I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Hospice Care Account5 ability, Reform, and Enforcement Act of 2024’’ or the 

6 ‘‘Hospice CARE Act of 2024’’. 


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1 SEC. 2. ENSURING THE INTEGRITY OF HOSPICE CARE FUR2 NISHED UNDER THE MEDICARE PROGRAM. 

3 (a) MANDATORY TEMPORARY MORATORIUM ON EN4 ROLLMENT.— 

5 (1) IN GENERAL.—Section 1866(j) of the Social 

6 Security Act (42 U.S.C. 1395cc(j)) is amended by 

7 adding at the end the following new paragraph: 

8 ‘‘(10) MANDATORY TEMPORARY MORATORIUM

9 ON ENROLLMENT OF HOSPICE PROGRAMS.— 

10 ‘‘(A) IN GENERAL.—Except as provided in 

11 subparagraphs (B) and (C), the Secretary shall 

12 impose a nationwide temporary moratorium on 

13 the enrollment of new hospice programs under 

14 this title for the 5-year period beginning on the 

15 date of the enactment of this paragraph. 

16 ‘‘(B) EXEMPTION FOR CERTAIN HOS17 PICES.— 

18 ‘‘(i) IN GENERAL.—The Secretary 

19 may exempt a hospice program seeking to 

20 enroll under this title from the moratorium 

21 described in subparagraph (A) if the Sec22 retary determines that such program will 

23 furnish hospice care to individuals entitled 

24 to benefits under part A in an area with 

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1 fied by the Secretary, taking into account 

2 the considerations described in clause (ii)). 

3 ‘‘(ii) CONSIDERATIONS DESCRIBED.— 

4 For purposes of clause (i), the consider5 ations described in this clause are, with re6 spect to a hospice program seeking to en7 roll under this title, the following: 

8 ‘‘(I) The specific geographic area 

9 that such program intends to serve. 

10 ‘‘(II) The current availability of 

11 hospice care in such area. 

12 ‘‘(III) Any evidence of unmet 

13 need for hospice care in such area 

14 (such as wait times for such care, the 

15 extent to which such area (or a popu16 lation in such area) is considered un17 derserved, and evidence that existing 

18 hospice programs are provided a sub19 standard quality of care in such area). 

20 ‘‘(IV) The program’s plan to ad21 dress any identified gaps in the provi22 sion of hospice care in such area. 

23 ‘‘(C) AUTHORITY TO LIFT MORATORIUM.— 

24 The Secretary may lift the moratorium imposed 

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1 graphic region of a State) specified by the Sec2 retary in the same manner as the Secretary 

3 may lift a temporary moratorium (as described 

4 in paragraph (7)) under section 424.570(d) of 

5 title 42, Code of Federal Regulations (or a suc6 cessor regulation). 

7 ‘‘(D) APPLICATION OF PREPAYMENT MED8 ICAL REVIEW DURING THE TEMPORARY MORA9 TORIUM IN CERTAIN CIRCUMSTANCES.— 

10 ‘‘(i) IN GENERAL.—Subject to clause 

11 (ii), the Secretary shall apply prepayment 

12 medical review to hospice care consisting of 

13 routine home care furnished during the 5- 

14 year period beginning on the date of the 

15 enactment of this paragraph by an applica16 ble hospice program to a covered indi17 vidual. 

18 ‘‘(ii) TERMINATION OF APPLICATION

19 OF PREPAYMENT MEDICAL REVIEW.— 

20 ‘‘(I) IN GENERAL.—The Sec21 retary shall terminate the application 

22 of prepayment medical review under 

23 clause (i) with respect to hospice care 

24 furnished by an applicable hospice 

25 program to a covered individual if the 


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1 Secretary determines that, during the 

2 period in which such care so furnished 

3 by such program was subject to such 

4 review, such care was subject to a low 

5 rate of denial (as specified by the Sec6 retary) under such review. 

7 ‘‘(II) REVOCATION OF TERMI8 NATION.—The Secretary may revoke 

9 any termination of prepayment med10 ical review under subclause (I) if de11 termined appropriate by the Sec12 retary. 

13 ‘‘(iii) DEFINITIONS.—For purposes of 

14 this subparagraph: 

15 ‘‘(I) APPLICABLE HOSPICE PRO16 GRAM.—The term ‘applicable hospice 

17 program’ means a hospice program 

18 with a history of claim submissions 

19 with respect to hospice care furnished 

20 under this title that is aberrant (such 

21 as by demonstrating that such pro22 gram is an outlier with respect to live 

23 discharges) compared to such history 

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1 ated hospice programs, as determined 

2 by the Secretary. 

3 ‘‘(II) COVERED INDIVIDUAL.— 

4 The term ‘covered individual’ means 

5 an individual receiving hospice care 

6 under this title during the second 90- 

7 day period described in section 

8 1812(d)(1) (or during any subsequent 

9 period) applicable to such individual. 

10 ‘‘(E) REVALIDATION OF ENROLLMENT IN11 FORMATION.— 

12 ‘‘(i) IN GENERAL.—During the 6- 

13 month period beginning on the date of the 

14 enactment of this paragraph and notwith15 standing any applicable revalidation cycle 

16 under section 424.515 of title 42, Code of 

17 Federal Regulations (or a successor regula18 tion), the Secretary shall revalidate the en19 rollment information of each hospice pro20 gram enrolled under this title in accord21 ance with the requirements applicable to 

22 revalidations of such information under 

23 such section. 

24 ‘‘(ii) PUBLICATION OF OWNERSHIP IN25 FORMATION.—Not later than 1 year after 


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1 the date of the enactment of this para2 graph, the Secretary shall publish on a 

3 public website of the Centers for Medicare 

4 & Medicaid Services ownership interest and 

5 managing control information collected 

6 pursuant to revalidations described in 

7 clause (i) for each hospice program en8 rolled under this title. 

9 ‘‘(iii) REPORT.—Not later than Janu10 ary 1, 2027, the Secretary, acting through 

11 the Assistant Secretary for Planning and 

12 Evaluation, shall submit to Congress a re13 port on hospice ownership and control 

14 trends and the role of private equity in 

15 ownership and control of hospice programs. 

16 Such report shall include— 

17 ‘‘(I) validation, to the extent fea18 sible, of the ownership and control in19 formation reported on form CMS– 

20 855A (or any successor form); 

21 ‘‘(II) an analysis of hospice cost 

22 report data by ownership type; 

23 ‘‘(III) recommendations on ways 

24 to improve the integrity of the owner25 ship and control information reported 


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1 by hospices during the enrollment 

2 process under this title; and 

3 ‘‘(IV) to the extent practicable, 

4 recommendations on policies to pro5 mote health care competition. 

6 ‘‘(F) IMPLEMENTATION.—The Secretary 

7 shall implement this paragraph through pro8 gram instruction or other forms of subregu9 latory guidance.’’. 

10 (2) AUTHORITY TO PROVIDE EXEMPTIONS TO

11 TEMPORARY MORATORIA.—Section 1866(j)(7) of the 

12 Social Security Act (42 U.S.C. 1395cc(j)(7)) is 

13 amended— 

14 (A) in subparagraph (A), by adding at the 

15 end the following new sentence: ‘‘The Secretary 

16 may exempt a provider of services or supplier 

17 that would otherwise be subject to a morato18 rium imposed under the preceding sentence 

19 from such moratorium if determined appro20 priate by the Secretary.’’; and 

21 (B) in subparagraph (C)(iii)— 

22 (i) in subclause (I), by striking ‘‘and’’ 

23 at the end; 

24 (ii) in subclause (II), by striking the 

25 period and inserting ‘‘; and’’; and 


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1 (iii) by adding at the end the fol2 lowing new subclause: 

3 ‘‘(III) is not subject to an exemp4 tion described in such subpara5 graph.’’. 

6 (b) EXTENSION OF OVERSIGHT OF NEWLY-EN7 ROLLED HOSPICE PROGRAMS.— 

8 (1) IN GENERAL.—Section 1866(j)(3)(A) of the 

9 Social Security Act (42 U.S.C. 1395cc(j)(3)(A)) is 

10 amended by inserting ‘‘(or, in the case of a hospice 

11 program, not more than 2 years)’’ after ‘‘1 year’’. 

12 (2) MANDATORY APPLICATION OF ENHANCED

13 OVERSIGHT FOR CERTAIN HOSPICE PROGRAMS.— 

14 Section 1866(j)(3) of the Social Security Act (42 

15 U.S.C. 1395cc(j)(3)) is amended— 

16 (A) by redesignating subparagraph (B) as 

17 subparagraph (C); and 

18 (B) by inserting after subparagraph (A) 

19 the following new subparagraph: 

20 ‘‘(B) MANDATORY APPLICATION TO CER21 TAIN HOSPICE PROGRAMS.—The procedures es22 tablished by the Secretary under subparagraph 

23 (A) shall provide that any hospice program en24 rolling under this title that would, but for appli25 cation of subparagraph (B) or (C) of paragraph 


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1 (10), have been prohibited from so enrolling be 

2 subject to the enhanced oversight described in 

3 such subparagraph for a period of not less than 

4 30 days.’’. 

5 (c) INCREASE IN SURVEY FREQUENCY FOR CERTAIN

6 HOSPICE PROGRAMS.—Section 1822(a) of the Social Se7 curity Act (42 U.S.C. 1395i–6(a)) is amended— 

8 (1) in paragraph (1)— 

9 (A) by inserting ‘‘, with respect to such a 

10 survey conducted with respect to a hospice pro11 gram that is not included on the list established 

12 under paragraph (5),’’ after ‘‘local survey agen13 cy, or’’; and 

14 (B) by inserting ‘‘(or, in the case of a hos15 pice program that is included on the list estab16 lished under paragraph (5), not less frequently 

17 than once every 18 months)’’ after ‘‘36 

18 months’’; 

19 (2) by redesignating paragraph (5) as para20 graph (6); 

21 (3) by inserting after paragraph (4) the fol22 lowing new paragraph: 

23 ‘‘(5) HOSPICE PROGRAMS SUBJECT TO IN24 CREASED SURVEY FREQUENCY.— 


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1 ‘‘(A) IN GENERAL.—The Secretary shall 

2 establish a list of hospice programs subject to 

3 increased survey frequency under paragraph (1) 

4 in accordance with the provisions of this para5 graph. 

6 ‘‘(B) INCLUSION ON LIST.— 

7 ‘‘(i) IN GENERAL.—The Secretary 

8 shall include a hospice program on the list 

9 established under subparagraph (A) if such 

10 program is not participating in the special 

11 focus program under subsection (b) and 

12 such hospice program meets either of the 

13 following criteria: 

14 ‘‘(I) The program first submitted 

15 a claim for an item or service under 

16 this title during the 5-year period end17 ing on the date of the enactment of 

18 this paragraph. 

19 ‘‘(II) The program first submits 

20 a claim for an item or service under 

21 this title on or after such date of en22 actment. 

23 ‘‘(ii) DISCRETIONARY INCLUSION.— 

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1 gram on the list established under sub2 paragraph (A)— 

3 ‘‘(I) if claims data submitted by 

4 such program indicates that such pro5 gram is not providing the full scope of 

6 hospice care services payable under 

7 this title; 

8 ‘‘(II) if the Secretary determines 

9 that such program is an outlier with 

10 respect to live discharges; or 

11 ‘‘(III) for any other reason deter12 mined appropriate by the Secretary. 

13 ‘‘(C) REMOVAL FROM LIST.—The Sec14 retary shall remove a hospice program included 

15 in the list established under subparagraph 

16 (A)— 

17 ‘‘(i) if— 

18 ‘‘(I) such program has been sub19 ject to 2 surveys under this subsection 

20 while included on such list; and 

21 ‘‘(II) neither such survey resulted 

22 in such program being cited for a de23 ficiency for failure to comply with a 

24 condition of participation relating to 

25 quality of care; or 


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1 ‘‘(ii) if such program is placed in the 

2 special focus program established under 

3 subsection (b).’’; and 

4 (4) in paragraph (6), as so redesignated, by 

5 striking ‘‘each fiscal year (beginning with fiscal year 

6 2022)’’ and inserting ‘‘each of fiscal years 2022 

7 through 2025, and of $15,000,000 for fiscal year 

8 2026 and for each subsequent fiscal year,’’. 

9 (d) PROHIBITION ON PAYMENT FOR FAILURE TO

10 MEET QUALITY DATA REPORTING REQUIREMENTS.— 

11 Section 1814(i)(5) of the Social Security Act (42 U.S.C. 

12 1395f(i)(5)) is amended— 

13 (1) in subparagraph (A)— 

14 (A) in the header, by striking ‘‘REDUCTION

15 IN UPDATE FOR’’; 

16 (B) in clause (i)— 

17 (i) in the header, by striking ‘‘IN

18 GENERAL’’ and inserting ‘‘FISCAL YEARS

19 2014 THROUGH 2026’’; 

20 (ii) by inserting ‘‘through fiscal year 

21 2026’’ after ‘‘each subsequent fiscal year’’; 

22 and 

23 (iii) by adding at the end the fol24 lowing new sentence: ‘‘The application of 

25 the preceding sentence may result in the 


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1 market basket percentage increase under 

2 paragraph (1)(C)(ii)(VII) or paragraph 

3 (1)(C)(iii), as applicable, being less than 

4 0.0 for a fiscal year, and may result in 

5 payment rates under this subsection for a 

6 fiscal year being less than such payment 

7 rates for the preceding fiscal year.’’; and 

8 (C) by amending clause (ii) to read as fol9 lows: 

10 ‘‘(ii) SUBSEQUENT FISCAL YEARS.— 

11 For purposes of fiscal year 2027 and each 

12 subsequent fiscal year, no payment may be 

13 made under this title to a hospice program 

14 that does not submit data to the Secretary 

15 in accordance with subparagraph (C) with 

16 respect to such fiscal year.’’; and 

17 (2) in subparagraph (B), by striking ‘‘subpara18 graph (A)’’ and inserting ‘‘subparagraph (A)(i)’’. 

19 (e) ENSURING INDEPENDENCE OF PHYSICIAN CER20 TIFICATIONS OF TERMINAL ILLNESS.—Section 

21 1814(a)(7)(A)(i) of the Social Security Act (42 U.S.C. 

22 1395f(a)(7)(A)(i)) is amended— 

23 (1) in subclause (I), by inserting ‘‘or, with re24 spect to certifications under this clause occurring on 

25 or after October 1, 2026, in the case such individual 


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1 fails to designate such an attending physician (or in 

2 the case such attending physician is employed by the 

3 hospice program at which such individual will receive 

4 such care or otherwise has a significant ownership 

5 interest in, or a significant financial relationship 

6 with, such program (as determined by the Sec7 retary)), by a physician, physician assistant, or 

8 nurse practitioner that does not have such a signifi9 cant ownership interest in, or such a significant fi10 nancial relationship with, such program (as deter11 mined by the Secretary)’’ before ‘‘, and’’; and 

12 (2) in the matter following subclause (II), by 

13 striking ‘‘physician’s’’ and inserting ‘‘physician’s, 

14 physician assistant’s, nurse practitioner’s,’’. 

15 (f) ALLOWING ADDITIONAL PROVIDERS TO CERTIFY

16 TERMINAL ILLNESS.— 

17 (1) IN GENERAL.—Section 1814(a)(7)(A)(i)(I) 

18 of the Social Security Act (42 U.S.C. 

19 1395f(a)(7)(A)(i)(I)) is amended by striking ‘‘(which 

20 for purposes of this subparagraph does not include 

21 a nurse practitioner or a physician assistant)’’. 

22 (2) EFFECTIVE DATE.—The amendment made 

23 by paragraph (1) shall apply with respect to certifi24 cations of terminal illnesses made on or after Octo25 ber 1, 2026. 


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1 (g) ALLOWABLE USE OF SUPPORTING MATERIAL IN

2 MEDICAL REVIEW OF HOSPICE CARE.—Section 1814(a) 

3 of the Social Security Act (42 U.S.C. 1395f(a)) is amend4 ed by adding at the end the following new sentence: ‘‘For 

5 purposes of conducting medical review of hospice care fur6 nished to an individual, in addition to using documenta7 tion in the medical record of such individual’s attending 

8 physician (as defined in section 1861(dd)) or of the physi9 cian, physician assistant, or nurse practitioner otherwise 

10 making the certification described in paragraph 

11 (7)(A)(i)(I) with respect to such individual, the Secretary 

12 may use documentation in the medical record of the hos13 pice program furnishing such care as supporting material, 

14 as determined appropriate by the Secretary.’’. 

15 (h) PROHIBITION ON CERTAIN CHANGES IN MAJOR16 ITY OWNERSHIP.—With respect to any change in the ma17 jority ownership of a hospice program occurring during 

18 the 5-year period beginning on the date of the enactment 

19 of this Act, the Secretary of Health and Human Services 

20 shall apply section 424.550(b) of title 42, Code of Federal 

21 Regulations (or a successor regulation) as if the references 

22 to ‘‘36 months’’ in paragraph (1) of such section were ref23 erences to ‘‘60 months’’. 

24 (i) ADVANCED NOTICE OF CHANGES IN OWNERSHIP

25 OR CONTROL.—Section 1822 of the Social Security Act 


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1 (42 U.S.C. 1395i–6) is amended by adding at the end the 

2 following new subsection: 

3 ‘‘(d) ADVANCED NOTICE OF CHANGES IN OWNER4 SHIP OR CONTROL.— 

5 ‘‘(1) IN GENERAL.—Beginning January 1, 

6 2027, in the case a change occurs in— 

7 ‘‘(A) the persons with an ownership or 

8 control interest (as defined in section 

9 1124(a)(3)) in the hospice program; 

10 ‘‘(B) the persons who are officers, direc11 tors, agents, or managing employees (as defined 

12 in section 1126(b)) of the hospice program; 

13 ‘‘(C) the corporation, association, or other 

14 company responsible for the management of the 

15 hospice program; or 

16 ‘‘(D) the individual who is the adminis17 trator of the hospice program, or (v) the indi18 vidual who is the medical director of the hospice 

19 program; 

20 such program shall provide notice at the time of the 

21 change (or, in the case such change is with respect 

22 to a person described in subparagraph (A), at least 

23 90 days before the effective date of the change) to 

24 the Secretary, the appropriate State or local survey 

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1 cy of the change and of the identity of each new per2 son, company, or individual described in the respec3 tive subparagraph. 

4 ‘‘(2) ENFORCEMENT.— 

5 ‘‘(A) IN GENERAL.—In the case that the 

6 Secretary determines that a hospice program 

7 has violated paragraph (1), the Secretary 

8 may— 

9 ‘‘(i) impose a civil monetary penalty 

10 in an amount not to exceed $1,000,000 per 

11 violation; and 

12 ‘‘(ii) if determined appropriate by the 

13 Secretary, terminate such program’s en14 rollment under this title. 

15 ‘‘(B) PROCEDURES.—The provisions of 

16 section 1128A (other than subsections (a) and 

17 (b) of such section) shall apply to a civil mone18 tary penalty imposed under subparagraph (A) 

19 in the same manner as such provisions apply to 

20 a penalty or proceeding under such section.’’. 

21 (j) REQUIRED PROVISION OF ADDENDUM OF NON22 COVERED SERVICES.—Section 1812(d)(1) of the Social 

23 Security Act (42 U.S.C. 1395d(d)(1)) is amended by add24 ing at the end the following new sentence: ‘‘With respect 

25 to such an election made on or after October 1, 2026, in 


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1 the case such program determines that there are items 

2 and services being furnished to such individual that are 

3 not related to the treatment of the individual’s condition 

4 with respect to which a diagnosis of terminal illness has 

5 been made, such election shall include an addendum that 

6 specifies such items and services and includes such addi7 tional information as may be specified by the Secretary. 

8 Such program shall provide an updated addendum de9 scribed in the preceding sentence to such individual if, 

10 while such election is in effect with respect to such indi11 vidual, such program makes any alteration to the adden12 dum provided to such individual at the time of such elec13 tion.’’. 

14 (k) MEDICAL REVIEW OF HOSPICE OUTLIERS AND

15 CARE UNRELATED TO TERMINAL CONDITION.— 

16 (1) IN GENERAL.— 

17 (A) MEDICAL REVIEW.—Section 

18 1814(a)(7) of the Social Security Act (42 

19 U.S.C. 1395f(a)(7)) is amended— 

20 (i) in subparagraph (D), by striking 

21 ‘‘and’’ at the end; 

22 (ii) in subparagraph (E), by inserting 

23 ‘‘before the date of the enactment of sub24 paragraph (F),’’ after ‘‘subparagraph,’’; 

25 and 


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1 (iii) by adding at the end the fol2 lowing new subparagraph: 

3 ‘‘(F) beginning on the date that is 5 years 

4 after the date of the enactment of this subpara5 graph, in the case of hospice care provided an 

6 individual for more than 90 days by a hospice 

7 program with aberrant billing patterns (as de8 termined by the Secretary), the hospice care 

9 provided to such individual is subject to prepay10 ment medical review (in accordance with proce11 dures established by the Secretary); and’’. 

12 (B) TECHNICAL EXPERT PANEL.— 

13 (i) IN GENERAL.—The Secretary of 

14 Health and Human Services shall establish 

15 a technical expert panel for purposes of es16 tablishing standards for identifying a hos17 pice program with a history of aberrant 

18 billing patterns under section 

19 1814(a)(7)(F) of the Social Security Act, 

20 as added by subparagraph (A). In making 

21 recommendations with respect to such 

22 standards, such panel shall take into ac23 count the results of prepayment medical 

24 reviews conducted under section 


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1 1866(j)(10)(D) of such Act, as added by 

2 subsection (a). 

3 (ii) FACA WAIVER.—The provisions 

4 of chapter 10 of title 5, United States 

5 Code, shall not apply to the panel estab6 lished under clause (i). 

7 (2) PREPAYMENT MEDICAL REVIEW REQUIRE8 MENT.—Section 1812(d)(2) of the Social Security 

9 Act (42 U.S.C. 1395d(d)(2)) is amended by adding 

10 at the end the following new subparagraph: 

11 ‘‘(E) Notwithstanding any other provision of this 

12 title, in the case of items and services (other than items 

13 and services described in the matter following clause 

14 (ii)(II) of subparagraph (A)) furnished on or after October 

15 1, 2026, to an individual with an election in effect under 

16 paragraph (1) by a provider of services or supplier, if such 

17 provider of services or supplier indicates that such items 

18 and services are unrelated to the individual’s condition 

19 with respect to which a diagnosis of terminal illness has 

20 been made, no payment may be made under this title for 

21 such items and services before the Secretary has con22 ducted a medical review of such items and services to de23 termine whether such items and services are unrelated to 

24 such condition. Such review shall include a review of any 


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1 addendum described in paragraph (1) included in such 

2 election.’’. 

3 (3) FUNDING.—The Secretary of Health and 

4 Human Services shall provide for the transfer, from 

5 the Federal Hospital Insurance Trust Fund estab6 lished under section 1817 of the Social Security Act 

7 (42 U.S.C. 1395i) to the Centers for Medicare & 

8 Medicaid Services Program Management Account, of 

9 $20,000,000 for fiscal year 2026, to remain avail10 able until expended, for purposes of carrying out the 

11 amendments made by this subsection. 

12 (l) PROVISION OF EXPLANATION OF BENEFITS UPON

13 HOSPICE ELECTION.— 

14 (1) IN GENERAL.—Section 1806 of the Social 

15 Security Act (42 U.S.C. 1395b–7) is amended by 

16 adding at the end the following new subsection: 

17 ‘‘(d) PROVISION OF EXPLANATION OF BENEFITS

18 UPON HOSPICE ELECTION.—The Secretary shall furnish 

19 to each individual who makes an election described in sec20 tion 1812(d)(1), not later than 15 days after such indi21 vidual makes such election, a notice that— 

22 ‘‘(1) specifies— 

23 ‘‘(A) the effective date of such election; 

24 ‘‘(B) the hospice program that will be fur25 nishing hospice care to such individual; 


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1 ‘‘(C) the telephone number and address of 

2 such program; 

3 ‘‘(D) the physician, physician assistant, or 

4 nurse practitioner who made the certification 

5 described in section 1814(a)(7)(A)(i)(I) with re6 spect to such individual; 

7 ‘‘(E) the toll-free telephone number of the 

8 medicare administrative contractor responsible 

9 for processing claims for such care; 

10 ‘‘(2) informs such individual of the waiver of 

11 rights described in section 1812(d)(2)(A); 

12 ‘‘(3) includes a statement which indicates that, 

13 because errors do occur and because Medicare waste, 

14 fraud, and abuse is a significant problem, such indi15 vidual should carefully check the individual’s hospice 

16 election information and if such individual suspects 

17 Medicare waste, fraud, or abuse with respect to the 

18 provision of such care, the individual should contact 

19 the toll-free phone number 1–800–MEDICARE and 

20 a toll-free phone number maintained by the Inspec21 tor General of the Department of Health and 

22 Human Services for the receipt of complaints and 

23 information about waste, fraud, and abuse in the 

24 provision or billing of services under this title; and 


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1 ‘‘(4) includes any other information determined 

2 appropriate by the Secretary.’’. 

3 (2) FUNDING.—The Secretary of Health and 

4 Human Services shall provide for the transfer from 

5 the Federal Hospital Insurance Trust Fund estab6 lished under section 1817 of the Social Security Act 

7 (42 U.S.C. 1395i) to the Centers for Medicare & 

8 Medicaid Services Program Management Account of 

9 $10,000,000 for fiscal year 2026, to remain avail10 able until expended, for purposes of carrying out the 

11 amendment made by paragraph (1). 

12 (3) EFFECTIVE DATE.—The amendment made 

13 by paragraph (1) shall apply to individuals making 

14 elections described in section 1812(d)(1) of the So15 cial Security Act (42 U.S.C. 1395d(d)(1)) on or 

16 after the date that is 1 year after the date of the 

17 enactment of this Act. 

18 (m) MEDICAL REVIEW OF HOSPICE CARE CON19 TRACTOR REQUIREMENTS.— 

20 (1) IN GENERAL.—The Secretary of Health and 

21 Human Services (in this subsection referred to as 

22 the ‘‘Secretary’’) shall require any entity performing 

23 medical review under contract with Secretary of hos24 pice care furnished under part A of title XVIII of 

25 the Social Security Act (42 U.S.C. 1395c et seq.) to, 


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1 with respect to such reviews performed on or after 

2 January 1, 2027, utilize only individuals who have 

3 received specialized instruction on the philosophy be4 hind hospice care and medical prognostication (as 

5 specified by the Secretary) in performing such re6 views. In so specifying such instruction and in up7 dating such instruction, the Secretary shall consult 

8 with hospice programs as to the content of such in9 struction. 

10 (2) PUBLICATION.—The Secretary shall make 

11 any instruction specified for purposes of paragraph 

12 (1) publicly available on the website of the Centers 

13 for Medicare & Medicaid Services. 

14 (3) REPORT.—Not later than October 1, 2027, 

15 the Secretary shall submit to Congress a report on 

16 activities relating to the medical review of hospice 

17 care furnished under part A of title XVIII of the So18 cial Security Act (42 U.S.C. 1395c et seq.). Such re19 port shall include— 

20 (A) with respect to the medical review of 

21 hospice care performed during the period begin22 ning on January 1, 2019, and ending on De23 cember 31, 2024, the accuracy rates of such re24 views when performed by— 


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1 (i) medicare administrative contrac2 tors; 

3 (ii) recovery audit contractors; 

4 (iii) supplemental medical review con5 tractors; and 

6 (iv) uniform program integrity con7 tractors; 

8 (B) the total number of hospice claims 

9 submitted during the period described in sub10 paragraph (A) subject to medical review; 

11 (C) the percentage of such claims that 

12 were denied and appealed and the percentage of 

13 such claims so appealed that were overturned 

14 on appeal, broken down by the type of con15 tractor conducing review of such claims and by 

16 each level of appeal; 

17 (D) a list of medical review projects relat18 ing to hospice care undertaken by contractors 

19 described in subparagraph (A); and 

20 (E) actions the Secretary will take to re21 duce the audit burden on hospice programs 

22 with claims selected for medical review under 

23 multiple projects described in subparagraph (D) 

24 and to minimize the number of denials of 


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1 claims for hospice care that are overturned on 

2 appeal. 

3 (n) REQUIRING FACE-TO-FACE ENCOUNTERS BE4 FORE RECERTIFICATIONS OF TERMINAL ILLNESS.—Sec5 tion 1814(a)(7) of the Social Security Act (42 U.S.C. 

6 1395f(a)(7)) is amended— 

7 (1) in subparagraph (D)— 

8 (A) by inserting ‘‘, and before October 1, 

9 2026’’ after ‘‘2011’’; and 

10 (B) by striking ‘‘and’’ at the end; and 

11 (2) by adding at the end the following new sub12 paragraph: 

13 ‘‘(F) on and after October 1, 2026, not 

14 more than 30 days before each recertification 

15 described in subparagraph (A)(ii) is made with 

16 respect to an individual, a hospice physician, 

17 hospice nurse practitioner, or hospice physician 

18 assistant has a face-to-face encounter (which 

19 may, with respect to any such recertification 

20 made for a 60-day period described in such sub21 paragraph, be conducted via telehealth, but only 

22 if a registered nurse, licensed practical nurse, 

23 or home health aide employed by the hospice 

24 program furnishing hospice care to such indi25 vidual is physically present with such individual 


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1 during such encounter) with such individual to 

2 gather clinical findings to determine such indi3 vidual’s continue eligibility for hospice care; 

4 and’’. 

5 (o) ENSURING MEDICAL DIRECTOR AND PHYSICIAN

6 AVAILABILITY.— 

7 (1) IN GENERAL.—Section 1861(dd) of the So8 cial Security Act (42 U.S.C. 1395x(dd)) is amend9 ed— 

10 (A) in paragraph (2)— 

11 (i) in subparagraph (F), by striking 

12 ‘‘and’’ at the end; 

13 (ii) by redesignating subparagraph 

14 (G) as subparagraph (I); and 

15 (iii) by inserting after subparagraph 

16 (F) the following new subparagraphs: 

17 ‘‘(G) has a medical director responsible for 

18 the medical component of hospice care provided 

19 by such program who— 

20 ‘‘(i) is a doctor of medicine or osteop21 athy licensed to practice in the State in 

22 which such program is located; and 

23 ‘‘(ii) subject to paragraph (6), is not 

24 the medical director of more than 1 other 

25 hospice program; 


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1 ‘‘(H) ensures that the medical director de2 scribed in subparagraph (G) or a physician 

3 member of the group described in subparagraph 

4 (B) is available for immediate consultation 

5 (which may be through telehealth) when hospice 

6 care is provided in an individual’s home; and’’; 

7 and 

8 (B) by adding at the end the following new 

9 paragraph: 

10 ‘‘(6) The Secretary may waive the requirement de11 scribed in paragraph (2)(G)(ii) with respect to the medical 

12 director of a hospice program if determined appropriate 

13 by the Secretary on a case-by-case basis. In determining 

14 whether to grant a waiver under the preceding sentence, 

15 the Secretary shall take into consideration— 

16 ‘‘(A) the average daily census for each hospice 

17 program with respect to which such director is med18 ical director; 

19 ‘‘(B) the geographic areas served by such pro20 grams; and 

21 ‘‘(C) any other information determined appro22 priate by the Secretary.’’. 

23 (2) EFFECTIVE DATE.—The amendments made 

24 by paragraph (1) shall apply beginning January 1, 

25 2028. 


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1 (p) REPORT ON HOSPICE ACCREDITING ORGANIZA2 TIONS.—Not later than 2 years after the date of the enact3 ment of this Act, the Comptroller General of the United 

4 States shall submit to Congress a report on the Secretary 

5 of Health and Human Services’ (in this subsection re6 ferred to as the ‘‘Secretary’’) oversight of hospice program 

7 accrediting organizations. Such report shall include the 

8 following: 

9 (1) An analysis of deficiencies relating to qual10 ity of care found pursuant to surveys conducted 

11 under section 1822(a) of the Social Security Act (42 

12 U.S.C. 1395i–6(a)) following complaints when such 

13 surveys were of hospice programs accredited by such 

14 an organization and such surveys were conducted by 

15 such an organization compared to such deficiencies 

16 so found following such complaints when such sur17 veys were of hospice programs certified by State or 

18 local survey agencies and such surveys were con19 ducted by such agencies. 

20 (2) A list of hospice programs determined by 

21 the Secretary not to be in compliance with all re22 quirements applicable to such programs, along with 

23 a list of the accrediting organization of each such 

24 program. 


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1 (3) A list of hospice programs that have been 

2 deactivated, terminated, or investigated due to con3 cerns relating to waste, fraud, or abuse, along with 

4 a list of the accrediting organization of each such 

5 program. 

6 (4) An analysis of any conflicts of interest of 

7 hospice program accrediting organizations. 

8 (5) Performance data for hospice program ac9 crediting organizations. 

10 SEC. 3. PAYMENT REFORMS FOR HOSPICE CARE FUR11 NISHED UNDER THE MEDICARE PROGRAM. 

12 (a) ADJUSTING PAYMENTS FOR HOSPICE CARE.— 

13 (1) IN GENERAL.—Section 1814(i)(1)(C) of the 

14 Social Security Act (42 U.S.C. 1395f(i)(1)(C)) is 

15 amended— 

16 (A) in clause (iii)— 

17 (i) by moving such clause 6 ems to 

18 the left; 

19 (ii) by striking ‘‘With respect to’’ and 

20 inserting ‘‘Except as provided under 

21 clauses (viii) through (x), with respect to’’; 

22 (iii) by inserting ‘‘in a setting (as 

23 specified by the Secretary for purposes of 

24 clause (vii))’’ after ‘‘hospice care fur25 nished’’; 


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1 (iv) by inserting ‘‘for such setting’’ 

2 after ‘‘payment rates in effect’’; and 

3 (v) by striking ‘‘under this clause’’ 

4 and inserting ‘‘under this subparagraph’’; 

5 (B) in clause (iv), by striking ‘‘clause 

6 (ii)(VII) or (iii)’’ each place such phrase ap7 pears and inserting ‘‘clause (iii) or (iv) of para8 graph (2)(D) or clause (ii)(VII), (iii), (viii), 

9 (ix), or (x)’’ in each such place; and 

10 (C) by adding at the end the following new 

11 clauses: 

12 ‘‘(vii) Prior to the beginning of a specified fiscal year 

13 (as defined in clause (xi)), the Secretary shall specify per14 centages by which the payment rates for hospice care con15 sisting of services other than routine home care (and, for 

16 specified years beginning on or after October 1, 2033, for 

17 hospice care consisting of routine home care and other 

18 services included in hospice care) in effect for the pre19 ceding fiscal year shall be adjusted in such specified fiscal 

20 year to align such rates with the costs of such care. In 

21 specifying such percentages— 

22 ‘‘(I) the Secretary shall take into account 

23 changes in the average cost of such care and such 

24 other factors as determined appropriate by the Sec25 retary; and 


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1 ‘‘(II) the Secretary may specify different per2 centages for such care based on the setting (as spec3 ified by the Secretary) in which such care is fur4 nished. 

5 ‘‘(viii)(I) With respect to routine home care furnished 

6 during fiscal year 2029, the payment rates for such care 

7 shall be equal to the sum of— 

8 ‘‘(aa) a per diem amount (which may include an 

9 a case mix adjustment to account for variations in 

10 cost among different units of service) reflecting the 

11 cost of routine home care not consisting of direct pa12 tient care for nursing care, physical therapy, occupa13 tional therapy, speech-language pathology services, 

14 medical social services (other than counseling serv15 ices), home health aide services, and physician serv16 ices (other than such services that are considered 

17 administrative services); and 

18 ‘‘(bb) subject to such frequency limits as may 

19 be specified by the Secretary, a per visit amount 

20 (which may vary depending on the type and duration 

21 of the visit, as determined appropriate by the Sec22 retary) reflecting the cost of routine home care con23 sisting of direct patient care excluded from the per 

24 diem amount established under item (aa) (other 

25 than, in the case of such care furnished at a skilled 


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1 nursing facility or nursing facility (as defined in sec2 tion 1919(a)), the component of such rates attrib3 utable to home health aide services). 

4 ‘‘(II) With respect to routine home care furnished 

5 during fiscal year 2030 or a subsequent fiscal year, the 

6 payment rates for such care shall be equal to the sum of— 

7 ‘‘(aa) the per diem amount attributable to hos8 pice care described in subclause (I)(aa) in effect 

9 under this clause for the preceding fiscal year, ad10 justed, in the case of a specified fiscal year, by the 

11 percentages specified pursuant to clause (vii) for 

12 such specified fiscal year, increased by the market 

13 basket percentage increase (as defined in section 

14 1886(b)(3)(B)(iii)) for the fiscal year (reduced in ac15 cordance with clause (iv)); and 

16 ‘‘(bb) the per visit amount for hospice care de17 scribed in subclause (I)(bb) in effect under this 

18 clause for the preceding fiscal year, adjusted, in the 

19 case of a specified fiscal year, by the percentages 

20 specified pursuant to clause (vii) for such specified 

21 fiscal year, increased by such market basked per22 centage increase for the fiscal year (reduced in ac23 cordance with clause (iv)). 

24 ‘‘(III) For purposes of this clause, the term ‘visit’ 

25 means, with respect to an individual receiving hospice care 


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1 from a hospice program, in-person contact with such indi2 vidual by staff of such program (or by others under ar3 rangements with such program), not including any such 

4 contact conducted via telehealth or any other form of tele5 communications technology. 

6 ‘‘(ix)(I) With respect to routine home care consisting 

7 of specified hospice care (as defined in subclause (II)) fur8 nished by, or under arrangements made by, a hospice pro9 gram during the period beginning on October 1, 2026, and 

10 ending on September 30, 2031, in lieu of the rates other11 wise payable under this subparagraph for such routine 

12 home care, the Secretary shall pay to the hospice program 

13 furnishing such care an amount equal to 400 percent of 

14 the amount payable for routine home care furnished in 

15 fiscal year 2026, increased by the market basket percent16 age increase (as defined in section 1886(b)(3)(B)(iii)) for 

17 the fiscal year (reduced in accordance with clause (iv)), 

18 or such other amount determined appropriate by the Sec19 retary (which may vary based on the type of service fur20 nished) for each day during which such specified hospice 

21 care was furnished. 

22 ‘‘(II) For purposes of subclause (I), the term ‘speci23 fied hospice care’ means any of the following items and 

24 services: 


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1 ‘‘(aa) Palliative chemotherapy or radiation fur2 nished under the supervision of an oncologist and in 

3 accordance with accepted clinical guidelines. 

4 ‘‘(bb) Palliative radiation therapy furnished 

5 under the supervision of an oncologist and in accord6 ance with accepted clinical guidelines. 

7 ‘‘(cc) Subject to such frequency limitations as 

8 the Secretary may establish, palliative blood trans9 fusions furnished to an individual diagnosed with a 

10 blood cancer and furnished under the supervision of 

11 an oncologist and in accordance with accepted clin12 ical guidelines. 

13 ‘‘(dd) Palliative dialysis furnished under the su14 pervision of a nephrologist, but only if— 

15 ‘‘(AA) the individual receiving such pallia16 tive dialysis was receiving dialysis treatments 

17 prior to making the election under section 

18 1812(d); and 

19 ‘‘(BB) such individual has received fewer 

20 than 10 sessions of such palliative in-center or 

21 home hemodialysis or the equivalent for peri22 toneal dialysis or other modalities (or, in the 

23 case such individual has received 10 or more 

24 such sessions or the equivalent of such sessions, 


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1 such session or equivalent of such session is 

2 subject to prior authorization). 

3 ‘‘(x) With respect to hospice care consisting of serv4 ices other than routine home care furnished during 2029 

5 or a subsequent fiscal year, the payment rates for such 

6 care shall be equal to the rates in effect for such care for 

7 the preceding fiscal year, adjusted, in the case of a speci8 fied fiscal year, by the percentages specified pursuant to 

9 clause (vii) for such specified fiscal year, increased by the 

10 market basket percentage increase (as defined in section 

11 1886(b)(3)(B)(iii)) for the fiscal year (reduced in accord12 ance with clause (iv)). 

13 ‘‘(xi) For purposes of this subparagraph, the term 

14 ‘specified fiscal year’ means fiscal years 2029, 2034, and 

15 2039. 

16 ‘‘(xii)(I) The Secretary shall, with respect to cost re17 porting periods beginning during an applicable fiscal year 

18 (as defined in subclause (III)), conduct an audit of a rep19 resentative sample of cost reports submitted by hospice 

20 programs. 

21 ‘‘(II) The Secretary shall, for each applicable fiscal 

22 year, convene a technical expert panel for purposes of re23 viewing the methodology and results of the audit con24 ducted under subclause (I) with respect to such applicable 

25 fiscal year. 


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1 ‘‘(III) For purposes of this clause, the term ‘applica2 ble fiscal year’ means fiscal years 2025, 2030, and 2035. 

3 ‘‘(IV) The provisions of chapter 10 of title 5, United 

4 States Code, shall not apply to the panel established under 

5 subclause (II). 

6 ‘‘(V) The Secretary shall provide for the transfer, 

7 from the Federal Hospital Insurance Trust Fund estab8 lished under section 1817 to the Centers for Medicare & 

9 Medicaid Services Program Management Account, of 

10 $10,000,000 for each of fiscal years 2026, 2031, and 

11 2036, to remain available until expended, for purposes of 

12 carrying out this clause.’’. 

13 (2) OUTLIER PAYMENTS.—Section 1814(i) of 

14 the Social Security Act (42 U.S.C. 1395f(i)) is 

15 amended— 

16 (A) by redesignating paragraph (7) as 

17 paragraph (8); and 

18 (B) by inserting after paragraph (6) the 

19 following new paragraph: 

20 ‘‘(7)(A) Subject to subparagraph (B), with respect to 

21 routine home care furnished during a fiscal year beginning 

22 on or after October 1, 2031, the Secretary may, if deter23 mined appropriate by the Secretary, provide an additional 

24 payment for types of such care (such as specified hospice 

25 care (as defined in paragraph (1)(C)(ix))) specified by the 


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1 Secretary to account for unusual variations in the type 

2 or amount of such routine home care. 

3 ‘‘(B)(i) The total amount of additional payments esti4 mated to be made under subparagraph (A) for routine 

5 home care furnished during a fiscal year may not exceed 

6 5 percent of the total amount of payments estimated to 

7 be made for such care furnished during such fiscal year 

8 without application of this paragraph for such fiscal year. 

9 ‘‘(ii) The total amount of additional payments esti10 mated to be made under subparagraph (A) for routine 

11 home care furnished during a fiscal year to an individual 

12 hospice program may not exceed 10 percent of the total 

13 amount of payments estimated to be made for such care 

14 furnished during such fiscal year by such program without 

15 application of this paragraph for such fiscal year. 

16 ‘‘(C) The Secretary shall reduce any per diem rate 

17 applicable under paragraph (1) to routine home care fur18 nished during the first fiscal year for which payments are 

19 made under subparagraph (A) by such proportion as will 

20 result, not taking into account any additional payments 

21 made under subparagraph (A) for such care furnished 

22 during such fiscal year, in an aggregate reduction of 5 

23 percent in payment for such care furnished during such 

24 fiscal year.’’. 

25 (3) PLAN OF CARE REQUIREMENTS.— 


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1 (A) IN GENERAL.—Section 1814(a)(7)(B) 

2 of the Social Security Act (42 U.S.C. 

3 1395f(a)(7)(B)) is amended by inserting ‘‘and, 

4 with respect to the establishment of such plan, 

5 in the case such plan includes the furnishing of 

6 specified hospice care (as defined in subsection 

7 (i)(1)(C)(x)(II)), by a nephrologist (if such care 

8 is care described in item (dd) of such sub9 section) or by an oncologist (if such care is care 

10 described in any of items (aa) through (cc) of 

11 such subsection) who does not have a signifi12 cant ownership interest in, or a significant fi13 nancial relationship with, such hospice program, 

14 as determined by the Secretary, and, with re15 spect to the periodic review of such plan, in the 

16 case such plan includes the furnishing of speci17 fied hospice care (as defined in subsection 

18 (i)(1)(C)(x)(II)), by the nephrologist super19 vising the furnishing of such care (if such care 

20 is described in item (dd) of such subsection) or 

21 by the oncologist supervising the furnishing of 

22 such care (if such care is described in any of 

23 items (aa) through (cc) of such subsection)’’ 

24 after ‘‘of the hospice program’’. 


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1 (B) EFFECTIVE DATE.—The amendment 

2 made by subparagraph (A) shall apply with re3 spect to written plans for providing hospice care 

4 developed or reviewed on or after October 1, 

5 2026. 

6 (4) EXCLUDING HOME HEALTH AIDE SERVICES

7 AND HOMEMAKER FROM THE DEFINITION OF HOS8 PICE CARE IN CERTAIN CIRCUMSTANCES.— 

9 (A) IN GENERAL.—Section 

10 1861(dd)(1)(D)(i) of the Social Security Act 

11 (42 U.S.C. 1395x(dd)(1)(D)(i)) is amended by 

12 inserting ‘‘in the case such individual is not re13 siding in a skilled nursing facility or a nursing 

14 facility,’’ before ‘‘services of a’’. 

15 (B) HOMEMAKER SERVICES.—Section 

16 1861(dd)(1)(D)(ii) of the Social Security Act 

17 (42 U.S.C. 1395x(dd)(1)(D)(ii)) is amended by 

18 inserting ‘‘(but only if such individual is not re19 siding in a skilled nursing facility or a nursing 

20 facility (as defined in section 1919(a)) or, if 

21 such individual is residing in such a skilled 

22 nursing facility or nursing facility, only if such 

23 services are provided on a volunteer basis in ac24 cordance with paragraph (2)(E))’’ after ‘‘home25 maker services’’. 


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1 (C) EFFECTIVE DATE.—The amendments 

2 made by subparagraphs (A) and (B) shall apply 

3 to items and services furnished on or after Oc4 tober 1, 2028. 

5 (5) CONFORMING ADJUSTMENT TO PAYMENT

6 CAP.—Section 1814(i)(2)(B) of the Social Security 

7 Act (42 U.S.C. 1395f(i)(2)(B)) is amended— 

8 (A) in clause (i), by striking ‘‘clause (ii)’’ 

9 and inserting ‘‘clauses (ii) through (iv)’’; 

10 (B) in clause (ii), by inserting ‘‘, subject to 

11 clause (iii),’’ after ‘‘subparagraph (A)’’; 

12 (C) by striking clause (iii) and inserting 

13 the following new clause: 

14 ‘‘(iii) For purposes of subparagraph (A), in the case 

15 of a specified fiscal year (as defined in paragraph 

16 (1)(C)(xi)), the ‘cap amount’ for such year is the cap 

17 amount under this subparagraph for the preceding fiscal 

18 year, adjusted by the estimated percentage change in the 

19 total amount of payment made under this part for hospice 

20 care attributable to application of the amendments made 

21 by section 3(a)(1) of the Hospice CARE Act of 2024 for 

22 such specified fiscal year and then increased by the market 

23 basket percentage increase (as defined in section 

24 1886(b)(3)(B)(iii)) for such specified fiscal year (reduced 

25 in accordance with paragraph (1)(C)(iv)).’’; and 


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1 (D) by adding at the end the following new 

2 clause: 

3 ‘‘(iv) For purposes of subparagraph (A), subject to 

4 clause (iii), for a fiscal year beginning on or after October 

5 1, 2034, the ‘cap amount’ for such year is the cap amount 

6 under this subparagraph for the preceding fiscal year, in7 creased by the market basket percentage increase (as de8 fined in section 1886(b)(3)(B)(iii)) for such fiscal year 

9 (reduced in accordance with paragraph (1)(C)(iv)).’’. 

10 (b) WAGE ADJUSTING CAPS.— 

11 (1) IN GENERAL.—Section 1814(i)(2) of the 

12 Social Security Act (42 U.S.C. 1395f(i)(2)), as 

13 amended by subsection (a), is further amended— 

14 (A) in subparagraph (A)— 

15 (i) by striking ‘‘ ‘cap amount’ for the 

16 year (computed under subparagraph (B))’’ 

17 and inserting ‘‘wage-adjusted cap (as de18 fined in subparagraph (B)) for such pro19 gram and year’’; and 

20 (ii) by striking ‘‘subparagraph (C)’’ 

21 and inserting ‘‘subparagraph (E)’’; 

22 (B) by redesignating subparagraphs (B) 

23 through (D) as subparagraphs (D) through (F), 

24 respectively; 


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1 (C) by inserting after subparagraph (A) 

2 the following new subparagraphs: 

3 ‘‘(B) For purposes of subparagraph (A), the term 

4 ‘wage-adjusted cap’ means, with respect to a hospice pro5 gram and a year, the product of— 

6 ‘‘(i) the wage index ratio (as computed under 

7 subparagraph (C)) for such program and year; and 

8 ‘‘(ii) the cap amount for such year (as com9 puted under subparagraph (D)). 

10 ‘‘(C) For purposes of subparagraph (B), the wage 

11 index ratio for a hospice program and a year is the ratio 

12 of— 

13 ‘‘(i) the aggregate payments to such program 

14 for such year under paragraph (1); to 

15 ‘‘(ii) the aggregate payments to such program 

16 for such year under such paragraph that would have 

17 been made had such payments not been subject to 

18 any wage adjustment.’’; 

19 (D) in subparagraph (D), as so redesig20 nated— 

21 (i) by striking ‘‘subparagraph (A)’’ 

22 each place it appears and inserting ‘‘sub23 paragraph (B)’’ in each such place; and 

24 (ii) by adding at the end the following 

25 new clause: 


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1 ‘‘(v) Notwithstanding the preceding provisions of this 

2 subparagraph, for a fiscal year beginning on or after Octo3 ber 1, 2025, the cap amount otherwise determined under 

4 this subparagraph for such fiscal year shall be decreased 

5 by the same percentage reduction (if any) applied to the 

6 amount of payment made under this part for such fiscal 

7 year under an order issued pursuant to section 251 of the 

8 Balanced Budget and Emergency Deficit Control Act of 

9 1985. Any reduction to the cap amount for a fiscal year 

10 under the preceding sentence shall not be taken into ac11 count for purposes of determining the cap amount for any 

12 succeeding fiscal year.’’; and 

13 (E) by adding at the end the following new 

14 subparagraph: 

15 ‘‘(G) Not later than 1 year after the date of the en16 actment of this subparagraph, and annually thereafter, 

17 the Secretary shall submit to Congress and make public 

18 on the website of the Centers for Medicare & Medicaid 

19 Services a report on the calculation of hospice programs’ 

20 cap amounts under this paragraph. Such report shall con21 tain, with respect to each of the 5 most recent accounting 

22 years for which data is available and each hospice program 

23 receiving payments under this section for hospice care fur24 nished during such year, the following: 


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1 ‘‘(i) Such program’s cap amount determined 

2 under such section. 

3 ‘‘(ii) The percentage of such program’s cap 

4 amount paid to such program for such care. 

5 ‘‘(iii) In the case payments to such program ex6 ceeded such cap, any amount recouped by the Sec7 retary with respect to such program. 

8 ‘‘(iv) The live discharge rate of such program.’’. 

9 (2) IMPLEMENTATION.—Notwithstanding any 

10 other provision of law, the Secretary of Health and 

11 Human Services may implement the amendments 

12 made by paragraph (1) by program instruction or 

13 otherwise. 

14 (3) EFFECTIVE DATE.—The amendments made 

15 by subparagraphs (A) through (C) of paragraph (1) 

16 shall apply with respect to payment for hospice care 

17 furnished during fiscal years beginning on or after 

18 October 1, 2026. 

19 (c) MODIFICATION OF REQUIREMENTS RELATING TO

20 SHORT-TERM INPATIENT CARE.— 

21 (1) IN GENERAL.—Section 1861(dd) of the So22 cial Security Act (42 U.S.C. 1395x(dd)) is amend23 ed— 

24 (A) in paragraph (1)— 


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1 (i) in subparagraph (G), by striking 

2 ‘‘consecutively over longer than five days’’ 

3 and inserting ‘‘for more than 5 days dur4 ing any 90-day election period (or 60-day 

5 election period, as applicable) described in 

6 section 1812(d)(1)’’; and 

7 (ii) in the flush matter following sub8 paragraph (I), by adding at the end the 

9 following new sentence: ‘‘In the case of an 

10 individual who receives short-term inpa11 tient care described in subparagraph (G) 

12 consisting of respite care during an elec13 tion period and the furnishing of such care 

14 is immediately preceded by a hospital stay 

15 (which may include a stay for observation) 

16 during which such individual made an elec17 tion described in section 1812(d)(1) for the 

18 first time during such individual’s lifetime 

19 (or if such care is immediately preceded by 

20 the furnishing of hospice care consisting of 

21 general inpatient care and such general in22 patient care is immediately preceded by 

23 such a hospital stay), the first continuous 

24 15 days of such care shall not be taken 

25 into account for purposes of applying the 


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1 limitation on the number of days during 

2 which such care may be furnished during 

3 an election period under such subpara4 graph, but only if such individual does not 

5 have sufficient caregiver support to be dis6 charged to the individual’s home.’’; and 

7 (B) in paragraph (2)— 

8 (i) in subparagraph (A)(iii)— 

9 (I) by striking ‘‘provides assur10 ances satisfactory to the Secretary 

11 that’’ and inserting ‘‘ensures that the 

12 sum of’’; and 

13 (II) by striking ‘‘20 percent’’ and 

14 inserting ‘‘10 percent (or a higher 

15 percent (not to exceed 20 percent) 

16 specified by the Secretary if deter17 mined necessary by the Secretary to 

18 ensure sufficient access to such inpa19 tient care)’’; and 

20 (ii) by adding at the end the following 

21 flush sentence: 

22 ‘‘For purposes of subparagraph (A)(iii), the Sec23 retary shall ensure that the limitation described in 

24 such subparagraph is applied, to the extent prac25 ticable, on a real-time basis.’’. 


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1 (2) ALLOWING RESPITE CARE TO BE FUR2 NISHED IN RESIDENTIAL CARE FACILITIES.—Not 

3 later than October 1, 2026, the Secretary of Health 

4 and Human Services (in this paragraph referred to 

5 as the ‘‘Secretary’’) shall revise section 418.108 of 

6 title 42, Code of Federal Regulations (or a successor 

7 regulation) to allow short-term inpatient care con8 sisting of respite care (as described in section 

9 1861(dd)(1)(G) of the Social Security Act (42 

10 U.S.C. 1395x(dd)(1)(G))) to be furnished in residen11 tial care facilities (as defined by the Secretary) that 

12 only provide care to individuals receiving hospice 

13 care (as specified by the Secretary) and that meet 

14 such standards relating to health and safety as the 

15 Secretary may specify (which may be based on State 

16 licensure requirements applicable to such facilities). 

17 (3) EFFECTIVE DATE.—The amendments made 

18 by paragraph (1) shall apply to hospice care fur19 nished on or after October 1, 2026. 

20 (d) HOSPITAL DISCHARGE PLANNING REQUIRE21 MENTS.— 

22 (1) IN GENERAL.—Section 1861(ee)(2)(D) of 

23 the Social Security Act (42 U.S.C. 1395x(ee)(2)(D)) 

24 is amended— 


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1 (A) by inserting ‘‘, home health services,’’ 

2 after ‘‘including hospice care’’; 

3 (B) by striking ‘‘including the availability 

4 of home health services through individuals and 

5 entities’’ and inserting the following: ‘‘includ6 ing— 

7 ‘‘(i) in the case of individuals who are like8 ly to need home health services, the availability 

9 of such services through home health agencies’’; 

10 (C) by striking ‘‘listed by the hospital as 

11 available and, in the case of individuals who are 

12 likely to need post-hospital extended care serv13 ices,’’ and inserting the following: ‘‘listed by the 

14 hospital as available; 

15 ‘‘(ii) in the case of individuals who are 

16 likely to need post-hospital extended care serv17 ices,’’; 

18 (D) by striking the period and inserting ‘‘; 

19 and’’; and 

20 (E) by adding at the end the following new 

21 clause: 

22 ‘‘(iii) in the case of individuals who 

23 are likely eligible for hospice care, the 

24 availability of such care (including the 

25 availability of respite care described in subVerDate Sep 11 2014 16:14 Oct 08, 2024 Jkt 059200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H9803.IH H9803

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1 section (dd)(1)(G)) through hospice pro2 grams that participate in the program 

3 under this title and that serve the area in 

4 which the patient resides.’’. 

5 (2) EFFECTIVE DATE.—The amendments made 

6 by paragraph (1) shall apply with respect to dis7 charges occurring on or after October 1, 2026. 

8 (e) PAYMENT FOR RESPITE CARE FURNISHED IN

9 THE HOME.— 

10 (1) IN GENERAL.—Section 1861(dd)(1) of the 

11 Social Security Act (42 U.S.C. 1395x(dd)(1)) is 

12 amended— 

13 (A) in subparagraph (H), by striking 

14 ‘‘and’’ at the end; 

15 (B) by redesignating subparagraph (I) as 

16 subparagraph (J); and 

17 (C) by inserting after subparagraph (H) 

18 the following new subparagraph: 

19 ‘‘(I) short-term home respite care furnished to 

20 an individual on or after October 1, 2028, that— 

21 ‘‘(i) is furnished in the place of residence 

22 used as such individual’s home (other than a 

23 skilled nursing facility, a nursing facility (as de24 fined in section 1919(a)), an assisted living faVerDate Sep 11 2014 16:14 Oct 08, 2024 Jkt 059200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H9803.IH H9803

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1 cility (as defined by the Secretary), or another 

2 facility specified by the Secretary); 

3 ‘‘(ii) is furnished on an intermittent, non4 routine, and occasional basis; 

5 ‘‘(iii) is furnished for not more than 120 

6 hours during any 90-day period described in 

7 section 1812(d)(1) (or, in the case such indi8 vidual is 60-day period described in such sec9 tion, for not more than 80 hours during such 

10 period); and 

11 ‘‘(iv) meets such other requirements as the 

12 Secretary may specify.’’. 

13 (2) PAYMENT RATES.—Section 1814(i)(1)(C) of 

14 the Social Security Act (42 U.S.C. 1395f(i)(1)(C)), 

15 as amended by subsection (a), is further amended— 

16 (A) in clause (iii), by striking ‘‘through 

17 (x)’’ and inserting ‘‘through (x) and clause 

18 (xiii)’’; and 

19 (B) by adding at the end the following new 

20 clause: 

21 ‘‘(xiii) With respect to short-term home respite care 

22 furnished to an individual during fiscal year 2029 or a 

23 subsequent fiscal year, the rates payable for such care 

24 shall be equal to the sum of the per diem rate established 

25 for routine home care for such fiscal year and an hourly 


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1 rate established by the Secretary, except that in no case 

2 may such rate payable for such short-term home respite 

3 care furnished in a 24-hour period exceed the rate of pay4 ment for general inpatient care furnished during such a 

5 period.’’. 

Æ 


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