On July 1, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that includes new provider enrollment provisions that would apply to Medicare provider and supplier types - a 2027 Home Health Prospective Payment System.
The ability to claw-back payments retroactive to the date of noncompliance for all revocations is among the provisions, essentially giving CMS the ability to make all revocation grounds retroactive.
CMS Administrator Dr. Mehmet Oz stated: “These proposals would give CMS stronger tools to protect Medicare beneficiaries and taxpayer dollars from fraud, waste, and abuse. The Trump Administration is committed to ensuring only qualified providers and suppliers participate in Medicare while preserving access to high-quality care for patients across the country.”
Not ALL organizations approach this proposed rule with full support. In fact, LeadingAge - an association representing more than 5,300 nonprofit and mission-driven aging services providers - has expressed some caution.
Katie Smith Sloan, president and CEO of LeadingAge, stated: “The rule also makes several proposals related to program integrity focused on provider enrollment, personnel, and more—areas we asked CMS to focus on. We look forward to reviewing these proposals in more detail with an eye toward ensuring targeted efforts that do not overly burden legitimate providers, including our members.”
HME News lists some of CMS' most pertinent proposed changes to add or expand bases for revocation or denial:
- Change in majority ownership. Hospices, HHAs and suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) must reenroll in Medicare as a new provider and undergo a survey/accreditation if they experience certain changes in majority ownership. CMS proposes to deny or revoke enrollment if this requirement is violated.
- Program or license suspension/termination. CMS currently may deny or revoke enrollment if a provider: (1) has a suspended/revoked license in another state; or (2) is suspended/revoked from Medicaid or another federal health care program. The agency proposes expanding this to include similar suspensions/revocations involving the provider’s owners or managing employees/organizations.
Furthermore, CMS plans to expand the number of opportunities for which an agency could act against problematic providers:
- CMS could revoke a provider’s or supplier’s Medicare enrollment if the enrollment presents a high risk of fraud, waste, and abuse because the provider/supplier is located within a limited geographic area that has an excessive number of providers and suppliers.
- CMS could deny or revoke a provider’s or supplier’s Medicare enrollment if they have been convicted of a misdemeanor related to sexual assault or financial misconduct within the past 10 years.
Read more:
- The fact sheet can be found here: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-home-health-prospective-payment-system-proposed-rule-fact-sheet-cms-1844-p
- The full proposed rule can be viewed here: https://www.federalregister.gov/d/2026-13602
What Could This Proposed Rule Mean for DMEs/ HMEs?
CMS' proposed rule could have several practical implications for providers:
- Greater compliance risk: CMS would have broader authority to deny or revoke Medicare enrollment, making it even more important to keep enrollment records, ownership information, and licensing status accurate and up to date.
- Potential repayment of Medicare claims: If CMS revokes a supplier's enrollment, it is proposing to make all revocations retroactive to the date of noncompliance, meaning DME suppliers could be required to repay Medicare reimbursements received during that period.
- More scrutiny during ownership changes: DMEPOS suppliers experiencing certain majority ownership changes would need to properly reenroll and complete required accreditation and survey processes. Failure to do so could result in enrollment denial or revocation.
- Expanded background checks: CMS is proposing to consider license suspensions, Medicaid exclusions, and similar actions involving owners or managing employees - not just the supplier itself - when evaluating Medicare enrollment.
- Higher importance of governance and documentation: Providers should regularly review enrollment records, ownership structures, accreditation status, and internal compliance processes to reduce the risk of enforcement actions under the expanded rules.
