Medicare tightens home health fraud rules, resets payment rates for 2027
S. 5250 — Medicare Home Health Payment Integrity and Protection Act of 2026 · Filed by Susan Collins (R-ME) · Introduced Aug 5, 2026 · Referred to committee
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What it does
This bill tightens Medicare's oversight of home health agencies to combat fraud. It requires stricter enrollment screening (fingerprinting, liability insurance) for high-risk agencies, increases survey frequency for newly enrolled or ownership-changed agencies, mandates quality-data submission with payment penalties for non-compliance, and upgrades accreditation standards. It also resets the Medicare payment rate for home health services to $2,382.87 per unit in 2027 and suspends certain payment adjustments. The bill funds these enforcement efforts with $550 million over five years.
Why we flagged it
The bill's core mechanism is anti-fraud enforcement (enrollment screening, survey frequency, data integrity) paired with a payment-rate reset. The fraud-prevention purpose is stated plainly; the payment adjustment is a direct policy choice, not hidden.
What the text implies
- The $2,382.87 payment rate for 2027 may represent a significant reduction from current rates depending on prior adjustments; agencies unable to absorb margin pressure may exit the market, potentially reducing access in rural or low-income areas.
- Suspension of permanent and temporary adjustments (Section 202) freezes behavioral-change offsets tied to the 2020 Patient-Driven Groupings Model, locking in a payment structure that may not reflect current cost realities.
The full analysis lists 5 implications of this text.
Who stands to gain
Medicare program (reduced fraud-related expenditures); Larger home health agencies with compliance infrastructure; Accreditation organizations meeting upgraded survey standards