CMS Home Health and Hospice Moratoria Update: Emerging Guidance and Enforcement Update

As discussed in our prior Alert,¹ on May 13, 2026, the Centers for Medicare & Medicaid Services (CMS) announced two nationwide, six-month moratoria on Medicare enrollment of new hospices and home health agencies (HHAs).² Since then, additional guidance from Medicare Administrative Contractors (MACs), state agencies, and industry stakeholders has begun to provide further clarity regarding CMS’s implementation of the moratoria, related state Medicaid and licensure developments, and the broader enforcement environment surrounding the agency’s program integrity initiative. This Alert discusses those developments, as well as related state Medicaid and licensure activity, increasing enforcement activity, and recent federal legislative developments affecting the hospice and HHA sectors.

Guidance from the MACs

In the two weeks following CMS’s announcement, two of the MACs – CGS and Palmetto GBA – have issued moratorium-related guidance providing additional clarity regarding implementation of the moratoria.³ Notably, CGS’s guidance indicates that the moratoria apply not only to initial enrollment applications and certain change of ownership (CHOW) filings requiring initial enrollment, but also to applications by existing providers to add new hospice practice locations or HHA branches.⁴ While CMS’s original announcement suggested this possibility, the guidance provides the clearest indication to date that the moratoria restrict not only initial Medicare enrollments, but also certain expansion activity by currently enrolled providers. Palmetto GBA has likewise issued moratorium-related guidance generally consistent with CMS’s implementation approach, although less detailed than CGS’s publication.⁵

State Licensure and Medicaid Activity

In FAQs accompanying the moratoria announcement, CMS clarified that the federal hospice and HHA enrollment moratoria do not automatically apply to Medicaid or Children’s Health Insurance Program (CHIP) enrollments. CMS encouraged states to evaluate whether corresponding state-level Medicaid or CHIP moratoria may be appropriate.⁶

Consistent with CMS’s guidance, several states have either taken or are considering related Medicaid enrollment, licensure, or oversight actions.

• Arkansas. The Arkansas Health Services Permit Agency announced that effective May 13, 2026, it will no longer accept applications for hospice agencies per CMS’s imposition of the federal moratorium.⁷ The announcement does not specify an end date, but includes as an attachment CMS’s Federal Register notice announcing the six-month federal moratorium, suggesting the state intends to align its timeline with the federal moratorium period.
• California. California continues to maintain its statewide hospice licensure moratorium, which has been in effect since January 1, 2022.⁸ The moratorium has since been extended multiple times, most recently in 2024, via legislation that extended the moratorium through January 1, 2027, or until one year after the California Department of Public Health adopts specified emergency regulations,⁹ whichever occurs first. CMS specifically referenced California’s hospice oversight activity in the Federal Register notice announcing the federal hospice moratorium.¹⁰
• Nevada. On June 5, 2026, the Nevada Health Authority announced a temporary pause on the issuance of new state licenses for hospices and HHAs, together with a moratorium on new Medicaid enrollments for such providers, pending validation of currently enrolled providers and subject to federal approval.¹¹ The state indicated that the pause expected to remain in effect for at least six months while Nevada undertakes a review of provider enrollment and oversight processes.¹² Nevada and Ohio (as detailed below) appear to be among the first states to formally adopt a parallel Medicaid enrollment restriction following CMS’s announcement.
• Ohio. On May 14, 2026, the Ohio Department of Medicaid (ODM) implemented a Medicaid enrollment moratorium applicable to hospices and HHAs through November 14, 2026.¹³ According to ODM and related announcements from Governor Mike DeWine’s office, the moratorium is intended to align with CMS’s nationwide Medicare enrollment moratoria and forms part of a broader state Medicaid program integrity initiative focused on fraud prevention and provider oversight.¹⁴ Further demonstrating the state’s aggressive enforcement posture, on June 4, 2026, ODM announced the temporary suspension of payments to 49 Medicaid home health providers identified as “high-risk” through data analytics and fraud-detection initiatives.¹⁵ The suspensions were implemented pursuant to Governor DeWine’s Executive Order 2026-02D, authorizing ODM to immediately suspend payments based on billing patterns and data anomalies suggesting a high probability of fraudulent activity.¹⁶ The action underscores Ohio’s increasingly proactive use of predictive analytics to support enforcement actions before the completion of traditional audit, documentation review, or investigative processes.

These state actions may further complicate transaction planning, de novo and expansion strategies, and Medicaid participation efforts, particularly for providers operating across multiple jurisdictions. In addition, because Medicare participation is often a prerequisite to enrollment in Medicaid programs and certain commercial payor networks, the practical effects of the moratoria may extend beyond Medicare reimbursement alone.¹⁷ As a result, the inability to obtain or maintain Medicare enrollment could have broader operational, contracting, and reimbursement implications for affected providers.

Enforcement and Program Integrity Activity

The moratoria also appear to reflect a broader federal enforcement and program integrity initiative targeting the hospice and HHA sectors. In announcing the moratoria, CMS cited concerns regarding fraud, waste, and abuse in the hospice and home health industries, including rapid provider proliferation in certain geographic markets, questionable ownership and CHOW activity, and suspicious billing patterns. The moratoria also align with CMS’s broader use of enhanced enrollment and oversight tools in these sectors, including the agency’s Provisional Period of Enhanced Oversight (PPEO) initiative for newly enrolled hospices,¹⁸ Expanded Prepayment Review (EPR) for existing hospices,¹⁹ and the Department of Health and Human Services’ (HHS) broader health care fraud enforcement efforts, including CMS’s recently announced “Comprehensive Regulations to Uncover Suspicious Healthcare” (CRUSH) initiative and related Request for Information seeking stakeholder input on potential future program integrity and anti-fraud measures.²⁰

Consistent with these enhanced oversight and enforcement initiatives, providers have also reported increased oversight activity in certain regions—particularly in Southern and Western states—including payment suspension notices arising from Unified Program Integrity Contractor (UPIC) audits, expanded Targeted Probe and Educate (TPE) review activity, heightened provider screening and enrollment scrutiny, broader pre- and post-payment claims review efforts, and payment suspensions and revocation actions involving newly enrolled providers. Industry reports further indicate that providers subject to UPIC-related payment suspensions may encounter substantial delays when seeking to appeal UPIC findings or otherwise communicate with CMS or UPIC regarding such suspensions, potentially prolonging the suspension period and adding to the operational and financial challenges associated with such enforcement actions.²¹ Taken together with the moratoria announcement, these actions reflect CMS’s increasingly aggressive approach to hospice and HHA program integrity and suggest that providers, investors, and others in the hospice and home health industry should expect heightened scrutiny of enrollment, ownership, billing, and compliance practices going forward.

Federal Legislative Activity

Lastly, federal lawmakers and regulators are also prioritizing hospice and HHA program integrity, with recent legislation reflecting heightened scrutiny of provider enrollment, ownership, and oversight practices.

Most recently, the House Ways and Means Committee advanced the Protecting Seniors and Stopping Fraudsters Act (H.R. 8883), bipartisan legislation aimed at addressing alleged fraud and abuse involving hospice providers and other high-risk Medicare suppliers. Among other things, the bill would increase survey and inspection requirements for newly enrolled hospices and providers undergoing changes of ownership, expand fingerprinting and screening requirements for high-risk providers, strengthen oversight of accrediting organizations, enhance beneficiary notification requirements relating to hospice selection, and impose penalties for certain reporting and compliance failures.²²

Additionally, legislators in both houses introduced the Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act of 2026, which also proposes broad reforms to the Medicare hospice benefit and CMS’s hospice oversight framework.²³ Among other things, the legislation would require CMS to impose temporary enrollment moratoria in geographic areas or provider categories identified as presenting elevated fraud, waste, or abuse risks. The legislation would also expand provider screening and oversight requirements, strengthen quality reporting and transparency obligations, increase scrutiny of ownership and CHOW activity, and direct CMS to adopt additional safeguards intended to better align reimbursement incentives with patient care quality and beneficiary protections. Both pieces of legislation were introduced on March 17, 2026 and, as of this publication, neither bill has advanced beyond the committee stage.

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We are actively monitoring CMS guidance and implementation activity related to the moratoria and would be happy to discuss implications for pending transactions, de novo strategies, enrollment planning, or other operational considerations.

Please speak with your Ropes & Gray representative if you have questions.