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