80_FR_45111 80 FR 44967 - Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Extended Temporary Moratoria on Enrollment of Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations

80 FR 44967 - Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Extended Temporary Moratoria on Enrollment of Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services

Federal Register Volume 80, Issue 144 (July 28, 2015)

Page Range44967-44970
FR Document2015-18327

This document announces the extension of temporary moratoria on the enrollment of new ambulance suppliers and home health agencies, subunits, and branch locations in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse.

Federal Register, Volume 80 Issue 144 (Tuesday, July 28, 2015)
[Federal Register Volume 80, Number 144 (Tuesday, July 28, 2015)]
[Notices]
[Pages 44967-44970]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-18327]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-6059-N3]


Medicare, Medicaid, and Children's Health Insurance Programs: 
Announcement of the Extended Temporary Moratoria on Enrollment of 
Ambulance Suppliers and Home Health Agencies in Designated Geographic 
Locations

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Extension of temporary moratoria.

-----------------------------------------------------------------------

SUMMARY: This document announces the extension of temporary moratoria 
on the enrollment of new ambulance suppliers and home health agencies, 
subunits, and branch locations in specific locations within designated 
metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, 
and New Jersey to prevent and combat fraud, waste, and abuse.

DATES: Effective Date: July 29, 2015.

FOR FURTHER INFORMATION CONTACT: Belinda Gravel, (410) 786-8934.
    News media representatives must contact CMS' Public Affairs Office 
at (202) 690-6145 or email them at press@cms.hhs.gov.

SUPPLEMENTARY INFORMATION:

I. Background

A. CMS' Imposition of Temporary Enrollment Moratoria

    Section 6401(a) of the Affordable Care Act added a new section 
1866(j)(7) to the Social Security Act (the Act) to provide the 
Secretary with authority to impose a temporary moratorium on the 
enrollment of new Medicare, Medicaid, or CHIP providers and suppliers, 
including categories of providers and suppliers, if the Secretary 
determines a moratorium is necessary to prevent or combat fraud, waste, 
or abuse under these programs. For a more detailed explanation of these 
authorities, please see the July 31, 2013 notice (78 FR 46339) or 
February 4, 2014 extension and establishment of a temporary moratoria 
document (hereinafter referred to as the February 4, 2014 moratoria 
document or notice) (79 FR 6475).
    Based on this authority and our regulations at Sec.  424.570, we 
initially imposed moratoria to prevent enrollment of new home health 
agencies, subunits, and branch locations \1\ (hereafter referred to as 
HHAs) in Miami-Dade County, Florida and Cook County, Illinois, as well 
as surrounding counties, and part B ambulance suppliers in Harris 
County, Texas and surrounding counties, in a notice issued on July 31, 
2013 (78 FR 46339). We then exercised this authority again in a notice 
published on February 4, 2014 (79 FR 6475) when we extended the 
existing moratoria for an additional 6 months and expanded it to 
include enrollment of HHAs in Broward County, Florida; Dallas County, 
Texas; Harris County, Texas; and Wayne County, Michigan and surrounding 
counties, and enrollment of ground ambulance suppliers in Philadelphia, 
Pennsylvania and surrounding counties. Then, we further extended the 
previously mentioned moratoria in moratoria documents issued on August 
1, 2014 (79 FR 44702) and February 2, 2015 (80 FR 5551).
---------------------------------------------------------------------------

    \1\ As noted in the preamble to the final rule implementing the 
moratorium authority (February 2, 2011, CMS-6028-FC (76 FR 5870), 
home health agency subunits and branch locations are subject to the 
moratoria to the same extent as any other newly enrolling home 
health agency.

---------------------------------------------------------------------------

[[Page 44968]]

B. Determination of the Need for Moratorium

    In imposing these enrollment moratoria, CMS considered both 
qualitative and quantitative factors suggesting a high risk of fraud, 
waste, or abuse. CMS relied on law enforcement's longstanding 
experience with ongoing and emerging fraud trends and activities 
through civil, criminal, and administrative investigations and 
prosecutions. CMS' determination of a high risk of fraud, waste, or 
abuse in these provider and supplier types within these geographic 
locations was then confirmed by CMS' data analysis, which relied on 
factors the agency identified as strong indicators of risk. (For a more 
detailed explanation of this determination process and of these 
authorities, see the July 31, 2013 notice (78 FR 46339) or February 4, 
2014 moratoria document (79 FR 6475)).
1. Consultation With Law Enforcement
    In consultation with the HHS-Office of Inspector General (OIG) and 
the Department of Justice (DOJ), CMS identified two provider and 
supplier types in nine geographic locations that warrant a temporary 
enrollment moratorium. For a more detailed discussion of this 
consultation process, see the July 31, 2013 notice (78 FR 46339) or 
February 4, 2014 moratoria document (79 FR 6475).
2. Beneficiary Access to Care
    Beneficiary access to care in Medicare, Medicaid, and CHIP is of 
critical importance to CMS and its state partners, and CMS carefully 
evaluated access for the target moratorium locations. Prior to imposing 
these moratoria, CMS reviewed Medicare data for these areas and found 
no concerns with beneficiary access to HHAs or ground ambulance 
suppliers. CMS also consulted with the appropriate State Medicaid 
Agencies and with the appropriate State Departments of Emergency 
Medical Services to determine if the moratoria would create access to 
care concerns for Medicaid and CHIP beneficiaries in the targeted 
locations and surrounding counties. All of CMS' state partners were 
supportive of CMS analysis and proposals, and together with CMS, 
determined that these moratoria would not create access to care issues 
for Medicaid or CHIP beneficiaries.
3. Lifting a Temporary Moratorium
    In accordance with Sec.  424.570(b), a temporary enrollment 
moratorium imposed by CMS will remain in effect for 6 months. If CMS 
deems it necessary, the moratorium may be extended in 6-month 
increments. CMS will evaluate whether to extend or lift the moratorium 
before any subsequent moratorium periods. If one or more of the 
moratoria announced in this document are extended or lifted, CMS will 
publish a document to that effect in the Federal Register.
    Once a moratorium is lifted, the provider or supplier types that 
were unable to enroll because of the moratorium will be designated to 
CMS' high screening level under Sec.  424.518(c)(3)(iii) and Sec.  
455.450(e)(2) for 6 months from the date the moratorium is lifted.

II. Extension of Home Health and Ambulance Moratoria--Geographic 
Locations

    As noted earlier, we previously imposed moratoria on the enrollment 
of new HHAs in the Florida counties of Broward, Miami-Dade, and Monroe; 
the Illinois counties of Cook, DuPage, Kane, Lake, McHenry, and Will; 
the Michigan counties of Macomb, Monroe, Oakland, Washtenaw, and Wayne; 
and the Texas counties of Brazoria, Chambers, Collin, Fort Bend, 
Galveston, Dallas, Harris, Liberty, Denton, Ellis, Kaufman, Montgomery, 
Rockwall, Tarrant, and Waller. Further, we previously imposed moratoria 
on the enrollment of new ground ambulance suppliers in the Texas 
counties of Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, 
Montgomery, and Waller; the Pennsylvania counties of Bucks, Delaware, 
Montgomery, and Philadelphia; and the New Jersey counties of 
Burlington, Camden, and Gloucester. These moratoria became effective 
upon publication in the Federal Register of a notice on July 31, 2013 
(78 FR 46339) and a moratoria document on February 4, 2014 (79 FR 
6475), and were subsequently extended by documents published in the 
Federal Register on August 1, 2014 (79 FR 44702) and February 2, 2015 
(80 FR 5551).
    As provided in Sec.  424.570(b), CMS may deem it necessary to 
extend previously-imposed moratoria in 6-month increments. Under this 
authority, CMS is extending the temporary moratoria on the Medicare 
enrollment of HHAs and ground ambulance suppliers in the geographic 
locations discussed herein. Under regulations at Sec.  455.470 and 
Sec.  457.990, these moratoria also apply to the enrollment of HHAs and 
ground ambulance suppliers in Medicaid and CHIP. Under Sec.  
424.570(b), CMS is required to publish a document in the Federal 
Register announcing any extension of a moratorium, and this extension 
of moratoria document fulfills that requirement.
    CMS consulted with the HHS-OIG regarding the extension of the 
moratoria on new HHAs and ground ambulance suppliers in all of the 
moratoria counties, and HHS-OIG agrees that a significant potential for 
fraud, waste, and abuse continues to exist in these geographic areas. 
The circumstances warranting the imposition of the moratoria have not 
yet abated, and CMS has determined that the moratoria are still needed 
as we monitor the indicators and continue with administrative actions, 
such as payment suspensions and revocations of provider/supplier 
numbers. (For more information regarding the monitored indicators, see 
the February 4, 2014 moratoria document (79 FR 6475)).
    Based upon CMS' consultation with the relevant State Medicaid 
Agencies, CMS has concluded that extending these moratoria will not 
create an access to care issue for Medicaid or CHIP beneficiaries in 
the affected counties at this time. CMS also reviewed Medicare data for 
these areas and found there are no current problems with access to HHAs 
or ground ambulance suppliers. Nevertheless, the agency will continue 
to monitor these locations to make sure that no access to care issues 
arise in the future.
    Based upon our consultation with law enforcement and consideration 
of the factors and activities described previously, CMS has determined 
that the temporary enrollment moratoria should be extended for an 
additional 6 months.

III. Summary of the Moratoria Locations

    CMS is executing its authority under sections 1866(j)(7), 
1902(kk)(4), and 2107(e)(1)(D) of the Act to extend these moratoria in 
the following counties for these providers and suppliers:

                         Table 1--HHA Moratoria
------------------------------------------------------------------------
       State               City/metro area                Counties
------------------------------------------------------------------------
FL................  Fort Lauderdale..............  Broward.

[[Page 44969]]

 
FL................  Miami........................  Monroe, Miami-Dade.
IL................  Chicago......................  Cook, DuPage, Kane,
                                                    Lake, McHenry, Will.
MI................  Detroit......................  Macomb, Monroe,
                                                    Oakland, Washtenaw,
                                                    Wayne.
TX................  Dallas.......................  Collin, Dallas,
                                                    Denton, Ellis,
                                                    Kaufman, Rockwall,
                                                    Tarrant.
TX................  Houston......................  Brazoria, Chambers,
                                                    Fort Bend,
                                                    Galveston, Harris,
                                                    Liberty, Montgomery,
                                                    Waller.
------------------------------------------------------------------------


                   Table 2--Part B Ambulance Moratoria
------------------------------------------------------------------------
       State               City/metro area                Counties
------------------------------------------------------------------------
PA/NJ.............  Philadelphia.................  Bucks, Burlington
                                                    (NJ), Camden (NJ),
                                                    Delaware, Gloucester
                                                    (NJ), Montgomery,
                                                    Philadelphia.
TX................  Houston......................  Brazoria, Chambers,
                                                    Fort Bend,
                                                    Galveston, Harris,
                                                    Liberty, Montgomery,
                                                    Waller.
------------------------------------------------------------------------

IV. Clarification of Right to Judicial Review

    Section 1866(j)(7)(B) of the Act states that there shall be no 
judicial review under section 1869, section 1878, or otherwise, of a 
temporary moratorium imposed on the enrollment of new providers of 
services and suppliers if the Secretary determines that the moratorium 
is necessary to prevent or combat fraud, waste, or abuse. Accordingly, 
our regulations at 42 CFR 498.5(l)(4) state that for appeals of denials 
based on a temporary moratorium, the scope of review will be limited to 
whether the temporary moratorium applies to the provider or supplier 
appealing the denial. The agency's basis for imposing a temporary 
moratorium is not subject to review. Our regulations do not limit the 
right to seek judicial review of a final agency decision that the 
temporary moratorium applies to a particular provider or supplier. In 
the preamble to the February 2, 2011 (76 FR 5918) final rule with 
comment period establishing this regulation, we explained that ``a 
provider or supplier may administratively appeal an adverse 
determination based on the imposition of a temporary moratorium up to 
and including the Department Appeal Board (DAB) level of review.'' We 
are clarifying that providers and suppliers that have received 
unfavorable decisions in accordance with the limited scope of review 
described in Sec.  498.5(l)(4) may seek judicial review of those 
decisions after they exhaust their administrative appeals. We 
reiterate, however, that section 1866(j)(7)(B) of the Act precludes 
judicial review of the agency's basis for imposing a temporary 
moratorium.

V. Collection of Information Requirements

    This document does not impose information collection requirements, 
that is, reporting, recordkeeping or third-party disclosure 
requirements. Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501 et seq.).

VI. Regulatory Impact Statement

    CMS has examined the impact of this document as required by 
Executive Order 12866 on Regulatory Planning and Review (September 30, 
1993), Executive Order 13563 on Improving Regulation and Regulatory 
Review (January 18, 2011), the Regulatory Flexibility Act (RFA) 
(September 19, 1980, Pub. L. 96-354), section 1102(b) of the Social 
Security Act, section 202 of the Unfunded Mandates Reform Act of 1995 
(March 22, 1995; Pub. L. 104-4), Executive Order 13132 on Federalism 
(August 4, 1999) and the Congressional Review Act (5 U.S.C. 804(2)).
    Executive Orders 12866 and 13563 direct agencies to assess all 
costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health, and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major regulatory 
actions with economically significant effects ($100 million or more in 
any 1 year). This document will prevent the enrollment of new home 
health providers and ambulance suppliers in Medicare and new home 
health providers and ambulance suppliers in Medicaid and CHIP. Though 
savings may accrue by denying enrollments, the monetary amount cannot 
be quantified. After the imposition of the moratoria on July 31, 2013, 
848 HHAs and 14 ambulance companies in all geographic areas affected by 
the moratoria had their applications denied. We have found the number 
of applications that are denied after 60 days declines dramatically, as 
most providers and suppliers will not submit applications during the 
moratoria period. Therefore, this document does not reach the economic 
threshold, and thus is not considered a major action.
    The RFA requires agencies to analyze options for regulatory relief 
of small entities. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and small governmental 
jurisdictions. Most hospitals and most other providers and suppliers 
are small entities, either by nonprofit status or by having revenues of 
$7.0 million to $35.5 million in any one year. Individuals and states 
are not included in the definition of a small entity. CMS is not 
preparing an analysis for the RFA because it has determined, and the 
Secretary certifies, that this document will not have a significant 
economic impact on a substantial number of small entities.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if an action may have a significant impact 
on the operations of a substantial number of small rural hospitals. 
This analysis must conform to the provisions of section 604 of the RFA. 
For purposes of section 1102(b) of the Act, CMS defines a small rural 
hospital as a hospital that is located outside of a Metropolitan 
Statistical Area for Medicare payment regulations and has fewer than 
100 beds. CMS is not preparing an analysis for section 1102(b) of the 
Act because it has determined, and the Secretary certifies, that this 
document will not have a significant impact on the operations of a 
substantial number of small rural hospitals.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any regulatory action whose mandates require spending in any 1 
year of $100

[[Page 44970]]

million in 1995 dollars, updated annually for inflation. In 2015, that 
threshold is approximately $144 million. This document will have no 
consequential effect on state, local, or tribal governments or on the 
private sector.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed regulatory action (and 
subsequent final action) that imposes substantial direct requirement 
costs on state and local governments, preempts state law, or otherwise 
has Federalism implications. Because this document does not impose any 
costs on state or local governments, the requirements of Executive 
Order 13132 are not applicable.
    In accordance with the provisions of Executive Order 12866, the 
Office of Management and Budget reviewed this document.

    Authority: Sections 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh) and 44 U.S.C. Chapter 35.

    Dated: July 1, 2015.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2015-18327 Filed 7-24-15; 4:15 pm]
BILLING CODE 4120-01-P



                                                                                        Federal Register / Vol. 80, No. 144 / Tuesday, July 28, 2015 / Notices                                                              44967

                                                    resilience. Even when these domains                             Departments Can Leverage Age-Friendly                         underway; and develop a toolkit to help
                                                    have been included, there is no                                 Cities Initiatives to Build Resilience in                     LHDs identify the need for AFIs,
                                                    evaluation of whether these efforts have                        Elderly Populations. Information                              evaluate and monitor AFIs ability to
                                                    resulted in improved resilience                                 collection activities will target four                        improve resilience, develop effective
                                                    outcomes among seniors (e.g., greater                           groups. Respondents will include AFI                          and efficient partnerships with AFIs to
                                                    self-sufficiency). This study will                              Staff, Village Directors, LHD                                 expand AFI–LHD efforts across the U.S
                                                    quantify the contribution that AFIs and                         Representatives, and adults aged 65+                          to build community resilience.
                                                    SVs have made to improving resilience                           within the AFI and SV communities.
                                                    outcomes for older adults and provide                             The study will outline where current                          OMB approval is requested for two
                                                    guidance to local health departments                            AFIs and CR efforts align; conduct                            years. Participation in the survey is
                                                    (LHDs) for improving their engagement                           interviews in AFIs and SVs across the                         voluntary. There are no costs to
                                                    with AFIs/SVs.                                                  U.S. to understand relationships with                         respondents other than their time. The
                                                      The Office of Public Health                                   LHDs; clarify the process through which                       total estimated annual burden hours are
                                                    Preparedness and Response proposes to                           policymakers can incorporate CR into                          302. A summary of annualized burden
                                                    conduct a new information collection,                           AFIs; survey test sites in a quasi-                           hours is below.
                                                    Examining How Local Health                                      experimental design of AFIs currently

                                                                                                                   ESTIMATED ANNUALIZED BURDEN HOURS
                                                                                                                                                                                                                         Average
                                                                                                                                                                                                    Number of
                                                                                                                                                                                  Number of                            burden per
                                                                    Type of respondents                                                 Form name                                                 responses per
                                                                                                                                                                                 respondents                            response
                                                                                                                                                                                                    respondent           (in hrs)

                                                    Age Friendly Initiative Staff .............................    Interview Guide for Age Friendly Initiative                              16                   1             30/60
                                                                                                                      Staff.
                                                    Senior Village Director ....................................   Interview Guide for Senior Village Director ...                          15                   1             30/60
                                                    Local Health Department Representative .......                 Interview Guide for Local Health Department                               8                   1             30/60
                                                                                                                      Representative.
                                                    Older Adult—Screened Out ............................          Senior Village Survey .....................................             716                   1              2/60
                                                    Older Adult—Participant .................................      Senior Village Survey .....................................             775                   1             20/60



                                                    Leroy A. Richardson,                                            prevent and combat fraud, waste, and                          imposed moratoria to prevent
                                                    Chief, Information Collection Review Office,                    abuse.                                                        enrollment of new home health
                                                    Office of Scientific Integrity, Office of the                                                                                 agencies, subunits, and branch
                                                                                                                    DATES: Effective Date: July 29, 2015.
                                                    Associate Director for Science, Office of the                                                                                 locations 1 (hereafter referred to as
                                                    Director, Centers for Disease Control and                       FOR FURTHER INFORMATION CONTACT:
                                                    Prevention.                                                     Belinda Gravel, (410) 786–8934.                               HHAs) in Miami-Dade County, Florida
                                                                                                                      News media representatives must                             and Cook County, Illinois, as well as
                                                    [FR Doc. 2015–18424 Filed 7–27–15; 8:45am]
                                                                                                                    contact CMS’ Public Affairs Office at                         surrounding counties, and part B
                                                    BILLING CODE 4163–18–P
                                                                                                                    (202) 690–6145 or email them at press@                        ambulance suppliers in Harris County,
                                                                                                                    cms.hhs.gov.                                                  Texas and surrounding counties, in a
                                                    DEPARTMENT OF HEALTH AND                                        SUPPLEMENTARY INFORMATION:                                    notice issued on July 31, 2013 (78 FR
                                                    HUMAN SERVICES                                                                                                                46339). We then exercised this authority
                                                                                                                    I. Background                                                 again in a notice published on February
                                                    Centers for Medicare & Medicaid                                 A. CMS’ Imposition of Temporary                               4, 2014 (79 FR 6475) when we extended
                                                    Services                                                        Enrollment Moratoria                                          the existing moratoria for an additional
                                                    [CMS–6059–N3]                                                     Section 6401(a) of the Affordable Care                      6 months and expanded it to include
                                                                                                                    Act added a new section 1866(j)(7) to                         enrollment of HHAs in Broward County,
                                                    Medicare, Medicaid, and Children’s                              the Social Security Act (the Act) to                          Florida; Dallas County, Texas; Harris
                                                    Health Insurance Programs:                                      provide the Secretary with authority to                       County, Texas; and Wayne County,
                                                    Announcement of the Extended                                    impose a temporary moratorium on the                          Michigan and surrounding counties,
                                                    Temporary Moratoria on Enrollment of                            enrollment of new Medicare, Medicaid,                         and enrollment of ground ambulance
                                                    Ambulance Suppliers and Home Health                             or CHIP providers and suppliers,                              suppliers in Philadelphia, Pennsylvania
                                                    Agencies in Designated Geographic                               including categories of providers and                         and surrounding counties. Then, we
                                                    Locations                                                       suppliers, if the Secretary determines a                      further extended the previously
                                                    AGENCY:  Centers for Medicare &                                 moratorium is necessary to prevent or                         mentioned moratoria in moratoria
                                                    Medicaid Services (CMS), HHS.                                   combat fraud, waste, or abuse under                           documents issued on August 1, 2014 (79
                                                    ACTION: Extension of temporary                                  these programs. For a more detailed                           FR 44702) and February 2, 2015 (80 FR
                                                    moratoria.                                                      explanation of these authorities, please                      5551).
                                                                                                                    see the July 31, 2013 notice (78 FR
asabaliauskas on DSK5VPTVN1PROD with NOTICES




                                                    SUMMARY:    This document announces the                         46339) or February 4, 2014 extension
                                                    extension of temporary moratoria on the                         and establishment of a temporary
                                                    enrollment of new ambulance suppliers                           moratoria document (hereinafter                                  1 As noted in the preamble to the final rule
                                                    and home health agencies, subunits, and                         referred to as the February 4, 2014                           implementing the moratorium authority (February
                                                    branch locations in specific locations                          moratoria document or notice) (79 FR                          2, 2011, CMS–6028–FC (76 FR 5870), home health
                                                    within designated metropolitan areas in                         6475).                                                        agency subunits and branch locations are subject to
                                                    Florida, Illinois, Michigan, Texas,                               Based on this authority and our                             the moratoria to the same extent as any other newly
                                                    Pennsylvania, and New Jersey to                                 regulations at § 424.570, we initially                        enrolling home health agency.



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                                                    44968                                 Federal Register / Vol. 80, No. 144 / Tuesday, July 28, 2015 / Notices

                                                    B. Determination of the Need for                               3. Lifting a Temporary Moratorium                       CMS is extending the temporary
                                                    Moratorium                                                       In accordance with § 424.570(b), a                    moratoria on the Medicare enrollment of
                                                      In imposing these enrollment                                 temporary enrollment moratorium                         HHAs and ground ambulance suppliers
                                                    moratoria, CMS considered both                                 imposed by CMS will remain in effect                    in the geographic locations discussed
                                                    qualitative and quantitative factors                           for 6 months. If CMS deems it                           herein. Under regulations at § 455.470
                                                    suggesting a high risk of fraud, waste, or                     necessary, the moratorium may be                        and § 457.990, these moratoria also
                                                    abuse. CMS relied on law enforcement’s                         extended in 6-month increments. CMS                     apply to the enrollment of HHAs and
                                                    longstanding experience with ongoing                           will evaluate whether to extend or lift                 ground ambulance suppliers in
                                                    and emerging fraud trends and activities                       the moratorium before any subsequent                    Medicaid and CHIP. Under § 424.570(b),
                                                    through civil, criminal, and                                   moratorium periods. If one or more of                   CMS is required to publish a document
                                                    administrative investigations and                              the moratoria announced in this                         in the Federal Register announcing any
                                                    prosecutions. CMS’ determination of a                          document are extended or lifted, CMS                    extension of a moratorium, and this
                                                    high risk of fraud, waste, or abuse in                         will publish a document to that effect in               extension of moratoria document fulfills
                                                    these provider and supplier types                              the Federal Register.                                   that requirement.
                                                    within these geographic locations was                            Once a moratorium is lifted, the                         CMS consulted with the HHS–OIG
                                                    then confirmed by CMS’ data analysis,                          provider or supplier types that were                    regarding the extension of the moratoria
                                                    which relied on factors the agency                             unable to enroll because of the                         on new HHAs and ground ambulance
                                                    identified as strong indicators of risk.                       moratorium will be designated to CMS’                   suppliers in all of the moratoria
                                                    (For a more detailed explanation of this                       high screening level under                              counties, and HHS–OIG agrees that a
                                                    determination process and of these                             § 424.518(c)(3)(iii) and § 455.450(e)(2)                significant potential for fraud, waste,
                                                    authorities, see the July 31, 2013 notice                      for 6 months from the date the                          and abuse continues to exist in these
                                                    (78 FR 46339) or February 4, 2014                              moratorium is lifted.                                   geographic areas. The circumstances
                                                    moratoria document (79 FR 6475)).                                                                                      warranting the imposition of the
                                                                                                                   II. Extension of Home Health and                        moratoria have not yet abated, and CMS
                                                    1. Consultation With Law Enforcement                           Ambulance Moratoria—Geographic                          has determined that the moratoria are
                                                                                                                   Locations                                               still needed as we monitor the
                                                      In consultation with the HHS-Office
                                                    of Inspector General (OIG) and the                                As noted earlier, we previously                      indicators and continue with
                                                    Department of Justice (DOJ), CMS                               imposed moratoria on the enrollment of                  administrative actions, such as payment
                                                    identified two provider and supplier                           new HHAs in the Florida counties of                     suspensions and revocations of
                                                    types in nine geographic locations that                        Broward, Miami-Dade, and Monroe; the                    provider/supplier numbers. (For more
                                                    warrant a temporary enrollment                                 Illinois counties of Cook, DuPage, Kane,                information regarding the monitored
                                                    moratorium. For a more detailed                                Lake, McHenry, and Will; the Michigan                   indicators, see the February 4, 2014
                                                    discussion of this consultation process,                       counties of Macomb, Monroe, Oakland,                    moratoria document (79 FR 6475)).
                                                    see the July 31, 2013 notice (78 FR                            Washtenaw, and Wayne; and the Texas                        Based upon CMS’ consultation with
                                                    46339) or February 4, 2014 moratoria                           counties of Brazoria, Chambers, Collin,                 the relevant State Medicaid Agencies,
                                                    document (79 FR 6475).                                         Fort Bend, Galveston, Dallas, Harris,                   CMS has concluded that extending
                                                                                                                   Liberty, Denton, Ellis, Kaufman,                        these moratoria will not create an access
                                                    2. Beneficiary Access to Care                                  Montgomery, Rockwall, Tarrant, and                      to care issue for Medicaid or CHIP
                                                      Beneficiary access to care in                                Waller. Further, we previously imposed                  beneficiaries in the affected counties at
                                                    Medicare, Medicaid, and CHIP is of                             moratoria on the enrollment of new                      this time. CMS also reviewed Medicare
                                                    critical importance to CMS and its state                       ground ambulance suppliers in the                       data for these areas and found there are
                                                    partners, and CMS carefully evaluated                          Texas counties of Brazoria, Chambers,                   no current problems with access to
                                                    access for the target moratorium                               Fort Bend, Galveston, Harris, Liberty,                  HHAs or ground ambulance suppliers.
                                                    locations. Prior to imposing these                             Montgomery, and Waller; the                             Nevertheless, the agency will continue
                                                    moratoria, CMS reviewed Medicare data                          Pennsylvania counties of Bucks,                         to monitor these locations to make sure
                                                    for these areas and found no concerns                          Delaware, Montgomery, and                               that no access to care issues arise in the
                                                    with beneficiary access to HHAs or                             Philadelphia; and the New Jersey                        future.
                                                    ground ambulance suppliers. CMS also                           counties of Burlington, Camden, and                        Based upon our consultation with law
                                                    consulted with the appropriate State                           Gloucester. These moratoria became                      enforcement and consideration of the
                                                    Medicaid Agencies and with the                                 effective upon publication in the                       factors and activities described
                                                    appropriate State Departments of                               Federal Register of a notice on July 31,                previously, CMS has determined that
                                                    Emergency Medical Services to                                  2013 (78 FR 46339) and a moratoria                      the temporary enrollment moratoria
                                                    determine if the moratoria would create                        document on February 4, 2014 (79 FR                     should be extended for an additional 6
                                                    access to care concerns for Medicaid                           6475), and were subsequently extended                   months.
                                                    and CHIP beneficiaries in the targeted                         by documents published in the Federal
                                                                                                                                                                           III. Summary of the Moratoria
                                                    locations and surrounding counties. All                        Register on August 1, 2014 (79 FR
                                                                                                                                                                           Locations
                                                    of CMS’ state partners were supportive                         44702) and February 2, 2015 (80 FR
                                                    of CMS analysis and proposals, and                             5551).                                                    CMS is executing its authority under
                                                    together with CMS, determined that                                As provided in § 424.570(b), CMS                     sections 1866(j)(7), 1902(kk)(4), and
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                                                    these moratoria would not create access                        may deem it necessary to extend                         2107(e)(1)(D) of the Act to extend these
                                                    to care issues for Medicaid or CHIP                            previously-imposed moratoria in 6-                      moratoria in the following counties for
                                                    beneficiaries.                                                 month increments. Under this authority,                 these providers and suppliers:

                                                                                                                          TABLE 1—HHA MORATORIA
                                                          State                  City/metro area                                                                Counties

                                                    FL .................    Fort Lauderdale ...........      Broward.



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                                                                                              Federal Register / Vol. 80, No. 144 / Tuesday, July 28, 2015 / Notices                                              44969

                                                                                                                       TABLE 1—HHA MORATORIA—Continued
                                                          State                   City/metro area                                                                    Counties

                                                    FL .................     Miami ...........................    Monroe, Miami-Dade.
                                                    IL ..................    Chicago .......................      Cook, DuPage, Kane, Lake, McHenry, Will.
                                                    MI .................     Detroit ..........................   Macomb, Monroe, Oakland, Washtenaw, Wayne.
                                                    TX ................      Dallas ..........................    Collin, Dallas, Denton, Ellis, Kaufman, Rockwall, Tarrant.
                                                    TX ................      Houston .......................      Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, Waller.


                                                                                                                      TABLE 2—PART B AMBULANCE MORATORIA
                                                          State                   City/metro area                                                                    Counties

                                                    PA/NJ ...........        Philadelphia .................       Bucks, Burlington (NJ), Camden (NJ), Delaware, Gloucester (NJ), Montgomery, Philadelphia.
                                                    TX ................      Houston .......................      Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, Waller.



                                                    IV. Clarification of Right to Judicial                              that is, reporting, recordkeeping or                    number of applications that are denied
                                                    Review                                                              third-party disclosure requirements.                    after 60 days declines dramatically, as
                                                                                                                        Consequently, there is no need for                      most providers and suppliers will not
                                                      Section 1866(j)(7)(B) of the Act states
                                                                                                                        review by the Office of Management and                  submit applications during the
                                                    that there shall be no judicial review
                                                                                                                        Budget under the authority of the                       moratoria period. Therefore, this
                                                    under section 1869, section 1878, or
                                                                                                                        Paperwork Reduction Act of 1995 (44                     document does not reach the economic
                                                    otherwise, of a temporary moratorium
                                                                                                                        U.S.C. 3501 et seq.).                                   threshold, and thus is not considered a
                                                    imposed on the enrollment of new                                                                                            major action.
                                                    providers of services and suppliers if                              VI. Regulatory Impact Statement                            The RFA requires agencies to analyze
                                                    the Secretary determines that the                                      CMS has examined the impact of this                  options for regulatory relief of small
                                                    moratorium is necessary to prevent or                               document as required by Executive                       entities. For purposes of the RFA, small
                                                    combat fraud, waste, or abuse.                                      Order 12866 on Regulatory Planning                      entities include small businesses,
                                                    Accordingly, our regulations at 42 CFR                              and Review (September 30, 1993),                        nonprofit organizations, and small
                                                    498.5(l)(4) state that for appeals of                               Executive Order 13563 on Improving                      governmental jurisdictions. Most
                                                    denials based on a temporary                                        Regulation and Regulatory Review                        hospitals and most other providers and
                                                    moratorium, the scope of review will be                             (January 18, 2011), the Regulatory                      suppliers are small entities, either by
                                                    limited to whether the temporary                                    Flexibility Act (RFA) (September 19,                    nonprofit status or by having revenues
                                                    moratorium applies to the provider or                               1980, Pub. L. 96–354), section 1102(b) of               of $7.0 million to $35.5 million in any
                                                    supplier appealing the denial. The                                  the Social Security Act, section 202 of                 one year. Individuals and states are not
                                                    agency’s basis for imposing a temporary                             the Unfunded Mandates Reform Act of                     included in the definition of a small
                                                    moratorium is not subject to review. Our                            1995 (March 22, 1995; Pub. L. 104–4),                   entity. CMS is not preparing an analysis
                                                    regulations do not limit the right to seek                          Executive Order 13132 on Federalism                     for the RFA because it has determined,
                                                    judicial review of a final agency                                   (August 4, 1999) and the Congressional                  and the Secretary certifies, that this
                                                    decision that the temporary moratorium                              Review Act (5 U.S.C. 804(2)).                           document will not have a significant
                                                    applies to a particular provider or                                    Executive Orders 12866 and 13563                     economic impact on a substantial
                                                    supplier. In the preamble to the                                    direct agencies to assess all costs and                 number of small entities.
                                                    February 2, 2011 (76 FR 5918) final rule                            benefits of available regulatory                           In addition, section 1102(b) of the Act
                                                    with comment period establishing this                               alternatives and, if regulation is                      requires us to prepare a regulatory
                                                    regulation, we explained that ‘‘a                                   necessary, to select regulatory                         impact analysis if an action may have a
                                                    provider or supplier may                                            approaches that maximize net benefits                   significant impact on the operations of
                                                    administratively appeal an adverse                                  (including potential economic,                          a substantial number of small rural
                                                    determination based on the imposition                               environmental, public health, and safety                hospitals. This analysis must conform to
                                                    of a temporary moratorium up to and                                 effects, distributive impacts, and                      the provisions of section 604 of the
                                                    including the Department Appeal Board                               equity). A regulatory impact analysis                   RFA. For purposes of section 1102(b) of
                                                    (DAB) level of review.’’ We are                                     (RIA) must be prepared for major                        the Act, CMS defines a small rural
                                                    clarifying that providers and suppliers                             regulatory actions with economically                    hospital as a hospital that is located
                                                    that have received unfavorable                                      significant effects ($100 million or more               outside of a Metropolitan Statistical
                                                    decisions in accordance with the                                    in any 1 year). This document will                      Area for Medicare payment regulations
                                                    limited scope of review described in                                prevent the enrollment of new home                      and has fewer than 100 beds. CMS is not
                                                    § 498.5(l)(4) may seek judicial review of                           health providers and ambulance                          preparing an analysis for section 1102(b)
                                                    those decisions after they exhaust their                            suppliers in Medicare and new home                      of the Act because it has determined,
                                                    administrative appeals. We reiterate,                               health providers and ambulance                          and the Secretary certifies, that this
                                                    however, that section 1866(j)(7)(B) of                              suppliers in Medicaid and CHIP.                         document will not have a significant
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                                                    the Act precludes judicial review of the                            Though savings may accrue by denying                    impact on the operations of a substantial
                                                    agency’s basis for imposing a temporary                             enrollments, the monetary amount                        number of small rural hospitals.
                                                    moratorium.                                                         cannot be quantified. After the                            Section 202 of the Unfunded
                                                                                                                        imposition of the moratoria on July 31,                 Mandates Reform Act of 1995 also
                                                    V. Collection of Information
                                                                                                                        2013, 848 HHAs and 14 ambulance                         requires that agencies assess anticipated
                                                    Requirements
                                                                                                                        companies in all geographic areas                       costs and benefits before issuing any
                                                      This document does not impose                                     affected by the moratoria had their                     regulatory action whose mandates
                                                    information collection requirements,                                applications denied. We have found the                  require spending in any 1 year of $100


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                                                    44970                           Federal Register / Vol. 80, No. 144 / Tuesday, July 28, 2015 / Notices

                                                    million in 1995 dollars, updated                         DEPARTMENT OF HEALTH AND                               Recovery Framework to report impacts
                                                    annually for inflation. In 2015, that                    HUMAN SERVICES                                         of disasters to ACF-supported human
                                                    threshold is approximately $144                                                                                 services programs to the HHS
                                                    million. This document will have no                      Administration for Children and                        Secretary’s Operation Center (SOC).
                                                    consequential effect on state, local, or                 Families                                               ACF/OHSEPR works in conjunction
                                                    tribal governments or on the private                                                                            with the Assistant Secretary for
                                                                                                             Proposed Information Collection                        Preparedness and Response (ASPR), and
                                                    sector.
                                                                                                             Activity; Comment Request                              the Federal Emergency Management
                                                       Executive Order 13132 establishes                                                                            Agency (FEMA) to ensure that impacted
                                                    certain requirements that an agency                      Proposed Projects
                                                                                                                                                                    ACF programs are returned to their
                                                    must meet when it promulgates a                            Title: Disaster Information Collection               normal or close to normal operations.
                                                    proposed regulatory action (and                          Plans.                                                   The primary purpose of the
                                                    subsequent final action) that imposes                      OMB No.: NEW.                                        information collection pertains to ACF’s
                                                    substantial direct requirement costs on                    Description: This request is for                     initiative to provide real time updates
                                                    state and local governments, preempts                    approval of a plan for conducting more                 during the response and recovery
                                                    state law, or otherwise has Federalism                   than one information collection that is                phases of a disaster; the information
                                                    implications. Because this document                      very similar, voluntary, low-burden and                will be used to respond to inquiries
                                                    does not impose any costs on state or                    uncontroversial. The Information                       about human services response and
                                                    local governments, the requirements of                   collections under this generic clearance               recovery efforts, specifically for
                                                    Executive Order 13132 are not                            will be activated during a disaster.                   individuals, children, and families that
                                                    applicable.                                              These forms will be used after a disaster              need support from ACF programs.
                                                                                                             to develop a technical assistance plan                 Further, the information collection will
                                                       In accordance with the provisions of
                                                                                                             for affected ACF programs.                             be used to support ACF/OHSEPR’s goal
                                                    Executive Order 12866, the Office of
                                                                                                               Presidential Policy Directive-8 (PPD–                to quickly identify critical gaps,
                                                    Management and Budget reviewed this                      8), which was signed into law in 2011,                 resources, needs, and services to
                                                    document.                                                provides federal guidance and planning                 support State, local and non-profit
                                                      Authority: Sections 1102 and 1871 of the               procedures under established phases—                   capacity for disaster case management
                                                    Social Security Act (42 U.S.C. 1302 and                  protection, preparedness, response,                    and to augment and build capacity
                                                    1395hh) and 44 U.S.C. Chapter 35.                        recovery, and mitigation. The data                     where none exists.
                                                      Dated: July 1, 2015.                                   collection addresses response, and                       Respondents: Varies, depending on
                                                                                                             recovery for ACF programs with a                       programmatic impact (could be state
                                                    Andrew M. Slavitt,
                                                                                                             statutory preparedness planning                        administrators, or grantees).
                                                    Acting Administrator, Centers for Medicare               requirement and other programs
                                                    & Medicaid Services.                                     without that requirement.                              Annual Burden Estimates
                                                    [FR Doc. 2015–18327 Filed 7–24–15; 4:15 pm]                ACF/Office of Human Services                           The estimate is based on a single
                                                    BILLING CODE 4120–01–P                                   Emergency Preparedness and Response                    disaster per year. The estimate is for one
                                                                                                             (OHSEPR) has a requirement under                       state administrator to go through all the
                                                                                                             PPD–8, the National Response                           applicable questions with the Regional
                                                                                                             Framework, and the National Disaster                   and Central Office staff, if applicable.

                                                                                                                                                           Number of             Burden
                                                                                                                                  Number of                                                      Total burden
                                                                                 Instrument                                                              responses per          hours per
                                                                                                                                 respondents                                                        hours
                                                                                                                                                           respondent           response

                                                    Program Specific Disaster Information Collection ...................                 50                   15                     0.5             25



                                                      In compliance with the requirements                    for the proper performance of the                      DEPARTMENT OF HEALTH AND
                                                    of Section 506(c)(2)(A) of the Paperwork                 functions of the agency, including                     HUMAN SERVICES
                                                    Reduction Act of 1995, the                               whether the information shall have
                                                    Administration for Children and                          practical utility; (b) the accuracy of the             Administration for Children and
                                                    Families is soliciting public comment                    agency’s estimate of the burden of the                 Families
                                                    on the specific aspects of the                           proposed collection of information; (c)
                                                    information collection described above.                                                                         Administration for Native Americans;
                                                                                                             the quality, utility, and clarity of the
                                                    Copies of the proposed collection of                                                                            Notice of Meeting
                                                                                                             information to be collected; and (d)
                                                    information can be obtained and                          ways to minimize the burden of the
                                                    comments may be forwarded by writing                                                                            AGENCY:Administration for Children
                                                                                                             collection of information on                           and Families, HHS.
                                                    to the Administration for Children and
                                                                                                             respondents, including through the use
                                                    Families, Office of Planning, Research                                                                          ACTION:   Notice of Tribal Consultation.
                                                    and Evaluation, 370 L’Enfant                             of automated collection techniques or
                                                                                                             other forms of information technology.
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                                                    Promenade SW., Washington, DC 20447,                                                                            SUMMARY:   The Department of Health and
                                                    Attn: ACF Reports Clearance Officer.                     Consideration will be given to                         Human Services (HHS), Administration
                                                    Email address: infocollection@                           comments and suggestions submitted                     for Children and Families (ACF), will
                                                    acf.hhs.gov. All requests should be                      within 60 days of this publication.                    host a Tribal Consultation to consult on
                                                    identified by the title of the information               Robert Sargis,                                         ACF programs and tribal priorities.
                                                    collection.
                                                      The Department specifically requests                   Reports Clearance Officer.                             DATES:   September 14, 2015.
                                                    comments on: (a) Whether the proposed                    [FR Doc. 2015–18440 Filed 7–27–15; 8:45 am]            ADDRESSES:901 D Street SW.,
                                                    collection of information is necessary                   BILLING CODE 4184–01–P                                 Washington, DC.


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Document Created: 2018-02-23 09:28:50
Document Modified: 2018-02-23 09:28:50
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionExtension of temporary moratoria.
DatesEffective Date: July 29, 2015.
ContactBelinda Gravel, (410) 786-8934.
FR Citation80 FR 44967 

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