2026 Hospital IQR Requirements

If you're trying to make sense of your 2026 Hospital Inpatient Quality Reporting (IQR) program requirements, good news: CMS has streamlined several areas while maintaining the core structure you're already familiar with. The most notable changes include the removal of four measures (including the COVID-19, health equity and social drivers of health measures) and significant adjustments to your hybrid measure requirements.

This step-by-step guide to your 2026 Hospital IQR requirements can help you make it your most successful reporting year yet.

Summary of Changes to the IQR Requirements

NEW: Required HAI Measures

• CAUTI-Onc: Catheter-Associated Urinary Tract Infection (CAUTI) Standardized Infection Ratio Stratified for Oncology Locations measure
• CLABSI-Onc: Central Line-Associated Bloodstream Infection Standardized Infection (CLABSI) Ratio Stratified for Oncology Locations measure

NEW: Available eCQMs

1. HH-FI: Hospital-Harm—Falls with Injury
2. HH-RF: Hospital Harm—Postoperative Respiratory Failure

REMOVED: Structural and Process Measures

1. HCHE: Hospital Commitment to Health Equity
2. SDOH-01: Screening for Social Drivers of Health
3. SDOH-02: Screen Positive Rate for Social Drivers of Health

REMOVED: HAI Measure

1. HCP COVID-19: COVID-19 Vaccination Coverage Among Healthcare Personnel

UPDATED: Hybrid Measures

1. Lower reporting thresholds from 90-95% to 70% for CCDEs and linking variables
2. Allow up to two missing laboratory results and two missing vital signs

UPDATED: Claims Measures

1. COMP-HIP-KNEE: Adding MA patients, shortening performance period to two years, using ICD-10 codes instead of HCCs
2. MORT-30-STK: Adding MA patients, shortening performance period to two years, using ICD-10 codes instead of HCCs

REMOVED: COVID-19 Exclusions

Removal of COVID-19 exclusions from all measures that currently include them, beginning with FY 2028. This affects:

• MORT-30-STK
• COMP-HIP-KNEE
• AMI Excess Days
• HF Excess Days
• PN Excess Days
• Hybrid Hospital-Wide Readmission (HWR)
• Hybrid Hospital-Wide Mortality (HWM)

2026 IQR Requirements Summary

These mandatory requirements are due quarterly:

• Submit one chart-abstracted measure
• Submit population and sampling numbers (for your chart-abstracted measure only)
• Submit HCAHPS survey data
• Submit two Healthcare-Associated Infection (HAI) measures

These mandatory requirements are due annually:

• Submit one PRO-PM measure (pre-op data + post-op data)
• Submit eight eCQMs (five required + three self-selected)
• Submit two hybrid measures
• Submit three structural measures
• Complete the Data Accuracy and Completeness Acknowledgement (DACA)
• Submit the Influenza Immunization Healthcare-Associated Infection (HAI) measure

You must also:

• Regularly review your claims-based data  

1. Submit One PRO-PM Annually

Building on the first year of mandatory PRO-PM reporting, you'll continue to submit the Hospital-Level Total Hip Arthroplasty/Total Knee Arthroplasty Patient-Reported Outcome-Based Performance Measure (THA/TKA PRO-PM).

	REQUIREMENT: Hospitals must submit pre-op and post-op data for the THA/TKA PRO-PM.
	SUBMISSION METHOD: Hospital Quality Reporting (HQR) System
	DEADLINE: Pre-op data: September 30, 2026  Post-op data: September 30, 2027

2. Submit Six eCQMs Annually

The number of required eCQMs has increased in 2026. You must submit four quarters (a full year) of data on five mandatory eCQMs and three self-selected ones. The newly required eCQMs are Hospital Harm – Hypoglycemia and Hospital Harm – Hyperglycemia. CMS will publicly report your performance on Care Compare. Be prepared for this requirement to steadily ramp up. You must submit nine eCQMs in 2027, and 11 in 2028.

The good news is that CMS is giving you more and more options to choose from, adding two optional eCQMs to the list for 2026.

	REQUIREMENT: Hospitals must report four quarters of data for at least eight of the available eCQMs. Hospitals MUST submit the Safe Use of Opioids, Cesarean Birth, Severe Obstetric Complications, Hospital Harm – Hypoglycemia, and Hospital Harm – Hyperglycemia eCQMs as five of their eight eCQMs.
	SUBMISSION METHOD: Hospital Quality Reporting (HQR) System
	DEADLINE: February 28, 2027*

*These are anticipated submission dates based on previous years. CMS has not officially released these submission dates.

eCQM Auditing Process

Beginning in 2025, CMS modified the data validation (audit) scoring system to include two distinct validation scores: one for clinical processes of care (CPoC) measures and one for eCQMs. Each score will carry an equal weight (50%). Hospitals must achieve passing scores in both measure types to secure the full annual payment update.

Previously, eCQM validation was assigned a weight of zero to allow hospitals time to gain experience with eCQM reporting and validation. However, hospitals that undergo audits from now on will have their eCQMs assessed for data accuracy, with a minimum acceptable accuracy threshold set at 75%.

3. Submit Two Hybrid Measures Annually

CMS made significant changes to the 2026 hybrid measure requirements that should make compliance considerably more achievable. The updates lower the reporting thresholds from 90-95% to 70% for both Core Clinical Data Elements (CCDEs) and linking variables. Additionally, CMS will allow up to two missing laboratory results and up to two missing vital signs among the required CCDE data elements.

These changes are in response to widespread feedback from hospitals about the difficulty of meeting the current thresholds.

	REQUIREMENT: Hospitals must report four quarters of data for the two hybrid measures.
	SUBMISSION METHOD: Hospital Quality Reporting (HQR) System
	DEADLINE: September 30, 2026

*These are anticipated submission dates based on previous years. CMS has not officially released these submission dates.

4. Submit One Chart-Abstracted Measure Quarterly

CMS did not make any changes to the 2026 chart-abstracted measure requirements.

	REQUIREMENT: Hospitals must report on one Chart-Abstracted measure: Sepsis.
	SUBMISSION METHOD: Hospital Quality Reporting (HQR) System
	DEADLINE: Quarterly Submission Deadline

*These are anticipated submission dates based on previous years. CMS has not officially released these submission dates.

5. Submit Population and Sample Size Data Quarterly

CMS did not make any changes to the 2026 population and sampling requirements for the SEP-1 chart-abstracted measure.

	REQUIREMENT: Hospitals must submit population and sampling numbers for the one required chart-abstracted measure: Sepsis.
	SUBMISSION METHOD: Hospital Quality Reporting (HQR) System
	DEADLINE: Quarterly Submission Deadlines

*These are anticipated submission dates based on previous years. CMS has not officially released these submission dates. 

6. Submit Three Structural Measures Annually

This year, CMS removed one of the four structural measures currently required: the Hospital Commitment to Health Equity (HCHE) measure. You must submit the remaining three structural measures for 2026.

	REQUIREMENT: Hospitals must submit four Structural measures.
	SUBMISSION METHOD: Hospital Quality Reporting (HQR) System & National Healthcare Safety Network (NHSN) Portal (Patient Safety Structural Measure only)
	DEADLINE: May 15, 2027*

*These are anticipated submission dates based on previous years. CMS has not officially released these submission dates.

7. Report HCAHPS Data Quarterly

CMS did not make any changes to the 2026 HCAHPS survey requirements. The survey modifications implemented in 2025 (which brought the total number of measures from 29 to 32) remain in place.

	REQUIREMENT: Hospitals must report Patient Experience of Care Survey measures data.
	SUBMISSION METHOD: Hospital Quality Reporting (HQR) System
	DEADLINE: Quarterly Submission Deadline

*These are anticipated submission dates based on previous years. CMS has not officially released these submission dates.

8. Complete DACA Annually

CMS did not make any changes to the 2026 DACA requirements.

	REQUIREMENT: Hospitals must complete the Data Accuracy and Completeness Acknowledgment (DACA).
	SUBMISSION METHOD: Hospital Quality Reporting (HQR) System
	DEADLINE: May 15, 2027

Data Accuracy and Completeness Acknowledgment (DACA) is a requirement for hospitals participating in the IQR program. The DACA is a method of electronically attesting that the data they submit to the program is accurate and complete to the best of their knowledge. You can attest anytime between April 1 - May 15, 2027. Hospitals may complete the DACA within the Hospital Quality Reporting (HQR) System. 

9. Report Three HAI Measures

For 2026, CMS has added two new Healthcare-Associated Infection measures that stratify CLABSI and CAUTI data for oncology locations. These measures are now mandatory.

	REQUIREMENT: Hospitals must report on three HAI measures
	SUBMISSION METHOD: National Healthcare Safety Network (NHSN) Portal
	DEADLINE: Influenza Vaccination Annual Submission Deadline  CLABSI and CAUTI Monthly Submission Deadlines

*These are anticipated submission dates based on previous years. CMS has not officially released these submission dates.

10. Review Your Claims-Based Data

CMS has proposed updates to two claims-based measures that would add Medicare Advantage patients, shorten the performance period from three years to two years, update the risk adjustment model to use ICD-10 codes instead of Hierarchical Condition Categories (HCCs), and remove the COVID-19 exclusion. These proposed changes affect the COMP-HIP-KNEE and MORT-30-STK measures.

Additionally, CMS has proposed to remove COVID-19 exclusions from all measures beginning with FY 2028 (which affects the 2026 reporting year). And finally, Medicare Spending Per Beneficiary (MSBP) is removed from the IQR program (though retained in other CMS programs).

	REQUIREMENT: Hospitals are evaluated for their performance on six Claims-Based measures in four categories.
	SUBMISSION METHOD: No additional submission is required
	DEADLINE: No Submission Deadline

Claims-Based Patient Safety Measures 

2025 IQR Next Steps

Even with proposed simplifications, Hospital IQR requirements remain complex and demanding. That's where Medisolv can lend a hand. That’s where Medisolv can lend a hand. Our game-changing Hospital Quality Reporting package makes it dramatically easier to meet all your IQR requirements, ensure your full Medicare reimbursements, and (most importantly) advance patient care every day.

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