Compliance Monitor (12/29/25)
Your source for federal updates
November/December 2025 Compliance Activity
| Medicare Care Compare Refresh Home health quality scores are publicly reported on the Care Compare website and updated on a quarterly basis. November 2025 (usually distributed in October) | Medicare Care Compare https://www.medicare.gov/care-compare/ Information about home health public reporting dates https://www.cms.gov/medicare/quality/home-health/home-health-quality-reporting-data-submission-deadlines |
| CMS HHQRP non-compliance letters November 2025 (usually distributed in October) | Providers will receive a letter if they are found not in compliance with quality reporting requirements – most likely there will be late distribution due to the 43-day federal government shutdown. – Providers may submit a request for reconsideration to CMS if they do not agree with the CMS outcome – Non-compliance notifications will be distributed by the Medicare Administrative Contractors (MACs) and will be placed into provider CASPER folders in iQIES |
| CMS Home Health Payment Update Rule (Final) Annual CY issuance May include proposed regulatory information not included in the FY hospice payment update proposed rule November 2025 | 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 NOT updated in this quarterly refresh November 2025 | 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 |
| HH QRP Reconsideration Results | Reconsideration results delivered in November/December |
Top Items
CMS issues List of Measures Under Consideration (MUC)
CMS aims to align quality measures with the MAHA initiative in our Quality Reporting and Value Based Programs. The MAHA initiative emphasizes health care priorities such as chronic illness, disease prevention (primary: preventing disease onset; secondary: early detection and intervention; tertiary: managing established diseases), nutrition, physical fitness and wellness. CMS has accepted specific measures onto this year’s MUC List that support these priorities.
There is one measure proposed for home health providers; MUC2025-020 – Advance Care Planning (ACP). The numerator = Patients aged 18 years and older at the start of the measurement period with one or more inpatient encounters during the measurement period who have an advance care planning document and/or documentation of an advance care planning discussion resulting in a documented decision in the EHR by the time of hospital discharge during at least one inpatient encounter during the measurement period. The denominator = Patients aged 18 years and older as of the start of the measurement period, who are discharged from an inpatient hospitalization during the measurement period.
Read more about the 2025 MUC list.
Request for Information: Accelerating the Adoption and Use of Artificial Intelligence as part of Clinical Care
The HHS Office of the Deputy Secretary in collaboration with ASTP/ONC has published this Request for Information (RFI) to seek broad public comment on what HHS can do to accelerate the adoption and use of AI as part of clinical care. In this RFI we seek concrete, experience-based feedback from those building, buying, evaluating, using, and receiving care from AI tools that are part of clinical care as well as from those who wish to do so but face barriers. Public feedback will inform HHS-wide use of three different approaches: regulation, reimbursement, and research & development.
HHS seeks feedback on ways in which these approaches can be most effectively applied to support the rapid adoption and use of AI in clinical care, to foster public trust and confidence in modern technology solutions, to reduce uncertainty that impedes AI innovation, and to align federal incentives so that AI is deployed in ways that enhance productivity, reduce burden, lower health care costs, and improve health outcomes for patients, caregivers, and communities.
All comments received before the close of the comment period will be available for public inspection, including any personally identifiable or confidential business information that is included in a comment
CMS Rulemaking
CMS Proposed Model Test Would Lower Certain Medicare Part B Prescription Drugs
CMS announces the newly proposed GLOBE (Global Benchmark for Efficient Drug Pricing) Model that would lower costs of drugs covered by Medicare Part B. GLOBE would help make critical medications more accessible for people with Medicare, better enabling them to follow their prescribed care for optimal health outcomes, and alleviating financial strain on Medicare and for American taxpayers.
CMS is seeking public comment on GLOBE through an NPRM, which is available on the Federal Register.
Find out more:
CMS Proposes New Mandatory Drug Payment Model to Deliver Lower Drug Prices for Beneficiaries in Medicare Part D
The Centers for Medicare & Medicaid Services (CMS) is proposing a groundbreaking drug payment model to address the increasingly expensive cost of drugs in Medicare Part D while preserving or enhancing Medicare beneficiaries’ quality of care. Building upon the Trump Administration’s historic efforts, the Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model is expected to lower spending for Medicare beneficiaries without hurting their quality of care while also improving the sustainability of the Medicare program and the Medicare Trust Fund and protecting innovation.
The intent of the proposed GUARD Model is to test an innovative payment model that modifies the inflation rebate for GUARD Model drugs using international drug pricing information to identify a benchmark that reflects prices paid in a set of economically comparable countries, which CMS expects would reduce program expenditures for Medicare Part D while preserving or enhancing beneficiaries’ quality of care.
The GUARD Model would begin Jan. 1, 2027, and operate for five years with rebate invoicing and payment continuing until 2033. The model would encompass 25% of Part D enrollees and would only apply to beneficiaries that live in randomly selected geographic areas of the country.
For information on the GUARD Model, visit https://www.cms.gov/priorities/innovation/innovation-models/guard
CMS Press Release
Federal Register notice
Transparency in Coverage Proposed Rule (CMS 9882-P)
CMS in partnership with the Department of Labor and the Department of the Treasury (collectively, the Departments) 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. The proposed rules do not include major changes to prescription drug disclosure requirements, which the Departments intend to address separately.[1]
The Departments seek feedback from stakeholders during the 60-day comment period on all elements of the proposed rule, including opportunities for further standardization and burden reduction. The deadline to submit comments is February 26, 2026.
To access the proposed rule, visit: https://www.federalregister.gov/public-inspection/2025-23693/transparency-in-coverage
To read the CMS fact sheet, visit: cms.gov/newsroom/fact-sheets/transparency-coverage-proposed-rule-cms-9882-p
Hospice/Palliative Care Provider Updates
Long-Term Hospice Stay: New Edit to Prevent Overpayment
Learn about a new edit (PDF) that will help identify and prevent overpayments of long-term hospice care for claims submitted with matching “admission” and “from” dates.
MedPAC: Assessing Payment Adequacy – Hospice
For fiscal year 2027, MedPAC recommends the Congress eliminate the update to the 2026 Medicare base payment rates for hospice.
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
Medicare Provider Compliance Tips is now a CMS.gov webpage. We’re changing some Medicare Learning Network® products to webpages to improve user experience and content accessibility.
Home Health Provider Updates
The Outcome and Assessment Information Set Version E2 (OASIS-E2) Data Submission Specifications Version 3.02.0 are now available in the Downloads section of the OASIS Data Sets page at https://www.cms.gov/medicare/quality/home-health/data-specifications
This FINAL version applies to the OASIS-E2 item set, which is scheduled for implementation on April 1, 2026. Note that item A0810 replaces M0069_PAT_GENDER, item A1255 replaces the A1250 items, several items were added to RFA 03, and the dash (-) is now an allowed value for the item D0150 frequency items. These item changes resulted in several edit changes.
Review the OASIS-E2 Guidance manual for additional information and the Item Change and Edit Change reports within the data specifications. The draft Guidance Manual for the OASIS-E2 version of the OASIS data set, effective April 1, 2026, is available in the Downloads section of the OASIS User Manuals | CMS page, https://www.cms.gov/medicare/quality/home-health/oasis-user-manuals.
Home Health Prospective Payment System Grouper: January Update
Get the January 2026 release (Version 07.0.26 (ZIP)). See the Home Health Prospective Payment System Grouper Software webpage for a summary of changes.
More Information:
- Claims Processing Manual, Chapter 10 (PDF), section 80
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
MedPAC: Assessing Payment Adequacy – Home Health
- For calendar year 2027, MedPAC recommends the Congress reduce the 2026 Medicare base payment rate for home health care services by 7%.
DME Provider Updates
CMS Finalizes New DMEPOS Accreditation Provisions to Enhance Program Integrity
CMS finalized significant changes to the DMEPOS accreditation program as part of our ongoing commitment to program integrity. These provisions, included in the CY 2026 Home Health Prospective Payment System final rule address vulnerabilities in the accreditation process and strengthen quality standards for DMEPOS suppliers.
Find out how these provisions affect DMEPOS suppliers (PDF).
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
Medicare Provider Compliance Tips is now a CMS.gov webpage. We’re changing some Medicare Learning Network® products to webpages to improve user experience and content accessibility.
Home Infusion Therapy Updates
Home Intravenous Immune Globulin Items & Services: CY 2026 Rate Update
The CY 2026 payment rate for Q2052 (Services, Supplies, and Accessories used in the Home for the Administration of Intravenous Immune Globulin) is $442.19.
All Providers Updates
New CMS LEAD Model Aims to Expand Access to Accountable Care, Improve Health Outcomes
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, while providing care for patients, including those with high needs, such as dual eligibles and those who are homebound or home limited. 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.
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 March 2026.
Find out more: LEAD Model Webpage
Institutional Provider Enrollment Application Fee: CY 2026
Effective January 1, the application fee is $750 for institutional providers who are:
- Initially enrolling in the Medicare or Medicaid programs or the Children’s Health Insurance Program (CHIP)
- Revalidating their Medicare, Medicaid, or CHIP enrollment
- Adding a new Medicare practice location
CMS requires this fee with any of these enrollment applications submitted from January 1 – December 31, 2026. See the notice for more information.
MAHA ELEVATE Brings Lifestyle Medicine to Original Medicare
CMS announced the Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE) Model, a voluntary model to fund up to 30 chronic disease prevention and health promotion programs to assess evidence-based functional or lifestyle medicine interventions currently not covered by Original Medicare.
These types of interventions, including those focused on nutrition and physical activity, may slow or prevent chronic disease; MAHA ELEVATE will gather and evaluate necessary data on cost and quality to inform decisions about the feasibility of including such lifestyle-based interventions in Original Medicare in the future.
CMS will release a Notice of Funding Opportunity in early 2026 for the first cohort. The model will begin on September 1, 2026. The second cohort will begin 1 year later.
Visit the MAHA ELEVATE Model webpage for more information.
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.