New Medicare Compliance Regulations Effective January 2026: Key Changes
Beginning January 1, 2026, entities in the Medicare program must adhere to new regulatory compliance requirements as stipulated in the CY 2026 Home Health Agency Prospective Payment System (HH PPS) final rule. Published by the Centers for Medicare & Medicaid Services (CMS) on December 2, 2025, these changes aim to enhance compliance across Medicare providers and suppliers.
One significant update grants CMS expanded authority to retroactively revoke Medicare enrollment for non-compliance, applicable to all Medicare service providers. Previously, revocations were generally prospective, effective 30 days after notification. Now, revocations can be backdated, allowing CMS to reclaim previously issued payments for services linked to non-compliance from the start of a provider's enrollment issue.
Providers must ensure the accuracy of their enrollment information, as CMS can deny or revoke enrollment based on false or misleading details, regardless of intent. Retroactive revocation is possible if necessary updates, such as ownership changes or practice location shifts, are not promptly reported.
Increased Compliance Monitoring
CMS has expanded its authority to pause enrollment applications during compliance investigations. This includes new shortened reporting timelines for adverse legal actions, requiring notification within 30 days instead of the prior 90 days. This change aligns with CMS's goal of swift enforcement actions.
For Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers, new rules require annual surveys and reaccreditation, a shift from the previous three-year cycle. Suppliers must maintain constant compliance readiness, as any non-compliance may lead to enrollment revocation.
The Medicare "36-Month Rule" now applies to DMEPOS suppliers, extending a regulation initially for home health and hospice agencies. Changes in majority ownership within 36 months of initial enrollment or a prior ownership change necessitate re-enrollment, impacting payment continuity and potentially altering healthcare transaction timelines and structures.
These regulatory updates are designed to ensure qualified and compliant providers are the sole recipients of Medicare payments, aligning with CMS's goal to protect Medicare resources. Medicare providers and suppliers need to thoroughly understand these changes and proactively adjust their compliance practices to navigate this evolving regulatory environment effectively.