Late this afternoon CMS issued the calendar year (CY) 2026 Home Health Prospective Payment System Rate and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates proposed rule. There are some provider enrollment provisions that would apply to hospices which are explained below. CMS did not address other aspects related to hospice, most notably the HOPE and its implementation date. As you know, the Alliance separately and along with other national trade associations has requested a delay in the implementation timeframe for HOPE and a waiver of the timeliness submission requirements. We will continue our advocacy efforts on this front.
Provider Enrollment
CMS is proposing several Medicare provider enrollment provisions to strengthen and clarify certain aspects of the provider enrollment process. These include, but are not limited to, the following:
- Modifying grounds for denying, revoking, or deactivating a provider's or supplier's Medicare enrollment.
- Expanding the reasons for which CMS can apply a retroactive effective date for provider and supplier revocations.
- Expanding the reasons for which CMS can apply a stay of enrollment.
- Requiring providers and suppliers to report any adverse legal actions imposed against them, their owners, their managers, etc. within 30 days instead of the current 90 days.
CMS cites keeping unqualified providers and suppliers out of the Medicare program, which, in turn would prevent improper Medicare payments to such parties as the reason for these changes.
We will provide a detailed summary of these changes soon.
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Katie Wehri
Vice President of Regulatory Affairs, Quality & Compliance
National Alliance for Care at Home
Washington DC
+1 (202) 547-7424
kwehri@allianceforcareathome.org------------------------------