CMS Enrollment Moratoria: CHOW Implications for Home Health and Hospice Transactions

Key Takeaways

• The moratoria apply to initial enrollments and non-exempt changes in majority ownership under the 36-month rule.
• Transactions outside the 36-month window, or those qualifying for an exception, may still proceed without moratorium impact.
• Parties to home health agencies and hospice deals should assess early whether the 36-month rule applies.

The Centers for Medicare and Medicaid Services (“CMS”) has announced nationwide enrollment moratoria for new home health agencies (“HHA”) and hospices, effective May 13, 2026, for an initial period of six months. CMS has implemented the moratoria as an anti-fraud measure targeting waste and abuse in the HHA and hospice sectors. Although the announcement has significant implications for new HHA and hospice entrants, the practical impact on change of ownership (“CHOW”) transactions is narrower: the moratoria should affect only those CHOWs that are treated as new initial enrollment under the Medicare “36-month rule.”

CMS guidance provides that the moratoria apply to new enrollment applications and certain changes in majority ownership, as defined under Medicare regulations. HHA and hospice applications submitted after the moratoria effective date will be denied if they fall within these categories. Existing enrolled providers generally may continue participating in Medicare, submitting claims, and making certain enrollment updates.

The 36-month rule is critical for transaction planning. Under the rule, if an HHA or hospice undergoes a change in majority ownership within 36 months of its initial Medicare enrollment — or within 36 months of its most recent change in majority ownership — the provider’s existing Medicare enrollment does not transfer to the new owner. Instead, the new owner must enroll in Medicare as a new provider and obtain a new state survey or accreditation. During the moratoria, such applications will be denied.

The 36-month rule includes exceptions for:

• Providers that have filed two consecutive years of full Medicare cost reports;
• Internal parent-company restructurings;
• Changes in business structure where the underlying ownership remains the same; and
• The death of an individual owner.

The moratoria also do not apply to enrollment applications received by the Medicare contractor before the moratoria were imposed.

Parties to HHA and hospice transactions should assess early whether the target is subject to the 36-month rule, whether the transaction involves a change in majority ownership, and whether an exception applies. If the CHOW requires a new initial enrollment during the moratoria, Medicare enrollment will not be permitted. CMS may extend the moratoria in additional six-month increments.

For more information, please contact AGG CHOW attorneys Hedy Rubinger, Jessica Grozine, or Maggie Callahan.

The Arnall Golden Gregory Change of Ownership (“CHOW”) team leads all regulatory aspects of healthcare transactions for investors, operators, managers, capital partners, and developers of every size in all 50 states. The team streamlines the regulatory process so that clients close their transactions on or ahead of schedule. Whether obtaining licensure and Medicare/Medicaid approvals, structuring transactions to expedite closings, anticipating issues to minimize cash flow disruption, negotiating regulatory terms in deal documents, creatively resolving diligence issues, or advising on CHOW guidelines and compliance, the team provides extensive experience and practical solutions. To date, the CHOW team has served as primary regulatory counsel in transactions valued at more than $35 billion.​​