One Van Nuys Address Lists 23 Hospices. CMS Is Keeping New Ones Out of Medicare for Six More Months.

The Centers for Medicare and Medicaid Services on Nov. 12, 2026, extended its nationwide moratoria on Medicare enrollment of new hospices and new home health agencies for another six months. The freezes had already run 183 days since taking effect May 13. The extension covers initial enrollments and certain changes in majority ownership, while agencies already enrolled may again add practice locations and branches.

The CMS announcement pairs the freeze with enrollment rules that take effect Jan. 1, 2027, and one of them reaches physicians directly. From that date CMS can deny a new hospice's enrollment if its medical director serves multiple other hospices, practices too far away to do the job, or lacks an active license in the state where the physician practices. To see what the freeze is aimed at, we cut CMS's own hospice directory by certification date and street address.

What did CMS change on Nov. 12?

Two notices, one for hospices and one for home health agencies, took effect Nov. 12 and are scheduled for Federal Register publication on Nov. 16. Both extend moratoria CMS first announced on May 15, 2026. Under 42 CFR 424.570, a moratorium lasts six months and can be extended in six-month increments, so this one runs into May 2027 unless CMS lifts it sooner.

Both notices also narrow the freeze. The May version barred enrolled hospices from adding practice locations and enrolled home health agencies from adding branches, and that part ended Nov. 12. CMS wrote that its greater concern now is new hospices "with whom we may have no experience." It said it consulted the Department of Health and Human Services Office of Inspector General, which agreed "there remains a significant potential for fraud, waste, or abuse in the Medicare program" for both provider types.

CMS also wrote that it has seen no evidence the freeze "materially reduced Medicare beneficiary access to hospice services on a nationwide or even a State level," and that it will keep watching rural areas. Five states, Louisiana, Nevada, Ohio, Pennsylvania and Rhode Island, imposed their own Medicaid hospice moratoria after the May notice, and Ohio and Rhode Island did the same for home health. Under section 1866(j)(7)(B) of the Social Security Act, the decision to impose a moratorium is not subject to judicial review.

What the hospice directory shows

We downloaded CMS's Hospice General Information file, the directory behind Care Compare, in its August 2026 release and counted its 6,669 hospices by Medicare certification date. From 2013 through 2019, between 169 and 232 hospices were certified each year. Then the count jumped to 353 in 2020, 686 in 2021 and 723 in 2022, before falling to 375 in 2023, 255 in 2024 and 193 in 2025. The fall began in 2023, the year CMS placed new hospices in Arizona, California, Nevada and Texas under a provisional period of enhanced oversight.

Los Angeles County stands apart. It accounts for 1,160 of the 6,669 hospices in the file, 17 percent of the national total, and 610 of them were certified in 2021 and 2022 alone. The addresses cluster. After setting aside suite numbers, we found nine street addresses in the county that are each listed by five or more Medicare-certified hospices. One address on Friar Street in Van Nuys is listed by 23.

Two limits apply to these counts. The file lists hospices still in the directory, so agencies that closed or were revoked before August 2026 are missing, and the yearly figures understate how many opened. The newest certification date in the file is Jan. 19, 2026, so it cannot show the effect of the freeze itself. Nevada runs against the national trend: it certified 30 hospices in 2025, more than in any year before 2022.

The home health agency file (October 2026 release, 12,409 agencies) shows a different curve. Certifications rose from 269 in 2019 to 551 in 2021 and stayed between 551 and 641 a year through 2025. The home health notice cites well over 1,000 new agencies enrolled in Los Angeles County since 2019 and one Ohio address shared by 18 agencies.

Why are physicians in these notices?

Because the schemes CMS describes depend on physician signatures. The hospice notice lists hospices paying "kickbacks to physicians for the latter to falsely certify a patient's terminal status" and certifying patients who were not terminally ill. It cites a Federal Bureau of Investigation public service announcement of June 3, 2026, that names "Falsifying diagnosis paperwork for hospice care" among recent schemes. The home health notice describes a Michigan agency owner, convicted in May 2026, who "used the identities of real doctors" to fabricate home health evaluations those physicians never performed.

The freeze keeps new agencies out. The Jan. 1 rule asks a narrower question: whether the physician named as medical director can actually do the job.

What changes for hospice medical directors on Jan. 1?

The calendar year 2027 home health payment rule, published Nov. 9, finalized a new denial ground at 42 CFR 424.530(a)(20). From Jan. 1, 2027, CMS may deny a hospice's enrollment if its medical director is the medical director of multiple other hospices, practices at such a distance that the physician "cannot realistically perform all medical director functions required under 42 CFR part 418," or lacks an active physician license in the state where the physician practices. The same test applies to hospice administrators, without the license clause. CMS wrote that it had seen a medical director in New York listed for a hospice in California, and hospices using medical directors with inactive licenses.

Commenters objected that rural hospices share medical directors because candidates are scarce. CMS kept the provision unchanged. It declined to define "multiple" or to set a mileage limit, saying a number would effectively cap how many hospices one physician could oversee, which it did not intend. It refused an exemption for hospices in Health Professional Shortage Areas and a cure period for lapsed licenses. The ground applies to denials of new enrollments, not to revocations of hospices already enrolled.

The rule also adds a denial ground at 424.530(a)(21) for any applicant "attempting to enroll under another party's identity." CMS describes the problem as one party enrolling another, "for example, another physician or practitioner," without that person's knowledge and billing Medicare in that name.

How long has CMS used this tool?

Rarely, and for long stretches when it does. By our count from the Federal Register, CMS has run three series of enrollment moratoria since the Affordable Care Act gave it the authority in 2010.

The 2013 notice covered three metropolitan areas. The medical supply moratorium in February was the first nationwide one, and it was allowed to lapse after one term. The hospice and home health freezes are the first nationwide moratoria CMS has renewed.

What should physicians check now?

Physicians who certify terminal illness or sign home health certifications are the people these rules are written around, and the documents point to three checks. Hospice medical directors who certify terminal status must be enrolled in or opted out of Medicare under 42 CFR 418.22(c). A physician who serves as medical director for several hospices, or for one in another state, should know that from Jan. 1 a newly enrolling hospice naming that physician can be denied on that basis. And because CMS added a denial ground for enrolling under someone else's identity, it is worth reviewing your own Medicare enrollment record for organizations that list you.

The enrollment tightening sits alongside a fall in which CMS has proposed dropping several hospital requirements and finalized the 2027 physician fee schedule. CMS says it will watch rural hospice access, where states are also spending year-two Rural Health Transformation awards. The next decision point comes in May 2027, when CMS must extend the moratoria again or let them lapse.

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This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.