Compliance and accreditation news: week of November 2, 2026
CMS issued CY 2027 final rules for hospital outpatient and ambulatory surgical center payment, home health payment and the Medicare Shared Savings Program. It also issued a final rule revising the Conditions for Coverage for organ procurement organizations.
Accreditor news pages checked
NCQA, ACHC, CARF and NABP news pages were checked through November 5, 2026. None carried a new accreditation standard dated November 2 through November 5, 2026.
CMS revises Conditions for Coverage for organ procurement organizations
CMS published a final rule on November 3, 2026, that "revises the Conditions for Coverage for Organ Procurement Organizations (OPOs) to clarify outstanding procedural questions and provide additional operational flexibility for OPOs…" The rule "revises definitions, revises the designation requirements for OPOs, clarifies when an OPO's service area is open for competition, and updates the process for appeals." CMS states that the rule "does not revise the focus on improving the volume of donors and transplants assessed in the outcome measures or the tier structure used for re-certification and de-certification of OPOs." The rule says: "These regulations are effective on January 4, 2027." Source: Centers for Medicare & Medicaid Services, "Medicare and Medicaid Programs; Organ Procurement Organizations Conditions for Coverage: Revisions to the Conditions for Coverage", November 3, 2026. https://www.govinfo.gov/content/pkg/FR-2026-11-03/html/2026-22381.htm
CMS issues CY 2027 outpatient and ambulatory surgical center final rule
On November 4, 2026, CMS "issued a final rule that updates Medicare payment policies and rates for hospital outpatient and Ambulatory Surgical Center (ASC) services" for calendar year 2027. CMS stated that it "is updating payment rates for drugs purchased under the 340B Drug Pricing Program to better reflect what hospitals pay for these medications." CMS's press release says the rule also continues to phase out the Inpatient Only procedure list and continues to expand the ASC covered procedures list. Source: Centers for Medicare & Medicaid Services, "Calendar Year 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Final Rule (CMS-1850-F)", November 4, 2026. https://www.cms.gov/newsroom/fact-sheets/calendar-year-2027-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center-0 Source: Centers for Medicare & Medicaid Services, "Medicare Outpatient Final Rule Expands Surgical Options, Lowers Out-of-Pocket Costs for 340B Drugs", November 4, 2026. https://www.cms.gov/newsroom/press-releases/medicare-outpatient-final-rule-expands-surgical-options-lowers-out-pocket-costs-340b-drugs
Outpatient and surgical center rule published as final rule with comment period
CMS published the outpatient and ambulatory surgical center rule in the Federal Register on November 6, 2026, as a "final rule with comment period." Its summary states: "We finalized the expansion of the prior authorization requirement to include additional Botulinum Toxin Injection services." CMS also finalized a policy under which hospital accrediting organizations with deeming authority may assess certain Emergency Medical Treatment and Labor Act (EMTALA) administrative requirements during accreditation and reaccreditation surveys. The rule's title also lists a request for information on hospital price transparency data. The rule is effective January 1, 2027, and comments are due January 4, 2027. Source: Centers for Medicare & Medicaid Services, "Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs…", November 6, 2026. https://www.govinfo.gov/content/pkg/FR-2026-11-06/html/2026-22739.htm
CMS finalizes CY 2027 home health rule and Medicare enrollment changes
On November 4, 2026, CMS "issued a final rule that announces policy changes under the Home Health (HH) Prospective Payment System (PPS)…" In the rule, CMS is "finalizing several provider enrollment provisions" and states that "Most of the provisions will apply to all provider types enrolled in the Medicare program." Among them, CMS is "finalizing a policy to make all revocation grounds retroactive." Under the rule, hospices, home health agencies and DMEPOS suppliers "must reenroll in Medicare as a new provider and undergo a survey/accreditation if they experience certain changes in majority ownership." CMS's November 5, 2026 MLN Connects edition reports the changes are "expected to save taxpayers approximately $82 million annually…" Source: Centers for Medicare & Medicaid Services, "Calendar Year (CY) 2027 Home Health Prospective Payment System Final Rule - CMS-1844-F", November 4, 2026. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-home-health-prospective-payment-system-final-rule-cms-1844-f Source: Centers for Medicare & Medicaid Services, "CY 2027 Home Health Prospective Payment System Final Rule", November 5, 2026. https://www.cms.gov/training-education/medicare-learning-network/newsletter/mln-connects-newsletter-november-5-2026
Physician fee schedule final rule changes the Shared Savings Program
On November 4, 2026, CMS issued the CY 2027 Medicare Physician Fee Schedule final rule (CMS-1848-F), "which includes changes to the Medicare Shared Savings Program…" CMS is finalizing an increase in the shared savings rate for Level E of the BASIC track from 50% to 60%. CMS states that "…ACOs applying for an agreement period start date of Jan.1, 2027, will be able to change their final selection during Phase 2 RFI (Nov. 12-17, 2026, at 12:00 p.m. (noon) ET)." Source: Centers for Medicare & Medicaid Services, "Calendar Year (CY) 2027 Medicare Physician Fee Schedule Final Rule (CMS-1848-F) — Medicare Shared Savings Program", November 4, 2026. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-final-rule-cms-1848-f-medicare-shared-savings
CMS updates critical access hospital rural and distance evaluations
CMS issued transmittal R251SOMA, "Updates to Critical Access Hospital Rural and Distance Evaluations," on November 4, 2026. Its implementation date is also November 4, 2026. Source: Centers for Medicare & Medicaid Services, "Updates to Critical Access Hospital Rural and Distance Evaluations (Transmittal R251SOMA)", November 4, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r251soma
CMS modifies Medicare Secondary Payer edit SP31 in the Common Working File
CMS issued transmittal R14036OTN (Change Request 14670) on November 5, 2026. It modifies Medicare Secondary Payer maintenance edit SP31 "to Set When Zeros or Blanks are in the Effective Date Field for Non-Group Health Plan (NGHP) MSP Types." The implementation date is April 5, 2027. Source: Centers for Medicare & Medicaid Services, "The Common Working File (CWF) to Modify both CABEDMSP Program for Medicare Secondary Payer (MSP) Maintenance Edit 'SP31' to Set When Zeros or Blanks are in the Effective Date Field for Non-Group Health Plan (NGHP) MSP Types (Transmittal R14036OTN)", November 5, 2026. https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r14036otn
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