There May Be No Warning Before the November Moratorium Decision — What Home Health Owners Should Do Now

CMS may extend or lift the home health and hospice enrollment moratorium without providing owners with a meaningful advance warning. This article explains what CMS has actually committed to, why industry groups are urging expiration, and how the 36 month CIMO rule can affect a seller’s ability to close. Owners will also find a practical action plan for protecting expansion options, preparing for buyer diligence, and planning for both regulatory outcomes.

9/21/20269 min read

The nationwide Medicare enrollment moratorium for home health and hospice agencies is scheduled to end on November 13, 2026, but CMS has not promised advance warning if it decides to extend the freeze. This article explains how owners can plan under that uncertainty, protect transaction flexibility, and use the 36 month CIMO clock to make better decisions about growth, succession, and a potential sale.

Quick Scan Summary

Who this is for

Home health or hospice owners with $2 million to $10 million in annual revenue
Owners considering a sale, succession plan, acquisition, or new location
Operators affected by the Medicare enrollment freeze
Owners whose most recent enrollment or change in majority ownership occurred less than 36 months ago
Agencies that need to preserve buyer interest while regulatory timing remains uncertain

Key takeaways

The current moratorium began May 13, 2026, and is scheduled to run for six months through November 13, 2026.
CMS has no formal obligation to announce an extension before the current term ends.
CMS will announce either an extension or the lifting of the moratorium through a Federal Register notice.
The 36 month CIMO rule may be more important to a seller than the November decision itself.
Existing Medicare enrolled providers can generally continue operating, billing, and making certain enrollment changes.
Medicare enrolled providers may acquire and merge with other enrolled providers during the moratorium if the transaction does not require new enrollment and does not add new locations.
Owners should prepare for both outcomes now instead of waiting for a countdown that may never arrive.

Why the notice gap matters

Many owners are planning around November 13 as if it were a guaranteed decision date with a reliable warning beforehand. That assumption is risky.

CMS’s own Q&A document states that moratoria are implemented for six months and can be extended for additional six month periods if necessary. It also states that extensions are announced through a Federal Register notice and that lifting the moratorium will also be announced through a Federal Register notice.

That language establishes the communication mechanism, not an advance notice period. CMS may publish a notice before November 13, on November 13, or close to the effective date of an extension. The agency has not committed to giving owners several weeks to sequence a transaction, submit an enrollment application, open a branch, or revise a deal structure.

For an owner, that creates a practical planning problem. A transaction that is possible under one outcome could become delayed or require a different structure under another. A new branch planned for December may remain unavailable if the moratorium is extended. A sale involving a provider that is still within the 36 month CIMO period may face a more fundamental enrollment issue.

The right response is not to predict the announcement. It is to make the agency ready for either result.

What CMS has actually committed to

The CMS Q&A provides several important boundaries.

Existing providers are not frozen

CMS states that the moratorium generally affects new enrollment applications. Existing Medicare enrolled providers can continue participating in Medicare, submit claims for covered services, and make certain changes to enrollment information.

That means a compliant home health or hospice agency can continue serving patients during the freeze. The moratorium does not automatically stop current operations, suspend claims, or prevent ordinary compliance activity.

New applications submitted during the freeze will be denied

Initial enrollment applications submitted during the moratorium will be denied and must be resubmitted after the moratorium is lifted. Owners should not treat a submission during the freeze as a way to preserve a place in line.

Pending applications received by the Medicare contractor before the moratorium date are treated differently. CMS states that the moratorium does not apply to an enrollment application received before the implementation date.

New locations are prohibited

CMS states that the moratorium prohibits adding a new practice location to an existing Medicare enrollment. This includes new branches, satellite offices, and expansion locations added to an existing CCN.

A move or change in practice location is generally exempt, but that exemption is not unconditional. CMS or the State Survey Agency may determine that a move represents a substantive operational change if the agency enters a new geographic community, serves a new patient population, or operates with new clinical or administrative staff. In that case, the move may be treated as the creation of a new provider entity.

Appeals are limited

A provider may appeal a denial under the procedures in 42 CFR Part 498. However, the appeal is limited to whether the moratorium applies. CMS’s regulations do not permit individual exceptions to the moratorium.

That makes advance transaction analysis especially important. An owner should not assume that a compelling access need, a strong compliance history, or a qualified buyer will create an exception.

Where the industry pressure stands

The pressure on CMS is moving in one direction, but it does not guarantee the outcome.

Tom Koutsoumpas, founder and CEO of the National Partnership for Healthcare and Hospice Innovation, said the moratorium has been successful as a short term response but is not sustainable for the long term. NPHI represents approximately 140 nonprofit, community based programs.

Koutsoumpas has also said that some NPHI members had to put expansion plans on hold during the moratorium. His position is that the pause was worth using to get control of the problem, but that CMS should now move toward a more targeted approach focused on bad actors rather than a nationwide freeze affecting legitimate providers.

The National Alliance for Care at Home has urged CMS to allow the moratorium to expire. In a September 4 letter, Alliance CEO Jennifer Sheets wrote:

> “National data does not demonstrate that fraud, waste or abuse in home health or hospice is so pervasive and geographically uniform as to warrant an extension of the enrollment moratoria across all 50 states and territories.”

The Alliance also reported that 38 percent of Medicare beneficiaries did not receive the home health services to which they were referred after a hospital discharge in the third quarter of 2025. Rural beneficiaries faced worse access. The organization said health systems are delaying or abandoning home health partnerships because agencies cannot submit Medicare enrollment paperwork.

LeadingAge initially supported the moratorium as a temporary tool that would give CMS time to develop a longer term solution. In its September 9 letter, the organization urged CMS to allow the moratorium to expire, warning that legitimate providers are being caught in the crossfire of the fraud fight. LeadingAge represents approximately 5,300 nonprofit providers.

In an August 31 comment letter on the CY 2027 proposed rule, LeadingAge also warned that legitimate providers could face severe enrollment consequences because of technical errors, conduct outside their control, or third party associations. It urged CMS to distinguish intentional misconduct from good faith errors and preserve due process.

The message for owners is clear: industry groups are pressing for expiration, but owners should not build a transaction plan that depends on that result.

The 36 month CIMO clock is the planning deadline sellers miss

For sellers, the November decision may not be the most important date on the calendar.

CMS Q&A 11 explains that under 42 CFR 424.550(b), an HHA or hospice that undergoes a change in majority ownership, or CIMO, within 36 months after its initial enrollment or most recent CIMO must initially enroll as a brand new provider. The rule can apply to an asset sale, stock transfer, merger, or consolidation.

The provider must also undergo a new state survey or accreditation. Because it is treated as a new provider, it is subject to the moratorium.

A CIMO occurring more than 36 months after initial enrollment or more than 36 months after the most recent CIMO generally does not cause the provider to be treated as new.

Owners should identify three dates immediately:

The original Medicare enrollment date
The date of the most recent CIMO
The earliest date on which a new CIMO would fall outside the 36 month period

A seller who misses this clock may discover that a transaction cannot proceed as expected, even if CMS allows the moratorium to expire in November. A buyer may need to delay closing, restructure the transaction, require additional conditions, or price the risk differently.

Consider an agency with $750,000 in adjusted EBITDA. At a 6.0 times multiple, the illustrative enterprise value is $4.5 million. At a 5.0 times multiple, it is $3.75 million. The $750,000 difference may reflect transaction risk, delayed enrollment, additional survey requirements, or uncertainty about whether the provider can preserve its Medicare participation.

These are illustrative figures, not market guarantees. The point is that regulatory timing can affect both the ability to close and the price a buyer is willing to underwrite.

What transactions can still close during the freeze?

CMS Q&A 10 provides an important distinction. Medicare enrolled providers can acquire and merge with other enrolled providers during the moratorium when:

The transaction does not involve a CIMO that requires new enrollment
No new practice location is being added
Existing locations are transferred to the surviving entity’s enrollment

This does not mean every acquisition can close. The parties must evaluate ownership history, enrollment records, locations, survey status, and the precise legal structure. But it does mean the moratorium does not eliminate every path for an existing provider to acquire another existing provider.

For an owner considering a sale, the practical question is not simply, “Is the moratorium active?” It is, “Does this transaction require the provider to be treated as new?”

That question should be answered before signing a letter of intent, not after the buyer has completed diligence.

What owners should do now

Use this decision tree regardless of what CMS announces.

If your agency may be sold within the next 12 to 24 months

Confirm your original Medicare enrollment date and most recent CIMO date.
Ask transaction counsel and the buyer to analyze whether the proposed structure triggers new enrollment.
Separate existing certified locations from planned expansion locations.
Organize enrollment records, surveys, accreditation documents, ownership filings, and correspondence.
Prepare a clear explanation of any ownership changes, relocations, or pending applications.

If you are planning a new branch or expansion

Do not assume the November date will create enough time to open the location.
Confirm whether the proposed site is a new practice location or a relocation of existing operations.
Document the intended patient population, staffing model, service area, and operational leadership.
Build a plan that can proceed without adding the location until CMS formally lifts the restriction.

If you are evaluating an acquisition

Focus first on already enrolled providers and existing certified locations.
Review the target’s CIMO history before discussing a closing date.
Confirm whether the transaction can be completed without new enrollment.
Keep a second structure available if CMS extends the moratorium.
Monitor Federal Register notices and CMS communications rather than relying on informal market updates.

If you are not currently planning a transaction

Keep Medicare enrollment and revalidation records current.
Maintain clean ownership documentation.
Track key-person dependence, referral concentration, compliance findings, and financial performance.
Prepare a buyer ready data room so a regulatory announcement does not become an operational scramble.

Plain Language Glossary

Moratorium: A temporary pause on new Medicare enrollment for specified provider types or locations.
CIMO: A change in majority ownership, including certain asset sales, stock transfers, mergers, and consolidations.
CCN: The Medicare Certification Number assigned to a participating provider.
New provider: An agency that must enroll again and complete a new survey or accreditation.
Federal Register notice: The formal government publication used to announce regulatory actions such as extending or lifting a moratorium.
Buyer underwriting: The process an acquiring organization uses to evaluate financial, regulatory, operational, and enrollment risk before setting price and deal terms.

So what should you do now?

Stop waiting for a reliable announcement countdown and build plans for both expiration and extension.
Calculate your 36 month CIMO date before discussing a sale, merger, or ownership transfer.
Separate transactions involving existing enrolled providers from plans that require new enrollment or new locations.
Assemble your enrollment, compliance, financial, and operational records now so a buyer can evaluate the agency without avoidable delay.

Partner with Senate Healthcare

Senate Healthcare LLC is the buyer and strategic partner pursuing acquisitions of home health or hospice agencies. We work directly with owners who are evaluating a sale, succession plan, or transaction during a period of regulatory uncertainty.

Your agency does not need to be perfectly positioned today to begin a confidential conversation. Senate Healthcare can evaluate the ownership timeline, enrollment status, operating performance, and transition objectives of the business while considering a structure designed to reduce risk and protect continuity of care.

If you are considering a sale or partnership, contact Senate Healthcare to discuss your agency, your timing, and the steps required to preserve the strongest possible transaction outcome.

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