Hospice CARE Act of 2026
Sponsored By: Senator Mark Warner
Introduced
Summary
A nationwide five-year moratorium on new hospice enrollments would pause new hospice program starts while forcing tighter ownership transparency, stricter clinician and governance rules, and a major rewrite of hospice payment rates to curb abuse and better align payments with costs.
Show full summary
- Patients and families: Would require a detailed Medicare notice within 15 days after a hospice election, add mandatory face-to-face recertification visits, and create a short-term home respite benefit of up to 120 hours in any 90-day period.
- Hospice programs and clinicians: Would freeze new enrollments for five years, expand ownership and control reporting and penalties, tighten credentialing and medical director rules, and generally limit a medical director to one other hospice program (effective January 1, 2029).
- Medicare payments and oversight: Would overhaul rate-setting, pay 400 percent of certain routine home care amounts for specified palliative services during Oct 1, 2027–Sept 30, 2032, add an outlier payment program with a 5 percent annual cap, and require audits, technical panels, and expanded surveys to inform caps and rates.
*Authorizes transfers of at least $40.0 million from the Federal Hospital Insurance Trust Fund to CMS accounts for notices, audits, and oversight, and would increase federal outlays for those activities.*
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
7 provisions identified: 3 benefits, 1 costs, 3 mixed.
Major Medicare hospice payment overhaul
If enacted, the bill would change how Medicare pays hospices and how the yearly hospice cap is set. For some fiscal years the cap would first be adjusted by the bill's estimated payment change and then increased by the market basket, and from fiscal year 2036 the cap would be increased only by the market basket. The bill would create a wage-adjusted cap using a ratio of payments under the new rules to payments absent the changes. The bill would lower the inpatient-share limit to 10 percent (but allow the Secretary to raise it up to 20 percent to protect access), change routine home care payment rules in fiscal year 2030, and add limited outlier payments for unusually high-cost routine home care starting October 1, 2032 subject to an aggregate 5 percent cap and a 10 percent per-program cap.
Broader hospice certifying clinician rules
If enacted, nurse practitioners and physician assistants would be allowed to certify terminal illness for hospice elections on or after October 1, 2027. The bill would require a face-to-face clinical encounter by a hospice physician, nurse practitioner, or physician assistant within 30 days before each recertification starting October 1, 2027, with limited telehealth exceptions. For written plans that include palliative dialysis, chemotherapy, radiation, or transfusion, an independent nephrologist or oncologist must prepare or review the plan. A medical director must be available for immediate consultation beginning January 1, 2029.
Limits on hospice aide coverage
If enacted, the bill would remove home health aide and homemaker services from the hospice benefit for people who live at home starting October 1, 2029. For people in skilled nursing or nursing facilities, homemaker services would be excluded except when provided by volunteers as allowed today. This change could raise out-of-pocket care costs or shift services to other programs.
Moratorium and payment bans for hospices
If enacted, the bill would place a nationwide 5-year moratorium on new Medicare hospice enrollments starting on the date of enactment, with Secretary exemptions for areas with insufficient access. The Secretary would require revalidation of existing enrollments in the first 6 months and publish ownership and control information within 1 year, and report to Congress by January 1, 2028. Starting with fiscal year 2028, hospices that fail to submit required quality data would be barred from receiving Medicare payments for that fiscal year and could face reduced payment updates. For items a hospice marks as unrelated to a patient's terminal illness, Medicare payment would be withheld until the Secretary completes a medical review for items furnished on or after October 1, 2027.
New hospice audits and reviews
If enacted, the bill would require special training for anyone who does medical review of hospice claims for reviews done on or after January 1, 2028 and would require a public report to Congress by October 1, 2028 on review accuracy, denials, appeals, and audit work. The Secretary would audit representative hospice cost reports for fiscal years 2026, 2031, and 2036 and convene technical expert panels to review methods. The bill would provide $10,000,000 transfers in FY2027, FY2032, and FY2037 for audits and set aside $15,000,000 each year starting in FY2027 for hospice survey work. The Secretary would also establish standards and prepayment review rules for programs with aberrant billing histories.
Hospice election notices and discharge info
If enacted, hospice elections made on or after October 1, 2027 would need an addendum listing services not related to the terminal illness and be updated if things change. The Secretary would have to send a written notice within 15 days after elections made one year after enactment, showing the effective date, hospice contact, certifying clinician, and a Medicare contractor toll-free number and warning about waiver-of-rights and fraud reporting. The bill would provide $10,000,000 in fiscal year 2027 to CMS to implement the notice requirement.
New short-term home respite rules
If enacted, the bill would create a short-term home respite benefit starting October 1, 2029. Respite would be limited to no more than 120 hours in any 90-day period (or 80 hours in any 60-day period) and must be intermittent and nonroutine. For fiscal year 2030 and later, respite pay would equal the routine home care daily rate plus an hourly rate set by the Secretary, but pay for any 24-hour period could not exceed the general inpatient care rate.
Sponsors & CoSponsors
Sponsor
Mark Warner
VA • D
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Start a Free Government Policy Watch to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in