On July 6, 2026, the Centers for Medicare & Medicaid Services (CMS) published its Calendar Year 2027 Home Health Prospective Payment System Proposed Rule (the “Proposed Rule”) in the Federal Register, which includes several provider enrollment changes that would be applicable to all provider and supplier types. In its efforts to strengthen program integrity, CMS has proposed changes to the grounds for, and consequences of, provider enrollment denials and revocations.
Key proposed provider enrollment changes are described below. Comments to the Proposed Rule are due by 5pm ET on August 31, 2026.
Link to New and Updated Denial and Revocations Grounds New and Updated Denial and Revocations Grounds
CMS proposes to update existing, and add new, denial and revocation grounds. These include, but are not limited to, the following:
Updated Revocation Grounds
- False or Misleading Information: Currently, CMS can revoke an enrollment if a provider or supplier provides misleading or false information on its Medicare enrollment application. CMS proposes to expand this to include any false or misleading information on or associated with a Medicare enrollment-related form and documentation furnished in conjunction with the form.
- Abuse of Billing Privileges: Currently, CMS can revoke enrollment if it determines a provider or supplier has a pattern or practice of submitting claims that fail to meet Medicare requirements based on enumerated considerations, which include the percentage of denied claims and history of final adverse actions. CMS proposes eliminating the enumerated considerations to provide greater latitude for identifying and addressing cases of improper billing.
New Revocation Grounds
- High-Risk Enrollments: CMS proposes the ability to revoke a provider’s or supplier’s enrollment if it deems the enrollment as presenting a 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 has increasingly observed numerous providers and suppliers, often of the same type, simultaneously operating in a very small geographic area, like the same city block or same building. CMS noted that this can be an indicator of fraud when there is not an increased need for such a provider or supplier in the area.
- Certain Misdemeanor Convictions: CMS proposes a revocation right 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.
Updated Denial Grounds
- Medicare Debt: Currently, CMS can deny enrollment where the provider or an owner (i) has an existing Medicare debt, or (ii) was previously the owner of a provider that had a Medicare debt at the time that prior provider’s enrollment was voluntarily terminated, involuntarily terminated, or revoked. CMS proposes to expand this to include managing employees, managing organizations, and any individual or entity with any other business or financial relationship with the provider.
- Payment Suspension: Currently, CMS can deny enrollment where the provider, or any owning or managing employee or organization of the provider is under a Medicare or Medicaid suspension. CMS proposes to expand this to include any individual or entity with any other business or financial relationship with the provider.
New Denial Grounds
- Misdemeanor Convictions: Like the proposed revocation right for certain misdemeanors described above, CMS proposes a corresponding denial right for such misdemeanor convictions.
- Revocation or Denial in Same Suite: CMS proposes a new denial ground based on the provider having its practice location in the same suite or office as another provider whose Medicare enrollment has been revoked or denied. CMS’s rationale for this new denial ground mirrors its reason for proposing revocation for high-risk enrollments.
- Misuse of Identity: CMS proposes the ability to deny enrollment of a prospective provider or supplier that attempts to enroll under another party’s identity. A similar revocation right already exists and allows CMS to revoke the enrollment of a provider or supplier that knowingly sells to or allows another individual or entity to use its billing number.
Link to Reapplication Bar Reapplication Bar
Currently, CMS can impose a reapplication bar of up to 10 years for denials based on the submission of false or misleading information. CMS proposes broadening this to allow for a reapplication bar of up to 10 years for any denial reason.
Link to Retroactive Revocation Date Retroactive Revocation Date
Currently, revocations generally become effective 30 calendar days after CMS mails notice to the provider, except in specified situations where the revocation date is retroactive to the date on which the noncompliance began. CMS proposes that all revocations, regardless of reason, be retroactive to the date of noncompliance. For example, the effective date of a revocation based on a referral of debt to Treasury would be the date CMS referred the debt to Treasury, and the effective date of a revocation based on the failure to report a change in enrollment information (e.g., change of ownership, adverse legal action, or other enrollment information) would be the due date for reporting the change.
Link to Claims Submitted After Revocation Claims Submitted After Revocation
Currently, revoked providers, excluding home health agencies (HHAs), have 60 calendar days after the revocation’s effective date to submit all claims for items and services furnished prior to the revocation date, and HHAs have 60 days after the later of (1) the revocation effective date and (2) the date that the HHA’s last payable episode ends. CMS proposes to change this so that providers (except HHAs) have 15 calendar days from the date of the revocation letter to submit all claims for items and services furnished prior to the revocation date, and HHAs would have 15 calendar days from the date of the revocation letter to submit all claims for items and services furnished before the later of: (1) the revocation effective date and (2) the date that the HHA’s last payable episode ends.
For questions about these proposed provider enrollment changes, please contact the authors, your McGuireWoods contact, or a member of the Healthcare Compliance, Regulatory & Policy Practice Group.