H.R. 7966

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7966 Introduced in House (IH)]

<DOC>

119th CONGRESS
2d Session
H. R. 7966

To amend title XVIII of the Social Security Act to ensure the integrity 
of hospice care furnished under the Medicare program, and for other 
purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

March 17, 2026

Ms. Sanchez introduced the following bill; which was 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

_______________________________________________________________________

A BILL

To amend title XVIII of the Social Security Act to ensure the integrity 
of hospice care furnished under the Medicare program, and for other 
purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Hospice Care Accountability, Reform, 
and Enforcement Act of 2026'' or the ``Hospice CARE Act of 2026''.

SEC. 2. ENSURING THE INTEGRITY OF HOSPICE CARE FURNISHED UNDER THE 
MEDICARE PROGRAM.

(a) Mandatory Temporary Moratorium on Enrollment.--
(1) In general.--Section 1866(j) of the Social Security Act 
(42 U.S.C. 1395cc(j)) is amended by adding at the end the 
following new paragraph:
``(10) Mandatory temporary moratorium on enrollment of 
hospice programs.--
``(A) In general.--Except as provided in 
subparagraphs (B) and (C), the Secretary shall impose a 
nationwide temporary moratorium on the enrollment of 
new hospice programs under this title for the 5-year 
period beginning on the date of the enactment of this 
paragraph.
``(B) Exemption for certain hospices.--
``(i) In general.--The Secretary may exempt 
a hospice program seeking to enroll under this 
title from the moratorium described in 
subparagraph (A) if the Secretary determines 
that such program will furnish hospice care to 
individuals entitled to benefits under part A 
in an area with insufficient access to such 
care (as specified by the Secretary, taking 
into account the considerations described in 
clause (ii)).
``(ii) Considerations described.--For 
purposes of clause (i), the considerations 
described in this clause are, with respect to a 
hospice program seeking to enroll under this 
title, the following:
``(I) The specific geographic area 
that such program intends to serve.
``(II) The current availability of 
hospice care in such area.
``(III) Any evidence of unmet need 
for hospice care in such area (such as 
wait times for such care, the extent to 
which such area (or a population in 
such area) is considered underserved, 
and evidence that existing hospice 
programs are provided a substandard 
quality of care in such area).
``(IV) The program's plan to 
address any identified gaps in the 
provision of hospice care in such area.
``(C) Authority to lift moratorium.--The Secretary 
may lift the moratorium imposed under subparagraph (A) 
within a State (or geographic region of a State) 
specified by the Secretary in the same manner as the 
Secretary may lift a temporary moratorium (as described 
in paragraph (7)) under section 424.570(d) of title 42, 
Code of Federal Regulations (or a successor 
regulation).
``(D) Application of prepayment medical review 
during the temporary moratorium in certain 
circumstances.--
``(i) In general.--Subject to clause (ii), 
the Secretary shall apply prepayment medical 
review to hospice care consisting of routine 
home care furnished during the 5-year period 
beginning on the date of the enactment of this 
paragraph by an applicable hospice program to a 
covered individual.
``(ii) Termination of application of 
prepayment medical review.--
``(I) In general.--The Secretary 
shall terminate the application of 
prepayment medical review under clause 
(i) with respect to hospice care 
furnished by an applicable hospice 
program to a covered individual if the 
Secretary determines that, during the 
period in which such care so furnished 
by such program was subject to such 
review, such care was subject to a low 
rate of denial (as specified by the 
Secretary) under such review.
``(II) Revocation of termination.--
The Secretary may revoke any 
termination of prepayment medical 
review under subclause (I) if 
determined appropriate by the 
Secretary.
``(iii) Definitions.--For purposes of this 
subparagraph:
``(I) Applicable hospice program.--
The term `applicable hospice program' 
means a hospice program with a history 
of claim submissions with respect to 
hospice care furnished under this title 
that is aberrant (such as by 
demonstrating that such program is an 
outlier with respect to live 
discharges) compared to such history of 
claim submissions of similarly situated 
hospice programs, as determined by the 
Secretary.
``(II) Covered individual.--The 
term `covered individual' means an 
individual receiving hospice care under 
this title during the second 90-day 
period described in section 1812(d)(1) 
(or during any subsequent period) 
applicable to such individual.
``(E) Revalidation of enrollment information.--
``(i) In general.--During the 6-month 
period beginning on the date of the enactment 
of this paragraph and notwithstanding any 
applicable revalidation cycle under section 
424.515 of title 42, Code of Federal 
Regulations (or a successor regulation), the 
Secretary shall revalidate the enrollment 
information of each hospice program enrolled 
under this title in accordance with the 
requirements applicable to revalidations of 
such information under such section.
``(ii) Publication of ownership 
information.--Not later than 1 year after the 
date of the enactment of this paragraph, the 
Secretary shall publish on a public website of 
the Centers for Medicare & Medicaid Services 
ownership interest and managing control 
information collected pursuant to revalidations 
described in clause (i) for each hospice 
program enrolled under this title.
``(iii) Report.--Not later than January 1, 
2028, the Secretary, acting through the 
Assistant Secretary for Planning and 
Evaluation, shall submit to Congress a report 
on hospice ownership and control trends and the 
role of private equity in ownership and control 
of hospice programs. Such report shall 
include--
``(I) validation, to the extent 
feasible, of the ownership and control 
information reported on form CMS-855A 
(or any successor form);
``(II) an analysis of hospice cost 
report data by ownership type;
``(III) recommendations on ways to 
improve the integrity of the ownership 
and control information reported by 
hospices during the enrollment process 
under this title; and
``(IV) to the extent practicable, 
recommendations on policies to promote 
health care competition.
``(F) Implementation.--The Secretary shall 
implement this paragraph through program instruction or 
other forms of subregulatory guidance.''.
(2) Authority to provide exemptions to temporary 
moratoria.--Section 1866(j)(7) of the Social Security Act (42 
U.S.C. 1395cc(j)(7)) is amended--
(A) in subparagraph (A), by adding at the end the 
following new sentence: ``The Secretary may exempt a 
provider of services or supplier that would otherwise 
be subject to a moratorium imposed under the preceding 
sentence from such moratorium if determined appropriate 
by the Secretary.''; and
(B) in subparagraph (C)(iii)--
(i) in subclause (I), by striking ``and'' 
at the end;
(ii) in subclause (II), by striking the 
period and inserting ``; and''; and
(iii) by adding at the end the following 
new subclause:
``(III) is not subject to an 
exemption described in such 
subparagraph.''.
(b) Extension of Oversight of Newly-Enrolled Hospice Programs.--
(1) In general.--Section 1866(j)(3)(A) of the Social 
Security Act (42 U.S.C. 1395cc(j)(3)(A)) is amended by 
inserting ``(or, in the case of a hospice program, not more 
than 2 years)'' after ``1 year''.
(2) Mandatory application of enhanced oversight for certain 
hospice programs.--Section 1866(j)(3) of the Social Security 
Act (42 U.S.C. 1395cc(j)(3)) is amended--
(A) by redesignating subparagraph (B) as 
subparagraph (C); and
(B) by inserting after subparagraph (A) the 
following new subparagraph:
``(B) Mandatory application to certain hospice 
programs.--The procedures established by the Secretary 
under subparagraph (A) shall provide that any hospice 
program enrolling under this title that would, but for 
application of subparagraph (B) or (C) of paragraph 
(10), have been prohibited from so enrolling be subject 
to the enhanced oversight described in such 
subparagraph for a period of not less than 30 days.''.
(c) Increase in Survey Frequency for Certain Hospice Programs.--
Section 1822(a) of the Social Security Act (42 U.S.C. 1395i-6(a)) is 
amended--
(1) in paragraph (1)--
(A) by inserting ``, with respect to such a survey 
conducted with respect to a hospice program that is not 
included on the list established under paragraph (5),'' 
after ``local survey agency, or''; and
(B) by inserting ``(or, in the case of a hospice 
program that is included on the list established under 
paragraph (5), not less frequently than once every 18 
months)'' after ``36 months'';
(2) by redesignating paragraph (5) as paragraph (6);
(3) by inserting after paragraph (4) the following new 
paragraph:
``(5) Hospice programs subject to increased survey 
frequency.--
``(A) In general.--The Secretary shall establish a 
list of hospice programs subject to increased survey 
frequency under paragraph (1) in accordance with the 
provisions of this paragraph.
``(B) Inclusion on list.--
``(i) In general.--The Secretary shall 
include a hospice program on the list 
established under subparagraph (A) if such 
program is not participating in the special 
focus program under subsection (b) and such 
hospice program meets either of the following 
criteria:
``(I) The program first submitted a 
claim for an item or service under this 
title during the 5-year period ending 
on the date of the enactment of this 
paragraph.
``(II) The program first submits a 
claim for an item or service under this 
title on or after such date of 
enactment.
``(ii) Discretionary inclusion.--The 
Secretary may include a hospice program on the 
list established under subparagraph (A)--
``(I) if claims data submitted by 
such program indicates that such 
program is not providing the full scope 
of hospice care services payable under 
this title;
``(II) if the Secretary determines 
that such program is an outlier with 
respect to live discharges; or
``(III) for any other reason 
determined appropriate by the 
Secretary.
``(C) Removal from list.--The Secretary shall 
remove a hospice program included in the list 
established under subparagraph (A)--
``(i) if--
``(I) such program has been subject 
to 2 surveys under this subsection 
while included on such list; and
``(II) neither such survey resulted 
in such program being cited for a 
deficiency for failure to comply with a 
condition of participation relating to 
quality of care; or
``(ii) if such program is placed in the 
special focus program established under 
subsection (b).''; and
(4) in paragraph (6), as so redesignated, by striking 
``each fiscal year (beginning with fiscal year 2022)'' and 
inserting ``each of fiscal years 2022 through 2026, and of 
$15,000,000 for fiscal year 2027 and for each subsequent fiscal 
year,''.
(d) Prohibition on Payment for Failure To Meet Quality Data 
Reporting Requirements.--Section 1814(i)(5) of the Social Security Act 
(42 U.S.C. 1395f(i)(5)) is amended--
(1) in subparagraph (A)--
(A) in the header, by striking ``Reduction in 
update for'';
(B) in clause (i)--
(i) in the header, by striking ``In 
general'' and inserting ``Fiscal years 2014 
through 2027'';
(ii) by inserting ``through fiscal year 
2027'' after ``each subsequent fiscal year''; 
and
(iii) by adding at the end the following 
new sentence: ``The application of the 
preceding sentence may result in the market 
basket percentage increase under paragraph 
(1)(C)(ii)(VII) or paragraph (1)(C)(iii), as 
applicable, being less than 0.0 for a fiscal 
year, and may result in payment rates under 
this subsection for a fiscal year being less 
than such payment rates for the preceding 
fiscal year.''; and
(C) by amending clause (ii) to read as follows:
``(ii) Subsequent fiscal years.--For 
purposes of fiscal year 2028 and each 
subsequent fiscal year, no payment may be made 
under this title to a hospice program that does 
not submit data to the Secretary in accordance 
with subparagraph (C) with respect to such 
fiscal year.''; and
(2) in subparagraph (B), by striking ``subparagraph (A)'' 
and inserting ``subparagraph (A)(i)''.
(e) Ensuring Independence of Physician Certifications of Terminal 
Illness.--Section 1814(a)(7)(A)(i) of the Social Security Act (42 
U.S.C. 1395f(a)(7)(A)(i)) is amended--
(1) in subclause (I), by inserting ``or, with respect to 
certifications under this clause occurring on or after October 
1, 2027, in the case such individual fails to designate such an 
attending physician (or in the case such attending physician is 
employed by the hospice program at which such individual will 
receive such care or otherwise has a significant ownership 
interest in, or a significant financial relationship with, such 
program (as determined by the Secretary)), by a physician, 
physician assistant, or nurse practitioner that does not have 
such a significant ownership interest in, or such a significant 
financial relationship with, such program (as determined by the 
Secretary)'' before ``, and''; and
(2) in the matter following subclause (II), by striking 
``physician's'' and inserting ``physician's, physician 
assistant's, nurse practitioner's,''.
(f) Allowing Additional Providers To Certify Terminal Illness.--
(1) In general.--Section 1814(a)(7)(A)(i)(I) of the Social 
Security Act (42 U.S.C. 1395f(a)(7)(A)(i)(I)) is amended by 
striking ``(which for purposes of this subparagraph does not 
include a nurse practitioner or a physician assistant)''.
(2) Effective date.--The amendment made by paragraph (1) 
shall apply with respect to certifications of terminal 
illnesses made on or after October 1, 2027.
(g) Allowable Use of Supporting Material in Medical Review of 
Hospice Care.--Section 1814(a) of the Social Security Act (42 U.S.C. 
1395f(a)) is amended by adding at the end the following new sentence: 
``For purposes of conducting medical review of hospice care furnished 
to an individual, in addition to using documentation in the medical 
record of such individual's attending physician (as defined in section 
1861(dd)) or of the physician, physician assistant, or nurse 
practitioner otherwise making the certification described in paragraph 
(7)(A)(i)(I) with respect to such individual, the Secretary may use 
documentation in the medical record of the hospice program furnishing 
such care as supporting material, as determined appropriate by the 
Secretary.''.
(h) Prohibition on Certain Changes in Majority Ownership.--With 
respect to any change in the majority ownership of a hospice program 
occurring during the 5-year period beginning on the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
apply section 424.550(b) of title 42, Code of Federal Regulations (or a 
successor regulation), as if the references to ``36 months'' in 
paragraph (1) of such section were references to ``60 months''.
(i) Advanced Notice of Changes in Ownership or Control.--Section 
1822 of the Social Security Act (42 U.S.C. 1395i-6) is amended by 
adding at the end the following new subsection:
``(d) Advanced Notice of Changes in Ownership or Control.--
``(1) In general.--Beginning January 1, 2028, in the case a 
change occurs in--
``(A) the persons with an ownership or control 
interest (as defined in section 1124(a)(3)) in the 
hospice program;
``(B) the persons who are officers, directors, 
agents, or managing employees (as defined in section 
1126(b)) of the hospice program;
``(C) the corporation, association, or other 
company responsible for the management of the hospice 
program;
``(D) the individual who is the administrator of 
the hospice program; or
``(E) the individual who is the medical director of 
the hospice program;
such program shall provide notice at the time of the change 
(or, in the case such change is with respect to a person 
described in subparagraph (A), at least 90 days before the 
effective date of the change) to the Secretary, the appropriate 
State or local survey agency, or appropriate approved 
accreditation agency of the change and of the identity of each 
new person, company, or individual described in the respective 
subparagraph.
``(2) Enforcement.--
``(A) In general.--In the case that the Secretary 
determines that a hospice program has violated 
paragraph (1), the Secretary may--
``(i) impose a civil monetary penalty in an 
amount not to exceed $1,000,000 per violation; 
and
``(ii) if determined appropriate by the 
Secretary, terminate such program's enrollment 
under this title.
``(B) Procedures.--The provisions of section 1128A 
(other than subsections (a) and (b) of such section) 
shall apply to a civil monetary penalty imposed under 
subparagraph (A) in the same manner as such provisions 
apply to a penalty or proceeding under such section.''.
(j) Required Provision of Addendum of Noncovered Services.--Section 
1812(d)(1) of the Social Security Act (42 U.S.C. 1395d(d)(1)) is 
amended by adding at the end the following new sentence: ``With respect 
to such an election made on or after October 1, 2027, in the case such 
program determines that there are items and services being furnished to 
such individual that are not related to the treatment of the 
individual's condition with respect to which a diagnosis of terminal 
illness has been made, such election shall include an addendum that 
specifies such items and services and includes such additional 
information as may be specified by the Secretary. Such program shall 
provide an updated addendum described in the preceding sentence to such 
individual if, while such election is in effect with respect to such 
individual, such program makes any alteration to the addendum provided 
to such individual at the time of such election.''.
(k) Medical Review of Hospice Outliers and Care Unrelated to 
Terminal Condition.--
(1) In general.--
(A) Medical review.--Section 1814(a)(7) of the 
Social Security Act (42 U.S.C. 1395f(a)(7)) is 
amended--
(i) in subparagraph (D), by striking 
``and'' at the end;
(ii) in subparagraph (E), by inserting 
``before the date of the enactment of 
subparagraph (F),'' after ``subparagraph,''; 
and
(iii) by adding at the end the following 
new subparagraph:
``(F) beginning on the date that is 5 years after 
the date of the enactment of this subparagraph, in the 
case of hospice care provided an individual for more 
than 90 days by a hospice program with aberrant billing 
patterns (as determined by the Secretary), the hospice 
care provided to such individual is subject to 
prepayment medical review (in accordance with 
procedures established by the Secretary); and''.
(B) Technical expert panel.--
(i) In general.--The Secretary of Health 
and Human Services shall establish a technical 
expert panel for purposes of establishing 
standards for identifying a hospice program 
with a history of aberrant billing patterns 
under section 1814(a)(7)(F) of the Social 
Security Act, as added by subparagraph (A). In 
making recommendations with respect to such 
standards, such panel shall take into account 
the results of prepayment medical reviews 
conducted under section 1866(j)(10)(D) of such 
Act, as added by subsection (a).
(ii) FACA waiver.--The provisions of 
chapter 10 of title 5, United States Code, 
shall not apply to the panel established under 
clause (i).
(2) Prepayment medical review requirement.--Section 
1812(d)(2) of the Social Security Act (42 U.S.C. 1395d(d)(2)) 
is amended by adding at the end the following new subparagraph:
``(E) Notwithstanding any other provision of this title, in the 
case of items and services (other than items and services described in 
the matter following clause (ii)(II) of subparagraph (A)) furnished on 
or after October 1, 2027, to an individual with an election in effect 
under paragraph (1) by a provider of services or supplier, if such 
provider of services or supplier indicates that such items and services 
are unrelated to the individual's condition with respect to which a 
diagnosis of terminal illness has been made, no payment may be made 
under this title for such items and services before the Secretary has 
conducted a medical review of such items and services to determine 
whether such items and services are unrelated to such condition. Such 
review shall include a review of any addendum described in paragraph 
(1) included in such election.''.
(3) Funding.--The Secretary of Health and Human Services 
shall provide for the transfer, from the Federal Hospital 
Insurance Trust Fund established under section 1817 of the 
Social Security Act (42 U.S.C. 1395i) to the Centers for 
Medicare & Medicaid Services Program Management Account, of 
$20,000,000 for fiscal year 2027, to remain available until 
expended, for purposes of carrying out the amendments made by 
this subsection.
(l) Provision of Explanation of Benefits Upon Hospice Election.--
(1) In general.--Section 1806 of the Social Security Act 
(42 U.S.C. 1395b-7) is amended by adding at the end the 
following new subsection:
``(d) Provision of Explanation of Benefits Upon Hospice Election.--
The Secretary shall furnish to each individual who makes an election 
described in section 1812(d)(1), not later than 15 days after such 
individual makes such election, a notice that--
``(1) specifies--
``(A) the effective date of such election;
``(B) the hospice program that will be furnishing 
hospice care to such individual;
``(C) the telephone number and address of such 
program;
``(D) the physician, physician assistant, or nurse 
practitioner who made the certification described in 
section 1814(a)(7)(A)(i)(I) with respect to such 
individual;
``(E) the toll-free telephone number of the 
medicare administrative contractor responsible for 
processing claims for such care;
``(2) informs such individual of the waiver of rights 
described in section 1812(d)(2)(A);
``(3) includes a statement which indicates that, because 
errors do occur and because Medicare waste, fraud, and abuse is 
a significant problem, such individual should carefully check 
the individual's hospice election information and if such 
individual suspects Medicare waste, fraud, or abuse with 
respect to the provision of such care, the individual should 
contact the toll-free phone number 1-800-MEDICARE and a toll-
free phone number maintained by the Inspector General of the 
Department of Health and Human Services for the receipt of 
complaints and information about waste, fraud, and abuse in the 
provision or billing of services under this title; and
``(4) includes any other information determined appropriate 
by the Secretary.''.
(2) Funding.--The Secretary of Health and Human Services 
shall provide for the transfer from the Federal Hospital 
Insurance Trust Fund established under section 1817 of the 
Social Security Act (42 U.S.C. 1395i) to the Centers for 
Medicare & Medicaid Services Program Management Account of 
$10,000,000 for fiscal year 2027, to remain available until 
expended, for purposes of carrying out the amendment made by 
paragraph (1).
(3) Effective date.--The amendment made by paragraph (1) 
shall apply to individuals making elections described in 
section 1812(d)(1) of the Social Security Act (42 U.S.C. 
1395d(d)(1)) on or after the date that is 1 year after the date 
of the enactment of this Act.
(m) Medical Review of Hospice Care Contractor Requirements.--
(1) In general.--The Secretary of Health and Human Services 
(in this subsection referred to as the ``Secretary'') shall 
require any entity performing medical review under contract 
with Secretary of hospice care furnished under part A of title 
XVIII of the Social Security Act (42 U.S.C. 1395c et seq.) to, 
with respect to such reviews performed on or after January 1, 
2028, utilize only individuals who have received specialized 
instruction on the philosophy behind hospice care and medical 
prognostication (as specified by the Secretary) in performing 
such reviews. In so specifying such instruction and in updating 
such instruction, the Secretary shall consult with hospice 
programs as to the content of such instruction.
(2) Publication.--The Secretary shall make any instruction 
specified for purposes of paragraph (1) publicly available on 
the website of the Centers for Medicare & Medicaid Services.
(3) Report.--Not later than October 1, 2028, the Secretary 
shall submit to Congress a report on activities relating to the 
medical review of hospice care furnished under part A of title 
XVIII of the Social Security Act (42 U.S.C. 1395c et seq.). 
Such report shall include--
(A) with respect to the medical review of hospice 
care performed during the period beginning on January 
1, 2020, and ending on December 31, 2025, the accuracy 
rates of such reviews when performed by--
(i) medicare administrative contractors;
(ii) recovery audit contractors;
(iii) supplemental medical review 
contractors; and
(iv) uniform program integrity contractors;
(B) the total number of hospice claims submitted 
during the period described in subparagraph (A) subject 
to medical review;
(C) the percentage of such claims that were denied 
and appealed and the percentage of such claims so 
appealed that were overturned on appeal, broken down by 
the type of contractor conducting review of such claims 
and by each level of appeal;
(D) a list of medical review projects relating to 
hospice care undertaken by contractors described in 
subparagraph (A); and
(E) actions the Secretary will take to reduce the 
audit burden on hospice programs with claims selected 
for medical review under multiple projects described in 
subparagraph (D) and to minimize the number of denials 
of claims for hospice care that are overturned on 
appeal.
(n) Requiring Face-to-Face Encounters Before Recertifications of 
Terminal Illness.--Section 1814(a)(7) of the Social Security Act (42 
U.S.C. 1395f(a)(7)) is amended--
(1) in subparagraph (D)--
(A) by inserting ``, and before October 1, 2027'' 
after ``2011''; and
(B) by striking ``and'' at the end; and
(2) by adding at the end the following new subparagraph:
``(F) on and after October 1, 2027, not more than 
30 days before each recertification described in 
subparagraph (A)(ii) is made with respect to an 
individual, a hospice physician, hospice nurse 
practitioner, or hospice physician assistant has a 
face-to-face encounter (which may, with respect to any 
such recertification made for a 60-day period described 
in such subparagraph, be conducted via telehealth, but 
only if a registered nurse, licensed practical nurse, 
or home health aide employed by the hospice program 
furnishing hospice care to such individual is 
physically present with such individual during such 
encounter) with such individual to gather clinical 
findings to determine such individual's continue 
eligibility for hospice care; and''.
(o) Ensuring Medical Director and Physician Availability.--
(1) In general.--Section 1861(dd) of the Social Security 
Act (42 U.S.C. 1395x(dd)) is amended--
(A) in paragraph (2)--
(i) in subparagraph (F), by striking 
``and'' at the end;
(ii) by redesignating subparagraph (G) as 
subparagraph (I); and
(iii) by inserting after subparagraph (F) 
the following new subparagraphs:
``(G) has a medical director responsible for the 
medical component of hospice care provided by such 
program who--
``(i) is a doctor of medicine or osteopathy 
licensed to practice in the State in which such 
program is located; and
``(ii) subject to paragraph (6), is not the 
medical director of more than 1 other hospice 
program;
``(H) ensures that the medical director described 
in subparagraph (G) or a physician member of the group 
described in subparagraph (B) is available for 
immediate consultation (which may be through 
telehealth) when hospice care is provided in an 
individual's home; and''; and
(B) by adding at the end the following new 
paragraph:
``(6) The Secretary may waive the requirement described in 
paragraph (2)(G)(ii) with respect to the medical director of a hospice 
program if determined appropriate by the Secretary on a case-by-case 
basis. In determining whether to grant a waiver under the preceding 
sentence, the Secretary shall take into consideration--
``(A) the average daily census for each hospice program 
with respect to which such director is medical director;
``(B) the geographic areas served by such programs; and
``(C) any other information determined appropriate by the 
Secretary.''.
(2) Effective date.--The amendments made by paragraph (1) 
shall apply beginning January 1, 2029.
(p) Report on Hospice Accrediting Organizations.--Not later than 2 
years after the date of the enactment of this Act, the Comptroller 
General of the United States shall submit to Congress a report on the 
Secretary of Health and Human Services' (in this subsection referred to 
as the ``Secretary'') oversight of hospice program accrediting 
organizations. Such report shall include the following:
(1) An analysis of deficiencies relating to quality of care 
found pursuant to surveys conducted under section 1822(a) of 
the Social Security Act (42 U.S.C. 1395i-6(a)) following 
complaints when such surveys were of hospice programs 
accredited by such an organization and such surveys were 
conducted by such an organization compared to such deficiencies 
so found following such complaints when such surveys were of 
hospice programs certified by State or local survey agencies 
and such surveys were conducted by such agencies.
(2) A list of hospice programs determined by the Secretary 
not to be in compliance with all requirements applicable to 
such programs, along with a list of the accrediting 
organization of each such program.
(3) A list of hospice programs that have been deactivated, 
terminated, or investigated due to concerns relating to waste, 
fraud, or abuse, along with a list of the accrediting 
organization of each such program.
(4) An analysis of any conflicts of interest of hospice 
program accrediting organizations.
(5) Performance data for hospice program accrediting 
organizations.

SEC. 3. PAYMENT REFORMS FOR HOSPICE CARE FURNISHED UNDER THE MEDICARE 
PROGRAM.

(a) Adjusting Payments for Hospice Care.--
(1) In general.--Section 1814(i)(1)(C) of the Social 
Security Act (42 U.S.C. 1395f(i)(1)(C)) is amended--
(A) in clause (iii)--
(i) by moving such clause 6 ems to the 
left;
(ii) by striking ``With respect to'' and 
inserting ``Except as provided under clauses 
(viii) through (x), with respect to'';
(iii) by inserting ``in a setting (as 
specified by the Secretary for purposes of 
clause (vii))'' after ``hospice care 
furnished'';
(iv) by inserting ``for such setting'' 
after ``payment rates in effect''; and
(v) by striking ``under this clause'' and 
inserting ``under this subparagraph'';
(B) in clause (iv), by striking ``clause (ii)(VII) 
or (iii)'' each place such phrase appears and inserting 
``clause (iii) or (iv) of paragraph (2)(D) or clause 
(ii)(VII), (iii), (viii), (ix), or (x)'' in each such 
place; and
(C) by adding at the end the following new clauses:
``(vii) Prior to the beginning of a specified fiscal year (as 
defined in clause (xi)), the Secretary shall specify percentages by 
which the payment rates for hospice care consisting of services other 
than routine home care (and, for specified years beginning on or after 
October 1, 2034, for hospice care consisting of routine home care and 
other services included in hospice care) in effect for the preceding 
fiscal year shall be adjusted in such specified fiscal year to align 
such rates with the costs of such care. In specifying such 
percentages--
``(I) the Secretary shall take into account changes in the 
average cost of such care and such other factors as determined 
appropriate by the Secretary; and
``(II) the Secretary may specify different percentages for 
such care based on the setting (as specified by the Secretary) 
in which such care is furnished.
``(viii)(I) With respect to routine home care furnished during 
fiscal year 2030, the payment rates for such care shall be equal to the 
sum of--
``(aa) a per diem amount (which may include an a case mix 
adjustment to account for variations in cost among different 
units of service) reflecting the cost of routine home care not 
consisting of direct patient care for nursing care, physical 
therapy, occupational therapy, speech-language pathology 
services, medical social services (other than counseling 
services), home health aide services, and physician services 
(other than such services that are considered administrative 
services); and
``(bb) subject to such frequency limits as may be specified 
by the Secretary, a per visit amount (which may vary depending 
on the type and duration of the visit, as determined 
appropriate by the Secretary) reflecting the cost of routine 
home care consisting of direct patient care excluded from the 
per diem amount established under item (aa) (other than, in the 
case of such care furnished at a skilled nursing facility or 
nursing facility (as defined in section 1919(a)), the component 
of such rates attributable to home health aide services).
``(II) With respect to routine home care furnished during fiscal 
year 2031 or a subsequent fiscal year, the payment rates for such care 
shall be equal to the sum of--
``(aa) the per diem amount attributable to hospice care 
described in subclause (I)(aa) in effect under this clause for 
the preceding fiscal year, adjusted, in the case of a specified 
fiscal year, by the percentages specified pursuant to clause 
(vii) for such specified fiscal year, increased by the market 
basket percentage increase (as defined in section 
1886(b)(3)(B)(iii)) for the fiscal year (reduced in accordance 
with clause (iv)); and
``(bb) the per visit amount for hospice care described in 
subclause (I)(bb) in effect under this clause for the preceding 
fiscal year, adjusted, in the case of a specified fiscal year, 
by the percentages specified pursuant to clause (vii) for such 
specified fiscal year, increased by such market basked 
percentage increase for the fiscal year (reduced in accordance 
with clause (iv)).
``(III) For purposes of this clause, the term `visit' means, with 
respect to an individual receiving hospice care from a hospice program, 
in-person contact with such individual by staff of such program (or by 
others under arrangements with such program), not including any such 
contact conducted via telehealth or any other form of 
telecommunications technology.
``(ix)(I) With respect to routine home care consisting of specified 
hospice care (as defined in subclause (II)) furnished by, or under 
arrangements made by, a hospice program during the period beginning on 
October 1, 2027, and ending on September 30, 2032, in lieu of the rates 
otherwise payable under this subparagraph for such routine home care, 
the Secretary shall pay to the hospice program furnishing such care an 
amount equal to 400 percent of the amount payable for routine home care 
furnished in fiscal year 2027, increased by the market basket 
percentage increase (as defined in section 1886(b)(3)(B)(iii)) for the 
fiscal year (reduced in accordance with clause (iv)), or such other 
amount determined appropriate by the Secretary (which may vary based on 
the type of service furnished) for each day during which such specified 
hospice care was furnished.
``(II) For purposes of subclause (I), the term `specified hospice 
care' means any of the following items and services:
``(aa) Palliative chemotherapy or radiation furnished under 
the supervision of an oncologist and in accordance with 
accepted clinical guidelines.
``(bb) Palliative radiation therapy furnished under the 
supervision of an oncologist and in accordance with accepted 
clinical guidelines.
``(cc) Subject to such frequency limitations as the 
Secretary may establish, palliative blood transfusions 
furnished to an individual diagnosed with a blood cancer and 
furnished under the supervision of an oncologist and in 
accordance with accepted clinical guidelines.
``(dd) Palliative dialysis furnished under the supervision 
of a nephrologist, but only if--
``(AA) the individual receiving such palliative 
dialysis was receiving dialysis treatments prior to 
making the election under section 1812(d); and
``(BB) such individual has received fewer than 10 
sessions of such palliative in-center or home 
hemodialysis or the equivalent for peritoneal dialysis 
or other modalities (or, in the case such individual 
has received 10 or more such sessions or the equivalent 
of such sessions, such session or equivalent of such 
session is subject to prior authorization).
``(x) With respect to hospice care consisting of services other 
than routine home care furnished during 2030 or a subsequent fiscal 
year, the payment rates for such care shall be equal to the rates in 
effect for such care for the preceding fiscal year, adjusted, in the 
case of a specified fiscal year, by the percentages specified pursuant 
to clause (vii) for such specified fiscal year, increased by the market 
basket percentage increase (as defined in section 1886(b)(3)(B)(iii)) 
for the fiscal year (reduced in accordance with clause (iv)).
``(xi) For purposes of this subparagraph, the term `specified 
fiscal year' means fiscal years 2030, 2035, and 2040.
``(xii)(I) The Secretary shall, with respect to cost reporting 
periods beginning during an applicable fiscal year (as defined in 
subclause (III)), conduct an audit of a representative sample of cost 
reports submitted by hospice programs.
``(II) The Secretary shall, for each applicable fiscal year, 
convene a technical expert panel for purposes of reviewing the 
methodology and results of the audit conducted under subclause (I) with 
respect to such applicable fiscal year.
``(III) For purposes of this clause, the term `applicable fiscal 
year' means fiscal years 2026, 2031, and 2036.
``(IV) The provisions of chapter 10 of title 5, United States Code, 
shall not apply to the panel established under subclause (II).
``(V) The Secretary shall provide for the transfer, from the 
Federal Hospital Insurance Trust Fund established under section 1817 to 
the Centers for Medicare & Medicaid Services Program Management 
Account, of $10,000,000 for each of fiscal years 2027, 2032, and 2037, 
to remain available until expended, for purposes of carrying out this 
clause.''.
(2) Outlier payments.--Section 1814(i) of the Social 
Security Act (42 U.S.C. 1395f(i)) is amended--
(A) by redesignating paragraph (7) as paragraph 
(8); and
(B) by inserting after paragraph (6) the following 
new paragraph:
``(7)(A) Subject to subparagraph (B), with respect to routine home 
care furnished during a fiscal year beginning on or after October 1, 
2032, the Secretary may, if determined appropriate by the Secretary, 
provide an additional payment for types of such care (such as specified 
hospice care (as defined in paragraph (1)(C)(ix))) specified by the 
Secretary to account for unusual variations in the type or amount of 
such routine home care.
``(B)(i) The total amount of additional payments estimated to be 
made under subparagraph (A) for routine home care furnished during a 
fiscal year may not exceed 5 percent of the total amount of payments 
estimated to be made for such care furnished during such fiscal year 
without application of this paragraph for such fiscal year.
``(ii) The total amount of additional payments estimated to be made 
under subparagraph (A) for routine home care furnished during a fiscal 
year to an individual hospice program may not exceed 10 percent of the 
total amount of payments estimated to be made for such care furnished 
during such fiscal year by such program without application of this 
paragraph for such fiscal year.
``(C) The Secretary shall reduce any per diem rate applicable under 
paragraph (1) to routine home care furnished during the first fiscal 
year for which payments are made under subparagraph (A) by such 
proportion as will result, not taking into account any additional 
payments made under subparagraph (A) for such care furnished during 
such fiscal year, in an aggregate reduction of 5 percent in payment for 
such care furnished during such fiscal year.''.
(3) Plan of care requirements.--
(A) In general.--Section 1814(a)(7)(B) of the 
Social Security Act (42 U.S.C. 1395f(a)(7)(B)) is 
amended by inserting ``and, with respect to the 
establishment of such plan, in the case such plan 
includes the furnishing of specified hospice care (as 
defined in subsection (i)(1)(C)(x)(II)), by a 
nephrologist (if such care is care described in item 
(dd) of such subsection) or by an oncologist (if such 
care is care described in any of items (aa) through 
(cc) of such subsection) who does not have a 
significant ownership interest in, or a significant 
financial relationship with, such hospice program, as 
determined by the Secretary, and, with respect to the 
periodic review of such plan, in the case such plan 
includes the furnishing of specified hospice care (as 
defined in subsection (i)(1)(C)(x)(II)), by the 
nephrologist supervising the furnishing of such care 
(if such care is described in item (dd) of such 
subsection) or by the oncologist supervising the 
furnishing of such care (if such care is described in 
any of items (aa) through (cc) of such subsection)'' 
after ``of the hospice program''.
(B) Effective date.--The amendment made by 
subparagraph (A) shall apply with respect to written 
plans for providing hospice care developed or reviewed 
on or after October 1, 2027.
(4) Excluding home health aide services and homemaker from 
the definition of hospice care in certain circumstances.--
(A) In general.--Section 1861(dd)(1)(D)(i) of the 
Social Security Act (42 U.S.C. 1395x(dd)(1)(D)(i)) is 
amended by inserting ``in the case such individual is 
not residing in a skilled nursing facility or a nursing 
facility,'' before ``services of a''.
(B) Homemaker services.--Section 1861(dd)(1)(D)(ii) 
of the Social Security Act (42 U.S.C. 
1395x(dd)(1)(D)(ii)) is amended by inserting ``(but 
only if such individual is not residing in a skilled 
nursing facility or a nursing facility (as defined in 
section 1919(a)) or, if such individual is residing in 
such a skilled nursing facility or nursing facility, 
only if such services are provided on a volunteer basis 
in accordance with paragraph (2)(E))'' after 
``homemaker services''.
(C) Effective date.--The amendments made by 
subparagraphs (A) and (B) shall apply to items and 
services furnished on or after October 1, 2029.
(5) Conforming adjustment to payment cap.--Section 
1814(i)(2)(B) of the Social Security Act (42 U.S.C. 
1395f(i)(2)(B)) is amended--
(A) in clause (i), by striking ``clause (ii)'' and 
inserting ``clauses (ii) through (iv)'';
(B) in clause (ii), by inserting ``, subject to 
clause (iii),'' after ``subparagraph (A)'';
(C) by striking clause (iii) and inserting the 
following new clause:
``(iii) For purposes of subparagraph (A), in the case of a 
specified fiscal year (as defined in paragraph (1)(C)(xi)), the `cap 
amount' for such year is the cap amount under this subparagraph for the 
preceding fiscal year, adjusted by the estimated percentage change in 
the total amount of payment made under this part for hospice care 
attributable to application of the amendments made by section 3(a)(1) 
of the Hospice CARE Act of 2026 for such specified fiscal year and then 
increased by the market basket percentage increase (as defined in 
section 1886(b)(3)(B)(iii)) for such specified fiscal year (reduced in 
accordance with paragraph (1)(C)(iv)).''; and
(D) by adding at the end the following new clause:
``(iv) For purposes of subparagraph (A), subject to clause (iii), 
for a fiscal year beginning on or after October 1, 2035, the `cap 
amount' for such year is the cap amount under this subparagraph for the 
preceding fiscal year, increased by the market basket percentage 
increase (as defined in section 1886(b)(3)(B)(iii)) for such fiscal 
year (reduced in accordance with paragraph (1)(C)(iv)).''.
(b) Wage Adjusting Caps.--
(1) In general.--Section 1814(i)(2) of the Social Security 
Act (42 U.S.C. 1395f(i)(2)), as amended by subsection (a), is 
further amended--
(A) in subparagraph (A)--
(i) by striking ```cap amount' for the year 
(computed under subparagraph (B))'' and 
inserting ``wage-adjusted cap (as defined in 
subparagraph (B)) for such program and year''; 
and
(ii) by striking ``subparagraph (C)'' and 
inserting ``subparagraph (E)'';
(B) by redesignating subparagraphs (B) through (D) 
as subparagraphs (D) through (F), respectively;
(C) by inserting after subparagraph (A) the 
following new subparagraphs:
``(B) For purposes of subparagraph (A), the term `wage-adjusted 
cap' means, with respect to a hospice program and a year, the product 
of--
``(i) the wage index ratio (as computed under subparagraph 
(C)) for such program and year; and
``(ii) the cap amount for such year (as computed under 
subparagraph (D)).
``(C) For purposes of subparagraph (B), the wage index ratio for a 
hospice program and a year is the ratio of--
``(i) the aggregate payments to such program for such year 
under paragraph (1); to
``(ii) the aggregate payments to such program for such year 
under such paragraph that would have been made had such 
payments not been subject to any wage adjustment.'';
(D) in subparagraph (D), as so redesignated--
(i) by striking ``subparagraph (A)'' each 
place it appears and inserting ``subparagraph 
(B)'' in each such place; and
(ii) by adding at the end the following new 
clause:
``(v) Notwithstanding the preceding provisions of this 
subparagraph, for a fiscal year beginning on or after October 1, 2026, 
the cap amount otherwise determined under this subparagraph for such 
fiscal year shall be decreased by the same percentage reduction (if 
any) applied to the amount of payment made under this part for such 
fiscal year under an order issued pursuant to section 251 of the 
Balanced Budget and Emergency Deficit Control Act of 1985. Any 
reduction to the cap amount for a fiscal year under the preceding 
sentence shall not be taken into account for purposes of determining 
the cap amount for any succeeding fiscal year.''; and
(E) by adding at the end the following new 
subparagraph:
``(G) Not later than 1 year after the date of the enactment of this 
subparagraph, and annually thereafter, the Secretary shall submit to 
Congress and make public on the website of the Centers for Medicare & 
Medicaid Services a report on the calculation of hospice programs' cap 
amounts under this paragraph. Such report shall contain, with respect 
to each of the 5 most recent accounting years for which data is 
available and each hospice program receiving payments under this 
section for hospice care furnished during such year, the following:
``(i) Such program's cap amount determined under such 
section.
``(ii) The percentage of such program's cap amount paid to 
such program for such care.
``(iii) In the case payments to such program exceeded such 
cap, any amount recouped by the Secretary with respect to such 
program.
``(iv) The live discharge rate of such program.''.
(2) Implementation.--Notwithstanding any other provision of 
law, the Secretary of Health and Human Services may implement 
the amendments made by paragraph (1) by program instruction or 
otherwise.
(3) Effective date.--The amendments made by subparagraphs 
(A) through (C) of paragraph (1) shall apply with respect to 
payment for hospice care furnished during fiscal years 
beginning on or after October 1, 2027.
(c) Modification of Requirements Relating to Short-Term Inpatient 
Care.--
(1) In general.--Section 1861(dd) of the Social Security 
Act (42 U.S.C. 1395x(dd)) is amended--
(A) in paragraph (1)--
(i) in subparagraph (G), by striking 
``consecutively over longer than five days'' 
and inserting ``for more than 5 days during any 
90-day election period (or 60-day election 
period, as applicable) described in section 
1812(d)(1)''; and
(ii) in the flush matter following 
subparagraph (I), by adding at the end the 
following new sentence: ``In the case of an 
individual who receives short-term inpatient 
care described in subparagraph (G) consisting 
of respite care during an election period and 
the furnishing of such care is immediately 
preceded by a hospital stay (which may include 
a stay for observation) during which such 
individual made an election described in 
section 1812(d)(1) for the first time during 
such individual's lifetime (or if such care is 
immediately preceded by the furnishing of 
hospice care consisting of general inpatient 
care and such general inpatient care is 
immediately preceded by such a hospital stay), 
the first continuous 15 days of such care shall 
not be taken into account for purposes of 
applying the limitation on the number of days 
during which such care may be furnished during 
an election period under such subparagraph, but 
only if such individual does not have 
sufficient caregiver support to be discharged 
to the individual's home.''; and
(B) in paragraph (2)--
(i) in subparagraph (A)(iii)--
(I) by striking ``provides 
assurances satisfactory to the 
Secretary that'' and inserting 
``ensures that the sum of''; and
(II) by striking ``20 percent'' and 
inserting ``10 percent (or a higher 
percent (not to exceed 20 percent) 
specified by the Secretary if 
determined necessary by the Secretary 
to ensure sufficient access to such 
inpatient care)''; and
(ii) by adding at the end the following 
flush sentence:
``For purposes of subparagraph (A)(iii), the Secretary shall 
ensure that the limitation described in such subparagraph is 
applied, to the extent practicable, on a real-time basis.''.
(2) Allowing respite care to be furnished in residential 
care facilities.--Not later than October 1, 2027, the Secretary 
of Health and Human Services (in this paragraph referred to as 
the ``Secretary'') shall revise section 418.108 of title 42, 
Code of Federal Regulations (or a successor regulation), to 
allow short-term inpatient care consisting of respite care (as 
described in section 1861(dd)(1)(G) of the Social Security Act 
(42 U.S.C. 1395x(dd)(1)(G))) to be furnished in residential 
care facilities (as defined by the Secretary) that only provide 
care to individuals receiving hospice care (as specified by the 
Secretary) and that meet such standards relating to health and 
safety as the Secretary may specify (which may be based on 
State licensure requirements applicable to such facilities).
(3) Effective date.--The amendments made by paragraph (1) 
shall apply to hospice care furnished on or after October 1, 
2027.
(d) Hospital Discharge Planning Requirements.--
(1) In general.--Section 1861(ee)(2)(D) of the Social 
Security Act (42 U.S.C. 1395x(ee)(2)(D)) is amended--
(A) by inserting ``, home health services,'' after 
``including hospice care'';
(B) by striking ``including the availability of 
home health services through individuals and entities'' 
and inserting the following: ``including--
``(i) in the case of individuals who are likely to 
need home health services, the availability of such 
services through home health agencies'';
(C) by striking ``listed by the hospital as 
available and, in the case of individuals who are 
likely to need post-hospital extended care services,'' 
and inserting the following: ``listed by the hospital 
as available;
``(ii) in the case of individuals who are likely to 
need post-hospital extended care services,'';
(D) by striking the period and inserting ``; and''; 
and
(E) by adding at the end the following new clause:
``(iii) in the case of individuals who are 
likely eligible for hospice care, the 
availability of such care (including the 
availability of respite care described in 
subsection (dd)(1)(G)) through hospice programs 
that participate in the program under this 
title and that serve the area in which the 
patient resides.''.
(2) Effective date.--The amendments made by paragraph (1) 
shall apply with respect to discharges occurring on or after 
October 1, 2027.
(e) Payment for Respite Care Furnished in the Home.--
(1) In general.--Section 1861(dd)(1) of the Social Security 
Act (42 U.S.C. 1395x(dd)(1)) is amended--
(A) in subparagraph (H), by striking ``and'' at the 
end;
(B) by redesignating subparagraph (I) as 
subparagraph (J); and
(C) by inserting after subparagraph (H) the 
following new subparagraph:
``(I) short-term home respite care furnished to an 
individual on or after October 1, 2029, that--
``(i) is furnished in the place of residence used 
as such individual's home (other than a skilled nursing 
facility, a nursing facility (as defined in section 
1919(a)), an assisted living facility (as defined by 
the Secretary), or another facility specified by the 
Secretary);
``(ii) is furnished on an intermittent, nonroutine, 
and occasional basis;
``(iii) is furnished for not more than 120 hours 
during any 90-day period described in section 
1812(d)(1) (or, in the case such individual is 60-day 
period described in such section, for not more than 80 
hours during such period); and
``(iv) meets such other requirements as the 
Secretary may specify.''.
(2) Payment rates.--Section 1814(i)(1)(C) of the Social 
Security Act (42 U.S.C. 1395f(i)(1)(C)), as amended by 
subsection (a), is further amended--
(A) in clause (iii), by striking ``through (x)'' 
and inserting ``through (x) and clause (xiii)''; and
(B) by adding at the end the following new clause:
``(xiii) With respect to short-term home respite care furnished to 
an individual during fiscal year 2030 or a subsequent fiscal year, the 
rates payable for such care shall be equal to the sum of the per diem 
rate established for routine home care for such fiscal year and an 
hourly rate established by the Secretary, except that in no case may 
such rate payable for such short-term home respite care furnished in a 
24-hour period exceed the rate of payment for general inpatient care 
furnished during such a period.''.
<all>