CMS Nationwide Enrollment Moratorium on Hospice and Home Health Agencies

CMS coordinated this action with Vice President JD Vance’s Anti-Fraud Task Force, and the agency describes it as one of the most significant fraud prevention measures in its history. The action builds on the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier moratorium announced on February 27. Each moratorium is initially set for six months and may be extended in additional six-month increments. The moratoria apply to all initial enrollment applications, including certain changes in majority ownership submitted after May 13 and extend to new branch offices and practice locations. Existing enrolled HHAs and hospices may continue to operate, bill Medicare, and submit claims for covered services.

This alert summarizes the key provisions of the moratoria, addresses practical implications for physicians and affiliated professionals, compares the hospice and home health moratoria to the earlier DMEPOS moratorium, and identifies recommended action items for affected providers and their counsel.

Key Provisions of the Hospice and Home Health Moratorium

Scope and Legal Authority

CMS imposed the moratoria pursuant to section 1866(j)(7) of the Social Security Act and 42 C.F.R. § 424.570(a)(2). These provisions authorize the secretary to impose a temporary moratorium on newly enrolling Medicare providers and suppliers upon a determination that there is a “significant potential for fraud, waste, or abuse” with respect to a particular provider or supplier type, geographic location, or both. CMS made the determination in consultation with the US Department of Health and Human Services Office of Inspector General (OIG) and the US Department of Justice.

The moratoria were published in two separate Federal Register notices: Document No. 2026-09717 (HHAs) and Document No. 2026-09718 (hospices).

Affected Provider Types

Beginning May 13, CMS will not enroll any new HHAs or new hospice providers into Medicare. The moratorium also extends to new HHA branch offices and new hospice practice locations. CMS will not permit any such new enrollments during the moratorium period.

Effective Date and Duration

Both moratoria became effective on May 13. CMS implemented each for an initial period of six months and may extend them in additional six-month increments if it deems an extension necessary. CMS will announce extensions and the lifting of the moratorium through Federal Register notices. CMS evaluates whether to extend or lift the moratorium before the end of each six-month period.

Geographic Scope

Unlike prior moratoria (2013–2019), which CMS limited to specific states or counties such as Florida, Michigan, Texas, and New Jersey, these moratoria are nationwide in scope. CMS specifically noted that a nationwide approach eliminates the ability of bad actors to evade detection by shifting across state lines. This vulnerability plagued earlier, geographically limited moratoria.

Circumstances in Which the Moratoria May Be Lifted

CMS may lift a moratorium at any time if (1) the president declares an area a disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act; (2) the circumstances warranting the moratorium have abated or CMS has implemented program safeguards; (3) the secretary declares a public health emergency; or (4) the secretary determines the moratorium is no longer needed.

Enrollment and Re-Enrollment Restrictions

What the Moratoria Prohibit

The moratoria prohibits the processing of any new initial enrollment application from an HHA or hospice submitted after May 13. CMS will deny initial enrollment applications submitted during the moratoria. Applicants will need to resubmit their applications once CMS lifts the moratoria.

The moratoria also apply to non-exempt changes in majority ownership (CIMOs). Under CMS rules, an HHA or hospice that undergoes a CIMO within 36 months after its initial enrollment (or its most recent CIMO) must enroll as a new provider and undergo a state survey or accreditation. Because CMS treats such CIMOs as “new” enrollments, the moratorium blocks them.

What the Moratoria Do Not Affect

Under applicable regulations, the moratoria do not apply to:

• Changes in practice location (except from a location outside the moratorium area to a location inside the moratorium area; however, because the moratorium is nationwide, this exception has limited practical effect for moves within the United States).
• Changes in provider or supplier information, such as phone number or address. 
• Changes in ownership that do not require initial enrollment (i.e., CIMOs outside the 36-month window or those meeting a regulatory exception, such as death of the prior owner).
• Any enrollment application received by the Medicare contractor prior to May 13. 

Exceptions and Hardship Exemptions

CMS’ regulations do not permit exceptions to a moratorium for individual providers or suppliers. Providers may, however, use existing administrative appeal procedures to appeal a denial of billing privileges based on the moratorium. The scope of any such appeal is limited solely to assessing whether the temporary moratorium applies to the provider or supplier appealing the denial.

Post-Moratorium Heightened Screening

Once CMS lifts the moratoria, providers that apply to enroll within six months of the lifting date will be assigned to the “high” screening level if they were previously unable to enroll due to the moratorium. The “high” screening level subjects applicants to site visits and fingerprint-based criminal background checks for owners with 5% or greater ownership interests.

Impact on Existing Enrolled Providers

The moratoria do not affect existing enrolled HHAs and hospices. Existing enrolled providers can generally continue to participate in Medicare, submit claims for covered services, and make certain changes to their enrollment information. Existing providers should, however, continue to comply with all changes-of-information and revalidation reporting requirements.

Impact on Physicians, Podiatrists, and Other Licensed Professionals

Ordering and Referring Privileges

The moratoria apply to institutional provider enrollment (i.e., HHAs and hospices as entities) and do not directly prohibit individual physician or practitioner enrollment in Medicare. Physicians, podiatrists, and other ordering and referring providers who are already enrolled in or have validly opted out of Medicare may continue to order and refer services to currently enrolled HHAs and hospices without interruption.

The Federal Register notice for the hospice moratorium specifically notes that CMS revised its regulations in 2023 to require that the hospice medical director, physician designee, or physician member of the hospice interdisciplinary group, as well as the attending physician, be enrolled in or opted out of Medicare in order for hospice services to be paid. This requirement remains in effect and is separate from the moratorium itself. Physicians associated with enrolled hospices should verify their own individual enrollment status.

Physicians Practicing at Hospice or HHA Locations

Individual physicians and practitioners who practice at or are affiliated with enrolled HHAs and hospices are not directly affected by the moratorium in terms of their personal Medicare enrollment. The moratorium targets the institutional enrollment of HHAs and hospices, not individual provider enrollment under Form CMS-855I or ordering and referring enrollment under Form CMS-855O.

Compliance Implications for Physicians

The Federal Register notices address extensive fraud allegations involving physician kickback arrangements with HHAs and hospices. Examples include physicians accepting payments for referrals and certifying patients as terminally ill when they were not. While the moratoria themselves do not impose new obligations on individual physicians, CMS’ intensified enforcement environment heightens the importance of robust Anti-Kickback Statute and Stark Law compliance for any physician ordering home health services or certifying hospice eligibility. Physicians should also be aware that CMS has begun deactivating individual providers enrolled using the CMS-855O (ordering and referring only) who have not appeared on claims for 13 or more consecutive months.

Telehealth for Hospice Recertification

The nationwide hospice moratorium does not impact the telehealth flexibility currently available for face-to-face recertification requirements. Hospices that are already enrolled can continue to utilize telehealth to conduct recertification encounters. 

Impact on Medicaid

CMS has chosen not to impose the moratorium on Medicaid or the Children’s Health Insurance Program (CHIP) at the federal level. Instead, CMS is allowing each state to decide whether some form of an HHA or hospice moratorium is appropriate for their respective Medicaid and CHIP programs. CMS is encouraging each state to implement a moratorium tailored to its beneficiary population and geographic considerations. CMS is also offering every state and territory the opportunity to consult with CMS on implementing a Medicaid-based moratorium.

Implications for Mergers, Acquisitions, and Growth Strategies

The moratoria have significant implications for transactional activity in the hospice and home health sectors. Any transaction that requires a new Medicare enrollment may face material delays or may not be able to proceed during the moratorium period. This includes transactions involving a new application, a CIMO that CMS treats as a new enrollment, or a restructuring resulting in a new provider number. Competition for acquisition targets with existing Medicare enrollments is expected to intensify, which may affect valuations as the scarcity value of an existing enrollment increases during the moratorium period.

Parties contemplating transactions structured as asset acquisitions or changes in majority ownership should evaluate whether initial enrollment requirements would be triggered under the 36-month rule. The moratorium would also block any such triggered requirements.

Comparison: Hospice and Home Health Moratoria vs. DMEPOS Moratorium

Lessons From the DMEPOS Moratorium Applicable to Hospice and Home Health Providers

The DMEPOS moratorium preceded the hospice and home health moratorium by several months. It offers several instructive points.

First, CMS has made clear that it will closely screen all applications to ensure entities are not attempting to circumvent moratorium restrictions by enrolling under a different provider type. Misrepresentation can result in denial with a reapplication bar of up to 10 years, revocation with a reenrollment bar of up to 10 years, and referral to the OIG for investigation and possible criminal, civil, or administrative penalties. Hospice and home health entities should exercise similar caution.

Second, the DME moratorium experience confirms that CMS intends to rigorously apply the 36-month CIMO rule. The CY 2026 HH PPS final rule extended this rule to DMEPOS suppliers specifically to close what CMS identified as a fraud vulnerability. This signals that CMS will subject transactional structuring around the CIMO rule to heightened scrutiny for hospice and home health entities.

Third, CMS advised existing enrolled suppliers under the DMEPOS moratorium to maintain enrollment records, promptly respond to MAC inquiries, and continue compliance with all revalidation requirements. These practices are equally critical for currently enrolled HHAs and hospices, particularly given the concurrent intensification of enforcement actions.

Fourth, CMS followed the DMEPOS moratorium’s implementation with a request for stakeholder input on its CRUSH (Comprehensive Regulations to Uncover Suspicious Healthcare) initiative by March 20. Providers should anticipate that additional rulemaking may follow the hospice and home health moratorium as well.

Key Takeaways and Action Items

For Prospective HHA and Hospice Providers

1. CMS will deny any initial enrollment application submitted after May 13. Prospective providers should not submit applications during the moratorium period. CMS will reject such applications, and applicants will need to resubmit them after CMS lifts the moratorium.
2. Monitor the Federal Register for notices regarding extensions or the lifting of the moratorium. 
3. Do not attempt to circumvent the moratorium by misrepresenting organizational type. This could result in severe penalties, including bars from future enrollment and criminal referral.

For Existing Enrolled HHAs and Hospices

1. Continue normal operations, claims submission, and compliance with all Medicare requirements. 
2. Maintain current enrollment records, respond timely to MAC communications, and comply with revalidation obligations. 
3. Evaluate any planned expansion involving new branch offices or practice locations, as these are blocked during the moratorium. 
4. Assess whether any pending or planned changes in majority ownership would trigger the 36-month rule, and plan transaction timelines accordingly.

For Parties to M&A Transactions

1. Immediately evaluate whether pending or planned transactions involve enrollment actions subject to the moratoria. Reassess deal timelines and closing conditions. Review purchase agreements for adequate representations, warranties, conditions precedent, and termination rights addressing enrollment delays or denials.
2. For transactions that remain viable, conduct enhanced due diligence on target compliance history, billing patterns, pending investigations, and potential fraud exposure. 

For Physicians and Other Ordering/Referring Providers

1. Verify personal Medicare enrollment or opt-out status. This is particularly important for physicians serving as hospice medical directors or attending physicians.
2. Ensure robust compliance with the Anti-Kickback Statute and Stark Law in all arrangements with HHAs and hospices, given the intensified enforcement environment. 
3. Monitor for potential CMS deactivation of ordering-and-referring-only enrollments (CMS-855O) for non-billing after 13 consecutive months.

For Entities With Grandfathered Applications

Providers that submitted enrollment applications to a Medicare Administrative Contractor before May 13 should retain documentation of the submission date to demonstrate eligibility for the grandfathering exception. 

For All Affected Stakeholders

1. Monitor state-level decisions regarding whether Medicaid and CHIP moratoria will be adopted, as CMS is encouraging states to follow suit. 
2. Engage health care regulatory counsel promptly to assess organizational exposure, evaluate compliance programs, and adjust strategic plans in light of this rapidly evolving regulatory landscape.

For questions about this alert or assistance evaluating the implications of the CMS moratoria for your organization, please contact one of the authors.