The New York State Department of Health (DOH) recently announced changes to Medicaid provider revalidation and a temporary moratorium on certain industries with Medicaid applications. This temporary moratorium will run until late January 2027 for certain “high risk” industries. Although the temporary moratorium will impact six Medicaid provider classes, all Medicaid providers will be impacted by the revalidation changes. Below, we discuss both the revalidation changes and the provider moratorium.
Medicaid Provider Revalidation Changes
The Centers for Medicare and Medicaid Services (CMS) announced an initiative in April 2026 to require every state to develop a two-year provider revalidation strategy to have every Medicaid provider revalidated within the next two years. This is in addition to the federal regulations that require State Medicaid agencies to revalidate Medicaid providers at least once every five years. The two-year revalidation system is intended to capture fraudulent actors within the Medicaid system.
New York’s two-year provider revalidation plan was approved by CMS at the end of July 2026. This plan creates three tiers of provider-risk designation, and revalidation timing will depend on the provider-risk tier. Those tiers are as follows:
- High-risk providers: revalidation required every three years
- Moderate-risk providers: revalidation required every four years
- Limited-risk providers: revalidation required every five years
This revalidation process will require the following procedures based on the provider’s designated risk level:
- All providers (regardless of risk level) must complete the following “Standard Screening” measures:
- Verification of provider identity and credentials
- Confirmation of practice location and contact information
- National Provider Identifier (NPI) validation
- Submission of all required documentation through the new online Provider Services Portal, which was launched by DOH in September 2025
- Moderate-risk providers:
- All the Standard Screening measures
- Pre/post-enrollment site visit by DOH
- High-risk providers:
- All the Standard Screening measures
- Pre/post-enrollment site visit by DOH
- Finger printing and background check for all owners of 5% or more
To date, DOH has designated the following as high-risk providers: Applied Behavior Analysis, Home and Community-Based Services under a 1915(c) Waiver, and Licensed Home Care Services Agencies. Individual providers not in these high-risk categories may have their risk level change if any of the following conditions are met:
- Payment suspension based on credible allegations of fraud, waste, or abuse
- Unreported Medicaid overpayment of $1,500 or greater
- Provider has been excluded (and since reinstated) by the federal Office of the Inspector General (OIG) or another state’s Medicaid program
- At least six months following the lifting of the temporary moratorium for a provider impacted by the moratorium
- Billing anomaly flags, Office of the Medicaid Inspector General referral, or a change of ownership application in certain fields
DOH began issuing revalidation notices to providers in July and will continue to do so over the next eighteen months. These notices will be sent out on a rolling basis depending on the provider’s risk level and other factors. The revalidation process will continue through June 2028. Additional information regarding the revalidation process may be found on DOH’s website.
Temporary Moratorium
As part of its revalidation initiative, CMS encouraged states to implement temporary enrollment and application change moratoriums for provider classes that pose a higher risk of fraud, waste, and abuse. New York’s moratorium was approved by CMS at the end of July and will last until late January 2027. The moratorium will last for six months, until late January 2027, but may be extended or amended by DOH at that time.
The temporary moratorium applies to the following provider classes:
- Laboratory
- Durable medical equipment
- Applied Behavior Analysis
- Licensed Home Care Services Agencies
- Pharmacy
- Managed long-term care plans
It applies to new enrollees, changes of ownership or pending applications for those providers meeting the above categories.
If you would like to discuss, or if you have questions about this update, please reach out to a member of the Harter Secrest & Emery Government Affairs practice group.