Compliance and accreditation news: week of October 4, 2026
CMS and CDC published a proposed CLIA rule. CMS's MLN Connects newsletter stated a MIPS virtual group election deadline, and CMS issued a revised hospital database worksheet memo and payment and claims transmittals. The Trump Administration announced Rural Health Transformation Program funding for North Carolina.
Proposed CLIA rule on virtual access, gynecologic cytology proficiency testing and personnel
CMS and the Centers for Disease Control and Prevention (CDC) published a proposed rule in the Federal Register on October 8, 2026 that "…would amend the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations to allow for virtual access under the CLIA certificate of the primary testing laboratory that generated the data, with the exception of the subspecialty of cytology, and the use of digital images for gynecologic cytology proficiency testing." The rule also proposes changes to personnel qualification requirements, to SARS-CoV-2 reporting, certificate, test reporting, enforcement and public consultation requirements, and editorial and technical updates. Comments are due December 7, 2026 (file code CMS-3478-P). Source: Centers for Medicare & Medicaid Services and Centers for Disease Control and Prevention, "Clinical Laboratory Improvement Amendments of 1988 (CLIA); Virtual Access, Gynecologic Cytology Proficiency Testing (PT), Personnel Qualifications, and Other Changes", October 8, 2026. https://www.govinfo.gov/content/pkg/FR-2026-10-08/html/2026-20613.htm
2027 MIPS virtual group election period, submit by December 31
CMS's MLN Connects newsletter of October 8, 2026 stated that for the 2027 Merit-based Incentive Payment System (MIPS) performance year, "…the election period started on October 1, 2026." It also stated: "To form a virtual group, submit your election to CMS at MIPS_VirtualGroups@cms.hhs.gov by December 31, 2026." The notice is addressed to those interested in forming a virtual group for the 2027 MIPS performance year. Source: Centers for Medicare & Medicaid Services, "Quality Payment Program: 2027 Virtual Group Election Period – Submit by December 31", October 8, 2026. https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-october-8-2026
Exhibit 286 hospital, CAH and REH database worksheet revised
CMS issued transmittal R249SOMA, "Exhibit 286, Hospital, Critical Access Hospital (CAH) and Rural Emergency Hospital (REH) Database Worksheet", on October 9, 2026, with an implementation date of October 9, 2026. Source: Centers for Medicare & Medicaid Services, "Exhibit 286, Hospital, Critical Access Hospital (CAH) and Rural Emergency Hospital (REH) Database Worksheet (Transmittal R249SOMA)", October 9, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r249soma The same day, CMS posted a revised version of policy memo S&C-12-06-Hospitals/CAHs/REH, the instructions for completing Exhibit 286. The original memo was released December 2, 2011. Source: Centers for Medicare & Medicaid Services, "REVISED: Instructions for Completing Exhibit 286, Hospital/Critical Access Hospital (CAH)/Rural Emergency Hospital (REH) Database Worksheet", October 9, 2026. https://www.cms.gov/medicare/provider-enrollment-and-certification/surveycertificationgeninfo/policy-and-memos-to-states-and-regions-items/cms1254593
October 2026 update of the ASC payment system
CMS issued transmittal R13983CP (Change Request 14634), "October 2026 Update of the Ambulatory Surgical Center (ASC) Payment System", on October 8, 2026, with an implementation date of October 5, 2026. Source: Centers for Medicare & Medicaid Services, "October 2026 Update of the Ambulatory Surgical Center (ASC) Payment System (Transmittal R13983CP)", October 8, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13983cp
Inpatient psychiatric facility PPS updates for fiscal year 2027
CMS issued transmittal R14000CP (Change Request 14591), "Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2027", on October 8, 2026, with an implementation date of October 5, 2026. Source: Centers for Medicare & Medicaid Services, "Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2027 (Transmittal R14000CP)", October 8, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r14000cp
Annual update of HCPCS codes for home health consolidated billing
CMS issued transmittal R13988CP (Change Request 14639), "Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes Used for Home Health Consolidated Billing Enforcement", on October 8, 2026, with an implementation date of January 4, 2027. Source: Centers for Medicare & Medicaid Services, "Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes Used for Home Health Consolidated Billing Enforcement (Transmittal R13988CP)", October 8, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13988cp
Home health reason code 19963 edit: notice of admission not found
CMS issued transmittal R13996OTN, "Home Health Reason Code 19963 Edit – Notice of Admission Not Found", on October 8, 2026, with an implementation date of April 5, 2027. Source: Centers for Medicare & Medicaid Services, "Home Health Reason Code 19963 Edit – Notice of Admission Not Found (Transmittal R13996OTN)", October 8, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13996otn
Revised edits to prevent overpayment of long-term hospice stays
CMS issued transmittal R13997OTN (Change Request 14622), "Revisions to the Edits to Prevent Overpayment of Long-term Stay in Hospice", on October 8, 2026, with an implementation date of April 5, 2027. Source: Centers for Medicare & Medicaid Services, "Revisions to the Edits to Prevent Overpayment of Long-term Stay in Hospice (Transmittal R13997OTN)", October 8, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13997otn
Update on payment accuracy for physician services in skilled nursing facilities
CMS issued transmittal R13995CP, "Enhancing Compliance and Payment Accuracy for Physician Services in Skilled Nursing Facilities-Update", on October 8, 2026, with an implementation date of April 5, 2027. Source: Centers for Medicare & Medicaid Services, "Enhancing Compliance and Payment Accuracy for Physician Services in Skilled Nursing Facilities-Update (Transmittal R13995CP)", October 8, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13995cp
More than $17 million in rural health funding for North Carolina
On October 7, 2026, a CMS press release stated that the Trump Administration announced "…more than $17 million in Rural Health Transformation Program (RHTP) funding to expand mental health and substance use disorder services for North Carolina's rural residents." The release breaks this down as $4 million for three new mental health clinics, $3 million for stationary medication units in five counties to expand access to medications for opioid use disorder, $4 million for mobile crisis teams in six additional counties, and another $6.7 million to help young people get early support when they first start experiencing serious mental health symptoms, build regional partnerships so communities can respond faster to crisis, and give new and expecting mothers in underserved areas better access to mental health care. Source: Centers for Medicare & Medicaid Services, "Trump Administration Announces More Than $17 Million for New Mental Health Clinics, Mobile Crisis Teams, and Expanded Addiction Treatment in North Carolina", October 7, 2026. https://www.cms.gov/newsroom/press-releases/trump-administration-announces-more-17-million-new-mental-health-clinics-mobile-crisis-teams
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