What The CMS Moratorium Means For Home Health And Hospice Providers

CMS Hospice & Home Health Moratorium: What CHAP Knows So Far – CHAP is updating this page as frequently as possible based on official CMS guidance and publicly available information.

We break down the May 13, 2026 National Home Health and Hospice Enrollment Moratorium and what it means for Medicare-certified providers trying to enroll, expand, or change ownership. We also share what we expect CMS and state agencies to scrutinize next and how strong compliance and quality programs keep you ready. 
• why the moratorium timing feels sudden but predictable amid fraud and abuse enforcement 
• what “received before May 13” means for CMS-855A applications, branches, and practice locations 
• how nationwide coverage prevents providers from relocating to bypass restrictions 
• what still moves forward, including certain address changes and ownership changes that do not trigger initial enrollment 
• why the 36-month rule and CMS denial authority still create risk even for pre-May 13 submissions 
• how long the moratorium lasts, how extensions happen, and why history suggests planning for renewals 
• what CMS says about beneficiary access and how that may shape next steps 
• how states may respond on Medicaid and CHIP, including early state-level action 
• why licensure is separate from Medicare certification and what market-entry alternatives may exist 
• how existing providers can use the pause to strengthen compliance, quality metrics, and differentiation 
We will at CHAP will be keeping you updated via our new webpage that's dedicated to the Home Health and Hospice Moratoria. Make sure that you stay tuned not only to special email blasts and information that's posted on the page, but to our compliance monitor.

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Transcript

Why CMS Imposed The Moratorium

SPEAKER_01 0:29

Greetings and salutation. I'm Jennifer Kennedy, the lead for compliance and quality at CHAP, and welcome to CHAPCAST. Today we're going to attack the topic of the National Home Health and Hospice Enrollment Moratorium, which was effective on May 13th, 2026. So we're going to set the stage just a little bit. And when I say we, I'm meaning I'm on with my trusty coworker, friend, companion, whatever else we can say.

SPEAKER_00 1:22

So happy to be here with you again.

SPEAKER_01 1:26

Yeah, absolutely. And we're just gonna talk it out. So let's set the stage before we get into the details. Uh the moratorium was announced, as I mentioned, on May 13th, and it is for home health and hospice, and we'll get into some details. Um well I think the for me the timing was unexpected, that it came overall was not unexpected. And and Kim, I I would invite you to weigh in on that. But um you know, seeing that a moratorium was established, I think I felt like it has been uh coming. Uh this decision has been coming from CMS for a while. They just had to get their logistical ducts in a row. Um, and all you had to do was watch all of the um the stuff that has been unfolding, particularly on hospice fraud and abuse, to know definitely um that a moratorium was expected. What are your thoughts on that, Kim?

SPEAKER_00 2:28

No, I agree. I mean, I we we definitely knew that something was coming, even as far back as the Blumenhauer, you know, um the congressional uh bill that that was never moved forward because Congressman Blumenhauer retired. Um the the um for me it was um looking at the scope, the breadth and scope, including both home health and hospice. Um, you know, that was surprising moratorium, right? And and um and again the um immediate effectiveness of it. Um, but you know, as we'll talk about in a minute, um, it is a little less, it is somewhat less onerous than it was, than the home health moratorium was in um, you know, in 2013. But you know, we at CHAP, we again we we have the we watched this, right? You as you said, you love the smell of the Federal Register in the morning. And we trust you, we trust you to um, you know, stay on top of all of the um everything that's coming down the pike. And so at CHAP, we we were prepared, anticipating, you know, what we um what what the potential impact could be, um, certainly on our customers as well as our organization. So we that's why we were able, I believe, to be able to pivot as quickly as we were to be able to provide, you know, the insight and support, at least on the information that has been uh that's available so far.

SPEAKER_01 4:01

Yeah, absolutely. And I I will say that while I wasn't surprised about the hospice moratorium, the home health actually did take me a little bit unawares. Um but you know, given that, you know, I read the OIG stuff on a regular basis as well and seeing all of the home health um fraud and abuse, um, I guess, you know, maybe in the overall context, it's not too too surprising. But let's go ahead and get into some of the nuts and bolts, Kim, of what the provisions in the moratorium,

The May 13 Line In Sand

SPEAKER_01 4:35

both of them would be. So uh your choice, you want to start with hospice or home health?

SPEAKER_00 4:40

Well, to be honest, I think the provisions are very similar. Um, if you look at the language um in both federal register publication, you know, the register announcements, um, the the bottom line is the moratorium is in effect for all initial enrollments, they refer to it as applications, that's the CMS 855A, that were have been received as of the effective date. So, in other words, any 855A for a hospice or home health agency or hospice or home health branch or or practice location, additional practice location, um, as well as certain changes in ownership that require an initial enrollment or 855A, if that application was sub received by the MAC, uh the Medicare Administrative Contractor before May 13th, then it's presumed that those applications are going to be able to proceed. So an organization that had submitted the 855A and is waiting for a survey, um, you know, will will continue to be processed. Um, and and again, there are some some other caveats associated with that, but they both were um both are really essentially the same. That that the the the line in the sand that I'm calling it is May 13th. If somebody has an application in before May 13th, then they can proceed. If they have have or require an application as of May 13th and forward through the moratorium, they will be denied or you know, they either not submitted or it will be denied by CMS.

SPEAKER_01 6:40

This is a nationwide, yes. This is a nationwide moratorium, and um uh it is applicable to Medicare, correct?

SPEAKER_00 6:52

Yes, yep. At the moment, yes, the federal moratoria is is applicable to Medicare, you know, or Medicare certified organizations. I want to be clear about that. You know, it's not just the billing of Medicare, it's the Medicare certified organizations. Any any organization that's required to be Medicare certified um will um, you know, that this applies to them. Um and yes, it applies to uh anywhere in the United States, including all states, territories, and the District of Columbia. And the reason for this, the rationale, is because in past moratoria, uh there has there has been um an experience where some providers will move from the area of the moratorium and to an area outside of the moratorium. And this is CMS's um way to be able to limit, and I'm just gonna use the term bad actors from you know from making those moves and you know moving to additional locations. Unfortunately, it also um does limit um restricts um any any organizations that do want to expand, right? Or or open or expand.

SPEAKER_01 8:11

Right. Now in the provisions, um there are some uh uh caveats or uh direct uh guidance as um how it does not apply. So can we talk about those for just a couple minutes?

SPEAKER_00 8:28

So any um change in practice location, uh meaning if an organization, if an agency is moving to a different um a different address, for example, um, or you know, just moving that location, as long as the move the move is again within the moratorium and not outside of the moratorium, um which in this case it can't be outside of the moratorium since it's um so broad and nationwide. So they can move their practice or the agency, they can change their address, their um their phone numbers, things like that, and then changes in ownership that do not require an initial enrollment. Um and and there's just a couple of you know, just a couple of things there. CMS also or the MAX were very clear that even though an 855A is submitted, even if it was submitted before the moratorium, andor a change in ownership is submitted and they're outside of what CMS calls the 36-month rule, meaning you can't sell change ownership with very few exceptions, if uh within 36 months of initial certification or the last change of the most recent change of ownership. Um, the issue

Nationwide Scope And Medicare Focus

SPEAKER_00 9:55

here is CMS still reserves the right to deny, uh deny an 855 or deny um or require an initial enrollment, you know, on a Chow. So by and large, organizations just need to understand that even if they have submitted, they um, you know, they it they and and it's been received, and that's that's the word, right? Prior to the the dead, the um the um the start of the moratorium. If CMS denies for any reason, although there's a rebuttal process, but if they deny, um then the organization is then placed into the moratorium.

SPEAKER_01 10:37

It's kind of like what I said to you this morning that hope records for hospice, they may be submitted, but they're not unless they are accepted, you know, it's it's not a good record. So it's kind of the same principle that applies here.

unknown 10:52

Yeah.

SPEAKER_01 10:52

And this this uh moratoria is uh good for um six months that puts us um somewhere around November 13th, I think, uh, for when the six months expires. Could CMS lift or extend, or what what is uh what are their options there as considerations?

SPEAKER_00 11:15

So again, in the moratorium, it does um state um CMS can lift the moratorium, um, a moratorium or moratorium at any time uh for different reasons, some of which um related to disasters, but but uh one of the key provisions is circumstances warranting the imposition of the moratorium have abated, or CMS has implemented program safeguards to address the program vulnerability. Here's the thing. We know from the uh 2013 home health moratorium, um that that was re-renewed uh, I think nine times. It was like between 2013 and almost into two thousand and into 2019. Um so the key here is it's I think we need to be prepared uh because it's unlikely that CMS is going to uh determine that the risk has abated or that they have put the uh safeguards in place within six months. We certainly can hope. We certainly, I know on the national associate this national level and the state association level, and all of us in the industry are certainly um advocating for the moratoria not to be longer than absolutely necessary. The other thing that um that can happen is they may make a decision to reduce the the footprint, if you will, of the moratoria, depending on what what you know what where they are in terms of whatever information that they have. But that um that that decision will then be um um um sorry, published in the Federal Register.

SPEAKER_01 13:07

Right. And I did read in the Federal Register notices that they did feel that putting um a restriction on enrollment of new providers wasn't going to impact beneficiary access, current access, either to home health or hospice. So I guess that would be one metric they would be assessing during this um moratorium period is if there are any access issues. Um that that's my two cents. What do you think about that?

SPEAKER_00 13:37

Well, I would agree with that, and I know that that's one of the points that the state and national associations have made, you know, in in um in opposition against a nationwide moratorium. But we have seen uh other state individual states implement

Exceptions And The 36 Month Rule

SPEAKER_00 13:55

um efforts such as uh California with their moratorium for hospice, as well as, for example, CON certificate of need states. Um, you know, there already are some guardrails, if you will, in some places, but again, I think CMS, uh again, uh my assumption is that this is a pause to be able to allow for the applicants that are currently in the system to be very thoroughly vetted, and that's an extreme, uh, extreme warning to anybody who does have their you made it through it, you have your application in, but everything's gonna be scrutinized very, very thoroughly. You know, until they can make that determination.

SPEAKER_01 14:41

Yeah. Right. Yeah, exactly. You know, catch them at the at the beginning of the process, basically. Um, so CMS, they did um, to my recollection, talk about um states and the states' ability to um establish their own moratoriums. Do you want to uh tell us a little bit about that?

SPEAKER_00 15:03

Sure. So we know that in the moratorium they did discuss that um CMS stated that it's in Medicaid and chip beneficiaries' best interest to allow each state to decide whether some form of a home health or hospice uh provide a moratorium is appropriate for their respective programs. Um so they are leaving it to the states, although they weren't there encouraging uh states to look very closely at um at the moratorium and even offering guidance. We do know that as of today, or as of May 14th, the state of Ohio implemented a um a moratorium on their Medicaid program. Now it's not just the state plan, but it's all of the Medicaid plans programs. So your Medicaid waivers, your, you know, um, you know, those that that pertain even to um, you know, potentially non-medical, you know, um uh uh patients, not just those that would have otherwise received uh, you know, Medicaid state plan services. So everyone, um every provider really should be connecting with their state association and their state agencies to see how, in fact, the moratorium may impact them. We know that when DME imposed demipost um uh moratorium was imposed in February, that there were states um right um right off right off the bat that did implement moratorium specific for their states. So it's just something that that um you know we do encourage uh uh really every provider to be contacting their own work states as well as uh again using um, you know, really utilizing the support of their state associations.

SPEAKER_01 17:01

Absolutely, they're a great resource and they really do have their finger on the pulse of what's happening in their state. So um that's really great advice. And if you're not um if you're a provider that's not connected with your uh state organization, you know, maybe you do have connection to a national organization. Um, hopefully you can leverage your relationship there to see if there are any um state announcements that they make as well. So I agree. Like going on, Kim.

SPEAKER_00 17:32

Absolutely. The other thing, just to make a note, um, you know, the uh the moratorium does not affect licensure, state licensure, that's actually state specific. So unless a state has a a certificate of need requirement, uh, you know, requirement there or uh any sort of their own individual moratorium, then you know, the licensure process itself should not be implemented. But again, agencies need to check with their own states. Um it's just important that they stay uh on top of what

Six Months Or Much Longer

SPEAKER_00 18:05

those requirements may be. You know, for organizations that might be subject to the moratorium, um, they may, if they're able to, they may want to consider continuing on with licensure, potentially having non-deemed home health uh agency services, if they're able to, depending on the state, or even home care or non-what we call home care, non-medical homemaker companion or private duty um nursing. Um if again it's available, it's eligible, it's able to be provided without a home health agency license that requires Medicare certification, then agencies really need to think about or providers get creative with what they want to be able to do or may be able to do to continue to you know expand into the market and assist supporting um patients and caregivers to the best of their ability.

SPEAKER_01 19:08

Yeah, absolutely. I couldn't have said it better. And I really feel um that hospices should now I know there are there are what you call the bad actors out there, and we have our uh hospices that are very compliant and and following regulations, but you know, during this pause, um, because of all of the lead up to um uh this moratorium, at least for the hospice, I'll I'll keep to my hospice uh knitting just for a moment. Um this is a great opportunity for hospices to really um look at their performance, look at all of their metrics, um, look at all the data sources and the data that um may be available uh to them from external sources to shore up performance. This is what I'm thinking. You know, um even if they're really good hospices, there's always room for improvement. And um, you know, think about how they're uh going to do ongoing monitoring of what is happening out there. Again, maybe they are a member of a state organization or a national organization, or they even read our compliance monitor a couple of times a month. You know, uh I think I guess what I'm trying to say is my thought is this is a good time for hospices to get back to basics, to make sure their foundations in compliance and quality are strong, um, and use all of those data sources that are available in order to do that self-assessment and um uh performance improvement. And this is a really great opportunity for organizations to uh uh represent themselves in terms of their quality footprint outside of their measurable scores reported on uh care compare. So if they have uh significant partnerships in their organization uh in their community, rather, if they've won awards, if they have uh relationships with various payers, this is the time to distinguish yourself from those bad actors, in my thinking, uh, to show that you are a quality hospice, that you're not part of that turn and burn scheme, that you're not part of the the and which has now become an endemic uh fraud and abuse um uh uh cycle that is happening in overall hospice. Taking the opportunity to figure out how you're going to do that, put that information out there to show that you are reputable, that you are compliant, that you are working with. CMS, and that you're not going to walk the low road of compliance or quality, that you're

Medicaid And State Level Actions

SPEAKER_01 22:10

definitely walking the high road of compliance and quality. So I'm going to get off my soapbox now, Kim. I'm going to ask you to go on your soapbox for home health in terms of um, you know, uh what what do you think home health organizations should be doing now during the moratorium?

SPEAKER_00 22:33

So all I can say to that, uh Jennifer, is ditto. Basically everything, you just said it all. Um really, uh it's all of those efforts for both hospices and home health agencies who are existing providers to really be able to demonstrate, you know, again, the value that they bring, their their own, have their own internal compliance um, you know, and quality oversight, you know, um programs. Again, you know, having a corporate compliance program and our compliance standards at CHAP really align, uh do align with the seven elements of an O of an effective of the OIG seven elements of an effective compliance program. So really putting that into place. Um but also, you know, uh certainly at CHAP, we have uh uh through our our Center for Excellence and Learning Solutions, we have uh disease program certification. We also have age-friendly care at home. And and the those are and pretty pediatrics, pediatric palliative care, you know, the the certifications that can set an organization apart as a differentiator in the in the environment uh certainly will uh will I do also believe that also demonstrates the strength and diversity um of an organization and the commitment of an organization to really uh meet the needs, grow to meet the needs of the patients uh that they serve.

SPEAKER_01 24:14

Absolutely. And you know, it's CMS is adopting that proactive versus, you know, what they've called in the past pay and chase type of mentality. So I don't think it's out of the realm that we would see um tightening at the beginning of the enrollment process coming out of a morator as it relates to home health at hospice. And and I know we have both um fronts seen more tightening in rulemaking in the last couple of years, but it seems to me that um CMS knows what they want to do as it results or relates to the enrollment process, and they just need to figure you know figure out the logistics of how to get that done. Um but uh I am thinking also we're gonna see increasing of other types of activity. And um let's talk about that for a a couple of minutes, like uh you know, increased scrutiny on um documentation, for example. Uh what what are your thoughts on some of the activity that could happen at the provider level? And then you know, we can talk about what's happening at the accreditation organization level as well. So let's start with provider level.

SPEAKER_00 25:38

Correct. From the provider level, we've already seen a lot of the activity through the MAX and the other uh CMS contractors and the auditing. So while we are as an AO, we focus on survey and regulatory, of which in there we also have seen significant increases in terms of you know uh more uh focused reviews, if you will, or more scrutinizing of you know surveys and uh and follow-up by CMS. And of course, we now have the direct observation validation surveys, which are CMS contractors joining the AO on site with a survey to observe the AO processes. Things like that as far as really more, I think, boots on the ground and really looking closely at oversight. But CMS also has indicated that during this program, they're gonna be uh or the moratorium, they're gonna be looking at their own, their program analytics, and as well as, you know, in uh and continuing the uh effort that that the administration and CMS have put has put forth with uh really uh uh involuntarily terminating organizations. And I think by and large that uh a lot of that does have to do with looking at billing practices and documentation. Like I said, we've had you know uh the alphabet soup of audits for quite some time. We don't expect that to let up at all. In fact, it likely will be, you know, even increased.

SPEAKER_01 27:18

So I agree. And you know, we we as an AO have been feeling the squeeze over the last couple of years, particularly um the last um, let's say eight months. Um you did mention the doves, but um what are some of the other things um that we can talk about that's happening on our front

Build Trust Through Quality Proof

SPEAKER_01 27:40

as an AO?

SPEAKER_00 27:42

Well, I think you know, we you and I can tag on tag in together on this, but really um we are seeing more inquiries from state agencies and from CMS regarding follow-up, uh their own follow-up, you know, regarding organizations where they're asking for more information. Um, for example, if there are multiple providers in one address, you know, location or you know, one building, if you will. We know, we know from the um the example of Friday Street in Los Angeles or Glendale in California, that you know, this is um we we've heard it, we've seen what the inquiry inquiries are, which tell us that you know CMS is is looking at at areas such as that um as well. And like I said, we we do a very thorough review, um, three triple layer, if you will, um not counting your quality team just on accreditation alone, um, to make sure that the surveys are valid and appropriate and um the findings are are are you know are sufficient, the evidence supports the findings. And and we you know certainly are able to through that process ensure that providers that we are crediting are meeting the standards. Um what we're seeing more of is either outside of our surveys, again, these questions directly from CMS or the state agency, you know, and a lot of and a lot of times it has to do with uh it appears as though it has to do with things like a I guess that physical location, and then in some cases with the involuntary terminations, uh, again, from the information we can see, it appears as though it may be billing related. So I agencies just we can't stress enough. Organizations have to maintain compliance with both survey readiness, COPs, regulatory requirements, and the billing and payment requirements in order to be able to really make sure that they're actively addressing all of these areas, and there are a lot, and oh, by the way, above all, ensure the um quality and safe patient care.

SPEAKER_01 30:10

Absolutely. Are there any other things you think providers should be doing right now during this period of moratoria?

SPEAKER_00 30:21

I think to you, I think you made the best point. I think for organizations that are currently enrolled, take this time to make sure that your house is in order, that patient care is, you know, of top quality, and you can demonstrate your own compliance and your own quality, you know, within the organization. And um, and I think that's most important there, and looking at your outcomes and processes. For those those providers that um were not able to make it um before the moratorium, taking a look at what options there are made to be to enter the market, again, whether through non-deemed you know, um accreditation or home care or whatever um uh uh ability they have to be able to uh begin to serve patients, develop their model, and you know, be ready for when the moratorium is lifted, because CMS did say that anyone who was not able to um submit an 855 during the moratorium, once the moratorium is lifted, they'll be in a high screening, you know, and uh and be able to move forward if they're they submit that 855 within six months that uh that the moratorium is lifted. So in addition to operationally, everything we talked about, um making sure that they keep their ear to the ground, you know, certainly

More Audits More Oversight Next

SPEAKER_00 31:55

between national associations, state associations, and of course us, CHAP, um, our updates and yes, your fabulous compliance monitor and all the other resources that we are are making available uh for uh you know, certainly both our customers, but also for you know for the industry, for the for the public to be able to review to to utilize is really important.

SPEAKER_01 32:24

It's gonna be important. So every piece of scrap, uh piece of information, scrap of information is gonna be critical to monitor. So my friend Kim, final wrap-up, epiphany, thoughts.

SPEAKER_00 32:39

No, I uh I I feel like we've said it all. We ja I just can't say enough. Again, the the the line in the sand, May 13th. Um, you know, and and if you were under the the deadline, if you will, before May 13th, you know, keep moving forward, but you know, understand that CMS is and state agencies are still looking, you know, very closely. And for current providers, we can't stress enough the importance of a compliance program and a survey readiness program and a quality program to really make sure that you uh not just are crossing the T's and dotting the I's on the on to the letter of the regulation, but operationally your organization functions in you know, in it demonstrates compliance through through their functions, through staff, through um the actual evidence of patient care delivery.

SPEAKER_01 33:44

Well said. And just a reminder that um we will at CHAP will be keeping you updated via our new webpage that's dedicated to the Home Health and Hospice Moratoria. Uh we've got um information on that page, including FAQs and updates. And Kim did a great um webinar uh on 515 uh 26 uh about the moratoria. So all of those are available on our web page. And um make sure that you stay tuned not only to special uh uh email blasts and information that's posted on the page, but to our compliance monitor. We'll keep you updated uh via that resource as well. So um with that, uh I want to thank you all for uh taking time out of your day to tap into our podcast. From Kim, me, and the entire CHAP staff, keep your quality needle surging

Where To Get CHAP Updates

SPEAKER_01 34:45

forward, stay safe and well, get back to basics, and thanks for all you do.