The Compliance Monitor (8/13/26)
Your source for federal updates
August/September 2026 Compliance Activity
| Compliance Item & Date | Additional info & Links |
| 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 |
| PEPPER webinar – Home Health September 24, 2026, 1:00 p.m. ET: Register today. | PEPPER for Home Health Agencies is available via the PEPPER Portal at https://pepper-file.cbrpepper.org. Current PEPPER User Guide: Home Health Agencies PEPPER User Guide (PDF, CY 2025 Release, August 2026) Demonstration PEPPER: Demonstration PEPPER version CY 2025 (XLSX) |
Top Items
Quality Reporting Program: Hospice Non-Compliance Letters for FY 2027 APU
The Centers for Medicare & Medicaid Services (CMS) is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2025, which will affect their FY 2027 Annual Payment Update (APU). Non-compliance notifications will be placed into facilities’ My Reports folders in the Internet Quality Improvement and Evaluation System (iQIES), for Hospices, IRFs, LTCHs and SNFs, on August 5, 2026. Additionally, notifications are being distributed by the Medicare Administrative Contractors (MACs). Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, September 4, 2026.
If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notice of non-compliance and on the appropriate QRP webpage:
Hospice Quality Reporting Reconsideration Requests
CMS Announces Resources, Flexibilities to Assist with Public Health Emergency in the State of Washington
The Centers for Medicare & Medicaid Services (CMS) has announced emergency resources, blanket waivers, and flexibilities to assist residents and healthcare providers in Washington state following a Public Health Emergency declaration on August 7, 2026, caused by major wildfires near Spokane County.
Washington Waivers: CMS’ blanket waivers and other flexibilities are available to affected providers in Washington state who have been affected by the wildfires—retroactively from Aug. 1, 2026. Healthcare providers in need of additional flexibility specific to the effects resulting from the Washington state wildfires can submit a request to CMS here: CMS 1135 Waiver/Flexibility Request and Inquiry Form.
Key actions and resources provided by CMS include:
- Medical Equipment & Prescription Relief: Authorization for Medicare beneficiaries to replace lost or damaged durable medical equipment, alongside required Part D plan coverage for out-of-network pharmacy refills and the removal of “refill too soon” edits.
- Medicaid, CHIP & Privacy Support: Flexibilities through the Medicaid/CHIP disaster toolkit and temporary HIPAA Privacy Rule waivers for affected hospitals during emergency protocols.
Recent natural disasters have demonstrated the importance of ensuring accessibility to health and human services for everyone living in the United States, including individuals in need of interpretation and translation services. To help first responders provide on-the-ground language assistance and communicate effectively during disasters and in accordance with federal civil rights laws, the HHS Office for Civil Rights offers a plain language checklist - PDF, including recommendations, specific action steps, resources, and tips such as to how to identify language needs in a disaster-impacted community to effectively utilize interpreters. Additional information is available on the HHS OCR website.
More Information:
CMS Rulemaking/ Federal Register Notices
On August 3, 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.
Review the CMS Fact Sheet.
Review the CHAP summary of the final rule.
Fraud and Abuse Update
CMS Reports Highest Program Integrity ROI Ever Recorded
Due to the bold actions this administration has taken to crush fraud, CMS delivered unprecedented results in Fiscal Year (FY) 2025, protecting taxpayer dollars and holding bad actors accountable like never before.
Total Medicare program integrity savings surged 59%, from $26.3 billion in FY 2024 to a record-shattering $41.9 billion in FY 2025. The FY 2025 Medicare Return on Investment (ROI) reached $22.3 to 1, up from $14.6 to 1, the highest ROI ever.
More information can be found here.
Home Health Care Provider Updates
Home Health Agencies: Download Your 2025 PEPPER
CMS released the 2025 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for home health agencies. Your PEPPER helps you review your billing data to make sure claims are accurate. 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 you can request it at the same time.
- Your AO or AM must approve your request.
More Information:
- Visit the Training & Resources webpage for more information about the release and the User Guide
- See the I&A Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs
- Contact the External User Services Help Desk
- Register for a webinar on September 24 at 1 pm ET
DMEPOS Updates
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
Power Mobility Devices
Learn how Medicare Part B covers power mobility devices, including power-operated vehicles and power wheelchairs.
All Providers Updates
Medicare Part A Cost Report Overpayments: Default Recoupment Date Extension
Learn about changes (PDF), effective January 4, 2027.
CMS is extending the Healthcare Integrated General Ledger Accounting System default recoupment date for Part A cost report overpayments from 16 to 41 calendar days after the demand date. This change more closely aligns with the schedule for other recoupments, such as Part A and Medicare Part B claim overpayments, which start on day 41. They expect this change to reduce the financial burden of administrative processes in the Medicare Program that increase costs and reduce efficiency.
CMS Celebrates Delivery of the Health Technology Ecosystem, One Year After Launch
The Centers for Medicare & Medicaid Services highlighted the first-year achievements of the Health Technology Ecosystem, emphasizing advances in interoperability, health data sharing, and patient access to digital health tools through collaboration between government, healthcare, and technology organizations. Readout: CMS Celebrates Delivery of the Health Technology Ecosystem, One Year After Launch noted progress in initiatives such as the National Provider Directory, Medicare App Library, Blue Button access services, and technology-enabled solutions that help patients access and manage their health information. The event concluded with a focus on future priorities, including real-time benefits, price transparency, advanced appointment scheduling, clinical trial matching, expanded FHIR capabilities, and broader industry participation to support a more connected healthcare system.
Educational Opportunities
CCSQ Quarterly Stakeholder Webinar – August 26
Wednesday, August 26 from 11 am – 12 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.
Shape the Future of PAC Interoperability – Join Us at the September HL7 FHIR Connectathon
CMS, and the PACIO (Post-Acute Care InterOperability) Project invite healthcare information technology (HIT) vendors, facilities with their own EHRs and interested third parties to participate in the PACIO testing track at the upcoming HL7 FHIR Connectathon, taking place in person September 19-20, 2026, in Rockville, MD.
What’s Being Tested?
MITRE will test a potential interoperability-focused quality measure concept: Interoperability Capability & Readiness Evaluation (I-CARE) for Post-Acute Care Settings. An early-stage quality measure concept for PAC settings, building on the feedback received through the Request for Information (RFI) included in the CY 2026 Home Health Prospective Payment System (PPS) rule.
Why Participate?
- Test real-world feasibility of I-CARE in your systems and workflows.
- Shape implementation before requirements are locked in.
- Provide direct feedback to CMS at the earliest stage possible.
Don’t miss this rare opportunity to help build a measure that works in the real world. Bring your expertise to the table — engage with the PACIO track at the September HL7 FHIR Connectathon.
Note: I-CARE is not a proposed or finalized measure. CMS is in an early, exploratory phase — and your feedback now will directly shape what comes next.
Key Details
| Event | September HL7 FHIR Connectathon — PACIO Track 2026 – 09 PACIO IG Testing Track – FHIR – Confluence |
| Dates | September 19-20, 2026, in Rockville, MD. |
| Participation Format | In person; Member Early Bird : Member $670, Non-Member $820 After 8/21: Member $885, Non-Member $1035 |
| Registration Link/Deadline | FHIR Connectathon |
| Primary Contact | James Patterson, MITRE Corporation | jpatterson@mitre.org |
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.