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Sen. Susan Collins, R-Maine, has introduced a bill that, if enacted, would give the Centers for Medicare & Medicaid Services additional tools to prevent and detect home health fraud and reset the Medicare home health payment rate to levels seen before years of payment cuts. The Medicare Home Health Payment Integrity Act, formally titled the Medicare Home Health Payment Integrity and Protection Act of 2026, would require additional pre-enrollment steps for home health agencies and require more frequent surveys of some home health agencies, along with other elements.
Why Collins Introduced This Medicare Home Health Payment Integrity Act
“When billions of dollars are improperly siphoned from the Medicare home health program, this can undermine the integrity of the payment system used to reimburse legitimate providers and threaten care for the seniors who depend on it,” Collins said in a statement. “My legislation would give CMS stronger tools to stop fraud before payments are made and prevent fraudulent spending from distorting the data used to reimburse honest agencies for medically necessary care.”
Why Legitimate Providers Support the Rate Reset
According to the National Alliance for Care at Home, CMS’s several years of rate cuts to the home health base payment rate were made on data “entirely unrelated to the payment system adopted in 2020, along with data tainted by the inclusion of fraudulent providers in the rate analysis.” The new bill would bring rates back in line with rates before several years of cuts and would be a step in making payment rates better reflect the actual cost of care, according to the organization.
What the Medicare Home Health Payment Integrity Act Would Require of High-Risk Agencies
The bill would require fingerprinting of administrators at home health agencies CMS deems to present extreme fraud risk, along with proof of liability insurance for those same high-risk entities. CMS would gain authority to determine which factors indicate extreme fraud risk and impose correspondingly strict screening requirements.
Increased Survey Frequency Under This Bill
Survey frequency would increase for newly enrolled Medicare home health agencies, those undergoing ownership changes, and those reactivating billing privileges. Agencies failing to submit quality data to CMS or engaging in potentially fraudulent behavior would face more frequent inspections and higher financial penalties for quality-data non-submission.
Additional Provisions Within the Medicare Home Health Payment Integrity Act
The legislation would also require accrediting agencies that work with CMS to meet or exceed CMS standards, require CMS training of home health surveyors for accreditation purposes, establish ongoing CMS oversight of accrediting organizations, and provide CMS with authority to terminate deficient accreditors.
New Funding for Fraud Investigation and Enforcement
The bill would authorize funding for CMS and federal law enforcement agencies for the investigation and prosecution of organized home health fraud schemes, and authorize funding for CMS and its state agency partners to conduct accelerated surveys, enrollment validation, unannounced site visits, and operational verification of home health agencies.
Industry Support for This Medicare Home Health Payment Integrity Act
Industry representatives voiced support for the bill’s program integrity elements, saying they would stop bad actors from entering the Medicare program without relying on sweeping enforcement strategies that could implicate legitimate providers.
How This Bill Fits the Broader CMS Home Health Rulemaking Context
This legislative push arrives alongside CMS’s own July 2026 proposed rule for the CY 2027 Home Health Prospective Payment System, which separately estimates total Medicare payments to home health agencies would increase by approximately 2.4%, or $420 million, compared to CY 2026, while also including its own provider enrollment provisions aimed at reducing improper Medicare payments. The Collins bill and the CMS proposed rule both reflect a broader, converging push across the legislative and executive branches to simultaneously combat home health fraud and stabilize reimbursement for compliant providers.
What the Medicare Home Health Payment Integrity Act Means Going Forward
With the bill now introduced and expected to move through the Senate Finance Committee, home health agencies should monitor its progress closely, as passage would materially alter both reimbursement levels and pre-enrollment compliance requirements. Agencies operating in markets CMS identifies as high fraud risk, particularly regions like Los Angeles County and other known hot spots, should prepare for potential fingerprinting mandates, liability insurance verification, and increased survey frequency if the legislation advances.
What to Watch Going Forward
As the Medicare Home Health Payment Integrity Act moves through the Senate Finance Committee, industry observers will likely watch how the bill’s payment-rate reset provision, which directly addresses years of cuts tied to fraud-tainted data, interacts with CMS’s own concurrent rulemaking efforts under the CY 2027 Home Health Prospective Payment System proposed rule. Given the bill’s emphasis on distinguishing compliant operators from bad actors through targeted, risk-based screening rather than blanket enforcement, home health agencies serving rural and other underserved communities may find this approach offers more predictable compliance expectations than broader industry-wide crackdowns have provided in the past.
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