CMS seeks to tighten provider enrollment provisions

WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) on July 1 released a 2027 Home Health Prospective Payment System proposed rule that includes new provider enrollment provisions that would apply across Medicare provider and supplier types. Among the provisions: The ability to claw-back payments retroactive to the date of noncompliance for all revocations.

Under current regulations, certain Medicare enrollment revocations become effective prospectively — specifically, 30 days after the date that CMS or its contractor mails notice of the revocation to the affected provider or supplier. However, other revocations take effect retroactively to the date the provider’s noncompliance began. The agency is proposing to make all revocation grounds retroactive.

“These proposals would give CMS stronger tools to protect Medicare beneficiaries and taxpayer dollars from fraud, waste, and abuse,” said CMS Administrator Dr. Mehmet Oz. “The Trump Administration is committed to ensuring only qualified providers and suppliers participate in Medicare while preserving access to high-quality care for patients across the country.”

CMS is also proposing to add or expand bases for revocation or denial to include:

• Change in majority ownership. Hospices, HHAs and suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) must reenroll in Medicare as a new provider and undergo a survey/accreditation if they experience certain changes in majority ownership. CMS proposes to deny or revoke enrollment if this requirement is violated.
• Program or license suspension/termination. CMS currently may deny or revoke enrollment if a provider: (1) has a suspended/revoked license in another state; or (2) is suspended/revoked from Medicaid or another federal health care program. The agency proposes expanding this to include similar suspensions/revocations involving the provider’s owners or managing employees/organizations.

In addition, CMS is proposing to expand the number of reasons for which the agency can take action against problematic providers. These would include, but not be limited to:

• CMS could revoke a provider’s or supplier’s Medicare enrollment if the enrollment presents a high risk of fraud, waste, and abuse because the provider/supplier is located within a limited geographic area that has an excessive number of providers and suppliers.
• CMS could deny or revoke a provider’s or supplier’s Medicare enrollment if they have been convicted of a misdemeanor related to sexual assault or financial misconduct within the past 10 years.

To view a fact sheet on the proposed rule, visit: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-home-health-prospective-payment-system-proposed-rule-fact-sheet-cms-1844-p.

The proposed rule can be viewed on the Federal Register at: https://www.federalregister.gov/d/2026-13602.

• Related: CMS announces temporary moratorium on new Medicare enrollment for certain DMEPOS providers.