Hospice CARE Act of 2026

This bill amends the Social Security Act to reform Medicare hospice care by imposing a temporary moratorium on new hospice enrollment, increasing oversight and survey frequency for certain hospices, changing payment structures, and requiring independent physician certifications. It aims to ensure program integrity and align payments with costs.

Sec. 2, Ensuring the integrity of hospice care: This section imposes a nationwide 5-year moratorium on enrolling new hospice programs, with exemptions for areas lacking access. It requires prepayment medical review for certain hospices with aberrant claims, revalidates enrollment info within 6 months, and mandates public reporting of ownership data. It extends enhanced oversight for newly enrolled hospices to up to 2 years and requires surveys every 18 months for hospices on a new list (including those newly enrolling or with live discharge outliers). It also prohibits Medicare payments to hospices failing to meet quality data reporting requirements starting fiscal year 2028, and ensures physician certifications of terminal illness are independent.

Sec. 3, Payment reforms for hospice care: This section adjusts payment rates for hospice care. Starting fiscal year 2030, routine home care payments split into a per diem for non-direct patient care and a per visit amount for direct care. It provides higher payments (400% of 2027 rates) for specified palliative services like chemotherapy, radiation, transfusions, and dialysis from 2027 to 2032, subject to conditions. It allows outlier payments for unusual care variations starting 2032, capped at 5% of total payments. It requires plans of care for specified services to be established by independent specialists. It also excludes home health aide and homemaker services from hospice care for individuals not in skilled nursing or nursing facilities.