The Compliance Monitor (10/30/26)
Your source for federal updates
October/November 2026 Compliance Activity
| Compliance Item & Date | Additional info & Links |
| FY 2027 Hospice Payment Update final rule effective Oct 1, 2026 | Provisions of this rule are effective |
| CMS Home Health Payment Update Rule (Final) Annual CY issuance Usually posted in late October – early November | 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 a few days of initial posting https://www.federalregister.gov/do cuments/current |
| CMS HHQRP non-compliance letters – Providers will receive a letter if they are found not in compliance with quality reporting requirements – 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 Usually distributed in October | Instructions for appeal are included in the notification and on the Home Health Quality Reporting Reconsideration and Exception & Extension webpage |
| Medicare Care Compare Refresh Home health quality scores are publicly reported on the Care Compare website and updated on a quarterly basis. October 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 |
| 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 | 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 | Compliance reconsideration results delivered in November/ December |
Top Items
CMS Seeks Industry Input on Future Fraud Defense Contracts by November 4, 2026
CMS released a Request for Information (RFI) on a new approach to Medicare and Medicaid fraud investigations. The proposed framework gives us a greater role in directing investigations, and we want industry feedback on how to make this model work.
Review the proposed Statement of Objectives and submit your ideas by November 4, 2026, at 11 am ET. This RFI is for planning purposes only—we won’t award a contract as a result.
HHS Declares Public Health Emergencies for Florida, Alabama following Hurricane Isaias
HHS Secretary Robert F. Kennedy, Jr. has determined that public health emergencies exist in Florida and Alabama due to Hurricane Isaias, following President Trump’s October 9 emergency declarations for both states (Florida, Alabama). These actions allow HHS to authorize temporary waivers and modifications so CMS can support providers and suppliers serving Medicare, Medicaid, and CHIP enrollees in the affected areas.
Secretary Kennedy declared the public health emergency and authorized flexibilities for CMS providers, suppliers, and beneficiaries under the Public Health Service Act and Social Security Act. These actions are retroactive to October 6, 2026, in Florida and October 7, 2026, in Alabama.
Individuals experiencing storm-related emotional distress can call or text SAMHSA’s Disaster Distress Helpline at 1-800-985-5990, a toll-free, multilingual crisis line available 24/7, with counselors available in more than 100 languages through interpretation services.
HETS: Verify Email by December 1 to Avoid Rejected Eligibility Requests
If you use HIPAA Eligibility Transaction System (HETS) 270/271 to check Medicare eligibility through a software vendor, billing company, electronic health record (EHR) system, practice management system, or electronic data interchange (EDI) clearinghouse, make sure the email address on your HETS EDI Enrollment is correct by December 1, 2026. If you get a notification from your clearinghouse about an email delivery failure, or you don’t get a monthly transaction count report after submitting your HETS EDI enrollment, update your email address through your Medicare Administrative Contractor (MAC) to avoid disruption (your billing company, EHR vendor, or clearinghouse can’t make this change for you).
If your HETS email fails to deliver for 3 consecutive months — October 1, November 1, and December 1, 2026, HETS will suspend your HETS EDI enrollment and reject all eligibility requests submitted for your NPI. HETS will return an error until you correct your email address through your MAC.
CMS Rulemaking/ Federal Register Notices/RFIs
CY 2027 Home Health Final Rule
The CY 2027 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Payment Update (CMS-1844) final rule is currently in the OMB queue for review.
This document corrects technical errors in the final rule that appeared in the August 3, 2026, Federal Register titled “Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements”. DATES: This correction is effective October 1, 2026.
In FR Doc. 2026-15686 of August 3, 2026 (91 FR 49118), there were a number of technical errors that are identified and corrected in this correcting document. The provisions in this correction document are effective as if they had been included in the final rule that appeared in the August 3, 2026 Federal Register. Accordingly, the corrections are effective October 1, 2026.
Notice: Pre-Claim Review Demonstration For Home Health Services Use
Pre-Claim Review Demonstration For Home Health Services Use: Section 402(a)(1)(J) of the Social Security Amendments of 1967 (42 U.S.C. 1395b-1(a)(1)(J)) authorizes the Secretary to “develop or demonstrate improved methods for the investigation and prosecution of fraud in the provision of care or services under the health programs established by the Social Security Act (the Act).” Pursuant to this authority, the CMS seeks to develop and implement a Medicare demonstration project, which CMS believes will help assist in developing improved procedures for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies (HHA) providing services to Medicare beneficiaries. This revised demonstration helps assist in developing improved procedures for the identification, investigation, and prosecution of potential Medicare fraud. The demonstration helps make sure that payments for home health services are appropriate through either pre-claim or post payment review, thereby working towards the prevention and identification of potential fraud, waste, and abuse; the protection of Medicare Trust Funds from improper payments; and the reduction of Medicare appeals. CMS has implemented the demonstration in Illinois, Ohio, North Carolina, Florida, and Texas with the option to expand to other states in the Palmetto/JM jurisdiction. Under this demonstration, CMS offers choices for providers to demonstrate their compliance with CMS’ home health policies. Providers in the demonstration states may participate in either 100 percent pre-claim review or 100 percent post payment review. These providers will continue to be subject to a review method until the HHA reaches the target affirmation or claim approval rate. Once an HHA reaches the target pre-claim review affirmation or post-payment review claim approval rate, it may choose to be relieved from claim reviews, except for a spot check of their claims to ensure continued compliance. Providers who do not wish to participate in either 100 percent pre-claim or post payment reviews have the option to furnish home health services and submit the associated claim for payment without undergoing such reviews; however, they will receive a 25 percent payment reduction on all claims submitted for home health services and may be eligible for review by the Recovery Audit Contractors. The information required under this collection is required by Medicare contractors to determine proper payment or if there is a suspicion of fraud. Under the pre-claim review option, the HHA sends the pre-claim review request along with all required documentation to the Medicare contractor for review prior to submitting the final claim for payment. If a claim is submitted without a pre-claim review decision on one file, the Medicare contractor will request the information from the HHA to determine if payment is appropriate. For the post payment review option, the Medicare contractor will also request the information from the HHA provider who submitted the claim for payment from the Medicare program to determine if payment was appropriate. Form Number: CMS-10599 (OMB control number: 0938-1311); Frequency: Frequently, until the HHA reaches the target affirmation or claim approval threshold and then occasionally; Affected Public: Private Sector (Business or other for-profits).
ICYMI: HTI-5 is Here
ONC and HHS recently released the Health Data, Technology, and Interoperability: ONC Deregulatory Actions to Unleash Prosperity (HTI-5) Final Rule. It advances administration initiatives by significantly reducing administrative burden for health IT developers participating in the ONC Health IT Certification Program and is projected to save more than $1.5 billion in regulatory costs. Ultimately, HTI-5 frees up resources for health IT developers, offering flexibility and support in pursuing innovations that enhance user experiences for patients and clinicians.
Register to attend the information session on October 29 from 1:00 – 2:00 PM ET.
View the final rule →
Learn more →
CMS Proposes Reforms to Strengthen Transparency and Affordability in Medicare Advantage and Part D
CMS’s October 16, 2026, proposed rule would strengthen Medicare Advantage and Part D transparency and reduce certain beneficiary costs through three main changes:
- More accurate provider directories: Medicare Advantage plans would verify and update provider information at least every 90 days, report directory accuracy to CMS, and publicly display accuracy scores. Beneficiaries who receive out-of-network care because they relied on inaccurate directory information would pay no more than the applicable in-network cost-sharing amount.
- Greater pharmacy benefit manager accountability: PBMs would annually report compensation and drug-cost performance to plan sponsors and CMS. Payments would reflect the fair market value of services rather than being tied to drug costs.
- Lower generic drug copayments: Beginning January 1, 2028, the proposal would eliminate the $1 generic drug copayment for full-benefit Medicare–Medicaid beneficiaries with incomes at or below 100% of the federal poverty level.
The proposal aims to make provider networks more reliable, increase oversight of prescription drug spending, and strengthen financial protections for beneficiaries. These are proposed regulations, not a final rule.
Notice of a New Matching Program
CMS has announced a new data-matching program with the Veterans Health Administration (VHA) to identify veterans enrolled in both Medicare and VA health care and detect duplicate payments for the same services. The agencies will exchange enrollment and claims data to recover improper payments, improve payment accuracy, and strengthen fraud, waste, and abuse oversight. The agreement will be effective for 18 months, with the option for renewal.
This is a program integrity initiative focused on identifying and recovering duplicate Medicare and VA payments, not a change to provider payment rates, coverage, or beneficiary benefits.
Fraud and Abuse Update
Oz Defers Additional $1.2B in California Home Care Medicaid Payments
In a recent press conference, CMS’s Dr. Oz announced that they has deferred an additional $1.2 billion in federal Medicaid payments to California for personal home care services as part of a broader fraud, waste, and abuse crackdown. CMS Administrator Dr. Mehmet Oz cited rapid spending growth as a concern, saying California’s personal care services grew more than 24% over the past three years, roughly twice the average growth rate in other states.
Key points:
- CMS is increasing scrutiny of personal care, home health, adult day care, and hospice services in California amid concerns about potential improper spending.
- The action follows an earlier July deferral of more than $1 billion involving certain Medicaid claims in California and Minnesota.
- A deferral is not a permanent funding cut. Federal funds are delayed while the state provides documentation demonstrating that claims meet Medicaid requirements.
- California officials and Sen. Alex Padilla have criticized the action, warning that delaying funding could affect older adults, people with disabilities, and individuals recovering from illness or injury.
The action reinforces CMS’s growing emphasis on Medicaid program integrity and heightened scrutiny of home- and community-based services. For home care organizations, it underscores the importance of strong documentation, billing accuracy, and evidence that services provided and claimed meet Medicaid requirements.
Department of Health and Human Services and the Justice Department’s Civil Division Announce Anti-Fraud Healthcare Self-Disclosure Pilot Program
The U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice’s Civil Division recently launched a six-month Healthcare False Claims Act Self-Disclosure Pilot Program for healthcare companies that voluntarily disclose potential civil violations of the federal False Claims Act. Companies that meet the pilot’s requirements can resolve disclosed conduct through a coordinated civil release from liability under the federal False Claims Act and certain HHS administrative authorities.
To participate, companies must disclose all relevant details about the potential violations, provide documents showing the full nature and operation of the conduct, describe the remedial steps they have taken, and make a repayment calculated under the protocol, which applies a multiplier of 1.25 to 1.6. The multiplier will vary based on factors such as the timeliness of the disclosure, the duration and scope of the misconduct, senior leadership involvement, the financial benefit to the company, and whether the company has successor liability for the misconduct but promptly remediated.
In exchange, companies will receive a release from DOJ for the disclosed potential False Claims Act violations, the HHS Office of Inspector General (OIG) will not impose an exclusion or require a Corporate Integrity Agreement as part of the resolution, and CMS not revoke the provider’s or supplier’s enrollment and billing privileges, and neither CMS nor OIG will impose civil monetary penalties.
Companies may submit disclosures electronically to FCA-SDPP@usdoj.gov through April 22, 2027. Late or incomplete submissions will not be reviewed.
The DOJ-HHS Healthcare False Claims Act Self-Disclosure Pilot Program protocol is available here.
OIG – Health Care Fraud and Abuse Control Program Report Fact Sheet (Fiscal Year 2025)
This fact sheet highlights a summary of the enforcement results and program impact of the Health Care Fraud and Abuse Control (HCFAC) initiative during Fiscal Year (FY) 2025.
Hospice Care Provider Updates
Hospices: Initial Implementation of the Mandatory Election Statement Addendum
In the FY 2027 Hospice Prospective Payment System final rule, CMS made the following changes to the hospice election statement addendum:
- Mandatory for all hospice elections starting on and after October 1, 2026
- Must be furnished in writing (paper or electronic) to the beneficiary or their representative
- Must include the required content described in § 418.24(c)
- Must be furnished within 5 calendar days of the effective date of the hospice election
- Any updates to the addendum must be furnished within 3 calendar days of the plan of care change
- Condition for payment is satisfied when there’s a valid signed addendum in the beneficiary’s medical record with the hospice
To help hospices adjust to the new requirement, from October 1, 2026, to December 31, 2026, while hospices are required to furnish the addendum to every electing beneficiary, CMS will exercise enforcement discretion during this three-month window. During this time, Medicare Administrative Contractors will not deny claims solely because the addendum is missing or incomplete and will focus on educating hospices to help them come into full compliance.
HOPE Update
CMS posted an update to the Hospice Outcomes and Patient Evaluation (HOPE) webpage. The changes include clarifications to the guidance based on Help Desk questions and suggestions received during the first year of HOPE implementation. Updated materials include the HOPE Guidance Manual v1.03 and the Item sets (HOPE Admission v1.03, HOPE Update Visit (HUV) v1.03, HOPE Discharge v1.03 and HOPE ALL Item v1.03). The HOPE v1.02 to v1.03 Guidance Manual and Item Set Change Table details these changes. All materials can be accessed from the Downloads section on the CMS HQRP HOPE webpage. PLEASE NOTE: None of the changes impact current HOPE Data Specifications.
Long-Term Hospice Stay: New Edit to Prevent Overpayment – Revised
CMS revised this article to include bypass conditions for edits U5565 and U5566 (PDF).
Home Health Care Provider Updates
NOW AVAILABLE- Updated Quarterly OASIS Q&As and Pay Source Change Guidance One-pager
The October 2026 CMS Quarterly OASIS Q&A’s are available in the OASIS Quarterly Q&As section of the CMS QTSO webpage, https://qtso.cms.gov/providers/home-health-agency-hha-providers/reference-manuals .
Additionally, CMS has posted a new resource document related to pay source changes in the download section on the Home Health Quality Reporting OASIS User Manuals webpage, https://www.cms.gov/medicare/quality/home-health/oasis-user-manuals.
Home Health Quality Reporting Program: Non-Compliance Notifications
The Centers for Medicare & Medicaid Services (CMS) is providing notifications to home health agencies that were determined to be out of compliance with the Home Health Quality Reporting Program (HHQRP) requirements for calendar year (CY) 2027 Annual Payment Update (APU). Non-compliance notifications were placed into Home Health Agencies (HHA) My Reports folders in iQIES on October 23, 2026. Additionally, the Medicare Administrative Contractors (MACs) will distribute a letter by email or regular mail to non-compliant HHAs in their service area.
HHAs that receive a letter of non-compliance notification may submit a request for reconsideration to CMS via email no later than 11:59 pm, November 23, 2026. If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notification and on the Home Health Quality Reporting Reconsideration and Exception & Extension webpage.
Please note: Any reconsideration request emails greater than 20 MB in size or containing protected health information (PHI) will not be processed. All PHI must be removed in order for a reconsideration to be reviewed.
October 21, 2026
AVAILABLE: Home Health Discharge to Community–Post Acute Care Measure Technical Specification Report
The Home Health (HH) Discharge to Community–Post Acute Care (DTC-PAC) Measure Technical Specification Report is now available. The report presents the technical specifications for the updated HH DTC-PAC measure, including updates to add Medicare Advantage encounter records as a data source in addition to Medicare fee-for-service claims.
The report describes the measure overview and rationale, data sources, HH stay construction and inclusion and exclusion criteria, denominator and numerator specifications, risk adjustment model, measure calculation algorithm, and measure testing results. Additional updates related to the public reporting timeline for the updated measure will be provided at a future date.
The report can be found in the Downloads section on the Home Health Quality Measures | CMS webpage.
Public Reporting October 2026 Refresh of HH QRP Data – Now Available
The October 2026 quarterly refresh for the Home Health Quality Reporting Program (HH QRP) is now available on the compare tool on Medicare.gov and the Provider Data Catalog (PDC).
The data are based on quality assessment data submitted by home health agencies (HHAs) to the Centers for Medicare & Medicaid Services (CMS) from Quarter 1, 2025 through Quarter 4, 2025. The data for the claims-based measures will display data from Quarter 1, 2024 through Quarter 4, 2025 for the Discharge to Community measure, Quarter 1, 2023 through Quarter 4, 2025 for the Potentially Preventable 30-Day Post-Discharge Readmission measure, and Quarter 1, 2025 through Quarter 4, 2025 for the Home Health Within-Stay Potentially Preventable Hospitalization measure. Additionally, the data for the Home Health Care CAHPS Survey (HHCAHPS) measures will display data from Quarter 2, 2025 through Quarter 1, 2026.
Due to delays in the availability of CMS claims data, the Medicare Spending Per Beneficiary (MSPB) measure will not be updated in October 2026. CMS will continue to display the current MSPB measure results (Quarter 1, 2023 through Quarter 4, 2024) and will release updated provider measure scores with the January 2027 Care Compare refresh (Quarter 1, 2024 through Quarter 4, 2025).
Please visit the compare tool on Medicare.gov and PDC to view the updated quality data. For questions about HH QRP Public Reporting, please email homehealthqualityquestions@cms.hhs.gov.
HCPCS Codes Used for Home Health Consolidated Billing Enforcement: January 2027 Annual Update
Learn about changes to the non-routine supply code list (PDF).
Summary of Expanded HHVBP Model: Preliminary CY 2026 Annual Performance Reports
CMS announced that Preliminary CY 2026 Annual Performance Reports (APRs) for the Expanded Home Health Value-Based Purchasing (HHVBP) Model were released in iQIES on October 1, 2026. These reports determine each Home Health Agency’s Adjusted Payment Percentage (APP) based on CY 2025 performance, which will affect Medicare Fee-for-Service payments in CY 2027. APP adjustments can range from**-5% to +5%**.
Key Points
- The CY 2026 APR is the first report using the CY 2025 measure set, which includes:
- 3 OASIS-based measures (Dyspnea, Oral Medications, Discharge Function)
- 2 claims-based measures (DTC-PAC and Potentially Preventable Hospitalizations)
- 5 HHCAHPS measures (Care of Patients, Communication, Team Discussion, Overall Rating, and Willingness to Recommend)
- APRs include:
- Measure scores
- Achievement and Improvement Points
- Care Points
- Total Performance Score (TPS)
- Adjusted Payment Percentage (APP)
- Agencies receive a report if they:
- Were Medicare-certified before January 1, 2024
- Had a prior-year payment amount
- Had sufficient data for at least five quality measures to calculate a TPS and APP
Important Dates
| Event | Date |
| Preview APRs Released | August 20, 2026 |
| Recalculation Request Deadline | September 4, 2026 |
| Preliminary APRs Released | October 1, 2026 |
| Reconsideration Request Deadline | October 16, 2026 |
| Administrator Review Request Deadline | November 5, 2026 |
| Payment Adjustments Effective | January 1, 2027 |
Accessing Reports
Reports are available only through iQIES in the HHA Provider Preview Reports folder and are organized by CMS Certification Number (CCN). Only authorized iQIES users may access them.
Why This Matters for Home Health Agencies
The release of the Preliminary APRs marks the final opportunity for agencies that previously submitted a recalculation request to challenge CMS’s findings through the reconsideration and Administrator review processes. Organizations should review their TPS, APP, and measure-level performance immediately to understand expected payment impacts for CY 2027 and determine whether additional appeals are warranted.
Executive takeaway: Home health agencies should download and review their Preliminary CY 2026 APRs now, confirm the accuracy of performance scores and payment adjustments, and ensure any eligible reconsideration requests are submitted by October 16, 2026.
Expanded Home Health Value-Based Purchasing Model — CMS
DMEPOS/Supplier Updates
DMEPOS Competitive Bidding Program: Registration & Bid Window Dates for Round 2028
CMS announced the bidding timeline for Round 2028 of the DMEPOS Competitive Bidding Program:
- December 1, 2026: Bidder registration window opens
- January 5, 2027: Bid window opens
Visit the Competitive Bidding Implementation Contractor website for more information, including:
We encourage bidders to review all these materials for guidance needed to submit complete bids by the close of the bid window. Read the full news article for more information.
Patient Lifts: Prevent Claim Denials
In 2024, the improper payment rate for patient lifts was 25.4%, with a projected improper payment amount of $3 million. Learn how to bill correctly for these services. Review the Patient Lifts provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Documentation requirements
DMEPOS Fee Schedule: October 2026 Quarterly Update
Learn about updates (PDF):
- Added and deleted HCPCS codes, effective October 1, 2026
- New fee schedule amounts, effective October 1, 2026
- Level II HCPCS changes for continuous glucose monitors and external insulin infusion pump supplies, effective January 1, 2028
All Provider Updates
ACCESS: Refer Your Patients with Chronic Conditions
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model focuses on chronic conditions affecting three-quarters of people with Medicare, including high blood pressure, diabetes, musculoskeletal pain, and depression. It offers ongoing, technology-supported chronic care between visits—such as lifestyle support (including nutrition, exercise, and sleep), remote monitoring, wearables, coaching, and medication management—from Medicare-enrolled healthcare providers at low or no cost to your patients.
Visit the ACCESS for Primary Care Providers & Referring Clinicians webpage to learn about:
- Patient eligibility
- Current tracks
- How to refer your patients
How ACCESS works:
- Connect your Original Medicare patient with an ACCESS care provider
- Receive care updates
- Bill for the co-management payment
More Information:
- ACCESS Model webpage
- Support for chronic health condition information for your patients
Medicaid Program Integrity Pillars
CMS released the Medicaid Program Integrity Pillars on October 26, 2026. This new framework organizes new and existing CMS guidance into 6 best practice areas to assist States, Medicaid managed care plans, and law enforcement partners to effectively crush fraud in the Medicaid program:
- Claims Editing & Data Analytics
- Provider Enrollment
- Targeted Reviews & Audits
- Managed Care Oversight
- Investigations & Law Enforcement Referrals
- Robust Administrative Actions
Learn more at the Program Integrity Pillars for Medicaid and the Children’s Health Insurance Program webpage.
Medicare Advantage & Medicare Prescription Drug Programs Expected to Remain Stable in 2027
CMS announced significant premium savings for millions of Medicare beneficiaries in 2027, with weighted average Medicare Advantage (MA) premiums projected to fall more than 16% from 2026 to 2027, and average prescription drug premiums in MA projected to plummet 38%.
Additionally, the average premium for stand-alone Part D prescription drug plans is projected to rise by less than $1 per month in 2027.
Read the full press release.
HHS Unveils Bold New Plan to Combat Alzheimer’s and Dementia
The U.S. Department of Health and Human Services (HHS) today announced the 2026 Update to the National Plan to Address Alzheimer’s Disease and Related Dementias, taking Department-wide actions to guide coordinated federal action on dementia risk reduction, research and innovation, care, and support for people living with dementia and their families.
The updated plan puts greater emphasis on reducing dementia risk across the lifespan and translating scientific discoveries into better prevention, diagnosis, treatment, and care. It also formally recognizes related dementias in the plan’s title, reflecting public input and the shared challenges that patients and families face across different forms of dementia.
HHS is advancing new and ongoing initiatives across 10 agencies to turn the National Plan’s priorities into action. The Food and Drug Administration today launched an Alzheimer’s Prevention Accelerator to advance the development of new approaches to prevention.
The Advanced Research Projects Agency for Health announced a collective investment of up to $48.8 million in projects focused on earlier detection and intervention. These new ARPA-H awards join existing, complementary efforts across ARPA-H that address Alzheimer’s disease, totaling up to $155.3 million.
The Administration for Community Living will expand brain health resources and training for elder justice professionals. Other HHS initiatives will expand dementia training and screening in health centers, develop behavioral health and crisis response resources for older adults experiencing cognitive decline, strengthen public health approaches to dementia, study diagnostic delays and the economic burden of dementia, review evidence on prevention, and test a lifestyle intervention for beneficiaries with mild cognitive impairment.
The 2026 National Plan provides a coordinated framework for federal action to protect brain health, accelerate scientific progress, improve dementia care, and strengthen support for patients and families.
Details on the National Plan and participating agencies’ initiatives are available at hhs.gov/aging/adrd.
CMS Refocuses Medicaid Quality on Health Outcomes, Launches Innovative Partnership With 37 States
CMS launched the Investing in Health Outcomes initiative with a founding group of 37 state partners to focus on how quality is measured in Medicaid and the Children’s Health Insurance Program. The effort will put health outcomes — not processes and paperwork — at the center of how success is defined. CMS and its partners will prioritize measures that demonstrate meaningful improvements in prevention, chronic disease management, and behavioral health.
Read the full press release
HHS Announces Up to $27.8 Million for Falls Prevention
HHS announced up to $27.8 million over three years to expand falls prevention programs for older adults, strengthen healthcare-community partnerships, and increase access to evidence-based interventions that help seniors remain safely at home. HHS Announces Up to $27.8 Million for Falls Prevention. Key investments include:
- $4.8 million to the National Council on Aging to scale clinical-community falls prevention partnerships. HHS Announces Up to $27.8 Million for Falls Prevention
- Nearly $15.4 million to state and community organizations, including the Maryland Department of Health, to expand proven falls prevention programs. HHS Announces Up to $27.8 Million for Falls Prevention
- $7.5 million for the National Falls Prevention Resource Center to provide training, technical assistance, and sustainability support. HHS Announces Up to $27.8 Million for Falls Prevention
Research shows that falls among older adults are preventable through person centered, evidenced based interventions. However, there are gaps in widespread adoption and implementation of these strategies. Through ACL, HHS is coordinating a cross-agency effort, informed by the National Falls Prevention Action Plan. It unites ACL, the Centers for Disease Control and Prevention, the Health Resource and Services Administration, CMS’s Center for Clinical Standards and Quality, the National Institute of Aging, and Agency for Healthcare Research and Quality. Together, these agencies will move beyond siloed approaches to deliver significant progress in reducing falls over the next three years.
Learn more about ACL’s Falls Prevention Program here.
Educational Opportunities
CMS National Provider Enrollment Conference – November 18 & 19
Wednesday, November 18 & Thursday, November 19 in Orlando, Florida
Meet with provider enrollment experts from CMS, Medicare Administrative Contractors, and DME National Provider Enrollment Contractors. Visit the 2026 CMS National Provider Enrollment Conference webpage for more information. Registration opens in mid-September.
OIG Workplan
HHS-OIG’s Work Plan sets forth various projects including audits and evaluations that are underway or planned to be addressed during the fiscal year and beyond. The work planning process is dynamic and adjustments are made throughout the year to meet priorities and to anticipate and respond to emerging issues with the resources available.
Review active action items on the Office of the Inspector General’s Work Plan by provider type.
Resources
2027 Medicare & You Handbook
Share the 2027 Medicare & You handbook with your patients and their caregivers. New and important this year:
- More login options for Medicare.gov accounts
- New health initiatives, including the ACCESS Model and GLP-1 drugs
- Improved fight against Medicare fraud
- Medicare eligibility requirement changes
- Medicare third-party apps available for personalized health experience
- Rural health care expansion
- Extended telehealth flexibilities
Encourage your patients to go digital and switch to electronic versions of the handbook and Medicare Summary Notices.