CMS Announces Nationwide Six-Month Hospice and Home Health Enrollment Moratoria 

Hospice and Home Health Moratorium 

The Centers for Medicare and Medicaid Services (CMS) posted notices in the Federal Register on May 13, 2026, announcing 6-month nationwide moratoria on the Medicare enrollment of hospices and home health agencies (HHAs). These moratoria are effective on May 13, 2026. 
 
If CMS deems it necessary, the moratoria may be extended in 6-month increments. CMS evaluates whether to extend or lift the moratorium before the end of the initial 6-month period and, if applicable, before the expiration of any subsequent moratorium period. If the moratorium announced in this notice is extended, CMS will publish a document regarding such extension(s) in the Federal Register. 
 
With the need to prevent potential fraud before it begins rather than after the fact, CMS has determined to impose nationwide moratoria on the enrollment of hospices, hospice practice locations, HHAs, HHA branches, and HHA practice locations. 
 
Beginning on May 13, 2026: 

• No new hospices or hospice practice locations will be enrolled in Medicare unless the hospice’s enrollment application was received by the applicable Medicare contractor prior to the effective date. 
• No new HHAs or HHA branches or practice locations will be enrolled into Medicare unless the HHA’s enrollment application was received by the applicable Medicare contractor prior to this notice’s effective date. 
   
  Geographically, the moratoria apply to providers seeking to enroll anywhere in the United States, including all States, territories, and the District of Columbia. 
   
  An HHA “branch office,” is defined in 42 CFR 484.2 as an approved location or site from which an HHA provides services within a portion of the total geographic area served by the parent HHA – the parent providing supervision and administrative control of the branch. The branch need not independently meet the HHA CoPs. For purposes of provider enrollment, CMS has always considered an HHA branch to be a practice location of the HHA. 
   
  Providers undergoing a non-exempt change in majority ownership (CIMO) within 36 months of initial enrollment (or within 36 months of the most recent CIMO) must enroll in Medicare as a brand-new provider and undergo a state survey or deemed status accreditation. The provider’s current enrollment and provider agreements are terminated. This means the provider’s new enrollment is an initial enrollment similar to a provider that has never enrolled in Medicare before. Hence, the moratoria will prevent providers undergoing a non-exempt CIMO from reenrolling in Medicare because it would constitute an initial enrollment; the provider is “new.” 
   
  CMS does not believe that a national moratorium will threaten beneficiaries’ ability to receive hospice or home health services in any of these programs. However, CMS will monitor for any access to care issues, including in rural areas. 

CHAP will also be hosting a webinar on Friday, May 15, covering what is currently known about the moratoria, operational considerations, and questions providers are already beginning to raise across hospice and home health. 

Moratorium Cessation 

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) circumstances warranting the imposition of a moratorium have abated or CMS has implemented program safeguards to address the program vulnerability; 
 
(3) the Secretary has declared a public health emergency; or 
 
(4) in the judgment of the Secretary, the moratorium is no longer needed. 
 
Once a moratorium is lifted, the provider or supplier types that were unable to enroll because of the moratorium will be assigned to the “high” screening level in accordance with §§ 424.518(c)(3)(iii) and 455.450(e)(2) if such provider or supplier applies for enrollment at any time within 6 months from the date the moratorium was lifted. 

Circumstances in Which Moratorium Is Inapplicable 

Under § 424.570(a)(1)(iii), a temporary moratorium does not apply to any of the following: 

• Changes in practice location (except if the location is changing from a location outside the moratorium area to a location inside the moratorium area). 
• Changes in provider or supplier information, such as phone numbers or addresses. 
• Changes in ownership (except changes in ownership of home health agencies, hospices, or suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that would require an initial enrollment). 

Also, in accordance with § 424.570(a)(1)(iv), a temporary moratorium does not apply to any enrollment application that has been received by the Medicare contractor prior to the date the moratorium is imposed. 

Rationale for the Hospice Moratorium 

The HHS-OIG has highlighted the problem of hospice fraud, waste, and abuse. It recently stated: “There are significant problems with the (hospice) program. Our reports and investigations have revealed several concerning issues, including poor—sometimes harmful— quality of care, fraud schemes that involve enrolling beneficiaries without their consent, inappropriate billing practices, limited transparency for patients and their families, a payment system that creates incentives to minimize services, and a rapid growth in the number of new hospices, often to take advantage of these conditions.  The OIG and DOJ have in the past encouraged CMS to undertake anti-fraud measures regarding hospices, and we believe the action announced by this notice is consistent therewith.  

This program integrity risk has increased significantly over the past seven years, to the point that hospices now present a payment safeguard threat comparable to home health agencies and DMEPOS suppliers. In 2023, CMS highlighted several concerning trends that illustrate the growing scope of fraud, waste, and abuse in the hospice sector.  

Key concerns identified by CMS  

Ineligible patients enrolled in hospice: Some hospices certified patients who were not terminally ill and then provided little or no services. In some cases, beneficiaries were incorrectly told they were terminally ill. When individuals are improperly enrolled in hospice, they may also lose coverage for other care because they are receiving the hospice benefit.  

Rapid growth of potentially fraudulent hospices: CMS identified a sharp increase in questionable hospice providers, particularly in Arizona, California, Nevada, and Texas. Some listed addresses appeared to be non-operational.  

“Churn and burn” schemes: In these cases, a hospice opens and begins billing Medicare, then shuts down once it is audited or reaches its annual payment limit. The operators keep the funds, obtain a new Medicare billing number, transfer patients to the new entity, and resume billing.  

Additional problematic practices  

• Paying recruiters to target beneficiaries who are not eligible for hospice care, sometimes without the beneficiary’s knowledge.  

• Paying kickbacks to physicians to falsely certify a patient’s terminal status or submitting false certifications without payment.  

• Establishing hospices primarily to sell them for profit or to avoid revocation from Medicare after fraudulent activity.  

• In these situations, providing quality patient care was not the priority—and in some cases was not a consideration at all.  

Hospice anti-fraud efforts require a broad approach across all hospice activities, not just post-enrollment review, enhanced owner screening, or both. All aspects of enrollment must be addressed. Given the severity of hospice program integrity issues, CMS argues that a key gap exists at the earliest stage of enrollment—before contractors begin reviewing applications or screening owners. Preventing fraud before it starts is a stronger strategy than the traditional pay-and-chase model, which acts only after fraud has occurred.  

Rationale for the Home Health Moratorium 

Home health fraud, waste, and abuse has been a severe problem for over two decades. Based on our experience, low start-up costs and the home-based nature of the services – with little direct supervision of the persons performing them – help make the HHA arena ripe for fraud. Indeed, HHAs have long been among the highest-risk Medicare provider/supplier types in terms of program integrity, with the OIG stating in 2018: “Home health has long been recognized by OIG and CMS as a program area vulnerable to fraud, waste, and abuse.”  To help address this, CMS over the years has established a number of provider enrollment payment safeguards concerning HHAs.   

Despite numerous initiatives implemented by CMS in the past, HHA program integrity risks are still among the highest of any provider/supplier type. Our actions might have lessened the degree of HHA fraud, waste, and abuse, but certainly not to the extent that CMS need no longer undertake additional initiatives.  

CMS cited specific information in this notice showing a significant potential for fraud, waste or abuse with respect to HHAs nationwide.  Readers are encouraged to review this detail to understand the full scope and rationale CMS provide for this moratorium.  

Applicability to Medicaid & CHIP 

CMS states it is in Medicaid and CHIP beneficiaries’ best interest to allow each State to decide whether some form of a hospice or home health provider moratorium is appropriate for their respective Medicaid programs and CHIPs, and the scope of any such moratorium. 
 
CMS encourages each State to, as appropriate, implement a provider moratorium tailored to the specifics of their beneficiary population as well as any geographic considerations, in accordance with 42 CFR 455.470(b). CMS is also offering every State and territory the opportunity to consult with CMS on the prospect of implementing a Medicaid- or CHIP-based moratorium in their jurisdictions. 

Additional Resources from CMS 

Home Health and Hospice Nationwide Moratorium Q&As  

CMS Press release – CMS Announces Aggressive Nationwide Crackdown on Fraud with Six-Month Hospice and Home Health Agency Enrollment Moratoria