Medicare Home Health Payment Integrity and Protection Act of 2026
Sponsored By: Senator Collins, Susan M. [R-ME]
Introduced
Summary
This bill would tighten Medicare's home health fraud defenses and reset payment rates, with new enrollment checks, stronger surveys, and data‑integrity safeguards. It targets unreliable claims and aims to stop fraud from distorting payments and quality measures.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 1 benefits, 1 costs, 2 mixed.
Home health payment and data changes
If enacted, the bill would set the standard Medicare home health unit payment at $2,382.87 for services in 2027. Beginning in 2027 the Secretary would be barred from using certain PDGM-based offsets when adjusting payments. The Secretary would have to exclude or adjust "suspect claims" when computing quality, benchmark, or value-based payment adjustments. Starting in 2029 agencies that fail to submit required quality data would face a payment adjustment 15 percentage points higher, but HHS would start a process in 2029 to grant up to 30 extra days for good-faith submissions.
Funding to fight home health fraud
If enacted, the bill would provide $300 million to CMS, $150 million to DOJ and the HHS Inspector General, and $100 million to CMS for State survey activities for fiscal years 2027–2031. The funds would support implementing the bill, investigations and prosecutions of organized home health fraud, and accelerated State surveys and unannounced site visits. The money would be in addition to other funds already available.
Tighter enrollment and agency surveys
If enacted, starting one year after enactment the Secretary would flag home health agencies at "extreme risk" based on local spikes in agency counts. Agencies the Secretary flags would need to provide administrator fingerprints (when fingerprinting is part of screening) and show they carry comprehensive liability insurance. New agencies, those with ownership changes, or those that reactivate billing would get annual surveys for three years. Agencies that miss required quality data or have odd admission rates would get a survey within 18 months, but no agency could get more than one such triggered survey in any 18-month period.
Stronger accreditation and oversight rules
If enacted, beginning one year after enactment the Secretary would only approve national accreditation bodies whose survey procedures meet or exceed State survey standards. Surveyors would have to finish CMS basic surveyor training before serving. The Secretary would set up regular performance checks of approved accreditation bodies and could require fixes, monitor performance, or end approval. The bill would also say the Secretary keeps current enforcement tools and would require notice-and-comment rulemaking to put Titles I and II into effect.
Sponsors & CoSponsors
Sponsor
Collins, Susan M. [R-ME]
ME • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov