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CMS officials discussed possible alternatives to a nationwide home health enrollment moratorium, including exceptions for established providers with strong compliance records and limits focused on specific geographic areas. The agency has announced no decision or criteria, and providers were also awaiting the Medicare home health final rule.
CMS is considering alternatives to a nationwide freeze on new home health provider enrollments, including a possible exception for established agencies with strong compliance records and geographic limits on the restrictions, according to comments at the National Alliance for Care at Home’s annual meeting in Washington. The agency has not announced a policy change, leaving providers uncertain about whether they will be able to expand and how the government will target suspected fraud.
Kim Brandt, CMS deputy administrator and chief operating officer, said the agency had heard concerns from existing home health operators that want to expand, including into rural areas, but face enrollment restrictions. Brandt discussed a possible “gold card” approach, under which established providers with strong compliance records could receive an exception to open new locations. Denis Fleming Jr., the Alliance’s chief government affairs officer, described that concept during the event. Neither speaker provided eligibility criteria, and CMS has not established such a program.
Brandt also raised the possibility of geographic limits, which could target enrollment restrictions to particular markets rather than applying a nationwide freeze. Other possible paths include allowing the moratorium to expire while using different program-integrity tools. These options were discussed as possibilities, not finalized agency plans. The report on the meeting said Brandt indicated CMS was working with its counsel’s office on potential solutions.
The enrollment restriction has prevented about 250 home health agencies from being approved, according to the source report. That figure counts agencies whose enrollment was not approved during the moratorium; it does not establish that those agencies committed fraud. The distinction matters as policymakers weigh fraud controls against the ability of legitimate providers to enter or expand in areas with limited access.
Expansion and Fraud Controls
The policy choice affects both provider growth and patient access. A limited exception for compliant, established agencies could let some operators add locations while retaining a barrier to new entrants. If those expansions reach areas where services are scarce, the change could offer communities another source of home health care. But the concept would not necessarily help a legitimate new provider seeking to enter a market, and its effect would depend on the criteria and how quickly CMS applies them.
Changing the enrollment freeze would not, by itself, settle the broader question of how CMS addresses fraud. Hillary Loeffler, BrightSpring Health Services’ vice president of federal government relations, said during a separate panel that a moratorium stops new entrants but does not remove fraudulent providers already enrolled in the program. A narrower restriction could therefore coexist with other oversight measures—and potentially with more compliance work for providers.
Katie Wehri, the Alliance’s vice president for regulatory affairs, quality and compliance, warned that proposed enrollment requirements could require providers to commit more staffing and financial resources. For agencies, the practical impact may depend on the combination of enrollment rules, enforcement and reimbursement policy, not just whether a nationwide freeze continues.
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Freeze Meets Payment Rule
The discussion took place as the home health sector awaited CMS’s Medicare home health final rule, which typically is released around Halloween, according to the source report. CMS’s July proposal included an aggregate payment increase of 2.4% and a temporary 3% reduction to the 2027 national standardized payment rate, alongside other proposed measures. Those figures describe the proposal, not the final rule.
The proposal also included fraud-fighting tools, a request for information on developing a home health-specific wage index, and discussion of expanding access to palliative care. Brandt linked anti-fraud work to payment rates, arguing that funds going to bad actors were funds taken away from compliant providers. The source report said the rule’s final contents remained pending at the time of publication.
“A moratorium stops new entrants; it does not, by itself, remove fraudulent providers already in the program.”
— Hillary Loeffler, BrightSpring Health Services’ vice president of federal government relations
Rules and Eligibility Remain Open
CMS has not announced whether it will extend, narrow or end the nationwide moratorium, or whether it will create a gold-card exception. No criteria were provided for what would count as a strong compliance record, how an agency would apply, or how long an exception might take. The agency also has not identified which geographic markets might face restrictions if it chose a more targeted approach.
The source report does not establish how any potential enrollment changes would affect access in rural or underserved communities. Nor does it confirm the final payment provisions or timing of the home health rule. The approximately 250 agencies not approved during the moratorium should not be treated as a count of proven fraudulent providers.
CMS Decision and Final Rule
Providers are awaiting CMS’s decision on the enrollment moratorium and the release of the Medicare home health final rule. The agency’s next steps will show whether the ideas discussed at the meeting become formal proposals or policy changes. Key details to watch include any eligibility standards for exceptions, the areas covered by geographic restrictions, and the enforcement tools CMS would use alongside or instead of a moratorium.
Until CMS publishes its decisions, the gold-card concept and geographic limits remain options discussed by officials, not confirmed relief for providers. The final rule will also determine which payment and oversight measures from the July proposal are adopted.
Key Questions
Has CMS approved a gold-card program for home health providers?
No. CMS officials discussed the possibility of exceptions for established providers with strong compliance records, but the agency has not announced a program or its eligibility rules.
What would geographic limits mean for the enrollment freeze?
They could focus enrollment restrictions on selected markets rather than applying a nationwide freeze. CMS has not identified any locations or confirmed that it will adopt this approach.
Do the roughly 250 agencies not approved count as proven fraudsters?
No. The number refers to agencies not approved for enrollment during the moratorium. It does not show that each agency committed fraud.
What payment changes were included in CMS’s July proposal?
The proposal included an aggregate payment increase of 2.4% and a temporary 3% reduction to the 2027 national standardized payment rate. Those were proposed figures; the final rule had not yet been released in the source report.
Source: homehealthcarenews.com
