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CMS COO Kim Brandt said a federal Medicare enrollment moratorium has blocked 250 home health agencies from enrolling, alongside 50 hospices. CMS says the restrictions target fraud and improper payments, while industry representatives warn a nationwide ban could constrain access, particularly in rural communities. The agency is considering possible adjustments, but Brandt said any extension must be for six months.
Medicare enrollment moratoria have blocked 250 home health agencies and 50 hospices from enrolling, Centers for Medicare & Medicaid Services (CMS) Chief Operating Officer Kim Brandt said at an industry meeting in Washington on Wednesday. The figures offer a measure of the restrictions’ reach as CMS defends them as a way to limit fraud and improper payments, while providers warn that a nationwide enrollment ban could affect access to care.
Brandt, who is also CMS deputy administrator, said the moratoria had led to large drops in billing rates in certain areas. She said the restrictions were intended to protect beneficiaries and Medicare, and to prevent improper payments from diverting money from providers she described as legitimate. Brandt connected the agency’s efforts to more favorable payment rates in the current year’s rule, though the report did not provide figures measuring the moratoria’s effect on rates or the Medicare trust fund.
At the National Alliance for Care at Home’s annual meeting and expo, Brandt said CMS was not seeking to implicate compliant providers, but acknowledged that some could be caught in program-integrity investigations. She said the agency had sent letters to beneficiaries in California asking whether they knew they were enrolled to receive services. Brandt also said CMS had been able to resolve many cases involving people caught up in the process, while some beneficiaries did not know they were affiliated with people suspected of wrongdoing.
The agency is examining possible ways to reduce the restrictions’ effects, Brandt said, including geographic limits and a “gold card” approach that could make exceptions for established providers with strong compliance records. She said CMS was working with its counsel office on a balanced approach. No decision or timeline for a change was reported.
Enrollment Limits and Care Access
The figures show that the moratoria have affected a substantial number of prospective providers, but they do not establish how many would have served communities with unmet needs or how many applications were blocked in areas with adequate coverage. The restrictions have two competing consequences: they can impede enrollment by entities CMS considers a program-integrity risk, and they can also prevent legitimate agencies from entering or expanding in a market.
That tension matters to people who rely on home health or hospice services, as well as to providers planning to serve them. Denis Fleming Jr., the Alliance’s chief government affairs officer, warned that a nationwide restriction could create gaps, particularly in rural areas. He said access to home health services was already especially constrained. The source report provides no community-level data confirming that the moratorium has caused specific closures or service losses.
For providers, the possibility of a “gold card” or geographic exceptions could affect how CMS balances screening with enrollment. Until the agency announces a policy decision, providers and patients do not know whether the current restrictions will change, or how any exceptions would work.
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CMS Weighs Fraud Controls
The moratoria were introduced as a tool to restrict new Medicare enrollment in home health and hospice while CMS addresses concerns about fraud, waste and abuse. Brandt described them as necessary to protect beneficiaries and the program. The Alliance has said it supports CMS’s efforts against improper conduct, but argues that a nationwide ban is too broad and that targeted measures would better address risks without blocking compliant providers.
The debate is not limited to the number of blocked applications. Some large home health providers have said the moratorium has not affected their growth plans, while other industry participants have warned it could curb growth by compliant agencies and restrict access, especially in rural areas. Those positions reflect different experiences across the sector; the report does not provide an independent analysis of the restrictions’ effects on enrollment, care availability or spending.
“That was money that was taking away from the good providers.”
— Kim Brandt, CMS deputy administrator and chief operating officer
Scope and Duration Still Open
The reported totals do not show when the 250 home health and 50 hospice applications were blocked, how many applicants remain under review, or how many were ultimately denied rather than delayed. The report also does not specify the moratoria’s start date, their current expiration dates, or whether CMS has decided to extend either restriction.
CMS has considered geographic limits and a compliance-based “gold card,” but Brandt did not say that either option had been approved. The potential effect on service access, including in rural areas, remains disputed: industry representatives have warned of gaps, but the report does not quantify resulting shortages or identify particular communities affected.
CMS Must Set Its Next Steps
CMS is working with its counsel office to assess possible adjustments, according to Brandt. The next key development will be whether the agency keeps the moratoria as they are, extends them, or adopts exceptions such as geographic limits or a compliance-based program. Brandt said that if CMS extends either restriction, the extension must be for a six-month period under the statutory requirement she described.
The agency has not announced a decision or a date for one. Providers, beneficiaries and lawmakers will be watching for details on the restrictions’ duration, eligibility rules and any steps intended to prevent access gaps while CMS pursues program-integrity goals.
Key Questions
How many home health agencies were blocked from Medicare enrollment?
CMS COO Kim Brandt said 250 home health agencies that applied were blocked from gaining approval under the moratorium.
How many hospices were affected?
Brandt said the hospice enrollment moratorium had blocked 50 hospices from enrolling. The report does not provide further details about those applications.
Why does CMS say it imposed the moratoria?
Brandt said the restrictions are intended to protect Medicare beneficiaries, curb fraud and improper payments, and protect funds for providers CMS considers compliant.
Could the restrictions affect access to home health care?
The Alliance’s Denis Fleming Jr. warned that a nationwide ban could contribute to care gaps, particularly in rural areas. The report does not quantify any access losses or confirm specific communities have experienced shortages.
When will CMS decide whether to extend the moratoria?
Brandt did not give a decision date. She said any extension of either moratorium must be for six months; CMS is considering possible approaches with its counsel office.
Source: homehealthcarenews.com
