representatives must contact CMS'
SUPPLEMENTARY INFORMATION:
I. Background
A. CMS' Imposition of Temporary Enrollment Moratoria
Section 6401(a) of the Affordable Care Act added a new section 1866(j)(7) to the Social Security Act (the Act) to provide the Secretary with authority to impose a temporary moratorium on the enrollment of new
Based on this authority and our regulations at section 424.570, we initially imposed moratoria to prevent enrollment of new home health agencies, subunits, and branch locations [1] (hereafter referred to as HHAs) in
B. Determination of the Need for Moratorium
In imposing these enrollment moratoria, CMS considered both qualitative and quantitative factors suggesting a high risk of fraud, waste, or abuse. CMS relied on law enforcement's longstanding experience with ongoing and emerging fraud trends and activities through civil, criminal, and administrative investigations and prosecutions. CMS' determination of a high risk of fraud, waste, or abuse in these provider and supplier types within these geographic locations was then confirmed by CMS' data analysis, which relied on factors the agency identified as strong indicators of risk. (For a more detailed explanation of this determination process and of these authorities, see the
1. Consultation With Law Enforcement
In consultation with the HHS-Office of Inspector General (OIG) and the
2. Beneficiary Access to Care
Beneficiary access to care in
3. Lifting a Temporary Moratorium
In accordance with section 424.570(b), a temporary enrollment moratorium imposed by CMS will remain in effect for 6 months. If CMS deems it necessary, the moratorium may be extended in 6-month increments. CMS will evaluate whether to extend or lift the moratorium before any subsequent moratorium periods. If one or more of the moratoria announced in this document are extended or lifted, CMS will publish a document to that effect in the
Once a moratorium is lifted, the provider or supplier types that were unable to enroll because of the moratorium will be designated to CMS' high screening level under section 424.518(c)(3)(iii) and section 455.450(e)(2) for 6 months from the date the moratorium is lifted.
II. Extension of
As noted earlier, we previously imposed moratoria on the enrollment of new HHAs in the
As provided in section 424.570(b), CMS may deem it necessary to extend previously-imposed moratoria in 6-month increments. Under this authority, CMS is extending the temporary moratoria on the
CMS consulted with the HHS-OIG regarding the extension of the moratoria on new HHAs and ground ambulance suppliers in all of the moratoria counties, and HHS-OIG agrees that a significant potential for fraud, waste, and abuse continues to exist in these geographic areas. The circumstances warranting the imposition of the moratoria have not yet abated, and CMS has determined that the moratoria are still needed as we monitor the indicators and continue with administrative actions, such as payment suspensions and revocations of provider/supplier numbers. (For more information regarding the monitored indicators, see the
Based upon CMS' consultation with the relevant State Medicaid Agencies, CMS has concluded that extending these moratoria will not create an access to care issue for
Based upon our consultation with law enforcement and consideration of the factors and activities described previously, CMS has determined that the temporary enrollment moratoria should be extended for an additional 6 months.
III. Summary of the Moratoria Locations
CMS is executing its authority under sections 1866(j)(7), 1902(kk)(4), and 2107(e)(1)(D) of the Act to extend these moratoria in the following counties for these providers and suppliers:Show citation box
Table 1--HHA Moratoria
State ..... City/metro area ..... Counties
FL .....
FL .....
IL .....
MI .....
TX .....
TX .....
Table 2--Part B Ambulance Moratoria
State ..... City/metro area ..... Counties
PA/NJ .....
TX .....
IV. Clarification of Right to Judicial Review
Section 1866(j)(7)(B) of the Act states that there shall be no judicial review under section 1869, section 1878, or otherwise, of a temporary moratorium imposed on the enrollment of new providers of services and suppliers if the Secretary determines that the moratorium is necessary to prevent or combat fraud, waste, or abuse. Accordingly, our regulations at 42 CFR 498.5(l)(4) state that for appeals of denials based on a temporary moratorium, the scope of review will be limited to whether the temporary moratorium applies to the provider or supplier appealing the denial. The agency's basis for imposing a temporary moratorium is not subject to review. Our regulations do not limit the right to seek judicial review of a final agency decision that the temporary moratorium applies to a particular provider or supplier. In the preamble to the
V. Collection of Information Requirements
This document does not impose information collection requirements, that is, reporting, recordkeeping or third-party disclosure requirements. Consequently, there is no need for review by the
VI. Regulatory Impact Statement
CMS has examined the impact of this document as required by Executive Order 12866 on Regulatory Planning and Review (
Executive Orders 12866 and 13563 direct agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health, and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major regulatory actions with economically significant effects (
The RFA requires agencies to analyze options for regulatory relief of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of
In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if an action may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102(b) of the Act, CMS defines a small rural hospital as a hospital that is located outside of a Metropolitan Statistical Area for
Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any regulatory action whose mandates require spending in any 1 year of
Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed regulatory action (and subsequent final action) that imposes substantial direct requirement costs on state and local governments, preempts state law, or otherwise has Federalism implications. Because this document does not impose any costs on state or local governments, the requirements of Executive Order 13132 are not applicable.
In accordance with the provisions of Executive Order 12866, the
Authority:
Sections 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh) and 44
Dated:
Acting Administrator,
[FR Doc. 2015-18327 Filed 7-24-15;
BILLING CODE 4120-01-P
Footnotes
1. As noted in the preamble to the final rule implementing the moratorium authority (
[*Federal RegisterBF 2015-07-28]
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