07/16/2026

CMS Proposal Threatens Sweeping Changes to Medicare Enrollment and Provider Participation

The Centers for Medicare & Medicaid Services has proposed substantial Medicare enrollment and program integrity changes that could affect providers across the care continuum. Although included in the calendar year 2027 home health proposed rule, the provisions would apply broadly to Medicare providers and suppliers as CMS continues to take aim at waste, fraud, and abuse in the Medicare program. Join Monday’s Advocacy in Action at 10 a.m. for a review and Q&A of the proposed rules, where concerns lie, and action steps moving forward. 

What You Need To Know

• CMS is proposing a new authority to revoke a provider’s or supplier’s enrollment if it deems the enrollment as presenting as high risk of fraud, waste, or abuse due to the provider’s or supplier’s location within a limited geographic area that has an excessive number of providers and suppliers.
• CMS is proposing revocation of enrollment if the provider or supplier - or any owner, managing employee or organization, officer, or director thereof - was convicted of a Federal or State misdemeanor related to sexual assault or financial misconduct within the past 10 years that CMS deems detrimental to the best interests of the Medicare program and its beneficiaries. 
• CMS proposes making all enrollment revocations retroactive, generally to the date noncompliance began, which could increase repayment exposure.
• Providers subject to revocation would have 15 calendar days from the revocation letter to submit remaining claims, down from 60 days for most providers.
• New or expanded denial and revocation grounds would address billing practices, false or misleading enrollment information, certain misdemeanor convictions, high-risk geographic areas and violations of the 36-month change-in-majority-ownership rule.
• CMS also proposes broader definitions of managing employees and affiliations, new requirements for hospice reactivation and additional scrutiny of owners, managers and related entities.

What to Do

Members are highly encouraged to review LeadingAge’s full analysis of the proposed enrollment and revocation provisions. Join Advocacy in Action Monday, July 20, at 10 a.m. Katy Barnett of LeadingAge will discuss the proposals with LeadingAge Ohio members and answer questions about their potential impact.