---
kind: "section"
citation: "42 C.F.R. § 424.570"
title: "42"
number: "424.570"
heading: "Moratoria on newly enrolling Medicare providers and suppliers."
url: "https://uscodex.org/cfr/42/424.570"
---

# §424.570. Moratoria on newly enrolling Medicare providers and suppliers.

- (a) **Temporary moratoria—**
  - (1) **General rules.**
    - (i) CMS may impose a moratorium on the enrollment of new Medicare providers and suppliers of a particular type or the establishment of new practice locations of a particular type in a particular geographic area.
    - (ii) CMS will announce the temporary enrollment moratorium in a Federal Register document that includes the rationale for imposition of the temporary enrollment moratorium.
    - (iii) **The temporary moratorium does not apply to any of the following—**
      - (A) Changes in practice location (except if the location is changing from a location outside the moratorium area to a location inside the moratorium area).
      - (B) **Changes in provider or supplier information, such as phone numbers.**
      - (C) Changes in ownership (except changes in ownership of home health agencies that would require an initial enrollment).
    - (iv) A temporary moratorium does not apply to any enrollment application that has been received by the Medicare contractor prior to the date the moratorium is imposed.
  - (2) **Imposition of a temporary moratoria.** CMS may impose the temporary moratorium if—
    - (i) CMS determines that there is a significant potential for fraud, waste or abuse with respect to a particular provider or supplier type or particular geographic area or both. CMS's determination is based on its review of existing data, and without limitation, identifies a trend that appears to be associated with a high risk of fraud, waste or abuse, such as a—
      - (A) Highly disproportionate number of providers or suppliers in a category relative to the number of beneficiaries; or
      - (B) Rapid increase in enrollment applications within a category;
    - (ii) A State Medicaid program has imposed a moratorium on a group of Medicaid providers or suppliers that are also eligible to enroll in the Medicare program;
    - (iii) A State has imposed a moratorium on enrollment in a particular geographic area or on a particular provider or supplier type or both; or
    - (iv) CMS, in consultation the HHS OIG or the Department of Justice or both and with the approval of the CMS Administrator identifies either or both of the following as having a significant potential for fraud, waste or abuse in the Medicare program:
      - (A) **A particular provider or supplier type.**
      - (B) **Any particular geographic area.**
- (b) **Duration of moratoria.** A moratorium under this section may be imposed for a period of 6 months and, if deemed necessary by CMS, may be extended in 6-month increments. CMS will publish a document in the Federal Register when it extends a moratorium.
- (c) **Denial of enrollment: Moratoria.** A Medicare contractor denies the enrollment application of a provider or supplier if the provider or supplier is subject to a moratorium as specified in [paragraph (a)](#a) of this section.
- (d) **Lifting moratoria.** CMS will publish a document in the Federal Register when a moratorium is lifted. CMS may lift a temporary moratorium at any time after imposition of the moratorium if one of the following occur:
  - (1) **The President declares an area a disaster under the Robert T.** Stafford Disaster Relief and Emergency Assistance Act, [42 U.S.C. 5121-5206](/usc/42/5121-5206.md) (Stafford Act).
  - (2) Circumstances warranting the imposition of a moratorium have abated or CMS has implemented program safeguards to address the program vulnerability.
  - (3) The Secretary has declared a public health emergency under section 319 of the Public Health Service Act in the area subject to a temporary moratorium.
  - (4) **In the judgment of the Secretary, the moratorium is no longer needed.**

## Notes

### Amendments

[76 FR 5965, Feb. 2, 2011, as amended at 84 FR 47856, Sept. 10, 2019]

### Source

Source: 71 FR 20776, Apr. 21, 2006, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 53 FR 6634, Mar. 2, 1988, unless otherwise noted.

### Amendments

[76 FR 5965, Feb. 2, 2011, as amended at 84 FR 47856, Sept. 10, 2019]