Buried in the July 1, 2026, proposed rule for the Home Health Prospective Payment System (“Proposed Rule”), the Centers for Medicare & Medicaid Services (“CMS”) proposed changes to provider enrollment and a provider’s ability to obtain and maintain Medicare billing privileges. Notably, the changes to provider enrollment regulations at 42 CFR Part 424, Subpart P affect every Medicare-enrolled provider and supplier.
Revocation and Denial Updates Applicable to All Medicare Providers and Suppliers
CMS is proposing several provider enrollment provisions as part of its program integrity efforts. These amend Subpart P and would affect any provider or supplier participating in the Medicare program, except as specifically indicated. CMS estimates the proposed changes would result in roughly $82 million in annual government savings.
The generally applicable proposals fall into the following four groups:
Revocations to be Retroactive Rather Than Prospective
CMS would make all revocation grounds retroactive to the applicable date specified in § 424.535(g), generally the date the noncompliance, disqualifying conduct or other basis for revocation arose, rather than retaining the current prospective effective date of 30 days after the revocation notice is mailed for certain grounds.
New Grounds for Revocation or Denial
CMS proposes: 1) a new revocation ground where a provider’s location within a limited geographic area holding an excessive number of providers and suppliers presents a high risk of fraud, waste or abuse, which CMS states is not limited to high-screening-tier providers or traditional hotspots and does not require the nearby providers to be of the same type; 2) a new denial and revocation ground based on a federal or state misdemeanor conviction within the past 10 years related to sexual assault or financial misconduct; 3) a new denial ground where a provider shares a suite or office with a provider whose enrollment has been revoked or denied; and 4) a new denial ground for attempting to enroll under another party’s identity.
Expansion of Existing Grounds
CMS would: 1) remove the four regulatory factors it currently must consider when determining whether a pattern or practice of billing is abusive under section § 424.535(a)(8)(ii); 2) expand the false or misleading information ground to reach any enrollment-related form or documentation, regardless of whether it was certified as true or submitted to gain enrollment; 3) authorize revocation of a provider’s other enrollments when a triggering enrollment is denied, not only when it is revoked; and 4) expand the program and license action grounds so they reach not only the provider but also its owners and managing employees or organizations. That last expansion covers both a suspension, revocation or termination from Medicaid or another federal health care program and a license suspension or revocation in another state, and it would also reach licenses voluntarily surrendered in lieu of disciplinary action, along with parallel expansions to the debt and payment-suspension denial grounds to reach parties with any business or financial relationship with the provider.
Consequences and Process
CMS would: 1) expand the up-to-10-year reapplication bar to apply regardless of the reason for denial; 2) expand the Medicare Advantage and Part D preclusion list to reach felony convictions against a provider’s owners, managing employees, officers or directors; and 3) shorten the post-revocation claims-submission window from 60 days to 15 calendar days from the date of the revocation letter for services furnished before the revocation effective date subject to the Home Health Agency-specific (“HHA”) formulation in § 424.535(h)(1)(ii).
Revocation and Denial Updates Applicable to Certain Medicare Providers and Suppliers
Applicable specifically to home health agencies, hospices and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) suppliers, the Proposed Rule contains new denial and revocation grounds in the event these providers and suppliers fail to comply with the change in majority ownership re-enrollment requirements at sections § 424.550(b) or § 424.551. Additionally, CMS proposed new hospice-specific denial grounds addressing medical directors or administrators who serve at multiple hospices, are located too far from the facility to perform their duties or lack an active license, a requirement that reactivating hospices undergo a state survey or accreditation.
Practical Takeaways
- The Proposed Rule would significantly tighten Medicare enrollment oversight by expanding revocation and denial grounds and increasing scrutiny across all Medicare providers and suppliers – raising compliance expectations and enforcement risk nationwide.
- Organizations contemplating establishment, acquisition, or a majority-ownership change of an HHA, hospice, or DMEPOS line should account for the active moratoria and the expanded change of ownership scrutiny. See Hall Render’s alert here for more information.
- A copy of the fact sheet on the proposed rule can be found here.
- Comments to the Proposed Rule are due no later than 5:00 PM EDT on August 31, 2026, and can be submitted at regulations.gov using file code CMS-1844-P.
For more information on the Proposed Rule or assistance with submitting comments, please contact:
- Brian Jent at (317) 977-1402 or bjent@hallrender.com;
- Lauren Hulls at (317) 977-1467 or lhulls@hallrender.com;
- Lori Wink at (414) 721-0456 or lwink@hallrender.com;
- Regan Tankersley at (317) 977-1445 or rtankersley@hallrender.com;
- John Williams at (202) 370-9585 or jwilliams@hallrender.com;
- Katherine Schwartz at (317) 977-1432 or kschwartz@hallrender.com;
- Julie Mitchell at (317) 429-3643 or jmitchell@hallrender.com; or
- Your primary Hall Render contact.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
