CMS Home Health and Hospice Enrollment Moratorium
Tuesday, September 1st, 2026
By: Rossanna J. Madrigal, JD, MPH
The Centers for Medicare and Medicaid Services (“CMS”) announced a temporary nationwide moratorium on initial Medicare enrollments for home health agencies and hospices on May 13, 2026. This moratorium comes at the heels of an identical temporary bar on initial Medicare enrollments for durable medical equipment (“DME”) suppliers, which was announced in February. CMS stated that the moratoria are intended to protect the integrity of the Medicare program and weed out fraud in the system. The home health and hospice moratorium is currently in effect until November 12, 2026, however CMS has the authority to extend the moratorium for additional six-month periods.
Authority and Specifics
Federal law permits CMS to impose temporary moratoria on new enrollments for Medicare providers and suppliers under certain circumstances, including if CMS determines that there is a significant potential for fraud, waste or abuse with respect to the provider type or region; a State Medicaid program imposes a moratorium on Medicaid providers that are also eligible for Medicare enrollment; or a State has imposed a geographic moratorium on enrollment. CMS has discretion to place the moratorium on specific provider or supplier types and geographic regions.
From 2013 to 2018, CMS imposed several similar moratoria that were limited in provider type and by region. The first nationwide moratorium was the DME moratorium announced in February. The breadth of these moratoria has been met with mixed support, with agencies and professional associations applauding CMS’ commitment to combating fraud but questioning the extensive nature of a nationwide ban on initial enrollments for three different types of Medicare providers.
Impact on New Providers
New providers wishing to submit initial enrollment applications to Medicare are barred from doing so during the moratorium period. This includes currently enrolled providers that are attempting to open a new location (i.e., submitting a new enrollment application for the new location). Until the moratorium is lifted, home health and hospice providers will be unable to initiate new enrollments with Medicare. Any applications that are attempted will be denied.
Impact on Enrolled Providers
Current providers that are already enrolled in Medicare are not generally impacted by the moratorium. These providers can continue to operate, submit revalidations, and perform routine updates and changes to their enrollments with no issues. However, enrolled providers that undergo changes in majority ownership will be prevented from initiating a new enrollment, so it is imperative that providers understand these restrictions to avoid losing their enrolled status.
Change of Majority Ownership
When an individual or entity purchases a home health agency or hospice, that purchase must be reported to Medicare. Generally, buyers of these types of providers are able to take over an existing home health agency’s or hospice’s provider agreement and Medicare billing privileges. However, if the change is considered a change in majority ownership, then the provider will be prevented from enrolling during the moratorium period.
CMS defines a “change in majority ownership” or “CIMO” as a situation where an individual or entity acquires more than 50% of the direct ownership interest in a home health agency or hospice within 36 months of either of the following:
(1) The home health agency or hospice’s most recent CIMO, or
(2) The home health agency or hospice’s initial enrollment in Medicare.
Direct ownership interest includes acquisition of assets or stock, and can be achieved through outright purchase, merger, or consolidation. Furthermore, step-wise transactions occurring over the 36-month period can meet the definition of a CIMO, if the transactions cumulatively equal more than 50% of the direct ownership of a home health agency or hospice.
If a home health agency or hospice undergoes a CIMO, then it must initiate a new enrollment application with Medicare unless it can meet one of the few narrow exceptions to the rule. This restriction is referred to as the 36-month rule. If a home health agency or hospice undergoes a CIMO during the nationwide moratorium, and it cannot meet an exception to the 36-month rule, then it will be prevented from enrolling in Medicare until the moratorium is lifted.
Home health agencies and hospices, and any potential buyers, should be aware of the 36-month rule as well as the definition of and exceptions to a CIMO so that they can appropriately plan for ownership structure changes. Experienced healthcare counsel can assist and advise on these issues to ensure that your transaction is structured appropriately and to mitigate concerns about enrollment issues after closing.
To learn more, connect with Rossanna J. Madrigal for guidance on healthcare regulatory matters, including Medicare and Medicaid enrollment, licensing, and structuring transactions with healthcare regulations in mind. As a Senior Attorney in the healthcare group at Brown & Fortunato, Rossanna represents home health agencies, hospices, DME suppliers, pharmacies, and other providers. Reach out at 806-345-6308 or rmadrigal@bf-law.com to discuss how she can help support your healthcare business.
This article is for informational purposes only and does not constitute legal advice or establish an attorney-client relationship. This article was prepared on a specific date, and the law may have changed since it was written. You should contact your attorney to obtain advice with respect to your specific legal issue and needs.