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119-hr-7966119th CongressWALLET

Hospice CARE Act of 2026

Sponsored By: Representative Sánchez, Linda T. [D-CA-38]

Introduced

Summary

A 5-year nationwide moratorium on new hospice programs sits at the center of this bill, which also tightens enrollment checks, ownership transparency, beneficiary notices, and Medicare payment rules. It aims to curb aberrant billing while boosting oversight and clearer information for patients.

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  • Patients and families get a mandatory Explanation of Benefits within 15 days and a new short-term home respite benefit capped at 120 hours per 90-day period.
  • Hospice providers face a 60-month moratorium on most new enrollments, mandatory revalidation with published ownership data, stricter change-in-ownership rules, and civil penalties up to $1,000,000 per violation.
  • Medicare will expand prepayment medical review and create a technical expert panel to flag aberrant billing, and it phases in wage-indexed caps and rate changes starting in fiscal year 2030. Oversight and survey funding is increased by $15,000,000 yearly for fiscal year 2027 and beyond.

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Bill Overview

Analyzed Economic Effects

6 provisions identified: 1 benefits, 0 costs, 5 mixed.

Major Medicare hospice pay changes

If enacted, Medicare would change hospice payment rules and caps for several fiscal years and require CMS audits and technical panels to set new payment methods. For FY2030 routine home care would be paid as a per‑day amount for non‑direct costs plus a per‑visit amount for direct care, and CMS would set visit limits. Additional outlier payments could begin for fiscal years starting Oct 1, 2032 but would be capped at 5% of estimated routine-home-care payments per year and 10% for any hospice. The bill also authorizes transfers of $10 million to CMS in FY2027, FY2032, and FY2037 to run these changes and requires an initial per‑diem reduction so aggregate routine-home-care payments (excluding outliers) fall by 5% in the first year.

Changes to hospice respite and home care

If enacted, a new short‑term home respite benefit would be payable for care in a person's home starting October 1, 2029. The benefit would be limited to 120 hours in any 90‑day hospice election period (or 80 hours in a 60‑day period). The bill changes inpatient counting rules so short inpatient stays count as more than 5 days in a 90‑day period and says the first 15 days of respite after a qualifying hospital stay would not count toward that limit if the patient lacks caregiver support. The law would also limit when home health aide and homemaker services count as hospice services if a person resides in a nursing facility.

New clinical and certification rules

If enacted, nurse practitioners and physician assistants could certify terminal illness for hospice elections made on or after October 1, 2027. For certifications where there is no independent attending doctor, an independent clinician without significant financial ties must certify starting Oct 1, 2027. Starting Oct 1, 2027, face‑to‑face clinician encounters would be required within 30 days before each recertification, with limited telehealth rules for 60‑day recertifications. Beginning January 1, 2029 hospices must have a medical director who is an MD or DO licensed in the State and generally cannot serve as medical director for more than one other hospice unless the Secretary grants a waiver. Plans for certain hospice palliative services must be written or reviewed by an independent nephrologist or oncologist.

More audits, reviews, and penalties

If enacted, Medicare would increase targeted prepayment reviews and audits for hospices with aberrant billing patterns, starting five years after enactment for long stays and during the moratorium for later 90‑day periods. CMS would require special training for medical reviewers starting January 1, 2028 and could use hospice medical records in reviews. Medicare payments could be withheld pending review when a provider says a service is unrelated to the terminal illness, and hospices that fail to submit required quality data could be denied Medicare payments starting in fiscal year 2028.

Stronger hospice ownership controls

If enacted, the Secretary would pause new Medicare hospice enrollments for 5 years after enactment, with narrow exemptions for areas lacking access. Hospices would face longer ownership lookbacks for major sales during that moratorium (60 months instead of 36 months) and must revalidate enrollment information within 6 months of enactment. Ownership and managing-control details would be published on CMS's website within one year, and CMS would keep a list of newly billed hospices for more frequent surveys. The Secretary could extend enhanced oversight of new hospices up to 2 years.

Clear election notices and addendum

If enacted, the government would have to send an Explanation of Benefits to each person who elects hospice within 15 days. That notice would list the hospice name, contact info, certifying clinician, contractor phone number, and fraud contacts. For hospice elections made on or after October 1, 2027, hospices would have to attach an addendum listing items or services they determine are not related to the terminal illness and update it if the list changes. Congress would provide $10 million in FY2027 to help implement the EOB requirement, and the EOB rule would apply to elections made one year after enactment.

Sponsors & CoSponsors

Sponsor

Sánchez, Linda T. [D-CA-38]

CA • D

Cosponsors

  • Rep. Carbajal, Salud O. [D-CA-24]

    CA • D

    Sponsored 9/28/2026

  • Rep. Beyer, Donald S. [D-VA-8]

    VA • D

    Sponsored 4/20/2026

  • Rep. Larson, John B. [D-CT-1]

    CT • D

    Sponsored 4/20/2026

  • Rep. Suozzi, Thomas R. [D-NY-3]

    NY • D

    Sponsored 4/30/2026

  • Rep. DelBene, Suzan K. [D-WA-1]

    WA • D

    Sponsored 5/12/2026

  • Rep. Horsford, Steven [D-NV-4]

    NV • D

    Sponsored 5/21/2026

  • Rep. Wilson, Joe [R-SC-2]

    SC • R

    Sponsored 6/9/2026

Roll Call Votes

No roll call votes available for this bill.

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