S. 5250
Medicare Home Health Payment Integrity and Protection Act of 2026
Sponsor: Susan M. Collins
1 cosponsor
Official summary
No official summary yet.
Text of the bill
I Home health program integrity, anti-fraud, and enrollment reform
(a) Increased survey frequency for certain home health agencies. Section 1891(c)(2)(B) of the Social Security Act (42 U.S.C. 1395bbb(c)(2)(B)) is amended—
(1) in clause (ii), by striking the period at the end and inserting a semicolon;
(2) by redesignating clauses (i) and (ii) as subclauses (I) and (II), respectively, and adjusting the margins accordingly;
(3) by striking subparagraph (A), a standard survey and inserting the following: subparagraph (A)—
(i) a standard survey
; and
(4) by adding at the end the following new clauses:
(ii) beginning 1 year after the date of enactment of this clause, in the case where an agency is newly enrolled under this title, has undergone a change of ownership (as defined by the Secretary), or has reactivated billing privileges under this title in accordance with section 424.540(b) of title 42, Code of Federal Regulations (or a successor regulation), a standard survey of such agency shall be conducted not less frequently than once every 12 months during the 36-month period immediately following such enrollment, change of ownership, or reactivation of billing privileges; and
(iii) beginning 1 year after the date of enactment of this clause, a standard survey of an agency shall be conducted— except that an agency shall not be subject to more than 1 survey under this clause within any 18-month period.
(I) in the case where the agency does not submit quality data to the Secretary in accordance with subclauses (II) and (IV) of section 1895(b)(3)(B)(v) for the most recent year for which data is available (as determined by the Secretary), not later than 18 months after the date on which the most recent such survey was conducted with respect to such agency; and
(II) in the case where the agency has a beneficiary admission rate that is aberrant compared to peers (as determined by the Secretary) or otherwise displays characteristics or engages in practices that may indicate fraudulent or aberrant behavior (as specified by the Secretary after consultation with stakeholders, such as beneficiary advocates and representatives of the home health industry, and the Inspector General of the Department of Health and Human Services, and updated as necessary after additional consultation with such stakeholders not less often than once every 3 years), not later than 18 months after the date on which the most recent such survey was conducted with respect to such agency,
(b) Payment adjustment if quality data not submitted. Section 1895(b)(3)(B)(v) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(B)(v)) is amended—
(1) in subclause (I), in the first sentence, by inserting the following before the period: for years before 2029, and by 15 percentage points for 2029 and subsequent years;
(2) in subclause (II), by adding at the end the following new sentence: For 2029 and each subsequent year, in specifying a time for the submission of such data pursuant to the previous sentence, the Secretary shall establish a process under which any home health agency that has demonstrated a good faith effort to submit such data by such time may be granted additional time (not to exceed 30 days) to complete such submission.; and
(3) in subclause (IV)(cc), by adding at the end the following new sentence: For 2029 and each subsequent year, in specifying a time for the submission of such data pursuant to the previous sentence, the Secretary shall establish a process under which any home health agency that has demonstrated a good faith effort to submit such data by such time may be granted additional time (not to exceed 30 days) to complete such submission..
II Home health payment reset and data integrity
III Reports, rulemaking, program integrity funding, and implementation