Last week, Sen. Susan Collins (R-Maine) introduced a bill that would reset the home health base payment rate and give the Centers for Medicare & Medicaid Services (CMS) new fraud-fighting tools.

The bill serves as a microcosm of how lawmakers appear to view the home health industry: with equal parts support and suspicion.

It’s a frustrating contradiction in many ways, particularly insofar as the suspicion creates burdens and obstacles – such as the moratorium on new Medicare enrollments for home health agencies – that make it difficult for the sector to demonstrate its full potential for driving down costs and improving outcomes, and win greater support.

This bill may still be a step in the right direction, given that it addresses one of the sector’s most critical issues related to Medicare payment methodology. Still, the bill may also offer a preview of the kind of home health policy most likely to gain traction in Washington: fraud first, evolution second.

Two elements of the bill particularly caught my eye: expanded fingerprinting requirements and, of course, the proposed “reset” of the base Medicare payment rate.

In this week’s exclusive, members-only HHCN+ Update, I unpack two elements of the bill, offering analysis and key takeaways, including:

— Why anti-fraud efforts won’t make regulation more efficient anytime soon

— Why better payment rates depend on better fraud controls

The fingerprinting burden

I honestly had not thought much about home health provider leaders getting fingerprinted during new enrollments or changes of ownership until the most recent episode of HHCN+ TALKS, with Choice Health at Home founder and CEO David Jackson.

When I saw mention of an expansion of fingerprinting in the new bill, my mind immediately went to this quote from my conversation with Jackson:

“The enrollment process and how states and the federal government deal with that, it definitely can be improved,” Jackson said. “I probably have had my fingerprints taken 15 times this year. To me, there are some things that could be maybe moved forward from a technology perspective. This is a great time for them to look at that and say, ‘How do we bring this into the 21st century? What’s the opportunity there?’”

Under current requirements, CMS assigns newly enrolling home health agencies (HHAs)—and enrolled HHAs that submit a change-of-ownership application or report any new owner—to the high-risk screening category. At that level, CMS requires all individuals with a 5% or greater direct or indirect ownership interest in the HHA to submit fingerprints for a national background check. These fingerprints must be submitted with a Medicare enrollment application or within 30 days of a Medicare contractor’s request.

Of course, not all providers are growing as rapidly as Choice and therefore are not required to submit fingerprints as often. But Jackson made an important point: this process could be moved into the 21^st century. It seems totally plausible that CMS could update its systems and requirements so that an owner’s fingerprints, once collected, could be kept on file in a centralized record. Doing so could save time and hassle for both providers and CMS.

The new bill isn’t designed to modernize CMS’ enrollment practices, so I’m not suggesting that this was the opportunity to overhaul the fingerprinting process. But this bill does expand existing fingerprinting requirements.

Namely, the bill would expand the population subject to fingerprinting by adding the administrator of a newly enrolling HHA that CMS designates as posing an “extreme risk of fraud,” even if that administrator does not have a 5% ownership interest.

I’m not saying it’s a bad idea to have HHAs most likely at risk of fraud submit their fingerprints.

But what this bill shows is that, under the current program integrity crackdown, we’re unlikely to see the kind of innovation that would improve efficiency in the Medicare home health enrollment system. The focus is on rooting out fraud, which means compliant providers will have to wait before they can expect to see any meaningful changes to reduce administrative burden in these ways. I think a more complete modernization effort could pursue both goals: Stronger screening of high-risk organizations and a more efficient process for responsible owners and operators who are repeatedly submitting the same information for enrollment transactions.

Rethinking the fraud calculus

In speaking with industry experts about the past few years of changes to the Medicare home health base payment rate, the element of CMS’ decision-making that has most come into question is its methodology.  

For the last few years, CMS proposed and finalized aggregate cuts to the base payment rate. This year, CMS proposed an aggregate increase — but still proposed to continue temporary recoupments.

“While the proposed rate update results in increased payments relative to last year — a reflection of our continued advocacy and a much-needed reprieve for providers under the stress of increasing costs — the Alliance remains focused on working to stop unwarranted temporary adjustments that are based on a flawed methodology with underlying data integrity issues,” Jennifer Sheets, CEO of the National Alliance for Care at Home (the Alliance), said in a statement.

The Medicare Home Health Payment Integrity and Protection Act of 2026, if passed, promises to reset the standard prospective payment amount and suspend permanent and temporary adjustments, as well as conform protection for benchmarks and value-based programs. For 2027, the bill would make the standard prospective payment amount $2,382.87, per the bill text.

The bill would effectively reset CMS’ methodology.

The Alliance’s reaction to the Medicare Home Health Payment Integrity and Protection Act of 2026 said that the bill would correct CMS’ flaws in calculating Medicare rate updates, given that CMS has determined the cuts on data “tainted by the inclusion of fraudulent providers in the rate analysis.”

I think the fraud-fighting measures of this bill and the payment reset go hand-in-hand. Without the sections that give CMS extra power to fight fraud, it’s unlikely Collins and Blackburn, two Republican lawmakers representing the party whose tagline has basically become “fraud, waste and abuse,” would offer a positive reset for the payment landscape.

So while providers are unlikely to see meaningful process improvement like the kind mentioned in the section above, this bill shows that any home health transformation likely to gain traction will have to balance the government’s focus on the industry’s risk of fraud.  

Of course, these considerations ultimately depend on whether the bill passes. The broader odds for introduced bills are daunting. GovTrack, an independent congressional-tracking organization, reports that only 11% of bills made it past committee and roughly 2% became law from 2021 through 2023.

Perhaps the weight of the advocacy of the home-based care industry and its champions will make this bill one of the few that make it through but the overall prognosis for bills introduced to Congress suggests that home health providers should not count their chickens just yet.