The U.S. Centers for Medicare & Medicaid Services (CMS) should follow the six-month moratoria on hospice and home health enrollment in Medicare with more pinpointed efforts to root out fraud, according to the National Partnership for Healthcare and Hospice Innovation (NPHI).
The U.S. Centers for Medicare & Medicaid Services’ (CMS) implemented the moratoria in May. At the time, NPHI voiced support for the moratoria. The organization in March called for such action in a letter to CMS. Now, NPHI contends that the moratorium has “accomplished its intended purpose,” the nonprofit group said in a new letter to CMS Administrator Dr. Mehmet Oz and CMS COO Kim Brandt. The temporary moratoria is scheduled to expire in November.
NPHI proposed that CMS adopt a more targeted approach going forward.
“A moratorium designed to stop bad actors from entering the market does not distinguish between those actors and the mission-driven, community-based nonprofits that make up the backbone of hospice care in this country,” NPHI stated in the letter. “Over the past six months, we have heard directly from members who are ready and able to bring hospice services to communities that currently have little or no access but who have been categorically barred from doing so simply because the moratorium draws no line between expansion driven by fraud and expansion driven by genuine community need.”
CMS has the authority to extend the moratoria. The agency has done so in similar, past situations. NPHI called on CMS to let the moratoria expire. The home-based care industry groups LeadingAge and the National Alliance for Care at Home also released similar statements in recent weeks.
Following the moratoria, CMS should take a “targeted, data-driven approach” to hospice and home health program integrity using the agency’s current authority and enforcement mechanisms, NPHI indicated.
The organization also suggested the CMS create a Hospice Program Integrity Task Force, which NPHI could help convene, to seek further solutions.
“If CMS determines that circumstances warrant additional enrollment restrictions in the future, NPHI would support targeted, evidence-based moratoriums focused on specific geographies, provider types, or identified risk factors — an approach that helps ensure program integrity tools are matched to where risk is greatest,” NPHI said in the letter.
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