This legislation, known as the Hospice CARE Act of 2026, seeks to strengthen the integrity and accountability of hospice care provided under the Medicare program. It mandates a nationwide temporary moratorium on the enrollment of new hospice programs for five years, with exemptions possible for areas demonstrating insufficient access to care. During this moratorium, the Secretary of Health and Human Services must revalidate the enrollment information of all existing hospice programs and publish ownership details publicly. The bill introduces enhanced oversight measures, including mandatory prepayment medical review for hospice programs with aberrant billing patterns, particularly for routine home care after the initial 90-day period. It also increases the frequency of surveys for new or outlier hospice programs and prohibits payments to those failing to meet quality data reporting requirements starting in fiscal year 2028. Furthermore, the bill allows physician assistants and nurse practitioners to certify terminal illnesses and permits the use of hospice medical records in medical reviews. To address potential conflicts of interest and improve transparency, the legislation requires that physicians, physician assistants, or nurse practitioners certifying terminal illness not be employed by or have a significant financial interest in the hospice program. It also extends the look-back period for changes in majority ownership to 60 months and mandates advanced notice of ownership or control changes, backed by significant civil monetary penalties for non-compliance. Patients will receive an explanation of benefits upon hospice election, detailing services and providing fraud reporting contacts. The bill also implements significant payment reforms, including adjusting payment rates for non-routine home care to align with costs and introducing a new payment model for routine home care that separates per diem and per visit components. It establishes temporary enhanced payments for specific palliative services like chemotherapy, radiation, blood transfusions, and dialysis. Additionally, it allows for outlier payments for routine home care starting in fiscal year 2033 and modifies the hospice cap amount calculation to include wage adjustments. Further provisions include changes to short-term inpatient care, limiting it to five days per election period with an exception for initial respite care following a hospital stay if caregiver support is insufficient. The inpatient cap is reduced from 20% to 10%, with real-time application. The Secretary is directed to allow respite care in certain residential care facilities and to amend hospital discharge planning requirements to include information on hospice care availability, including respite care. Finally, the bill introduces payment for short-term home respite care furnished in the home, with specific hourly and daily rate limitations.