Hospice CARE Act of 2026
Sponsored By: Representative Sánchez, Linda T. [D-CA-38]
Introduced
Summary
A five-year nationwide moratorium on new Medicare hospice enrollments. This bill would also tighten oversight with prepayment audits, require public ownership disclosures, impose ownership-change notices and penalties, and phase in broad payment and care-rule changes.
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 1 benefits, 0 costs, 5 mixed.
New hospice visit and respite rules
If enacted, starting October 1, 2027 a hospice doctor, nurse practitioner, or physician assistant would need a face-to-face encounter within 30 days before each recertification. For 60-day recertifications, telehealth would be allowed only if a hospice-employed RN, LPN, or home health aide was physically with the patient. If enacted, short-term home respite would be defined (effective October 1, 2029) and limited to 120 hours per 90-day election or 80 hours per 60-day election, and inpatient respite days would be limited to 5 days per election period. If enacted, when inpatient respite follows a qualifying hospital stay and the patient lacks caregiver support, the first continuous 15 days would not count toward the inpatient respite day limit. Payment rules for home respite would change for FY2030 and later to a routine per diem plus an hourly rate, with a 24-hour cap at the general inpatient care rate.
New medical director rules for hospices
If enacted, beginning January 1, 2029 hospice programs would need a medical director who is an MD or DO licensed in the State. If enacted, that medical director generally could not serve as director for more than one other hospice program unless the Secretary grants a waiver. If enacted, the medical director or a physician member would need to be available for immediate consultation (telehealth allowed) when care is in a patient's home.
More audits and reviews for hospices
If enacted, the Secretary would expand prepayment medical review for certain hospices and longer stays, and require prepayment review for items billed as unrelated starting October 1, 2027. If enacted, CMS would set up a technical expert panel to make billing standards and would require special training for people doing hospice medical reviews for reviews on or after January 1, 2028, with a report to Congress due October 1, 2028. If enacted, the Secretary could use hospice medical records as supporting material in reviews. If enacted, hospices that fail to submit required quality data would not receive Medicare payments starting in fiscal year 2028. The bill also funds more frequent surveys for certain hospices and provides targeted survey funding.
Tighter hospice ownership and enrollment checks
If enacted, the bill would impose a nationwide 5-year moratorium on new Medicare hospice enrollments starting on enactment, with limited exemptions for areas lacking access. If enacted, hospices would have to give at least 90 days' notice of ownership changes starting January 1, 2028, and the Secretary could fine violators up to $1,000,000 per violation or end a hospice's Medicare enrollment. If enacted, CMS would revalidate hospice enrollment records in the six months after enactment and publish ownership and control information within one year. If enacted, ownership lookbacks for majority changes during the first five years after enactment would use a 60-month window instead of 36 months.
Clear hospice election notices and rights
If enacted, the Secretary would send each person who chooses hospice a written notice within 15 days listing the hospice, the start date, the certifying clinician, and how to report errors or fraud. If enacted, hospice elections made on or after October 1, 2027 would need an addendum listing items and services not related to the terminal illness, and hospices would have to update that addendum if it changes. If enacted, for certifications on or after October 1, 2027 a physician assistant or nurse practitioner could certify terminal illness when the attending physician has a conflict. If enacted, hospitals would have to tell patients at discharge about local Medicare home health and hospice options. The bill would also transfer $10 million to CMS in fiscal year 2027 to help send these notices.
New inpatient access and payment caps
If enacted, for inpatient access assurance the Secretary would set the required share to 10 percent, but could set it higher up to 20 percent where needed, and would try to apply the limit in real time. If enacted, beginning with fiscal years starting October 1, 2032 the Secretary could make capped outlier payments for unusual routine home care, where total extra payments per year could not exceed 5 percent of estimated routine home care payments and no hospice could get more than 10 percent extra of its estimated routine home care payments. If enacted, in the first year outlier payments are used the routine home per diem would be reduced to yield an aggregate 5 percent reduction before extras.
Sponsors & CoSponsors
Sponsor
Sánchez, Linda T. [D-CA-38]
CA • D
Cosponsors
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
DelBene
WA • D
Sponsored 5/12/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov