Medicare Home Health Payment Integrity and Protection Act of 2026

S. 5250 would tighten Medicare oversight of home health agencies to reduce fraud. It requires enhanced enrollment screening—including fingerprinting of administrators and proof of liability insurance—for agencies deemed at "extreme risk of fraud" based on factors like a sharp local surge in the number of agencies. It also mandates more frequent surveys for newly enrolled, recently sold, or reactivated agencies, and for agencies that skip quality-data reporting or show unusual admission patterns. Separately, it resets the standard Medicare home health payment rate to $2,382.87 for 2027, blocks certain future payment-rate adjustments tied to past behavioral assumptions, and requires excluding "suspect claims" from fraud-linked providers when calculating payment benchmarks and value-based program adjustments.

The bill affects Medicare-certified home health agencies (subject to new screening, surveys, and payment rules), Medicare beneficiaries who receive home health care, and federal agencies (CMS, DOJ, HHS Inspector General, state survey agencies) that would receive new funding—$300 million for CMS program integrity work, $150 million for DOJ/OIG enforcement, and $100 million for state survey agencies, all for fiscal years 2027–2031.

The bill was introduced by Sen. Susan Collins (R-ME) on August 5, 2026, and referred to the Senate Finance Committee. It would need committee action, floor votes in both chambers, and the President's signature to become law; agencies would then implement changes to enrollment, payment, and screening rules through standard notice-and-comment rulemaking.

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