The Compliance Monitor (9/1/26)
The Compliance Monitor
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 was 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 17, 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 Item
CMS DMEPOS Enrollment Moratorium Has Expired
The six-month nationwide Medicare enrollment moratorium on certain DMEPOS supplier types has expired, and enrollment applications are once again being accepted.
The moratorium was implemented by CMS in February 2026 as part of ongoing efforts to address fraud, waste, and abuse within the DMEPOS supplier community.
Read the CHAP blog for additional information.
CMS Rulemaking/ Federal Register Notices/RFIs
Invitation to Provide Input on Geo AHEAD Model
CMS is seeking input from external stakeholders on a novel, geographically based accountable care organization shared savings program called Geo AHEAD that is launching under the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model in 2028. This Geo AHEAD Participation Perspectives Survey is intended to gather perspectives that will help inform future planning, policy development, and potential implementation strategies. Responses will be reviewed both individually and, in the aggregate, to identify stakeholder priorities, anticipated opportunities and challenges, and areas where additional clarification or refinement may be needed as CMS continues to develop Geo AHEAD.
Complete the survey here
Fraud and Abuse Update
NFDC Opens with Widespread Collaboration with Inspectors General and Law Enforcement Agencies
The U.S. Department of Justice announced the launch of the National Fraud Detection Center (NFDC), a prosecutor-led, multi-agency team designed to investigate the most harmful actors defrauding federal government programs, including illicit actors overseas and those operating fraud schemes across federal programs. The NFDC will bring together law enforcement agencies and analytical capabilities to generate criminal leads to drive more impactful prosecutions and enhance fraud-fighting results for the American people.
New OIG Webpage: “Durable Medical Equipment: Protecting Medicare and Medicaid from Fraud, Waste, and Abuse”
The Nation’s Challenge to Combat Durable Medical Equipment Fraud in Medicare (OEI-02-24-00311)
Durable medical equipment (DME) fraud remains a persistent challenge as bad actors continually refine schemes to evade oversight. OIG’s new white paper examines how fraudulent actors gain access to Medicare through three core elements: enrolled suppliers, physician orders, and enrollee identification numbers. The paper outlines strategic actions to address these vulnerabilities, including strengthening enrollment safeguards, leveraging modern data analytics to catch fake physician orders, and expanding protections for enrollee identification numbers.
Hospice Care Provider Updates
Hospice Payments: FY 2027 Update
Learn about updates (PDF), effective October 1, 2026:
- Payment rates
- Inpatient aggregate caps
- Wage index
HQRP Public Reporting Quarterly Refresh – August 2026
The August 2026 quarterly refresh for the Hospice Quality Reporting Program is now available on the Compare tool on Medicare.gov.
For more information, please visit the Hospice QRP Public Reporting Background and Announcements webpage and see the Hospice Wage Index Final Rule at https://www.cms.gov/Center/Provider-Type/Hospice-Center.
Hospice Preview Reports for the November 2026 Refresh – NOW AVAILABLE IN iQIES
Providers can now access the latest Provider Preview Reports via iQIES. 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 November 2026 refresh.
In the Provider Preview Reports, HOPE measure scores are based on data submitted by hospices from Quarter 1, 2025 through Quarter 4, 2025. CAHPS measure scores are based on CAHPS data submitted from Quarter 1, 2024 through Quarter 4, 2025. CAHPS Star Ratings are calculated based on data from Quarter 4, 2023 through Quarter 3, 2025. The claims-based measures reflect claims data collected from Quarter 1, 2024 through Quarter 4, 2025.
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 August 14. 2026 to September 14. Although the actual “preview period” is 30 days, the reports will continue to be available for another 30 days, or a total of 60 days. 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.
You can learn more about the Provider Preview Report (HOPE and claims‑based measures) on the Provider Preview Report webpage, and more about the CAHPS Preview Report on the CAHPS Preview Report webpage. Hospice QRP Key Dates for Providers can be found on the Hospice QRP Key Dates webpage.
Home Health Care Provider Updates
Home Health Prospective Payment System Grouper: October Update
Get the October 2026 release (Version 07.2.26 (ZIP)). See the Home Health Prospective Payment System Grouper Software webpage for a summary of changes.
More Information:
- Claims Processing Manual, Chapter 10 (PDF), section 80
Expanded HHVBP Model: Preview CY 2026 Annual Performance Reports (APRs) are Available in iQIES
Preview Calendar Year (CY) 2026 Annual Performance Reports (APRs) for the Expanded Home Health Value-Based Purchasing (HHVBP) Model are now available in iQIES. These reports give home health agencies an opportunity to review their performance results before payment adjustments are finalized.
The APRs include information on each agency’s performance under the expanded HHVBP Model, including measure-level results, cohort assignment, Total Performance Score (TPS), and the potential payment adjustment that will apply in a future payment year. Under the model, Medicare-certified home health agencies may receive an upward or downward payment adjustment of up to 5% based on their performance compared with peers.
Agencies should review their APRs carefully to confirm that the performance data, scoring, and payment adjustment information appear accurate. If an agency identifies a potential error, it may submit the appropriate request through the established CMS process by the applicable deadline.
Why this matters:
The Expanded HHVBP Model links a portion of home health payment to quality performance. The APR preview period gives agencies time to evaluate their results, understand potential financial impact, and determine whether a recalculation, reconsideration, or administrator review request is warranted.
Key actions for agencies:
- Access the Preview CY 2026 APR in iQIES.
- Review measure performance, TPS, cohort assignment, and payment adjustment information.
- Validate whether the data accurately reflect agency performance.
- Submit any applicable requests by CMS deadlines.
- Use the report to support internal quality improvement and performance monitoring.
Key deadlines:
- September 4, 2026: Recalculation requests due
- October 16, 2026: Reconsideration requests due
- November 5, 2026: Administrator review requests due
Final July 2026 Interim Performance Reports (IPRs) for the Expanded Home Health Value-Based Purchasing (HHVBP) Model are now available in iQIES. These reports provide home health agencies with their cohort assignment, measure-level performance data, and interim Total Performance Score (TPS), allowing providers to monitor how they compare with peers throughout the performance year.
As outlined in the CY 2026 Home Health (HH) Prospective Payment System (PPS) Final Rule, there are changes to the expanded HHVBP Model 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.
Expanded Home Health Value-Based Purchasing Model
DMEPOS Updates
DMEPOS Competitive Bidding Program: Get Ready for Round 2028
CMS posted new fact sheets on the Competitive Bidding Implementation Contractor (CBIC) website to help bidders continue preparing for Round 2028 of the DMEPOS Competitive Bidding Program (CBP):
- Antitrust Guidance fact sheet
- Common Ownership & Common Control fact sheet
- Round 2028 Terms & Definitions fact sheet
These fact sheets cover key requirements and rules to help you submit an informed, competitive bid.
We also updated information on the bid surety bond amount for a remote item delivery competitive bidding area based on the release of the FY 2027 Inpatient Rehabilitation Facility Prospective Payment System final rule.
What you should do:
- Visit the CBIC website – the official source for bidder information and education
- Review the new fact sheets as soon as possible
- Use these resources to understand DMEPOS CBP requirements before the bidding period opens
All Providers Updates
ICYMI: FDA Seeks Public Feedback to Inform Regulatory Approach for Generative AI-Enabled Medical Devices
The U.S. Food and Drug Administration today issued a discussion paper on considerations for the regulation of generative artificial intelligence (GenAI)-enabled medical devices, seeking feedback from interested parties on risk assessment, premarket evaluation, post market monitoring, and other topics relevant to the regulation of GenAI-enabled medical devices.
The discussion paper begins by outlining a possible two-axis framework for risk assessment that might be used to inform regulatory expectations. It then discusses a potential approach to premarket evaluation built on the concept of competency assessment, inspired at a high level by how physicians are trained and evaluated, consisting of non-clinical device benchmarking and clinical confirmation to evaluate whether a GenAI-enabled medical device performs as intended before reaching patients. The paper also describes several potential approaches to risk-proportionate post market monitoring and discusses considerations around foundation models and agentic AI systems. For each of these areas, the FDA poses targeted questions to inform the development of a regulatory framework that is scientifically rigorous, prioritizes patient safety, and aligns with the novel capabilities of GenAI-enabled medical devices.
The FDA encourages feedback on the discussion paper from device manufacturers, clinicians, consumers, researchers, the public, and other interested parties, to be submitted under the docket FDA-2026-N-7874 on Regulations.gov by October 19, 2026.
CMS CCSQ Launches QualTech to Identify Innovative Technology Solutions
The Centers for Medicare & Medicaid Services (CMS), through the Center for Clinical Standards and Quality (CCSQ), is launching QualTech, an industry event initiative designed to identify innovative technology solutions aligned to key quality-related priorities and advance better health outcomes for all Americans.
CMS invites proposed technology solutions from U.S.-based teams, academic institutions, nonprofit organizations, private sector entities, industry associations, and other organizations with technology solutions or capabilities aligned to CMS quality priorities.
Following review of submissions, finalists will be invited to participate in the QualTech Event at CMS Headquarters, where they will present their proposed technology solutions to CMS and CCSQ leadership, subject matter experts, and invited stakeholders. Following the QualTech Event, CMS may pursue continued engagement with select organizations, including future demonstrations, pilots, collaboration discussions, and a potential role in the 2027 CMS Quality Conference.
Additional information, including eligibility, key dates, participation benefits, and the submission process, is available on the QualTech website: https://www.cms.gov/cms-ccsq-qualtech-0.
We encourage you to share this opportunity with colleagues and organizations that may have innovative technology solutions aligned with CMS quality priorities.
If you have any questions, please contact the CMS CCSQ QualTech team at CCSQQualTech@cms.hhs.gov.
For more information on CCSQ, including the Center’s Strategic Roadmap, please review CCSQ’s blog and accompanying fact sheet from earlier this year.
ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2027 Update (1 of 2)
Learn about updates (PDF), effective January 1, 2027.
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 |
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.