Compliance Monitor (07/28/2025)

Compliance Monitor (07/28/2025)

Your source for federal updates 

July 2025 Compliance Activity 

CMS Proposed Home Health Payment Update Rule (NPRM)  

Expected posting in late June – early July  

Rule was posted – see below    		Annual CY issuance May include proposed regulatory information not included in the FY hospice payment update proposed rule  

Subscribe to the Federal Register for emails of newly posted regulations. The selection of content can be customized. Link to subscribe is listed on the following webpage: https://www.federalregister.gov/documents/current Will first appear on the Federal Register Public Inspection Desk https://www.federalregister.gov/pu blic-inspection/current 

Will move over to the Federal Register within 7 days of initial posting https://www.federalregister.gov/do cuments/current 
Transition to All-Payer OASIS Data Collection and Submission  

July 1, 2025   		 Collect and submit OASIS data for all patients with any pay source who are not exempt from OASIS data collection and who begin receiving home health care services with an OASIS SOC M0090 date on or after July 1, 2025
 https://www.cms.gov/files/document/oasisall-payer-transition-fact-sheetdec-2024.pdf  
 1557 compliance date correction  

July 5, 2025 		Covered entities are required to distribute a new notice to inform individuals of the availability of non-English assistance. The new notice replaces the old foreign language “taglines” that were required under previous versions of the Section 1557 regulations. Some employers have already redesigned their notices to meet this requirement when they met earlier Section 1557 notice deadlines in the fall. 
CMS Proposed Home Health Payment Update Rule (NPRM)Annual CY issuance May include proposed regulatory information not included in the FY hospice payment update proposed rule  

Subscribe to the Federal Register for emails of newly posted regulations. The selection of content can be customized. Link to subscribe is listed on the following webpage: https://www.federalregister.gov/documents/current   		Usually posted in late June – early July Will first appear on the Federal Register Public Inspection Desk https://www.federalregister.gov/pu blic-inspection/current 

Will move over to the Federal Register within 7 days of initial posting https://www.federalregister.gov/do cuments/current 
August Preview 
  CMS Hospice Payment Update Rule (Final) 
– Annual FY issuance 
– Includes final annual payment update and quality program information. 
– Other regulations or changes to standing regulations outcome with effective dates (as applicable). 		Usually posted in late early August Annual payment rate update begins October 1st Will first appear on the Federal Register Public Inspection Desk https://www.federalregister.gov/pu blic-inspection/current  

Will move over to the Federal Register within 7 days of initial posting https://www.federalregister.gov/do cuments/current 
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 updated in this quarterly refresh August Medicare Care Compare  https://www.medicare.gov/care- compare/  

Information about hospice public reporting https://www.cms.gov/medicare/qu ality/hospice/public-reporting- background-and-announcements 
 CY 2026 Home Health Payment Update Rule comment due  

August 29, 20205 		Comments are due to CMS on August 29, 2025.  Instructions for submitting comments appear in the beginning of the rule.   

Top Items 

HOPE Training Available:  

Course I: HOPE National Implementation Virtual Training Program Didactic Recorded Training Series 

Hospice Outcomes and Patient Evaluation (HOPE) National Implementation Virtual Training Program Course 1: Didactic Recorded Training Series  

The Centers for Medicare & Medicaid Services (CMS) is offering a series of five self-paced recorded presentations and corresponding PDFs which highlight items that are new for HOPE, as well as the existing and updated items carried over from the Hospice Item Set (HIS).  

It is highly recommended that all five parts of this didactic course be reviewed prior to attending the coding workshop in August. To access the videos, select the following links: 

If you have questions about accessing resources or feedback regarding trainings, please email the PAC Training Mailbox. Content-related questions should be submitted to HospiceQualityQuestions@cms.hhs.gov. 

Course II: HOPE Coding Workshop 

Registration open for live HOPE training: Hospice Outcomes and Patient Evaluation (HOPE) National Implementation Virtual Training Program Course 2: Coding Workshop 

The Centers for Medicare & Medicaid Services (CMS) is offering a live coding workshop on August 5, 2025 which will provide coding practice for items that are new for HOPE, as well as the existing and updated items carried over from the Hospice Item Set (HIS). 

Register now at: The Hospice Outcomes and Patient Evaluation (HOPE) National Implementation Coding Workshop 

Completion of Course 1: Didactic Recorded Training Series is recommended as a prerequisite for the coding workshop. This course can be found here. 

CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in State of Texas 

CMS announced resources and flexibilities to support individuals and health care providers affected by the severe storms, straight-line winds, and flooding in Texas. 

Following a Major Disaster Declaration by President Donald J. Trump on July 6 and a Public Health Emergency declaration by HHS Secretary Robert F. Kennedy, Jr. on July 8, CMS is working with Texas and federal partners to ensure continued access to care. 

Read the full news alert. 

Core-Based Statistical Area: Revised ZIP Code Files 

CMS identified a discrepancy in the rural indicators within the core-based statistical area ZIP Code files for January, April, and July of 2025, resulting in incorrect designations. 

They issued revised files on June 25. Your Medicare Administrative Contractor will automatically reprocess all affected claims. You don’t need to take any action. 

Hospice/Palliative Care Provider Updates 

Quality Reporting Program: Non-Compliance Letters for FY 2026 APU 

The Centers for Medicare & Medicaid Services (CMS) is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2024, which will affect their FY 2026 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were placed into facilities’ CASPER folders in QIES, for Hospices and into facilities’ My Reports folders in the Internet Quality Improvement and Evaluation System (iQIES), for IRFs, LTCHs and SNFs, on July 21, 2025. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 26, 2025.  

If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notice of non-compliance and on the appropriate QRP webpage: 

Hospice Quality Reporting Reconsideration Requests 

FY 2026 Hospice Payment Update Rule 

The FY 2026 Hospice Payment Update Final Rule in in the Office of Management and Budget’s review queue as of 7/15/2025.  When the final rule is posted in the Federal Register, CHAP will post a summary of the provision highlights. 

Hospice Fast Facts 

CMS posted a new Hospice Fast Facts (PDF) sheet to inform the public about significant enhancements to address hospice fraud, including: 

  • What hospice fraud is 
  • How we’ve enhanced oversight 
  • What we’re doing to stop fraud 

Carter, Bera Introduce Bill to Strengthen Palliative and Hospice Care Workforce 

Reps. Earl L. “Buddy” Carter (R-GA) and Ami Bera, M.D. (D-CA) today introduced the Palliative Care and Hospice Education and Training Act (PCHETA), bipartisan legislation to invest in training, education, and research for the palliative care and hospice workforce, allowing more practitioners to enter these in-demand fields.  

Read full bill text here. 

Home Health Provider Updates 

Public Reporting July 2025 Refresh of HH QRP Data – Now Available 

The July 2025 refresh of the HH QRP is now available on the compare tool on Medicare.gov and Provider Data Catalog (PDC). 

The data are based on quality assessment data submitted by HHAs to Centers for Medicare & Medicaid Services (CMS) 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. 

Please visit the compare tool on Medicare.gov and PDC to view the updated quality data. For questions about HH QRP Public Reporting, please email homehealthqualityquestions@cms.hhs.gov. 

Preview Reports and Star Rating Preview Reports for the October 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 October 2025 refresh. 

Data contained within the Provider Preview Reports are based on quality assessment data submitted by HHAs from Quarter 1, 2024 through Quarter 4, 2024. The data for the claims-based measures will display data from Quarter 1, 2023 through Quarter 4, 2024 for the Discharge to Community and Medicare Spending Per Beneficiary measures, Quarter 1, 2022 through Quarter 4, 2024 for the Potentially Preventable 30-Day Post-Discharge Readmission measure, and Quarter 1, 2024 through Quarter 4, 2024 for the Home Health Within-Stay Potentially Preventable Hospitalization measure. Additionally, the data for the HHCAHPS measures will display data from Quarter 2, 2024 through Quarter 1, 2025. 

Providers have until August 8, 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 July 2025 Interim Performance Reports (IPRs) are Available in iQIES 

The Preliminary July 2025 IPRs for the expanded HHVBP Model have been published in the Internet Quality Improvement and Evaluation System (iQIES). Starting with this IPR, HHAs that were initially Medicare certified in 2023 are eligible to receive IPRs. For additional details on cohort assignment in the expanded Model, please navigate to Section 2 in the Expanded HHVBP Model Guide, available on the Expanded HHVBP Model webpage, under “FAQs & Model Guide.” 

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 a July 2025 IPR if the HHA: 

  • Was Medicare certified prior to January 1, 2024, 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: July 2025 IPR quality measure performance scores time periods for each measure category 

Measure Category Time Period Minimum Threshold 
OASIS-based Apr 1, 2024 – Mar 31, 2025 (except TNC Change in Mobility, TNC Change in Self-Care, and DTC) TNC/DTC: Jan 1, 2024 – Dec 31, 2024 20 home health quality episodes 
Claims-based Jan 1, 2024 – Dec 31, 2024 20 home health stays 
HHCAHPS Survey-based*  Jan 1, 2024 – Dec 31, 2024 40 completed surveys 

* Not included in the TPS calculation for HHAs in the smaller-volume cohort. 

TNC = Total Normalized Composite. DTC = Discharged to Community. 

Note: IPRs are only available to HHAs through iQIES and are located in the “HHA Provider Preview Reports” folder. IPRs are not available to the public. 

As outlined in the CY 2024 Home Health (HH) Prospective Payment System (PPS) Final Rule, there are changes to the expanded HHVBP Model measure set starting with CY 2025 (referred to as the “CY 2025 measure set”). The October 2025 IPRs will be the first IPRs to generate Improvement, Achievement, and Care Points based on the CY 2025 measure set. To help HHAs get ready for this change, CMS has started providing resources, including the following three worksheets, that provide a preview of HHAs’ performance on the CY 2025 measure set:  

  1. “CY 2025 AT and BM” tab: Starting with the July 2024 IPRs, preliminary Achievement Thresholds (AT) and Benchmarks (BM) have been available to HHAs in each IPR. In the July 2025 IPRs, this tab shows final AT and BM. 
  1. “CY 2025 Baseline” tab: The January 2025 IPRs reported on HHAs’ preliminary Improvement Thresholds for the CY 2025 measure set. NEW – In the July 2025 IPRs, this tab shows final Improvement Thresholds. 
  1. NEW – “CY 2025 Performance” tab: In the July 2025 IPRs, CMS provides an additional worksheet that reports on the most current performance period available by measure category. Note: As some measures are included in both the CY 2024 and CY 2025 measure set, this additional tab will only report on the measures that are new to the CY 2025 measure set (i.e., Home Health Within-Stay Potentially Preventable Hospitalization, Discharge to Community-Post Acute Care Discharge Function Score). 

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/. 
  1. Select the My Reports option from the Reports menu. 
  1. 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). 
  1. 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 July 2025 IPR, HHAs must submit a recalculation request by August 8, 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 or PII, the HHA wishes to submit in electronic form. 

Note: When submitting recalculation and reconsideration requests: 

  • CMS asks HHAs to only include one CCN per request. 
  • If you are submitting a recalculation request due to a suspected discrepancy between measure values reported in your IPR and measure values calculated internally or by your HHA’s vendor, please consider providing a copy of the internal/vendor report used to generate the internal data to assist CMS with investigating your HHA’s request. 
  • If possible, confirm whether 1) your internal data are risk-adjusted and 2) the data source used to generate your internal measure values (e.g., OASIS data, claims data). 
  • Please do not include any PHI/PII. 

These instructions are also available on the Expanded HHVBP Model webpage, under “Model Reports.” 

DME Provider Updates 

Ostomy Supplies: Prevent Claim Denials 

In 2023, the improper payment rate for ostomy supplies was 25.6%, with a projected improper payment amount of $56.8 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Ostomy Supplies provider compliance tip for more information, including: 

  • Billing codes 
  • Denial reasons and how to prevent them 
  • Refill and documentation requirements 

All Providers Updates  

Letter to States: Section 1115 Demonstration Authority for Workforce Initiatives 

CMS) has approved five demonstration projects, under the authority of section 1115 of the Social Security Act (section 1115 demonstrations), that authorize federal financial participation (FFP) for expenditures for workforce initiatives. The approved initiatives amount to significant investments of federal funds. In order to ensure scarce federal resources, prioritize providing quality care to our nation’s most vulnerable, at this time CMS does not anticipate approving new state proposals for section 1115 demonstration workforce initiatives authority or extending existing section 1115 authority for workforce initiatives and will continue to monitor results of currently approved initiatives to assess the impact.  

Read the letter  

CMS Reinforces Medicaid and CHIP Integrity by Strengthening Eligibility Oversight and Limiting Certain Demonstration Authorities 

CMS) is taking steps to restore accountability and safeguard the long-term integrity of Medicaid and the Children’s Health Insurance Program (CHIP). Through newly issued letters to states, CMS is emphasizing a clear shift away from policies that extend beyond statutory limits, specifically policies on continuous eligibility and workforce initiatives. This shift in approach reflects the agency’s commitment to preserving these vital programs for the most vulnerable Americans and using taxpayer dollars carefully. These initiatives require large investments of federal funds, estimated at more than a billion dollars. Specifically: 

  • Expanded continuous eligibility allows some people to remain enrolled in Medicaid for a period of time, even if they are no longer qualified. As a result, states could be overpaying for coverage of individuals who would not normally be eligible for Medicaid or CHIP. 
  • Workforce initiatives were intended to strengthen and build the workforce serving Medicaid through primary care, behavioral health, dental, and home and community-based services (HCBS).  

Read the CMS press release 

CMS Finds 2.8 Million Americans Potentially Enrolled in Two or More Medicaid/ACA Exchange Plans 

CMS) continue to crush fraud, waste, and abuse in America’s healthcare programs by stopping duplicative enrollment in government health programs, with the potential to save taxpayers approximately $14 billion annually.  

A recent analysis of 2024 enrollment data identified 2.8 million Americans either enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in multiple states or simultaneously enrolled in both Medicaid/CHIP and a subsidized Affordable Care Act (ACA) Exchange plan.  

CMS will partner with states to reduce duplicate enrollment through three initiatives: 

  • Individuals Enrolled in Two or More Medicaid Programs: CMS will provide states with a list of individuals who are enrolled in Medicaid or CHIP in two or more states and ask states to recheck Medicaid or CHIP eligibility for these individuals. CMS will work with states to prevent individuals from losing coverage inappropriately.  
  • Individuals Enrolled in Medicaid or CHIP + a Subsidized Federally Facilitated Exchange (FFE) Plan: CMS notified individuals enrolled in both Medicaid or CHIP and an FFE plan with a subsidy. 
  • Individuals Enrolled in Medicaid or CHIP + a Subsidized State-based Exchange (SBE) Plan: CMS will provide SBEs with a list of individuals who are potentially enrolled in the state’s Medicaid or CHIP and a subsidized Exchange plan and ask SBEs to determine whether these individuals are dually enrolled, and if so, to implement a process, similar to the federal Exchange, to recheck eligibility. CMS will work with states to prevent individuals from losing coverage inappropriately. 

Read the CMS press release 

Remote Patient Monitoring: Use & Bill Correctly 

In a report, the Office of the Inspector General recommended additional oversight of remote patient monitoring in Medicare. About 43% of enrollees who received remote patient monitoring didn’t receive all 3 components, raising questions about whether it’s being used as intended. 

Learn how to correctly use and bill for remote patient monitoring: 

MedPAC releases 2025 data book on health care spending and the Medicare program 

The Medicare Payment Advisory Commission (MedPAC) announces the release of its 2025 data book on health care spending and the Medicare program. The publication provides data on Medicare spending, demographics of the Medicare population, beneficiaries’ access to care, and quality of care in the program, among other information. You may go to the data book page on our website (www.medpac.gov) to view the data book and Excel data files. 

Meeting Employers Where They Are on Workplace Safety 

OSHA is enhancing their Voluntary Protection Programs and other recognition programs to meet employers where they are to increase their pathway to safety. These programs help businesses strengthen their safety practices, reduce injury rates, and conduct regular self-evaluations – while minimizing the need for routine inspections. To further support employers, OSHA is increasing its efforts through the agency’s On-Site Consultation Program, which provides no-cost, confidential safety and health services for small and medium-sized businesses seeking to improve their workplace safety culture. Read more about how the Department of Labor can help your business.  

OSHA updates penalty guidelines to support small businesses and eliminate workplace hazards 

OSHA released updated guidance on penalty and debt collection procedures to make it easier for employers – especially small businesses – to fix hazards quickly and stay in compliance. The new policy increases penalty reductions for small employers, allowing them to invest in resources in hazard abatement to keep workers safe. For example, a penalty reduction level of 70%, which used to only apply to businesses with 10 or fewer employees, now extends to those with up to 25 employees. The update also adds a new 15% penalty reduction for employers who take immediate steps to correct a hazard after it’s identified.  

The new policies are effective immediately. Penalties issued before July 14, 2025, will remain under the previous penalty structure. Open investigations in which penalties have not yet been issued are covered by the new guidance.  See the news release for more details.  

2025 Quality Conference Highlights 

CMS hosted the 2025 Quality Conference on July 1–2, convening health care leaders, clinicians, researchers, and patient advocates from across the country. This year’s theme —“Make America Healthy: Improving Health Outcomes Through Prevention, Quality, and Safety,”— focused on practical strategies to reduce harm, improve outcomes, and modernize care delivery. 

Read the full press release 

Join an Accountable Care Organization 

Medicare Providers: To participate in an Accountable Care Organization (ACO) for performance year 2026, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 1, 2025, by: 

Participant taxpayer identification numbers cannot overlap multiple ACO participant lists. Resolve any overlaps by September 8.  

More Information: 

Patients in Custody Under a Penal Authority — Revised 

Learn about changes effective January 1, 2025 (PDF): 

  • Patients in custody no longer includes those on bail, on parole, on probation, on home detention, or who are required to live in halfway houses or other community-based transitional facilities 
  • Expanded the eligibility criteria for the special enrollment period for formerly incarcerated individuals 

Educational Opportunities 

Next CMS Home Health, Hospice & Durable Medical Equipment Open Door Forum 

Wednesday, August 7, 2024- Agenda: Home Health, Hospice & DME Open Door Forum (PDF)