Compliance Monitor (08/12/2025)
Your source for federal updates
August 2025 Compliance Activity
| 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
Posted – FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (CMS-1835-F)
On August 1, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1835-F) that updates Medicare hospice payment rates and the aggregate cap amount for fiscal year (FY) 2026 in accordance with existing statutory and regulatory requirements. This fact sheet outlines the key provisions of the final rule.
Review the CHAP summary
Review the CMS summary
Reporting Exception Granted Due to Texas Severe Storms, Straight-line Winds, and Flooding
The Centers for Medicare & Medicaid Services (CMS) is granting exceptions[1] under certain Medicare quality reporting and value-based purchasing programs to providers and facilities located in areas affected in the state Texas by the Texas Severe Storms, Straight-line Winds, and Flooding, as identified by both a Department of Health and Human Services (HHS) Public Health Emergency (PHE) declaration (https://aspr.hhs.gov/legal/PHE/Pages/Texas-Floods-8Jul2025.aspx) and the Federal Emergency Management Agency (FEMA) disaster declaration (DR-4879-TX), to assist these providers and facilities while they direct their resources toward caring for their patients and addressing potential infrastructural challenges affecting their healthcare operations.
Affected areas covered by these exceptions are detailed on the Designated Areas: Disaster 4879 page, under the section Public Assistance, designations PA-A and PA-B, of the FEMA website. If FEMA expands the emergency disaster declaration to include additional affected areas at a later date, CMS will likewise extend reporting requirement exceptions to accommodate these areas but will not necessarily publish updated communications.
[1] The terminology “exception” is used as a general term intended for ease of reference to collectively refer to extraordinary circumstance exception (ECE) policies established under separate programs and may not be consistent with the specific terminology established under each individual program.
At the time of this communication, the exceptions being granted are for the reporting requirements and deadlines as detailed as follows:
| Post-Acute Care Quality Reporting Programs: Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long- Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs) | All Quality Reporting Program (QRP) reporting requirements, including the reporting of data on measures and any other data requested by CMS for the post-acute care quality reporting programs | Q1 2025 (submission deadline 8/18/2025) |
| Post-Acute Care Quality Reporting Programs: Hospices | All QRP reporting requirements, including the reporting of data on measures and any other data requested by CMS for the post-acute care quality reporting programs | Q3 2025 |
CONSIDERATIONS FOR AFFECTED PROVIDERS AND FACILITIES THAT CHOOSE TO REPORT DATA UNDER AN EXTRAORDINARY CIRCUMSTANCE EXCEPTION (ECE)
Providers and facilities should be aware of the potential impact to reporting requirements and payment programs when deciding whether or not to report data included in the exceptions. If data are voluntarily submitted, they will be publicly reported or used in scoring.
In particular, hospitals located within the designated affected areas listed under this disaster declaration should be aware of the potential subsequent impact to the Hospital VBP Program and HACRP minimum case threshold counts for inclusion in these programs and which measures have enough data for scoring. For example, hospitals might be scored solely on the HACRP’s claims-based CMS Patient Safety and Adverse Events Composite (CMS PSI- 90) measure due to non-submissions resulting in not meeting the minimum number of Centers for Disease Control and Prevention’s HAI measures with sufficient cases. For the HACRP, if data for the excepted period are submitted, they will be used for scoring in the program.
CMS Issues Memo – REVISED: Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE)(QSO-25-23-ALL)
The revised memo content remains unchanged except for the following: Focused infection control surveys are no longer part of the standard survey process. Any COVID-19 or infection control concerns should be conducted through complaint investigations outside of the LTCSP process.
Review Memo QSO-25-23-ALL
Hospice/Palliative Care Provider Updates
HOPE Tool Updates
- CMS is excited to announce that the HOPE assessment submission and reporting functionality will be launched within the Internet Quality Improvement and Evaluation System (iQIES) on October 1, 2025.
- The HOPE Validation Utility Tool (VUT) for vendor testing is now available. The link to the VUT and more information about the transition to iQIES can be found on the HOPE Technical Information webpage.
- NEW RESOURCE AVAILABLE: HOPE Implementation Frequently Asked Questions (FAQs)
- The Centers for Medicare & Medicaid Services (CMS) answered Frequently Asked Questions about the transition from the HIS to the HOPE tool and updated HQRP reporting requirements. This FAQ can be accessed through the Hospice Quality Reporting Training and Education Library webpage. If you have questions about accessing this resource, please email the PAC Training Mailbox. Content-related questions should be submitted to HospiceQualityQuestions@cms.hhs.gov.
- RESOURCES AVAILABLE: HOPE Coding Workshop Materials
Downloadable materials including PDF copies of the slides are available on the Hospice Quality Reporting Training and Education Library webpage.
OIG Posts Potential Cost Savings: HHS Actions
The OIG posted a document that outlines potential cost savings for different provider types and hospice was mentioned as follows:
- $6.6 billion – By preventing Medicare from paying providers for services that hospices are paid to provide for their enrollees.
Home Health Provider Updates
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.
All Providers Updates
FDA Requires Major Changes to Opioid Pain Medication Labeling to Emphasize Risks
The U.S. Food and Drug Administration is requiring safety labeling changes to all opioid pain medications to better emphasize and explain the risks associated with their long-term use.
Read the press release
White House, Tech Leaders Commit to Create Patient-Centric Healthcare Ecosystem
The Trump Administration announced progress toward building a smarter, more secure, and more personalized healthcare experience in partnership with innovative private sector companies. During a White House “Make Health Tech Great Again” event hosted with CMS, the Administration secured commitments from major healthcare and information technology firms – including Amazon, Anthropic, Apple, Google, and OpenAI – to begin laying the foundation for a next-generation digital health ecosystem that will improve patient outcomes, reduce provider burden, and drive value.
The Administration’s efforts focus on two broad areas: promoting a CMS Interoperability Framework to easily and seamlessly share information between patients and providers, and increasing the availability of personalized tools so that patients have the information and resources they need to make better health decisions.
Read the full press release
HTI-4 Final Rule
ASTP released a new final rule: Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit and Electronic Prior Authorization (HTI-4). The rule will enable health care providers to use certified electronic health records to streamline electronic prior authorization, access real-time prescription drug cost information for patients, and easily exchange electronic prescription information with pharmacies and health plans.
Read the HTI-4 final rule →
Read the blog post →
Register for the upcoming HTI-4 final rule information session to learn more about the rule and its impact.
Register for the info session →
Medicare & Medicaid at 60: Strengthening Health Care for the Future
This summer marks 60 years since the creation of Medicare and Medicaid, 2 programs that have shaped the modern foundation of American health care. Today, they provide coverage for more than 160 million people and continue to be vital lifelines for older adults, people with disabilities, and low-income families.
Their impact goes beyond access. Medicare played a key role in the desegregation of American hospitals. Within months of the law being signed, 90% of hospitals accepted Black patients, changing our healthcare landscape forever. And Medicaid helped launch coordinated care models that continue to improve patient outcomes today. As technology has evolved, these programs have evolved as well, supporting everything from telehealth to remote monitoring to better reach the people they serve.
In recent months, CMS has cracked down on the largest health care fraud schemes in U.S. history, launched reforms to overhaul prior authorization, and invested in modern tools like real-time data to better protect patients and preserve trust in these programs.
At CMS, we’re honoring this legacy by taking decisive action to reform, strengthen, and safeguard these programs for the next generation. We’re driving innovation, improving outcomes, and protecting the integrity of Medicare and Medicaid so they remain strong for decades to come.
We invite our partners to mark this milestone not just with celebration, but with action—to work with us to drive innovation, eliminate waste, and ensure these programs continue to work better for everyone.
Read more on the history of Medicare and Medicaid, including a timeline of program milestones.
Educational Opportunities
CMS Listening Session: Opportunities to Enhance Real-Time Claims Processing & EDI Cybersecurity Controls — August 13
Wednesday, August 13 from 3–4 pm ET
Register for this online event.
As part of CMS’ 2025 priorities, we’re holding a listening session to gather feedback from our industry partners for innovative ideas and opportunities for real-time claims processing. We’re also looking to improve Medicare’s Electronic Data Interchange (EDI) cybersecurity controls that support the security and integrity of electronic transactions physicians, suppliers, and other providers use to submit Medicare Part A and Part B claims.
We’re interested in getting your feedback based on your experiences with other insurers with real-time claims processing integration and solutions in the industry (such as revenue cycle health, denials, rejections, appeals, reimbursement time frames).
We also want to hear your feedback to improve and enhance our processes related to strengthening Medicare’s EDI cybersecurity controls to better protect the integrity and availability of information systems involved in processing Medicare claims and the security and privacy of the sensitive beneficiary data being exchanged.
Email comments or questions in advance of the listening session to cmslistens@cms.hhs.gov with “Real-Time Claims & EDI Cybersecurity” in the subject line. We may address them during the listening session or use them to develop other resources following the session.
Read the full announcement (PDF) for more information.
CMS Resource
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