Sen. Susan Collins (R-Maine) has introduced a bill that, if enacted, would give the Centers for Medicare & Medicaid Services (CMS) additional tools to prevent and detect home health fraud and reset the Medicare home health payment rate to levels seen before years of payment cuts.
The bill, called the Medicare Home Health Payment Integrity and Protection Act of 2026, would require additional pre-enrollment steps for home health agencies and require more frequent surveys of some home health agencies, along with other elements.
“When billions of dollars are improperly siphoned from the Medicare home health program, this can undermine the integrity of the payment system used to reimburse legitimate providers and threaten care for the seniors who depend on it,” Collins said in a statement. “My legislation would give CMS stronger tools to stop fraud before payments are made and prevent fraudulent spending from distorting the data used to reimburse honest agencies for medically necessary care.”
Specifically, the legislation would:
— Require fingerprinting of the administrator of a home health agency deemed to present an extreme risk of fraud
— Require proof of liability insurance for agencies that exhibit extreme risk of fraud
— Allow CMS to determine the factors that indicate that an agency presents an extreme risk of fraud, and impose stricter screening requirements on those agencies
— Require more frequent surveys of home health agencies that are newly enrolled in Medicare, that undergo ownership changes or that reactivate billing privileges
— Increase inspections of home health agencies that fail to submit quality data to CMS or engage in potentially fraudulent behavior
— Increase financial penalties for failing to report quality data
— Require CMS training of home health surveyors and require accrediting agencies that work with CMS to meet or exceed CMS’ standards
— Direct CMS to reset home health payment rates to adjust for fraud in the system and changes in home health utilization since the COVID-19 pandemic
— Authorize CMS and federal law enforcement funding for the investigation and prosecution of organized home health fraud schemes
— Authorize funding for CMS and state agencies to conduct accelerated surveys, enrollment validation, unannounced site visits and operational verification of home health agencies
— Give CMS rulemaking authority to carry out its provisions and require it to report to Congress
Industry advocacy groups applauded the bill.
The National Alliance for Care at Home (the Alliance) said that, if passed, the bill would provide core payment integrity reforms by correcting the methodology that the Centers for Medicare & Medicaid Services (CMS) uses to calculate Medicare payment rate updates.
“This bill corrects longstanding flaws in home health reimbursement and takes a meaningful step toward a home health benefit that is stable and built for how care is delivered today,” Jennifer Sheets, CEO of the Alliance, said in a statement.
According to the Alliance, CMS’ several years of rate cuts to the home health base payment rate were made on data “entirely unrelated to the payment system adopted in 2020, along with data tainted by the inclusion of fraudulent providers in the rate analysis.” The new bill would bring rates back in line with rates before several years of cuts and would be a step in making payment rates better reflect the actual cost of care, according to the organization.
Sheets also voiced support for the bill’s program integrity elements, saying they would stop bad actors from entering the Medicare program without relying on sweeping enforcement strategies that could implicate legitimate providers.
Katie Smith Sloan, president and CEO of LeadingAge, said that the organization was encouraged by the bill’s recognition that the standard prospective payment amount requires recalibration.
“LeadingAge has long expressed concern about the disproportionate increase in home health providers in Los Angeles County,” Sloan said in a statement. “This bill’s oversight provisions are reasonable, appropriately targeted policies that would help maintain the benefit’s integrity. Those, along with the important proposed payment changes, will help to ensure support for legitimate providers — including our nonprofit and mission-driven members. We look forward to working with Senator Collins to advance this legislation.”
The bill was referred to the Committee on Finance after its introduction.
The Alliance has been a vocal supporter of CMS’ efforts to root out fraud, waste and abuse in the home health industry, while advocating for a targeted approach to program integrity.
“The overwhelming majority of providers serve their communities with integrity,” read a letter signed by a group of advocacy organizations, including the Alliance. “Any federal response must be carefully targeted to protect patients and preserve access to high-quality care from providers who have earned the trust of the families they serve.”
The Alliance has advocated for CMS to better leverage and enforce its existing authorities, rather than creating new requirements that could burden compliant providers. The organization has also suggested that CMS narrow in on fraud hot spots, rather than a sweeping, nationwide approach.
CMS has demonstrated its willingness to take a large-scale approach to tackling bad actors in the industry by imposing a nationwide moratorium on home health and hospice Medicare enrollment.