LeadingAge has urged the U.S. Centers for Medicare & Medicaid Services (CMS) to end the temporary hospice and home health moratoria in advance of the November expiration date.
The association of nonprofit aging service providers recently submitted the request in a letter to CMS Administrator Dr. Mehmet Oz. The six-month national moratoria on new home health and hospice Medicare enrollment took effect on May 13.
Many providers support the agency’s efforts to curb new fraudulent operators entering the space, according to Mollie Gurian, vice president of policy and government affairs at LeadingAge. However, the moratoria have challenged access and sustainability, particularly in underserved areas, Gurian said.
“It is important for providers to understand that even if the moratoria ends, CMS’ focus on hospice and home health as an area of concern will remain,” Gurian told Hospice News in an email. “In terms of access and sustainability related directly to the moratoria, [that’s] we are hearing from members that had planned to open in underserved areas, or who wanted to open a new office in order to better serve areas in which they already provide care.”
The national moratoria prohibits applications for initial Medicare enrollment, and it applies to certain changes in majority ownership for hospices and home health agencies. CMS unveiled the regulatory initiative with a federal anti-fraud task force established in March. Led by Vice President J.D. Vance, the task force is a collaboration among about 10 federal agencies.
The hospice community has voiced concerns about the adverse effects on patient access and quality of care. Some industry organizations have indicated that the national pause on hospice and home health enrollment takes a sledgehammer approach to combating fraud.
Much of the current fraudulent activity has occurred in Arizona, California, Georgia, Nevada, Ohio and Texas. Hospice providers in these states are currently under provisional periods of enhanced oversight. Swarms of new operators have entered these states and have received federal funding through illegitimate business practices. Some fraud schemes involved “license flipping” practices, which owners sold their licenses soon after obtaining them, or before regulators could act on alleged malfeasance.
LeadingAge, along with other industry organizations, has pushed for more targeted approaches to regulatory oversight. The moratoria have limited access to care during a time of rising demand, according to LeadingAge President and CEO Katie Sloan.
“The blunt nature of this national moratorium, which does not allow exceptions to enrollments in areas with clear needs, necessitates our voice now,” Sloan said in the letter to Oz. “We have heard from numerous of our provider members who had made substantial investments to develop hospice or home health services for their communities but were delayed in their efforts due to the moratorium. It is becoming increasingly clear that legitimate providers are being caught in the crossfire of this war against fraud.”
A lack of targeted oversight strains legitimate providers’ resources, Gurian said. Hospice and home health organizations are diverting more operational and clinical resources toward addressing audits and other regulatory requests, rather than allocating them toward care delivery or innovation, she stated.
The National Alliance for Care at Home recently raised similar concerns. The Alliance is one of the largest industry organizations of hospice and home health care providers. The organization’s CEO Jennifer Sheets penned a letter on Wednesday to CMS commenting on the moratoria. Among the concerns presented is that the policy adversely affects access to care, as well as providers’ financial positions. Medicare beneficiaries in rural and underserved areas are missing opportunities for improved resources, the Alliance indicated.
Providers should monitor the agency’s response to the concerns raised thus far related to the moratoria, Gurian said. Organizations also need to watch for other regulatory developments, such as new reporting or other requirements that could emerge.
Hospices could be facing difficult challenges without stronger, improved regulatory approaches, according to Gurian.
“Without establishing objective standards and procedural safeguards, providers could face significant consequences,” she told Hospice News.
Companies featured in this article:
