Home health leaders and stakeholders have largely responded to the Centers for Medicare and Medicaid Services’ (CMS) moratorium on home health enrollment with concerns about a broad-brush approach to program integrity – as well as the length of the moratorium.

CMS announced the moratorium as a six-month freeze on home health and hospice, but specified that the pause could be extended in six-month increments if CMS deems it necessary. In a recent webinar co-hosted by Home Health Care News, Hospice News and HME Business, experts warned that the moratorium is at risk of being extended beyond the initial time frame.  

“My sense is that they will probably extend it at least once for home health and hospice,” Hillary Loeffler, vice president of policy and regulatory affairs at the National Alliance for Care at Home, said during the webinar. “Don’t hold me to that. Don’t go to Vegas and place bets on that. That’s what I think at the moment.”

Several pieces of evidence point to the relative likelihood of an extension, Loeffler said. For one, the timing of the moratorium coincides unfortunately with the timing of the midterm elections. The moratorium took effect in May, meaning the initial six-month period expires in October, just weeks before the Nov. 3 midterm elections.

This timing is bad news for providers, Loeffler said.

“CMS very much takes specific actions around the time of midterms,” she said. “They’re very careful about what they announce, what they release. There are a lot of timing considerations around midterm and presidential election years, so the agency is already going to [have] heightened awareness of things that are coming out of the agency. … I think they might sneak in at least one extension, get them past the midterms, and then reevaluate.”

CMS might announce the extension earlier than the six-month expiration date, Loeffler added.

Home health providers may get an indication in August, when CMS’ enrollment moratorium on durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) is set to expire. If CMS extends the DMEPOS moratorium, it could signal that an extension to the home health moratorium is imminent, Loeffler said.

While there are some tells regarding the possibility of an extension, CMS has failed to release sufficient information to make a clear guess, Loeffler said. When announcing the moratoria on home health, hospice or DMEPOS, CMS did not provide insight into what metrics needed to be achieved for the enrollment moratoria for home health. The same was true for the moratorium on new Medicare home health agencies introduced in 2013, Loeffler said. CMS continually expanded and extended the moratorium, which ultimately lasted five years. 

Dan Fedor, the director of reimbursement and education for U.S. Rehab, a division of the VGM Group, predicted that the DMEPOS moratorium would indeed be extended. 

“Even though… there are other methods to look at the waste, fraud, and abuse … I do believe it will be extended,” Fedor said on the webinar. “Given the current environment we’re in, I see at least another six-month extension.”

The VGM Group provides services and solutions for home medical equipment (HME) and complex rehab technology (CRT) companies.

While predicting that CMS is likely to extend the moratorium past the six-month mark, Loeffler emphasized that the Alliance would advocate against such sweeping responses to fraud.

“We really think there are definite actions that CMS can take to target fraudulent actors without using this blunt tool,” she said.