CMS Proposes Significant Changes to Medicare Provider Enrollment

Firm Publication

On July 6, 2026, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would significantly expand CMS’s authority to revoke and deny Medicare enrollment and broaden disclosure obligations.

Among the most significant proposals, CMS would:

  1. Make all revocations retroactive to the date of noncompliance.
  2. Add new revocation and denial grounds based on violation of the 36-month rule, geographic concentration, and co-location with revoked providers.
  3. Remove regulatory constraints on its discretion to find billing abuse and impose reapplication bars.
  4. Broaden the definitions of “managing employee” and “affiliation” and eliminate the five-year lookback for affiliation disclosures.
  5. Extend private equity and real estate investment trust (REIT) disclosure requirements to additional enrollment forms.

These proposals are the latest in a series of enrollment-related rulemakings through which CMS has steadily expanded its program integrity enforcement authority, often at the expense of well-meaning providers who face disproportionate compliance burdens and heightened risk of adverse enrollment actions for conduct that does not involve fraud. Although housed within the calendar year 2027 Home Health Prospective Payment System Rate Update, the enrollment provisions would apply to all providers and suppliers. Comments are due by August 31, 2026.

Highlights of Proposed Changes

1.       Universal Retroactive Revocations

Many of the grounds for revocation carry retroactive effective dates, but certain others take effect prospectively—30 days after CMS mails notice. The proposed rule would make every revocation retroactive to the date of noncompliance. For example, a revocation for failure to report an enrollment update would be effective the day following the reporting deadline—a significant increase in consequences given that reporting oversights can and do occur and are often attributable to inadvertent administrative errors.

2.       New and Modified Revocation Grounds

New Grounds for Revocation

  • 36-Month Rule. CMS proposes a new revocation and denial ground for hospices, home health agencies (HHAs), and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers that circumvent the 36-month rule. The proposed ground addresses inappropriate attempts to avoid triggering the 36-month rule, such as the following two scenarios: (1) situations in which the enrollee fails to notify CMS of a change in majority ownership and the buyer assumes ownership under the existing enrollment without re-enrolling as a new provider; and (2) arrangements in which the parties use a management agreement or similar instrument to transfer operational control while deferring a formal sale until the 36-month period expires.
  • Geographic Over-Saturation. CMS could revoke enrollment if the provider or supplier is located in a geographic area with an excessive concentration of providers and suppliers—not necessarily of the same type—presenting a high risk of fraud, waste, and abuse. No actual finding of fraud is required.
  • Misdemeanor Convictions. CMS could revoke enrollment if the provider or supplier, or any owner, managing employee, managing organization, officer, or director, has been convicted of a misdemeanor related to sexual assault or financial misconduct within the past 10 years.

Changes to Existing Revocation Grounds

  • Abuse of Billing Privileges. CMS proposes removing the four factors it must currently consider when determining whether a provider has a “pattern or practice” of non-compliant billing, explaining that it wants maximum flexibility to address all scenarios without the constraints of enumerated criteria.
  • Extension of Revocation. CMS proposes allowing revocation of a provider’s or supplier’s other Medicare enrollments when the triggering enrollment is denied (not just revoked), broadening the cascade effect of an adverse enrollment determination.
  • False or Misleading Information. Revocations based on false or misleading information would be expanded to cover information on any CMS or Medicare enrollment-related form, not just the CMS-855 application, and would no longer require that the information be submitted to “gain or maintain enrollment” or certified as “true.”
  • Claims Submission After Revocation. CMS proposes reducing the post-revocation claims submission period from 60 days to 15 days, measured from the date of the revocation letter.
3.       New and Revised Grounds for Denial
  • Debt and Payment Suspension. The grounds for denial based on debt and payment suspension would be expanded beyond the provider and its owners to reach managing employees, managing organizations and any party with a “business or financial relationship” with the provider.
  • Program Termination/License Suspension. CMS proposes expanding this ground to cover license suspensions and state or federal healthcare program terminations involving the provider’s owners, managing employees and managing organizations—not just the enrolling entity.
  • Revocation or Denial in Same Suite. CMS proposes a new denial ground based on sharing a suite or office with a provider whose Medicare enrollment has been revoked or denied—no finding of wrongdoing by the applicant is required.
  • Hospice Medical Directors and Administrators. A new ground would permit denial if the hospice’s medical director or administrator serves at multiple hospices, is located too far from the facility to perform required functions, or lacks an active license in the state in which they are practicing.
  • Expanded Reapplication Bar. The reapplication bar under 42 C.F.R. § 424.530(f), currently limited to denials for false or misleading information, would be expanded so CMS can impose a bar of up to 10 years for any denial reason.
4.       Other Provisions
  • Managing Employee Definition. The definition of “managing employee” would be broadened to expressly include medical directors, clinical directors, departmental heads, supervising physicians, nursing directors, alternate administrators and other clinical personnel with managerial control. While the current definition of “managing employee” is broad enough to arguably capture many of these positions, enumerating them eliminates ambiguity and puts providers on notice that clinical leadership positions must be reported.
  • Affiliation Disclosures. Currently, when requested by CMS, providers must disclose affiliations with other providers that have “disclosable events,” both at the entity level and through the provider’s owners, managing employees, and managing organizations. If CMS deems the affiliation an undue risk of fraud, waste, or abuse, it may deny or revoke enrollment. CMS proposes removing the current five-year lookback period, meaning affiliations must be reported regardless of how long ago they occurred. CMS would also expand the definition of “affiliation” to include any marketing, business, fulfillment, financial, managerial or beneficiary relationship.
  • Private Equity/REIT Disclosures. CMS intends to require disclosure of private equity companies and REITs through the revision of the CMS-855B, CMS-855S, and CMS-20134 forms.
  • Temporary Moratoria. CMS proposes several changes to its temporary enrollment moratorium authority, which is particularly notable given the active moratoria on the enrollment of new HHAs, hospices, and DMEPOS companies. CMS clarifies that a moratorium’s effective date is the date on which the moratorium notice is filed for public inspection at the Office of the Federal Register. Also, CMS would expand the definition of “new” enrollments subject to a moratorium to include reactivation applications and applications from voluntarily terminated providers seeking to re-enter Medicare, not just initial enrollment and change of ownership applications.

How Should You Prepare?

If finalized, these proposals will require significant operational adjustments across a wide range of enrollment-related functions. While the following is not an exhaustive list, here are steps we believe providers and suppliers should prioritize now:

  • Conduct an enrollment audit to confirm that all information on file is current and accurate.
  • Confirm adverse action status (including newly captured misdemeanors) with all reportable persons and entities (including newly captured managing employees).
  • Reassess affiliation disclosures.
  • Confirm 36-month rule compliance.
  • Evaluate hospice leadership arrangements.
  • Review geographic risk.
  • Prioritize enrollment review in transactional diligence.
  • Prepare for private equity and REIT disclosure requirements.
  • Submit comments by August 31, 2026.

If you have any questions about the proposed rule or Medicare enrollment matters generally, please contact the authors.

Related Professionals
Related Services
Firm Publication

On July 6, 2026, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would significantly expand CMS’s authority to revoke and deny Medicare enrollment and broaden disclosure obligations.

Among the most significant proposals, CMS would:

  1. Make all revocations retroactive to the date of noncompliance.
  2. Add new revocation and denial grounds based on violation of the 36-month rule, geographic concentration, and co-location with revoked providers.
  3. Remove regulatory constraints on its discretion to find billing abuse and impose reapplication bars.
  4. Broaden the definitions of “managing employee” and “affiliation” and eliminate the five-year lookback for affiliation disclosures.
  5. Extend private equity and real estate investment trust (REIT) disclosure requirements to additional enrollment forms.

These proposals are the latest in a series of enrollment-related rulemakings through which CMS has steadily expanded its program integrity enforcement authority, often at the expense of well-meaning providers who face disproportionate compliance burdens and heightened risk of adverse enrollment actions for conduct that does not involve fraud. Although housed within the calendar year 2027 Home Health Prospective Payment System Rate Update, the enrollment provisions would apply to all providers and suppliers. Comments are due by August 31, 2026.

Highlights of Proposed Changes

1.       Universal Retroactive Revocations

Many of the grounds for revocation carry retroactive effective dates, but certain others take effect prospectively—30 days after CMS mails notice. The proposed rule would make every revocation retroactive to the date of noncompliance. For example, a revocation for failure to report an enrollment update would be effective the day following the reporting deadline—a significant increase in consequences given that reporting oversights can and do occur and are often attributable to inadvertent administrative errors.

2.       New and Modified Revocation Grounds

New Grounds for Revocation

  • 36-Month Rule. CMS proposes a new revocation and denial ground for hospices, home health agencies (HHAs), and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers that circumvent the 36-month rule. The proposed ground addresses inappropriate attempts to avoid triggering the 36-month rule, such as the following two scenarios: (1) situations in which the enrollee fails to notify CMS of a change in majority ownership and the buyer assumes ownership under the existing enrollment without re-enrolling as a new provider; and (2) arrangements in which the parties use a management agreement or similar instrument to transfer operational control while deferring a formal sale until the 36-month period expires.
  • Geographic Over-Saturation. CMS could revoke enrollment if the provider or supplier is located in a geographic area with an excessive concentration of providers and suppliers—not necessarily of the same type—presenting a high risk of fraud, waste, and abuse. No actual finding of fraud is required.
  • Misdemeanor Convictions. CMS could revoke enrollment if the provider or supplier, or any owner, managing employee, managing organization, officer, or director, has been convicted of a misdemeanor related to sexual assault or financial misconduct within the past 10 years.

Changes to Existing Revocation Grounds

  • Abuse of Billing Privileges. CMS proposes removing the four factors it must currently consider when determining whether a provider has a “pattern or practice” of non-compliant billing, explaining that it wants maximum flexibility to address all scenarios without the constraints of enumerated criteria.
  • Extension of Revocation. CMS proposes allowing revocation of a provider’s or supplier’s other Medicare enrollments when the triggering enrollment is denied (not just revoked), broadening the cascade effect of an adverse enrollment determination.
  • False or Misleading Information. Revocations based on false or misleading information would be expanded to cover information on any CMS or Medicare enrollment-related form, not just the CMS-855 application, and would no longer require that the information be submitted to “gain or maintain enrollment” or certified as “true.”
  • Claims Submission After Revocation. CMS proposes reducing the post-revocation claims submission period from 60 days to 15 days, measured from the date of the revocation letter.
3.       New and Revised Grounds for Denial
  • Debt and Payment Suspension. The grounds for denial based on debt and payment suspension would be expanded beyond the provider and its owners to reach managing employees, managing organizations and any party with a “business or financial relationship” with the provider.
  • Program Termination/License Suspension. CMS proposes expanding this ground to cover license suspensions and state or federal healthcare program terminations involving the provider’s owners, managing employees and managing organizations—not just the enrolling entity.
  • Revocation or Denial in Same Suite. CMS proposes a new denial ground based on sharing a suite or office with a provider whose Medicare enrollment has been revoked or denied—no finding of wrongdoing by the applicant is required.
  • Hospice Medical Directors and Administrators. A new ground would permit denial if the hospice’s medical director or administrator serves at multiple hospices, is located too far from the facility to perform required functions, or lacks an active license in the state in which they are practicing.
  • Expanded Reapplication Bar. The reapplication bar under 42 C.F.R. § 424.530(f), currently limited to denials for false or misleading information, would be expanded so CMS can impose a bar of up to 10 years for any denial reason.
4.       Other Provisions
  • Managing Employee Definition. The definition of “managing employee” would be broadened to expressly include medical directors, clinical directors, departmental heads, supervising physicians, nursing directors, alternate administrators and other clinical personnel with managerial control. While the current definition of “managing employee” is broad enough to arguably capture many of these positions, enumerating them eliminates ambiguity and puts providers on notice that clinical leadership positions must be reported.
  • Affiliation Disclosures. Currently, when requested by CMS, providers must disclose affiliations with other providers that have “disclosable events,” both at the entity level and through the provider’s owners, managing employees, and managing organizations. If CMS deems the affiliation an undue risk of fraud, waste, or abuse, it may deny or revoke enrollment. CMS proposes removing the current five-year lookback period, meaning affiliations must be reported regardless of how long ago they occurred. CMS would also expand the definition of “affiliation” to include any marketing, business, fulfillment, financial, managerial or beneficiary relationship.
  • Private Equity/REIT Disclosures. CMS intends to require disclosure of private equity companies and REITs through the revision of the CMS-855B, CMS-855S, and CMS-20134 forms.
  • Temporary Moratoria. CMS proposes several changes to its temporary enrollment moratorium authority, which is particularly notable given the active moratoria on the enrollment of new HHAs, hospices, and DMEPOS companies. CMS clarifies that a moratorium’s effective date is the date on which the moratorium notice is filed for public inspection at the Office of the Federal Register. Also, CMS would expand the definition of “new” enrollments subject to a moratorium to include reactivation applications and applications from voluntarily terminated providers seeking to re-enter Medicare, not just initial enrollment and change of ownership applications.

How Should You Prepare?

If finalized, these proposals will require significant operational adjustments across a wide range of enrollment-related functions. While the following is not an exhaustive list, here are steps we believe providers and suppliers should prioritize now:

  • Conduct an enrollment audit to confirm that all information on file is current and accurate.
  • Confirm adverse action status (including newly captured misdemeanors) with all reportable persons and entities (including newly captured managing employees).
  • Reassess affiliation disclosures.
  • Confirm 36-month rule compliance.
  • Evaluate hospice leadership arrangements.
  • Review geographic risk.
  • Prioritize enrollment review in transactional diligence.
  • Prepare for private equity and REIT disclosure requirements.
  • Submit comments by August 31, 2026.

If you have any questions about the proposed rule or Medicare enrollment matters generally, please contact the authors.

In Case You Missed It: