Hospice CARE Act of 2026
- Bill Number
- H.R. 7966
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-03-17: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-06-10T08:07:32Z
AI-Generated Summary
Hospice CARE Act of 2026 (H.R. 7966)
Purpose
The legislation aims to strengthen the integrity of hospice care under Medicare (Part A of title XVIII of the Social Security Act) by combating fraud, waste, and abuse; improving quality oversight; ensuring appropriate certifications and reviews; and reforming payment structures to better align with costs and services.
Key Provisions
Integrity and Oversight Measures (Section 2)
- Enrollment Moratorium: Imposes a 5-year nationwide moratorium on new hospice program enrollments starting from enactment, with exemptions for underserved areas based on geography, availability, unmet needs, and program plans. Secretary can lift it regionally.
- Prepayment Reviews: Requires prepayment medical review (review before payment) for routine home care by "applicable" hospices (outliers with aberrant claims, like high live discharges) during patients' later hospice periods; ends if low denial rates.
- Enrollment Revalidation: Mandates revalidation of all hospice enrollment data within 6 months; publishes ownership/control info online; requires HHS report on ownership trends, private equity role, and competition by Jan. 1, 2028.
- Extended Oversight: New hospices face up to 2 years of enhanced oversight (vs. 1 year previously); mandatory for those that would have been blocked by moratorium.
- Increased Surveys: New or outlier hospices surveyed every 18 months (vs. 36 months); list-based for recent entrants or problematic programs (e.g., incomplete services, high live discharges). Removal after clean surveys.
- Quality Reporting: From FY2028, no Medicare payments to non-compliant hospices (previously just payment reductions).
- Certifications: Ensures independent certifiers of terminal illness (no significant ties to hospice) from Oct. 1, 2027; allows physician assistants (PAs) and nurse practitioners (NPs) to certify.
- Ownership Changes: Treats majority ownership changes as requiring re-enrollment within 60 months (vs. 36); requires 90-day advance notice for ownership/control shifts, with civil penalties up to $1M/violation and possible termination.
- Patient Notices: Hospices must list non-terminal services in election addendums (updated as needed) from Oct. 1, 2027; CMS sends benefit explanations within 15 days of election.
- Medical Reviews: Prepayment review for long-stay outliers (over 90 days) after 5 years; no payment for non-terminal services without review; specialized training for reviewers from 2028; face-to-face encounters before recertifications from Oct. 1, 2027 (telehealth allowed with nurse present).
- Medical Directors: Limits to one hospice (waivers possible); ensures availability for home care consultations from Jan. 1, 2029.
- Reports: GAO on accrediting organizations; HHS on review accuracy/appeals.
Payment Reforms (Section 3)
- Routine Home Care Payments: From FY2030, splits into per diem (non-direct care) + per-visit (direct care like nursing/therapy); adjusts for costs/settings in specified years (2030, 2035, 2040).
- Specified Palliative Care: Higher payments (up to 400% of 2027 rates) through 2032 for limited chemotherapy, radiation, transfusions, dialysis under specialist supervision.
- Other Adjustments: Aligns non-routine payments with costs; outlier add-ons from FY2033 (capped at 5% total/10% per hospice); home respite payments from FY2030.
- Caps and Audits: Wage-adjusts per-beneficiary caps from FY2027; periodic cost report audits with expert panels; conforming cap increases.
- Service Changes: Limits short-term inpatient/respite; allows home respite (up to 120 hours/90-day period); excludes aides/homemakers in facilities from FY2029.
- Planning: Hospitals must inform on hospice availability in discharge plans from Oct. 1, 2027.
Funding: Transfers from Medicare Trust Fund for implementation (e.g., $20M reviews, $10M notices/audits).
Significant Changes to Existing Law
- New Restrictions: First nationwide hospice enrollment moratorium; extended oversight/re-enrollment periods; mandatory surveys/prepayments for subsets.
- Payment Overhaul: Replaces flat routine home care rates with hybrid model; introduces palliative add-ons, home respite, wage-adjusted caps.
- Certifications/Reviews: Expands certifiers (PAs/NPs); mandates independence, face-to-face, hospice records in reviews, addendums.
- Enforcement: Advance ownership notices/penalties; no payments for quality non-reporting; specialized reviewer training.
Potential Impacts
- Government Agencies (CMS/HHS): Increased administrative burden for moratoriums, reviews, surveys, revalidations, reports; potential savings from fraud reduction and better-aligned payments.
- Citizens (Medicare Beneficiaries): Improved hospice quality/access in underserved areas; protections against improper billing/enrollments; clearer info on benefits/non-covered care; possible payment stability for complex palliative needs.
- No notable international relations impacts.
Main Stakeholders Affected
- Hospice Programs: Heaviest impact—moratoriums, surveys, reviews, reporting, ownership rules, payment shifts; new entrants/outliers most burdened.
- Medicare Patients/Families: Terminally ill elderly; gain safeguards, service expansions (e.g., home respite, palliative).
- Healthcare Providers: Physicians/PAs/NPs (certification roles); medical directors (limits); specialists (palliative oversight).
- CMS Contractors: Reviewers/auditors (training mandates); hospitals (discharge rules).
- Accreditors/Private Equity: Scrutiny via reports/publications.
Notable Legal, Constitutional, or Political Implications
- Legal: Enhances CMS enforcement (penalties, terminations, prepayments); subregulatory implementation allowed; FACA waivers for panels speed processes.
- Constitutional: None identified; standard congressional authority over Medicare spending/oversight.
- Political: Targets hospice fraud growth (e.g., live discharges, ownership opacity); promotes competition/transparency without broad bans; phased implementation (2026–2040) allows adaptation.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Sánchez, Linda T. [D-CA-38]
Cosponsors (6)
Rep. Beyer, Donald S. [D-VA-8], Rep. Larson, John B. [D-CT-1], Rep. Suozzi, Thomas R. [D-NY-3], Rep. DelBene, Suzan K. [D-WA-1], Rep. Horsford, Steven [D-NV-4], Rep. Wilson, Joe [R-SC-2]
Recent Actions
- 2026-03-17: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-03-17: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-03-17: Introduced in House
- 2026-03-17: Introduced in House
Bill Versions
- Hospice Care Accountability, Reform, and Enforcement Act of 2026 — issued 2026-03-17 — PDF (53 pages)