www.cms.gov: Accessibility — week 2026-W38

Automated Accessibility Conformance Report (OpenACR): Download ACR. Machine-readable; compatible with GSA OpenACR tooling. Automated tools find ~⅓ of real barriers — supplement with manual AT testing.

Training priorities

Top WCAG success criteria by pages affected this week. Use these to focus team training on the highest-impact issues.

SC	Criterion	Pages	Rules	Notes
1.4.8	WCAG 1.4.8	696	4	Component inconsistency
2.5.5	WCAG 2.5.5	491	1
1.4.1	Use of Color	430	2
1.3.1	Info and Relationships (semantic structure)	399	9
3.1.1	Language of Page	361	2

Next 10 actions

Clusters are fingerprinted by normalized selector path + rule id + snippet shape. Rank score = (severity weight × pages affected) / distinct components for the rule. This supersedes the template threshold heuristic while still surfacing it as a validation signal.

Design-system alignment (cms-ds / default). No design-system components detected in sampled findings.

Top 10 clustered component fixes for this week.
Cluster	Severity	Pages	Who it affects	How to fix	Evidence	Decision
<html> element must have a lang attribute · unattributed component Fix one place, resolve ~305 finding(s) on 305 page(s). XPath / selector: `html` `<html>`	Serious	305	Without vision, Limited cognitive, language, or learning ability	Add a lang attribute to <html> (e.g. lang="en").	pages (CSV)	Decision Assigned to Notes
Form field label is visible · unattributed component Fix one place, resolve ~435 finding(s) on 435 page(s). XPath / selector: `{"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys`	Moderate	435	Requires manual testing.	See remediation guidance: https://alfa.siteimprove.com/rules/sia-r61	pages (CSV)	Decision Assigned to Notes
Document should have one main landmark · unattributed component Fix one place, resolve ~305 finding(s) on 305 page(s). XPath / selector: `html` `<html>`	Moderate	305	Requires manual testing.	Each page should have exactly one <main> landmark.	pages (CSV)	Decision Assigned to Notes
Images must have alternative text · unattributed component Fix one place, resolve ~293 finding(s) on 293 page(s). XPath / selector: `img[src$="cms-site-logo.png"]` `<img src="cms-site-logo.png">`	Critical	293	Without vision, Limited vision, Limited cognitive, language, or learning ability	Give every <img> a meaningful alt attribute. Use alt="" only for decorative images so screen readers skip them.	pages (CSV)	Decision Assigned to Notes
Scrolling content can be accessed by keyboard · unattributed component Fix one place, resolve ~163 finding(s) on 163 page(s). XPath / selector: `text: "Feedback"`	Moderate	163	Requires manual testing.	See remediation guidance: https://alfa.siteimprove.com/rules/sia-r57	pages (CSV)	Decision Assigned to Notes
Document has a valid lang attribute · unattributed component Fix one place, resolve ~56 finding(s) on 56 page(s). XPath / selector: `<html>`	Moderate	56	Without vision, Limited cognitive, language, or learning ability	Add a valid lang attribute to <html>.	pages (CSV)	Decision Assigned to Notes
Image has accessible name · unattributed component Fix one place, resolve ~55 finding(s) on 55 page(s). XPath / selector: `<img src="cms-site-logo.png">`	Moderate	55	Without vision, Limited vision, Limited cognitive, language, or learning ability	Give every <img> an accessible name (alt text), or alt="" if purely decorative.	pages (CSV)	Decision Assigned to Notes
Element has required owned roles · unattributed component Fix one place, resolve ~55 finding(s) on 55 page(s). XPath / selector: `<h1>`	Moderate	55	Without vision, Limited vision, Limited cognitive, language, or learning ability	See remediation guidance: https://alfa.siteimprove.com/rules/sia-r64	pages (CSV)	Decision Assigned to Notes
Headings should not be empty · unattributed component Fix one place, resolve ~293 finding(s) on 293 page(s). XPath / selector: `h1:nth-child(2)` `<h1></h1>`	Minor	293	Requires manual testing.	Remove empty headings or give them text. Don't use heading tags for spacing.	pages (CSV)	Decision Assigned to Notes
Text has enhanced contrast · unattributed component Fix one place, resolve ~189 finding(s) on 189 page(s). XPath / selector: `text: "Here's how you know"`	Moderate	189	Requires manual testing.	Increase text contrast to meet WCAG AAA (7:1).	pages (CSV)	Decision Assigned to Notes

Bug reports

14 issue type(s) are shown by default out of 39 total. Prioritized by severity, key pages, WCAG level, and prevalence; use the toggle to show everything.

Overall severity mix: 3 critical, 7 serious, 27 moderate, 2 minor. By WCAG category: 15 WCAG 2.0 A, 4 WCAG 2.0 AA, 1 WCAG 2.2 AA, 3 WCAG 2.x AAA, 9 Best Practice, 7 Undetermined. Ordered by severity, key-page impact, WCAG level, and prevalence. Following accessibility bug-reporting best practices. Download: Markdown · JSON (full archive) · JSON (AI diagnostic) · CSV (all findings) · Priority pages CSV · Priority pages JSON.

Automated testing does not establish full WCAG conformance. Findings in the verification lane require manual testing before they are treated as confirmed failures.

Default view shows 14 prioritized issue type(s); 25 more are available if you switch to "Show everything".

3 finding(s) marked "possible duplicate" — Alfa and axe-core both flagged the same WCAG SC on overlapping pages. If they target the same element, the axe-core report is authoritative. Filter the CSV by possible_duplicate_of to see these. Two engines flagging the same barrier reduces the chance of a false positive.

Findings needing review

These findings need manual verification before they can be treated as confirmed failures. Obligation remains visible for each finding.

Serious axe html-has-lang WCAG 2.0 A <html> element must have a lang attribute (WCAG 3.1.1) 305/4664 pages · 305 instances Likely template

Bug ID: VS-d3d81fae
Pattern ID: VS-c126b6a6
Combined ID: VS-d3d81fae (pattern VS-c126b6a6) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 3.1.1 Language of Page (Level A, WCAG 2.0)
Rule: axe-core — <html> element must have a lang attribute [html-has-lang]
Example URL: http://www.cms.gov/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html
XPath / selector: html
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<html>

Description

<html> element must have a lang attribute. Detected by axe-core rule html-has-lang on 305 of 4664 scanned pages (305 instances).

Steps to reproduce

Open http://www.cms.gov/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html.
Locate the element: html
Confirm the axe-core finding for rule html-has-lang against WCAG 3.1.1 Language of Page.

Impact

Affects Without vision (1.0%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

…and more — all 305 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Add a lang attribute to <html> (e.g. lang="en").

Drupal tip: Drupal sets the page lang attribute from Admin › Configuration › Regional and Language › Languages. Ensure the default language is configured.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/html-has-lang?application=axeAPI

Triage status Notes

Critical axe image-alt WCAG 2.0 A Images must have alternative text (WCAG 1.1.1) 294/4664 pages · 295 instances Likely template

Bug ID: VS-8b7fb0ff
Pattern ID: VS-9074b4dd
Combined ID: VS-8b7fb0ff (pattern VS-9074b4dd) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.1.1 Non-text Content (Level A, WCAG 2.0)
Rule: axe-core — Images must have alternative text [image-alt]
Example URL: http://www.cms.gov/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html
XPath / selector: img[src$="cms-site-logo.png"]
History: first seen 2026-W24, last seen 2026-W38 (14 wk)

HTML snippet — use this to validate the finding without re-running the tool

<img src="cms-site-logo.png">

Description

Images must have alternative text. Detected by axe-core rule image-alt on 294 of 4664 scanned pages (295 instances).

Steps to reproduce

Open http://www.cms.gov/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html.
Locate the element: img[src$="cms-site-logo.png"]
Confirm the axe-core finding for rule image-alt against WCAG 1.1.1 Non-text Content.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

…and more — all 294 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Give every <img> a meaningful alt attribute. Use alt="" only for decorative images so screen readers skip them.

Drupal tip: In Drupal's Media Library, fill the "Alternative text" field when uploading or editing an image. For images in body fields, the CKEditor "Image Properties" dialog includes an Alt Text field.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/image-alt?application=axeAPI

Triage status Notes

Critical axe label WCAG 2.0 A Form elements must have labels (WCAG 4.1.2) 12/4664 pages · 12 instances Likely template

Bug ID: VS-a1cb7157
Pattern ID: VS-fafffee0
Combined ID: VS-a1cb7157 (pattern VS-fafffee0) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 4.1.2 Name, Role, Value (Level A, WCAG 2.0)
Rule: axe-core — Form elements must have labels [label]
Example URL: https://www.cms.gov/icd10m/version33-fullcode-cms/fullcode_cms/P1462.html
XPath / selector: #q
History: first seen 2026-W26, last seen 2026-W38 (13 wk)

HTML snippet — use this to validate the finding without re-running the tool

<input type="text" name="q" id="q" value="Search now" size="10" maxlength="50" class="srchbox" onfocus="this.value='';">

Description

Form elements must have labels. Detected by axe-core rule label on 12 of 4664 scanned pages (12 instances).

Steps to reproduce

Open https://www.cms.gov/icd10m/version33-fullcode-cms/fullcode_cms/P1462.html.
Locate the element: #q
Confirm the axe-core finding for rule label against WCAG 4.1.2 Name, Role, Value.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited manipulation/strength (13.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited manipulation/strength — 13.0% of population

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Associate every form control with a <label> (via for/id) or an aria-label/aria-labelledby.

Drupal tip: Use Drupal's form element "Label" setting. In Webform, every element has a Label field — ensure it's not empty or hidden. Check that twig templates don't strip <label> elements from form fields.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/label?application=axeAPI

Triage status Notes

Serious axe color-contrast WCAG 2.0 AA Elements must meet minimum color contrast ratio thresholds (WCAG 1.4.3) 7/4664 pages · 143 instances Likely template

Bug ID: VS-27ba545a
Pattern ID: VS-be8d563e
Combined ID: VS-27ba545a (pattern VS-be8d563e) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 AA
Obligation: required
Handling: review
WCAG SC: 1.4.3 Contrast (Minimum) (Level AA, WCAG 2.0)
Rule: axe-core — Elements must meet minimum color contrast ratio thresholds [color-contrast]
Example URL: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?areaId=all&bc=1&contractOption=all&docType=F&keyword=psych&keywordType=all&lcdid=39464&sortBy=relevance&ver=7
XPath / selector: td[rowspan="2"]:nth-child(1) > p
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<p style="text-align: center;">Outcomes</p>

Description

Elements must meet minimum color contrast ratio thresholds. Detected by axe-core rule color-contrast on 34 of 4664 scanned pages (510 instances).

Steps to reproduce

Open https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?areaId=all&bc=1&contractOption=all&docType=F&keyword=psych&keywordType=all&lcdid=39464&sortBy=relevance&ver=7.
Locate the element: td[rowspan="2"]:nth-child(1) > p
Confirm the axe-core finding for rule color-contrast against WCAG 1.4.3 Contrast (Minimum).

Impact

Affects Limited vision (2.4%), Without color perception (4.5%).

Limited vision — 2.4% of population
Without color perception — 4.5% of population

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Increase the contrast between text and its background to at least 4.5:1 (3:1 for large text). Check both light and dark modes.

Drupal tip: Check your Drupal theme's base CSS. Themes like Olivero and Bartik have contrast issues in default color schemes — override failing color pairs in your subtheme's style.css.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/color-contrast?application=axeAPI

Triage status Notes

Serious axe link-name WCAG 2.0 A Links must have discernible text (WCAG 2.4.4) 2/4664 pages · 3 instances

Bug ID: VS-5e5751f9
Pattern ID: VS-e9fe47ac
Combined ID: VS-5e5751f9 (pattern VS-e9fe47ac) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 2.4.4 Link Purpose (In Context) (Level A, WCAG 2.0)
Rule: axe-core — Links must have discernible text [link-name]
Example URL: http://cms.gov/data-research/cms-data/learn-more-about-cms-data
XPath / selector: p:nth-child(12) > a[target="_blank"][data-entity-substitution="canonical"][data-entity-type="node"]
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<a href="/data-research/cms-data/qualified-entity-program" target="_blank" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="bc2a682a-8a5c-4bf6-ab96-775413fb703f" data-onc

Description

Links must have discernible text. Detected by axe-core rule link-name on 4 of 4664 scanned pages (6 instances).

Steps to reproduce

Open http://cms.gov/data-research/cms-data/learn-more-about-cms-data.
Locate the element: p:nth-child(12) > a[target="_blank"][data-entity-substitution="canonical"][data-entity-type="node"]
Confirm the axe-core finding for rule link-name against WCAG 2.4.4 Link Purpose (In Context).

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Give the link discernible text. Avoid empty links and icon-only links without an aria-label.

Drupal tip: "Read more" links from Drupal Views should use the "Link text" rewrite field to add context, or add aria-label via the Views rewrite output.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/link-name?application=axeAPI

Triage status Notes

Serious axe td-headers-attr WCAG 2.0 A Table cell headers attributes must refer to other <th> elements in the same tabl (WCAG 1.3.1) 2/4664 pages · 2 instances Likely content

Bug ID: VS-bfc90016
Pattern ID: VS-07ba3b17
Combined ID: VS-bfc90016 (pattern VS-07ba3b17) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.3.1 Info and Relationships (Level A, WCAG 2.0)
Rule: axe-core — Table cell headers attributes must refer to other <th> elements in the same tabl [td-headers-attr]
Example URL: https://www.cms.gov/medicare/regulations-guidance/transmittals/2022-transmittals?items_per_page=25&order=field_dyna_transmittal_number&page=0&sort=desc
XPath / selector: .MsoTableGrid
History: first seen 2026-W25, last seen 2026-W38 (14 wk)

HTML snippet — use this to validate the finding without re-running the tool

<table class="MsoTableGrid">

Description

Table cell headers attributes must refer to other <th> elements in the same tabl. Detected by axe-core rule td-headers-attr on 2 of 4664 scanned pages (2 instances).

Steps to reproduce

Open https://www.cms.gov/medicare/regulations-guidance/transmittals/2022-transmittals?items_per_page=25&order=field_dyna_transmittal_number&page=0&sort=desc.
Locate the element: .MsoTableGrid
Confirm the axe-core finding for rule td-headers-attr against WCAG 1.3.1 Info and Relationships.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Associate data cells with their headers correctly using headers/id or scope.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/td-headers-attr?application=axeAPI

Triage status Notes

Critical axe aria-required-children WCAG 2.0 A Certain ARIA roles must contain particular children (WCAG 1.3.1) 1/4664 pages · 1 instances Likely content

Bug ID: VS-a301806f
Pattern ID: VS-9429bb8d
Combined ID: VS-a301806f (pattern VS-9429bb8d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.3.1 Info and Relationships (Level A, WCAG 2.0)
Rule: axe-core — Certain ARIA roles must contain particular children [aria-required-children]
Example URL: http://cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html
XPath / selector: #SERVICES
History: first seen 2026-W28, last seen 2026-W38 (3 wk)

HTML snippet — use this to validate the finding without re-running the tool

<ul id="SERVICES" class="closed openMenu" role="menu" tabindex="-1" style="background-color: rgb(255, 255, 255); margin-bottom: 60px;">

Description

Certain ARIA roles must contain particular children. Detected by axe-core rule aria-required-children on 1 of 4664 scanned pages (1 instances).

Steps to reproduce

Open http://cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html.
Locate the element: #SERVICES
Confirm the axe-core finding for rule aria-required-children against WCAG 1.3.1 Info and Relationships.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Add the child roles this container role requires (e.g. a list needs listitem children).

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/aria-required-children?application=axeAPI

Triage status Notes

Serious axe nested-interactive WCAG 2.0 A Interactive controls must not be nested (WCAG 4.1.2) 1/4664 pages · 1 instances Likely content

Bug ID: VS-a95beaad
Pattern ID: VS-58301a87
Combined ID: VS-a95beaad (pattern VS-58301a87) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 4.1.2 Name, Role, Value (Level A, WCAG 2.0)
Rule: axe-core — Interactive controls must not be nested [nested-interactive]
Example URL: https://cms.gov/files/linked-video-files/new-features-medicare-gov
XPath / selector: .ytPageHeaderViewModelScrollContainer > .ytPageHeaderViewModelContent > .ytPageHeaderViewModelHeadline > .ytPageHeaderViewModelHeadlineInfo > .ytPageHeaderViewModelContentMetadata.ytPageHeaderViewModelContentMetadataOverlay > .ytContentMetadataViewModelMetadataRow[role="group"]:nth-child(1) > yt-avatar-stack-view-model
History: first seen 2026-W33, last seen 2026-W38 (2 wk)

HTML snippet — use this to validate the finding without re-running the tool

<yt-avatar-stack-view-model class="ytAvatarStackViewModelHost ytContentMetadataViewModelAvatarStack ytAvatarStackViewModelTappable ytAvatarStackViewModelIsOverlay" tabindex="0" role="button" aria-labe

Description

Interactive controls must not be nested. Detected by axe-core rule nested-interactive on 1 of 4664 scanned pages (1 instances).

Steps to reproduce

Open https://cms.gov/files/linked-video-files/new-features-medicare-gov.
Locate the element: .ytPageHeaderViewModelScrollContainer > .ytPageHeaderViewModelContent > .ytPageHeaderViewModelHeadline > .ytPageHeaderViewModelHeadlineInfo > .ytPageHeaderViewModelContentMetadata.ytPageHeaderViewModelContentMetadataOverlay > .ytContentMetadataViewModelMetadataRow[role="group"]:nth-child(1) > yt-avatar-stack-view-model
Confirm the axe-core finding for rule nested-interactive against WCAG 4.1.2 Name, Role, Value.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited manipulation/strength (13.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited manipulation/strength — 13.0% of population

Affected pages

/files/linked-video-files/new-features-medicare-gov

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Don't nest interactive controls (e.g. a button inside a link); split them apart.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/nested-interactive?application=axeAPI

Triage status Notes

Serious axe valid-lang WCAG 2.0 AA lang attribute must have a valid value (WCAG 3.1.2) 1/4664 pages · 1 instances Likely content

Bug ID: VS-8f470a84
Pattern ID: VS-dd1c019f
Combined ID: VS-8f470a84 (pattern VS-dd1c019f) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 AA
Obligation: required
Handling: review
WCAG SC: 3.1.2 Language of Parts (Level AA, WCAG 2.0)
Rule: axe-core — lang attribute must have a valid value [valid-lang]
Example URL: https://www.cms.gov/data-research/monitoring-programs/improper-payment-measurement-programs/exchange-improper-payment-measurement-eipm/improper-payment-findings
XPath / selector: a[href$="#_ftnref1"] > span[lang="X-NONE"]
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<span lang="X-NONE">[1]</span>

Description

lang attribute must have a valid value. Detected by axe-core rule valid-lang on 1 of 4664 scanned pages (1 instances).

Steps to reproduce

Open https://www.cms.gov/data-research/monitoring-programs/improper-payment-measurement-programs/exchange-improper-payment-measurement-eipm/improper-payment-findings.
Locate the element: a[href$="#_ftnref1"] > span[lang="X-NONE"]
Confirm the axe-core finding for rule valid-lang against WCAG 3.1.2 Language of Parts.

Impact

Affects Without vision (1.0%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

/data-research/monitoring-programs/improper-payment-measurement-programs/exchange-improper-payment-measurement-eipm/improper-payment-findings

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/valid-lang?application=axeAPI

Triage status Notes

Serious axe accesskeys Best Practice accesskey attribute value should be unique (WCAG criterion undetermined) 98/4664 pages · 288 instances Likely template

Bug ID: VS-68047ab5
Pattern ID: VS-bd13f00a
Combined ID: VS-68047ab5 (pattern VS-bd13f00a) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — accesskey attribute value should be unique [accesskeys]
Example URL: https://cms.gov/icd10m/fy2025-version42.0-fullcode-cms/fullcode_cms/P0369.html
XPath / selector: td[width="31"]:nth-child(3) > a[accesskey="p"][href$="P0368.html"]
History: first seen 2026-W25, last seen 2026-W38 (12 wk)

HTML snippet — use this to validate the finding without re-running the tool

<a accesskey="p" id="prev_page" href="P0368.html"><img src="bakpg.png" alt="Previous Page [Alt-p]" height="14" width="31" vspace="0" hspace="0" align="bottom" border="0"></a>

Description

accesskey attribute value should be unique. Detected by axe-core rule accesskeys on 98 of 4664 scanned pages (288 instances).

Steps to reproduce

Open https://cms.gov/icd10m/fy2025-version42.0-fullcode-cms/fullcode_cms/P0369.html.
Locate the element: td[width="31"]:nth-child(3) > a[accesskey="p"][href$="P0368.html"]
Confirm the axe-core finding for rule accesskeys.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 98 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/accesskeys?application=axeAPI

Triage status Notes

Moderate alfa sia-r4 WCAG 2.0 A Document has a valid lang attribute (WCAG 3.1.1) 56/4664 pages · 56 instances Likely template

Bug ID: VS-503d9f31
Pattern ID: VS-7a0e5645
Combined ID: VS-503d9f31 (pattern VS-7a0e5645) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 3.1.1 Language of Page (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Document has a valid lang attribute [sia-r4]
Example URL: https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html
XPath / selector: <html>
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Document has a valid lang attribute. Detected by Siteimprove Alfa rule sia-r4 on 56 of 4664 scanned pages (56 instances).

Steps to reproduce

Open https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html.
Locate the element: <html>
Confirm the Siteimprove Alfa finding for rule sia-r4 against WCAG 3.1.1 Language of Page.

Impact

Affects Without vision (1.0%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

…and more — all 56 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Add a valid lang attribute to <html>.

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r4

Triage status Notes

Moderate alfa sia-r64 WCAG 2.0 A Element has required owned roles (WCAG 1.3.1) 55/4664 pages · 55 instances Likely template

Bug ID: VS-d8d82b1c
Pattern ID: VS-3c632d31
Combined ID: VS-d8d82b1c (pattern VS-3c632d31) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.3.1 Info and Relationships (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Element has required owned roles [sia-r64]
Example URL: https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html
XPath / selector: <h1>
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Element has required owned roles. Detected by Siteimprove Alfa rule sia-r64 on 55 of 4664 scanned pages (55 instances).

Steps to reproduce

Open https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html.
Locate the element: <h1>
Confirm the Siteimprove Alfa finding for rule sia-r64 against WCAG 1.3.1 Info and Relationships.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

…and more — all 55 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r64

Triage status Notes

Moderate alfa sia-r2 WCAG 2.0 A Image has accessible name (WCAG 1.1.1) 55/4664 pages · 55 instances Likely template

Bug ID: VS-a58f673c
Pattern ID: VS-a24eaa8c
Combined ID: VS-a58f673c (pattern VS-a24eaa8c) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.1.1 Non-text Content (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Image has accessible name [sia-r2]
Example URL: https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html
XPath / selector: <img src="cms-site-logo.png">
History: first seen 2026-W24, last seen 2026-W38 (14 wk)

Description

Image has accessible name. Detected by Siteimprove Alfa rule sia-r2 on 55 of 4664 scanned pages (55 instances).

Steps to reproduce

Open https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html.
Locate the element: <img src="cms-site-logo.png">
Confirm the Siteimprove Alfa finding for rule sia-r2 against WCAG 1.1.1 Non-text Content.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

…and more — all 55 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Give every <img> an accessible name (alt text), or alt="" if purely decorative.

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r2

Triage status Notes

Moderate alfa sia-r113 WCAG 2.2 AA Target size is at least 24×24 CSS pixels or has spacing (Minimum) (WCAG 2.5.8) 11/4664 pages · 174 instances Likely template

Bug ID: VS-a955bf79
Pattern ID: VS-179ad9b3
Combined ID: VS-a955bf79 (pattern VS-179ad9b3) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.2 AA
Obligation: required
Handling: review
WCAG SC: 2.5.8 Target Size (Minimum) (Level AA, WCAG 2.2)
Rule: Siteimprove Alfa — Target size is at least 24×24 CSS pixels or has spacing (Minimum) [sia-r113]
Example URL: https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html
XPath / selector: <a href="http://www.hhs.gov">
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Target size is at least 24×24 CSS pixels or has spacing (Minimum). Detected by Siteimprove Alfa rule sia-r113 on 103 of 4664 scanned pages (395 instances).

Steps to reproduce

Open https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html.
Locate the element: <a href="http://www.hhs.gov">
Confirm the Siteimprove Alfa finding for rule sia-r113 against WCAG 2.5.8 Target Size (Minimum).

Impact

Affects Limited manipulation/strength (13.0%), Limited reach (2.0%), Limited vision (2.4%).

Limited manipulation/strength — 13.0% of population
Limited reach — 2.0% of population
Limited vision — 2.4% of population

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r113

Triage status Notes

Moderate axe region Best Practice All page content should be contained by landmarks (WCAG criterion undetermined) 307/4664 pages · 5687 instances Likely template

Bug ID: VS-c1e86e3b
Pattern ID: VS-f18df681
Combined ID: VS-c1e86e3b (pattern VS-f18df681) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — All page content should be contained by landmarks [region]
Example URL: http://www.cms.gov/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html
XPath / selector: .arrows > tbody > tr:nth-child(1)
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<tr>
		<td><img src="cms-site-logo.png"></td>
		<td style="text-align:center;"><h1>ICD-10-CM/PCS MS-DRG v40.1 Definitions Manual</h1><h1></h1></td>
		<td></td>
		<td></td>
		<td></td>
	</tr>

Description

All page content should be contained by landmarks. Detected by axe-core rule region on 307 of 4664 scanned pages (5687 instances).

Steps to reproduce

Open http://www.cms.gov/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html.
Locate the element: .arrows > tbody > tr:nth-child(1)
Confirm the axe-core finding for rule region.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 307 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Wrap all page content in landmarks (header, nav, main, footer) so users can navigate by region.

Drupal tip: Use Drupal's region system (header, navigation, main, sidebar, footer) and map each to an HTML5 landmark element in your theme's page.html.twig.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/region?application=axeAPI

Triage status Notes

Moderate axe landmark-one-main Best Practice Document should have one main landmark (WCAG criterion undetermined) 305/4664 pages · 305 instances Likely template

Bug ID: VS-39f3a6ee
Pattern ID: VS-d5d82446
Combined ID: VS-39f3a6ee (pattern VS-d5d82446) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Document should have one main landmark [landmark-one-main]
Example URL: http://www.cms.gov/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html
XPath / selector: html
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<html>

Description

Document should have one main landmark. Detected by axe-core rule landmark-one-main on 305 of 4664 scanned pages (305 instances).

Steps to reproduce

Open http://www.cms.gov/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html.
Locate the element: html
Confirm the axe-core finding for rule landmark-one-main.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 305 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Each page should have exactly one <main> landmark.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/landmark-one-main?application=axeAPI

Triage status Notes

Minor axe empty-heading Best Practice Headings should not be empty (WCAG criterion undetermined) 298/4664 pages · 298 instances Likely template

Bug ID: VS-aeff9e5d
Pattern ID: VS-0066c67d
Combined ID: VS-aeff9e5d (pattern VS-0066c67d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Headings should not be empty [empty-heading]
Example URL: http://www.cms.gov/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html
XPath / selector: h1:nth-child(2)
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<h1></h1>

Description

Headings should not be empty. Detected by axe-core rule empty-heading on 298 of 4664 scanned pages (298 instances).

Steps to reproduce

Open http://www.cms.gov/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html.
Locate the element: h1:nth-child(2)
Confirm the axe-core finding for rule empty-heading.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 298 pages (CSV).

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Remove empty headings or give them text. Don't use heading tags for spacing.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/empty-heading?application=axeAPI

Triage status Notes

Moderate alfa sia-r57 Undetermined Scrolling content can be accessed by keyboard (WCAG criterion undetermined) 163/4664 pages · 163 instances Likely template

Bug ID: VS-9de3455b
Pattern ID: VS-c18be945
Combined ID: VS-9de3455b (pattern VS-c18be945) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Scrolling content can be accessed by keyboard [sia-r57]
Example URL: https://cms.gov/medicare/regulations-guidance/transmittals/2021-transmittals?items_per_page=25&order=field_dyna_subject_formatted&page=0&sort=asc
XPath / selector: text: "Feedback"
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Scrolling content can be accessed by keyboard. Detected by Siteimprove Alfa rule sia-r57 on 163 of 4664 scanned pages (163 instances).

Steps to reproduce

Open https://cms.gov/medicare/regulations-guidance/transmittals/2021-transmittals?items_per_page=25&order=field_dyna_subject_formatted&page=0&sort=asc.
Locate the element: text: "Feedback"
Confirm the Siteimprove Alfa finding for rule sia-r57.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

…and more — all 163 pages (CSV).

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r57

Triage status Notes

Moderate alfa sia-r111 WCAG 2.x AAA Target size is at least 44×44 CSS pixels (Enhanced) (WCAG 2.5.5) 19/4664 pages · 12550 instances Likely template

Bug ID: VS-4ad50af1
Pattern ID: VS-cb53cc4d
Combined ID: VS-4ad50af1 (pattern VS-cb53cc4d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.x AAA
Obligation: aspirational
Handling: review
WCAG SC: 2.5.5 Target Size (Enhanced) (Level AAA, WCAG 2.1)
Rule: Siteimprove Alfa — Target size is at least 44×44 CSS pixels (Enhanced) [sia-r111]
Example URL: https://cms.gov/medicare/regulations-guidance/transmittals/2021-transmittals?items_per_page=25&order=field_dyna_subject_formatted&page=0&sort=asc
XPath / selector: <a href="/about-cms" class="menu-item-link" data-drupal-link-system-path="node/132926" data-once="navigationLinkMatch">
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Target size is at least 44×44 CSS pixels (Enhanced). Detected by Siteimprove Alfa rule sia-r111 on 491 of 4664 scanned pages (16513 instances).

Steps to reproduce

Open https://cms.gov/medicare/regulations-guidance/transmittals/2021-transmittals?items_per_page=25&order=field_dyna_subject_formatted&page=0&sort=asc.
Locate the element: <a href="/about-cms" class="menu-item-link" data-drupal-link-system-path="node/132926" data-once="navigationLinkMatch">
Confirm the Siteimprove Alfa finding for rule sia-r111 against WCAG 2.5.5 Target Size (Enhanced).

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r111

Triage status Notes

Moderate alfa sia-r73 WCAG 2.x AAA Text has minimum contrast ratio of 4.5:1 (WCAG 1.4.8) 19/4664 pages · 4458 instances Likely template

Bug ID: VS-b6d90ef7
Pattern ID: VS-2208081b
Combined ID: VS-b6d90ef7 (pattern VS-2208081b) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.x AAA
Obligation: aspirational
Handling: review
WCAG SC: 1.4.8 Visual Presentation (Level AAA, WCAG 2.0)
Rule: Siteimprove Alfa — Text has minimum contrast ratio of 4.5:1 [sia-r73]
Example URL: https://cms.gov/medicare/regulations-guidance/transmittals/2021-transmittals?items_per_page=25&order=field_dyna_subject_formatted&page=0&sort=asc
XPath / selector: <p class="ds-c-usa-banner__header-text">
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Text has minimum contrast ratio of 4.5:1. Detected by Siteimprove Alfa rule sia-r73 on 484 of 4664 scanned pages (5866 instances).

Steps to reproduce

Open https://cms.gov/medicare/regulations-guidance/transmittals/2021-transmittals?items_per_page=25&order=field_dyna_subject_formatted&page=0&sort=asc.
Locate the element: <p class="ds-c-usa-banner__header-text">
Confirm the Siteimprove Alfa finding for rule sia-r73 against WCAG 1.4.8 Visual Presentation.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r73

Triage status Notes

Moderate axe page-has-heading-one Best Practice Page should contain a level-one heading (WCAG criterion undetermined) 18/4664 pages · 18 instances Likely template

Bug ID: VS-2872563b
Pattern ID: VS-fa44f293
Combined ID: VS-2872563b (pattern VS-fa44f293) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Page should contain a level-one heading [page-has-heading-one]
Example URL: https://www.cms.gov/icd10m/version33-fullcode-cms/fullcode_cms/P1462.html
XPath / selector: html
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<html>

Description

Page should contain a level-one heading. Detected by axe-core rule page-has-heading-one on 18 of 4664 scanned pages (18 instances).

Steps to reproduce

Open https://www.cms.gov/icd10m/version33-fullcode-cms/fullcode_cms/P1462.html.
Locate the element: html
Confirm the axe-core finding for rule page-has-heading-one.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/page-has-heading-one?application=axeAPI

Triage status Notes

Moderate alfa sia-r61 Undetermined Form field label is visible (WCAG criterion undetermined) 17/4664 pages · 296 instances Likely template

Bug ID: VS-a837040e
Pattern ID: VS-7118fead
Combined ID: VS-a837040e (pattern VS-7118fead) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Form field label is visible [sia-r61]
Example URL: https://cms.gov/medicare/regulations-guidance/transmittals/2021-transmittals?items_per_page=25&order=field_dyna_subject_formatted&page=0&sort=asc
XPath / selector: {"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Form field label is visible. Detected by Siteimprove Alfa rule sia-r61 on 435 of 4664 scanned pages (435 instances).

Steps to reproduce

Open https://cms.gov/medicare/regulations-guidance/transmittals/2021-transmittals?items_per_page=25&order=field_dyna_subject_formatted&page=0&sort=asc.
Locate the element: {"type":"document","children":[{"type":"type","name":"html","publicId":null,"sys
Confirm the Siteimprove Alfa finding for rule sia-r61.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r61

Triage status Notes

Moderate deprecated-html presentational-attr Undetermined Presentational attribute (use CSS) (WCAG criterion undetermined) 14/4664 pages · 1173 instances Likely template

Bug ID: VS-365bc046
Pattern ID: VS-04a9d28c
Combined ID: VS-365bc046 (pattern VS-04a9d28c) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: deprecated-html — Presentational attribute (use CSS) [presentational-attr]
Example URL: https://cms.gov/icd10m/fy2025-version42.0-fullcode-cms/fullcode_cms/P0369.html
XPath / selector: img
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<img src="bakpg.png" alt="Previous Page [Alt-p]" height="14" width="31" vspace="0" hspace="0" align="bottom" border="0">

Description

Presentational attribute (use CSS). Detected by deprecated-html rule presentational-attr on 57 of 4664 scanned pages (2094 instances).

Steps to reproduce

Open https://cms.gov/icd10m/fy2025-version42.0-fullcode-cms/fullcode_cms/P0369.html.
Locate the element: img
Confirm the deprecated-html finding for rule presentational-attr.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: deprecated-html, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

Not captured by automated scan — requires manual testing.

Triage status Notes

Moderate alfa sia-r78 Undetermined Table header has scope (WCAG criterion undetermined) 14/4664 pages · 83 instances Likely template

Bug ID: VS-aba61594
Pattern ID: VS-2cd767ca
Combined ID: VS-aba61594 (pattern VS-2cd767ca) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Table header has scope [sia-r78]
Example URL: https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html
XPath / selector: <h1>
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Table header has scope. Detected by Siteimprove Alfa rule sia-r78 on 124 of 4664 scanned pages (149 instances).

Steps to reproduce

Open https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html.
Locate the element: <h1>
Confirm the Siteimprove Alfa finding for rule sia-r78.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r78

Triage status Notes

Moderate axe heading-order Best Practice Heading levels should only increase by one (WCAG criterion undetermined) 5/4664 pages · 56 instances Likely template

Bug ID: VS-527e4804
Pattern ID: VS-d25f622d
Combined ID: VS-527e4804 (pattern VS-d25f622d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Heading levels should only increase by one [heading-order]
Example URL: https://cms.gov/medicare-coverage-database/reports/local-coverage-proposed-lcds-alphabetical-report.aspx?proposedStatus=all
XPath / selector: #navStickyHeader
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<h3 id="navStickyHeader" class="bg-white d-inline expand-head-pad">Report Information</h3>

Description

Heading levels should only increase by one. Detected by axe-core rule heading-order on 277 of 4664 scanned pages (280 instances).

Steps to reproduce

Open https://cms.gov/medicare-coverage-database/reports/local-coverage-proposed-lcds-alphabetical-report.aspx?proposedStatus=all.
Locate the element: #navStickyHeader
Confirm the axe-core finding for rule heading-order.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Use heading levels in order (h1 → h2 → h3) without skipping; structure, not size.

Drupal tip: Drupal Views and blocks can insert headings at arbitrary levels. In the Views UI, set "Title tag" for each display. For block titles, configure the heading level in the block's layout settings.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/heading-order?application=axeAPI

Triage status Notes

Moderate alfa sia-r53 Undetermined Headings are structured hierarchically (WCAG criterion undetermined) 4/4664 pages · 26 instances Likely template

Bug ID: VS-60b9a0b0
Pattern ID: VS-f054f4a4
Combined ID: VS-60b9a0b0 (pattern VS-f054f4a4) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Headings are structured hierarchically [sia-r53]
Example URL: https://cms.gov/medicare-coverage-database/view/article.aspx?articleid=54790&articleStatus=all&bc=5&contractorNumber=all&sortBy=title&stateRegion=all&ver=2
XPath / selector: <h3 id="h3GeneralInformationHeader" class="document-view-section-header">
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Headings are structured hierarchically. Detected by Siteimprove Alfa rule sia-r53 on 164 of 4664 scanned pages (165 instances).

Steps to reproduce

Open https://cms.gov/medicare-coverage-database/view/article.aspx?articleid=54790&articleStatus=all&bc=5&contractorNumber=all&sortBy=title&stateRegion=all&ver=2.
Locate the element: <h3 id="h3GeneralInformationHeader" class="document-view-section-header">
Confirm the Siteimprove Alfa finding for rule sia-r53.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Use headings in a logical, non-skipping order.

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r53

Triage status Notes

Moderate alfa sia-r68 WCAG 2.0 A Presentational children of an element are not focusable (WCAG 1.3.1) 3/4664 pages · 26 instances Likely template

Bug ID: VS-9b72e82a
Pattern ID: VS-d6097011
Combined ID: VS-9b72e82a (pattern VS-d6097011) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.3.1 Info and Relationships (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Presentational children of an element are not focusable [sia-r68]
Example URL: https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html
XPath / selector: <tr>
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Presentational children of an element are not focusable. Detected by Siteimprove Alfa rule sia-r68 on 60 of 4664 scanned pages (216 instances).

Steps to reproduce

Open https://cms.gov/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html.
Locate the element: <tr>
Confirm the Siteimprove Alfa finding for rule sia-r68 against WCAG 1.3.1 Info and Relationships.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r68

Triage status Notes

Moderate axe landmark-unique Best Practice Landmarks should have a unique role or role/label/title (i.e. accessible name) c (WCAG criterion undetermined) 3/4664 pages · 3 instances

Bug ID: VS-c0aac923
Pattern ID: VS-8806389c
Combined ID: VS-c0aac923 (pattern VS-8806389c) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Landmarks should have a unique role or role/label/title (i.e. accessible name) c [landmark-unique]
Example URL: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-08.html
XPath / selector: .views-field-field-topic[aria-label="Related search topics"][role="region"]:nth-child(1)
History: first seen 2026-W25, last seen 2026-W38 (14 wk)

HTML snippet — use this to validate the finding without re-running the tool

<span class="views-field views-field-field-topic" role="region" aria-label="Related search topics">
<a href="/newsroom/search?about[]=33506&amp;keys= " data-once="linkMatch">Administration</a>
</span>

Description

Landmarks should have a unique role or role/label/title (i.e. accessible name) c. Detected by axe-core rule landmark-unique on 3 of 4664 scanned pages (3 instances).

Steps to reproduce

Open http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-08.html.
Locate the element: .views-field-field-topic[aria-label="Related search topics"][role="region"]:nth-child(1)
Confirm the axe-core finding for rule landmark-unique.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: When a landmark role/type repeats (e.g. two <nav>s), give each a distinct accessible name with aria-label or aria-labelledby (e.g. "Primary" and "Footer" navigation) so screen-reader users can tell them apart.

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/landmark-unique?application=axeAPI

Triage status Notes

Minor axe empty-table-header Best Practice Table header text should not be empty (WCAG criterion undetermined) 3/4664 pages · 7 instances Likely template

Bug ID: VS-3b0f2d77
Pattern ID: VS-d69fc059
Combined ID: VS-3b0f2d77 (pattern VS-d69fc059) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — Table header text should not be empty [empty-table-header]
Example URL: http://www.cms.gov/medicare-coverage-database/view/lcd.aspx?bc=7&contractorName=all&contractorNumber=all&lcdid=36868&lcdStatus=all&sortBy=title&ver=20
XPath / selector: tbody > tr > th
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<th>&nbsp;</th>

Description

Table header text should not be empty. Detected by axe-core rule empty-table-header on 20 of 4664 scanned pages (45 instances).

Steps to reproduce

Open http://www.cms.gov/medicare-coverage-database/view/lcd.aspx?bc=7&contractorName=all&contractorNumber=all&lcdid=36868&lcdStatus=all&sortBy=title&ver=20.
Locate the element: tbody > tr > th
Confirm the axe-core finding for rule empty-table-header.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/empty-table-header?application=axeAPI

Triage status Notes

Moderate axe scope-attr-valid Best Practice scope attribute should be used correctly (WCAG criterion undetermined) 2/4664 pages · 68 instances Likely template

Bug ID: VS-da77ec2b
Pattern ID: VS-0ba8ce9d
Combined ID: VS-da77ec2b (pattern VS-0ba8ce9d) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Best Practice
Obligation: advisory
Handling: review
WCAG SC: Best Practice — not a WCAG requirement
Rule: axe-core — scope attribute should be used correctly [scope-attr-valid]
Example URL: https://cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?ncaid=258&proposed=Y
XPath / selector: tr:nth-child(2) > td[scope="row"]
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

HTML snippet — use this to validate the finding without re-running the tool

<td valign="top" scope="row">September  30, 2011</td>

Description

scope attribute should be used correctly. Detected by axe-core rule scope-attr-valid on 42 of 4664 scanned pages (850 instances).

Steps to reproduce

Open https://cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?ncaid=258&proposed=Y.
Locate the element: tr:nth-child(2) > td[scope="row"]
Confirm the axe-core finding for rule scope-attr-valid.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

Testing environment

Automated: axe-core, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://dequeuniversity.com/rules/axe/4.12/scope-attr-valid?application=axeAPI

Triage status Notes

Moderate alfa sia-r46 WCAG 2.0 A Element has required aria-owns (WCAG 1.3.1) 2/4664 pages · 3 instances Likely template

Bug ID: VS-8dd542f7
Pattern ID: VS-4408605e
Combined ID: VS-8dd542f7 (pattern VS-4408605e) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.3.1 Info and Relationships (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Element has required aria-owns [sia-r46]
Example URL: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57948&bc=13&contractorName=all&contractorNumber=all&sortBy=updated&updatePeriod=1204&ver=26
XPath / selector: <th scope="col">
History: first seen 2026-W25, last seen 2026-W38 (14 wk)

Description

Element has required aria-owns. Detected by Siteimprove Alfa rule sia-r46 on 18 of 4664 scanned pages (30 instances).

Steps to reproduce

Open https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57948&bc=13&contractorName=all&contractorNumber=all&sortBy=updated&updatePeriod=1204&ver=26.
Locate the element: <th scope="col">
Confirm the Siteimprove Alfa finding for rule sia-r46 against WCAG 1.3.1 Info and Relationships.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r46

Triage status Notes

Moderate alfa sia-r77 WCAG 2.0 A Table cell has header (WCAG 1.3.1) 2/4664 pages · 3 instances · possible duplicate

Bug ID: VS-12fb485e
Pattern ID: VS-3f067795
Combined ID: VS-12fb485e (pattern VS-3f067795) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.3.1 Info and Relationships (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Table cell has header [sia-r77]
Example URL: https://cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?bc=AiAAAAAAAAAA&NCAId=279&proposed=Y&type=Closed
XPath / selector: <td>
History: first seen 2026-W24, last seen 2026-W38 (15 wk)
Possible duplicate: Same WCAG SC covered by axe report VS-bfc90016 (pattern VS-07ba3b17). If axe and this engine flag the same element, the axe report takes precedence — mark this as duplicate in JIRA.

Description

Table cell has header. Detected by Siteimprove Alfa rule sia-r77 on 3 of 4664 scanned pages (4 instances).

Steps to reproduce

Open https://cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?bc=AiAAAAAAAAAA&NCAId=279&proposed=Y&type=Closed.
Locate the element: <td>
Confirm the Siteimprove Alfa finding for rule sia-r77 against WCAG 1.3.1 Info and Relationships.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r77

Triage status Notes

Moderate alfa sia-r45 WCAG 2.0 A aria-hidden element is not exposed to assistive technology (WCAG 1.3.1) 1/4664 pages · 197 instances · possible duplicate Likely content

Bug ID: VS-181d7ef3
Pattern ID: VS-9207ed51
Combined ID: VS-181d7ef3 (pattern VS-9207ed51) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 1.3.1 Info and Relationships (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — aria-hidden element is not exposed to assistive technology [sia-r45]
Example URL: https://cms.gov/medicare/regulations-guidance/transmittals/2020-transmittals?items_per_page=25&order=field_dyna_transmittal_number&page=5&sort=desc
XPath / selector: @headers="view-field-dyna-revision-date-table-column"
History: first seen 2026-W26, last seen 2026-W38 (8 wk)
Possible duplicate: Same WCAG SC covered by axe report VS-bfc90016 (pattern VS-07ba3b17). If axe and this engine flag the same element, the axe report takes precedence — mark this as duplicate in JIRA.

Description

aria-hidden element is not exposed to assistive technology. Detected by Siteimprove Alfa rule sia-r45 on 1 of 4664 scanned pages (197 instances).

Steps to reproduce

Open https://cms.gov/medicare/regulations-guidance/transmittals/2020-transmittals?items_per_page=25&order=field_dyna_transmittal_number&page=5&sort=desc.
Locate the element: @headers="view-field-dyna-revision-date-table-column"
Confirm the Siteimprove Alfa finding for rule sia-r45 against WCAG 1.3.1 Info and Relationships.

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

/medicare/regulations-guidance/transmittals/2020-transmittals

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r45

Triage status Notes

Moderate alfa sia-r66 WCAG 2.x AAA Text has enhanced contrast (WCAG 1.4.6) 1/4664 pages · 43 instances Likely template

Bug ID: VS-1827b8a8
Pattern ID: VS-646b1e0b
Combined ID: VS-1827b8a8 (pattern VS-646b1e0b) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.x AAA
Obligation: aspirational
Handling: review
WCAG SC: 1.4.6 Contrast (Enhanced) (Level AAA, WCAG 2.0)
Rule: Siteimprove Alfa — Text has enhanced contrast [sia-r66]
Example URL: https://cms.gov/medicare-coverage-database/view/article.aspx?articleid=54790&articleStatus=all&bc=5&contractorNumber=all&sortBy=title&stateRegion=all&ver=2
XPath / selector: text: "Here's how you know"
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Text has enhanced contrast. Detected by Siteimprove Alfa rule sia-r66 on 190 of 4664 scanned pages (1073 instances).

Steps to reproduce

Open https://cms.gov/medicare-coverage-database/view/article.aspx?articleid=54790&articleStatus=all&bc=5&contractorNumber=all&sortBy=title&stateRegion=all&ver=2.
Locate the element: text: "Here's how you know"
Confirm the Siteimprove Alfa finding for rule sia-r66 against WCAG 1.4.6 Contrast (Enhanced).

Impact

Not captured by automated scan — requires manual testing.

Affected pages

/medical-bill-rights/help/submit-a-complaint/get-started

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Increase text contrast to meet WCAG AAA (7:1).

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r66

Triage status Notes

Moderate alfa sia-r75 Undetermined Form field error is identified and described (WCAG criterion undetermined) 1/4664 pages · 2 instances Likely content

Bug ID: VS-53910536
Pattern ID: VS-e43903a1
Combined ID: VS-53910536 (pattern VS-e43903a1) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Form field error is identified and described [sia-r75]
Example URL: https://www.cms.gov/icd10m/version33-fullcode-cms/fullcode_cms/P0617.html
XPath / selector: <ul id="globar">
History: first seen 2026-W26, last seen 2026-W38 (12 wk)

Description

Form field error is identified and described. Detected by Siteimprove Alfa rule sia-r75 on 1 of 4664 scanned pages (2 instances).

Steps to reproduce

Open https://www.cms.gov/icd10m/version33-fullcode-cms/fullcode_cms/P0617.html.
Locate the element: <ul id="globar">
Confirm the Siteimprove Alfa finding for rule sia-r75.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

/icd10m/version33-fullcode-cms/fullcode_cms/P0617.html

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r75

Triage status Notes

Moderate alfa sia-r7 WCAG 2.0 AA Element with lang attribute has correct language (WCAG 3.1.2) 1/4664 pages · 1 instances · possible duplicate Likely content

Bug ID: VS-765760a0
Pattern ID: VS-400f3a18
Combined ID: VS-765760a0 (pattern VS-400f3a18) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 AA
Obligation: required
Handling: review
WCAG SC: 3.1.2 Language of Parts (Level AA, WCAG 2.0)
Rule: Siteimprove Alfa — Element with lang attribute has correct language [sia-r7]
Example URL: https://www.cms.gov/data-research/monitoring-programs/improper-payment-measurement-programs/exchange-improper-payment-measurement-eipm/improper-payment-findings
XPath / selector: @lang="X-NONE"
History: first seen 2026-W26, last seen 2026-W38 (7 wk)
Possible duplicate: Same WCAG SC covered by axe report VS-8f470a84 (pattern VS-dd1c019f). If axe and this engine flag the same element, the axe report takes precedence — mark this as duplicate in JIRA.

Description

Element with lang attribute has correct language. Detected by Siteimprove Alfa rule sia-r7 on 1 of 4664 scanned pages (1 instances).

Steps to reproduce

Open https://www.cms.gov/data-research/monitoring-programs/improper-payment-measurement-programs/exchange-improper-payment-measurement-eipm/improper-payment-findings.
Locate the element: @lang="X-NONE"
Confirm the Siteimprove Alfa finding for rule sia-r7 against WCAG 3.1.2 Language of Parts.

Impact

Affects Without vision (1.0%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

/data-research/monitoring-programs/improper-payment-measurement-programs/exchange-improper-payment-measurement-eipm/improper-payment-findings

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r7

Triage status Notes

Moderate alfa sia-r59 Undetermined Element with orientation is not locked (WCAG criterion undetermined) 1/4664 pages · 1 instances Likely content

Bug ID: VS-1bc326ac
Pattern ID: VS-7fbb8b20
Combined ID: VS-1bc326ac (pattern VS-7fbb8b20) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: Undetermined
Obligation: unmapped
Handling: review
WCAG SC: undetermined
Rule: Siteimprove Alfa — Element with orientation is not locked [sia-r59]
Example URL: https://www.cms.gov/icd10m/version33-fullcode-cms/fullcode_cms/P0617.html
XPath / selector: {"type":"document","children":[{"type":"element","children":[{"type":"element","
History: first seen 2026-W26, last seen 2026-W38 (12 wk)

Description

Element with orientation is not locked. Detected by Siteimprove Alfa rule sia-r59 on 1 of 4664 scanned pages (1 instances).

Steps to reproduce

Open https://www.cms.gov/icd10m/version33-fullcode-cms/fullcode_cms/P0617.html.
Locate the element: {"type":"document","children":[{"type":"element","children":[{"type":"element","
Confirm the Siteimprove Alfa finding for rule sia-r59.

Impact

Not captured by automated scan — requires manual testing.

Affected pages

/icd10m/version33-fullcode-cms/fullcode_cms/P0617.html

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r59

Triage status Notes

Moderate alfa sia-r11 WCAG 2.0 A Link has accessible name (WCAG 2.4.4) 1/4664 pages · 1 instances Likely content

Bug ID: VS-bd64c680
Pattern ID: VS-28ebd979
Combined ID: VS-bd64c680 (pattern VS-28ebd979) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 A
Obligation: required
Handling: review
WCAG SC: 2.4.4 Link Purpose (In Context) (Level A, WCAG 2.0)
Rule: Siteimprove Alfa — Link has accessible name [sia-r11]
Example URL: http://cms.gov/data-research/cms-data/learn-more-about-cms-data
XPath / selector: <a href="/data-research/cms-data/qualified-entity-program" target="_blank" data-entity-substitution="canonical" data-entity-type="node">
History: first seen 2026-W24, last seen 2026-W38 (13 wk)

Description

Link has accessible name. Detected by Siteimprove Alfa rule sia-r11 on 1 of 4664 scanned pages (1 instances).

Steps to reproduce

Open http://cms.gov/data-research/cms-data/learn-more-about-cms-data.
Locate the element: <a href="/data-research/cms-data/qualified-entity-program" target="_blank" data-entity-substitution="canonical" data-entity-type="node">
Confirm the Siteimprove Alfa finding for rule sia-r11 against WCAG 2.4.4 Link Purpose (In Context).

Impact

Affects Without vision (1.0%), Limited vision (2.4%), Limited cognitive, language, or learning ability (11.0%).

Without vision — 1.0% of population
Limited vision — 2.4% of population
Limited cognitive, language, or learning ability — 11.0% of population

Affected pages

/data-research/cms-data/learn-more-about-cms-data

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Give the link an accessible name via text content or aria-label.

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r11

Triage status Notes

Moderate alfa sia-r69 WCAG 2.0 AA Text has sufficient color contrast (Enhanced) (WCAG 1.4.3) 1/4664 pages · 1 instances Likely content

Bug ID: VS-74ba4388
Pattern ID: VS-f7e99f4b
Combined ID: VS-74ba4388 (pattern VS-f7e99f4b) — use this format in JIRA/spreadsheets to filter by instance or pattern
WCAG category: WCAG 2.0 AA
Obligation: required
Handling: review
WCAG SC: 1.4.3 Contrast (Minimum) (Level AA, WCAG 2.0)
Rule: Siteimprove Alfa — Text has sufficient color contrast (Enhanced) [sia-r69]
Example URL: https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started
XPath / selector: text: "Pages in this section"
History: first seen 2026-W24, last seen 2026-W38 (15 wk)

Description

Text has sufficient color contrast (Enhanced). Detected by Siteimprove Alfa rule sia-r69 on 2 of 4664 scanned pages (2 instances).

Steps to reproduce

Open https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started.
Locate the element: text: "Pages in this section"
Confirm the Siteimprove Alfa finding for rule sia-r69 against WCAG 1.4.3 Contrast (Minimum).

Impact

Affects Limited vision (2.4%), Without color perception (4.5%).

Limited vision — 2.4% of population
Without color perception — 4.5% of population

Affected pages

/medical-bill-rights/help/submit-a-complaint/get-started

Testing environment

Automated: Siteimprove Alfa, headless Chromium (Playwright). Manual AT verification: Not captured by automated scan — requires manual testing.

Suggested fix

How to fix: Increase text contrast to meet WCAG AA (4.5:1, or 3:1 for large text).

See remediation guidance: https://alfa.siteimprove.com/rules/sia-r69

Triage status Notes

Deque axe-core findings

Rule-level axe-core summary (22 rule type(s))

Each failing rule links out to the axe-core documentation. For full element-level detail including HTML snippets and XPaths, see the bug reports above.

axe-core rules failing in 2026-W38, by pages affected
Rule	Impact	Pages affected	Instances	Example pages	All affected
Links must be distinguishable without relying on color [link-in-text-block]	serious	424	965	/medicare-coverage-database/view/lcd.aspx /medicare-coverage-database/view/lcd.aspx /medicare-coverage-database/view/cal.aspx	all 424 pages (CSV)
All page content should be contained by landmarks [region]	moderate	307	5687	/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html /icd10m/version37-fullcode-cms/fullcode_cms/P0242.html /icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0091.html	all 307 pages (CSV)
<html> element must have a lang attribute [html-has-lang]	serious	305	305	/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html /icd10m/version37-fullcode-cms/fullcode_cms/P0242.html /icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0091.html	all 305 pages (CSV)
Document should have one main landmark [landmark-one-main]	moderate	305	305	/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html /icd10m/version37-fullcode-cms/fullcode_cms/P0242.html /icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0091.html	all 305 pages (CSV)
Headings should not be empty [empty-heading]	minor	298	298	/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html /icd10m/version37-fullcode-cms/fullcode_cms/P0242.html /icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0091.html	all 298 pages (CSV)
Images must have alternative text [image-alt]	critical	294	295	/icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0093.html /icd10m/version37-fullcode-cms/fullcode_cms/P0242.html /icd10m/FY2023-version40.1-fullcode-cms/fullcode_cms/P0091.html	all 294 pages (CSV)
Heading levels should only increase by one [heading-order]	moderate	277	280	/medicare-coverage-database/reports/local-coverage-proposed-lcds-alphabetical-report.aspx /medicare-coverage-database/reports/local-coverage-final-lcds-contractor-report.aspx /about-cms/grants-cooperative-agreements/currentnts-funding-opportunities	all 277 pages (CSV)
<ul> and <ol> must only directly contain <li>, <script> or <template> elements [list]	serious	254	1344	/medicare-coverage-database/view/lcd.aspx /medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/lcd.aspx	all 254 pages (CSV)
accesskey attribute value should be unique [accesskeys]	serious	98	288	/icd10m/fy2025-version42.0-fullcode-cms/fullcode_cms/P0369.html /icd10m/FY2027-fr-v44-fullcode-cms/fullcode_cms/P1212.html /icd10m/FY2026-fr-v43-fullcode-cms/fullcode_cms/P0027.html	all 98 pages (CSV)
scope attribute should be used correctly [scope-attr-valid]	moderate	42	850	/medicare-coverage-database/view/ncacal-decision-memo.aspx /medicare-coverage-database/view/ncacal-decision-memo.aspx /icd10m/fy2025-version42.0-fullcode-cms/fullcode_cms/P1138.html	all 42 pages (CSV)
Elements must meet minimum color contrast ratio thresholds [color-contrast]	serious	34	510	/medicare-coverage-database/view/lcd.aspx /medicare-coverage-database/view/lcd.aspx /medicare-coverage-database/view/lcd.aspx	all 34 pages (CSV)
Table header text should not be empty [empty-table-header]	minor	20	45	/medicare-coverage-database/view/lcd.aspx /icd10m/fy2025-version42.0-fullcode-cms/fullcode_cms/P1138.html /medicare-coverage-database/view/ncacal-decision-memo.aspx	all 20 pages (CSV)
Page should contain a level-one heading [page-has-heading-one]	moderate	18	18	/icd10m/version33-fullcode-cms/fullcode_cms/P1462.html /icd10m/version33-fullcode-cms/fullcode_cms/P0113.html /icd10m/version33-fullcode-cms/fullcode_cms/P0384.html	all 18 pages (CSV)
Form elements must have labels [label]	critical	12	12	/icd10m/version33-fullcode-cms/fullcode_cms/P1462.html /icd10m/version33-fullcode-cms/fullcode_cms/P0113.html /icd10m/version33-fullcode-cms/fullcode_cms/P0384.html	all 12 pages (CSV)
<li> elements must be contained in a <ul> or <ol> [listitem]	serious	5	198	/medicare-coverage-database/view/lcd.aspx /medicare-coverage-database/view/ncacal-decision-memo.aspx /medicare-coverage-database/view/ncacal-decision-memo.aspx	all 5 pages (CSV)
Links must have discernible text [link-name]	serious	4	6	/data-research/cms-data/learn-more-about-cms-data /medicare/quality/clinical-laboratory-improvement-amendments /medicare-coverage-database/view/ncacal-decision-memo.aspx	all 4 pages (CSV)
Landmarks should have a unique role or role/label/title (i.e. accessible name) combination [landmark-unique]	moderate	3	3	/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-08.html /about-cms/contact/newsroom /apps/media	all 3 pages (CSV)
Table cell headers attributes must refer to other <th> elements in the same table [td-headers-attr]	serious	2	2	/medicare/regulations-guidance/transmittals/2022-transmittals /medicare/regulations-guidance/transmittals/2020-transmittals	all 2 pages (CSV)
Interactive controls must not be nested [nested-interactive]	serious	1	1	/files/linked-video-files/new-features-medicare-gov	all 1 pages (CSV)
Scrollable region must have keyboard access [scrollable-region-focusable]	serious	1	1	/medicare-coverage-database/view/ncacal-decision-memo.aspx	all 1 pages (CSV)
Certain ARIA roles must contain particular children [aria-required-children]	critical	1	1	/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html	all 1 pages (CSV)
lang attribute must have a valid value [valid-lang]	serious	1	1	/data-research/monitoring-programs/improper-payment-measurement-programs/exchange-improper-payment-measurement-eipm/improper-payment-findings	all 1 pages (CSV)

Siteimprove Alfa findings

Rule-level Alfa summary (27 rule type(s))

Rule-level summary from Siteimprove Alfa (W3C ACT-based). Findings that overlap with axe-core on the same WCAG success criterion are noted as possible duplicates in the bug reports above.

Alfa rules failing in 2026-W38, by pages affected
Rule	Impact	Pages affected	Instances	Example pages	All affected
Target size is at least 44×44 CSS pixels (Enhanced) [sia-r111]	n/a	491	16513	/medicare/regulations-guidance/transmittals/2021-transmittals /about-cms/work-with-us/careers/positions /icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html	all 491 pages (CSV)
Text has minimum contrast ratio of 4.5:1 [sia-r73]	n/a	484	5866	/medicare/regulations-guidance/transmittals/2021-transmittals /about-cms/work-with-us/careers/positions /icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html	all 484 pages (CSV)
Form field label is visible [sia-r61]	n/a	435	435	/medicare/regulations-guidance/transmittals/2021-transmittals /about-cms/work-with-us/careers/positions /medicare-coverage-database/view/article.aspx	all 435 pages (CSV)
Link is distinguishable without relying on color [sia-r74]	n/a	190	13131	/medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/article.aspx	all 190 pages (CSV)
Text has enhanced contrast [sia-r66]	n/a	190	1073	/medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/article.aspx	all 190 pages (CSV)
Accessible name of link or button matches visible label [sia-r14]	n/a	189	481	/medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/article.aspx	all 189 pages (CSV)
Headings are structured hierarchically [sia-r53]	n/a	164	165	/medicare-coverage-database/view/article.aspx /about-cms/grants-cooperative-agreements/currentnts-funding-opportunities /medicare-coverage-database/view/article.aspx	all 164 pages (CSV)
Scrolling content can be accessed by keyboard [sia-r57]	n/a	163	163	/medicare/regulations-guidance/transmittals/2021-transmittals /about-cms/work-with-us/careers/positions /medicare/regulations-guidance/transmittals/2024-transmittals/r12626otn	all 163 pages (CSV)
Table header has scope [sia-r78]	n/a	124	149	/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html /about-cms/grants-cooperative-agreements/currentnts-funding-opportunities /medicare-coverage-database/view/article.aspx	all 124 pages (CSV)
Target size is at least 24×24 CSS pixels or has spacing (Minimum) [sia-r113]	n/a	103	395	/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html /medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/article.aspx	all 103 pages (CSV)
Presentational children of an element are not focusable [sia-r68]	n/a	60	216	/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html /medicare-coverage-database/view/lcd.aspx /icd10m/version%20371r1-fullcode-cms/fullcode_cms/P0043.html	all 60 pages (CSV)
Document has a valid lang attribute [sia-r4]	n/a	56	56	/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html /icd10m/version38-fullcode-cms/fullcode_cms/P0331.html /icd10m/version39-fullcode-cms/fullcode_cms/P0135.html	all 56 pages (CSV)
Image has accessible name [sia-r2]	n/a	55	55	/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html /icd10m/version38-fullcode-cms/fullcode_cms/P0331.html /icd10m/version39-fullcode-cms/fullcode_cms/P0135.html	all 55 pages (CSV)
Element has required owned roles [sia-r64]	n/a	55	55	/icd10m/FY2023-version40-fullcode-cms/fullcode_cms/P0340.html /icd10m/version38-fullcode-cms/fullcode_cms/P0331.html /icd10m/version39-fullcode-cms/fullcode_cms/P0135.html	all 55 pages (CSV)
Element has required aria-owns [sia-r46]	n/a	18	30	/medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/article.aspx	all 18 pages (CSV)
Scrollable element is keyboard accessible [sia-r80]	n/a	16	456	/medicare-coverage-database/view/lcd.aspx /medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/article.aspx	all 16 pages (CSV)
iframe element is not empty [sia-r71]	n/a	6	59	/medicare-coverage-database/view/article.aspx /medicare-coverage-database/view/lcd.aspx /medicare-coverage-database/view/lcd.aspx	all 6 pages (CSV)
Link in text block is visually distinguishable without color [sia-r62]	n/a	6	12	/medicare-coverage-database/view/lcd.aspx /medicare-coverage-database/view/lcd.aspx /medicare-coverage-database/view/article.aspx	all 6 pages (CSV)
Table cell has header [sia-r77]	n/a	3	4	/medicare-coverage-database/view/ncacal-decision-memo.aspx /icd10m/fy2025-version42.0-fullcode-cms/fullcode_cms/P1686.html /medicare/quality/value-based-programs/value-based-purchasing-snf-vbp-program/spotlights-announcements	all 3 pages (CSV)
Duplicate role landmark is labeled [sia-r79]	n/a	3	3	/medicare-coverage-database/view/ncacal-decision-memo.aspx /medicare-coverage-database/view/ncacal-decision-memo.aspx /medicare-coverage-database/view/ncacal-decision-memo.aspx	all 3 pages (CSV)
Text has sufficient color contrast (Enhanced) [sia-r69]	n/a	2	2	/medical-bill-rights/help/submit-a-complaint/get-started /medicare-coverage-database/view/lcd.aspx	all 2 pages (CSV)
No obsolete or deprecated elements are used [sia-r70]	n/a	2	2	/medicare-coverage-database/view/ncacal-decision-memo.aspx /medicare-coverage-database/view/article.aspx	all 2 pages (CSV)
aria-hidden element is not exposed to assistive technology [sia-r45]	n/a	1	197	/medicare/regulations-guidance/transmittals/2020-transmittals	all 1 pages (CSV)
Form field error is identified and described [sia-r75]	n/a	1	2	/icd10m/version33-fullcode-cms/fullcode_cms/P0617.html	all 1 pages (CSV)
Link has accessible name [sia-r11]	n/a	1	1	/data-research/cms-data/learn-more-about-cms-data	all 1 pages (CSV)
Element with orientation is not locked [sia-r59]	n/a	1	1	/icd10m/version33-fullcode-cms/fullcode_cms/P0617.html	all 1 pages (CSV)
Element with lang attribute has correct language [sia-r7]	n/a	1	1	/data-research/monitoring-programs/improper-payment-measurement-programs/exchange-improper-payment-measurement-eipm/improper-payment-findings	all 1 pages (CSV)

Unique accessibility issues (axe + Alfa consolidated)

axe and Alfa both implement W3C ACT rules, so the same issue is often caught by both. These are deduplicated by ACT rule and page, so a shared finding counts once (5526 raw engine findings → 5357 unique).

Unique issues (rule × page): 5357
Caught by both engines: 169 highest confidence
axe only: 2537
Alfa only: 2651

6 rule type(s) caught by both engines — highest confidence

Two independent ACT-rule implementations (Deque axe-core and Siteimprove Alfa) flagged the same issue on the same pages. Agreement between separate engines is strong evidence the barrier is real, not a single-tool false positive — the best place to start.

Rules flagged by both axe-core and Alfa in 2026-W38, by pages affected.
Issue	Pages	Rule references
<html> element must have a lang attribute	305	axe html-has-lang · Alfa sia-r4 · ACT b5c3f8
Headings should not be empty	298	axe empty-heading · Alfa sia-r64 · ACT ffd0e9
Images must have alternative text	294	axe image-alt · Alfa sia-r2 · ACT 23a2a8
Links must have discernible text	4	axe link-name · Alfa sia-r11 · ACT c487ae
Table cell headers attributes must refer to other <th> elements in the same table	2	axe td-headers-attr · Alfa sia-r45 · ACT a25f45
lang attribute must have a valid value	1	axe valid-lang · Alfa sia-r7 · ACT de46e4