The Compliance Monitor (5/28/26)
Your source for federal updates
May 2026 Compliance Activity
| Compliance Item & Date | Additional info & Links |
| HETS Action Required: Enroll Third-Party Vendors for Access by May 11, 2026 Providers using third-party vendors to check Medicare beneficiary eligibility must now enroll these vendors with CMS for HIPAA Eligibility Transaction System (HETS) access by linking each vendor to your NPI. If you haven’t already enrolled, visit HETS EDI: How to Enroll | If you opt not to enroll, you may still check eligibility through your Medicare Administrative Contractor’s secure internet portal. After enrollment, you’ll receive monthly transaction volume reports for each vendor you enrolled. Questions? – For report questions, contact your vendor – If you have concerns about your NPI being misused to check eligibility, contact mcare@cms.hhs.gov |
| The FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Comments due on June 1, 2026 | FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Read the CHAP summary of the proposed rule. |
| Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures Final Rule CMS-0053-F The rule is effective on May 19, 2026 [60 days after publication in the Federal Register]. Covered entities must comply by May 19, 2028 [24 months of the effective date]. | To view the final rule fact sheet, visit: https://www.cms.gov/newsroom/fact-sheets/administrative-simplification-adoption-standards-health-care-claims-attachments-transactions. For more information, visit: https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa/events-latest-news. To view the final rule, visit https://www.federalregister.gov/ |
| 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 |
Top Items
CMS Announces Aggressive Nationwide Crackdown on Fraud with Six-Month Hospice & Home Health Agency Enrollment Moratoria
In coordination with Vice President JD Vance’s Anti-Fraud Task Force, CMS is taking decisive action to protect Medicare beneficiaries and taxpayer dollars through implementation of a six-month, nationwide data-driven moratoria on new Medicare enrollment for hospices and home health agencies (HHAs). The moratoria will allow CMS to temporarily halt the influx of new providers into these high-risk categories, a key source of fraudulent activity.
More information:
- Crushing Fraud, Waste, & Abuse webpage
CMS Posts Memo: Six-Month National Moratoria on Hospice and Home Health Agency (HHA) Enrollment
CMS posted the Memo: Six-Month National Moratoria on Hospice and Home Health Agency (HHA) Enrollment (QSO-26-11-HHA & Hospice) on 5/20/2026. Memo summary includes:
- Six-Month Moratoria – On May 13, 2026, the Centers for Medicare & Medicaid Services (CMS) announced a national moratorium on Hospice and Home Health Agency (HHA) enrollment for the next six months. Effective May 13, 2026, CMS will halt the enrollment of new Hospice and HHA providers or HHA branch or practice locations.
- Length of Moratorium – The moratorium will be in place for six months and can be extended for additional six-month periods, if necessary. Federal regulations allow CMS to lift the moratorium, as warranted, or in response to a Presidential disaster declaration under the Robert T Stafford Disaster Relief and Emergency Assistance Act. Any action to lift or extend the moratoria will be publicly announced in the Federal Register.
- Hospice or HHA Application Status – Prospective Hospice or HHA Medicare enrollment applications that were received by the applicable Medicare contractors prior to May 13, 2026, will continue to be processed.
- Exceptions- CMS regulations do not permit exceptions to a moratorium for individual providers or suppliers.
HHA and hospice providers are strongly recommended to review this memo in its entirety.
OCR Extends Web and Mobile Accessibility Compliance Deadline
HHS Office for Civil Rights (OCR) announced an Interim Final Rule (IFR) extending, for one-year, the compliance dates that recipients of HHS funding must meet for conforming web content and mobile applications to specific accessibility standards under Section 504 of the Rehabilitation Act of 1973 (Section 504). Under the revised timeline:
- Recipients with 15 or more employees will now have until May 11, 2027, to comply.
- Recipients with fewer than 15 employees will now have until May 10, 2028, to comply.
Reporting Exception Granted Due to Hawaii Kona Low Weather Systems and Commonwealth of the Northern Mariana Islands Super Typhoon Sinlaku
CMS is granting extraordinary circumstance exceptions1 under certain Medicare quality reporting and value-based purchasing programs to providers and facilities located in areas affected in the state of Hawaii by the Hawaii Kona Low Weather Systems, and in the Commonwealth of the Northern Mariana Islands by Super Typhoon Sinlaku, as identified by both Department of Health and Human Services (HHS) Public Health Emergency (PHE) declarations (PHE | Hawaii – Severe Storms; PHE | Northern Mariana Islands – Super Typhoon Sinlaku) and the Federal Emergency Management Agency (FEMA) major disaster declarations (FEMA | HI Major Disaster Declaration (4909); FEMA | Northern Mariana Islands Major Disaster Declaration (4910)), to support these providers and facilities which may require the focusing or redirecting of resources toward accommodating circumstantial care needs of their patients and addressing potential infrastructure challenges affecting their healthcare operations.
Affected areas covered by these exceptions are detailed on the Designated Areas: Disaster 4909 and Designated Areas: Disaster 4910 pages, under the section Public Assistance, designations PA-A and PA-B, of the FEMA website. If FEMA expands the major disaster declaration to include additional affected areas at a later date and it is operationally feasible, CMS will likewise extend reporting requirement exceptions to accommodate these areas but will not necessarily publish updated communications.
At the time of this communication, the exceptions being granted are for the reporting requirements and deadlines as detailed in the table below:
| Program | Affected Measure/Requirement(s) | Reporting Period(s)/ Performance Period(s) |
| Post-Acute Care Quality Reporting Programs: Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs) | All Quality Reporting Program (QRP) reporting requirements, including the reporting of data on measures and any other data requested by CMS for the post-acute care quality reporting programs | Q1 2026 (submission deadline 8/17/2026) |
| Post-Acute Care Quality Reporting Programs: Hospices | All QRP reporting requirements, including the reporting of data on measures and any other data requested by CMS for the post-acute care quality reporting programs | Q1 2026 |
DMEPOS: Send Enrollment Appeals & Rebuttals to Your National Provider Enrollment Contractor
Starting Friday, May 8, send DMEPOS provider enrollment appeals and rebuttals to your National Provider Enrollment contractor.
For suppliers under NPEast jurisdiction – Alabama, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, West Virginia, Wisconsin, District of Columbia, Puerto Rico, and the U.S. Virgin Islands:
Novitas Solutions, Inc
Fax: 888-213-2710
Phone: 866-520-5193
Email: NPEASTAppeals@novitas-solutions.com or NPEASTRebuttals@novitas-solutions.com
Mailing Address: Novitas Solutions, Inc; NPEast DMEPOS; P.O. Box 3704; Mechanicsburg, PA 17055-1863
For suppliers under NPWest jurisdiction – Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Louisiana, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wyoming, American Samoa, Guam, and the Northern Mariana Islands:
Palmetto GBA
Fax: 803-870-6761
Phone: 866-938-9652
Email: NPWest.Appeals@palmettogba.com or NPWest.Rebuttals@palmettogba.com
Mailing Address: Palmetto GBA; NPWest DMEPOS; P.O. Box 100142; Columbia, SC 29202-3142
Thursday, May 7 is the last day Chags Health Information Technology, LLC (C-HIT) will accept appeals and rebuttals. C-HIT will continue to review and decide on appeals and rebuttals submitted before the transition date.
For questions about the transition, contact ProviderEnrollmentARC@cms.hhs.gov.
2026 Hantavirus Outbreak: Testing for Potential Infection
CDC issued a Health Alert Network Health Update to inform clinicians and health departments about testing available for patients with suspected hantavirus infection to include Andes virus. CDC first issued a Health Advisory about this outbreak on May 8, 2026. Hantaviruses are a group of viruses that typically spread to people who come in contact with sylvatic rodents. These viruses can cause severe illness or death in humans. Andes virus, a type of hantavirus endemic in South America, is the only type of hantavirus that is known to spread from person to person. Several other New World hantaviruses are endemic to the United States and are not transmissible from person to person. New World hantaviruses can cause hantavirus pulmonary syndrome, a potentially serious disease that can cause damage to the lungs.
Read the full Health Update, including recommendations for clinicians.
Protecting Seniors and Stopping Fraudsters Act Introduced
The Protecting Seniors and Stopping Fraudsters Act (H.R. 8883) is a bipartisan legislative measure designed to crack down on hospice and home healthcare fraud within the Medicare system. It aims to protect vulnerable seniors by strengthening Medicare oversight, improving screening, and implementing strict quality standards.
Key provisions of the bill focus on enhancing oversight and accountability to combat fraud:
- Hospice Oversight: Mandates annual surveys for new or changed hospice programs for the first 36 months, with additional reviews triggered by low quality metrics or suspicious discharge rates.
- Revalidation & Penalties: Requires revalidation of Medicare enrollments for hospice providers in targeted states and enforces payment penalties for failing to submit quality data.
- Patient Protections: Improves transparency by ensuring clear communication regarding patient enrollment and disenrollment, allowing seniors to make informed decisions. [1, 2]
The full text and status of the legislation can be tracked via Congress.gov.
CMS Rulemaking
New Comment Guide Available for 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062-P)
CMS is pleased to share that a new comment guide is now available to assist the public in preparing comments on the 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062-P).
You may access the guide, as well as other proposed rule resources here.
The proposed rule is open for public comment until June 15, 2026.
Home Health Payment Update Rule Posts in OMB Queue
The CY 2027 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Payment Update (CMS-1844) proposed rule posed in the Office of Management and Budget’s review queue on 5/11/2026. CHAP will develop a summary of the prosed rule when it officially posts in the Federal Register.
The Centers for Medicare & Medicaid Services (CMS) proposed a sweeping crackdown on state Medicaid payment practices that have driven payment rates well above Medicare levels, leading to excessive federal costs. The Medicaid Managed Care State Directed Payments (SDP) and Medicaid Fee-for-Service (FFS) Targeted Practitioner Payments Proposed Rule would set clear caps and better align Medicaid payments with Medicare standards. If finalized, the proposed rule would generate an estimated $775 billion in total savings over 10 years, including $510 billion in federal savings.
CMS goal: to refocus Medicaid dollars on individuals and families instead of inefficient payment schemes.
CMS is proposing revisions to Medicaid managed care and FFS payment arrangements to improve fiscal and program integrity over a transitional timeframe so that states and providers would have the time they need to adjust payment arrangements.
The proposed rule would:
- Cap SDP provider payment rates at 100% of Medicare payment rates for expansion states and 110% of Medicare payment rates for non-expansion states (or 100% of the Medicaid state plan rate if a comparable Medicare rate is not available), consistent with section 71116 of the WFTC legislation and historical Medicaid FFS payment levels,
- Apply similar limits to certain targeted Medicaid fee-for-service payments, and
- Establish consistent national standards to improve transparency and accountability.
CMS is seeking public comment on the proposed rule, including feedback on implementation. To view the proposed rule on the Federal Register, visit: https://www.federalregister.gov/d/2026-10292.
Fraud and Abuse Update
Vice President JD Vance Holds News Conference on Federal Anti-Fraud Initiatives
Vice President JD Vance announced new federal anti-fraud initiatives, such as the suspension of $1.3 billion in Medicaid reimbursements to California. He also warned that states that failed to prosecute fraud risked losing federal funds. He was joined by members of the anti-fraud task force, Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz, and Federal Trade Commission Chair Andrew Ferguson. Vance emphasized that states failing to prosecute fraud could risk losing federal funds, signaling a more aggressive federal posture on enforcement.
- Federal Funding Can Now Be Withheld or Deferred More Aggressively
The administration is using its authority to defer or suspend large sums of Medicaid reimbursements, most notably the $1.3 billion deferral to California—as a tool to pressure states into stronger anti‑fraud enforcement. This signals a shift toward conditional federal funding, where states risk losing money if they do not meet federal expectations on fraud prevention.
- States Face Heightened Oversight and Potential Penalties
Vance announced that all 50 states’ Medicaid Fraud Control Units (MFCUs) will be reviewed, and federal funding for these units may be “turned off” if their efforts are deemed insufficient. This represents a major escalation in federal oversight of state‑level fraud enforcement.
- Increased Pressure on States to Prosecute Fraud
States are being warned that failure to aggressively investigate and prosecute Medicaid fraud could result in broader funding freezes—not just for fraud units but potentially for other Medicaid program resources. This creates a strong incentive for states to adopt stricter enforcement policies.
OIG Enforcements
Hospice/Palliative Care Provider Updates
Hospice Preview Reports for the August 2026 Refresh – NOW AVAILABLE IN iQIES
Providers can now access the latest Provider Preview Reports via iQIES. These reports include provider performance scores for quality measures that will be published on the Compare tool on Medicare.gov and the Provider Data Catalog (PDC) during the August 2026 refresh.
The Provider Preview Reports include:
- Hospice Outcomes and Patient Evaluation (HOPE) measure scores based on hospice-submitted data reported to CMS for Quarter 4, 2024, to Quarter 3, 2025.
- CAHPS® measure scores reflecting data submitted to CMS for Quarter 4, 2023, to Quarter 3, 2025.
- CAHPS Star Ratings based on survey data submitted to CMS for Quarter 4, 2023, to Quarter 3, 2025.
- Claims-based measures based on Medicare claims data for Quarter 1, 2023, to Quarter 4, 2024.
Once released in iQIES, providers will have 30 days during which to review their quality measure results. The preview period for the latest Provider Preview Report lasts from May 20, 2026, to June 19, 2026. Although the formal preview period is 30 days, reports will remain accessible for an additional 30 days (60 days total). CMS encourages providers to download and save their Hospice Provider Preview Reports for future reference, as they will no longer be available in iQIES after this 60-day period.
Learn more about the Provider Preview Report (Assessment- and Claims-based measures) and the CAHPS Preview Report. Hospice QRP Key Dates for Providers are also available.
HQRP Public Reporting Quarterly Refresh – May 2026
The May 2026 quarterly refresh for the Hospice Quality Reporting Program is now available on the Compare tool on Medicare.gov.
The May 2026 refresh includes:
- Assessment-based measure scores are based on data submitted by hospices to the Centers for Medicare & Medicaid Services from Quarter 3, 2024 through Quarter 2, 2025.
- CAHPS® measure scores are based on Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey data submitted from Quarter 3, 2023 through Quarter 2, 2025.
- CAHPS® Star Ratings are calculated using CAHPS® Hospice Survey data from Quarter 2, 2023 through Quarter 1, 2025.
- Claims-based measure scores reflect Medicare claims data collected from Quarter 1, 2023 through Quarter 4, 2024.
For additional information, please see the FY2026 Hospice Wage Index, Final Rule
Home Health Provider Updates
HHQRP Update
CMS recently determined that due to an unintended processing issue, risk adjustment coefficient values for home health (HH) episodes with start of care (SOC) or resumption of care (ROC) completion dates (M0090) on or after January 1, 2025 that were released to the public in 2025 had not been implemented in iQIES HH measure calculation (see HHQRP QM Risk Adjustment Technical Specifications 2026 (PDF), “Downloads” section at Home Health Quality Measures | CMS). Instead, OASIS-based measures for these HH episodes were calculated using the risk adjustment models developed for home health episodes with SOC/ROC completion dates between January 1, 2024 and December 31, 2024 only. The impacted HH episodes with SOC/ROC completion dates between January 1, 2025 and December 31, 2025, were used to calculate a portion of performance measures reported in the following performance reports:
- October 2025 Provider Preview Reports for January 2026 Public Reporting (Q1 2025)
- January 2026 Provider Preview Reports for April 2026 Public Reporting (Q1- Q2 2025)
- April 2026 Provider Preview Reports for July 2026 Public Reporting (Q1- Q3 of 2025)
A correction for this processing issue was deployed in iQIES in early April 2026 and will be reflected starting with the April 2026 IPRs. Note that this necessary correction is limited to HH episodes with SOC/ROC completion dates in CY 2025. Both the HHQRP 2025 QM Manual and risk adjustment technical specifications presented the correct risk adjustment values that were intended for use with HH episodes SOC/ROC completion dates in calendar year 2025.
In sum, the HHQRP 2025 QM Manual and risk adjustment technical specifications presented the correct risk adjustment values that were intended for use with HH episodes SOC/ROC completion dates in calendar year 2025, whereas implementation in iQIES needed to be corrected to align with the documentation.
To assess the implications of this processing issue on publicly reported performance, CMS completed an impact analysis by comparing OASIS-based measure values that were incorrectly risk-adjusted with 2024 risk adjustment coefficients as reported in Risk Adjustment Technical_Specifications_2025 (PDF) with OASIS-based measure values that were correctly risk-adjusted using 2025 risk adjustment coefficients as reported in the HHQRP QM Risk Adjustment Technical Specifications 2026 (PDF). This analysis used a CY 2025 reporting period based on HH episodes ending in CY 2025. Overall, analysis results showed small changes in agency-level OASIS-based measure scores. There were also very small changes to agency-level, relative measure performance rankings for agencies with at least 20 eligible HH episodes to generate a measure value.
DMEPOS Updates
Suction Pumps: Prevent Claim Denials
In 2024, the improper payment rate for suction pumps was 33.5%, with a projected improper payment amount of $4.7M. Learn how to bill correctly for these services. Review the Suction Pumps provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
DMEPOS Benefit Category Determinations
CMS updated the Medicare Benefit Policy Manual, Chapter 15 (PDF), Section 110.8 with DMEPOS benefit category determinations.
See the Instruction to your Medicare Administrative Contractor (PDF).
All Providers Updates
Electronic Prior Authorization Improvements: Get Involved & Start Testing
The current prior authorization process can create unnecessary delays and burden for providers. It has eroded trust between payers and providers even as we all work to ensure patients get the high quality care they need. This past summer, HHS Secretary Robert F. Kennedy, Jr., CMS Administrator Dr. Mehmet Oz, and National Coordinator for Health IT Dr. Thomas Keane announced a landmark healthcare industry pledge with major health plans from across the country to streamline and improve the prior authorization system. This pledge reflects a shared commitment to modernize prior authorization and create a more responsive, patient-centered health care experience.
Get Involved — Start Testing
CMS strongly encourages providers to take an active role in advancing electronic prior authorization by participating in Fast Healthcare Interoperability Resources® (FHIR) Application Programming Interface (API) testing with your electronic health record (EHR) vendor and payer partners. Contact your EHR vendor to learn how you can test to make sure your systems are ready for electronic prior authorization. Early testing and collaboration between your practice, EHR vendor, and payers is essential to ensure seamless, real-world implementation of electronic prior authorization workflows. Engage now to:
- Identify gaps
- Validate workflows
- Build the technical readiness needed to meet upcoming implementation goals
- Improve the experience for your patients and staff
Visit the new Electronic Prior Authorization webpage to get started.
CMS Announces Early Adopters to Advance Solutions for Electronic Prior Authorization, Accelerating Momentum Ahead of 2027 Requirements
CMS, through its Health Tech Ecosystem, is advancing its electronic prior authorization efforts through a newly established Electronic Prior Authorization Acceleration initiative to address key challenges and drive solutions ahead of 2027 requirements.
30 healthcare organizations—including health systems, electronic health record developers, physician practices, networks, and digital health developers—have signed on as early adopters in this cross-sector effort. They join many of the nation’s largest payers that have already committed to working with CMS to identify and address workflow, technical, and operational barriers that have slowed adoption of electronic prior authorization across the healthcare system.
Read the full press release.
HHS Announces Restructuring of its Office for Civil Rights
HHS announced a reorganization of its Office for Civil Rights (OCR), the Department’s law enforcement agency charged with enforcing laws protecting civil rights, conscience and religious freedom, and health information privacy and security. The reorganization returns OCR to a program-based structure that aligns OCR’s three critical substantive areas with three distinct subject-matter divisions: the Conscience and Religious Freedom Division, the Civil Rights Division, and the Health Information Privacy, Data, and Cybersecurity Division.
Educational Opportunities
CCSQ Quarterly Stakeholder Webinar – May 12
Tuesday, May 12 from 12–1 pm ET
Register for this webinar.
You’re invited to join Dr. Dora Hughes, Chief Medical Officer of CMS and Director of the Center for Clinical Standards and Quality (CCSQ), and the CCSQ leadership team for an engaging update on our work to strengthen health care quality, safety, and coverage. Hear the latest on recent policy developments and how these efforts are accelerating progress toward improving care and outcomes for beneficiaries in Medicare, Medicaid, and the Marketplace.
HCPCS Public Meeting – June 1–2
Monday, June 1 and Tuesday, June 2 from 9 am – 5 pm ET
Attend a hybrid public meeting for the first biannual 2026 HCPCS coding cycle. Visit HCPCS Level II Public Meetings for more information, including:
- Meeting materials
- Guidelines
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.
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.