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At the National Alliance for Care at Home’s annual meeting, CMS Deputy Administrator Kim Brandt discussed potential alternatives to a nationwide home health enrollment moratorium, including exceptions for established providers with strong compliance records and geographic limits. CMS has announced no decision or gold-card program, and the awaited Medicare home health final rule may affect payment and oversight.
CMS is considering alternatives to a nationwide freeze on new home health agency enrollments, including a possible exception for established providers with strong compliance records and restrictions limited to specific geographic areas, according to remarks at the National Alliance for Care at Home’s annual meeting in Washington. The agency has not announced a policy change, leaving providers uncertain about whether they can open new locations and how the government will balance access with fraud controls.
Kim Brandt, CMS deputy administrator and chief operating officer, said the agency had heard concerns from existing providers that want to expand, particularly in rural areas where enrollment restrictions can make it harder to open new locations. Brandt said CMS was working with its counsel’s office on possible solutions. She did not announce a program or provide a timetable.
Denis Fleming Jr., the Alliance’s chief government affairs officer, described one option as a “gold card” approach: CMS could allow exceptions to the moratorium for providers with demonstrated compliance records. The idea would preserve a barrier for some new entrants while giving qualifying operators a route to expand. No eligibility standards, application process or number of potential participants were specified.
Brandt also raised geographic limits as a possible way to target enrollment restrictions to particular markets instead of applying a nationwide freeze. Other possibilities discussed included allowing the current moratorium to expire while using additional program-integrity tools. These were options raised at the meeting, not confirmed CMS decisions. The report said about 250 agencies were blocked from enrollment during the moratorium; that figure counts agencies not approved, not providers proven to have committed fraud.
Expansion Rules Could Affect Local Access
The policy choice could shape whether home health providers can add locations in communities where services are difficult to access. A compliance-based exception might let established operators expand without removing enrollment barriers for all applicants. Geographic restrictions could instead focus the freeze on selected markets. In either case, the effect would depend on the details, including which providers and locations qualify.
The discussion also highlights a distinction between blocking new entrants and addressing providers already enrolled. BrightSpring Health Services vice president of federal government relations Hillary Loeffler said a moratorium stops new entrants but does not, by itself, remove fraudulent providers already in the program. Meanwhile, wider enrollment requirements could add administrative and financial demands even if some expansion restrictions are eased.
Providers are also awaiting CMS’ Medicare home health final rule. Its payment decisions could affect agencies’ finances at the same time that enrollment and compliance rules shape their ability to grow. For patients and communities, the practical issue is whether changes preserve program oversight while leaving a workable path for legitimate services to expand.
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Moratorium And Payment Rule
The discussion took place during the Alliance’s annual meeting, where CMS’ fraud crackdown was a recurring subject in public sessions and industry conversations. The current enrollment moratorium has restricted approvals for new home health agencies. The report’s author suggested CMS may choose a modified approach rather than simply extending the nationwide freeze or letting it expire; that is the author’s expectation, not an agency commitment.
The policy debate is unfolding alongside the Medicare home health rulemaking. CMS’ July proposal included an aggregate payment increase of 2.4% and a temporary 3% reduction to the 2027 national standardized payment rate, as well as proposed fraud-fighting measures. It also sought input on developing a home-health-specific wage index and discussed expanding access to palliative care. Those figures and measures are from the proposal; the final rule had not been released in the source report.
Brandt linked fraud prevention to payment policy, saying funds paid to bad actors were funds unavailable to compliant providers. Alliance regulatory affairs vice president Katie Wehri, speaking on a separate panel, warned that proposed enrollment requirements could require additional staffing and financial resources. That means reduced restrictions in one area would not necessarily mean less oversight overall.
“He described a potential “gold card” system in which CMS would provide exceptions to the moratorium for existing providers with strong compliance track records.”
— Denis Fleming Jr., the Alliance’s chief government affairs officer
Eligibility And Timing Remain Open
CMS has not announced whether it will extend, narrow or end the moratorium, or adopt a gold-card model. The agency has not set out possible eligibility criteria, how compliance would be measured, which geographic areas might face restrictions, or when a decision could take effect. It is also unclear whether any exception would cover only existing providers or provide a route for legitimate new agencies.
The roughly 250 agencies cited as blocked from enrollment should not be treated as 250 confirmed fraud cases: the figure records agencies that were not approved, and the report does not establish why each was denied. The final payment rule was also still pending in the source material, so its final rates and provisions could differ from the July proposal.
Final Rule And CMS Decision
The next key development is the Medicare home health final rule, which providers were awaiting at the time of the annual meeting. It will show whether CMS keeps, changes or removes the payment and oversight provisions included in its July proposal. The source report noted that the rule typically arrives around Halloween, but did not confirm a release date.
Providers will also be watching for a formal CMS decision on the enrollment moratorium and any published details on geographic limits, compliance-based exceptions or other enforcement tools. Until the agency sets out its policy and criteria, the gold-card idea remains a possibility discussed at the meeting—not a confirmed pathway for expansion.
Key Questions
Has CMS approved a gold-card program for home health providers?
No. CMS officials discussed a possible compliance-based exception, but the agency has not announced a gold-card program, its criteria or an implementation date.
What would a gold-card approach do?
As described by Alliance government affairs chief Denis Fleming Jr., it could let existing providers with strong compliance records apply for exceptions to the enrollment moratorium, potentially allowing them to open new locations.
What are geographic limits in this discussion?
They are a possible way to restrict enrollment in selected markets rather than maintain a nationwide freeze. CMS has not identified any affected locations or announced that it will use this approach.
Do the 250 agencies blocked from enrollment represent confirmed fraud cases?
No. The figure reported at the meeting refers to agencies that were not approved during the moratorium. It does not establish that those agencies committed fraud.
What is the next major development for providers?
Providers were awaiting CMS’ Medicare home health final rule, which could settle payment and other proposed provisions. A separate decision on the enrollment moratorium and any exceptions remains pending.
Source: homehealthcarenews.com
