H.R. 7966 — Hospice CARE Act of 2026

This section imposes a nationwide 5-year moratorium, beginning on the date of enactment, on the enrollment of new Medicare hospice programs, with exemptions for programs serving areas with insufficient access to hospice care (considering local availability, unmet needs such as wait times or substandard care, and the program's gap-filling plan) and authority for the Secretary to lift the moratorium in specified states or regions. It further requires (1) prepayment medical review of routine home care furnished by applicable hospice programs (i.e., those with aberrant claim histories such as outlier live discharge rates) to covered individuals (i.e., those in their second 90-day or subsequent hospice period), terminable if denial rates are low but revocable by the Secretary; (2) revalidation of all enrolled hospice programs' information within 6 months of enactment; (3) public website publication of ownership and control information within 1 year; and (4) a report to Congress by January 1, 2028, on hospice ownership trends (including private equity), cost report analyses by ownership type, and recommendations to improve ownership reporting and competition. This section also authorizes the Secretary to exempt providers or suppliers from any temporary enrollment moratorium if appropriate.

This section revises Medicare payment rates for hospice care furnished under Part A of the Medicare program (i.e., coverage for terminally ill beneficiaries electing the hospice benefit). Specifically, it (1) requires the Secretary, prior to specified fiscal years, to adjust payment rates for hospice care other than routine home care (and, for years on or after October 1, 2034, routine home care and other services) to align with costs, using specified percentages that account for average cost changes and other factors and that may vary by setting; (2) for routine home care (the most common level of hospice service), establishes FY2030 rates as the sum of a per diem amount for non-direct patient care costs (e.g., nursing, therapies, medical social services excluding counseling, home health aides, non-administrative physician services) and a per-visit add-on (subject to frequency limits, varying by type/duration, excluding telehealth) for direct patient care, with rates for FY2031 and later updated annually by the market basket percentage increase (reduced for productivity) and any applicable cost-alignment adjustment under the new clause (vii); and (3) for specified hospice care (i.e., palliative chemotherapy or radiation under oncologist supervision per clinical guidelines; palliative blood transfusions for blood cancer patients under oncologist supervision and frequency limits; or palliative dialysis under nephrologist supervision for patients previously on dialysis) furnished from October 1, 2027, through September 30, 2032, pays 400% of the FY2027 routine home care rate (updated annually by the market basket percentage increase, reduced for productivity) or such other daily amount as the Secretary determines appropriate.