S 5250: Medicare Home Health Payment Integrity and Protection Act of 2026

S 5250 in plain English: This bill would set a specific Medicare home health payment rate of $2,382.87 for 2027 and adjust it in subsequent years, while also directing new federal funding to combat fraud and improve oversight in the Medicare home health program.

Stated purpose

This bill aims to reduce fraud in Medicare's home health agency program by strengthening enrollment screening, increasing oversight and inspections, and resetting payment rates to better reflect accurate data.

Key points

• Sets the Medicare home health standard prospective payment amount at $2,382.87 for 2027
• Provides $300 million for fiscal years 2027–2031 to implement the bill's changes
• Provides $150 million for fiscal years 2027–2031 to investigate organized home health fraud
• Provides $100 million for fiscal years 2027–2031 to support State survey agency activities

Arguments supporters make

• Home health fraud costs Medicare billions of dollars and hurts honest patients and providers, so stronger screening and more inspections are needed to protect the program.
• Requiring fingerprinting, liability insurance, and more frequent surveys for newly enrolled or high-risk agencies targets the specific entry points fraudsters most often exploit.
• Resetting payment rates using cleaner data ensures Medicare pays accurate amounts rather than rates inflated by fraudulent billing patterns.

Arguments opponents make

• Stricter enrollment rules and more inspections could burden legitimate home health agencies, especially small or rural providers, making it harder for patients to access care.
• Resetting payment rates could cut reimbursements for honest agencies that deliver quality care, threatening their financial stability and their patients' access to services.
• Flagging agencies based on rapid growth in a county may unfairly target areas with a genuine rise in elderly or homebound residents who need more home health services.

Tradeoffs

Tighter fraud controls and payment resets may save Medicare money and deter bad actors, but they also add compliance costs and potential payment cuts that could affect agencies serving patients who depend on home health care.

Current status in Congress: In committee.

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