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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9803 Introduced in House (IH)]

<DOC>

118th CONGRESS
  2d Session
                                H. R. 9803

To amend title XVIII of the Social Security Act to ensure the integrity 
  of hospice care furnished under the Medicare program, and for other 
                               purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 25, 2024

Mr. Blumenauer introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
    and Commerce, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
To amend title XVIII of the Social Security Act to ensure the integrity 
  of hospice care furnished under the Medicare program, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Hospice Care Accountability, Reform, 
and Enforcement Act of 2024'' or the ``Hospice CARE Act of 2024''.

SEC. 2. ENSURING THE INTEGRITY OF HOSPICE CARE FURNISHED UNDER THE 
              MEDICARE PROGRAM.

    (a) Mandatory Temporary Moratorium on Enrollment.--
            (1) In general.--Section 1866(j) of the Social Security Act 
        (42 U.S.C. 1395cc(j)) is amended by adding at the end the 
        following new paragraph:
            ``(10) Mandatory temporary moratorium on enrollment of 
        hospice programs.--
                    ``(A) In general.--Except as provided in 
                subparagraphs (B) and (C), the Secretary shall impose a 
                nationwide temporary moratorium on the enrollment of 
                new hospice programs under this title for the 5-year 
                period beginning on the date of the enactment of this 
                paragraph.
                    ``(B) Exemption for certain hospices.--
                            ``(i) In general.--The Secretary may exempt 
                        a hospice program seeking to enroll under this 
                        title from the moratorium described in 
                        subparagraph (A) if the Secretary determines 
                        that such program will furnish hospice care to 
                        individuals entitled to benefits under part A 
                        in an area with insufficient access to such 
                        care (as specified by the Secretary, taking 
                        into account the considerations described in 
                        clause (ii)).
                            ``(ii) Considerations described.--For 
                        purposes of clause (i), the considerations 
                        described in this clause are, with respect to a 
                        hospice program seeking to enroll under this 
                        title, the following:
                                    ``(I) The specific geographic area 
                                that such program intends to serve.
                                    ``(II) The current availability of 
                                hospice care in such area.
                                    ``(III) Any evidence of unmet need 
                                for hospice care in such area (such as 
                                wait times for such care, the extent to 
                                which such area (or a population in 
                                such area) is considered underserved, 
                                and evidence that existing hospice 
                                programs are provided a substandard 
                                quality of care in such area).
                                    ``(IV) The program's plan to 
                                address any identified gaps in the 
                                provision of hospice care in such area.
                    ``(C) Authority to lift moratorium.--The Secretary 
                may lift the moratorium imposed under subparagraph (A) 
                within a State (or geographic region of a State) 
                specified by the Secretary in the same manner as the 
                Secretary may lift a temporary moratorium (as described 
                in paragraph (7)) under section 424.570(d) of title 42, 
                Code of Federal Regulations (or a successor 
                regulation).
                    ``(D) Application of prepayment medical review 
                during the temporary moratorium in certain 
                circumstances.--
                            ``(i) In general.--Subject to clause (ii), 
                        the Secretary shall apply prepayment medical 
                        review to hospice care consisting of routine 
                        home care furnished during the 5-year period 
                        beginning on the date of the enactment of this 
                        paragraph by an applicable hospice program to a 
                        covered individual.
                            ``(ii) Termination of application of 
                        prepayment medical review.--
                                    ``(I) In general.--The Secretary 
                                shall terminate the application of 
                                prepayment medical review under clause 
                                (i) with respect to hospice care 
                                furnished by an applicable hospice 
                                program to a covered individual if the 
                                Secretary determines that, during the 
                                period in which such care so furnished 
                                by such program was subject to such 
                                review, such care was subject to a low 
                                rate of denial (as specified by the 
                                Secretary) under such review.
                                    ``(II) Revocation of termination.--
                                The Secretary may revoke any 
                                termination of prepayment medical 
                                review under subclause (I) if 
                                determined appropriate by the 
                                Secretary.
                            ``(iii) Definitions.--For purposes of this 
                        subparagraph:
                                    ``(I) Applicable hospice program.--
                                The term `applicable hospice program' 
                                means a hospice program with a history 
                                of claim submissions with respect to 
                                hospice care furnished under this title 
                                that is aberrant (such as by 
                                demonstrating that such program is an 
                                outlier with respect to live 
                                discharges) compared to such history of 
                                claim submissions of similarly situated 
                                hospice programs, as determined by the 
                                Secretary.
                                    ``(II) Covered individual.--The 
                                term `covered individual' means an 
                                individual receiving hospice care under 
                                this title during the second 90-day 
                                period described in section 1812(d)(1) 
                                (or during any subsequent period) 
                                applicable to such individual.
                    ``(E) Revalidation of enrollment information.--
                            ``(i) In general.--During the 6-month 
                        period beginning on the date of the enactment 
                        of this paragraph and notwithstanding any 
                        applicable revalidation cycle under section 
                        424.515 of title 42, Code of Federal 
                        Regulations (or a successor regulation), the 
                        Secretary shall revalidate the enrollment 
                        information of each hospice program enrolled 
                        under this title in accordance with the 
                        requirements applicable to revalidations of 
                        such information under such section.
                            ``(ii) Publication of ownership 
                        information.--Not later than 1 year after the 
                        date of the enactment of this paragraph, the 
                        Secretary shall publish on a public website of 
                        the Centers for Medicare & Medicaid Services 
                        ownership interest and managing control 
                        information collected pursuant to revalidations 
                        described in clause (i) for each hospice 
                        program enrolled under this title.
                            ``(iii) Report.--Not later than January 1, 
                        2027, the Secretary, acting through the 
                        Assistant Secretary for Planning and 
                        Evaluation, shall submit to Congress a report 
                        on hospice ownership and control trends and the 
                        role of private equity in ownership and control 
                        of hospice programs. Such report shall 
                        include--
                                    ``(I) validation, to the extent 
                                feasible, of the ownership and control 
                                information reported on form CMS-855A 
                                (or any successor form);
                                    ``(II) an analysis of hospice cost 
                                report data by ownership type;
                                    ``(III) recommendations on ways to 
                                improve the integrity of the ownership 
                                and control information reported by 
                                hospices during the enrollment process 
                                under this title; and
                                    ``(IV) to the extent practicable, 
                                recommendations on policies to promote 
                                health care competition.
                    ``(F) Implementation.--The Secretary shall 
                implement this paragraph through program instruction or 
                other forms of subregulatory guidance.''.
            (2) Authority to provide exemptions to temporary 
        moratoria.--Section 1866(j)(7) of the Social Security Act (42 
        U.S.C. 1395cc(j)(7)) is amended--
                    (A) in subparagraph (A), by adding at the end the 
                following new sentence: ``The Secretary may exempt a 
                provider of services or supplier that would otherwise 
                be subject to a moratorium imposed under the preceding 
                sentence from such moratorium if determined appropriate 
                by the Secretary.''; and
                    (B) in subparagraph (C)(iii)--
                            (i) in subclause (I), by striking ``and'' 
                        at the end;
                            (ii) in subclause (II), by striking the 
                        period and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(III) is not subject to an 
                                exemption described in such 
                                subparagraph.''.
    (b) Extension of Oversight of Newly-Enrolled Hospice Programs.--
            (1) In general.--Section 1866(j)(3)(A) of the Social 
        Security Act (42 U.S.C. 1395cc(j)(3)(A)) is amended by 
        inserting ``(or, in the case of a hospice program, not more 
        than 2 years)'' after ``1 year''.
            (2) Mandatory application of enhanced oversight for certain 
        hospice programs.--Section 1866(j)(3) of the Social Security 
        Act (42 U.S.C. 1395cc(j)(3)) is amended--
                    (A) by redesignating subparagraph (B) as 
                subparagraph (C); and
                    (B) by inserting after subparagraph (A) the 
                following new subparagraph:
                    ``(B) Mandatory application to certain hospice 
                programs.--The procedures established by the Secretary 
                under subparagraph (A) shall provide that any hospice 
                program enrolling under this title that would, but for 
                application of subparagraph (B) or (C) of paragraph 
                (10), have been prohibited from so enrolling be subject 
                to the enhanced oversight described in such 
                subparagraph for a period of not less than 30 days.''.
    (c) Increase in Survey Frequency for Certain Hospice Programs.--
Section 1822(a) of the Social Security Act (42 U.S.C. 1395i-6(a)) is 
amended--
            (1) in paragraph (1)--
                    (A) by inserting ``, with respect to such a survey 
                conducted with respect to a hospice program that is not 
                included on the list established under paragraph (5),'' 
                after ``local survey agency, or''; and
                    (B) by inserting ``(or, in the case of a hospice 
                program that is included on the list established under 
                paragraph (5), not less frequently than once every 18 
                months)'' after ``36 months'';
            (2) by redesignating paragraph (5) as paragraph (6);
            (3) by inserting after paragraph (4) the following new 
        paragraph:
            ``(5) Hospice programs subject to increased survey 
        frequency.--
                    ``(A) In general.--The Secretary shall establish a 
                list of hospice programs subject to increased survey 
                frequency under paragraph (1) in accordance with the 
                provisions of this paragraph.
                    ``(B) Inclusion on list.--
                            ``(i) In general.--The Secretary shall 
                        include a hospice program on the list 
                        established under subparagraph (A) if such 
                        program is not participating in the special 
                        focus program under subsection (b) and such 
                        hospice program meets either of the following 
                        criteria:
                                    ``(I) The program first submitted a 
                                claim for an item or service under this 
                                title during the 5-year period ending 
                                on the date of the enactment of this 
                                paragraph.
                                    ``(II) The program first submits a 
                                claim for an item or service under this 
                                title on or after such date of 
                                enactment.
                            ``(ii) Discretionary inclusion.--The 
                        Secretary may include a hospice program on the 
                        list established under subparagraph (A)--
                                    ``(I) if claims data submitted by 
                                such program indicates that such 
                                program is not providing the full scope 
                                of hospice care services payable under 
                                this title;
                                    ``(II) if the Secretary determines 
                                that such program is an outlier with 
                                respect to live discharges; or
                                    ``(III) for any other reason 
                                determined appropriate by the 
                                Secretary.
                    ``(C) Removal from list.--The Secretary shall 
                remove a hospice program included in the list 
                established under subparagraph (A)--
                            ``(i) if--
                                    ``(I) such program has been subject 
                                to 2 surveys under this subsection 
                                while included on such list; and
                                    ``(II) neither such survey resulted 
                                in such program being cited for a 
                                deficiency for failure to comply with a 
                                condition of participation relating to 
                                quality of care; or
                            ``(ii) if such program is placed in the 
                        special focus program established under 
                        subsection (b).''; and
            (4) in paragraph (6), as so redesignated, by striking 
        ``each fiscal year (beginning with fiscal year 2022)'' and 
        inserting ``each of fiscal years 2022 through 2025, and of 
        $15,000,000 for fiscal year 2026 and for each subsequent fiscal 
        year,''.
    (d) Prohibition on Payment for Failure To Meet Quality Data 
Reporting Requirements.--Section 1814(i)(5) of the Social Security Act 
(42 U.S.C. 1395f(i)(5)) is amended--
            (1) in subparagraph (A)--
                    (A) in the header, by striking ``Reduction in 
                update for'';
                    (B) in clause (i)--
                            (i) in the header, by striking ``In 
                        general'' and inserting ``Fiscal years 2014 
                        through 2026'';
                            (ii) by inserting ``through fiscal year 
                        2026'' after ``each subsequent fiscal year''; 
                        and
                            (iii) by adding at the end the following 
                        new sentence: ``The application of the 
                        preceding sentence may result in the market 
                        basket percentage increase under paragraph 
                        (1)(C)(ii)(VII) or paragraph (1)(C)(iii), as 
                        applicable, being less than 0.0 for a fiscal 
                        year, and may result in payment rates under 
                        this subsection for a fiscal year being less 
                        than such payment rates for the preceding 
                        fiscal year.''; and
                    (C) by amending clause (ii) to read as follows:
                            ``(ii) Subsequent fiscal years.--For 
                        purposes of fiscal year 2027 and each 
                        subsequent fiscal year, no payment may be made 
                        under this title to a hospice program that does 
                        not submit data to the Secretary in accordance 
                        with subparagraph (C) with respect to such 
                        fiscal year.''; and
            (2) in subparagraph (B), by striking ``subparagraph (A)'' 
        and inserting ``subparagraph (A)(i)''.
    (e) Ensuring Independence of Physician Certifications of Terminal 
Illness.--Section 1814(a)(7)(A)(i) of the Social Security Act (42 
U.S.C. 1395f(a)(7)(A)(i)) is amended--
            (1) in subclause (I), by inserting ``or, with respect to 
        certifications under this clause occurring on or after October 
        1, 2026, in the case such individual fails to designate such an 
        attending physician (or in the case such attending physician is 
        employed by the hospice program at which such individual will 
        receive such care or otherwise has a significant ownership 
        interest in, or a significant financial relationship with, such 
        program (as determined by the Secretary)), by a physician, 
        physician assistant, or nurse practitioner that does not have 
        such a significant ownership interest in, or such a significant 
        financial relationship with, such program (as determined by the 
        Secretary)'' before ``, and''; and
            (2) in the matter following subclause (II), by striking 
        ``physician's'' and inserting ``physician's, physician 
        assistant's, nurse practitioner's,''.
    (f) Allowing Additional Providers To Certify Terminal Illness.--
            (1) In general.--Section 1814(a)(7)(A)(i)(I) of the Social 
        Security Act (42 U.S.C. 1395f(a)(7)(A)(i)(I)) is amended by 
        striking ``(which for purposes of this subparagraph does not 
        include a nurse practitioner or a physician assistant)''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply with respect to certifications of terminal 
        illnesses made on or after October 1, 2026.
    (g) Allowable Use of Supporting Material in Medical Review of 
Hospice Care.--Section 1814(a) of the Social Security Act (42 U.S.C. 
1395f(a)) is amended by adding at the end the following new sentence: 
``For purposes of conducting medical review of hospice care furnished 
to an individual, in addition to using documentation in the medical 
record of such individual's attending physician (as defined in section 
1861(dd)) or of the physician, physician assistant, or nurse 
practitioner otherwise making the certification described in paragraph 
(7)(A)(i)(I) with respect to such individual, the Secretary may use 
documentation in the medical record of the hospice program furnishing 
such care as supporting material, as determined appropriate by the 
Secretary.''.
    (h) Prohibition on Certain Changes in Majority Ownership.--With 
respect to any change in the majority ownership of a hospice program 
occurring during the 5-year period beginning on the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
apply section 424.550(b) of title 42, Code of Federal Regulations (or a 
successor regulation) as if the references to ``36 months'' in 
paragraph (1) of such section were references to ``60 months''.
    (i) Advanced Notice of Changes in Ownership or Control.--Section 
1822 of the Social Security Act (42 U.S.C. 1395i-6) is amended by 
adding at the end the following new subsection:
    ``(d) Advanced Notice of Changes in Ownership or Control.--
            ``(1) In general.--Beginning January 1, 2027, in the case a 
        change occurs in--
                    ``(A) the persons with an ownership or control 
                interest (as defined in section 1124(a)(3)) in the 
                hospice program;
                    ``(B) the persons who are officers, directors, 
                agents, or managing employees (as defined in section 
                1126(b)) of the hospice program;
                    ``(C) the corporation, association, or other 
                company responsible for the management of the hospice 
                program; or
                    ``(D) the individual who is the administrator of 
                the hospice program, or (v) the individual who is the 
                medical director of the hospice program;
        such program shall provide notice at the time of the change 
        (or, in the case such change is with respect to a person 
        described in subparagraph (A), at least 90 days before the 
        effective date of the change) to the Secretary, the appropriate 
        State or local survey agency, or appropriate approved 
        accreditation agency of the change and of the identity of each 
        new person, company, or individual described in the respective 
        subparagraph.
            ``(2) Enforcement.--
                    ``(A) In general.--In the case that the Secretary 
                determines that a hospice program has violated 
                paragraph (1), the Secretary may--
                            ``(i) impose a civil monetary penalty in an 
                        amount not to exceed $1,000,000 per violation; 
                        and
                            ``(ii) if determined appropriate by the 
                        Secretary, terminate such program's enrollment 
                        under this title.
                    ``(B) Procedures.--The provisions of section 1128A 
                (other than subsections (a) and (b) of such section) 
                shall apply to a civil monetary penalty imposed under 
                subparagraph (A) in the same manner as such provisions 
                apply to a penalty or proceeding under such section.''.
    (j) Required Provision of Addendum of Noncovered Services.--Section 
1812(d)(1) of the Social Security Act (42 U.S.C. 1395d(d)(1)) is 
amended by adding at the end the following new sentence: ``With respect 
to such an election made on or after October 1, 2026, in the case such 
program determines that there are items and services being furnished to 
such individual that are not related to the treatment of the 
individual's condition with respect to which a diagnosis of terminal 
illness has been made, such election shall include an addendum that 
specifies such items and services and includes such additional 
information as may be specified by the Secretary. Such program shall 
provide an updated addendum described in the preceding sentence to such 
individual if, while such election is in effect with respect to such 
individual, such program makes any alteration to the addendum provided 
to such individual at the time of such election.''.
    (k) Medical Review of Hospice Outliers and Care Unrelated to 
Terminal Condition.--
            (1) In general.--
                    (A) Medical review.--Section 1814(a)(7) of the 
                Social Security Act (42 U.S.C. 1395f(a)(7)) is 
                amended--
                            (i) in subparagraph (D), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (E), by inserting 
                        ``before the date of the enactment of 
                        subparagraph (F),'' after ``subparagraph,''; 
                        and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(F) beginning on the date that is 5 years after 
                the date of the enactment of this subparagraph, in the 
                case of hospice care provided an individual for more 
                than 90 days by a hospice program with aberrant billing 
                patterns (as determined by the Secretary), the hospice 
                care provided to such individual is subject to 
                prepayment medical review (in accordance with 
                procedures established by the Secretary); and''.
                    (B) Technical expert panel.--
                            (i) In general.--The Secretary of Health 
                        and Human Services shall establish a technical 
                        expert panel for purposes of establishing 
                        standards for identifying a hospice program 
                        with a history of aberrant billing patterns 
                        under section 1814(a)(7)(F) of the Social 
                        Security Act, as added by subparagraph (A). In 
                        making recommendations with respect to such 
                        standards, such panel shall take into account 
                        the results of prepayment medical reviews 
                        conducted under section 1866(j)(10)(D) of such 
                        Act, as added by subsection (a).
                            (ii) FACA waiver.--The provisions of 
                        chapter 10 of title 5, United States Code, 
                        shall not apply to the panel established under 
                        clause (i).
            (2) Prepayment medical review requirement.--Section 
        1812(d)(2) of the Social Security Act (42 U.S.C. 1395d(d)(2)) 
        is amended by adding at the end the following new subparagraph:
    ``(E) Notwithstanding any other provision of this title, in the 
case of items and services (other than items and services described in 
the matter following clause (ii)(II) of subparagraph (A)) furnished on 
or after October 1, 2026, to an individual with an election in effect 
under paragraph (1) by a provider of services or supplier, if such 
provider of services or supplier indicates that such items and services 
are unrelated to the individual's condition with respect to which a 
diagnosis of terminal illness has been made, no payment may be made 
under this title for such items and services before the Secretary has 
conducted a medical review of such items and services to determine 
whether such items and services are unrelated to such condition. Such 
review shall include a review of any addendum described in paragraph 
(1) included in such election.''.
            (3) Funding.--The Secretary of Health and Human Services 
        shall provide for the transfer, from the Federal Hospital 
        Insurance Trust Fund established under section 1817 of the 
        Social Security Act (42 U.S.C. 1395i) to the Centers for 
        Medicare & Medicaid Services Program Management Account, of 
        $20,000,000 for fiscal year 2026, to remain available until 
        expended, for purposes of carrying out the amendments made by 
        this subsection.
    (l) Provision of Explanation of Benefits Upon Hospice Election.--
            (1) In general.--Section 1806 of the Social Security Act 
        (42 U.S.C. 1395b-7) is amended by adding at the end the 
        following new subsection:
    ``(d) Provision of Explanation of Benefits Upon Hospice Election.--
The Secretary shall furnish to each individual who makes an election 
described in section 1812(d)(1), not later than 15 days after such 
individual makes such election, a notice that--
            ``(1) specifies--
                    ``(A) the effective date of such election;
                    ``(B) the hospice program that will be furnishing 
                hospice care to such individual;
                    ``(C) the telephone number and address of such 
                program;
                    ``(D) the physician, physician assistant, or nurse 
                practitioner who made the certification described in 
                section 1814(a)(7)(A)(i)(I) with respect to such 
                individual;
                    ``(E) the toll-free telephone number of the 
                medicare administrative contractor responsible for 
                processing claims for such care;
            ``(2) informs such individual of the waiver of rights 
        described in section 1812(d)(2)(A);
            ``(3) includes a statement which indicates that, because 
        errors do occur and because Medicare waste, fraud, and abuse is 
        a significant problem, such individual should carefully check 
        the individual's hospice election information and if such 
        individual suspects Medicare waste, fraud, or abuse with 
        respect to the provision of such care, the individual should 
        contact the toll-free phone number 1-800-MEDICARE and a toll-
        free phone number maintained by the Inspector General of the 
        Department of Health and Human Services for the receipt of 
        complaints and information about waste, fraud, and abuse in the 
        provision or billing of services under this title; and
            ``(4) includes any other information determined appropriate 
        by the Secretary.''.
            (2) Funding.--The Secretary of Health and Human Services 
        shall provide for the transfer from the Federal Hospital 
        Insurance Trust Fund established under section 1817 of the 
        Social Security Act (42 U.S.C. 1395i) to the Centers for 
        Medicare & Medicaid Services Program Management Account of 
        $10,000,000 for fiscal year 2026, to remain available until 
        expended, for purposes of carrying out the amendment made by 
        paragraph (1).
            (3) Effective date.--The amendment made by paragraph (1) 
        shall apply to individuals making elections described in 
        section 1812(d)(1) of the Social Security Act (42 U.S.C. 
        1395d(d)(1)) on or after the date that is 1 year after the date 
        of the enactment of this Act.
    (m) Medical Review of Hospice Care Contractor Requirements.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall 
        require any entity performing medical review under contract 
        with Secretary of hospice care furnished under part A of title 
        XVIII of the Social Security Act (42 U.S.C. 1395c et seq.) to, 
        with respect to such reviews performed on or after January 1, 
        2027, utilize only individuals who have received specialized 
        instruction on the philosophy behind hospice care and medical 
        prognostication (as specified by the Secretary) in performing 
        such reviews. In so specifying such instruction and in updating 
        such instruction, the Secretary shall consult with hospice 
        programs as to the content of such instruction.
            (2) Publication.--The Secretary shall make any instruction 
        specified for purposes of paragraph (1) publicly available on 
        the website of the Centers for Medicare & Medicaid Services.
            (3) Report.--Not later than October 1, 2027, the Secretary 
        shall submit to Congress a report on activities relating to the 
        medical review of hospice care furnished under part A of title 
        XVIII of the Social Security Act (42 U.S.C. 1395c et seq.). 
        Such report shall include--
                    (A) with respect to the medical review of hospice 
                care performed during the period beginning on January 
                1, 2019, and ending on December 31, 2024, the accuracy 
                rates of such reviews when performed by--
                            (i) medicare administrative contractors;
                            (ii) recovery audit contractors;
                            (iii) supplemental medical review 
                        contractors; and
                            (iv) uniform program integrity contractors;
                    (B) the total number of hospice claims submitted 
                during the period described in subparagraph (A) subject 
                to medical review;
                    (C) the percentage of such claims that were denied 
                and appealed and the percentage of such claims so 
                appealed that were overturned on appeal, broken down by 
                the type of contractor conducing review of such claims 
                and by each level of appeal;
                    (D) a list of medical review projects relating to 
                hospice care undertaken by contractors described in 
                subparagraph (A); and
                    (E) actions the Secretary will take to reduce the 
                audit burden on hospice programs with claims selected 
                for medical review under multiple projects described in 
                subparagraph (D) and to minimize the number of denials 
                of claims for hospice care that are overturned on 
                appeal.
    (n) Requiring Face-to-Face Encounters Before Recertifications of 
Terminal Illness.--Section 1814(a)(7) of the Social Security Act (42 
U.S.C. 1395f(a)(7)) is amended--
            (1) in subparagraph (D)--
                    (A) by inserting ``, and before October 1, 2026'' 
                after ``2011''; and
                    (B) by striking ``and'' at the end; and
            (2) by adding at the end the following new subparagraph:
                    ``(F) on and after October 1, 2026, not more than 
                30 days before each recertification described in 
                subparagraph (A)(ii) is made with respect to an 
                individual, a hospice physician, hospice nurse 
                practitioner, or hospice physician assistant has a 
                face-to-face encounter (which may, with respect to any 
                such recertification made for a 60-day period described 
                in such subparagraph, be conducted via telehealth, but 
                only if a registered nurse, licensed practical nurse, 
                or home health aide employed by the hospice program 
                furnishing hospice care to such individual is 
                physically present with such individual during such 
                encounter) with such individual to gather clinical 
                findings to determine such individual's continue 
                eligibility for hospice care; and''.
    (o) Ensuring Medical Director and Physician Availability.--
            (1) In general.--Section 1861(dd) of the Social Security 
        Act (42 U.S.C. 1395x(dd)) is amended--
                    (A) in paragraph (2)--
                            (i) in subparagraph (F), by striking 
                        ``and'' at the end;
                            (ii) by redesignating subparagraph (G) as 
                        subparagraph (I); and
                            (iii) by inserting after subparagraph (F) 
                        the following new subparagraphs:
                    ``(G) has a medical director responsible for the 
                medical component of hospice care provided by such 
                program who--
                            ``(i) is a doctor of medicine or osteopathy 
                        licensed to practice in the State in which such 
                        program is located; and
                            ``(ii) subject to paragraph (6), is not the 
                        medical director of more than 1 other hospice 
                        program;
                    ``(H) ensures that the medical director described 
                in subparagraph (G) or a physician member of the group 
                described in subparagraph (B) is available for 
                immediate consultation (which may be through 
                telehealth) when hospice care is provided in an 
                individual's home; and''; and
                    (B) by adding at the end the following new 
                paragraph:
    ``(6) The Secretary may waive the requirement described in 
paragraph (2)(G)(ii) with respect to the medical director of a hospice 
program if determined appropriate by the Secretary on a case-by-case 
basis. In determining whether to grant a waiver under the preceding 
sentence, the Secretary shall take into consideration--
            ``(A) the average daily census for each hospice program 
        with respect to which such director is medical director;
            ``(B) the geographic areas served by such programs; and
            ``(C) any other information determined appropriate by the 
        Secretary.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply beginning January 1, 2028.
    (p) Report on Hospice Accrediting Organizations.--Not later than 2 
years after the date of the enactment of this Act, the Comptroller 
General of the United States shall submit to Congress a report on the 
Secretary of Health and Human Services' (in this subsection referred to 
as the ``Secretary'') oversight of hospice program accrediting 
organizations. Such report shall include the following:
            (1) An analysis of deficiencies relating to quality of care 
        found pursuant to surveys conducted under section 1822(a) of 
        the Social Security Act (42 U.S.C. 1395i-6(a)) following 
        complaints when such surveys were of hospice programs 
        accredited by such an organization and such surveys were 
        conducted by such an organization compared to such deficiencies 
        so found following such complaints when such surveys were of 
        hospice programs certified by State or local survey agencies 
        and such surveys were conducted by such agencies.
            (2) A list of hospice programs determined by the Secretary 
        not to be in compliance with all requirements applicable to 
        such programs, along with a list of the accrediting 
        organization of each such program.
            (3) A list of hospice programs that have been deactivated, 
        terminated, or investigated due to concerns relating to waste, 
        fraud, or abuse, along with a list of the accrediting 
        organization of each such program.
            (4) An analysis of any conflicts of interest of hospice 
        program accrediting organizations.
            (5) Performance data for hospice program accrediting 
        organizations.

SEC. 3. PAYMENT REFORMS FOR HOSPICE CARE FURNISHED UNDER THE MEDICARE 
              PROGRAM.

    (a) Adjusting Payments for Hospice Care.--
            (1) In general.--Section 1814(i)(1)(C) of the Social 
        Security Act (42 U.S.C. 1395f(i)(1)(C)) is amended--
                    (A) in clause (iii)--
                            (i) by moving such clause 6 ems to the 
                        left;
                            (ii) by striking ``With respect to'' and 
                        inserting ``Except as provided under clauses 
                        (viii) through (x), with respect to'';
                            (iii) by inserting ``in a setting (as 
                        specified by the Secretary for purposes of 
                        clause (vii))'' after ``hospice care 
                        furnished'';
                            (iv) by inserting ``for such setting'' 
                        after ``payment rates in effect''; and
                            (v) by striking ``under this clause'' and 
                        inserting ``under this subparagraph'';
                    (B) in clause (iv), by striking ``clause (ii)(VII) 
                or (iii)'' each place such phrase appears and inserting 
                ``clause (iii) or (iv) of paragraph (2)(D) or clause 
                (ii)(VII), (iii), (viii), (ix), or (x)'' in each such 
                place; and
                    (C) by adding at the end the following new clauses:
    ``(vii) Prior to the beginning of a specified fiscal year (as 
defined in clause (xi)), the Secretary shall specify percentages by 
which the payment rates for hospice care consisting of services other 
than routine home care (and, for specified years beginning on or after 
October 1, 2033, for hospice care consisting of routine home care and 
other services included in hospice care) in effect for the preceding 
fiscal year shall be adjusted in such specified fiscal year to align 
such rates with the costs of such care. In specifying such 
percentages--
            ``(I) the Secretary shall take into account changes in the 
        average cost of such care and such other factors as determined 
        appropriate by the Secretary; and
            ``(II) the Secretary may specify different percentages for 
        such care based on the setting (as specified by the Secretary) 
        in which such care is furnished.
    ``(viii)(I) With respect to routine home care furnished during 
fiscal year 2029, the payment rates for such care shall be equal to the 
sum of--
            ``(aa) a per diem amount (which may include an a case mix 
        adjustment to account for variations in cost among different 
        units of service) reflecting the cost of routine home care not 
        consisting of direct patient care for nursing care, physical 
        therapy, occupational therapy, speech-language pathology 
        services, medical social services (other than counseling 
        services), home health aide services, and physician services 
        (other than such services that are considered administrative 
        services); and
            ``(bb) subject to such frequency limits as may be specified 
        by the Secretary, a per visit amount (which may vary depending 
        on the type and duration of the visit, as determined 
        appropriate by the Secretary) reflecting the cost of routine 
        home care consisting of direct patient care excluded from the 
        per diem amount established under item (aa) (other than, in the 
        case of such care furnished at a skilled nursing facility or 
        nursing facility (as defined in section 1919(a)), the component 
        of such rates attributable to home health aide services).
    ``(II) With respect to routine home care furnished during fiscal 
year 2030 or a subsequent fiscal year, the payment rates for such care 
shall be equal to the sum of--
            ``(aa) the per diem amount attributable to hospice care 
        described in subclause (I)(aa) in effect under this clause for 
        the preceding fiscal year, adjusted, in the case of a specified 
        fiscal year, by the percentages specified pursuant to clause 
        (vii) for such specified fiscal year, increased by the market 
        basket percentage increase (as defined in section 
        1886(b)(3)(B)(iii)) for the fiscal year (reduced in accordance 
        with clause (iv)); and
            ``(bb) the per visit amount for hospice care described in 
        subclause (I)(bb) in effect under this clause for the preceding 
        fiscal year, adjusted, in the case of a specified fiscal year, 
        by the percentages specified pursuant to clause (vii) for such 
        specified fiscal year, increased by such market basked 
        percentage increase for the fiscal year (reduced in accordance 
        with clause (iv)).
    ``(III) For purposes of this clause, the term `visit' means, with 
respect to an individual receiving hospice care from a hospice program, 
in-person contact with such individual by staff of such program (or by 
others under arrangements with such program), not including any such 
contact conducted via telehealth or any other form of 
telecommunications technology.
    ``(ix)(I) With respect to routine home care consisting of specified 
hospice care (as defined in subclause (II)) furnished by, or under 
arrangements made by, a hospice program during the period beginning on 
October 1, 2026, and ending on September 30, 2031, in lieu of the rates 
otherwise payable under this subparagraph for such routine home care, 
the Secretary shall pay to the hospice program furnishing such care an 
amount equal to 400 percent of the amount payable for routine home care 
furnished in fiscal year 2026, increased by the market basket 
percentage increase (as defined in section 1886(b)(3)(B)(iii)) for the 
fiscal year (reduced in accordance with clause (iv)), or such other 
amount determined appropriate by the Secretary (which may vary based on 
the type of service furnished) for each day during which such specified 
hospice care was furnished.
    ``(II) For purposes of subclause (I), the term `specified hospice 
care' means any of the following items and services:
            ``(aa) Palliative chemotherapy or radiation furnished under 
        the supervision of an oncologist and in accordance with 
        accepted clinical guidelines.
            ``(bb) Palliative radiation therapy furnished under the 
        supervision of an oncologist and in accordance with accepted 
        clinical guidelines.
            ``(cc) Subject to such frequency limitations as the 
        Secretary may establish, palliative blood transfusions 
        furnished to an individual diagnosed with a blood cancer and 
        furnished under the supervision of an oncologist and in 
        accordance with accepted clinical guidelines.
            ``(dd) Palliative dialysis furnished under the supervision 
        of a nephrologist, but only if--
                    ``(AA) the individual receiving such palliative 
                dialysis was receiving dialysis treatments prior to 
                making the election under section 1812(d); and
                    ``(BB) such individual has received fewer than 10 
                sessions of such palliative in-center or home 
                hemodialysis or the equivalent for peritoneal dialysis 
                or other modalities (or, in the case such individual 
                has received 10 or more such sessions or the equivalent 
                of such sessions, such session or equivalent of such 
                session is subject to prior authorization).
    ``(x) With respect to hospice care consisting of services other 
than routine home care furnished during 2029 or a subsequent fiscal 
year, the payment rates for such care shall be equal to the rates in 
effect for such care for the preceding fiscal year, adjusted, in the 
case of a specified fiscal year, by the percentages specified pursuant 
to clause (vii) for such specified fiscal year, increased by the market 
basket percentage increase (as defined in section 1886(b)(3)(B)(iii)) 
for the fiscal year (reduced in accordance with clause (iv)).
    ``(xi) For purposes of this subparagraph, the term `specified 
fiscal year' means fiscal years 2029, 2034, and 2039.
    ``(xii)(I) The Secretary shall, with respect to cost reporting 
periods beginning during an applicable fiscal year (as defined in 
subclause (III)), conduct an audit of a representative sample of cost 
reports submitted by hospice programs.
    ``(II) The Secretary shall, for each applicable fiscal year, 
convene a technical expert panel for purposes of reviewing the 
methodology and results of the audit conducted under subclause (I) with 
respect to such applicable fiscal year.
    ``(III) For purposes of this clause, the term `applicable fiscal 
year' means fiscal years 2025, 2030, and 2035.
    ``(IV) The provisions of chapter 10 of title 5, United States Code, 
shall not apply to the panel established under subclause (II).
    ``(V) The Secretary shall provide for the transfer, from the 
Federal Hospital Insurance Trust Fund established under section 1817 to 
the Centers for Medicare & Medicaid Services Program Management 
Account, of $10,000,000 for each of fiscal years 2026, 2031, and 2036, 
to remain available until expended, for purposes of carrying out this 
clause.''.
            (2) Outlier payments.--Section 1814(i) of the Social 
        Security Act (42 U.S.C. 1395f(i)) is amended--
                    (A) by redesignating paragraph (7) as paragraph 
                (8); and
                    (B) by inserting after paragraph (6) the following 
                new paragraph:
    ``(7)(A) Subject to subparagraph (B), with respect to routine home 
care furnished during a fiscal year beginning on or after October 1, 
2031, the Secretary may, if determined appropriate by the Secretary, 
provide an additional payment for types of such care (such as specified 
hospice care (as defined in paragraph (1)(C)(ix))) specified by the 
Secretary to account for unusual variations in the type or amount of 
such routine home care.
    ``(B)(i) The total amount of additional payments estimated to be 
made under subparagraph (A) for routine home care furnished during a 
fiscal year may not exceed 5 percent of the total amount of payments 
estimated to be made for such care furnished during such fiscal year 
without application of this paragraph for such fiscal year.
    ``(ii) The total amount of additional payments estimated to be made 
under subparagraph (A) for routine home care furnished during a fiscal 
year to an individual hospice program may not exceed 10 percent of the 
total amount of payments estimated to be made for such care furnished 
during such fiscal year by such program without application of this 
paragraph for such fiscal year.
    ``(C) The Secretary shall reduce any per diem rate applicable under 
paragraph (1) to routine home care furnished during the first fiscal 
year for which payments are made under subparagraph (A) by such 
proportion as will result, not taking into account any additional 
payments made under subparagraph (A) for such care furnished during 
such fiscal year, in an aggregate reduction of 5 percent in payment for 
such care furnished during such fiscal year.''.
            (3) Plan of care requirements.--
                    (A) In general.--Section 1814(a)(7)(B) of the 
                Social Security Act (42 U.S.C. 1395f(a)(7)(B)) is 
                amended by inserting ``and, with respect to the 
                establishment of such plan, in the case such plan 
                includes the furnishing of specified hospice care (as 
                defined in subsection (i)(1)(C)(x)(II)), by a 
                nephrologist (if such care is care described in item 
                (dd) of such subsection) or by an oncologist (if such 
                care is care described in any of items (aa) through 
                (cc) of such subsection) who does not have a 
                significant ownership interest in, or a significant 
                financial relationship with, such hospice program, as 
                determined by the Secretary, and, with respect to the 
                periodic review of such plan, in the case such plan 
                includes the furnishing of specified hospice care (as 
                defined in subsection (i)(1)(C)(x)(II)), by the 
                nephrologist supervising the furnishing of such care 
                (if such care is described in item (dd) of such 
                subsection) or by the oncologist supervising the 
                furnishing of such care (if such care is described in 
                any of items (aa) through (cc) of such subsection)'' 
                after ``of the hospice program''.
                    (B) Effective date.--The amendment made by 
                subparagraph (A) shall apply with respect to written 
                plans for providing hospice care developed or reviewed 
                on or after October 1, 2026.
            (4) Excluding home health aide services and homemaker from 
        the definition of hospice care in certain circumstances.--
                    (A) In general.--Section 1861(dd)(1)(D)(i) of the 
                Social Security Act (42 U.S.C. 1395x(dd)(1)(D)(i)) is 
                amended by inserting ``in the case such individual is 
                not residing in a skilled nursing facility or a nursing 
                facility,'' before ``services of a''.
                    (B) Homemaker services.--Section 1861(dd)(1)(D)(ii) 
                of the Social Security Act (42 U.S.C. 
                1395x(dd)(1)(D)(ii)) is amended by inserting ``(but 
                only if such individual is not residing in a skilled 
                nursing facility or a nursing facility (as defined in 
                section 1919(a)) or, if such individual is residing in 
                such a skilled nursing facility or nursing facility, 
                only if such services are provided on a volunteer basis 
                in accordance with paragraph (2)(E))'' after 
                ``homemaker services''.
                    (C) Effective date.--The amendments made by 
                subparagraphs (A) and (B) shall apply to items and 
                services furnished on or after October 1, 2028.
            (5) Conforming adjustment to payment cap.--Section 
        1814(i)(2)(B) of the Social Security Act (42 U.S.C. 
        1395f(i)(2)(B)) is amended--
                    (A) in clause (i), by striking ``clause (ii)'' and 
                inserting ``clauses (ii) through (iv)'';
                    (B) in clause (ii), by inserting ``, subject to 
                clause (iii),'' after ``subparagraph (A)'';
                    (C) by striking clause (iii) and inserting the 
                following new clause:
    ``(iii) For purposes of subparagraph (A), in the case of a 
specified fiscal year (as defined in paragraph (1)(C)(xi)), the `cap 
amount' for such year is the cap amount under this subparagraph for the 
preceding fiscal year, adjusted by the estimated percentage change in 
the total amount of payment made under this part for hospice care 
attributable to application of the amendments made by section 3(a)(1) 
of the Hospice CARE Act of 2024 for such specified fiscal year and then 
increased by the market basket percentage increase (as defined in 
section 1886(b)(3)(B)(iii)) for such specified fiscal year (reduced in 
accordance with paragraph (1)(C)(iv)).''; and
                    (D) by adding at the end the following new clause:
    ``(iv) For purposes of subparagraph (A), subject to clause (iii), 
for a fiscal year beginning on or after October 1, 2034, the `cap 
amount' for such year is the cap amount under this subparagraph for the 
preceding fiscal year, increased by the market basket percentage 
increase (as defined in section 1886(b)(3)(B)(iii)) for such fiscal 
year (reduced in accordance with paragraph (1)(C)(iv)).''.
    (b) Wage Adjusting Caps.--
            (1) In general.--Section 1814(i)(2) of the Social Security 
        Act (42 U.S.C. 1395f(i)(2)), as amended by subsection (a), is 
        further amended--
                    (A) in subparagraph (A)--
                            (i) by striking ```cap amount' for the year 
                        (computed under subparagraph (B))'' and 
                        inserting ``wage-adjusted cap (as defined in 
                        subparagraph (B)) for such program and year''; 
                        and
                            (ii) by striking ``subparagraph (C)'' and 
                        inserting ``subparagraph (E)'';
                    (B) by redesignating subparagraphs (B) through (D) 
                as subparagraphs (D) through (F), respectively;
                    (C) by inserting after subparagraph (A) the 
                following new subparagraphs:
    ``(B) For purposes of subparagraph (A), the term `wage-adjusted 
cap' means, with respect to a hospice program and a year, the product 
of--
            ``(i) the wage index ratio (as computed under subparagraph 
        (C)) for such program and year; and
            ``(ii) the cap amount for such year (as computed under 
        subparagraph (D)).
    ``(C) For purposes of subparagraph (B), the wage index ratio for a 
hospice program and a year is the ratio of--
            ``(i) the aggregate payments to such program for such year 
        under paragraph (1); to
            ``(ii) the aggregate payments to such program for such year 
        under such paragraph that would have been made had such 
        payments not been subject to any wage adjustment.'';
                    (D) in subparagraph (D), as so redesignated--
                            (i) by striking ``subparagraph (A)'' each 
                        place it appears and inserting ``subparagraph 
                        (B)'' in each such place; and
                            (ii) by adding at the end the following new 
                        clause:
    ``(v) Notwithstanding the preceding provisions of this 
subparagraph, for a fiscal year beginning on or after October 1, 2025, 
the cap amount otherwise determined under this subparagraph for such 
fiscal year shall be decreased by the same percentage reduction (if 
any) applied to the amount of payment made under this part for such 
fiscal year under an order issued pursuant to section 251 of the 
Balanced Budget and Emergency Deficit Control Act of 1985. Any 
reduction to the cap amount for a fiscal year under the preceding 
sentence shall not be taken into account for purposes of determining 
the cap amount for any succeeding fiscal year.''; and
                    (E) by adding at the end the following new 
                subparagraph:
    ``(G) Not later than 1 year after the date of the enactment of this 
subparagraph, and annually thereafter, the Secretary shall submit to 
Congress and make public on the website of the Centers for Medicare & 
Medicaid Services a report on the calculation of hospice programs' cap 
amounts under this paragraph. Such report shall contain, with respect 
to each of the 5 most recent accounting years for which data is 
available and each hospice program receiving payments under this 
section for hospice care furnished during such year, the following:
            ``(i) Such program's cap amount determined under such 
        section.
            ``(ii) The percentage of such program's cap amount paid to 
        such program for such care.
            ``(iii) In the case payments to such program exceeded such 
        cap, any amount recouped by the Secretary with respect to such 
        program.
            ``(iv) The live discharge rate of such program.''.
            (2) Implementation.--Notwithstanding any other provision of 
        law, the Secretary of Health and Human Services may implement 
        the amendments made by paragraph (1) by program instruction or 
        otherwise.
            (3) Effective date.--The amendments made by subparagraphs 
        (A) through (C) of paragraph (1) shall apply with respect to 
        payment for hospice care furnished during fiscal years 
        beginning on or after October 1, 2026.
    (c) Modification of Requirements Relating to Short-Term Inpatient 
Care.--
            (1) In general.--Section 1861(dd) of the Social Security 
        Act (42 U.S.C. 1395x(dd)) is amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (G), by striking 
                        ``consecutively over longer than five days'' 
                        and inserting ``for more than 5 days during any 
                        90-day election period (or 60-day election 
                        period, as applicable) described in section 
                        1812(d)(1)''; and
                            (ii) in the flush matter following 
                        subparagraph (I), by adding at the end the 
                        following new sentence: ``In the case of an 
                        individual who receives short-term inpatient 
                        care described in subparagraph (G) consisting 
                        of respite care during an election period and 
                        the furnishing of such care is immediately 
                        preceded by a hospital stay (which may include 
                        a stay for observation) during which such 
                        individual made an election described in 
                        section 1812(d)(1) for the first time during 
                        such individual's lifetime (or if such care is 
                        immediately preceded by the furnishing of 
                        hospice care consisting of general inpatient 
                        care and such general inpatient care is 
                        immediately preceded by such a hospital stay), 
                        the first continuous 15 days of such care shall 
                        not be taken into account for purposes of 
                        applying the limitation on the number of days 
                        during which such care may be furnished during 
                        an election period under such subparagraph, but 
                        only if such individual does not have 
                        sufficient caregiver support to be discharged 
                        to the individual's home.''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (A)(iii)--
                                    (I) by striking ``provides 
                                assurances satisfactory to the 
                                Secretary that'' and inserting 
                                ``ensures that the sum of''; and
                                    (II) by striking ``20 percent'' and 
                                inserting ``10 percent (or a higher 
                                percent (not to exceed 20 percent) 
                                specified by the Secretary if 
                                determined necessary by the Secretary 
                                to ensure sufficient access to such 
                                inpatient care)''; and
                            (ii) by adding at the end the following 
                        flush sentence:
        ``For purposes of subparagraph (A)(iii), the Secretary shall 
        ensure that the limitation described in such subparagraph is 
        applied, to the extent practicable, on a real-time basis.''.
            (2) Allowing respite care to be furnished in residential 
        care facilities.--Not later than October 1, 2026, the Secretary 
        of Health and Human Services (in this paragraph referred to as 
        the ``Secretary'') shall revise section 418.108 of title 42, 
        Code of Federal Regulations (or a successor regulation) to 
        allow short-term inpatient care consisting of respite care (as 
        described in section 1861(dd)(1)(G) of the Social Security Act 
        (42 U.S.C. 1395x(dd)(1)(G))) to be furnished in residential 
        care facilities (as defined by the Secretary) that only provide 
        care to individuals receiving hospice care (as specified by the 
        Secretary) and that meet such standards relating to health and 
        safety as the Secretary may specify (which may be based on 
        State licensure requirements applicable to such facilities).
            (3) Effective date.--The amendments made by paragraph (1) 
        shall apply to hospice care furnished on or after October 1, 
        2026.
    (d) Hospital Discharge Planning Requirements.--
            (1) In general.--Section 1861(ee)(2)(D) of the Social 
        Security Act (42 U.S.C. 1395x(ee)(2)(D)) is amended--
                    (A) by inserting ``, home health services,'' after 
                ``including hospice care'';
                    (B) by striking ``including the availability of 
                home health services through individuals and entities'' 
                and inserting the following: ``including--
                    ``(i) in the case of individuals who are likely to 
                need home health services, the availability of such 
                services through home health agencies'';
                    (C) by striking ``listed by the hospital as 
                available and, in the case of individuals who are 
                likely to need post-hospital extended care services,'' 
                and inserting the following: ``listed by the hospital 
                as available;
                    ``(ii) in the case of individuals who are likely to 
                need post-hospital extended care services,'';
                    (D) by striking the period and inserting ``; and''; 
                and
                    (E) by adding at the end the following new clause:
                            ``(iii) in the case of individuals who are 
                        likely eligible for hospice care, the 
                        availability of such care (including the 
                        availability of respite care described in 
                        subsection (dd)(1)(G)) through hospice programs 
                        that participate in the program under this 
                        title and that serve the area in which the 
                        patient resides.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply with respect to discharges occurring on or after 
        October 1, 2026.
    (e) Payment for Respite Care Furnished in the Home.--
            (1) In general.--Section 1861(dd)(1) of the Social Security 
        Act (42 U.S.C. 1395x(dd)(1)) is amended--
                    (A) in subparagraph (H), by striking ``and'' at the 
                end;
                    (B) by redesignating subparagraph (I) as 
                subparagraph (J); and
                    (C) by inserting after subparagraph (H) the 
                following new subparagraph:
            ``(I) short-term home respite care furnished to an 
        individual on or after October 1, 2028, that--
                    ``(i) is furnished in the place of residence used 
                as such individual's home (other than a skilled nursing 
                facility, a nursing facility (as defined in section 
                1919(a)), an assisted living facility (as defined by 
                the Secretary), or another facility specified by the 
                Secretary);
                    ``(ii) is furnished on an intermittent, nonroutine, 
                and occasional basis;
                    ``(iii) is furnished for not more than 120 hours 
                during any 90-day period described in section 
                1812(d)(1) (or, in the case such individual is 60-day 
                period described in such section, for not more than 80 
                hours during such period); and
                    ``(iv) meets such other requirements as the 
                Secretary may specify.''.
            (2) Payment rates.--Section 1814(i)(1)(C) of the Social 
        Security Act (42 U.S.C. 1395f(i)(1)(C)), as amended by 
        subsection (a), is further amended--
                    (A) in clause (iii), by striking ``through (x)'' 
                and inserting ``through (x) and clause (xiii)''; and
                    (B) by adding at the end the following new clause:
    ``(xiii) With respect to short-term home respite care furnished to 
an individual during fiscal year 2029 or a subsequent fiscal year, the 
rates payable for such care shall be equal to the sum of the per diem 
rate established for routine home care for such fiscal year and an 
hourly rate established by the Secretary, except that in no case may 
such rate payable for such short-term home respite care furnished in a 
24-hour period exceed the rate of payment for general inpatient care 
furnished during such a period.''.
                                 <all>
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