Editor's Note: This article was updated May 14 to add industry reactions.
WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) announced May 13 it will be implementing a six-month, nationwide moratorium on new Medicare enrollment for both hospices and home health agencies (HHAs).
The agency said the move is part of the administration's broader anti-fraud crackdown, which has especially targeted federal health care programs.
“We’ve seen systemic and deeply troubling fraud in the hospice and home health space, with bad actors exploiting some of our most vulnerable Medicare patients and stealing money from the American taxpayer,” said CMS Administrator Mehmet Oz. “Today we’re shutting the door on fraud—preventing new bad actors from entering Medicare while we aggressively identify, investigate and remove those already exploiting them. This is about protecting patients, restoring integrity and safeguarding taxpayer dollars.”
During the six-month moratoria, which officially went into effect May 13 but had was expected to be officially published in the Federal Register on May 15, CMS plans to intensify targeted investigations, deploy data analytics and accelerate the removal of hospice and HHA providers from the Medicare program that are suspected of committing fraud. In addition, the moratoria will apply to all applications for initial Medicare enrollment and certain changes in majority ownership. CMS added the moratoria will not impact current enrollments, and existing providers can continue to deliver services to Medicare beneficiaries.
Both moratoria can be extended beyond six months in additional six-month increments; CMS will decide within the six month period whether to extend the moratoria and will publish that information in the Federal Register. Only companies with applications submitted before May 13, 2026 will be considered. Hopsices undergoing non-exempt change in majority enrollment within 36 months of their initial enrollment are required to enroll as new entitities and therefore may not reenroll, the document says.
The moratoria do not include:
- Most changes in practice location
- Changes in ownership unless they require an initial enrollment
CMS said the new home health and hospice moratorium follows its February move to halt new Medicare enrollments by some durable medical equipment providers. "With three separate moratoria now in place, CMS has taken some of the most significant fraud prevention actions in the agency’s history," the agency said in a news release.
Recent actions by CMS include the suspension of payments to 773 hospices and 23 HHAs suspected of fraud in Los Angeles alone, representing $70 million in suspended funds thus far.
The National Alliance for Care at Home said the moratorium isn't the right way to fight fraud.
"The Alliance welcomes the Administration’s focus on combatting fraud, waste and abuse and appreciates that CMS has indicated providers will still be able to conduct face-to-face recertification visits via telehealth during the enrollment moratorium, which will help avoid unnecessary care disruptions for patients and families," the organization said. "However, an enrollment moratorium does not distinguish between bad actors and compliant providers and will ultimately reduce competition and slow innovation. More importantly, an enrollment moratorium raises serious access-to-care concerns in areas where patient demand is growing or existing capacity is already strained, leading to longer wait times, reduced service availability and fewer choices for patients—particularly in rural or underserved communities."
In the document, CMS says it does not believe that the moratoria will have an impact on a substantial number of small businesses. It says that the combined annual number of newly enrolling home health agencies has been less than 400 per year outside California, compared to roughly 11,500 currently enrolled home health agencies that can continue furnishing servies. For hospices, it says, the combined number of new enrollments was about 166 per year from 2023 through 2025—although that excludes Arizona, California, Goergia, Nevada and Texas, which it calls outliers—versus approximately 7,000 currently enrolled hospices.
“The majority of home health and hospice providers deliver compliant, patient-centered and clinically appropriate care to individuals with complex needs, often in their most vulnerable moments,” said Alliance CEO Jennifer Sheets. “CMS must use data-driven, risk-based program integrity measures and focus resources on boots-on-the-ground surveys and enforcement of existing oversight mechanisms that root out the blatantly bad actors without potentially limiting patient access to care or punishing high quality providers operating in good faith.”
The Texas Association for Home Care and Hospice especially praised CMS's decision to extend the moratorium to some changes in minority ownership.
"Ownership flips have been one of the most common tactics fraud networks use to evade detection and addressing them directly is a meaningful step forward," the organization said in a statement May 14, an dalso urged the agency to distinguish between fraudulent operators and those who are mission-driven compliant partners.
Tom Koutsoumpas, founder and CEO of the National Partnership for Hospice and Palliative Care, had previously urged CMS to institute a temporary nationwide moratorium on new hospice provider enrollments—including in the pages of HomeCare magazine.
“On behalf of NPHI and the nonprofit hospice providers we represent across the country, we are fully supportive of CMS taking this decisive step to protect patients, families, and the integrity of the Medicare hospice benefit,” Koutsoumpas said in a statement May 14. “For too long, fraudulent actors have exploited regulatory gaps to infiltrate hospice care, undermine public trust, and take advantage of vulnerable Americans at one of the most difficult moments in their lives. This temporary nationwide moratorium is an important and necessary action to stop fraudulent practices.”
Leading Age also said a temporary moratorium could help, as long as CMS is transparent about the criteria that goes into its decision when to end it.
"Short-term pauses on new provider enrollees ... can be appropriate tools to allow the agency time to develop and implement longer-term solutions," said Leading Age President and CEO Katie Smith Sloan. We support this approach and encourage, as we’ve recommended in recent comment letters, implementing focused approaches to oversight including enhanced site visits, as well as stronger enrollment controls. Such a robust oversight framework should produce desired results so that, when the freeze is lifted, newly enrolled providers are screened more appropriately for participation in the Medicare program and existing bad actors are caught."
Additional information can be found in the Federal Register for the home health moratorium and the hospice moratorium.