Provider Alert: Nationwide Moratoria on Hospice and Home Health Enrollments

The Centers for Medicare & Medicaid Services (“CMS”) has announced another nationwide moratorium on new Medicare provider enrollments just three months after announcing a moratorium on new DMEPOS suppliers. On May 15, 2026, CMS published a notice in the Federal Register announcing a six-month moratorium on the enrollment of new Hospice and Home Health Agencies, echoing similar concerns discussed in the DMEPOS moratorium announcement that a moratorium was warranted as a program integrity measure to prevent Medicare fraud, waste and abuse.

Background Authority and Justification for Implementing Moratorium

Section 6401(a) of the Affordable Care Act added Section 1866(j)(7) to the Social Security Act, which provides the Health and Human Services Secretary (the “Secretary”) with the authority to impose temporary moratoria on the enrollment of new fee-for-service  Medicare, Medicaid or CHIP providers and suppliers if the Secretary determines a moratorium is necessary to prevent fraud, waste or abuse within these programs. 42 C.F.R 424.570 details the parameters under which CMS may impose such a moratorium. Since implementation of this provision, CMS has issued a handful of moratoria, including bans affecting home health agencies and ambulance suppliers in designated areas of the country, as well as the current DMEPOS nationwide moratorium.

In both moratoria notices, CMS highlighted program integrity concerns which led to its decision to implement the moratoria. CMS presented data illustrating a large increase in home health enrollment in certain areas of the country, namely Los Angeles county and Ohio. To support its decision to implement a nationwide moratorium, CMS noted that fraud schemes can be “highly migratory.” 91 Fed. Reg. 27958 (May 15, 2026). CMS further pointed to its long-standing view that home health agencies are among the highest risk Medicare provider types. Indeed, CMS has implemented several provider enrollment safeguards regulating home health agencies including capitalization requirements, assignment to a high-risk screening category, implementation of the 36-month change of ownership rule and the authority to issue a provisional period of enhanced oversight for new providers. According to CMS, despite all of these safeguards, a high risk of fraud, waste and abuse remain. As justification for the hospice moratorium, CMS pointed to the publication of multiple HHS-OIG reports in recent years highlighting the issue of fraud, waste and abuse in the hospice industry. CMS has also noted the increase in concerning activity in recent years. Similar to trends noticed in the home health industry, CMS has noticed an upward trend of potentially fraudulent hospice agencies in certain areas of the country. CMS has also established safeguards applicable to hospice agencies, including switching hospice agencies from the moderate to the high enrollment screening category, expanding the 36-month change of ownership rule to include hospice agencies, permitting CMS to establish a provisional period of enhanced oversight for new providers, requiring both the hospice medical director (or designee) and the attending physician to initially certify a patient’s terminal condition, and clarifying that hospice medical directors and administrators qualify as “managing employees” requiring them to be reported on the hospice’s Medicare enrollment record, allowing for CMS to track and monitor such data. Lastly, CMS pointed to several criminal convictions and findings of health care fraud in recent years involving both home health and hospice agencies.

Scope of Moratorium

The nationwide moratorium prohibits the Medicare enrollment of new hospice and home health agencies. This includes initial hospice and home health agencies trying to enroll in Medicare, as well as new branches or practice locations of existing Medicare-enrolled agencies. The moratorium may also apply to some ownership changes if the transaction results in a hospice or home health agency being treated as a new Medicare provider.

Specifically, when a hospice or home health agency undergoes a change in majority ownership by sale within 36 months after its initial enrollment or its most recent change in majority ownership, it must enroll in Medicare as an initial provider and undergo a state survey or accreditation. This includes changes in majority ownership as a result of asset sales, stock transfers, mergers and consolidations. Acceptance of an agency’s Medicare provider agreement and transfer of billing privileges is not permitted in such circumstances. Under the moratorium, the new owners would be required to wait until the moratorium is lifted prior to enrolling in Medicare.

At a minimum, the hospice and home health agency moratoria will last six months; however, as with past moratoria, CMS has the authority under 42 C.F.R. 424.570(b) to extend each moratorium in six-month increments. CMS will evaluate whether to extend or lift each moratorium prior to the end of the six-month period and will announce any extension in the Federal Register.

While this moratorium severely limits the enrollment activities of both new providers trying to enter the market and existing providers desiring to expand operations, it does not impact the existing operations of enrolled providers. To the contrary, existing providers may continue to operate and file enrollment applications for activities such as revalidation, updates to the provider’s enrollment file, and relocations of existing practice locations to the extent such relocation does not require the provider to enroll the new location as a “new” practice location. Additionally, as with the DMEPOS moratorium, CMS declined to extend the hospice and home health moratoria to Medicaid. Rather, each State will need to determine whether some form of hospice or home health agency moratorium is appropriate for their respective State Medicaid program(s).

Recommendations for Home Health and Hospice Agencies

We have seen the actions CMS is willing to take to curb Medicare fraud, waste and abuse. It is possible CMS will issue additional moratoria in the coming months. The moratoria give CMS time to review and investigate areas of potential fraud, waste and abuse within the current market. We recommend providers review their compliance activities and bolster their efforts to document compliance with applicable program requirements. Enforcement activities will almost certainly continue into the foreseeable future and providers should be prepared to provide evidence of compliance.

“Provider Alert: Nationwide Moratoria on Hospice and Home Health Enrollments”

Written by  Lauren Ambler