Summary#
This bill changes parts of Medicare that cover hospice programs and home health agencies. It adds more oversight steps aimed at detecting and preventing fraud. Major changes include more frequent surveys of certain providers, stronger enrollment screening for high‑risk applicants, rules for accreditation organizations, new beneficiary notices about hospice elections, reporting on program integrity work, and specified funding transfers to carry out some changes.
Key provisions in the bill (from the bill text):
- Revalidation: The Secretary must revalidate enrollment of hospice programs in States subject to enhanced oversight within 1 year.
- Increased surveys: Newly enrolled hospices or home health agencies, those with ownership changes, or those that reactivate billing must receive surveys at least once every 12 months for the 36 months after those events. Providers that fail to submit required quality data or show "aberrant" live discharge or admission rates must receive a survey no later than 18 months after their last survey. Agencies may not be surveyed more than once in any 18‑month period under these rules.
- Payment adjustments: For failure to submit required quality data, the bill sets larger percentage reductions beginning in fiscal year 2029 (15 percentage points) for hospices and home health agencies, and allows a one‑time short extension (up to 30 days) if the provider showed a good faith effort to submit data.
- Enrollment screening: Beginning 1 year after enactment, applicants at "extreme risk of fraud" may face extra screening. If fingerprinting is used for these provider types, the administrator and medical director must be fingerprinted. Applicants must show evidence of a comprehensive liability insurance policy.
- Accreditation bodies: The Secretary may not approve national accreditation bodies unless their survey procedures meet or exceed applicable State standards and require surveyors to complete CMS basic surveyor training. The Secretary must establish a way to assess accreditation bodies and can impose remedies, including terminating approval, if performance is deficient.
- Notices and funding: For hospice elections made on or after 1 year after enactment, CMS must send a written notice to the individual within 15 days showing the hospice name, contact info, a plain‑language description of the waiver of rights, and how to revoke or change the election. The bill directs a $6,000,000 annual transfer from the Federal Hospital Insurance Trust Fund to CMS starting in fiscal year 2026 for these notices. The bill also directs a $100,000,000 transfer from the Trust Fund to CMS Program Management Account for fiscal year 2026 to carry out the increased survey work.
- Reporting: HHS must report annually for 5 years on program integrity activities related to hospice and home health providers, including numbers of reviews, trends, findings, enforcement actions, and steps to reduce duplication and administrative burden.
- Other: The bill extends certain hospice cap calculation adjustments to 2036 and makes several technical amendments to existing Medicare statutes.
What it means for you#
- If you choose hospice care: You should receive a written notice from Medicare within 15 days after your hospice election that lists the hospice contact information, explains the waiver of rights in simple language, and tells you how to revoke or change the election.
- If you run or work for a hospice or home health agency: Your organization may face more frequent surveys in the first 3 years after enrollment, ownership change, or reactivation. Failing to submit required quality data could result in a larger payment reduction starting in fiscal year 2029. Applicants in areas or circumstances the Secretary labels "extreme risk of fraud" may face extra screening, fingerprinting (for certain leaders), and must show liability insurance.
- If you rely on accreditation: National accreditation organizations will need to meet CMS and State survey standards and ensure surveyors complete CMS basic training. CMS will periodically assess accrediting bodies and can require fixes or remove approval.
Expenses#
- The bill specifies transfers from the Federal Hospital Insurance Trust Fund:
- $6,000,000 per fiscal year (beginning with fiscal year 2026) to CMS Program Management Account for sending hospice election notices. These funds remain available until expended.
- $100,000,000 for fiscal year 2026 to CMS Program Management Account to carry out increased surveys. This transfer remains available until expended.
- The bill also creates payment reductions (percentage point cuts) for providers that fail to submit required quality data beginning in fiscal year 2029 (15 percentage points), but it does not provide an overall cost or savings estimate.
- No publicly available information on the total budgetary impact or offsets beyond the amounts listed in the bill text.
Proponents' View#
No publicly available information.
Opponents' View#
No publicly available information.