Medicare Home Health Payment Integrity and Protection Act of 2026

This bill aims to combat fraud in Medicare home health services through enhanced screening, increased oversight, and payment reforms. It mandates enhanced enrollment screening for agencies at "extreme risk of fraud," requiring fingerprinting of administrators and comprehensive liability insurance, with risk determined by factors like location in high-growth areas. Oversight is strengthened by requiring increased survey frequency for newly enrolled, changed-ownership, or reactivated agencies, with surveys every 12 months for 36 months, and for agencies failing to submit quality data or displaying aberrant behavior, with surveys every 18 months. Accreditation organizations must also meet state survey standards and ensure their surveyors complete relevant CMS training, with CMS assessing their performance and imposing remedies for deficiencies. The legislation resets the standard prospective payment amount for home health services starting in 2027 and suspends certain payment adjustments related to behavioral changes from the Patient-Driven Groupings Model. Crucially, it requires the Secretary to exclude or adjust for "suspect claims" —those with unreliable data or from providers potentially engaged in fraud—when calculating benchmarks and value-based program adjustments to protect legitimate providers. To implement these changes, the bill appropriates significant funding: $300 million to CMS for program integrity, $150 million to the Department of Justice and Office of Inspector General for fraud investigations, and $100 million to State survey agencies for accelerated surveys and operational verification. It also mandates a report to Congress on the impact of suspect claims and recommendations for data integrity safeguards, while clarifying that existing fraud authorities remain unaffected.