Compliance Monitor (2/13/26)
Your source for federal updates – written by Jennifer Kennedy
February 2026 Compliance Activity
| Compliance Item & Date | Additional info & Links |
| Medicare Care Compare RefreshHospice 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 | 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 |
| HIPAA Update – February 16, 2026Covered entities, including health plans and employers subject to HIPAA, must revise their NPP to include new and more restrictive requirements related to protected health information (PHI). Specifically, the NPP must: Describe stricter limitations on the use and disclosure of substance use disorder records. State that an individual’s written consent or a court order is required to use substance use disorder records in civil, criminal, administrative, or legislative proceedings against the individual . Explain that PHI disclosed in accordance with HIPAA may be redisclosed by the recipient and may no longer be protected by HIPAA. | In February 2024, HHS finalized significant revisions to 42 CFR Part 2, the federal regulation governing the confidentiality of SUD treatment records. Part 2 has historically imposed stricter privacy protections than HIPAA, reflecting longstanding concerns about stigma and discrimination associated with SUD treatment. |
| Hospice Vendor Update and Errata (V1.00.3) for HOPE Data Specs (FINAL) Effective October 1, 2025. Errata V1.00.3 for the final HOPE data submission specifications (V1.00.1) contains one additional issue regarding edits, and these revisions will go into effect on February 18, 2026. | This information is available in the Downloads section of the HOPE Technical Information |
| HIPAA Breach Reporting: HIPAA-covered entities and their business associates are required annually to notify the Office for Civil Rights (OCR) of breaches for unsecured protected health information(PHI) that affected fewer than 500 individuals. Report breaches of unsecured protected health information affects fewer than 500 individuals utilizing the web portal in the link. Report annually as applicable; submit within 60 days of the end of the calendar year in which the breach was discovered | Establishments under Federal OSHA jurisdiction can use the ITA Coverage Application to determine if they are required to electronically report their injury and illness information to OSHA. Establishments under State Plan jurisdiction should contacttheir State Plan. https://www.osha.gov/news/newsreleases/tr ade/01092023 Form 300-A https://www.osha.gov/recordkeepi ng/forms |
| HIPAA Breach Reporting: HIPAA-covered entities and their business associates are required to notify the Office for Civil Rights (OCR) annually of breaches of unsecured protected health information (PHI) that affected fewer than 500 individuals. Report breaches of unsecured protected health information that affect fewer than 500 individuals utilizing the web portal in the link. Report annually as applicable; submit within 60 days of the end of the calendar year in which the breach was discovered | Submitting a notice of breach to the HHS secretary https://www.hhs.gov/hipaa/for- professionals/breach- notification/breach- reporting/index.html |
Top Items
Medicare Telehealth Flexibilities Extended
On February 3, 2026, President Trump signed HR 7148, the “Consolidated Appropriations Act, 2026” (the Act), ending the 4-day partial government shutdown. The Act, part of a broader fiscal year (FY) 2026 spending package, extends Medicare telehealth flexibilities that recently expired on January 31, 2026.
- Telehealth for the Recertification of Hospice Care: Hospice physicians and nurse practitioners may continue having face-to-face encounters to recertify a patient’s eligibility to remain on hospice via telehealth through December 31, 2027.
- The bill provides a five-year extension of the Acute Hospital Care at Home program and a two-year extension for Medicare telehealth flexibilities.
Review the CMS Telehealth Policy Update FAQs
Paper Fee Coupons & CLIA Certificates Ending March 1
CMS is improving the Clinical Laboratory Improvement Amendments (CLIA) program by switching to electronic fee coupons and CLIA certificates. After March 1, 2026, paper fee coupons and CLIA certificates will no longer be available; we’ll stop mailing paper versions after this date. In addition, you must pay your CLIA certification and survey fees online; checks will no longer be accepted.
This is the last chance for eligible laboratories and providers that perform laboratory testing to sign up for CMS email notifications to receive electronic CLIA fee coupons and certificates. Failure to switch may result in billing and certification issues.
You can switch to electronic notifications from CMS or update your email address by:
- Emailing your state agency (PDF)
- Contacting your Accreditation Organization if you’re an accredited laboratory
OIG Posts Top Management & Performance Challenges Facing HHS – 2025
The OIG issues its Top Management and Performance Challenges Facing HHS annually as required by statute. This publication is intended to help the Department improve the effectiveness and efficiency of its programs and operations.
This report targeted hospice providers in their efforts to combat fraud, waste, and abuse.
FY 2025 Medicare Fee-for-Service Improper Payment Rate
CMS reported the national Medicare Fee-for-Service (FFS) improper payment rate in the FY 2025 HHS Agency Financial Report (section 3, Payment Integrity Report).
The 2025 national Medicare FFS improper payment rate is 6.55%, or $28.83B in improper payments. Most of these improper payments fall into 2 categories:
- Insufficient documentation
- Documentation provided didn’t sufficiently demonstrate medical necessity
See the FY 2025 Improper Payments fact sheet for more information.
CMS Rulemaking
CMS Seeks Public Input on Strengthening Domestic Supply Chain for PPE, Essential Medicines
The Centers for Medicare & Medicaid Services (CMS) today issued an Advance Notice of Proposed Rulemaking (ANPRM) seeking public feedback on potential approaches to strengthen the American-made supply chain for personal protective equipment (PPE) and essential medicines. Building on lessons learned during the COVID-19 public health emergency, the agency is exploring ways to reduce reliance on foreign-made medical supplies, enhance the nation’s readiness for future emergencies, and support American workers and manufacturers.
The ANPRM seeks comments on new avenues the agency may consider to promote domestic purchasing by hospitals that participate in the Medicare program, including the potential creation of a new “Secure American Medical Supplies” designation for hospitals committed to American-made purchasing, and streamlined payment approaches to help offset the resource costs of domestic procurement.
CMS is seeking broad input on future supply chain policies to advance national security, strengthen domestic manufacturing capacity, improve care quality, and support a more resilient health care system.
Information on how to submit comments is available via the Federal Register at: https://www.federalregister.gov/public-inspection/current. There is a 60-day comment period.
Patient Protection and Affordable Care Act, Benefit and Payment Parameters for 2027 and Basic Health Program – Proposed Rule
CMS proposed regulations to lower health care costs, promote competition, and strengthen program integrity in the Federal and State-Based Health Insurance Exchanges. The proposed Notice of Benefit and Payment Parameters for 2027 would crack down on fraud and misleading practices by agents and brokers, restore accountability for taxpayer-funded subsidies, and remove federal barriers that have limited plan innovation and driven up premiums—helping ensure coverage is more affordable and works better for consumers, taxpayers, and states.
The proposed rule encourages new, consumer-focused plan designs that expand choice and support affordability. To review the proposed rule, visit https://www.federalregister.gov/d/2026-02769.
Public comments must be submitted by March 11, 2026.
To review the proposed rule fact sheet, visit https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-payment-parameters-2027-proposed-rule
Hospice/Palliative Care Provider Updates
Hospice Vendor Update and Errata (V1.00.3) for HOPE Data Specs (FINAL) Effective October 1, 2025
CMS announces the posting of an Errata V1.00.3 for the final HOPE data submission specifications (V1.00.1). This errata document contains one additional issue regarding edits, and these revisions will go into effect on February 18, 2026.
This information is available in the Downloads section of the HOPE Technical Information
Hospice Preview Reports for the May 2026 Refresh – NOW AVAILABLE IN QIES
Providers can now access the latest Provider Preview Reports via the Certification and Survey Provider Enhanced Reports (CASPER) application. 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 May 2026 refresh.
In the Provider Preview Reports, assessment-based measure scores are based on HIS data submitted by hospices from Quarter 3, 2024, through Quarter 2, 2025. CAHPS measure scores are based on CAHPS data submitted from Quarter 3, 2023, through Quarter 2, 2025. CAHPS Star Ratings are calculated based on data from Quarter 2, 202,3 through Quarter 1, 2025. The claims-based measures reflect claims data collected from Quarter 1, 2023, through Quarter 4, 2024.
Notably, one CAHPS measure—Training family to care for patient—will be removed from public reporting beginning with the May 2026 refresh. Reporting of this measure is expected to resume with the February 2028 refresh.
Once released in CASPER, providers will have 30 days during which to review their quality measure results. The preview period for the latest Provider Preview Report lasts from February 11, 2026, to March 13, 2025. Although the actual “preview period” is 30 days, the reports will remain available for an additional 30 days, for a total of 60 days. CMS encourages providers to download and save their Hospice Provider Preview Reports for future reference, as they will no longer be available in CASPER after this 60-day period.
Learn more about the Provider Preview Report (Assessment and Claims-based measures) here and about the CAHPS Preview Report here. Hospice QRP Key Dates for Providers are available here.
Home Health Provider Updates
Preview Reports and Star Rating Preview Reports for the April 2026 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 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 quality measure scores displayed in their Provider Preview Reports are inaccurate.
DMEPOS Updates
DMEPOS Competitive Bidding: Next Round & FAQs
CMS plans to conduct bidding for the next round of the DMEPOS Competitive Bidding Program (CBP). Read the new FAQs to learn more.
More Information:
- DMEPOS CBP – Updates & Important Information fact sheet
- CY 2026 Home Health Prospective Payment System final rule
Home-Based Noninvasive Positive Pressure Ventilation to Treat Chronic Respiratory Failure Due to Chronic Obstructive Pulmonary Disease – Revised
Learn what’s changed (PDF): CMS removed HCPCS code E0465 and the ICD-10 diagnosis codes; Medicare Administrative Contractors will manage all ICD-10 diagnosis codes locally.
Pneumatic Compression Devices: Prevent Claim Denials
In 2024, the improper payment rate for pneumatic compression devices was 61.5%, with a projected improper payment amount of $37.7M (see 2024 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF)). Learn how to bill correctly for these services. Review the Pneumatic Compression Devices & Accessories provider compliance tip for more information, including:
- Denial reasons and how to prevent them
- Indications and limitations of coverage
- Documentation requirements
- Example of improper payments due to insufficient documentation
All Providers Updates
ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2026 Update
Learn about updates to National Coverage Determinations (PDF) with new or deleted ICD-10 diagnosis codes, effective July 1, 2026.
Medicaid Technology Companies Pledge $600M in Savings to Support Community Engagement and Related State Medicaid System Improvements
CMS announced that 10 health technology companies that have existing Medicaid eligibility and enrollment contracts with states have voluntarily pledged to help states successfully prepare for and implement Medicaid community engagement requirements enacted under the Working Families Tax Cut (WFTC) legislation (Public Law 119-21).
Companies that currently support state Medicaid systems have informed CMS that they intend to offer states more than $600 million in no-cost and significantly discounted technology products and services to support community engagement implementation while accelerating broader Medicaid system modernization. These voluntary commitments are expected to generate significant savings over the coming years for states and taxpayers, and to improve the beneficiary experience.
States are required to implement community engagement requirements by January 1, 2027, and may do so earlier. CMS will continue to provide technical assistance, guidance, and resources to support states throughout implementation. The companies announced today represent an initial group of participants who have pledged to support community engagement and related Medicaid system improvements. CMS expects this effort to evolve over time and will continue working with states and industry to support successful implementation.
For more information, please view the fact sheet at cms.gov/newsroom/fact-sheets/fact-sheet-pledges-medicaid-technology-companies-support-community-engagement-implementation-related and visit medicaid.gov/medicaidreforms
Medicare Billing: CMS-1450 & 837I – Revised
CMS added COVID-19 shots to roster billing (PDF).
Medicare Billing: CMS-1500 & 837P – Revised
CMS added COVID-19 shots to roster billing (PDF).
2026 Medicare Accountable Care Organization Initiatives Participation Highlights
As of January 2026, 14.3 million Medicare beneficiaries are estimated to receive care coordinated by Accountable Care Organizations (ACOs), up from 13.7 million in 2025, representing a 4.4% increase. This includes patients whose health care providers are in Medicare Shared Savings Program (Shared Savings Program) ACOs and entities participating in Center for Medicare and Medicaid Innovation (CMS Innovation Center) accountable care models, as well as other CMS Innovation Center models focused on total cost of care, advanced primary care, and specialty care.
Educational Opportunities
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 on 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.
Reserve a hotel room →
2026 CMS Burden Reduction Conference!
The Centers for Medicare & Medicaid Services (CMS) invites you to join us on Wednesday, February 25, 2026, from 9:00 AM to 1:00 PM ET.
Building on insights and successes from past conferences, this year’s event will convene CMS leadership, clinicians, and healthcare stakeholders to explore the latest efforts to reduce administrative burden, improve care delivery, and advance the use of technology across the healthcare ecosystem. The conference will feature a keynote speech from CMS Administrator Dr. Mehmet Oz, along with panel discussions and sessions focused on practical approaches to reducing administrative burden.
Please register for the virtual event, as we have reached our in-person capacity. Upon registering, you may add your name to the in-person waitlist, and we will notify you if space becomes available to join in person leading up to the conference. Additional details, including an agenda with session topics, are available on the Conference webpage.
For questions or additional information, please email CMSBurdenReductionConference@rippleeffect.com . Be sure to add this event to your calendar after registering.
The 2026 CMS Quality Conference, is happening March 16–18 in Baltimore and online.
Focused on the mission to “Make America Healthy Again: Innovating Together for Better Health”, the conference offers an opportunity for you to engage in discussions shaping the future of healthcare quality. Explore five dynamic tracks tailored to your interests across March 16 and 17, including:
- Driving Quality, Ensuring Safety, Preventing Harm
- Transforming Health Quality with Data and Digital Solutions
- Wellness Starts with Prevention
- What’s Next at CMS for Quality and Safety
- Let’s Hear It! Share Your Ideas with CMS
March 18 will consist of closed sessions for designated participants.
CMS Administrator Dr. Mehmet Oz and other HHS, CMS, and national healthcare leaders will deliver inspiring keynotes and lead conversations that spark action and drive innovation.
Space is limited, so secure your spot today and join now for a meaningful experience!