A bipartisan bill introduced in the U.S. Senate could influence both Medicare home health payment and program integrity efforts if enacted.
The Medicare Home Health Payment Integrity and Protection Act (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 designed to identify high risk providers before they enter Medicare, rather than relying solely on broad enforcement strategies that can 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, stronger oversight of accrediting organizations, 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legislation, noting that current payment methodologies have been influenced by years of fraudulent billing activity and outdated utilization data. They say the proposal would help protect beneficiaries while creating a fairer reimbursement system for legitimate home health providers.
Why it matters
This legislation recognizes two issues providers have been raising for years: fraud should be addressed through targeted enforcement, and legitimate home health agencies should not continue to bear the financial consequences of fraudulent billing that has distorted Medicare payment rates. While the bill is still in the early stages of the legislative process, it signals continued congressional interest in strengthening both program integrity and payment stability for home health.
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