Compliance Monitor (1/13/26)
Your source for federal updates
January 2026 Compliance Activity
| Medicare Care Compare Refresh Home health quality scores are publicly reported on the Care Compare website and updated on a quarterly basis | Medicare Care Compare Information about home health public reporting dates |
| CMS Home Health Payment Update Rule (Final) Final payment update rates and provisions of the final rule are effective for home health, home infusion therapy, and DMEPOS providers January 1, 2026 | Final rule in the Federal Register |
| Telehealth extension – Hospice Section 6208 of the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026 extended the use of telehealth by a hospice physician or hospice nurse practitioner to conduct a face-to-face encounter for the sole purpose of hospice recertification. This extension is through January 30, 2026. This constitutes a temporary change in the regulations at 42 CFR 418.22(a)(4)(ii). | CMS Hospice Center |
| Telehealth extension – Home Health CMS home health telehealth flexibilities (like receiving care at home and waiving geographic restrictions for some services) have been extended through January 30, 2026 | CMS Telehealth Policy Updates |
Top Items
CMS Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, Texas, Georgia & Ohio
CMS is placing newly enrolling hospices located in Arizona, California, Nevada, Texas, Georgia, and Ohio in a provisional period of enhanced oversight. We received numerous reports of hospice fraud, waste, and abuse. The number of enrolled hospices has increased significantly in these states, raising serious concerns about market oversaturation.
CMS Request for Information (RFI)
The Center for Medicare & Medicaid Services (CMS) seeks information regarding large scale claims processing and adjudication vendors to accomplish our objectives of improving beneficiary experience, reducing provider burden, and improving administrative efficiency in Original Medicare. CMS seeks responses to questions listed in this RFI. CMS may use information collected through this RFI notice in its evaluation of overhauling its claims adjudication systems.
Medicare Provider Enrollment – Revised
CMS updated the enrollment fee amount for 2026.
CMS Rulemaking
In response to the COVID-19 Public Health Emergency (COVID-19 PHE), as declared by the Secretary of HHS (the “Secretary”) on January 31, 2020, pursuant to the authority under section 319 of the Public Health Service Act (42 U.S.C. 247), DEA granted temporary exceptions to the remote prescribing requirements of the Ryan Haight Act and DEA’s implementing regulations under the authority granted by 21 U.S.C. 802(54)(D).
With the December 31, 2025 expiration date of the Third Temporary Rule quickly approaching, DEA, jointly with HHS, is now issuing a fourth temporary extension (“Fourth Temporary Rule”) to prevent what has been commonly referred to as the “telemedicine cliff:” the reinstatement of the pre-pandemic restrictions imposed by the CSA, which could potentially and abruptly limit patients’ access to care until promulgation of a final set of regulations. Collaterally, the extension will provide time for DEA to promulgate a final set of regulations, to ensure a smooth transition for patients and providers that have come to rely on the availability of telemedicine to prescribe controlled substances to patients for whom they have never had an in-person medical evaluation, and allow sufficient time for providers to come into compliance with any new DEA registration, recordkeeping, or security requirements eventually adopted in a final set of regulations.
This document announces the updated Healthcare Common Procedure Coding System (HCPCS) codes on the Master List. It also announces updates to the HCPCS codes on the Required Face-to-Face and Written Order Prior to Delivery List and the Required Prior Authorization List. This Federal Register notice is adding the following eight additional HCPCS codes to the F2F/WOPD List.
HHS Releases the HTI-5 Proposed Rule to Modernize the ONC Health IT Certification Program
The U.S. Department of Health and Human Services (HHS), through ASTP/ONC, released the HTI-5 Proposed Rule. The proposed rule is open for public comment until February 27, 2026. ASTP/ONC recently posted a recorded information session with a more in-depth overview of the proposed rule.
More on HealthIT.gov/HTI5 →
ASTP/ONC is also withdrawing certain proposals not yet finalized from the HTI-2 Proposed Rule.
Read the notice →
Transparency in Coverage Proposed Rule
Consistent with the President’s Executive Order 14221, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information,” on December 19, 2025, CMS, in partnership with the Department of Labor and the Department of the Treasury jointly proposed changes to the payer price transparency regulations to improve the accessibility of pricing disclosures to participants, beneficiaries, and enrollees, and the standardization and reliability of the public pricing disclosures from non-grandfathered group health plans and health insurance issuers offering non-grandfathered group and individual health insurance coverage.
More Information:
Hospice/Palliative Care Provider Updates
Updated Information Gathering Report for Hospice Quality Reporting Program
CMS has released the Hospice Quality Reporting Program 2025 Information Gathering Report. This report provides information from literature reviews and supports an understanding of current trends in hospice care. It includes findings related to hospice use, hospice care delivery, and caregiver support
Review the updated Information Gathering Report – 2025; 2025_HQRPIGR_Final_Supplement (PDF)
OIG Report – Acute Care Hospital Outpatient Services for Hospice Enrollees: Reduce Improper Payments
In a report, the Office of the Inspector General found that Medicare improperly paid acute-care hospitals for outpatient services provided to hospice enrollees. To avoid improper payments, request and analyze hospice election statement addendums for these enrollees.
Review the Acute Care Hospital Inpatient Prospective Payment System educational tool for more information:
- We don’t pay for services given to palliate or manage a terminal illness and related conditions. Services should be provided under arrangements with the hospice provider.
- We only pay for Part B outpatient services that are unrelated to the terminal illness and related conditions.
Medicare Provider Compliance Tips — Revised Webpage
CMS updated the improper payment rate and denial reasons for the 2024 reporting period. Learn what’s changed:
- Hospice services: We added language clarifying the attestation requirement
Home Health Provider Updates
Home Health Prospective Payment System: CY 2026 Rate Update
Learn about updated payment rates (PDF) for CY 2026:
- 30-day period payments
- National per-visit amounts
- Disposable negative pressure wound therapy devices
- Cost-per-unit payment amounts used to calculate outlier payments
Preview Reports and Star Rating Preview Reports for the April 2026 Refresh of HH QRP Data – NOW AVAILABLE IN iQIES
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 April 2026 refresh.
Data contained within the Provider Preview Reports are based on quality assessment data submitted by HHAs from Quarter 3, 2024 through Quarter 2, 2025. 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 4, 2024 through Quarter 3, 2025.
The Preview Reports for April 2026 will no longer include one OASIS-based measure, COVID-19 Vaccine: Percent of Patients Who Are Up to Date.
Providers have until February 9, 2026, 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
Final October 2025 Interim Performance Reports (IPRs) are Available in iQIES
The Final October 2025 IPRs for the expanded HHVBP Model have been published in the Internet Quality Improvement and Evaluation System (iQIES). HHAs that were initially Medicare certified in 2023 (or before) are eligible to receive October 2025 IPRs.
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. Note that the CY 2025 measure set is reported and includes the following measures:
OASIS-based Measures
- Improvement in Dyspnea (Dyspnea)
- Improvement in Management of Oral Medications (Oral Medications)
- Discharge Function (DC Function)
Claims-based Measures
- Discharge to Community – Post Acute Care (DTC-PAC)
- Potentially Preventable Hospitalizations – Post Acute Care (PPH)
HHCAHPS Survey-based Measures
- Care of Patients (Professional Care)
- Communications between Providers and Patients (Communication)
- Specific Care Issues (Team Discussion)
- Overall rating of home health care (Overall Rating)
- Willingness to recommend the agency (Willing to Recommend)
An HHA receives an October 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: October 2025 IPR quality measure performance scores time periods for each measure category
| Measure Category | Time Period | Minimum Data Threshold |
| OASIS-based | Jul 1, 2024 – Jun 30, 2025 | 20 home health quality episodes |
| Claims-based | DTC-PAC: Apr 1, 2023 – Mar 31, 2025; PPH: Apr 1, 2024 – Mar 31, 2025 | 20 home health stays |
| HHCAHPS Survey-based* | Apr 1, 2024 – Mar 31, 2025 | 40 completed surveys |
Important note:
Due to a calculation error in the CY 2024 OASIS-based Discharge Function (DC Function) measure values reported in the July 2025 IPRs, CMS corrected improvement thresholds for HHAs with improvement thresholds based on CY 2024 data as reported in the October 2025 IPRs. HHAs with improvement thresholds based on CY 2023 data were not impacted by this correction as CY 2023 measure values were calculated correctly.
How to check if your HHA was impacted by this correction –
HHAs that received a July 2025 IPR, please go through the following steps to identify if you were impacted by this correction:
- Open your HHA’s July 2025 IPR and navigate to the “CY 2025 Baseline” tab.
- If you did not receive a July 2025 IPR and/or October 2025 IPR, no further action is required on your part.
- Locate the column labeled “Baseline Year Data Period [b].
- If you see “12-31-2024” in this column for the OASIS-based DC Function measure, the corresponding improvement threshold (listed in the adjacent column labeled “Your HHA’s Improvement Threshold”) was recalculated. Your HHA’s October 2025 IPR shows the correct CY 2024 Improvement Threshold for this measure.
- If you see “12-31-2023” in this column for the OASIS-based DC Function measure, no corrections were made to your improvement threshold as the CY 2023 measure data were not impacted.
For any questions related to this correction of the CY 2024 improvement thresholds for the OASIS-based DC Function measure, please contact the HHVBP Model Help Desk at HHVBPquestions@cms.hhs.gov.
OIG Advisory Opinion Posted
Advisory Opinion 25-12 Unfavorable opinion regarding a proposal for a home care agency to market sign-on bonuses to prospective employees with the intention of employing those individuals for the provision of services to other individuals, who most often would be family members of the prospective employees.
NOW AVAILABLE: Falls with Major Injury (FMI) HH Technical Specification Report
The Centers for Medicare & Medicaid Services (CMS) has released the official Technical Specification Report for the Falls with Major Injury (FMI) measure. This report incorporates feedback received during the cross-setting Technical Expert Panel (TEP) held on May 12 and 14, 2025. The report provides an overview of the measure, a high-level summary of the key features of the re-specified measure, a description of the methodology used to construct the FMI measure, and an overview of measure testing results. Additional guidance and related updates to the Quality Measure Calculations and Reporting User’s Manual, OASIS manuals, and public reporting timelines will be provided at a future date.
The report is available in the Downloads section on the Home Health QRP Quality Measures webpage.
DMEPOS Updates
DMEPOS Fee Schedule: CY 2026 Update
Learn about the updated payment policies (PDF), effective January 1, 2026:
- Fees for new codes
- Annual covered item fee updates
Medicare Provider Compliance Tips — Revised Webpage
CMS updated the improper payment rate and denial reasons for the 2024 reporting period. Learn what’s changed:
- Lower limb orthoses: We added HCPCS codes L1933 and L1952 to the list of covered ankle-foot-orthoses codes
- Lower limb prostheses: We added functional level characteristics
- Pneumatic compression devices and accessories: We added information about lymphedema compression treatment
- Respiratory assist devices: We added information about noninvasive positive pressure ventilation in the home for treating chronic respiratory failure consequent to chronic obstructive pulmonary disease
- Wheelchair options and accessories: We added HCPCS code E1032
All Providers Updates
ICD-10-PCS: CMS Announces 80 New Codes, Effective April 1, 2026
Visit the ICD-10 webpage to get April 2026 procedure code update files. Use these codes for discharges and patient encounters occurring from April 1 – September 30, 2026.
CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States
CMS announced that all 50 states will receive awards under the Rural Health Transformation (RHT) Program, a $50 billion initiative established under President Trump’s Working Families Tax Cuts legislation (Public Law 119-21) to strengthen and modernize health care in rural communities across the country. In 2026, states will receive first-year awards from CMS averaging $200 million within a range of $147 million to $281 million. This unprecedented federal investment will help states expand access to care in rural communities, strengthen the rural health workforce, modernize rural facilities and technology, and support innovative models that bring high-quality, dependable care closer to home.
More Information:
- RHT Program webpage
CMS Announces Establishment of the Office of Rural Health Transformation
New Office Will Continue Leading Implementation of the $50 Billion Rural Health Initiative
CMS) has announced the establishment of the Office of Rural Health Transformation (ORHT) within the Center for Medicaid and CHIP Services (CMCS). Following the creation of the Rural Health Transformation (RHT) Program earlier this year under President Trump’s Working Families Tax Cut legislation (Public Law 119-21), CMS has been carrying out this work and has now formally established ORHT within its organizational structure. The office will continue overseeing the RHT Program — a historic, $50 billion initiative to strengthen rural health systems and expand sustainable access to care nationwide.
For more information about the ORHT, visit: federalregister.gov/documents/2025/12/22/2025-23588/statement-of-organization-functions-and-delegations-of-authority.
For more information about the RHT Program, including state resources and program updates, visit: cms.gov/priorities/rural-health-transformation-rht-program/rural-health-transformation-rht-program
New CMS LEAD Model Aims to Expand Access to Accountable Care, Improve Health Outcomes
What’s New
The Long-term Enhanced ACO Design (LEAD) Model is the Innovation Center’s next Accountable Care Organization (ACO) model that will focus on reaching more health care providers who have not joined ACOs, with a 10-year pathway to sustainable benchmarks, flexible population-based payments to support team-based care, integrated support for patients with complex care needs, and new waivers and flexibilities to attract beneficiaries and promote preventive care and healthy living.
Why It Matters
LEAD’s improved benchmarking methodology and other design features will support smaller, independent, or rural-based practices and those who serve patients with more complex challenges that have faced financial and administrative obstacles to being in ACOs previously.
What to Expect
LEAD is a 10-year model that will begin January 1, 2027; ACOs can apply to participate in LEAD by responding to a Request for Applications, which will become available beginning in Spring 2026.
More Information:
- LEAD Model webpage
Educational Opportunities
CAHPS End-of-Life Care Survey Webcast
Date: Thursday, January 15, 2026
Time: 1–2 PM ET
Register for this free, one-hour webcast introducing AHRQ’s new Consumer Assessment of Healthcare Providers and Systems (CAHPS®) End-of-Life Care Survey. Join leading experts as they discuss why the survey was developed, how it was tested, and best practices for successful implementation. Kaiser Permanente will share lessons learned from field testing the survey in their end-of-life care programs.
Save the Date!
Mark your calendar! We are excited to announce that the 2026 CMS Quality Conference will return on March 16-18, 2026, both online and in person at the Hilton Baltimore Inner Harbor. The premier event for healthcare quality nationwide will bring together a community of healthcare leaders, clinicians, researchers, and patient advocates dedicated to improving care, so be sure to save the date.
More details, including registration and hotel information, will be shared in the coming months. In the meantime, let us know what you’re looking forward to by using #QualCon26 on social media or revisit the powerful presentations from the 2025 Quality Conference
CMS Burden Reduction Conference
CMS) is pleased to announce the 2026 CMS Burden Reduction Conference taking place February 25, 2026, from 9:00 a.m. to 1:00 p.m. ET. This year’s conference will be a hybrid event, with in-person programming at the Hubert H. Humphrey (HHH) Building in Washington, DC, and a fully supported virtual option for remote attendees. In-person attendance will be limited due to space.
Building on insights and successes from the 2023 and 2024 Optimizing Healthcare Delivery conferences, this year’s event will convene change makers from the healthcare community and federal government to share new ideas, lessons learned, and best practices aimed at increasing transparency, transforming chronic care, and empowering clinicians and patients through the use of Artificial Intelligence.
More details, including session topics and speaker announcements—will be shared soon.
You will receive an additional email when registration opens.
Register for the CMS Webinar on January 21, 2026 for the Digital Quality Measure (dQM) Public Comment Period
HL7 Fast Healthcare Interoperability Resources® (FHIR®) is the next-generation standard for electronic healthcare data exchange, supporting improved interoperability across clinical settings. The Centers for Medicare & Medicaid Services (CMS) is exploring the transition of electronic clinical quality measures (eCQMs) to digital quality measures (dQMs) using FHIR-based standards to enable standardized, electronic data sharing.
As CMS seeks public comment on draft dQMs, you are invited you to a webinar highlighting the transition to FHIR based standards and what to expect for the dQM Public Comment Period.
When: January 21, 2026
Who Should Attend:
Health IT developer/vendor, measure developers, implementers, and others interested in the transition to FHIR quality measurement. This webinar assumes the attendees have prior knowledge of Health Level Seven International® and FHIR terminology.
Webinar Topics Will Include:
- Overview of the transition to dQMs using FHIR
- Introduction to the Measure Authoring Development Integrated Environment (MADiE)
- Comparison of dQM and eCQM artifacts
- Test case examples
- CMS and CDC Hypoglycemic Reporting
- Details on the dQM public comment period
- Date: January 21, 2026
- Time: 2pm ET
Additional Information:
- Visit the FHIR Education and dQM pages on the Electronic Clinical Quality Improvement (eCQI) Resource Center for educational materials.
- Submit FHIR-related questions to: ecqi@lantanagroup.com.
- Learn more about electronic clinical quality measure standards on the eCQI Resource Center.
2026 ASTP Annual Meeting Registration Is Filling Up: Register Today
Registration is open but limited for the 2026 ASTP Annual Meeting! Register to secure your seat on February 11-12 in Washington, DC for two days of conversation, learning, and networking.
Register today →
On the main stage, we’ll discuss the latest TEFCA™ developments, HHS’s commitment to improving prior authorization, artificial intelligence in health care settings, and the newest innovations in digital health. Check out breakout sessions about information blocking (including an information blocking bootcamp!), TEFCA, the latest data analysis from ASTP, USCDI, and more.
For those who are unable to attend in person, the main stage sessions will be live-streamed. A room block at the Omni Shoreham is available on a first-come, first-served basis until January 19, 2026 so book your room today.
