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Temporary Moratorium on Home Health Agency (HHA) Enrollment-Metropolitan Areas of Miami and Chicago

On July 31, 2013, the Centers for Medicare & Medicaid Services (CMS) announced a temporary moratorium on Home Health Agency (HHA) enrollment in two geographic areas. Effective July 30, 2013, CMS will halt the enrollment of new HHA providers and HHA branch locations in the metropolitan areas of Miami, FL and Chicago, IL.

Prospective HHA applications within the affected areas which were not approved prior to July 30, 2013 will be denied by the Medicare Administrative Contractor (MAC). Approved means that by 12:00 AM July 30, 2013 the initial certification survey was completed; the second MAC review was completed; the CMS Regional Office (RO) sent the tie-in notice to the MAC; the MAC performed a site visit and the MAC decided to switch the HHA’s Provider Enrollment Chain Organization System (PECOS) record to an "approved" status.

All initial HHA applications for prospective providers in the affected zip codes that were still "pending at the SA or RO" as of 12:00 AM on July 30, 2013 are included in the moratorium and will be denied by the MAC. "Pending at the SA or RO" means those applications for which the RO had not transmitted a tie-in notice (Form CMS-2007) to the MAC for a prospective HHA provider in the affected zip codes by 12:00 AM July 30, 2013. All subsequent SA and RO survey and certification actions on pending HHA applications must cease immediately. The MAC will notify the applicant of the denial. Appeal information will be included in the MAC denial letter and prospective applicants should be referred to the MAC for any questions regarding the appeal process.

The moratorium will last for six months, but CMS may lift the moratorium early or extend it for additional six-month increments. CMS will publish another notice if the moratorium is to be lifted or extended. Once the moratorium is lifted, any prospective provider affected by the moratorium and thus denied by the MAC must complete the entire enrollment application and certification process again if it wishes to participate in the Medicare program.

During the moratorium, a prospective HHA’s accreditation by a CMS approved Accrediting Organization (AO) program will not serve as the basis for Medicare participation through deemed status. In such cases a new provider agreement will not be approved, nor will a new branch location for an existing deemed HHA be approved for the affected zip codes.

For additional information or questions related to survey and certification, contact your appropriate CMS RO. The Central Office contact for policy issues is Patricia Sevast at 410-786-8135.

Additional References are listed below:

SC13-53 01 Temporary Moratorium on Home Health Agency (HHA) Enrollment.doc

SC13-53 02 Qs and As Temp HHA Moratorium.doc

SC13-53 03 MAC Temporary Moratorium Denial Letter.doc