Article
Not just a home health rule
The proposed rule, published July 6, pairs a 2.4% home health payment update with a long list of provider enrollment changes that apply to all Medicare providers and suppliers. The AHA asked CMS to move those provisions into separate rulemaking, arguing that hospitals that do not follow home health policy may not have realized they were affected.
What CMS proposed
Several proposals would lower the bar for losing billing privileges:
- Fewer guardrails on revocation. CMS would drop the four factors it now weighs before revoking for a pattern of noncompliant claims, keeping only the pattern-or-practice standard.
- Any form counts. False or misleading information on any enrollment-related form, regardless of intent, could support revocation.
- One denial, many sites. A denied application for one location could be grounds to revoke a provider’s other enrollments.
- Retroactive effect. All revocations would reach back to when noncompliance began, and the window to submit claims after revocation would shrink from 60 days to 15.
- Wider disclosure. The definition of managing employee would add medical directors, department heads, nursing directors and similar roles. Affiliation reporting would lose its five-year lookback and add new categories of business and financial relationships.
- New denial grounds. CMS could deny enrollment based on Medicare debts of any business partner, or because a location shares a suite with a revoked provider. It could also revoke providers in areas it deems oversupplied.
The AHA’s response
The association urged CMS to finalize only policies that are narrowly tailored and based on objective standards, with protections for providers acting in good faith. It noted that a single health system may have hundreds of roles that would fall under the broader managing employee definition, and that turnover would trigger constant filings. It questioned CMS’s legal authority to revoke enrollment based on location alone, and asked for safe harbors for providers that correct errors promptly.
Why governance should engage
Medicare enrollment is the license to operate for most hospitals. If these proposals are finalized, routine administrative errors could carry consequences once reserved for fraud. Ask your compliance officer to map which proposals would affect your organization, estimate the reporting workload for leadership changes and affiliations, and confirm that enrollment filings have a clear owner and review process. Audit committees should add enrollment integrity to their risk register.
Archive entry for Aug 28, 2026, added Nov. 11, 2026.