CMS Extends Home Health, Hospice Moratoria for 6 Months

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) has extended its nationwide moratoria on new Medicare enrollments for hospices and home health agencies (HHAs) for an additional six months, the agency announced.

The agency said the initial moratoria, which began May 13, prevented potentially fraudulent operators from entering and exploiting Medicare by allowing CMS to conduct targeted investigations and deploy advanced data analytics to identify hospice and home health providers suspected of committing fraud and remove them.

“We’ve made real progress over the past six months, but fraud in hospice and home health persists and our work isn’t finished,” said CMS Administrator Mehmet Oz. “Medicare beneficiaries deserve protection from these bad actors, and American taxpayers need to know the programs they rely on aren’t being bled dry by fraudsters.”

The renewed pause is narrower than before, and allows currently enrolled hospices and HHAs to add new locations within their existing enrollment. That means providers can once again add hospice practice locations and home health branches to meet patient needs—a move praised by the National Alliance for Care at Home.

“By distinguishing between new entrants and established providers with a track record in Medicare, (this) modification reflects the Alliance’s previous recommendations that CMS utilize targeted, data-driven program integrity measures, rather than broad enrollment freezes,” the Alliance said in a statement. “The original moratoria prevented long-standing and legitimate hospices and home health agencies from opening new entities and expanding services to patients. The Alliance is grateful this decision allows long-standing hospices and home health agencies to expand and better serve unmet patient needs.”

Anti-Fraud Efforts Continue

CMS said in its announcement that extending the moratoria for an additional six months is necessary so the agency can continue to monitor providers for indicators of fraud, and, when appropriate, take administrative actions such as payment suspension and revocation to combat this conduct.

As with the original moratoria, the extensions apply nationwide, preventing potentially fraudulent operators from circumventing the enrollment restrictions by moving across state lines. The moratoria extensions will continue to cover new applications for initial Medicare enrollment and some changes in majority ownership.

“We urge CMS to use the next six months to transition to targeted, data-driven enforcement and will continue to work with regulators and policymakers to sharpen existing tools to extract fraudulent operators from the system,” said Alliance President and CEO Jennifer Sheets.

LeadingAge said while fighting fraud is important, extending the moratoria could harm legitimate providers and patient access.

“There are changes to the moratoria that address some of these concerns and represent a step in the right direction,” Leading Age President and CEO Katie Smith Sloan said in a statement. “We welcome CMS’ decision to allow new hospice locations and home health branches, which will help expand access to care in underserved communities and give providers greater flexibility to respond to local needs. At the same time, important challenges remain, and this adjustment does not fully address the broader impact of the continued moratoria.”

The extensions build on CMS’ broader fraud enforcement efforts, including payment suspensions, site visits, fingerprint-based background checks, enhanced enrollment screening, pre- and post-claim review programs and revocations, the agency said, citing an October operation in which is revoked 145 provider enrollments in California in two days. In October, a CMS oficial said that the moratoria were proving effective.

Also, the 2027 home health payment final rule adopted changes to Medicare enrollment rules that would make all revocations—including those for home medical equipment and other providers—retroactive to the date of noncompliance, allowing CMS to recover previous payments. CMS also added or expanded grounds for enrollment denial or revocation, including requirements for hospices and home health agencies to reenroll after certain majority-ownership changes, as well as consequences for license, Medicaid or federal healthcare program suspensions or revocations involving providers, owners, or managing employees and organizations.

Information on the hospice and home health moratoria extensions is published in the Federal Register.