‘Makes No Sense’: Home Health Community Reacts To CMS’ Moratorium – Image for illustrative purposes only (Image credits: Unsplash)
Agencies that have relied on opening new locations to reach more patients now find those plans on hold, raising questions about how quickly people in underserved areas can receive home health or hospice services. The six-month nationwide pause on Medicare enrollment for new agencies took effect recently and applies to both home health and hospice providers. Executives at several organizations say the move, while aimed at fraud, risks slowing legitimate growth at a time when demand for aging-in-place care continues to rise.
Executives Describe Direct Effects on Expansion Plans
Dean Alverson, president and CEO of LifeCare Home Health Family, noted that his organization has used a de novo strategy to enter high-demand markets in Texas, Florida, Nevada and Arizona. That approach allowed the company to add services through seven additional brands and address gaps in access. With the moratorium in place, those steps are no longer possible, he said, which could affect broader operations and the ability to meet patient needs.
At Interim HealthCare, a franchise network with more than 300 care centers, leaders are shifting focus to helping existing franchise partners grow inside their current service areas. President and CEO Rexanne Domico pointed out that local operators often know exactly where care is needed most. Senior vice president of operations Dan Borraga added that the nationwide scope of the moratorium hurts compliant businesses and limits options for people who want to receive care at home rather than in facilities.
Scope of the Pause and What Remains Allowed
The moratorium blocks new Medicare enrollments and prevents agencies from entering fresh geographic markets. It does not stop changes of ownership, so some transactions can still move forward. Providers must now conduct extra due diligence on any target’s enrollment history and prior ownership changes, according to Michelle Huntsman, a partner at Holland & Knight.
Huntsman advised organizations to perform thorough compliance reviews before any deal closes. She expects CMS to scrutinize change-of-ownership filings more closely and warned that processing times could lengthen across the board. Maintaining strong billing and coding practices, along with reviewing the Office of Inspector General’s compliance guidelines, will be essential for every provider during this period.
CMS Rationale and Questions From Industry Groups
CMS said the six-month pause will give investigators time to use advanced data analytics and remove suspected fraudulent providers. The agency chose a nationwide approach to keep bad actors from simply relocating operations across state lines. It also applied the moratorium to both home health and hospice because the two services are frequently co-located.
Hillary Loeffler, vice president of policy and regulatory affairs at the National Alliance for Care at Home, questioned whether the fraud problem truly justifies such a broad measure. She noted that CMS has already deployed tools such as review choice demonstration, provisional periods of enhanced oversight, and machine-learning algorithms. Without clear benchmarks for lifting the moratorium, she said, providers worry it could be extended in the same way an earlier home health moratorium lasted from 2013 until 2019.
Stakeholders Watching for Longer-Term Consequences
Rural and underserved communities stand to feel the effects first, because new agencies often fill gaps where established providers do not operate. Larger national chains may absorb some of the impact through acquisitions, yet smaller and franchise-based operators report fewer options for scaling services where they are most needed.
- Patients in high-demand markets may experience longer wait times for home health or hospice intake.
- Compliant agencies lose one established path for responding to population growth.
- Transaction activity is expected to slow while buyers complete additional compliance checks.
- CMS has signaled continued scrutiny through investigations and potential congressional hearings.
The coming months will show whether the moratorium achieves its stated goals without creating new barriers for families who prefer to receive care in familiar surroundings.
