Dear Members,
Please enjoy this article by Elizabeth E. Hogue, Esq. describing the enhanced oversight of new Medicare home health providers by CMS.
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CMS Announces Enhanced Oversight of New Providers
The Centers for Medicare and Medicaid (CMS) issued MLN Matters Number SE19005 on February 15, 2019, which says that new home health agencies (HHAs) will be placed into provisional periods of enhanced oversight effective immediately, including non-payment or suppression of Requests for Advance Payment (RAPs).
In the MLN Matters article, CMS first points out the Affordable Care Act (ACA) provides statutory authority for provisional periods of oversight for new providers and suppliers in the Medicare Program. Provisional periods of enhanced oversight are intended to help CMS address concerns about fraud, waste and abuse regarding particular providers and suppliers. According to CMS, provisional periods of oversight are also intended to help CMS closely monitor provider and supplier types that historically have engaged in high levels of fraud, waste and abuse.
CMS says that it will focus its enhanced oversight authority on new HHAs in all states and territories during its initial use of this authority.
The initial type of enhanced oversight of HHAs will include non-payment or suppression of all RAPs for between thirty days and one year. New HHAs will receive individual notices of how long they will be in the provision period of enhanced oversight with RAP suppression.
New HHAs, however, must still submit RAPs for each home health episode in order for final claims to be processed. When new HHAs submit RAPs while they are in the provisional period of RAP suppression, HHAs will not receive payment for their RAPs. New HHAs will receive appropriate, total payments for their services for home health episodes after the submission of final claims.
CMS says that it may begin putting new HHAs into provisional periods of enhanced oversight with RAP suppression immediately following issue of the MLN article.
New HHAs will be notified that they are in a provisional period of enhanced oversight by CMS or one of its contractors. Notice will be provided by mail sent to the correspondence address on file for the HHA. Written notice will include:
- The date on which the provisional period of enhanced oversight will be effective for the HHA and when it will end
- Notice that HHAs in provisional period of enhanced oversight will not receive RAP payments
- Notice that HHAs must still submit RAPs for all home health episodes in order for final claims to be processed and paid
CMS goes on to say that provisional periods of enhanced oversight are not related to the Medicare final rule with comment period published November 13, 2018 (CMS-1689-FC) that eliminated RAP payments for newly enrolled HHAs beginning on January 1, 2020. As a result of this rule, HHAs certified to participate in the Medicare Program on or after January 1, 2019, will not receive RAP payments beginning on January 1, 2020.
New providers other than HHAs should not celebrate yet! CMS may announce enhanced oversight of other types of providers. In the meanwhile, the resources needed to enter the Medicare home health industry become ever greater.
©2019 Elizabeth E. Hogue, Esq. All rights reserved.
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