CMS Sets Nationwide Moratoria on New Hospice and Home Health Enrollments in Medicare

Billed as an effort to combat fraud and protect program integrity, the Centers for Medicare & Medicaid Services (CMS) has imposed six‑month nationwide temporary enrollment moratoria on new Medicare hospices and home health agencies (HHAs). The moratoria, which took effect May 13, 2026, allow CMS to temporarily halt the enrollment of these new providers for six months, although CMS has authority to extend one or both moratoria for additional six-month periods as necessary. CMS announced the moratoria in the Federal Register. The hospice announcement is available here, and the HHA announcement is available here.

In announcing the nationwide moratoria, CMS cited rapid growth in hospice and home health providers and pointed to evidence of fraudulent billing schemes. According to CMS, the moratoria are intended to allow regulators to investigate providers it suspects are engaged in fraudulent activity, strengthen oversight mechanisms, and prevent additional high‑risk entities from entering the Medicare program.

Key Takeaways

• Nationwide Medicare enrollment freezes: CMS has imposed nationwide moratoria on new Medicare enrollments for hospice agencies and HHAs.
• Six‑month duration: Each moratorium will remain in effect for at least six months, with the possibility that one or both will be extended.
• Affected providers: CMS will deny Medicare enrollment applications for new hospices, hospice practice locations, HHAs, and HHA branch locations.
• Certain ownership transactions may be blocked: Transactions requiring new Medicare enrollment (new provider number) under the 36‑month rule may be unable to proceed during the moratorium period.
• Providers that are not affected: Providers already enrolled in Medicare may continue operating and updating enrollment records. The moratoria also do not apply to any enrollment application that was received by CMS prior to May 13, 2026.
• Part of broader program integrity efforts: The moratoria reflect CMS's efforts to "use data-driven prevention and real-time enforcement as part of a coordinated federal approach" to prevent fraud.

CMS Authority to Impose Enrollment Moratoria

Section 6401 of the Affordable Care Act added section 1866(j)(7) to the Social Security Act, which authorizes the Secretary of the Department of Health and Human Services (HHS) to impose a temporary moratorium on the enrollment of new fee‑for‑service (FFS) Medicare, Medicaid, or Children's Health Insurance Program (CHIP) providers and suppliers if the Secretary determines that such action is necessary to prevent or combat fraud, waste, or abuse. CMS implemented this authority through regulations at 42 C.F.R. § 424.570, which permit the agency to suspend new Medicare provider and supplier enrollments of a particular type or the establishment of new practice locations of a particular type in a particular geographic area.

CMS previously used the moratorium authority in 2013 to prevent enrollment of: (1) new home health agencies (HHAs) in Miami-Dade County, Florida and Cook County, Illinois, as well as surrounding counties; and (2) Part B ambulance suppliers in Harris County, Texas and surrounding counties. However, those efforts reflected more geographic-specific moratoria, as opposed to a nationwide freeze on new enrollment for hospices and HHAs. More recently, this year, CMS imposed a nationwide moratorium on the enrollment of certain DMEPOS suppliers.

The Big Chill: Scope of the Moratoria

The moratoria authorize CMS to deny new Medicare enrollment applications for hospices and HHAs nationwide.

CMS will not approve:

• Initial Medicare enrollment applications for new hospices or HHAs.
• Applications for new HHA branch offices and hospice practice locations requiring enrollment approval.
• Certain changes in majority ownership that require new enrollment.

However, several important exceptions apply. The moratoria do not affect:

• Providers already enrolled in Medicare.
• Enrollment applications submitted before May 13, 2026.
• Certain ownership transactions in which the buyer assumes the existing provider agreement and billing privileges.
• Changes in practice location.
• Changes in provider or supplier information, such as phone numbers.

Existing providers may continue operating and may update enrollment records for routine matters such as address changes or ownership disclosures.

In addition, the moratoria are limited to Medicare. CMS left it to individual states to determine whether a similar moratorium should be instituted for state Medicaid and CHIP programs, but encouraged states to implement a moratorium if appropriate. From a practical standpoint, however, a Medicare enrollment moratorium is likely to have a chilling effect on the establishment of new hospices and HHAs, regardless of actions taken by state Medicaid or CHIP programs.

Medicare 36‑Month Rule Increases Impact of Moratoria on Changes of Ownership

The moratoria may significantly affect transactions involving hospice and HHAs because of the Medicare "36‑month rule." Under 42 C.F.R. § 424.550, CMS may require a provider to undergo new enrollment rather than a simple change of ownership if certain ownership changes occur within 36 months of the provider's initial enrollment or a prior ownership change. Because CMS is not approving new enrollments during the moratorium period, transactions that trigger the 36-month rule may be delayed or unable to proceed until the moratorium is lifted.

Recent DME Moratorium Demonstrates CMS Willingness to Use Moratoria to Address Fraud

The hospice and HHA enrollment moratoria come on the heels of a moratorium on the new enrollment of seven types of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers in fee-for-service Medicare.[1] In February 2026, CMS imposed a nationwide moratorium on the new enrollment of certain DMEPOS suppliers after identifying billing patterns that the agency concluded presented a heightened risk of fraud and abuse. CMS had previously imposed more targeted moratoria on DMEPOS suppliers in specific geographic areas with unusually high utilization or suspected fraudulent activity. The nationwide DMEPOS moratorium coupled with the hospice and HHA moratoria reflects CMS's increasing willingness to use enrollment freezes as a program‑integrity tool to limit the entry of potentially high‑risk providers into federal healthcare programs while regulators investigate billing practices and strengthen oversight.

Why Hospice and Home Health Are Under Heightened Scrutiny

The hospice and HHA moratoria follow several years of heightened scrutiny of hospice providers, particularly in California. In 2022, the California State Auditor issued a highly critical report finding that weak regulatory oversight had allowed a rapid proliferation of hospice providers, especially in Los Angeles County, creating conditions vulnerable to fraud, patient brokering, and improper billing practices. The report concluded that state regulators lacked sufficient enforcement tools and resources to adequately oversee the growing number of hospice providers. In the years since, federal and state regulators have increased enforcement activity and oversight of hospice enrollment and operations, and policymakers have called for stronger safeguards to address fraud risks in the sector. The nationwide enrollment moratorium for hospices reflects these ongoing concerns and broader efforts by regulators to address suspected fraud in the hospice industry.

Similarly, HHAs have long been a focus of federal fraud enforcement efforts, with regulators identifying recurring schemes involving billing for services that were not medically necessary, enrolling beneficiaries who were not homebound or otherwise eligible for the home health benefit, and paying kickbacks in exchange for patient referrals. Federal prosecutors and the HHS Office of Inspector General have brought numerous enforcement actions involving home health providers, and the sector has frequently been a focus of nationwide healthcare fraud enforcement initiatives. These concerns have led CMS to adopt heightened screening requirements for new HHAs and, in prior years, to impose targeted enrollment moratoria in certain geographic areas where the agency identified unusually high provider growth or suspicious billing patterns. The nationwide moratorium reflects CMS's view that similar program‑integrity risks may now exist on a broader scale.

Fraud Enforcement Heats Up with Enrollment Freeze

The moratoria also align with the Trump Administration's broader emphasis on combating fraud, waste, and abuse across federal healthcare programs, including Medicare and Medicaid. Federal enforcement agencies, including the Department of Justice, the Department of Health and Human Services Office of Inspector General, and CMS, have emphasized increased coordination in identifying fraudulent billing schemes, improper referral arrangements, and ownership structures designed to evade regulatory oversight. Recent enforcement activity has focused heavily on post‑acute care sectors, including hospice, home health, and durable medical equipment suppliers. As federal and state regulators continue prioritizing Medicaid and Medicare program integrity, providers should expect increased audits, investigations, and enforcement activity affecting these sectors.

Implications for Healthcare Transactions and Investors

The moratoria may significantly affect healthcare transactions involving hospice and home health providers.

• Asset acquisitions that require new Medicare enrollment may be difficult or impossible to complete during the moratoria period. As a result, parties may consider equity transactions that preserve an existing provider's Medicare billing privileges. While these structures may allow transactions to proceed, they can expose buyers to potential historical liabilities that asset acquisitions are typically designed to avoid.
• The moratoria may also slow new platform formation and de novo expansion strategies in the hospice and home health sectors. Organizations planning to establish new providers or expand through new branch locations may need to delay those plans until the moratoria expire.

In this environment, investors and lenders should carefully evaluate provider enrollment history, prior ownership changes, and potential exposure to the 36‑month rule as part of transaction diligence. Regulatory risk related to enrollment status may become a more significant factor in transaction timing, deal structure, and valuation.

What Providers Should Consider

Providers and investors operating in these sectors should consider several steps during the moratoria period:

• Evaluate whether proposed transactions could trigger new Medicare enrollment requirements.
• Reassess expansion strategies that depend on new provider enrollment.
• Monitor CMS announcements regarding extensions or modifications to the moratoria.
• Strengthen compliance and documentation practices in light of increased federal scrutiny.

Looking Ahead

The nationwide moratoria reflect broader CMS efforts to strengthen program integrity in post‑acute care sectors, particularly hospice and home health. Providers should expect continued enforcement activity, closer review of ownership structures, and increased scrutiny of billing and referral practices even after the moratoria expire.

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Christine Parkins Johnson is counsel in the Los Angeles office and Marci Love is of counsel in the Washington, D.C. office of DWT. For questions or more insights, please reach out to the authors or another member of our healthcare team and sign up for our alerts.