83 FR 37747 - Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services Federal Register Volume 83, Issue 149 (August 2, 2018)
Centers for Medicare & Medicaid Services
Federal Register Volume 83, Issue 149 (August 2, 2018)
| Page Range | 37747-37750 | |
| FR Document | 2018-16547 |
[Federal Register Volume 83, Number 149 (Thursday, August 2, 2018)] [Rules and Regulations] [Pages 37747-37750] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2018-16547] [[Page 37747]] ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 424 [CMS-6059-N9] Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground 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 statewide temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers and Medicare home health agencies and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey, as applicable, to prevent and combat fraud, waste, and abuse. This extension also applies to the enrollment of new non- emergency ground ambulance suppliers and home health agencies and branch locations in Medicaid and the Children's Health Insurance Program in those states. DATES: Applicable July 29, 2018. FOR FURTHER INFORMATION CONTACT: Jung Kim, (410) 786-9370. News media representatives must contact CMS' Public Affairs Office at (202) 690-6145 or email them at [email protected]. SUPPLEMENTARY INFORMATION: I. Background A. CMS' Implementation of Temporary Enrollment Moratoria The Social Security Act (the Act) provides the Secretary with tools and resources to combat fraud, waste, and abuse in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). In particular, section 1866(j)(7) of the Act provides 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. Regarding Medicaid, section 1902(kk)(4) of the Act requires States to comply with any moratorium imposed by the Secretary unless the State determines that the imposition of such moratorium would adversely impact Medicaid beneficiaries' access to care. In addition, section 2107(e)(1)(F) of the Act provides that the Medicaid provisions in section 1902(kk) are also applicable to CHIP. In the February 2, 2011 Federal Register (76 FR 5862), CMS published a final rule with comment period titled, ``Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers,'' which implemented section 1866(j)(7) of the Act by establishing new regulations at 42 CFR 424.570. Under Sec. 424.570(a)(2)(i) and (iv), CMS, or CMS in consultation with the Department of Health and Human Services' Office of Inspector General (HHS OIG) or the Department of Justice (DOJ), or both, may impose a temporary moratorium on newly enrolling Medicare providers and suppliers if CMS determines that there is a significant potential for fraud, waste, or abuse with respect to a particular provider or supplier type, or particular geographic locations, or both. At Sec. 424.570(a)(1)(ii), CMS stated that it would announce any temporary moratorium in a Federal Register document that includes the rationale for the imposition of such moratorium. This document fulfills that requirement. In accordance with section 1866(j)(7)(B) of the Act, there is no judicial review under sections 1869 and 1878 of the Act, or otherwise, of the decision to impose a temporary enrollment moratorium. A provider or supplier may use the existing appeal procedures at 42 CFR part 498 to administratively appeal a denial of billing privileges based on the imposition of a temporary moratorium; however, the scope of any such appeal is limited solely to assessing whether the temporary moratorium applies to the provider or supplier appealing the denial. Under Sec. 424.570(c), CMS denies the enrollment application of a provider or supplier if the provider or supplier is subject to a moratorium. If the provider or supplier was required to pay an application fee, the application fee will be refunded if the application was denied as a result of the imposition of a temporary moratorium (see Sec. 424.514(d)(2)(v)(C)). 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 Medicare Part B ground ambulance suppliers in Harris County, Texas and surrounding counties, in a notice issued on July 31, 2013 (78 FR 46339).\2\ We 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 them 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. --------------------------------------------------------------------------- \1\ As noted in the preamble to the final rule with comment period implementing the moratorium authority (February 2, 2011, 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. \2\ CMS has identified an error in the provider and beneficiary saturation data described in our July 31, 2013 Federal Register notice (78 FR 46339). We have subsequently revised the methodology by which we determine provider and beneficiary saturation. Following these revisions to the methodology, we simulated application of our current 2016 methodology to the 2013 data, and determined that the 2013 decision to impose the moratorium would not have been impacted had the revised methodology been applied. Provider saturation remains one of the criteria used to determine whether to implement a moratorium. CMS has made market saturation data publicly available at https://data.cms.gov/market-saturation. --------------------------------------------------------------------------- Then, we further extended these moratoria in documents issued on August 1, 2014 (79 FR 44702), February 2, 2015 (80 FR 5551), July 28, 2015 (80 FR 44967), and February 2, 2016 (81 FR 5444). On August 3, 2016 (81 FR 51120), we extended the current moratoria for an additional 6 months and expanded them to statewide for the enrollment of new HHAs in Florida, Illinois, Michigan, and Texas, and Part B non-emergency ambulance suppliers in New Jersey, Pennsylvania, and Texas. Our August 3, 2016 publication also announced the lifting of temporary moratoria for all Part B emergency ambulance suppliers.\3\ On January 9, 2017 (82 FR 2363) and July 28, 2017 (82 FR 35122), CMS again issued a [[Page 37748]] document to extend the temporary moratoria for a period of 6 months. --------------------------------------------------------------------------- \3\ CMS also concurrently announced a demonstration under the authority provided in section 402(a)(l)(J) of the Social Security Amendments of 1967 (42 U.S.C. 1395b-l(a)(l)(J)) that allows for access to care-based exceptions to the moratoria in certain limited circumstances after a heightened review of that provider has been conducted. This exception process also applies to Medicaid and CHIP providers in each state. This announcement may be found in the Federal Register document issued on August 3, 2016 (81 FR 51116). --------------------------------------------------------------------------- On September 1, 2017, CMS lifted the statewide temporary moratorium on the enrollment of new Medicare Part B non-emergency ground ambulance suppliers in Texas under the authority of Sec. 424.570(d). This lifting of the moratorium also applied to Medicaid and CHIP in Texas. This decision was a result of the Presidential Disaster Declaration signed on August 25, 2017 for several counties in the State of Texas due to Hurricane Harvey. Upon declaration of the disaster, CMS carefully reviewed the potential impact of continued moratoria in Texas, and decided to lift the temporary enrollment moratorium on non- emergency ground ambulance suppliers in Texas in order to aid in the disaster response. CMS published a formal announcement of this decision on November 3, 2017 (82 FR 51274). Most recently, on January 30, 2018 (83 FR 4147), CMS announced the extension of the temporary moratoria for an additional six months. B. Determination of the Need for Moratoria 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)). Because fraud schemes are highly migratory and transitory in nature, many of CMS' program integrity authorities and anti-fraud activities are designed to allow the agency to adapt to emerging fraud in different locations. The laws and regulations governing CMS' moratoria authority give us flexibility to use any and all relevant criteria for future moratoria, and CMS may rely on additional or different criteria as the basis for future moratoria. 1. Application to Medicaid and the Children's Health Insurance Program (CHIP) The February 2, 2011, final rule also implemented section 1902(kk)(4) of the Act, establishing new Medicaid regulations at Sec. 455.470. Under Sec. 455.470(a)(1) through (3), the Secretary may impose a temporary moratorium, in accordance with Sec. 424.570, on the enrollment of new providers or provider types after consulting with any affected State Medicaid agencies. The State Medicaid agency must impose a temporary moratorium on the enrollment of new providers or provider types identified by the Secretary as posing an increased risk to the Medicaid program unless the State determines that the imposition of such moratorium would adversely affect Medicaid beneficiaries' access to medical assistance and so notifies the Secretary. The final rule also implemented section 2107(e)(1)(D) of the Act by providing, at Sec. 457.990 of the regulations, that all of the provisions that apply to Medicaid under sections 1902(a)(77) and 1902(kk) of the Act, as well as the implementing regulations, also apply to CHIP. Section 1866(j)(7) of the Act authorizes imposition of a temporary enrollment moratorium for Medicare, Medicaid, and/or CHIP, ``if the Secretary determines such moratorium is necessary to prevent or combat fraud, waste, or abuse under either such program.'' While there may be exceptions, CMS believes that generally, a category of providers or suppliers that poses a risk to the Medicare program also poses a similar risk to Medicaid and CHIP. Many of the anti-fraud provisions in the Act reflect this concept of ``reciprocal risk'' in which a provider that poses a risk to one program poses a risk to the other programs. For example, section 1902(a)(39) of the Act requires State Medicaid agencies to terminate the participation of an individual or entity if such individual or entity is terminated under Medicare or any other State Medicaid plan. Additional provisions in the Act also support the determination that categories of providers and suppliers pose the same risk to Medicaid as to Medicare. Section 1866(j) of the Act requires us to establish levels of screening for categories of providers and suppliers based on the risk of fraud, waste, and abuse determined by the Secretary. Section 1902(kk) of the Act requires State Medicaid agencies to screen providers and suppliers based on the same levels established for the Medicare program. This reciprocal concept is also reflected in the Medicare moratoria regulations at Sec. 424.570(a)(2)(ii) and (iii), which permit CMS to impose a Medicare moratorium based solely on a State imposing a Medicaid moratorium. Accordingly, CMS has determined that there is a reasonable basis for concluding that a category of providers or suppliers that poses a risk to Medicare also poses a similar risk to Medicaid and CHIP, and that a moratorium in all of these programs is necessary to effectively combat this risk. 2. Consultation With Law Enforcement In consultation with the HHS Office of Inspector General (OIG) and the Department of Justice (DOJ), CMS previously 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). 3. Data Analysis In addition to consulting with law enforcement, CMS also analyzed its own data to identify specific provider and supplier types within geographic locations with significant potential for fraud, waste or abuse, therefore warranting the imposition of enrollment moratoria. 4. 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 with every imposition and extension of the moratoria. Prior to imposing and extending 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. All of CMS' State partners were supportive of CMS' analysis and proposals, and together with CMS, determined that continuation of these moratoria would not create access to care issues for Medicaid or CHIP beneficiaries. 5. When a Temporary Moratorium Does Not Apply Under Sec. 424.570(a)(1)(iii), a temporary moratorium does not apply to any of the following: (1) Changes in practice [[Page 37749]] location (2) changes in provider or supplier information, such as phone number or address; or (3) changes in ownership (except changes in ownership of HHAs that require initial enrollment under Sec. 424.550). Also, in accordance with Sec. 424.570(a)(1)(iv), a temporary moratorium does not apply to any enrollment application that a Medicare contractor has already approved, but has not yet entered into the Provider Enrollment, Chain, and Ownership System (PECOS) at the time the moratorium is imposed. 6. 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 the end of the initial 6-month period and, if applicable, any subsequent moratorium periods. If one or more of the moratoria announced in this document are extended, CMS will publish a document regarding such extensions in the Federal Register. As provided in Sec. 424.570(d), CMS may lift a moratorium at any time if the President declares an area a disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, if circumstances warranting the imposition of a moratorium have abated, if the Secretary has declared a public health emergency, or if, in the judgment of the Secretary, the moratorium is no longer needed. Once a moratorium is lifted, the provider or supplier types that were unable to enroll because of the moratorium will be designated to the ``high'' screening level in accordance with Sec. Sec. 424.518(c)(3)(iii) and 455.450(e)(2) if such provider or supplier applies at any time within 6 months from the date the moratorium was lifted. II. Extension of Home Health and Ambulance Moratoria--Geographic Locations CMS currently has in place statewide moratoria on newly enrolling HHAs in Florida, Illinois, Michigan, and Texas and Part B non-emergency ambulance suppliers in New Jersey and Pennsylvania. 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 Part B non-emergency ground ambulance providers and suppliers in the geographic locations discussed herein. Under the regulations at Sec. 455.470 and Sec. 457.990, these moratoria also apply to the enrollment of HHAs and non-emergency ground ambulance providers and suppliers in Medicaid and CHIP in those locations. 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 Part B non-emergency ground ambulance providers and suppliers in all of the moratoria states, and HHS-OIG agrees that a significant potential for fraud, waste, and abuse continues to exist regarding those provider and supplier types 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 to combat fraud and abuse, 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 states at this time. CMS also reviewed Medicare data for these states and found there are no current problems with access to HHAs or ground ambulance providers or 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 current 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 and implement temporary enrollment moratoria on HHAs for all counties in Florida, Illinois, Michigan, and Texas, as well as Part B non-emergency ground ambulance providers and suppliers for all counties in New Jersey and Pennsylvania. 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. However, we reiterate 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 [[Page 37750]] 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 Part B non-emergency ground ambulance suppliers in Medicare, Medicaid, and CHIP in certain states. Though savings may accrue by denying enrollments, the monetary amount cannot be quantified. Since the imposition of the initial moratoria on July 31, 2013, more than 1204 HHAs and 26 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 less than $7.5 million to $38.5 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 (MSA) for Medicare payment purposes 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 million in 1995 dollars, updated annually for inflation. In 2018, that threshold is approximately $150 million. This document will have no consequential effect on state, local, or tribal governments or on the private sector. Executive Order 13771, titled ``Reducing Regulation and Controlling Regulatory Costs,'' was issued on January 30, 2017 (82 FR 9339, February 3, 2017). It has been determined that this notice is a transfer notice that does not impose more than de minimis costs and thus is not a regulatory action for the purposes of E.O. 13771. 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, this document was reviewed by the Office of Management and Budget. Dated: July 17, 2018. Seema Verma, Administrator, Centers for Medicare & Medicaid Services. [FR Doc. 2018-16547 Filed 7-30-18; 11:15 am] BILLING CODE 4120-01-P
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DEPARTMENT OF HEALTH AND moratorium imposed by the Secretary locations 1 (hereafter referred to as
HUMAN SERVICES unless the State determines that the HHAs) in Miami-Dade County, Florida
imposition of such moratorium would and Cook County, Illinois, as well as
Centers for Medicare & Medicaid adversely impact Medicaid surrounding counties, and Medicare
Services beneficiaries’ access to care. In addition, Part B ground ambulance suppliers in
section 2107(e)(1)(F) of the Act provides Harris County, Texas and surrounding
42 CFR Part 424 that the Medicaid provisions in section counties, in a notice issued on July 31,
[CMS–6059–N9] 1902(kk) are also applicable to CHIP. 2013 (78 FR 46339).2 We exercised this
In the February 2, 2011 Federal authority again in a notice published on
Medicare, Medicaid, and Children’s Register (76 FR 5862), CMS published a February 4, 2014 (79 FR 6475) when we
Health Insurance Programs: final rule with comment period titled, extended the existing moratoria for an
Announcement of the Extension of ‘‘Medicare, Medicaid, and Children’s additional 6 months and expanded them
Temporary Moratoria on Enrollment of Health Insurance Programs; Additional to include enrollment of HHAs in
Part B Non-Emergency Ground Screening Requirements, Application Broward County, Florida; Dallas
Ambulance Suppliers and Home Health Fees, Temporary Enrollment Moratoria, County, Texas; Harris County, Texas;
Agencies in Designated Geographic Payment Suspensions and Compliance and Wayne County, Michigan and
Locations Plans for Providers and Suppliers,’’
surrounding counties, and enrollment of
which implemented section 1866(j)(7) of
AGENCY: Centers for Medicare & ground ambulance suppliers in
the Act by establishing new regulations
Medicaid Services (CMS), HHS. Philadelphia, Pennsylvania and
at 42 CFR 424.570. Under
ACTION: Extension of temporary § 424.570(a)(2)(i) and (iv), CMS, or CMS surrounding counties.
moratoria. in consultation with the Department of Then, we further extended these
Health and Human Services’ Office of moratoria in documents issued on
SUMMARY: This document announces the
Inspector General (HHS OIG) or the August 1, 2014 (79 FR 44702), February
extension of statewide temporary
Department of Justice (DOJ), or both, 2, 2015 (80 FR 5551), July 28, 2015 (80
moratoria on the enrollment of new
may impose a temporary moratorium on FR 44967), and February 2, 2016 (81 FR
Medicare Part B non-emergency ground
newly enrolling Medicare providers and 5444). On August 3, 2016 (81 FR 51120),
ambulance providers and suppliers and
suppliers if CMS determines that there we extended the current moratoria for
Medicare home health agencies and
is a significant potential for fraud, an additional 6 months and expanded
branch locations in Florida, Illinois,
waste, or abuse with respect to a them to statewide for the enrollment of
Michigan, Texas, Pennsylvania, and
particular provider or supplier type, or new HHAs in Florida, Illinois,
New Jersey, as applicable, to prevent
particular geographic locations, or both. Michigan, and Texas, and Part B non-
and combat fraud, waste, and abuse.
At § 424.570(a)(1)(ii), CMS stated that it emergency ambulance suppliers in New
This extension also applies to the
would announce any temporary Jersey, Pennsylvania, and Texas. Our
enrollment of new non-emergency
moratorium in a Federal Register August 3, 2016 publication also
ground ambulance suppliers and home
document that includes the rationale for announced the lifting of temporary
health agencies and branch locations in
the imposition of such moratorium. This moratoria for all Part B emergency
Medicaid and the Children’s Health
document fulfills that requirement. ambulance suppliers.3 On January 9,
Insurance Program in those states.
In accordance with section 2017 (82 FR 2363) and July 28, 2017 (82
DATES: Applicable July 29, 2018. 1866(j)(7)(B) of the Act, there is no FR 35122), CMS again issued a
FOR FURTHER INFORMATION CONTACT: Jung judicial review under sections 1869 and
Kim, (410) 786–9370. 1878 of the Act, or otherwise, of the 1 As noted in the preamble to the final rule with
News media representatives must decision to impose a temporary comment period implementing the moratorium
contact CMS’ Public Affairs Office at enrollment moratorium. A provider or authority (February 2, 2011, 76 FR 5870), home
(202) 690–6145 or email them at press@ supplier may use the existing appeal health agency subunits and branch locations are
cms.hhs.gov. procedures at 42 CFR part 498 to subject to the moratoria to the same extent as any
other newly enrolling home health agency.
SUPPLEMENTARY INFORMATION: administratively appeal a denial of 2 CMS has identified an error in the provider and
I. Background billing privileges based on the beneficiary saturation data described in our July 31,
imposition of a temporary moratorium; 2013 Federal Register notice (78 FR 46339). We
A. CMS’ Implementation of Temporary however, the scope of any such appeal have subsequently revised the methodology by
which we determine provider and beneficiary
Enrollment Moratoria is limited solely to assessing whether saturation. Following these revisions to the
The Social Security Act (the Act) the temporary moratorium applies to the methodology, we simulated application of our
provides the Secretary with tools and provider or supplier appealing the current 2016 methodology to the 2013 data, and
denial. Under § 424.570(c), CMS denies determined that the 2013 decision to impose the
resources to combat fraud, waste, and moratorium would not have been impacted had the
abuse in Medicare, Medicaid, and the the enrollment application of a provider revised methodology been applied. Provider
Children’s Health Insurance Program or supplier if the provider or supplier is saturation remains one of the criteria used to
(CHIP). In particular, section 1866(j)(7) subject to a moratorium. If the provider determine whether to implement a moratorium.
or supplier was required to pay an CMS has made market saturation data publicly
of the Act provides the Secretary with available at https://data.cms.gov/market-saturation.
authority to impose a temporary application fee, the application fee will 3 CMS also concurrently announced a
moratorium on the enrollment of new be refunded if the application was demonstration under the authority provided in
Medicare, Medicaid, or CHIP providers denied as a result of the imposition of section 402(a)(l)(J) of the Social Security
a temporary moratorium (see Amendments of 1967 (42 U.S.C. 1395b–l(a)(l)(J))
and suppliers, including categories of
daltland on DSKBBV9HB2PROD with RULES
that allows for access to care-based exceptions to
providers and suppliers, if the Secretary § 424.514(d)(2)(v)(C)). the moratoria in certain limited circumstances after
determines a moratorium is necessary to Based on this authority and our a heightened review of that provider has been
prevent or combat fraud, waste, or abuse regulations at § 424.570, we initially conducted. This exception process also applies to
imposed moratoria to prevent Medicaid and CHIP providers in each state. This
under these programs. Regarding announcement may be found in the Federal
Medicaid, section 1902(kk)(4) of the Act enrollment of new home health Register document issued on August 3, 2016 (81 FR
requires States to comply with any agencies, subunits, and branch 51116).
VerDate Sep<11>2014 15:51 Aug 01, 2018 Jkt 244001 PO 00000 Frm 00013 Fmt 4700 Sfmt 4700 E:\FR\FM\02AUR1.SGM 02AUR1](https://thefederalregister.org/doc/83_FR_37896/page/1.svg)
![37750 Federal Register / Vol. 83, No. 149 / Thursday, August 2, 2018 / Rules and Regulations
Flexibility Act (RFA) (September 19, hospital as a hospital that is located SUMMARY: In this document, the
1980, Pub. L. 96–354), section 1102(b) of outside of a metropolitan statistical area Commission amends its rules governing
the Social Security Act, section 202 of (MSA) for Medicare payment purposes the Emergency Alert System (EAS) by
the Unfunded Mandates Reform Act of and has fewer than 100 beds. CMS is not establishing the Alert Reporting System
1995 (March 22, 1995; Pub. L. 104–4), preparing an analysis for section 1102(b) (ARS), a comprehensive online filing
Executive Order 13132 on Federalism of the Act because it has determined, system for EAS that combines the
(August 4, 1999) and the Congressional and the Secretary certifies, that this existing EAS Test Reporting System
Review Act (5 U.S.C. 804(2)). Executive document will not have a significant (ETRS) with a new, streamlined
Orders 12866 and 13563 direct agencies impact on the operations of a substantial electronic system for the filing of State
to assess all costs and benefits of number of small rural hospitals. EAS Plans. By replacing paper-based
available regulatory alternatives and, if Section 202 of the Unfunded State EAS Plans with an online filing
regulation is necessary, to select Mandates Reform Act of 1995 also system, the ARS will minimize the
regulatory approaches that maximize requires that agencies assess anticipated burdens on State Emergency
net benefits (including potential costs and benefits before issuing any Communications Committees (SECCs),
economic, environmental, public health, regulatory action whose mandates and allow the FCC, the Federal
and safety effects, distributive impacts, require spending in any 1 year of $100 Emergency Management Agency
and equity). A regulatory impact million in 1995 dollars, updated (FEMA), and other authorized entities to
analysis (RIA) must be prepared for annually for inflation. In 2018, that better access and use up-to-date
major regulatory actions with threshold is approximately $150 information about the EAS, thus
economically significant effects ($100 million. This document will have no increasing its value as a tool to protect
million or more in any 1 year). This consequential effect on state, local, or life and property for all Americans.
document will prevent the enrollment tribal governments or on the private
of new home health providers and Part sector. DATES: Effective September 4, 2018.
B non-emergency ground ambulance Executive Order 13771, titled Mandatory compliance dates: FCC will
suppliers in Medicare, Medicaid, and ‘‘Reducing Regulation and Controlling publish a document in the Federal
CHIP in certain states. Though savings Regulatory Costs,’’ was issued on Register announcing dates as outlined
may accrue by denying enrollments, the January 30, 2017 (82 FR 9339, February in paragraphs 54–55 and 72–73 in
monetary amount cannot be quantified. 3, 2017). It has been determined that SUPPLEMENTARY INFORMATION.
Since the imposition of the initial this notice is a transfer notice that does FOR FURTHER INFORMATION CONTACT:
moratoria on July 31, 2013, more than not impose more than de minimis costs Austin Randazzo, Attorney Advisor,
1204 HHAs and 26 ambulance and thus is not a regulatory action for Policy and Licensing Division, Public
companies in all geographic areas the purposes of E.O. 13771. Safety and Homeland Security Bureau,
affected by the moratoria had their Executive Order 13132 establishes at 202–418–1462, or by email at
applications denied. We have found the certain requirements that an agency Austin.Randazzo@fcc.gov. For
number of applications that are denied must meet when it promulgates a additional information concerning the
after 60 days declines dramatically, as proposed regulatory action (and information collection requirements
most providers and suppliers will not subsequent final action) that imposes contained in this document, send an
submit applications during the substantial direct requirement costs on email to PRA@fcc.gov or contact Nicole
moratoria period. Therefore, this state and local governments, preempts Ongele, Office of Managing Director,
document does not reach the economic state law, or otherwise has Federalism Performance Evaluation and Records
threshold, and thus is not considered a implications. Because this document Management, 202–418–2991, or by
major action. does not impose any costs on state or email to PRA@fcc.gov.
The RFA requires agencies to analyze local governments, the requirements of
options for regulatory relief of small Executive Order 13132 are not SUPPLEMENTARY INFORMATION: This is a
entities. For purposes of the RFA, small applicable. summary of the Commission’s Report
entities include small businesses, In accordance with the provisions of and Order (Report and Order) in PS
nonprofit organizations, and small Executive Order 12866, this document Docket No. 15–94, FCC 18–39, released
governmental jurisdictions. Most was reviewed by the Office of on April 10, 2018. The full text of this
hospitals and most other providers and Management and Budget. document is available for inspection
suppliers are small entities, either by and copying during normal business
Dated: July 17, 2018. hours in the FCC Reference Center
nonprofit status or by having revenues Seema Verma,
of less than $7.5 million to $38.5 (Room CY–1257), 445 12th Street SW,
Administrator, Centers for Medicare & Washington, DC 20554, or online at:
million in any one year. Individuals and Medicaid Services.
states are not included in the definition https://www.fcc.gov/document/fcc-
[FR Doc. 2018–16547 Filed 7–30–18; 11:15 am] make-emergency-alert-system-more-
of a small entity. CMS is not preparing
an analysis for the RFA because it has BILLING CODE 4120–01–P effective.
determined, and the Secretary certifies, Synopsis
that this document will not have a
significant economic impact on a FEDERAL COMMUNICATIONS 1. This Report and Order revises the
substantial number of small entities. COMMISSION Commission’s EAS rules to establish the
In addition, section 1102(b) of the Act Alert Reporting System (ARS), a
requires us to prepare a regulatory 47 CFR Part 11 comprehensive online filing system that
will combine the existing EAS Test
daltland on DSKBBV9HB2PROD with RULES
impact analysis if an action may have a [PS Docket No. 15–94; FCC 18–39]
significant impact on the operations of Reporting System (ETRS) with a new,
a substantial number of small rural Emergency Alert System streamlined electronic system for the
hospitals. This analysis must conform to AGENCY: Federal Communications filing of State EAS Plans. Further, to
the provisions of section 604 of the Commission. ensure that the rules for State EAS Plans
RFA. For purposes of section 1102(b) of are clear and unambiguous, the Report
ACTION: Final rule.
the Act, CMS defines a small rural and Order combines all State EAS Plan
VerDate Sep<11>2014 15:51 Aug 01, 2018 Jkt 244001 PO 00000 Frm 00016 Fmt 4700 Sfmt 4700 E:\FR\FM\02AUR1.SGM 02AUR1](https://thefederalregister.org/doc/83_FR_37896/page/4.svg)
Document Created: 2018-08-02 01:29:32
Document Modified: 2018-08-02 01:29:32
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Rules and Regulations | |
| Action | Extension of temporary moratoria. | |
| Dates | Applicable July 29, 2018. | |
| Contact | Jung Kim, (410) 786-9370. | |
| FR Citation | 83 FR 37747 |
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