A bipartisan bill introduced in the U.S. Senate could reshape both Medicare home health payment and program integrity efforts if enacted.
The Medicare Home Health Payment Integrity and Protection Act of 2026 (S. 5250) would direct CMS to reset Medicare home health payment rates by accounting for the impact of fraudulent billing and changes in home health utilization since the COVID-19 pandemic. The legislation also proposes targeted program integrity measures aimed at identifying high-risk providers before they enter Medicare, rather than relying on broad enforcement strategies that affect all agencies.
Among the proposals are enhanced screening requirements for providers identified as presenting an elevated fraud risk, more frequent surveys for certain home health agencies, additional funding for fraud investigations, and changes intended to improve payment accuracy.
LeadingAge and other national provider organizations support the legislation, noting that current payment methodologies have been influenced by years of behavioral adjustment reductions and data that may have been distorted by fraudulent providers. They also praised the bill's focus on targeted oversight instead of imposing additional administrative burdens on compliant agencies.
Why it matters
This is the first federal legislation to address both Medicare home health payment methodology and program integrity in a single proposal. While the bill has a long legislative process ahead, it reflects growing bipartisan recognition that fraud prevention and adequate reimbursement must work together to preserve beneficiary access to home health services.
What to do