Sponsor
Susan Margaret Collins
Senator · R-ME
Senator · R-ME
Official title: Amend title XVIII of the Social Security Act to decrease fraud related to home health agencies in Medicare, and for other purposes.
Introduced August 5, 2026 by Susan Margaret Collins · Last progress August 5, 2026
The bill strengthens oversight, data integrity, and predictability of some payment rules to reduce fraud and improve fairness in home health care, but does so at the cost of higher compliance burdens, potential mispricing and access risks for smaller/rural providers, and modest new federal spending.
Medicare beneficiaries and taxpayers: stronger enforcement (increased funding for fraud investigations and state surveys, improved data integrity, more frequent/high-risk surveys and enhanced screening) should reduce improper payments and remove bad actors from the program.
Medicare beneficiaries and patients: tighter accreditation standards and better-trained surveyors/survey processes should improve the quality and safety of home health care.
Medicare beneficiaries and home health agencies: fixing the 2027 national standard PPA and clarifying payment rules gives predictable 2027 payment rates and clearer budgeting/administrative rules for agencies.
Home health agencies — especially small and rural providers — and their patients: increased compliance requirements (more frequent surveys, fingerprinting, proof of insurance, audits, enrollment checks) will raise administrative costs and could reduce provider availability and local access to care.
Medicare beneficiaries, providers, and taxpayers: fixing the 2027 PPA and blocking PDGM behavioral‑change offsets may misprice payments (under- or over-pay agencies), risking provider financial strain and potential reductions in services or higher Medicare/taxpayer costs.
Home health providers and patients: granting the Secretary discretion to designate 'suspect' claims risks excluding legitimate claims or providers, which could unfairly reduce payments and harm patient access.
Based on analysis of 3 sections of legislative text.
Increases screening and annual surveys for high‑risk home health agencies, resets the 2027+ Medicare 30‑day home health payment, and requires excluding suspect claims from rate and quality calculations, with new funding for enforcement and surveys.
Requires stronger enrollment screening and more frequent surveys for high-risk home health agencies, resets the Medicare standard 30‑day home health payment amount for 2027 and after, and directs exclusion/adjustment of suspect claims from payment and quality calculations. It funds CMS, DOJ, and HHS OIG activities to support fraud investigations, accelerated surveys, and state survey work, and requires rulemaking and a report on data integrity and suspect claims.