Compliance Monitor (05/05/2025)
Your source for federal updates
May 2025 Compliance Activity
| May 2025 | Medicare Care Compare Refresh – Hospice quality scores are publicly reported on the Care Compare website and updated on a quarterly basis. – CAHPS star ratings are NOT updated in this quarterly refresh Medicare Care Compare https://www.medicare.gov/care- compare/ Information about hospice public reporting https://www.cms.gov/medicare/quality/hospice/public-reporting- background-and-announcements |
Top Item
CMS HOPE Materials Update
The Hospice Outcomes and Patient Evaluation (HOPE) updated final materials are now available. Materials include the HOPE Guidance Manual v1.01, the Items sets (HOPE Admission v1.01, HOPE Update Visit (HUV) v1.01, HOPE Discharge v1.01 and HOPE ALL Item v1.01), the HIS to HOPE v1.01 Change Table, and the HOPE Guidance Manual v1.00 to v1.01. All of these documents can be accessed from the Downloads section on the CMS HQRP HOPE webpage.
Hospice Provider Updates
Updates on the Hospice Quality Reporting Program (HQRP)
Swingtech sends informational messages to hospices related to the Quality Reporting Program (QRP) on a quarterly basis. Their latest outreach communication can be found on the HQRP Requirements and Best Practices webpage. If you want to receive Swingtech’s quarterly emails, add or update the email addresses to which these messages are sent by sending an email to QRPHelp@swingtech.com. Be sure to include the name of your facility and the Centers for Medicare & Medicaid Services (CMS) Certification Number (CCN) along with any requested updates.
HOPE assessment tool question to CMS
Question: Do hospice providers need to contract with a vendor to submit their future HOPE data?
Answer: As noted in the December 12, 2024 HQRP Forum slides (posted in the Downloads here: Provider and Stakeholder Engagement | CMS), Hospice providers will need to select a private vendor to complete and submit HOPE data. Providers can choose to submit the records themselves or arrange with a 3rd party to submit on their behalf. Providers are not required to contract with a third-party vendor for submission of HOPE data to IQIES. However, all HOPE records must be in an XML format in a zip file for submission, which requires a software application. The CMS HART software will sunset with the HIS.
Source: The Hospice Quality Help Desk – direct contact
See the updated CHAP CMS HOPE tool Q&A Repository
OIG Adds Hospice Work Plan Item
Federal requirements state that hospices must be certified by CMS and be licensed as required by State and local law. Medicare also requires that hospices meet its Conditions of Participation to receive payment. Our objective is to identify trends, patterns, and key comparisons that indicate potential vulnerabilities related to new Medicare hospice provider enrollments. The data brief may help CMS evaluate the need for additional monitoring and program integrity efforts to ensure that hospices meet all the requirements.
Expected report issues date – 2026
Home Health Provider Updates
CY 2026 Home Health Proposed Payment Rule in OMB Queue
The CY 2026 Home Health Prospective Payment System Rate and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive has posted in the Office of Management and Budget’s review queue.
Preview Reports and Star Rating Preview Reports for the July 2025 Refresh of HH QRP Data – NOW AVAILABLE IN iQIES
REMINDER: The HHA Provider Preview Reports have been updated and are now available. These reports contain provider performance scores for quality measures, which will be published on the compare tool on Medicare.gov and the Provider Data Catalog (PDC) during the July 2025 refresh.
Data contained within the Provider Preview Reports are based on quality assessment data submitted by HHAs from Quarter 4, 2023 through Quarter 3, 2024. The data for the claims-based measures will display data from Quarter 1, 2022 through Quarter 4, 2023 for the Discharge to Community and Medicare Spending Per Beneficiary measures, Quarter 1, 2021 through Quarter 4, 2023 for the Potentially Preventable 30-Day Post-Discharge Readmission measure, and Quarter 1, 2023 through Quarter 4, 2023 for the Home Health Within-Stay Potentially Preventable Hospitalization measure. Additionally, the data for the HHCAHPS measures will display data from Quarter 1, 2024 through Quarter 4, 2024.
Providers have until May 2, 2025, to review their performance data. Only updates/corrections to the underlying assessment data before the final data submission deadline will be reflected in the publicly reported data on Medicare.gov. If a provider updates assessment data after the final data submission deadline, the updated data will only be reflected in the Facility-Level Quality Measure (QM) report and Patient-Level QM report. Updates submitted after the final data submission deadline will not be reflected in the Provider Preview Reports or on Medicare.gov. However, providers can request a CMS review of their data during the preview period if they believe the displayed quality measure scores within their Provider Preview Reports are inaccurate.
For questions related to accessing your facility’s Provider Preview Report, please contact the iQIES Service Center by email at iqies@cms.hhs.gov or call 1-800-339-9313. For questions about HHA Quality Reporting Program (QRP) Public Reporting, please email homehealthqualityquestions@cms.hhs.gov.
Preliminary April 2025 Interim Performance Reports (IPRs) are Available on iQIES
The Preliminary April 2025 IPRs for the expanded HHVBP Model have been published on the Internet Quality Improvement and Evaluation System (iQIES). The quarterly IPRs provide home health agencies (HHAs) with the cohort assignment, performance year measure data for the 12 most recent months, and the interim Total Performance Score (TPS). Using the IPRs, an HHA can assess and track their performance relative to peers in their respective cohort throughout the expanded Model performance year.
An HHA receives an April 2025 IPR if the HHA:
- Was Medicare certified prior to January 1, 2023, and
- Meets the minimum threshold of data for at least one (1) quality measure in the quarterly reporting period for the performance year shown in Exhibit 1.
Exhibit 1: April 2025 IPR quality measure performance scores time periods for each measure category
| Measure Category | Time Period | Minimum Threshold |
| OASIS-based | Jan 1, 2024 – Dec 31, 2024 | 20 home health quality episodes |
| Claims-based | Oct 1, 2023 – Sep 30, 2024 | 20 home health stays |
| HHCAHPS Survey-based | Oct 1, 2023 – Sep 30, 2024 | 40 completed surveys |
Note: IPRs are only available to HHAs through iQIES. IPRs are not available to the public.
Accessing IPRs
IPRs are available via iQIES in the “HHA Provider Preview Reports” folder, by the CMS Certification number (CCN) assigned to the HHA. If your organization has more than one (1) CCN, then a report will be available for each CCN. Only iQIES users authorized to view an HHA’s reports can access expanded HHVBP Model reports. For assistance with downloading your HHA’s IPR, please contact the iQIES Service Center at 1-800-339-9313, Monday through Friday, 8:00 AM-8:00 PM ET, or by email (iqies@cms.hhs.gov). To create a ticket online or track an existing ticket, please go to CCSQ Support Central.
1. Log into iQIES at https://iqies.cms.gov/.
2. Select the My Reports option from the Reports menu.
3. From the My Reports page, select the HHA Provider Preview Reports folder.
The folders and reports on the My Reports page are listed in alphabetical order. Thus, users may need to utilize the “page forward” functionality at the bottom of the webpage to advance to the page where the HHA Provider Preview Reports folder is located. Alternatively, users may change the default number of rows that display on the webpage from 10 to a larger number to view the larger list of folders. Note: Files in the HHA Provider Preview Reports folder are listed in descending order (i.e., in the order of the newest reports to the oldest).
4. Select the HHVBP report file, and the contents of the file will display.
Instructions on how to access the IPRs are also available on the Expanded HHVBP Model webpage, under “Model Reports.”
Submitting an IPR Recalculation Request
There are two (2) versions of the quarterly IPRs: a Preliminary IPR and a Final IPR. The Preliminary IPR provides an HHA with an opportunity to submit a recalculation request for applicable measures and interim performance scores if the agency believes there is evidence of a discrepancy in the calculation. Please note, the recalculation request does not apply to errors in data submission since submission requirements for the expanded Model align with current Code of Federal Regulations (CFRs).
To dispute the calculation of the performance scores in the Preliminary IPR, an HHA must submit a recalculation request within 15 calendar days after publication of the Preliminary IPR. For the April 2025 IPR, HHAs must submit a recalculation request by May 15, 2025. The Final IPR will reflect any changes resulting from any approved recalculation request.
HHAs may submit requests for recalculation by emailing hhvbp_recalculation_requests@abtglobal.com. Recalculation requests must contain the following information, as cited in the CY 2022 HH PPS final rule (p. 62331) and CFR §484.375:
- The provider’s name, address associated with the services delivered, and CCN.
- The basis for requesting recalculation to include the specific data that the HHA believes is inaccurate or the calculation the HHA believes is incorrect.
- Contact information for a person at the HHA with whom CMS or its agent can communicate about this request, including name, email address, telephone number, and mailing address (must include physical address, not just a post office box).
- A copy of any supporting documentation, not containing PHI, the HHA wishes to submit in electronic form.
These instructions are also available on the Expanded HHVBP Model webpage, under “Model Reports.”
DME Provider Updates
Wheelchair Seating: Prevent Claim Denials
In 2023, the improper payment rate for wheelchair seating was 29.2%, with a projected improper payment amount of $15.5 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendices E and G). Learn how to bill correctly for these services. Review the Wheelchair Seating provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Example of improper payments due to insufficient documentation
- Resources
All Providers Updates
Medicare Shared Savings Program: Application Toolkit Materials
Starting May 29, CMS will accept Shared Savings Program applications through the Accountable Care Organization Management System. Apply no later than noon ET on June 12.
More Information:
- Application Toolkit: Get resources for the upcoming application submission cycle
- Application Types & Timeline webpage
- Email questions to SharedSavingsProgram@cms.hhs.gov
CMMI Model Data Sharing (CMDS) Initiative Makes New Model Participation Data Available to Researchers
CMS is pleased to announce the availability of Research Identifiable Files (RIFs) for two CMS Innovation Center models.
CMMI Model Data Sharing (CMDS) Model Participation Files
CMS is releasing new participation data for the following models:
These models join the existing models that have released data since 2022 as part of the CMS Innovation Center Model Data Sharing (CMDS) initiative. Each model in the release may have a separate file for each of the three types of participation data; entities, providers, and beneficiaries as appropriate; and if data is available. Not all models have data for each type of participation data.
This release includes data through March 31, 2025. Your Data Use Agreement (DUA) will need to be updated to include the 2025 service year to receive this data and not lose data access.
For information about the participating models and data files, please visit the CMMI Model Data Sharing Model Participation Data Initiative page.
Educational Opportunity
Mark your calendar for the premier healthcare quality event of the year – the 2025 CMS Quality Conference!
July 1-2, 2025.
This year’s theme is “Make America Healthy: Improving Health Outcomes Through Prevention, Quality, and Safety,” as CMS transforms healthcare from a system that focuses on sick care to one that fosters prevention, wellness, and chronic disease management.
Stay tuned for more conference updates and registration information.
