H.R. 8883

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8883 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 8883

To amend title XVIII of the Social Security Act to provide for 
additional oversight of hospice programs and home health agencies under 
the Medicare program, and for other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

May 19, 2026

Ms. Van Duyne 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 provide for 
additional oversight of hospice programs and home health agencies 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 ``Protecting Seniors and Stopping 
Fraudsters Act''.

SEC. 2. REVALIDATING ENROLLMENT OF HOSPICE PROGRAMS IN CERTAIN STATES.

(a) 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) Revalidation of hospice programs in certain 
states.--
``(A) In general.--In the case that the Secretary 
provides, pursuant to paragraph (3)(A), that new 
hospice programs located in a State are subject to the 
enhanced oversight described in such paragraph under 
the program under this title, the Secretary shall, not 
later than 1 year after the date specified in 
subparagraph (B) with respect to such enhanced 
oversight requirement, revalidate the enrollment in the 
program under this title of each hospice program 
located in such State that--
``(i) is not a new hospice program; and
``(ii) was not subject to such revalidation 
during the 18-month period preceding such date.
``(B) Date specified.--For purposes of subparagraph 
(A), the date specified in this subparagraph is, with 
respect to an enhanced oversight requirement described 
in subparagraph (A)--
``(i) in the case that such requirement 
took effect before the date of enactment of 
this paragraph and is in effect on such date of 
enactment, such date of enactment; and
``(ii) in the case that such requirement 
takes effect on or after the date of enactment 
of this paragraph, such effective date.''.
(b) Technical Correction.--Section 1866(j)(3)(A) of the Social 
Security Act (42 U.S.C. 1395cc(j)(3)(A)) is amended by striking ``title 
XIX. and'' and inserting ``title XIX, and''.

SEC. 3. ADDITIONAL OVERSIGHT PROVISIONS FOR HOSPICE PROGRAMS.

(a) Increased Survey Frequency for Certain Hospice Programs.--
Section 1822(a)(1) of the Social Security Act (42 U.S.C. 1395i-6(a)(1)) 
is amended--
(1) by striking ``Any entity'' and inserting:
``(A) In general.--Subject to subparagraph (B), any 
entity''; and
(2) by adding at the end the following new subparagraph:
``(B) Increased frequency for certain hospice 
programs.--
``(i) Newly enrolled; change of ownership; 
reactivated billing privileges.--Beginning 1 
year after the date of enactment of this 
clause, a hospice program that is newly 
enrolled under this title, has undergone a 
change of ownership (as defined by the 
Secretary), or has reactivated billing 
privileges under this title in accordance with 
section 424.540(b) of title 42, Code of Federal 
Regulations (or a successor regulation), shall 
be subject to such a survey not less frequently 
than once every 12 months during the 36-month 
period immediately following such enrollment, 
change, or reactivation.
``(ii) Additional hospice programs.--
``(I) In general.--Subject to 
subclause (II), beginning 1 year after 
the date of enactment of this clause--
``(aa) a hospice program 
that did not submit quality 
data to the Secretary in 
accordance with section 
1814(i)(5)(C) for the most 
recent fiscal year for which 
data is available (as 
determined by the Secretary) 
shall be subject to such a 
survey not later than 18 months 
after the most recent such 
survey conducted with respect 
to such hospice program; and
``(bb) a hospice program 
that has a live discharge rate 
that is aberrant compared to 
peers (as determined by the 
Secretary) or otherwise 
displays characteristics or 
engages in practices that may 
indicate fraudulent or aberrant 
behavior (as specified by the 
Secretary after consultation 
with stakeholders, such as 
beneficiary advocates and 
representatives of the hospice 
industry, and the Inspector 
General of the Department of 
Health and Human Services, and 
updated as necessary after 
additional consultation with 
such stakeholders not less 
often than once every 3 years) 
shall be subject to such a 
survey not later than 18 months 
after the most recent such 
survey conducted with respect 
to such hospice program.
``(II) Limiting duplicative 
surveys.--A hospice program shall not 
be subject to more than 1 survey under 
this clause within any 18-month 
period.''.
(b) Payment Adjustment if Quality Data Not Submitted.--Section 
1814(i)(5) of the Social Security Act (42 U.S.C. 1395f(i)(5)) is 
amended--
(1) in subparagraph (A)(i)--
(A) by striking ``for fiscal year 2024 and each 
subsequent fiscal year'' and inserting ``for fiscal 
years 2024 through 2028''; and
(B) by inserting ``, or, for fiscal year 2029 and 
each subsequent fiscal year, 15 percentage points'' 
after ``4 percentage points''; and
(2) in subparagraph (C), by adding at the end the following 
new sentence: ``For fiscal year 2029 and each subsequent fiscal 
year, in specifying a time for the submission of such data 
pursuant to the previous sentence, the Secretary shall 
establish a process under which any hospice program that has 
demonstrated a good faith effort to submit such data by such 
time may be granted additional time (not to exceed 30 days) to 
complete such submission.''.

SEC. 4. ADDITIONAL OVERSIGHT PROVISIONS FOR HOME HEALTH AGENCIES.

(a) Increased Survey Frequency for Certain Home Health Agencies.--
Section 1891(c)(2)(B) of the Social Security Act (42 U.S.C. 
1395bbb(c)(2)(B)) is amended--
(1) in clause (ii), by striking the period at the end and 
inserting a semicolon;
(2) by redesignating clauses (i) and (ii) as subclauses (I) 
and (II), respectively, and adjusting the margins accordingly;
(3) by striking ``, a standard survey'' and inserting the 
following: ``--
``(i) a standard survey''; and
(4) by adding at the end the following new clauses:
``(ii) beginning 1 year after the date of enactment of this 
clause, in the case that the agency is newly enrolled under 
this title, has undergone a change of ownership (as defined by 
the Secretary), or has reactivated billing privileges under 
this title in accordance with section 424.540(b) of title 42, 
Code of Federal Regulations (or a successor regulation), a 
standard survey of an agency shall be conducted not less 
frequently than once every 12 months during the 36-month period 
immediately following such enrollment, change, or reactivation; 
and
``(iii) beginning 1 year after the date of enactment of 
this clause, a standard survey of an agency shall be 
conducted--
``(I) in the case that the agency did not submit 
quality data to the Secretary in accordance with 
subclauses (II) and (IV) of section 1895(b)(3)(B)(v) 
for the most recent year for which data is available 
(as determined by the Secretary), not later than 18 
months after the most recent such survey conducted with 
respect to such agency; and
``(II) in the case that the agency has a 
beneficiary admission rate that is aberrant compared to 
peers (as determined by the Secretary) or otherwise 
displays characteristics or engages in practices that 
may indicate fraudulent or aberrant behavior (as 
specified by the Secretary after consultation with 
stakeholders, such as beneficiary advocates and 
representatives of the home health industry, and the 
Inspector General of the Department of Health and Human 
Services, and updated as necessary after additional 
consultation with such stakeholders not less often than 
once every 3 years), not later than 18 months after the 
most recent such survey conducted with respect to such 
agency,
except that an agency shall not be subject to more than 1 
survey under this clause within any 18-month period.''.
(b) Payment Adjustment if Quality Data Not Submitted.--Section 
1895(b)(3)(B)(v) of the Social Security Act (42 U.S.C. 
1395fff(b)(3)(B)(v)) is amended--
(1) in subclause (I)--
(A) by striking ``applicable under such clause for 
such year'' and inserting ``applicable under such 
clause for 2007 and each subsequent year through 
2028''; and
(B) by inserting ``, and, for 2029 and each 
subsequent year, shall be reduced by 15 percentage 
points'' after ``2 percentage points'';
(2) in subclause (II), by adding at the end the following 
new sentence: ``For 2029 and each subsequent year, in 
specifying a time for the submission of such data pursuant to 
the previous sentence, the Secretary shall establish a process 
under which any home health agency that has demonstrated a good 
faith effort to submit such data by such time may be granted 
additional time (not to exceed 30 days) to complete such 
submission.''; and
(3) in subclause (IV)(cc), by adding at the end the 
following new sentence: ``For 2029 and each subsequent year, in 
specifying a time for the submission of such data pursuant to 
the previous sentence, the Secretary shall establish a process 
under which any home health agency that has demonstrated a good 
faith effort to submit such data by such time may be granted 
additional time (not to exceed 30 days) to complete such 
submission.''.

SEC. 5. ENHANCING ENROLLMENT SCREENING FOR HOSPICE PROGRAMS AND HOME 
HEALTH AGENCIES.

Section 1866(j)(2) of the Social Security Act (42 U.S.C. 
1395cc(j)(2)) is amended--
(1) in subparagraph (B)--
(A) in clause (i), by striking ``and'' at the end;
(B) in clause (ii)(V), by striking the period at 
the end and inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iii) beginning 1 year after the date of 
enactment of this clause, in the case of a 
hospice program or home health agency applying 
for enrollment under this title that is at an 
extreme risk of fraud (as determined under 
subparagraph (G)), shall, in addition to any 
other screening required under this 
subparagraph--
``(I) in the case that 
fingerprinting is included in such 
screening with respect to hospice 
programs or home health agencies (as 
applicable) pursuant to clause 
(ii)(II), require fingerprinting of the 
administrator and the medical director 
of such hospice program or home health 
agency; and
``(II) require obtaining evidence 
that such hospice program or home 
health agency has a comprehensive 
liability insurance policy, as 
determined by the Secretary.''; and
(2) by adding at the end the following new subparagraph:
``(G) Hospice programs and home health agencies at 
extreme risk of fraud.--
``(i) In general.--Beginning 1 year after 
the date of enactment of this subparagraph, for 
purposes of subparagraph (B)(iii), the 
Secretary shall determine whether a hospice 
program or home health agency is at an extreme 
risk of fraud based on--
``(I) the determination made under 
clause (ii); and
``(II) such other factors as the 
Secretary may specify.
``(ii) Determination of high-risk areas.--
For purposes of clause (i), the Secretary shall 
determine whether a hospice program or home 
health agency is located in a State or county 
with respect to which, during the most recent 
year for which data is available, the total 
number of hospice programs or home health 
agencies (as applicable) located in such State 
or county significantly exceeded the total 
number of such programs or agencies located in 
such State or county during the preceding 
year.''.

SEC. 6. ADDITIONAL SURVEY AND TRAINING REQUIREMENTS FOR ACCREDITATION 
ORGANIZATIONS.

Section 1865 of the Social Security Act (42 U.S.C. 1395bb) is 
amended--
(1) in subsection (a)(2)--
(A) by striking ``In making'' and inserting the 
following: ``(A) In making''; and
(B) by adding at the end the following new 
subparagraph:
``(B)(i) Beginning 1 year after the date of enactment of 
this subparagraph, the Secretary may not approve a request for 
a finding under paragraph (1) with respect to a national 
accreditation body unless the survey procedures of such 
accreditation body--
``(I) met or exceeded the standards 
applicable to the survey procedures that State 
and local agencies that have entered into an 
agreement with the Secretary under section 
1864(a) are required to use; and
``(II) require surveyors to complete the 
relevant basic surveyor training courses 
offered by the Centers for Medicare & Medicaid 
Services before serving as a member of a survey 
team.
``(ii) The Secretary may only continue to give effect to 
any such finding made prior to the date that is 1 year after 
the date of enactment of this subparagraph with respect to a 
national accreditation body if the Secretary determines before 
such date that the survey procedures of such accreditation body 
meet the conditions described in clause (i) .''; and
(2) by adding at the end the following new subsection:
``(f)(1) Not later than 1 year after the date of enactment of this 
subsection, the Secretary shall establish and implement a mechanism for 
periodically assessing the performance of an accreditation body that 
has received approval from the Secretary under subsection (a)(3)(A) for 
accreditation of provider entities.
``(2) In the case that the Secretary finds, pursuant to the 
mechanism established under paragraph (1), that the performance of such 
accreditation body is deficient, the Secretary shall provide for an 
appropriate remedy, which may include the imposition of a corrective 
action plan, ongoing monitoring of the accreditation body, and the 
termination of such approval with respect to the accreditation body for 
accreditation of such provider entities.''.

SEC. 7. EXTENDING ADJUSTMENT TO CALCULATION OF HOSPICE CAP AMOUNT UNDER 
MEDICARE.

Section 1814(i)(2)(B) of the Social Security Act (42 U.S.C. 
1395f(i)(2)(B) is amended--
(1) in clause (ii), by striking ``2035'' and inserting 
``2036''; and
(2) in clause (iii), by striking ``2035'' and inserting 
``2036''.

SEC. 8. REQUIRING NOTICE REGARDING REVOCATION OF HOSPICE PROGRAM 
ELECTION UNDER MEDICARE.

(a) In General.--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) With respect to elections under this paragraph made on or 
after the date that is 1 year after the date of enactment of this 
subparagraph, the Secretary shall, not later than 15 calendar days 
after the effective date of such election, provide to such individual 
written notice of such election. Such notice shall display the toll-
free telephone number 1-800-MEDICARE, and shall include--
``(i) the name, address, and telephone number of the 
hospice program with respect to which such election is made;
``(ii) a description, in plain language, of the waiver of 
rights applicable under subparagraph (A); and
``(iii) an explanation of how such individual may revoke 
such election under subparagraph (B) or change the hospice 
program with respect to which such election is made under 
subparagraph (C).''.
(b) Funding.--Section 1812 of the Social Security Act (42 U.S.C. 
1395d) is amended by adding at the end the following new subsection:
``(h) Funding for Election Notices.--The Secretary shall provide 
for the transfer, from the Federal Hospital Insurance Trust Fund under 
section 1817 to the Centers for Medicare & Medicaid Services Program 
Management Account, of $6,000,000 for each fiscal year (beginning with 
fiscal year 2026) for purposes of carrying out subsection (d)(2)(E). 
Sums so transferred shall remain available until expended.''.

SEC. 9. REPORT ON PROGRAM INTEGRITY ACTIVITIES.

(a) In General.--Not later than the date that is 1 year after the 
date of the enactment of this section, and annually thereafter for a 
period of 5 years, the Secretary of Health and Human Services shall 
report to the appropriate committees of Congress on the outcome of 
program integrity activities conducted with respect to hospice programs 
or home health agencies enrolled under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.), which shall include the 
following information with respect to the preceding year:
(1) A description of each type of entity of the Centers for 
Medicare & Medicaid Services that conducted reviews, audits, or 
any other program integrity activities with respect to hospice 
programs or home health agencies enrolled under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.).
(2) The number of reviews, audits, or other program 
integrity activities performed by each such type of entity with 
respect to hospice programs or home health agencies.
(3) A description of any trends, including instances of 
individual physicians with high rates of ineligible 
certifications, identified by such entities with respect to 
improper payments made to hospice programs or home health 
agencies.
(4) Any findings made by such entities with respect to 
reviews, audits, or other program integrity activities 
conducted with respect to hospice programs and home health 
agencies.
(5) The number and nature of enforcement actions taken by 
the Centers for Medicare & Medicaid Services with respect to 
hospice programs and home health agencies as a result of the 
findings described in paragraph (4), including the number of 
revocations of enrollment in the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) of 
hospice programs and home health agencies.
(6) A description of any actions taken by the Centers for 
Medicare & Medicaid Services to reduce duplication of efforts 
among such entities, including any actions taken to prevent or 
mitigate the administrative burden on hospice programs and home 
health agencies associated with program integrity activities.
(b) Definitions.--In this section:
(1) Appropriate committees of congress.--The term 
``appropriate committees of Congress'' means--
(A) the Committee on Ways and Means and the 
Committee on Energy and Commerce of the House of 
Representatives; and
(B) the Committee on Finance of the Senate.
(2) Home health agency.--The term ``home health agency'' 
has the meaning given such term in section 1861(o) of the 
Social Security Act (42 U.S.C. 1395x(o)).
(3) Hospice program.--The term ``hospice program'' has the 
meaning given such term in section 1861(dd)(2) of the Social 
Security Act (42 U.S.C. 1395x(dd)(2)).

SEC. 10. 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 
$100,000,000 for fiscal year 2026 for purposes of carrying out section 
1822(a)(1) of such Act, as amended by section section 3(a), and section 
1891(c)(2) of such Act, as amended by section section 4(a). Sums so 
transferred shall remain available until expended. Any transfer 
pursuant to this subsection shall be in addition to any transfer 
pursuant to section 3(a)(2) of the Improving Medicare Post-Acute Care 
Transformation Act of 2014.
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