Medicare Home Health Payment Integrity and Protection Act 2026
Senator Susan Collins of Maine has introduced a significant piece of legislation aiming to boost the Centers for Medicare & Medicaid Services (CMS) capabilities in tackling fraud within the home health care sector. The Medicare Home Health Payment Integrity and Protection Act of 2026 seeks to reinstate Medicare home health payment rates to their former levels following several years of reductions. Key measures include stricter pre-enrollment requirements for home health agencies and more frequent inspections for specific agencies.
The proposed legislation would require stringent measures such as mandatory fingerprinting for administrators of agencies flagged as high-risk for fraud. These agencies must also provide proof of liability insurance. Additionally, CMS is empowered to set criteria for identifying agencies posing extreme fraud risks, with the option to enforce tighter screening processes. The bill also demands increased scrutiny for newly enrolled agencies, those with ownership changes, and those applying for reinstatement of billing privileges. Moreover, it introduces heavier penalties for non-compliance with quality data reporting and mandates CMS surveyor training.
Another focus of the proposal is adjusting home health payment rates to deter fraud and address utilization shifts post-COVID-19. It proposes the allocation of funds for CMS and federal law enforcement to tackle organized fraud schemes and for CMS and state bodies to carry out expedited surveys and operations checks of home health agencies. Additional provisions include granting CMS rulemaking authority and the obligation to report progress to Congress.
Industry groups have welcomed the proposal. The National Alliance for Care at Home praised the bill for its approach to enhancing payment integrity by correcting the CMS’s Medicare rate adjustment calculation methodology. The Alliance points out that previous rate cutbacks were premised on flawed data, and this bill aims to better align rates with actual care expenses.
Jennifer Sheets, CEO of the Alliance, emphasized the bill's potential to foster more accurate program integrity measures, thereby reducing reliance on broad enforcement actions that might negatively impact legitimate providers. Katie Smith Sloan, President and CEO of LeadingAge, underscored the necessity of recalibrating standard prospective payment rates, especially in areas witnessing an upsurge in home health providers.
Submitted to the Committee on Finance, the bill aligns with industry calls for targeted fraud deterrence rather than broad, potentially cumbersome interventions. While CMS has previously implemented a national moratorium on new home health and hospice enrollments to mitigate fraud, bodies like the Alliance champion initiatives that safeguard compliant providers and secure patient access to quality care.