AMARILLO, TX – There’s an old adage that the three factors most important to real estate are location, location, location. The recent CMS moratorium on new enrollments for DMEPOS suppliers effective as of February 27, 2026, has brought renewed industry focus on supplier locations.

How does the moratorium work in practice? Think of it like this. Imagine that on February 27, CMS took a snapshot of every PTAN issued to suppliers and tallied them all up. During the moratorium, that tally can either remain static or decrease, but not grow. Because the moratorium applies to “new” and “initial” enrollments, the total number of DMEPOS supplier PTANs will not increase so long as it remains in effect. But the tally can decrease when existing PTANs are deactivated.

The moratorium falls on the heels of CMS’s expansion at the beginning of 2026 of the 36-Month Rule, originally limited to home health agencies and hospices, to DME suppliers. Under the 36-Month Rule, with limited exceptions, medical supplier businesses that undergo a “change in majority ownership” or “CIMO” must apply for a new CMS enrollment and obtain a new survey and accreditation. Under the rule, a CIMO occurs whenever an individual or organization acquires greater than a 50% direct ownership interest in the company within 36 months of initial CMS enrollment or the 36-month period after the business’s most recent CIMO.

The 36-Month Rule has limited exceptions for internal corporate restructuring, changes in business structure where the owners remain the same, and death of an individual owner. Under the 36-Month Rule, a supplier that undergoes a CIMO will see the deactivation of its PTANs, and the new owner will need to submit a new enrollment and obtain a new accreditation. For businesses that have not had a CIMO, equity changes of ownership are allowed because they trigger a “change in information” for their associated PTANs and not new enrollments.

The moratorium also means that in most cases, asset purchases will result in deactivation of Medicare billing privileges. Under an asset acquisition, an existing supplier sells some portion of its business assets – often one or more practice locations and associated inventory, but not its business entity and associated equity – to a purchaser. In an asset transaction, the assets are transferred from one Tax Identification Number or “TIN” to another TIN.

A change in TIN typically requires a new enrollment, which will be denied under the moratorium. The change to the 36-Month Rule effectively expanded the new enrollment requirement to all equity purchases made within three years of either the initial enrollment or a transfer of more than 50% direct ownership in a supplier.

Although the moratorium affects initial and new supplier enrollments, it importantly does not prohibit changes in location for existing suppliers. Here, it is important to think clearly about distinguishing a “new enrollment” from a “change in practice location.” Under the moratorium, a DME supplier can undergo a change of location and keep its existing PTAN.

Again, though, what does that mean in practice? A change of location for a DME supplier requires careful planning and execution to remain compliant with both state law and the Medicare DMEPOS Supplier Standards. If you are considering relocating your DME business while the moratorium is in effect, you need to carefully plan and execute the move.

First, think through the Supplier Standards. In particular:

• Your new location must acquire any state licensure required to operate in the destination state;
• Your new location must be accredited;
• If the destination state requires facility licensure, that licensure needs to be in place and associated with your TIN by or before you submit your updated CMS-855S to CMS.
• Your location needs to meet a number of distinct criteria, including:
  • Area: With limited exceptions for orthotics and prosthetics services, it must be at least 200 square feet;
  • With narrow exceptions for closed-door operations like nursing home suppliers, it must be publicly accessible;
  • It must be open and staffed during posted hours;
  • It must maintain permanent visible signage, including at the main point of entrance if it is part of a broader office complex;
  • It must contain sufficient space to store records and manage inventory in space not accessible to the public;
• In addition, with narrow exceptions, your destination location may not share space with a separately-enrolled location or supplier.

You will need to consider whether your relocation will be within the same state or to a different state. State licensing agencies often require change of location applications and may also trigger distinct facility inspection and opening requirements. A relocation within a state will require completing these requirements.

A move to another state requires additional diligence. First, you will need to determine what licensure, if any, your new state will require for your supplier type. You must also make sure to avoid deactivation of your origin facility’s PTAN prior to the move and be mindful of the timing between the origin state license and new state license. State licensing agencies sometimes require an inspection prior to opening the facility for business. Allowing yourself some room for overlap between the closing of your origin location and the opening of your destination location, where feasible, can be helpful.

The moratorium also allowed states to pause Medicaid enrollments at the state level. So far, only Florida has extended the moratorium to new Medicaid enrollments. Out-of-state suppliers considering relocation to Florida should bear in mind that although they may retain their PTAN, they will likely not be able to obtain a new enrollment in Florida Medicaid while the state moratorium remains in effect. Suppliers should keep a close eye on possible relocation destinations as state Medicaid programs consider whether to join the moratorium.

The rules relating to the moratorium are complex and the proper interpretation is not always clear. If you are considering a relocation or change of ownership, be sure to seek the legal guidance of counsel with related health care experience.

Blinn E. Combs, Esq., is a member of the Health Care Group at Brown & Fortunato, PC, a law firm with a national healthcare practice based in Texas. He represents pharmacies, infusion companies, HME companies, manufacturers, and other healthcare providers throughout the United States. Mr. Combs can be reached at (806) 345-6355 or [email protected].

Phuong D. Nguyen, Esq., is a member of the Health Care Group at Brown & Fortunato, PC, a law firm with a national healthcare practice based in Texas. He represents pharmacies, infusion companies, HME companies, manufacturers, and other healthcare providers throughout the United States. Mr. Nguyen can be reached at (806) 345-6307 or [email protected].