S. 4118 — Hospice CARE Act of 2026

This section imposes a nationwide moratorium on the enrollment of new Medicare hospice programs for the 5-year period beginning on the date of enactment, with exemptions for programs serving areas with insufficient access (considering local availability, unmet needs such as wait times or substandard care, and the program's gap-closing plan) and authority for the Secretary to lift the moratorium in specified states or regions. (Thus, no new hospice providers may bill Medicare during this period absent an exemption.) It further (1) requires 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 hospice period or later), terminable if the program demonstrates a low denial rate and revocable if appropriate; (2) directs revalidation of enrollment information for all enrolled hospice programs within 6 months of enactment, public posting of ownership and control data within 1 year, and a report to Congress by January 1, 2028, analyzing ownership trends (including private equity), cost reports by ownership type, data validation, and integrity/competition recommendations; and (3) authorizes exemptions from any enrollment moratorium if determined appropriate by the Secretary.

This section revises Medicare payment rates for hospice care (i.e., Part A benefit providing comprehensive palliative and supportive services to terminally ill beneficiaries who elect hospice) as follows: (1) requires the Secretary, prior to specified fiscal years, to adjust payment rates for hospice care other than routine home care (and, for years beginning October 1, 2034, routine home care and other services) to align with costs, accounting for average cost changes and other factors, with possible variations by setting specified by the Secretary; (2) for routine home care in FY2030, establishes payment rates equal to a per diem amount (potentially case-mix adjusted) for non-direct patient care costs (excluding specified nursing, therapy, social services, aide, and physician services) plus a per-visit amount (varying by type and duration, subject to frequency limits) for direct patient care costs (excluding home health aide at SNFs/NFs), where a "visit" is defined as in-person staff contact (excluding telehealth); for FY2031 and later, updates prior-year amounts with cost-alignment percentages (if applicable) and the market basket percentage increase (reduced per existing productivity adjustment); (3) for specified hospice care (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 October 1, 2027, through September 30, 2032, pays 400% of the FY2027 routine home care rate (updated by market basket percentage increase, reduced per productivity adjustment) or another Secretary-determined amount (potentially varying by service type); and (4) makes conforming updates to existing rate references and exceptions.