Compliance Monitor (4/10/26)
Your source for federal updates
April 2026 Compliance Activity
| Compliance Item & Date | Additional info & Links |
| OASIS-E2 CMS is implementing OASIS-E2, an “off-cycle” update to the home health assessment instrument aimed at refining data collection and improving alignment across post-acute settings. All assessments completed on or after this date must use the E2 version. Effective April 1, 2026 | The final OASIS-E2 Instruments (All Items and Time Point versions) and OASIS-E2 Change Table, effective April 1, 2026, are available Outcome and Assessment Information Set OASIS-E2 Manual OASIS Data Sets |
| CMS Hospice Payment Update Rule (NPRM) Annual FY issuance Includes proposed annual payment update and quality program information Other proposed regulations or changes to standing regulations may be included with the opportunity for comments (as applicable). Usually posted in late March – early April | 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 |
| HHCAHPS Changes: CMS will update the HHCAHPS survey and remove three survey-based measures from the expanded HHVBP Model: Care of Patients, Communications between Providers and Patients, and Specific Care Issues. Beginning April 1, 2026 | Calendar Year (CY) 2026 Home Health Prospective Payment System Final Rule (CMS-1828-F) |
| CMS updated the Medicare DMEPOS Master List, including 83 items on the Required Face-to-Face (F2F) and Written Order Prior to Delivery (WOPD) List and 74 items on the Required Prior Authorization List. Key changes include added codes for oxygen systems (F2F/WOPD) and orthoses/pneumatic compressors (Prior Authorization) to reduce improper payments. Order Prior to Delivery List, and the Required Prior Authorization List are effective on April 13, 2026 | https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/medical-review-and-education/dmepos-order-requirements#:~:text=On%2C%20January%2013%2C%202026%2C,Order%20Prior%20to%20Delivery%20List. |
| Medicare Care Compare Refresh Home health quality scores are publicly reported on the Care Compare website and updated on a quarterly basis. Before each quarterly release of data, Home health providers should review their quality measure results during a 30-day preview period using the Provider Preview Report available in iQIES. April 2026 | 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 |
Top Items
CMS revised Memo QSO 18-12-Deemed Providers/Suppliers on 3/25/2026. A summary of the revisions include:
- Temporary Removal of Deemed Status due to Non-compliance: AOs must suspend or postpone any Medicare deeming recertification survey until the CMS Location restores deemed status, regardless of the provider’s/supplier’s deeming cycle.
- Impact on AOs: If an organization’s deemed 36-month cycle lapses while the organization is under the temporary jurisdiction of the State Survey Agency (SA), CMS will not consider the AO late or as having missed a survey.
- Non-deeming Accreditation Surveys: CMS is not prohibiting an AO from conducting non-deeming accreditation surveys while an organization is under state jurisdiction; however, we recommend AOs suspend or postpone these activities.
- Complaint Investigation Guidance: CMS is providing additional guidance for complaint investigations and coordination among the SAs and AOs.
Effective Date: for complaint investigation guidance – 60 days from issuance of the memorandum.
Effective Date: for all other provisions within this memorandum- Immediately.
CMS Proposes New Transparency Measures to Strengthen Oversight of Hospice Providers
Hospice Scoring System Would Increase Accountability and Protect Beneficiaries
As part of its continuing efforts to combat fraud and strengthen program integrity, the Centers for Medicare & Medicaid Services (CMS) is looking to shine a light on potentially concerning hospice billing and beneficiary care delivery. In the FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Proposed Rule, CMS is unveiling a new, publicly available hospice scoring system based on indicators of potential inappropriate utilization, quality of care, and compliance concerns, holding suspicious facilities accountable while allowing legitimate hospices to thrive.
CMS maintains that virtually all care and services needed for individuals approaching the end of life should be provided in a hospice setting except in rare and unusual instances. However, CMS has seen non-hospice spending continue to rise for terminally ill individuals in recent years. CMS’ service and spending variation index (SSVI) will assign hospices a score based on a variety of metrics CMS gathers from hospice claims including: non-hospice spending, percent of beneficiaries discharged with a length of stay of 180 days or more, average minutes per routine home care day, and percent of live discharges where beneficiaries return to the same hospice in seven days, among others. These metrics were chosen to compare spending and care delivery between hospices.
While this information is not a direct indicator of fraud, waste, or abuse, a high SSVI score would represent a potential higher level of concern, as this may signal potential program integrity risks or inappropriate utilization. This could potentially indicate further need for oversight.
Provider-level data and each facility’s SSVI score would be posted on CMS’ Hospice Center webpage. While most hospices are anticipated to have a low score, facilities with high-end scores could be subject to additional review to assess potential program integrity or compliance issues.
The proposed rule can be viewed in the Federal Register at https://www.federalregister.gov/public-inspection/current.
Review the Fact Sheet at: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2027-hospice-wage-index-payment-rate-update-hospice-quality-reporting-program.
CMS Rulemaking
CMS Posts FY 2027 Hospice Wage Index Proposed Rule
The FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements [CMS-1851-P] was posted on the Federal Register Public Inspection desk on 4/2/2026. The rule was posted in the Federal Register on 4/6/2025. CMS will accept comments related to the proposed rule through June 1, 2026, 11:59 pm. Information about submitting comments appears at the beginning of the rule.
Highlights of the rule include:
- The FY 2026 proposed hospice payment update percentage is 2.4%.
- Data related to spending outside of the Medicare Hospice Benefit
- Proposal to make the utilization of the hospice election addendum mandatory for all patients at the time of election of hospice care.
- Proposed implementation of a Hospice Scoring System Would Increase Accountability and Protect Beneficiaries.
- Proposed implementation of a Care Compare icon for non-compliant hospices
- Several Requests for Information (RFIs)
Read the CHAP summary of the proposed rule.
Hospice/Palliative Care Provider Updates
Medicare Cost Report E-Filing System Webinar – April 22
Wednesday, April 22 from 1–3 pm ET
Learn about new and upcoming functionality for Medicare Part A cost reports and hospice cap determinations in the Medicare Cost Report e-filing (MCReF) system, including:
- Ready-made Provider Statistical & Reimbursement summary reports on the home page
- New dashboard for tracking hospice cap status, review dates, and documentation for cap determinations
- Tips and reminders on common questions, like how to e-file Home Office Cost Statements, get feedback on cost report exhibits, and avoid common problems
- Quick refresher on how to e-file one cost report or many
The webinar will include a live Q&A session and an opportunity to provide feedback. You may also send questions in advance to OFMDPAOQuestions@cms.hhs.gov with “MCReF Webinar” in the subject line. We’ll answer your questions during the webinar or use them to develop educational materials.
Important Updates on the Hospice Quality Reporting Program (HQRP)
CMS the March 2026 quarterly HQRP update. The latest outreach communication can be found on the HQRP Requirements and Best Practices webpage.
To receive Swingtech’s quarterly emails, send an email to QRPHelp@swingtech.com. Be sure to include the name of your facility and the Centers for Medicare & Medicaid Services (CMS) Certification Number (CCN) along with any requested updates.
DMEPOS Updates
DMEPOS Fee Schedule: April 2026 Quarterly Update
Learn about updates (PDF), effective April 1, 2026:
- Added and deleted codes
- Fees for new codes
Therapeutic Footwear: Prevent Claim Denials
In 2024, the improper payment rate for diabetic shoes was 47.1%, with a projected improper payment amount of $35.7M. Learn how to bill correctly. Review the Therapeutic Footwear provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Coverage limitations
- Documentation requirements
- Resources
All Providers Updates
CMS Finalizes 2027 Medicare Advantage and Part D Payment Policies that Strengthen Accountability and Long-Term Sustainability
The Centers for Medicare & Medicaid Services released the Calendar Year (CY) 2027 Medicare Advantage (MA) and Part D Rate Announcement today to improve payment accuracy across both programs.
The policies in the Rate Announcement address coding differentials between MA and Original Medicare for CY 2027. CMS is working towards a MA risk adjustment system guided by three principles: (1) simplicity to reduce day-to-day administrative burden for both plans and providers; (2) competition for all plans irrespective of size or resources, creating greater value for patients; and (3) achieving payments that accurately reflect beneficiary health risk and facilitate the efficient use of healthcare resources, enhanced program integrity, and greater accountability. Working towards a risk adjustment system guided by these principles will promote a more stable and sustainable MA program in the long run by giving beneficiaries and taxpayers confidence that CMS is mitigating unnecessary cost growth from coding practices that do not lead to better quality coverage.
The CY 2027 MA and Part D Rate Announcement may be viewed at: https://www.cms.gov/files/document/2027-announcement.pdf.
A fact sheet discussing the provisions of the CY 2027 MA and Part D Rate Announcement can be viewed at: https://www.cms.gov/newsroom/fact-sheets/2027-medicare-advantage-part-d-rate-announcement.
The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced the members of the Healthcare Advisory Committee, a new federal advisory body comprised of leaders from across the healthcare system to provide expert advice on improving, strengthening and modernizing U.S. healthcare.
The Committee will advise HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz on ways to improve how care is financed and delivered across Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace.
CMS Invites ACOs to Apply to the New LEAD Model
What’s new: Today, CMS released the Request for Applications (RFA) for the Long-term Enhanced ACO Design (LEAD) Model, which aims to expand the benefits of Accountable Care Organizations (ACOs) to more Medicare beneficiaries; the model supports a broad range of participants and providers by offering enhanced support to small, independent, and rural practices delivering primary care, as well as those serving high-needs beneficiaries, and introduces new flexibilities and opportunities for specialist integration and health promotion.
ACOs interested in the voluntary, 10-year model have until May 17, 2026, to respond to the RFA; the model will launch Jan.1, 2027.
Find out more:
Eligible organizations participating in the Innovation Center’s ACO REACH and Enhancing Oncology Models may now begin offering a new, optional Substance Access Beneficiary Engagement Incentive (BEI) starting today (April 1, 2026). The Substance Access BEI will also be available in the Long-term Enhanced ACO Design (LEAD) Model, which begins on January 1, 2027. Through this optional incentive, eligible hemp-derived products can be incorporated into patient care plans under clinician guidance, consistent with model requirements and applicable law.
This is not a Medicare coverage change. CMS will not pay for or reimburse providers for these products under the Substance Access BEI. The incentive includes strong safeguards to protect patients and ensure appropriate use, including physician oversight, strict product standards, and program integrity requirements. The Substance Access BEI is made available consistent with federal law, including the 2018 Agriculture Improvement Act, and is being implemented through existing Innovation Center model authorities. CMS will monitor implementation and evaluate outcomes as part of its ongoing work to test new approaches to appropriate and cost-effective care delivery and payment. CMS does not make claims regarding the therapeutic value of these products.
More information about the Substance Access Beneficiary Engagement Incentive, including eligibility criteria and program requirements, is available at: https://www.cms.gov/priorities/innovation/substance-access-beneficiary-engagement-incentive.
New ASPIRE Model to Deliver Support to Children and Youth with Complex Medical Needs
What’s New
CMS is launching the Accelerating State Pediatric Innovation Readiness and Effectiveness (ASPIRE) Model to help children up to age 21 with complex medical and behavioral needs live healthier lives through whole-person care delivery in Medicaid and the Children’s Health Insurance Program, including wrap-around services to address physical and behavioral health needs.
What to Expect
CMS will select up to 5 state Medicaid agencies to take part in the voluntary model through a cooperative agreement; a Notice of Funding Opportunity will be available in 2026.
More Information:
- ASPIRE Model webpage
OIG: Medicaid Fraud Control Units Annual Report: Fiscal Year 2025
Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. The Department of Health and Human Services Office of Inspector General (OIG) is the designated Federal agency that oversees the Units. MFCUs operate in all 50 States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. This data snapshot provides aggregated case outcomes for 53 MFCUs for fiscal year (FY) 2025, along with case outcome trends over the past decade. We calculated the return on investment for the program by dividing the $2 billion in reported recoveries by the total MFCU grant expenditures. For FY 2025, combined Federal and State expenditures for the units totaled approximately $424 million, of which approximately $318 million represented Federal funds.
Technology is Key
The Innovation Center is leveraging technology to help people with Medicare and Medicaid manage their health. Read how Technology-Enabled Care and Artificial Intelligence can empower patients, support providers, and improve health care delivery in the latest key concept.
Looking for a clear explanation of other Innovation Center topics? Key concepts are short introductions to topics that play a critical role in the Innovation Center’s work—minus the jargon. Use them, share them!
Evaluation and Research Reports
Looking for the latest results from Innovation Center model evaluations? Visit the Evaluation and Reports page.
Educational Opportunities
2026 CMS & HL7 Virtual FHIR Connectathon
The Centers for Medicare & Medicaid Services (CMS) is excited to announce the 7th annual CMS & Health Level Seven International (HL7®) Fast Healthcare Interoperability Resources (FHIR®) Connectathon, taking place July 14-16, 2026. This virtual collaborative experience will bring together health care interoperability leaders, implementers, and innovators for three days of hands-on testing, shared learning, and alignment on how emerging CMS policies and FHIR-based solutions are taking shape in real-world systems.
How to Participate:
Additional details, including registration, track list, and full agenda will be available soon.
To learn more about the event and ways to participate, please contact: CMSInteroperability@cms.hhs.gov.
CMS Issues Guidance to Implement New Limits on Federal Medicaid and CHIP Funding for Certain Noncitizens
CMS is preparing states for an upcoming change that will limit the ability to claim federal matching funds for Medicaid and the Children’s Health Insurance Program (CHIP) for individuals who are not U.S. citizens or U.S. nationals, or who fall into specific noncitizen categories identified in statute. New guidance issued today will ensure states understand their responsibility in implementing this statutory change beginning October 1, 2026.
To view the SHO letter, visit: https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf