H.R. 8883 — Protecting Seniors and Stopping Fraudsters Act

This section requires the Secretary to revalidate the enrollment of each existing hospice program in a State subject to enhanced oversight for new programs, within 1 year after the date the oversight requirement took effect (or the date of enactment if already in effect), unless the program was revalidated in the prior 18 months. It also corrects a punctuation error in section 1866(j)(3)(A).

This section increases hospice program survey frequency requirements under Medicare. Beginning 1 year after enactment, programs that are newly enrolled, undergo a change of ownership, or reactivate billing privileges must receive a standard survey at least once every 12 months for the following 36 months. Programs that fail to submit required quality data or display aberrant live discharge rates or other specified indicators of potential fraud must receive a survey no later than 18 months after the most recent survey, with no more than one such survey permitted in any 18-month period. This section also increases the annual payment reduction for hospice programs that fail to submit quality data to 15 percentage points (from 4 percentage points) beginning in FY2029, while extending the existing 4-percentage-point reduction through FY2028, and directs the Secretary to establish a process granting up to 30 additional days for good-faith submissions.

This section increases standard survey frequency for home health agencies that are newly enrolled, undergo a change of ownership, or reactivate billing privileges to at least once every 12 months during the following 36-month period, and requires surveys no later than 18 months after the most recent survey for agencies that fail to submit required quality data or display aberrant admission rates or practices (beginning 1 year after enactment, with a limit of one such survey per 18-month period). It also increases the annual payment reduction for failure to submit quality data to 15 percentage points (from 2 percentage points) for 2029 and subsequent years, while allowing up to 30 additional days for good-faith submissions.

This section expands Medicare enrollment screening for hospice programs and home health agencies at extreme risk of fraud. Beginning one year after enactment, such providers must submit fingerprints of their administrator and medical director (if fingerprinting is otherwise required) and evidence of a comprehensive liability insurance policy. The Secretary must identify extreme-risk providers in states or counties where the number of such programs or agencies significantly exceeded the prior year, plus any other factors the Secretary specifies.

This section requires national accreditation bodies to meet or exceed state and local survey procedures under section 1864(a) and to require surveyors to complete relevant CMS basic training courses before serving on teams, beginning 1 year after enactment. It directs the Secretary to establish within 1 year a mechanism for periodic performance assessments of approved bodies, with remedies that may include corrective action plans, ongoing monitoring, or termination of approval.

This section extends the adjustment to the calculation of the hospice cap amount under Medicare through 2036 (from 2035).

This section requires the Secretary to provide written notice within 15 calendar days to Medicare beneficiaries who elect hospice care on or after the date that is one year after enactment. The notice must include the hospice program’s name, address, and telephone number, a plain-language description of the applicable waiver of rights, an explanation of how to revoke the election or change programs, and the 1–800–MEDICARE toll-free number. It transfers $6 million annually from the Federal Hospital Insurance Trust Fund to the Centers for Medicare & Medicaid Services Program Management Account beginning in FY2026 to carry out the notices.

This section requires the Secretary of Health and Human Services to report annually for five years to the House Ways and Means and Energy and Commerce Committees and the Senate Finance Committee on Medicare program integrity activities for hospice programs and home health agencies. The reports must cover the entities conducting reviews and audits, the number performed, trends in improper payments including ineligible physician certifications, findings, resulting enforcement actions such as enrollment revocations, and steps taken to reduce duplication and administrative burden.

This section provides for the transfer of $100 million from the Federal Hospital Insurance Trust Fund to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2026 to carry out survey and enforcement requirements under sections 1822(a)(1) and 1891(c)(2) of the Social Security Act. Funds remain available until expended and are in addition to transfers authorized under the Improving Medicare Post-Acute Care Transformation Act of 2014.