This bill aims to significantly enhance oversight of hospice programs and home health agencies under the Medicare program, primarily to combat fraud and ensure the delivery of high-quality care. It introduces a multi-faceted approach, including more rigorous enrollment processes, increased scrutiny through surveys, and stricter penalties for non-compliance. A key provision mandates increased survey frequencies for certain hospice programs and home health agencies, such as newly enrolled providers, those with a change of ownership, or those reactivating billing privileges, which will face surveys every 12 months for a 36-month period. Additionally, providers failing to submit required quality data or exhibiting characteristics indicative of fraudulent behavior, like aberrant live discharge or admission rates, will be surveyed more frequently, typically within 18 months of their last assessment, with a limit of one such survey per 18-month period. The legislation also strengthens enrollment screening for both types of providers, particularly for those deemed at "extreme risk of fraud." For these high-risk entities, the Secretary will require fingerprinting of administrators and medical directors, along with evidence of comprehensive liability insurance. Furthermore, the bill significantly increases the payment reduction for hospice programs and home health agencies that fail to submit required quality data, raising it from 4% (or 2% for HHAs) to 15% for fiscal year 2029 and beyond, though it allows for a 30-day extension for good faith efforts. To ensure robust oversight, the bill imposes additional requirements on accreditation organizations , mandating that their survey procedures meet or exceed state standards and that their surveyors complete CMS basic training. It also requires CMS to assess the performance of these bodies and take corrective action if deficiencies are found. The legislation extends the hospice cap amount adjustment under Medicare from 2035 to 2036 and mandates that the Secretary provide written notice to individuals within 15 days of their hospice election, detailing their rights and the chosen hospice's information. Finally, the bill requires the Secretary of Health and Human Services to submit annual reports to Congress for five years, detailing the outcomes of program integrity activities related to hospice programs and home health agencies, including trends, findings, and enforcement actions. To support these enhanced oversight measures, the bill allocates $100 million from the Federal Hospital Insurance Trust Fund for fiscal year 2026 to fund the increased survey frequencies.