The Compliance Monitor (7/31/26)
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
DMEPOS Requirement Updates
CMS added 20 items to the Master List of DMEPOS Items Potentially Subject to Conditions of Payment. We didn’t remove any items.
If these items are selected for a face-to-face encounter, written order prior to delivery, or prior authorization, you may be required to do one or both:
- Meet with your patient and give them a written order before delivering the item
- Ask your Medicare Administrative Contractor to authorize the item in advance
Learn more about extra order requirements:
- Face-to-Face Encounter and Written Order Prior to Delivery: Added 22 new items
- Prior Authorization: Added 8 new items
Strengthening Original Medicare
The Centers for Medicare & Medicaid Services (CMS) outlined a strategic framework to strengthen Original Medicare by aligning spending with value, empowering beneficiaries through price transparency, and expanding accountability. Key proposals focus on improving payment accuracy using empirical and market-based data, removing site-of-service payment differentials, and encouraging participation in Accountable Care Organizations (ACOs). Additionally, CMS is prioritizing technology modernization and data interoperability while seeking public input on redesigning primary care and streamlining quality reporting.
CMS Rulemaking/ Federal Register Notices
Fiscal Year (FY) 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Proposed Final Rule (CMS-1851-F) is Posted
The final rule went on display at the Federal Register Public Inspection Desk and is available at: https://www.federalregister.gov/public-inspection/current
On July 30, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1851-F) that would update Medicare hospice payments and the aggregate cap amount for fiscal year (FY) 2027 under existing statutory and regulatory requirements.
This final rule also highlights Medicare non-hospice spending under a hospice election, using data from the hospice service and spending variation index (SSVI). The SSVI includes a comprehensive scoring system calculated using nine claims-based measures, each representing a different aspect of hospice utilization as well as non-hospice spending. These data indicate hospice providers that might need additional targeted education and oversight. This rule also finalizes changes to the hospice election statement regulations; these regulations require hospices to provide to all Medicare beneficiaries, at the time of hospice election, an addendum to the election statement regarding coverage of non-hospice services. Additionally, this rule finalizes conforming regulation text changes that allow a physician designee and the physician member of the interdisciplinary group, in addition to the hospice medical director, to discharge a patient from hospice care, which will help improve flexibility for hospices and reduce regulatory burden.
This rule also finalizes conforming regulation text changes to the hospice telehealth face-to-face policy under the Consolidated Appropriations Act, 2026. The final rule includes a summary of comments from requests for information on enhancing community palliative care services under current Medicare benefits; developing a hospice-specific wage index using BLS data; and describing any experiences with overlap between hospice and assisted suicide or “medical aid in dying.”
Review the CMS Fact Sheet.
CHAP is reviewing and analyzing the final rule and will post a summary soon.
This Notice announces updates to the Healthcare Common Procedure Coding System (HCPCS) codes on the Master List. It also announces updates to the HCPCS codes on the Required Face-to-Face Encounter and Written Order Prior to Delivery List and the Required Prior Authorization List. Implementation of updates to the Master List, the Required Face-to-Face Encounter and Written Order Prior to Delivery List, and the Required Prior Authorization List, excluding upper limb orthoses, are effective [Insert date 90 days after the date of publication in the Federal Register.
The U.S. Department of Health and Human Services (HHS) details two regulatory changes made by the Office for Civil Rights (OCR) regarding Title VI of the Civil Rights Act of 1964:
- Ending Disparate-Impact Liability: HHS issued a final rule eliminating the “disparate-impact” or “effects-based” standard under its Title VI regulations. Enforcement will now focus strictly on intentional discrimination based on race, color, or national origin. HHS stated that previous provisions encouraged recipients to use race-based decision-making or quota balancing to avoid enforcement actions.
- Rescinding Appendix B: HHS separately rescinded Appendix B to 45 C.F.R. Part 80, removing obsolete 1979 vocational education guidelines left over from the former Department of Health, Education, and Welfare (HEW).
Both rules are effective immediately. OCR will continue to investigate intentional discrimination complaints while leaving non-discrimination authorities under Title VI, Title IX, and Section 504 intact.
Fraud and Abuse Update
CMS Medicaid Fraud War Room Stops More Than $203 Million in Improper Payments During First 88 Days
CMS announced that enforcement efforts from its Medicaid Fraud War Room (MFWR) stopped more than $203M in potentially improper Medicaid payments in just under 90 days, highlighting significant progress in protecting taxpayer dollars and strengthening Medicaid program integrity. Since its launch on April 23, the MFWR has coordinated actions against 50 unique, high-risk Medicaid providers identified through advanced data analytics and representing more than $203 million in Medicaid payments subject to federal exclusions and state enforcement efforts.
More information:
Updated Fraud Risk and Heightened Scrutiny: Q3
The HHS-OIG Fraud Risk and Heightened Scrutiny page outlines how the Office of Inspector General (OIG) evaluates risk and determines post-settlement oversight in health care False Claims Act (FCA) cases.
HHS Defers More Than $1 Billion in Medicaid Payments to California, Minnesota Pending Review of High-Risk Claims in Crackdown on Fraud
The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) today deferred more than $1 billion in federal Medicaid payments to California and Minnesota as the states submit additional documentation supporting certain high-risk Medicaid claims. CMS is deferring approximately $867.5 million in federal Medicaid payments to California and $199 million to Minnesota after focused financial reviews identified claims that require additional review before federal matching funds are released. These are payment deferrals (not permanent funding cuts) and both states will have the opportunity to provide documentation showing the claims meet federal Medicaid requirements.
Additionally, HHS will be expanding its exclusion authority, enabling both CMS and the HHS Office of Inspector General to utilize this critical tool to remove bad actors from federal healthcare programs — and, in many cases, permanently bar them from returning.
CALIFORNIA
CMS reviewed California’s claims for certain in-home care programs after identifying spending growth that far exceeded national trends and other claims that require additional documentation. As a result, CMS is deferring approximately $867.5 million in federal Medicaid payments until the state provides the information needed to support those claims.
MINNESOTA
CMS also reviewed Medicaid claims in 14 high-risk service areas in Minnesota. The review identified claims that require additional documentation, including expenditures linked to providers flagged through program integrity reviews and other claims with potential eligibility or billing concerns. CMS is deferring approximately $199 million in federal Medicaid payments while that review continues.
Hospice Care Provider Updates
H.R.9703 – Improving access to transfusion care for hospice patients act of 2026
H.R.9703, the Improving Access to Transfusion Care for Hospice Patients Act of 2026 introduced by Representative Debbie Dingell, directs the Center for Medicare and Medicaid Innovation (CMMI) to test paying for blood transfusions separately from standard hospice daily rates. You can track the official progress and text on Congress.gov.
Read the Dingell Press release
Home Health Care Provider Updates
July 2026 CMS Quarterly OASIS Q&As
NOW AVAILABLE- Updated Quarterly OASIS Q&As
The July 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 .
DMEPOS Updates
Enteral Nutrition: Prevent Claim Denials
In 2024, the improper payment rate for enteral nutrition was 23.8%, with a projected improper payment amount of $31.1M. Learn how to bill correctly for these services. Review the Enteral Nutrition provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
- Resources
All Providers Updates
Medicare Providers: Join an Accountable Care Organization for Performance Year 2027
To participate in an Accountable Care Organization (ACO) for performance year 2027, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 5, 2026, by:
- Noon ET for the Medicare Shared Savings Program
- 11:59 pm ET for the Long-Term Enhanced ACO Design (LEAD) Model
Your taxpayer identification numbers can’t overlap multiple ACO participant lists. Resolve any overlaps by September 8, 2026.
More Information:
- Application Types & Timeline webpage
- Email questions to SharedSavingsProgram@cms.hhs.gov or LEAD@cms.hhs.gov
All Medicare Facility Types: Get Ready for the PEPPER Relaunch
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is relaunching in the coming months for all Medicare facility types, including hospitals, post-acute care providers, and specialty facilities.
PEPPER is a free tool that helps you review your Medicare billing data so you can identify issues before problems arise and support accurate claims. Use it to:
- Spot billing patterns that may need review or improvement
- Identify areas that may need closer monitoring or internal audits
- Find services that may be under-coded or over-coded
- Track trends like longer patient stays
How to Get Your PEPPER
Authorized officials (AOs), access managers (AMs), and staff end users (SEUs) can download their organization’s report from the PEPPER Portal.
How to become an SEU:
- Sign in to the CMS Identity & Access (I&A) System using your existing NPPES or PECOS credentials.
- Request the PEPPER business function for your organization. The Comparative Billing Report business function is also available and can be requested at the same time.
- Your AO or AM must approve your request.
More Information:
- See the I&A Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs
- Contact the External User Services Help Desk
Medicare Beneficiary Date of Death: Manual Update
CMS added section 210 to the Medicare Claims Processing Manual, Chapter 1 (PDF). Find out how to correct a date of death for Medicare records.
More Information:
HHS Joins the Genesis Mission to End America’s Chronic Disease Epidemic
HHS today announced new efforts to support the Genesis Mission, aligning expertise and capabilities across the Department to harness artificial intelligence in support of biomedical research and accelerate discoveries that improve the health of the American people. Working in partnership with the White House Office of Science and Technology Policy (OSTP), HHS will launch a series of National Science and Technology Challenges that invite America’s scientific community to apply next-generation artificial intelligence to some of the nation’s most urgent health challenges. The flagship challenge will focus on identifying the root causes of chronic disease; additional challenges will accelerate research on pediatric cancer and transform drug discovery and development.
In addition to the chronic disease challenge, HHS will launch research challenges focused on:
- Accelerating breakthroughs in pediatric cancer research by identifying new biological insights and therapeutic opportunities.
- Transforming drug discovery and development by using AI to shorten development timelines, identify promising therapeutic targets, and bring safe, effective treatments to patients faster.
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.