Compliance Monitor (05/18/2025)

 MAY 13, 2025— The U.S. Department of Health and Human Services (HHS) and the U.S. Food and Drug Administration (FDA) the launch of a public Request for Information (RFI) to identify and eliminate outdated or unnecessary regulations. The initiative is part of a broader federal effort to reduce regulatory burdens and increase transparency, in alignment with President Trump’s Executive Order 14192, “Unleashing Prosperity Through Deregulation.” 

Under the Executive Order, HHS will implement the following measures: 

• The 10-to-1 rule: For every new regulation introduced, at least ten existing regulations must be eliminated. 

• Regulatory cost cap: The total cost of all new regulations in fiscal year 2025 must be significantly less than zero. 

• Expanded scope: The order applies not only to formal regulations but also to guidance documents, memoranda, policy statements, and similar directives. 

• Radical transparency: HHS will publish annual reports detailing estimated regulatory costs and the specific rules being offset, promoting greater transparency and accountability. 

The 60-day public comment period opens today. Stakeholders are encouraged to submit their ideas for deregulatory actions through the Regulations.gov docket (AHRQ-2025-0001) or the newly launched online portal at Regulations.gov/Deregulation. The portal includes tools to assist users in drafting proposals that HHS may formally consider. 

Comments for the FY 2026 Proposed Hospice Payment Update Rule are due June 10, 2025.  Instructions for submitting comments appear in the beginning of the rule. 

Review the rule 

The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training that provides an introduction to the Hospice Quality Reporting Program (HQRP) and public reporting on Care Compare.  

This web-based training can be accessed through the Hospice Quality Reporting Training and Education Library webpage. 

CMS recently discovered an error in the Discharge Function quality measure scores that were included in the 4/2/25 release of Home Health July 2025 Preview Reports.  The inaccurate scoring affected approximately 16% of HH providers and was caused by a technical error, which has now been resolved. 

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.  CMS has extended the current preview period until May 21, 2025 to allow a full 30-day review period. 

For additional information, please see the HH Quality Reporting Training webpage and the Home Health Data Submission Deadlines webpage. 

In 2023, the improper payment rate for walkers was 24.8%, with a projected improper payment amount of $8.7 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Walkers provider compliance tip for more information, including: 

• Billing Codes 

• Denial reasons and how to prevent them 

• Documentation Requirements 

• Resource 

Learn about these updates (PDF): 

• Clinical Laboratory Improvement Amendments requirements 

• New FDA-approved waived tests 

• Codes, effective dates, and descriptions  

Monday, June 2 and Tuesday, June 3 from 9 am – 5 pm ET 

Baltimore, MD or virtual 

Attend a hybrid public meeting for the first biannual 2025 HCPCS coding cycle. Visit the HCPCS Level II Public Meetings webpage for more information, including: 

• Meeting materials 

• Guidelines 

On May 12, 2025 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that, if finalized as proposed, would end states’ ability to exploit a health care-related tax loophole currently used by seven states to generate billions in federal Medicaid payments—without contributing their fair share or expanding care for Medicaid enrollees. These states impose higher taxes primarily on Medicaid business of managed care organizations (MCOs), although one such tax is on hospitals. After imposing the tax disproportionately on Medicaid plans or providers, the states reimburse them with federal funds, while avoiding any state financial cost. This, in turn, allows the states to use the surplus for other purposes—including the expansion of healthcare coverage for illegal immigrants. This effectively means federal money is financing these other interests, instead of enhancing the state Medicaid program.   The proposed rule can be viewed at the Federal Register at: https://www.federalregister.gov/public-inspection/2025-08566/medicaid-program-preserving-medicaid-funding-for-vulnerable-populations–closing-a-health  

Read the CMS rule summary 

Now is the time to abandon the status quo. The prospects for preventive care have never been stronger. Artificial intelligence is enabling providers to predict and spot health issues before they become symptomatic. Breakthrough cell and gene therapies offer not just management but actual cures for previously untreatable conditions. Digital technologies make health care more accessible and personalized, enabling patients to make informed choices and be active in their health. 

The CMS Innovation Center has tools to break down the barriers and build opportunities to preventive care.  With 15 years of experience and lessons learned, Innovation Center pilot programs, called models, have shown promise for supporting preventive care, but most of these models have not met the criteria for nationwide expansion. Focusing on evidence-based prevention will position us for meeting that aim.  

The Innovation Center will seize this moment by establishing logical payment systems that incentivize healthier lives. We will focus on a three-pronged strategy: 

1. Promote evidence-based prevention: Prevention will be part of every model we test. We will utilize the most effective ways for providers to offer patients services — such as exercise and nutritional support — that promote healthier lifestyles and slow disease progression, as well as provide easier access to evidence-based, complementary and alternative medicine. We will also focus on accurately measuring the outcomes of these interventions to ensure they effectively meet our disease prevention and health promotion goals while saving tax dollars. 

2. Empower people to achieve their health goals: We will increase beneficiary access to information and tools, including mobile-device applications, for disease management and healthy living. We will also publish data about providers and services, including cost and quality performance, to support beneficiary decision-making and issue waivers to support predictable cost-sharing for certain services, drugs, or devices. 

3. Drive choice and competition: Building on the progress made by the first Trump administration, we will introduce new programs into Medicare and Medicaid to foster even playing fields and fair competition whenever possible. We will help more providers be part of Innovation Center models, giving patients more options for care and opportunities to benefit from our services. We will make it easier for independent providers to work with us, connect with community-based care, and reduce the administrative burden for those who want to participate in our models. 

Read the CMS blog 

During National Mental Health Awareness Month, we recognize the millions of Americans affected by mental health challenges. Mental illnesses can affect anyone, regardless of their background or circumstances (see Presidential Proclamation). Recommend appropriate Medicare Preventive Services.  

Medicare covers preventive services, and your patients pay nothing if you accept assignment. Find out when your patient is eligible for these services. If you need help, contact your eligibility service provider. 

More Information: 

• Medicare & Mental Health Coverage booklet 

• Behavioral Health Integration Services (PDF) booklet 

• Preventive & screening services information for your patients 

The Medicare & You 2026 Pre-Order is open from TODAY, Monday, May 12 and will run through Friday, May 30.  You can access the pre-order by going to httsp://productordering.cms.hhs.gov, logging into your POW account, and then clicking on the blue Pre-Order button at the top left of the page. 

Please note that, due to budgetary constraints, pre-order quantities will be limited to 40 copies of the handbook for home health care organizations, hospice organizations, and local human services offices, and 100 copies for all other organizations.  There are no exceptions to these quantity limits.  Unlike past years, WE WILL NOT BE ACCEPTING ANY LATE PRE-ORDERS.  If you will be out of the office during the pre-order, please make arrangements for someone else to place a pre-order for you. 

Please note that all pre-ordered handbooks will not ship to you until the fall of 2025. 

If you have any questions, please feel free to reach out to our POW Support team at POWSupport@cms.hhs.gov.  Thank you for your attention. 

GAO identified 35 priority recommendations for the Department of Health and Human Services (HHS). Since then, HHS has implemented four of those recommendations, including sharing data that helps ensure the reproducibility of Centers for Disease Control and Prevention (CDC) research, and increasing agencies’ awareness of limitations related to cybersecurity. 

In May 2025, GAO identified four additional priority recommendations for HHS, bringing the total number of open priority recommendations to 35. These 35 recommendations involve the following seven areas: 

• Leadership of public health emergency preparedness and response;  

• Food and Drug Administration oversight; 

• Prevention and reduction of improper payments in Medicaid and Medicare; 

• Public health and human services program oversight; 

• Medicaid program oversight; 

• Medicare payment accuracy and appropriateness; and 

• Health care infrastructure, information technology, and cybersecurity improvements. 

Implementing these priority recommendations could help improve the efficiency and effectiveness of key federal health care programs and funding. 

Read the report 

Date: Tuesday, May 20, 2025 

Time: 1:00 p.m. EST 

Location: Virtual via Zoom (link will be provided following registration) 

Who Should Attend: Technology developers, patients, caregivers, providers, payers, and other healthcare stakeholders. 

Event Description: Help create modern digital technologies to empower seniors to manage their health journey. We want YOUR ideas. Please join us for a Q&A session on the recent CMS Request for Information (RFI) on Improving Technology to Empower Medicare Beneficiaries. The session will also review how to submit responses to the RFI. 

The CMS Office of the Administrator team will be present to hear your valuable input as we shape the future for Medicare beneficiaries. 

Registration: https://cms.zoomgov.com/webinar/register/WN_oNg1_jxNRaulMBeMxD6Ibw