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 estab-
lished 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 avail-
able 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 sec-
tion 1812(d)(1), not later than 15 days after such indi-
vidual makes such election, a notice that— 
‘‘(1) specifies— 
‘‘(A) the effective date of such election; 
‘‘(B) the hospice program that will be fur-
nishing hospice care to such individual; 
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‘‘(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 re-
spect 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 indi-
vidual 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 Inspec-
tor 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 
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‘‘(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 estab-
lished 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 avail-
able 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 So-
cial 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 CON-
TRACTOR 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 hos-
pice care furnished under part A of title XVIII of 
the Social Security Act (42 U.S.C. 1395c et seq.) to, 
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with respect to such reviews performed on or after 
January 1, 2027, utilize only individuals who have 
received specialized instruction on the philosophy be-
hind hospice care and medical prognostication (as 
specified by the Secretary) in performing such re-
views. In so specifying such instruction and in up-
dating such instruction, the Secretary shall consult 
with hospice programs as to the content of such in-
struction. 
(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 So-
cial Security Act (42 U.S.C. 1395c et seq.). Such re-
port shall include— 
(A) with respect to the medical review of 
hospice care performed during the period begin-
ning on January 1, 2019, and ending on De-
cember 31, 2024, the accuracy rates of such re-
views when performed by— 
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(i) medicare administrative contrac-
tors; 
(ii) recovery audit contractors; 
(iii) supplemental medical review con-
tractors; and 
(iv) uniform program integrity con-
tractors; 
(B) the total number of hospice claims 
submitted during the period described in sub-
paragraph (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 con-
tractor conducing review of such claims and by 
each level of appeal; 
(D) a list of medical review projects relat-
ing to hospice care undertaken by contractors 
described in subparagraph (A); and 
(E) actions the Secretary will take to re-
duce 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 
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claims for hospice care that are overturned on 
appeal. 
(n) REQUIRING FACE-TO-FACE ENCOUNTERS BE-
FORE RECERTIFICATIONS OF TERMINAL ILLNESS.—Sec-
tion 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 sub-
paragraph: 
‘‘(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 sub-
paragraph, 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 indi-
vidual is physically present with such individual 
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‘‘(H) ensures that the medical director de-
scribed 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 de-
scribed 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 med-
ical director; 
‘‘(B) the geographic areas served by such pro-
grams; and 
‘‘(C) any other information determined appro-
priate by the Secretary.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply beginning January 1, 
2028. 
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(p) REPORT ON HOSPICE ACCREDITING ORGANIZA-
TIONS.—Not later than 2 years after the date of the enact-
ment 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 re-
ferred to as the ‘‘Secretary’’) oversight of hospice program 
accrediting organizations. Such report shall include the 
following: 
(1) An analysis of deficiencies relating to qual-
ity 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 sur-
veys were of hospice programs certified by State or 
local survey agencies and such surveys were con-
ducted by such agencies. 
(2) A list of hospice programs determined by 
the Secretary not to be in compliance with all re-
quirements applicable to such programs, along with 
a list of the accrediting organization of each such 
program. 
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(3) A list of hospice programs that have been 
deactivated, terminated, or investigated due to con-
cerns 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 ac-
crediting organizations. 
SEC. 3. PAYMENT REFORMS FOR HOSPICE CARE FUR-
NISHED 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 fur-
nished’’; 
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(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 ap-
pears and inserting ‘‘clause (iii) or (iv) of para-
graph (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 per-
centages by which the payment rates for hospice care con-
sisting 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 pre-
ceding 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 Sec-
retary; and 
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‘‘(II) the Secretary may specify different per-
centages for such care based on the setting (as spec-
ified by the Secretary) in which such care is fur-
nished. 
‘‘(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 pa-
tient care for nursing care, physical therapy, occupa-
tional therapy, speech-language pathology services, 
medical social services (other than counseling serv-
ices), home health aide services, and physician serv-
ices (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 Sec-
retary) reflecting the cost of routine home care con-
sisting 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 
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nursing facility or nursing facility (as defined in sec-
tion 1919(a)), the component of such rates attrib-
utable 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 hos-
pice care described in subclause (I)(aa) in effect 
under this clause for the preceding fiscal year, ad-
justed, 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 ac-
cordance with clause (iv)); and 
‘‘(bb) the per visit amount for hospice care de-
scribed 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 per-
centage increase for the fiscal year (reduced in ac-
cordance with clause (iv)). 
‘‘(III) For purposes of this clause, the term ‘visit’ 
means, with respect to an individual receiving hospice care 
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from a hospice program, in-person contact with such indi-
vidual by staff of such program (or by others under ar-
rangements with such program), not including any such 
contact conducted via telehealth or any other form of tele-
communications technology. 
‘‘(ix)(I) With respect to routine home care consisting 
of specified hospice care (as defined in subclause (II)) fur-
nished by, or under arrangements made by, a hospice pro-
gram during the period beginning on October 1, 2026, and 
ending on September 30, 2031, in lieu of the rates other-
wise 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 percent-
age 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 Sec-
retary (which may vary based on the type of service fur-
nished) for each day during which such specified hospice 
care was furnished. 
‘‘(II) For purposes of subclause (I), the term ‘speci-
fied hospice care’ means any of the following items and 
services: 
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‘‘(aa) Palliative chemotherapy or radiation fur-
nished 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 accord-
ance with accepted clinical guidelines. 
‘‘(cc) Subject to such frequency limitations as 
the Secretary may establish, palliative blood trans-
fusions furnished to an individual diagnosed with a 
blood cancer and furnished under the supervision of 
an oncologist and in accordance with accepted clin-
ical guidelines. 
‘‘(dd) Palliative dialysis furnished under the su-
pervision of a nephrologist, but only if— 
‘‘(AA) the individual receiving such pallia-
tive 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 peri-
toneal dialysis or other modalities (or, in the 
case such individual has received 10 or more 
such sessions or the equivalent of such sessions, 
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such session or equivalent of such session is 
subject to prior authorization). 
‘‘(x) With respect to hospice care consisting of serv-
ices 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 speci-
fied 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 accord-
ance 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 re-
porting periods beginning during an applicable fiscal year 
(as defined in subclause (III)), conduct an audit of a rep-
resentative 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 re-
viewing the methodology and results of the audit con-
ducted under subclause (I) with respect to such applicable 
fiscal year. 
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‘‘(III) For purposes of this clause, the term ‘applica-
ble 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 estab-
lished 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 deter-
mined 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 
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Secretary to account for unusual variations in the type 
or amount of such routine home care. 
‘‘(B)(i) The total amount of additional payments esti-
mated 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 esti-
mated 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 fur-
nished 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.— 
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(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 sub-
section) 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 signifi-
cant ownership interest in, or a significant fi-
nancial relationship with, such hospice program, 
as determined by the Secretary, and, with re-
spect to the periodic review of such plan, in the 
case such plan includes the furnishing of speci-
fied hospice care (as defined in subsection 
(i)(1)(C)(x)(II)), by the nephrologist super-
vising 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’’. 
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(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall apply with re-
spect 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 HOS-
PICE 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 re-
siding 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 re-
siding 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 ac-
cordance with paragraph (2)(E))’’ after ‘‘home-
maker services’’. 
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(C) EFFECTIVE DATE.—The amendments 
made by subparagraphs (A) and (B) shall apply 
to items and services furnished on or after Oc-
tober 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 
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(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, in-
creased by the market basket percentage increase (as de-
fined 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 de-
fined in subparagraph (B)) for such pro-
gram 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; 
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(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 pro-
gram 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 com-
puted 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 redesig-
nated— 
(i) by striking ‘‘subparagraph (A)’’ 
each place it appears and inserting ‘‘sub-
paragraph (B)’’ in each such place; and 
(ii) by adding at the end the following 
new clause: 
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‘‘(v) Notwithstanding the preceding provisions of this 
subparagraph, for a fiscal year beginning on or after Octo-
ber 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 ac-
count 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 en-
actment 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 con-
tain, 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 fur-
nished during such year, the following: 
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‘‘(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 ex-
ceeded such cap, any amount recouped by the Sec-
retary 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 So-
cial Security Act (42 U.S.C. 1395x(dd)) is amend-
ed— 
(A) in paragraph (1)— 
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(i) in subparagraph (G), by striking 
‘‘consecutively over longer than five days’’ 
and inserting ‘‘for more than 5 days dur-
ing 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 sub-
paragraph (I), by adding at the end the 
following new sentence: ‘‘In the case of an 
individual who receives short-term inpa-
tient care described in subparagraph (G) 
consisting of respite care during an elec-
tion 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 elec-
tion 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 in-
patient 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 
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limitation on the number of days during 
which such care may be furnished during 
an election period under such subpara-
graph, but only if such individual does not 
have sufficient caregiver support to be dis-
charged to the individual’s home.’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (A)(iii)— 
(I) by striking ‘‘provides assur-
ances 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 deter-
mined necessary by the Secretary to 
ensure sufficient access to such inpa-
tient care)’’; and 
(ii) by adding at the end the following 
flush sentence: 
‘‘For purposes of subparagraph (A)(iii), the Sec-
retary shall ensure that the limitation described in 
such subparagraph is applied, to the extent prac-
ticable, on a real-time basis.’’. 
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(2) ALLOWING
RESPITE
CARE
TO
BE
FUR-
NISHED
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 con-
sisting 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 residen-
tial 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 fur-
nished on or after October 1, 2026. 
(d) HOSPITAL
DISCHARGE
PLANNING
REQUIRE-
MENTS.— 
(1) IN
GENERAL.—Section 1861(ee)(2)(D) of 
the Social Security Act (42 U.S.C. 1395x(ee)(2)(D)) 
is amended— 
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(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: ‘‘includ-
ing— 
‘‘(i) in the case of individuals who are like-
ly 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 serv-
ices,’’ 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 serv-
ices,’’; 
(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 sub-
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section (dd)(1)(G)) through hospice pro-
grams 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 dis-
charges 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 de-
fined in section 1919(a)), an assisted living fa-
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cility (as defined by the Secretary), or another 
facility specified by the Secretary); 
‘‘(ii) is furnished on an intermittent, non-
routine, 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 indi-
vidual is 60-day period described in such sec-
tion, 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 
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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 pay-
ment for general inpatient care furnished during such a 
period.’’. 
Æ 
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