The Hospice Care Accountability, Reform, and Enforcement Act of 2026, or the Hospice CARE Act of 2026, seeks to strengthen the integrity and oversight of hospice care provided under the Medicare program. A central provision is a five-year nationwide temporary moratorium on the enrollment of new hospice programs , beginning upon enactment. However, the Secretary may grant exemptions for programs serving areas with insufficient access to care, considering factors like geographic need and existing service availability. During this moratorium, the Secretary is mandated to apply prepayment medical review to routine home care furnished by hospice programs identified with aberrant billing patterns, particularly those with outlier live discharge rates. All existing hospice programs must undergo a revalidation of their enrollment information within six months, with ownership and control details publicly published, and a report on hospice ownership trends and private equity due by January 2028. The bill extends the oversight period for newly enrolled hospice programs to two years and subjects exempted programs to mandatory enhanced oversight. It also increases the survey frequency to every 18 months for certain hospice programs, including those newly enrolled or exhibiting specific billing anomalies. Beginning in fiscal year 2028, hospices failing to meet quality data reporting requirements will face a prohibition on payment , rather than just a reduction in their market basket update. To ensure independence, certifications of terminal illness made on or after October 1, 2027, must be by an independent physician, physician assistant, or nurse practitioner if the attending physician has a significant financial tie to the hospice. The bill also allows nurse practitioners and physician assistants to certify terminal illness and permits the use of hospice program medical records as supporting material during medical reviews. Additionally, it requires face-to-face encounters before each recertification of terminal illness, with specific telehealth allowances. Significant payment reforms are introduced, including a new routine home care payment model starting in fiscal year 2030, which separates per diem and per visit components. A special payment mechanism is established for "specified hospice care," such as palliative chemotherapy and dialysis, at 400% of the routine home care rate for a limited period. The legislation also mandates regular audits of hospice cost reports and establishes a technical expert panel to review methodologies and results. The bill modifies requirements for short-term inpatient care, limiting respite care to five days per election period, with an exception for initial elections following a hospital stay if caregiver support is insufficient. It also adjusts the percentage of inpatient care days required for hospices and allows respite care to be furnished in certain residential care facilities. Hospitals will be required to include hospice care availability in discharge planning. Finally, a new benefit for short-term home respite care is introduced, with specific hour limits and payment rates, effective October 1, 2029.