The Compliance Monitor (7/17/26)
Your source for federal updates
July – August 2026 Compliance Activity
| Compliance Item & Date | Additional info & Links |
| ICD-10 & Other Coding Revisions to National Coverage Determinations: July 2026 Update Effective July 1, 2026 | Learn about updates to National Coverage Determinations (PDF) with new or deleted ICD-10 diagnosis codes |
| CMS Quality (HQRP, HH QRP) non-compliance letters Non-compliance notifications will be distributed by the Medicare Administrative Contractors (MACs) and will be placed into hospices’ CASPER folders in QIES Usually distributed in July | – Providers will receive a letter if they chose not to submit quality information to CMS, or if their submission was not compliant – Hospices that receive a letter of non- compliance may submit a request for reconsideration to CMS Instructions for appeal are included in the notification and on the Reconsideration Requests webpage |
| Medicare Care Compare Refresh Home health quality scores are publicly reported on the Care Compare website and updated on a quarterly basis. | Medicare Care Compare https://www.medicare.gov/care-compare/ Information about home health public reporting dates https://www.cms.gov/medicare/quality/home-health/home-health-quality-reporting-data-submission-deadlines |
| CMS Hospice Payment Update Rule (Final) -Annual FY issuance – Includes final annual payment update and quality program information. Other proposed regulations or changes to standing regulations outcome with effective dates (as applicable). Usually posted in early August | Annual payment rate update begins October 1st Will first appear on the Federal Register Public Inspection Desk https://www.federalregister.gov/pu blic-inspection/current, then will move over to the Federal Register within a week of initial posting https://www.federalregister.gov/do cuments/current CHAP will post a summary of the final rule. |
| Notice of a New Matching Program The deadline for comments on this notice is August 6, 2026. | CMS is re-establishing a matching program with the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), to verify whether applicants are enrolled in minimum essential coverage through a VHA health care program and support CMS eligibility determinations for Insurance Affordability Programs. |
| CMS Rule: Medicare Program; CY 2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury Dialysis (AKI) Payment, and ESRD Quality Incentive Program [CMS-1846-P] Comments due August 24, 2026 | CMS seeks input on models and policies to improve coordination between ESRD and hospice care, including access to palliative dialysis, while preserving ESRD PPS and hospice per diem integrity and guarding against duplicative payment and program integrity risks. Commenters should review “C. Request for Information to Advance Palliative Care for Dialysis Patients, 3. Request for Information” for specific comment questions. |
| Medicare Program; Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflicts of Interest, and Related Provisions Comments due August 24, 2026 | Read the CHAP customer impact summary of the final rule. This final rule is effective June 16, 2027. CMS Full press release and Fact sheet |
| Hospice 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 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 |
| CMS HQRP Compliance Reconsideration Results | Reconsideration results usually delivered in August/ September |
Top Items
CMS issues Memo – Acceptance-to-Service Requirement for Home Health Agencies and updated Guidance [QSO-26-13-HHA]
Memorandum Summary
- Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) final rule amended the Home Health Agency (HHA) Conditions of Participation (CoPs) at 42 CFR part 484.
- Specifically, this final rule adds a new standard for an acceptance-to-service policy in the HHA Conditions of Participation (CoPs), effective January 1, 2025.
- Conforming revisions are being made to the regulatory tags and interpretive guidelines to the State Operations Manual (SOM) Appendix B – Guidance for Surveyors: Home Health Agencies. Additional clarifying guidance is being added to a single, unrelated tag that surveyors and HHAs frequently question.
The acceptance-to-service requirements ensure HHAs accept only patients whose care needs they can reasonably meet, helping reduce delays between eligibility determination and care initiation. CMS added two new Appendix B G-tags (G990 and G992) with surveyor guidance for citing noncompliance. CMS also clarified tag G1052 for §484.115(a), noting that administrators in the role before January 13, 2018, must meet §484.115(a)(1), while those hired on or after that date must meet §484.115(a)(2).
An advance copy of SOM Appendix B is attached to the memo; the online SOM will be updated shortly after the memo’s release.
CMS Rulemaking
The Calendar Year (CY) 2027 Home Health PPS Notice of Proposed Rulemaking (NPRM) was displayed on July 1st, 2026. In this NPRM, CMS proposes initiatives to improve alignments between the expanded HHVBP Model and the Home Health Quality Reporting Program (HH QRP). The following are the Home Health Quality Reporting Program proposals that have been outlined: CMS is proposing to revise the HH QRP OASIS and HHCAHPS Annual Payment Update (APU) reporting timeframe to report a calendar year of data (January 1 through December 31). CMS is also proposing some revisions to regulatory text in support of rule proposals or to improve digital transfer of information during the reconsiderations process. Finally, CMS is soliciting public comments on one Request for Information (RFI) on future measure concepts for the HH QRP. The proposed rule is available on the Federal Register. The 60-day public comment period closes on August 31st, 2026. Please visit the Regulations.gov to submit public comments. . Note: Table 31 on p. 41278 is missing headings. Please use this version until a correction is made on the Federal Register. Table 31-HHQRP HHVBP Measures (PDF)More Information:
- Read the CHAP summary of the proposed rule
CY 2027 Medicare Physician Fee Schedule Proposed Rule
CMS issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2027.
The proposed rule also includes:
- CY 2027 PFS rate setting and conversion factor
- Strengthening Medicare ACO participation and accountability
- Medicare Shared Savings Program requirements
- Quality Payment Program proposals and requests for information (RFIs)
- Evaluation and management (E/M) visits:
- Accounting for overlap between stand-alone E/M visits and global periods
- Complexity add-on code
- Remote monitoring
- Comment solicitation on:
- Redesigning primary care to make America healthy again
- Strategies for improving global surgery payment accuracy
- Policies to improve care for chronic illness and behavioral health needs
- Clinical Laboratory Fee Schedule payment and reporting requirements
- Medicare Prescription Drug Inflation Rebate Program
- Limiting Medicare coverage of certain individuals
- RFI on duplicate laboratory testing, imaging, and result sharing and interoperability
More Information:
- Medicare Shared Savings Proposals fact sheet
- Quality Payment Program fact sheet and policy comparison table
Opportunity to comment:
In this proposed rule, CMS has issued a specific Request for Information (RFI) on Community-Based Palliative Care. This RFI builds on prior agency efforts (such as the FY 2027 Hospice proposed rule) to understand how to better structure, pay for, and support palliative services delivered outside of acute-care hospitals (e.g., in outpatient clinics, patients’ homes, and other non-hospital settings). The RFI is structured around several critical core domains:
- Feedback Requested: The agency is seeking feedback on clinical documentation challenges, billing compliance obstacles, and potential enhancements to existing service codes to improve palliative care delivery.
- While programs like Complex Chronic Care Management (CCCM) rely on a threshold of two or more chronic conditions that put a patient at high risk of hospitalization, decline, or death, CMS is seeking feedback on whether this framework translates well to broader palliative services.
- The RFI explores incorporating alternative clinical indicators, such as a patient’s overall daily functional status or the level of caregiver strain, to determine who should receive supportive care.
- The agency is asking stakeholders how to redesign and value care management codes so that interdisciplinary palliative care teams can be sustainably compensated for this continuous, non-face-to-face care coordination.
- CMS is evaluating how Advanced Primary Care Management (APCM) services and other primary care models can be leveraged or aligned to deliver structured, high-quality community-based palliative care.
Federal Register- Notice of a New Matching Program
CMS is providing notice of a re-established matching program between CMS and the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), titled, “Verification of Eligibility for Minimum Essential Coverage Under the Patient Protection and Affordable Care Act”. Under this Matching Program, CMS will share data with the VA to verify if an applicant is enrolled in Minimum Essential Coverage in a Veterans Health Administration Health Care Program. This information from the VA will be used to assist CMS to determine if an individual is eligible for Insurance Affordability Programs
The deadline for comments on this notice is August 6, 2026. The reestablished matching program will commence not sooner than 30 days after publication of this notice, provided no comments are received that warrant a change to this notice. The matching program will be conducted for an initial term of 18 months (from approximately June 15, 2026, to December 15, 2027) and within 3 months of expiration may be renewed for one additional year if the parties make no change to the matching program and certify that the program has been conducted in compliance with the matching agreement.
Fraud and Abuse Update
Medicare Fraud & Abuse: 2 Updated Resources
Learn how to prevent, detect, and report Medicare fraud and abuse:
Spring 2026 Semiannual Report to Congress
This report highlights OIG’s work focusing on the most significant and high-risk issues in HHS programs and operations during the semiannual reporting period of October 1, 2025, through March 31, 2026. The semiannual reports are intended to keep the HHS Secretary and Congress informed of OIG’s crucial findings and recommendations.
Read the Full Report
Hospice/Palliative Care Provider Updates
Important Updates on the Hospice Quality Reporting Program (HQRP)
CMS posted a Hospice Outreach Email – June 2026 – Read the email for full content.
- FY 2027 Non-Compliance: CMS is posting non-compliance notifications in iQIES “My Reports” folders in July 2026. Reconsideration requests must be under 20 MB and contain no Protected Health Information (PHI).
- FY 2028 HQRP Requirements: To avoid a 4% payment reduction, hospices must meet reporting thresholds for calendar year 2026:
- HOPE Assessment: Submit and have accepted at least 90% of assessments within 30 days of the patient’s admission, update visit, or discharge.
- CAHPS® Survey: Contract with an approved vendor to conduct the 12-month caregiver survey.
- Training Materials: CMS has released several guides, including the HOPE Guidance Manual v1.02 (PDF) and a series of video tutorials, such as the HOPE Data Collection Timepoints Explainer Video.
- The HOPE Technical Information webpage is now available and provides updates and resources related to HOPE data submission specifications and other technical information.
- HOPE data specs errata (v1.00.3) 01-16-2026 (PDF)
- Errata (V1.00.2) for HOPE Data Specs (V1.00.1) FINAL 05-22-2025 (PDF)
- CMS Hospice Vendor Training June 2025 (PDF)
- iQIES Access & Security
- Access Requirements: iQIES does not require a VPN but does require credentials managed through the HARP registration portal.
- Provider Security Officials (PSOs): Hospices must designate at least one (ideally two) PSOs to approve user and vendor access requests.
- Demographic Data & Public Reporting
- Updating Details: Providers must correct demographic errors by submitting Form CMS-855A in PECOS, contacting their MAC, and requesting updates in iQIES. Changes can take up to 6 months to display on Care Compare.
- Care Compare Refresh: The most recent data refresh and the August 2026 Provider Preview Reports were both released on May 20, 2026.
Hospice Claims: Reporting a Face-to-Face Encounter for Recertification Using Telecommunications Technology
Learn about using a modifier or G code (PDF), starting January 1, 2027.
New OIG Work Plan Item – Savings in Medicare Hospice Payments for Care Provided in Nursing Homes – Announced on 07/15/2026
The fixed daily rates that Medicare pays hospices for routine home care provided in a nursing home include personal care services. However, nursing homes are already required to provide personal care services to their residents. Paying the hospice the full routine home care rate that covers personal care services when these services are already required from the nursing home can undermine the efficiency of Medicare payments and add to the incentives that bad actors have to exploit the program. This review will determine Medicare payments for routine home care provided to hospice beneficiaries in nursing homes, estimate potential cost savings from reducing the payment to address the inefficiency in the payment structure, and examine practices of hospices with a high percentage of their beneficiaries in nursing homes.
Home Health Care Provider Updates
HCPCS Codes Used for Home Health Consolidated Billing Enforcement: October 2026 Quarterly Update
Learn about the 19 new HCPCS codes (PDF) CMS is adding to the non-routine supply code list, effective October 1, 2026.
NEW RESOURCE AVAILABLE: Home Health QRP Essentials Course
The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training that provides an overview of the Home Health (HH) Quality Reporting Program (QRP), including its purpose, reporting requirements, and quality data sources. The course reviews Outcome and Assessment Information Set (OASIS) and Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey reporting requirements, explains how quality measures and star ratings are calculated and publicly reported, and highlights key CMS resources, help desks, and subscription options to support ongoing compliance with HH QRP requirements.
This training can be accessed through the Home Health Quality Reporting Training webpage.
Public Reporting July 2026 Refresh of HH QRP Data – Now Available
The July 2026 quarterly refresh for the Home Health Quality Reporting Program is now available on the compare tool on Medicare.gov and the Provider Data Catalog (PDC).
For more information, please visit the HH QRP Public Reporting Website.
Preview Reports and Star Rating Preview Reports for the October 2026 Refresh of HH QRP Data – NOW AVAILABLE IN iQIES
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 October 2026 refresh.
For additional information, please see the HH Quality Reporting Training and the Home Health Public Reporting webpage. For questions, please contact the appropriate team:
- Provider Preview Report access: iQIES Service Center at iqies@cms.hhs.gov or 1-800-339-9313
- HHA QRP Public Reporting: homehealthqualityquestions@cms.hhs.gov
All-Payer Related Changes to the Home Health Quality Reporting Program Annual Payment Update (APU)
Section 1895(b)(3)(B)(v) of the Social Security Act requires HHAs to submit CMS-specified HH QRP data; noncompliance results in a 2-percentage-point APU reduction.
The CY 2023 and CY 2025 HH PPS Final Rules require OASIS data collection and iQIES submission for all non-exempt HHA patients, regardless of payer, beginning with OASIS SOC M0090 dates on or after July 1, 2025. Exemptions include patients under 18; maternity, personal care, homemaker, chore, or outpatient therapy-only services without a home health plan of care; loaned-employee arrangements; and one-visit quality episodes.
CMS currently uses only Medicare and Medicaid OASIS data for HH QRP APU calculations. Beginning January 1, 2027, CMS intends to include all-payer OASIS data for non-Medicare/non-Medicaid patients who start skilled home health care on or after that date. Earlier SOC dates remain excluded for APU purposes.
HHAs must meet a 90% OASIS quality reporting compliance rate across all payer sources using the QAO metric below:
More information is available on the HH QRP Quality Reporting Requirements webpage.
Expanded HHVBP Model: Preliminary July 2026 Interim Performance Reports (IPRs) are Available in iQIES
The Preliminary July 2026 IPRs for the expanded HHVBP Model have been published in the Internet Quality Improvement and Evaluation System (iQIES).
The quarterly IPRs provide home health agencies (HHAs) with the cohort assignment, performance year measure data based on measure-specific 12-month and 24-month reporting periods, and the interim Total Performance Score (TPS). Using the IPRs, an HHA can assess and track their performance relative to peers in their respective cohort throughout the expanded Model performance year.
An HHA receives a July 2026 IPR if the HHA:
- Was Medicare certified prior to January 1, 2025, and
- Meets the minimum threshold of data for at least one (1) quality measure in the quarterly reporting period for the performance year shown in Exhibit 1.
Exhibit 1: July 2026 IPR quality measure performance time periods by measure category
| Measure Category | Time Period | Minimum Data Threshold |
| OASIS-based | Apr 1, 2025 – Mar 31, 2026 | 20 home health quality episodes |
| Claims-based | DTC-PAC: Jan 1, 2024 – Dec 31, 2025 PPH: Jan 1, 2025 – Dec 31, 2025 | 20 home health stays |
| HHCAHPS Survey-based* | Jan 1, 2025 – Dec 31, 2025 | 40 completed surveys |
* Not included in the TPS calculation for HHAs in the smaller-volume cohort. For additional details on cohort assignment in the expanded Model, please review Section 2 in the Expanded HHVBP Model Guide, available on the Expanded HHVBP Model webpage, under “FAQs & Model Guide.”
Please also refer to the updated Expanded HHVBP Model IPR Quick Reference Guide (PDF) available on the Expanded HHVBP Model webpage. This resource outlines the types of data included, eligibility criteria, how interim performance scores are calculated, and the process for submitting recalculation requests. This easy-to-scan two-pager provides all the key details to stay aligned with HHVBP performance expectations.
Looking Ahead to the CY 2026 Applicable Measure Set
As outlined in the CY 2026 Home Health (HH) Prospective Payment System (PPS) Final Rule, there are changes to the expanded HHVBP Model applicable measure set starting with CY 2026 (referred to as the “CY 2026 measure set”). The October 2026 IPRs will be the first IPRs to generate improvement, achievement, and care points based on the CY 2026 applicable measure set. To help HHAs get ready for this change, CMS has started providing a preview of HHAs’ performance on the CY 2026 measure set. Specifically, starting with the October 2025 IPRs, achievement thresholds (AT) and benchmarks (BM) (see “CY 2026 AT and BM” tab) and HHA’s improvement thresholds for the CY 2026 measure set are available to HHAs in each IPR. In the July 2026 IPRs, a preview of CY 2026 applicable measure performance based on the current performance period is provided in the “CY 2026 Performance” tab.
Important Note on the Preview MSPB-PAC measure performance:
- “CY 2026 Baseline” tab: Due to a delay in availability of data to calculate CY 2024/2025 MSPB-PAC measure performance, improvement thresholds based on this performance period are not yet assigned to HHAs that were previously ineligible or did not meet the minimum data threshold to establish a CY 2022/2023 or CY 2023/2024 HHA baseline year for this measure. Assignment of improvement thresholds based on CY 2024/2025 MSPB-PAC measure performance will occur as soon as technically feasible.
- “CY 2026 Performance” tab: This worksheet provides performance scores for three OASIS-based measures in the CY 2026 applicable measure set that are not included in the CY 2025 applicable measure set, namely Improvement in Bathing, Improvement in Upper Body Dressing, and Improvement in Lower Body Dressing. Note that CY 2024/2025 data to calculate performance scores for the claims-based MSPB-PAC measure are not yet available. Therefore, performance scores for this measure are not reported on this tab.
CMS is sharing these updates to help HHAs stay informed and prepared, and no action is needed from HHAs. Updated measure performance will be reflected in future reports once the data become available.
Accessing IPRs – IPRs are available via iQIES in the “HHA Provider Preview Reports” folder, by the CMS Certification number (CCN) assigned to the HHA.
Expanded HHVBP Model: QUARTERLY NEWSLETTER – June 2026
This newsletter contains information for home health agencies (HHAs) related to the expanded Home Health Value-Based Purchasing (HHVBP) Model, including Model highlights, training updates, new insights, reminders, resources, and contact information.
Save the Date for future PEPPER webinars. Registration information will be posted soon.
September 24, 2026, 1:00 p.m. ET: PEPPER for Home Health Agencies and Partial Hospitalization Programs.
OIG Posts HHA Advisory Opinion
OIG Advisory Opinion 26-15: Unfavorable opinion requested regarding a home health agency’s payment of remuneration to a vendor for the use of an online referral management software.
DMEPOS Updates
DMEPOS Fee Schedule: July 2026 Quarterly Update
Learn about guidance (PDF) on continuing to use the KF modifier on claims for HCPCS codes E0747, E0748, and E0760 for dates of service on or after May 18, 2026.
All Providers Updates
Domestically Acquired Cyclosporiasis Cases in Multiple U.S. States
CDC is notifying clinicians, public health practitioners, and laboratorians of cases of domestically acquired cyclosporiasis in multiple U.S. states. Since May 1, 2026, CDC has received reports of 1,645 confirmed domestic cases of cyclosporiasis and is aware of more than 5,100 cases that require further analysis to confirm the illness as domestically acquired cyclosporiasis. This is substantially higher than the 249 cases reported nationally by this same time last year. Of the 1,645 case-patients with available information, 141 (9%) were hospitalized, and none have died. CDC, FDA, and state and local health departments are working together to investigate multistate outbreaks of Cyclospora infections and to identify the sources of illness. Because cyclosporiasis is often underdiagnosed and underreported, the true number of illnesses is likely higher than what has been reported to CDC.
Read the full Health Advisory for information on disinfecting Cyclospora in health care settings and recommendations for:
- Clinicians
- Laboratories
- Health departments
- The public
VA Payments: Enroll in Direct Deposit
Veterans Affairs (VA) requires all community care providers to receive payment through direct deposit (electronic funds transfer). This includes those billing Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and other VA programs.
Providers must enroll in direct deposit or update existing banking information using VA Form 10091 through the VA‑FSC Customer Engagement Portal. For instructions, see the Vendor Webform User Guide.
ACO REACH Improves Health Care Quality
- What’s New: The CMS Innovation Center released the third annual evaluation report and early results ahead of the fourth report for ACO REACH that shows the model improved healthcare quality and reduced gross spending during its first four performance years.
- Why it Matters: This latest evaluation of ACO REACH provides strong evidence that accountable care organizations (ACOs) deliver on the Innovation Center’s mission to improve health care affordability and quality; future results for 2025 and 2026 will reflect model updates aimed at increasing the chances of saving money in the model’s final years.
- What to Expect: While ACO REACH ends this year, lessons-learned will help inform the next generation of ACO models, including the Long-term Enhanced ACO Design (LEAD) Model, which launches in January 2027, will run for 10 years, and improves benchmarking to appeal to a broader mix of health care providers, including those with specialized patient populations and those new to ACOs.
- The Big Picture: The Administration is strongly committed to helping Americans live healthier lives and reduce cost barriers to care and ACOs put greater emphasis on increased care coordination and provider accountability to achieve better health outcomes for people with Original Medicare.
- Additional Information: Gross spending decreased and quality improved more in 2024 than in any prior year of model performance, all while ACOs served larger numbers of people with Medicare—2.5 million. Survey data for 2023 showed that over 70% of ACOs reported prioritizing initiatives to reduce avoidable hospital utilization, increase interaction with primary care providers, and manage care for patients with complex needs. Additionally, performance year 2024 early results show a net savings for standard and new entrant ACOs, though those results were not statistically significant.
Find out more:
Educational Opportunities
2026 National Provider Compliance Conference – August 11–12
Tuesday, August 11 from 9 am – 5:30 pm ET and Wednesday, August 12 from 9 am – 1 pm ET
Charlotte, NC
Register for this in-person event by July 23; limited spots are available.
The National Provider Compliance Conference will bring together Medicare Administrative Contractors (MACs) and Center for Program Integrity experts to provide compliance professionals with the information and tools they need to efficiently and effectively submit Medicare Part A, Part B, Home Health and Hospice, and Durable Medical Equipment claims. Learning opportunities include individual presentations, Q&A segments, and panel discussions. Additionally, a dedicated exhibit area will allow for individual engagement between MACs and providers.
Target audience: Medicare Fee-for-Service providers only, including medical review contractors, compliance officers, nurse or billing managers, medical record staff, coders, and provider community associations.
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.