Centers for Medicare & Medicaid Services Requirements
CMS security and privacy requirements for organizations handling Medicare and Medicaid data. Includes Minimum Acceptable Risk Standards (MARS-E) and Acceptable Risk Safeguards (ARS).
What CMS draws on
This framework pulls on all three pillars — which is why running them as three separate tools means reconciling three sets of evidence at audit time.
Compliance
Security
What your auditor cites,
and what produces the evidence
The regulator's text is quoted below in italic, exactly as written. What follows each one is what the platform records, detects, or proves — not a claim about your compliance status, which no tool can confer.
Audit Events
Systems MUST be capable of auditing successful and unsuccessful account logon events, account management, and object access.
Authorisation is configured in the database; proving it holds is what this requirement actually needs. Vulnerability scanning surfaces excessive privilege and role sprawl, default and weak credentials, and stale or orphaned accounts — including privilege inherited through nested roles, which is where least-privilege reviews usually go wrong. Real-time SQL auditing then shows which of those grants were exercised, so an access review reflects observed use rather than intent.
Content of Audit Records
Audit records MUST contain type of event, when occurred, where occurred, source, outcome, and identity of individuals.
A record of processing is only as good as the layer producing it. Real-time SQL auditing captures every statement against the data — the identity, the session, the client, the objects touched, the outcome — with no nightly batch window where activity goes unrecorded. Classification is what makes that a record of *regulated* data rather than a log of everything: it tells you which tables are in scope, so the register describes the processing you actually have to declare. Policy templates then produce it in the shape the framework asks for, instead of leaving you to assemble it from raw logs the week before an inspection.
Account Management
Organizations MUST manage information system accounts including identifying account types and establishing conditions for membership.
Authorisation is configured in the database; proving it holds is what this requirement actually needs. Vulnerability scanning surfaces excessive privilege and role sprawl, default and weak credentials, and stale or orphaned accounts — including privilege inherited through nested roles, which is where least-privilege reviews usually go wrong. Real-time SQL auditing then shows which of those grants were exercised, so an access review reflects observed use rather than intent.
Audit Review
Organizations MUST review and analyze system audit records for indications of inappropriate or unusual activity.
Rules catch what you already thought of. Behavioural models baseline every user and application against their own history and their peer group, then score deviations in real time — so a service account reading tables it has never touched surfaces without anyone having written a rule for it first. That is what makes monitoring hold up as access patterns change, instead of decaying into a ruleset nobody maintains.
What CMS covers
This instrument defines no data category of its own. Borrows HIPAA’s definition of protected health information and adds programme integrity requirements on top. It defines no data class of its own.
How CMS is enforced
Every figure below is the ceiling the instrument publishes about itself, not a prediction of what anything would cost. Enforced by The Centers for Medicare & Medicaid Services, with the OIG and DOJ for fraud.
CMS enforces through the programme rather than through a fine schedule. Conditions of participation are audited, findings produce a corrective action plan, and unresolved findings escalate to suspension of payment and ultimately termination. Where claims data is involved the False Claims Act applies on top.
The monetary exposure in this area almost always arrives through the False Claims Act rather than through a CMS penalty.
Uncapped exposure that sits outside this instrument
These come from company law rather than from CMS, and they are not penalties — they are liability for a loss, which is why nothing caps them at a published maximum.
Duty of oversight
Delaware, and followed in most US corporate jurisdictions. It is a rule of company law, not of any privacy or security statute.
Triggered by. A sustained or systematic failure by the board to establish a reporting system for a mission-critical risk — or, having one, consciously disregarding what it reported. The second limb is what a documented, unremediated finding goes to.
Who. Directors, in their personal capacity, in a derivative action brought on behalf of the company.
This is liability for the loss the company suffered, not a statutory penalty, so nothing caps it at a published maximum. A bad-faith finding also takes the conduct outside the exculpation and indemnification the charter would otherwise provide.
In re Caremark Int’l Deriv. Litig. (Del. Ch. 1996); Marchand v. Barnhill (Del. 2019); In re Boeing Co. Deriv. Litig. (Del. Ch. 2021).
Enforcement data reviewed August 2026. Several figures are indexed annually and move.
Built for CMS,
not configured for it afterwards
Medicare/Medicaid Data Monitoring
Track all access to beneficiary data and claims information
CMS MARS-E Compliance Report
Evidence package for CMS security assessments
CMS Data Patterns
Detect Medicare IDs, Medicaid IDs, and beneficiary information
Unusual Access Pattern Detection
Alert on anomalous access to Medicare/Medicaid data
Other Healthcare frameworks
Walk into the CMS audit knowing the answer
228 cited requirements across 57 frameworks are mapped to the controls that evidence them. A fixed-fee gap assessment tells you which of them you can already prove today.