Protecting Seniors and Stopping Fraudsters Act
Sponsored By: Representative Van Duyne, Beth [R-TX-24]
In Committee
Summary
Strengthening Medicare integrity for hospice and home health programs by beefing up enrollment screening, increasing survey frequency, tying payment rules to data submission, and requiring beneficiary notices and accreditor oversight.
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Bill Overview
Analyzed Economic Effects
7 provisions identified: 4 benefits, 1 costs, 2 mixed.
Annual integrity reports to Congress
If enacted, the bill would require the Secretary to report to Congress within one year and then yearly for five years on Medicare program integrity for hospice and home health. Each report would cover the prior year and list the types and counts of CMS reviews and audits, trends (including physicians with high rates of ineligible certifications), audit findings, enforcement actions including enrollment revocations, and steps taken to reduce duplicate reviews and administrative burden.
Higher standards for accreditors
If enacted, the bill would bar the Secretary from approving a national accreditation body's findings unless the accreditor's survey procedures meet or exceed State and local standards and surveyors finish CMS basic training. These rules would take effect one year after enactment. The Secretary would also have to set up a mechanism within one year to continuously assess accreditors and could require corrective action, monitoring, or end approval for poor performance.
One-time $100M transfer to CMS
If enacted, the bill would transfer $100,000,000 from the Federal Hospital Insurance Trust Fund to the CMS Program Management Account for fiscal year 2026. The money would fund implementation of the bill's enhanced hospice and home health oversight provisions. The sums would remain available until expended and would be in addition to transfers under the IMPACT Act.
Stronger oversight for home health agencies
If enacted, the bill would increase oversight of Medicare home health agencies. Newly enrolled agencies, agencies with ownership changes, or those that reactivate billing would get a standard survey at least once every 12 months for 36 months after the event. Agencies that failed to submit required quality data or that have aberrant beneficiary admission rates would be surveyed within 18 months, with a limit of one such survey per 18-month period. For agencies that fail to submit required quality data, the bill would apply an added 15 percentage-point payment reduction beginning in 2029 and allow the Secretary to grant up to 30 extra days for good-faith data submissions.
Stronger oversight for hospice programs
If enacted, the bill would require more oversight of Medicare hospice programs. Newly enrolled hospices, those with ownership changes, or those that reactivate billing would be surveyed at least once every 12 months for 36 months. Hospices that miss required quality data, show an unusually high live discharge rate, or otherwise show fraud signs would face an additional survey within 18 months (but not more than one such survey in any 18-month period). The bill would also require revalidation of existing hospice enrollments in States with enhanced oversight within 1 year for non-new hospices not revalidated in the prior 18 months. Starting in fiscal year 2029, hospices that fail to submit required quality data would face an added 15 percentage-point Medicare payment reduction, and the Secretary would be able to grant up to 30 extra days for good-faith data submissions.
Written hospice notice for patients
If enacted, the bill would require a written notice to individuals who elect hospice for elections made one year after enactment. The notice would be sent no later than 15 days after the election and must show 1-800-MEDICARE and the hospice's name, address, and phone. It would explain the rights the patient waives and how to revoke or change the election. The bill would also fund $6,000,000 each fiscal year starting in FY2026 (from the Federal Hospital Insurance Trust Fund) to carry out the notice program.
Extra screening for high-risk providers
If enacted, the bill would require extra enrollment screening for hospice programs and home health agencies the Secretary identifies as at "extreme risk" starting one year after enactment. Where fingerprinting is used, the administrator and medical director would need to be fingerprinted. Applicants would also have to show proof of a comprehensive liability insurance policy. The Secretary would decide which States or counties are extreme risk based on large year-over-year increases and other factors.
Sponsors & CoSponsors
Sponsor
Van Duyne, Beth [R-TX-24]
TX • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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