Stay of Enrollment

A stay of enrollment (or "stay") is a Centers for Medicare & Medicaid Services (CMS) action that is less burdensome on providers and suppliers than a deactivation or revocation of Medicare enrollment. A stay is a preliminary, interim status representing a pause in enrollment.

There are two steps for implementing a stay, per 42 Code of Federal Regulations 424.541. 

1. Is the provider non-compliant with at least one Medicare enrollment requirement?
2. Can the provider remedy the non-compliance by submitting, as applicable, a Form CMS-855 (PDF), Form CMS-20134 (PDF) or Form CMS-588 (PDF). We refer to these forms as applicable CMS forms (ACFs)?
   • If the type of non-compliance involved cannot be corrected by the submission of an ACF, a stay cannot be imposed

Examples of Non-compliant with at Least One Medicare Enrollment Requirement

• A provider failed to timely (within 30 days) report a change in its address from "10 Smith Street" to "20 Smith Street"
• A provider did not respond to a revalidation request

Key Points of a Stay 

• The provider remains enrolled in Medicare during the stay
• A stay is not considered an adverse legal action of any kind
• The stay of enrollment lasts no longer than 60 days
  • Thirty days for missed revalidations
  • Sixty days for not reporting changes of information 
• A stay ends on the earlier of the following dates:
  • The date on which CMS or your contractor decides the provider resumed compliance with all Medicare enrollment requirements
  • The day after the imposed stay period expires
• CMS may impose a stay multiple times for separate instances of non-compliance, for example, a stay in June 2024 and another stay in December 2025

Stay Notification Letters 
The Medicare Administrative Contractor (MAC) will send all stay notification letters by hard-copy mail and e-mail if a valid email address is available. They will also send the notice via fax if a valid fax number is available. We will mail all the notification letters on the same date listed on the letter.

Stay Rebuttals
A provider may file a rebuttal under a stay of enrollment:

• If the agency needs to take action to resolve the reason for the implementation of the stay, i.e., submitting an enrollment application if needed, ensure that it is submitted first
• A rebuttal is an opportunity for you to show the provider mets all applicable enrollment requirements and that the stay should not have been imposed
• A provider may submit only one rebuttal request per enrollment stay

Home Health and Hospice Claims Processing During a Stay Period
Medicare will reject home health and hospice claims submitted with dates of admission within the stay period.

• Rejected with reason code 39998, Stay of Enrollment
• Claim with admission dates outside the stay period will process

Once a stay is removed due to provider compliance to remedy the issue, the provider will need to submit new claims for the stay rejections.

Do not adjust the 39998 rejected claims, as they will be returned.

Resources

• MM13449 - Stay of Enrollment (PDF)
• Medicare Program Integrity Manual, (PDF) Sections:
  • 10.4.9 — Stay of Enrollment
  • 10.4.9.1 — Stay of Enrollment Rebuttals 
  • 10.7.20 — Stay of Enrollment Letters