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CMS COO Kim Brandt said a Medicare enrollment moratorium has blocked 250 home health agencies from enrolling, while a separate hospice moratorium has blocked 50 hospices. CMS says the restrictions target improper payments, but industry representatives warn a nationwide ban could constrain access, particularly in rural areas; the agency is considering possible adjustments.
Centers for Medicare & Medicaid Services (CMS) COO Kim Brandt said the agency’s Medicare enrollment moratorium has blocked 250 home health agencies from gaining approval, while a separate restriction has blocked 50 hospices. The figures, shared at a national industry meeting in Washington, show the scope of the restrictions as CMS weighs how to limit improper payments without worsening access to care.
Brandt, CMS’s deputy administrator and chief operating officer, gave the figures during a panel at the National Alliance for Care at Home’s annual meeting. She said she was surprised by the relative number of home health and hospice enrollment attempts. The report does not specify the period covered by the counts or how many applications were ultimately denied, withdrawn or remain pending.
Brandt said the moratoria have contributed to large drops in billing rates in some areas. She argued that those changes help protect Medicare funds and providers operating appropriately. “That was money that was taking away from the good providers,” she said, linking the agency’s efforts to more favorable payment rates in the current year’s rule. Those statements reflect CMS’s rationale; the report does not provide independent data measuring the moratoria’s effect on billing or the Medicare trust fund.
The restrictions have also drawn concern from care providers. Denis Fleming Jr., the Alliance’s chief government affairs officer, said a nationwide policy could leave gaps, especially in rural areas, and that home health access was already constrained. The Alliance supports CMS efforts against fraud, waste and abuse, but argues that targeted measures would be preferable to a broad enrollment ban.
Enrollment Limits and Care Access
The blocked applications illustrate a direct trade-off in CMS’s effort to protect Medicare: tighter enrollment controls may make it harder for questionable operators to enter the program, but they can also affect providers seeking to serve patients. A restriction on new enrollments does not itself establish that every blocked applicant committed fraud or engaged in improper conduct.
For beneficiaries, the practical concern is whether there are enough enrolled agencies to provide home health services where people need them. Fleming’s warning focuses on rural communities, where fewer providers may be available. The source report does not document specific closures or quantify how many patients have lost access, so the scale of any service gaps remains unestablished.
CMS says limiting improper payments can help sustain the program and pay compliant providers fairly. The figures Brandt cited offer a measure of how many applicants have been stopped, but do not show how much money has been saved or how the policy has affected patient access overall.
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CMS Weighs Changes to the Moratorium
Brandt said CMS has considered ways to narrow or modify the restrictions, including geographic limits and a “gold card” approach that could exempt established providers with strong compliance records. She said the agency is consulting its counsel office to find a balance. Brandt also cautioned that some proposals from the industry had been “a little too creative,” without identifying which proposals she meant.
CMS has also taken steps aimed at checking whether beneficiaries know they are enrolled in services. Brandt said the agency sent letters to beneficiaries in California asking whether they knew they were enrolled to receive care. She acknowledged that providers who comply with program rules can still be caught up in efforts to identify improper affiliations, and said CMS had been successful in resolving many such cases.
Brandt said CMS is required by statute to set a moratorium for six months at a time. If the agency extends either or both restrictions, she said, any extension must last six months; CMS cannot choose a shorter two- or three-month extension. That requirement limits the agency’s ability to make brief renewals while it reviews the policy.
“That was money that was taking away from the good providers.”
— Kim Brandt, CMS deputy administrator and COO
Scope and Effects Still Unclear
The figures do not establish how many blocked applicants were suspected of wrongdoing, how many were compliant providers, or how many applications remain unresolved. CMS’s public explanation, as reported, does not give a timeframe for the 250 home health and 50 hospice counts, nor does it quantify the effect on improper payments or the trust fund.
It is also unclear whether CMS will extend either moratorium, adopt geographic limits, create a compliance-based exception, or choose another approach. The report cites industry concerns about rural access but does not provide a national measure of service shortages or identify particular communities where patients have been unable to obtain care.
Six-Month Extension Decision
CMS is reviewing possible approaches with its counsel office, Brandt said. The next major decision is whether to continue either or both moratoria and whether to adjust their scope. If CMS extends a restriction, Brandt said the law requires a six-month period, rather than a shorter renewal. The report does not give a decision date or say when CMS will announce its plans.
Further details from the agency would help clarify the application counts, the basis for any extensions and how CMS intends to address access concerns while pursuing program-integrity measures.
Key Questions
How many providers have been blocked from Medicare enrollment?
CMS COO Kim Brandt said the home health moratorium has blocked 250 agencies from gaining approval. She also said a separate hospice moratorium has blocked 50 hospices.
Does being blocked mean an agency was found to have committed fraud?
No such finding is established by the reported figures. They count applicants blocked from enrollment; the report does not say that every applicant was found to have committed fraud or provide a breakdown of their cases.
Why does CMS say the moratoria are needed?
Brandt said CMS considers the restrictions necessary to protect beneficiaries, prevent improper payments and support Medicare’s financial sustainability. Those are the agency’s stated reasons; the report does not quantify the savings attributable to the moratoria.
Could the restrictions affect patient access?
The Alliance’s Denis Fleming Jr. warned that a nationwide moratorium could contribute to care gaps, particularly in rural areas, and said home health access was already constrained. The report does not quantify the number of affected patients or identify confirmed local shortages.
When could CMS extend the moratoria?
Brandt did not give a decision date. She said statute requires any extension to last six months, rather than a shorter period, and CMS is considering possible approaches with its counsel office.
Source: homehealthcarenews.com
