The Hospice CARE Act of 2026 implements comprehensive reforms to the Medicare hospice program by establishing an enrollment moratorium, enhancing oversight and transparency, and restructuring payment models to improve care quality and program integrity.
Mark Warner
Senator
VA
The Hospice Care Accountability, Reform, and Enforcement (CARE) Act of 2026 aims to strengthen the integrity and quality of the Medicare hospice program through a five-year enrollment moratorium and enhanced oversight of hospice providers. The bill implements significant payment reforms, updates certification requirements, and increases transparency regarding hospice ownership and performance. These measures are designed to ensure high-quality care, curb fraudulent billing practices, and better align hospice services with patient needs.
Hospice CARE Act of 2026 Hits Pause on New Providers and Overhauls Medicare Payments to Curb Fraud
The Hospice CARE Act of 2026 is a massive reset button for end-of-life care in America. Its most immediate move is a nationwide five-year freeze on new hospice programs joining Medicare, starting the moment the bill is signed. It’s designed to clean up the industry by forcing every existing provider to re-verify their paperwork within six months and throwing a spotlight on who actually owns these companies—specifically targeting private equity’s growing footprint in the sector. For families, this means the hospice landscape will likely stay exactly as it is for the next half-decade, with very few new players allowed to enter the market unless a specific area is desperately underserved.
The End of the 'Wild West' for Billing
To stop what the bill calls "aberrant" billing, the government is getting much more hands-on with your medical records. Starting in 2027, if a patient’s regular doctor is also an employee or owner of the hospice company, a second, independent doctor must step in to certify that the patient is actually terminally ill. Think of it as a mandatory second opinion to ensure patients aren't being recruited into hospice before they truly need it. Additionally, the bill shifts how Medicare pays for routine home care. By 2030, instead of just getting a flat daily rate, hospices will get a base daily fee plus a per-visit payment for actual in-person time spent with the patient. This is a big deal for staff; it basically ties the company’s paycheck to how often they actually show up at your front door.
Room and Board Reality Checks
If you have a loved one in a nursing home, this bill changes the math on their support system. Starting in October 2029, Medicare will stop paying for hospice-funded home health aides or homemakers if the patient already lives in a skilled nursing facility. The logic is that the facility should already be providing those basic services, but for families, it could mean fewer friendly faces or less specialized attention for a resident. Furthermore, the bill cuts the limit on "inpatient" days—the time a patient spends in a hospital or hospice facility for intense symptom management—from 20% of a program’s total care down to just 10%. This might make it harder for hospices to offer those beds to families who are hit with a sudden crisis at home.
New Help for Caregivers at Home
It’s not all restrictions, though; there’s a new perk for the millions of people caring for relatives in their own living rooms. The bill creates "short-term home respite care," which allows for up to 120 hours of professional help per 90-day period specifically to give family caregivers a break. Unlike traditional respite, which usually requires moving the patient to a facility for a few days, this help comes to your house. It’s a nod to the reality that most people want to stay home, but their kids or spouses are burning out. However, with the five-year freeze on new providers and stricter caps on total payments, the big question is whether existing hospices will have the staff and budget to actually deliver these new home-based hours.