Warner, Sánchez Introduce Bicameral Bill to Strengthen Hospice Care for Patients, Protect Against Fraud

WASHINGTON - U.S. Sen. Mark R. Warner (D-VA) and U.S. Rep. Linda T. Sánchez (D-Calif.) today introduced the Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act to modernize the Medicare hospice benefit, protect patients and taxpayers from fraud, and expand access to essential services and caregiver support.

Medicare's hospice benefit has remained largely unchanged since its inception in 1982. However, the hospice industry has changed dramatically both in terms of the types of providers delivering and patients receiving end-of-life services. At the same time, documented and burgeoning fraud and abuse have raised questions about how to ensure the benefit continues to promote patient access while safeguarding the Medicare Trust Fund.

The Hospice CARE Act would strengthen the Medicare hospice benefit through a combination of program integrity provisions and payment reforms to ensure it better meets the needs of terminally ill patients and their families.

"Making decisions about hospice and end-of-life care is one of the most difficult moments that families can endure, yet Medicare's hospice benefit is out-of-touch with the needs of patients and providers," said Sen. Warner. "I'm proud to introduce this legislation that will prioritize patient comfort at home as well as in a health care facility, and protect patients and taxpayers from bad actors attempting to steal essential resources."

"Hospice should provide comfort and dignity at the end of life, yet the benefit has not evolved to meet families where there is need," said Rep. Sánchez. "This bill strengthens and enhances Medicare's hospice benefit so it provides the critical care patients and their families need - like respite care for caregivers and coverage of palliative treatments like dialysis and radiation - all while protecting the program from those trying to exploit it."

Program Integrity: The bill creates additional safeguards to prevent fraudulent providers from enrolling in Medicare and increases oversight of hospices, especially new hospices. Specifically, it:

• Temporarily prevents new hospices from enrolling in Medicare, while allowing exceptions for instances where additional access to care is needed.
• Requires increased transparency of hospice ownership and managing control information, ensuring CMS's enrollment records are up to date.
• Increases survey frequency for new hospices to ensure they meet hospice health and safety standards and prohibits payments to hospices that do not submit required quality data to the Secretary, with appropriate exceptions.
• Reduces the potential for inappropriate financial conflicts of interest when certifying individuals' eligibility for hospice care, while allowing nurse practitioners and physician assistants to also certify eligibility.
• Requires CMS to conduct additional oversight activities to ensure hospices are providing holistic and comprehensive care.
• Provides patients with an explanation of benefits within 15 days of an individual's hospice election to increase beneficiary awareness of hospice enrollment and prevent extended periods of fraudulent billing.

Payment Reform: The bill ensures that providers are incentivized to deliver high-quality care to individuals and their families. Specifically, it:

• Revises the payment structure for routine home care to reward hospices for providing in-person care.
• Increases payments to hospices for furnishing palliative radiation, chemotherapy, blood transfusions, and dialysis to address access barriers for individuals that require these costly treatments under a hospice election. Additionally, it creates an outlier payment policy to provide a backstop for providers delivering care to high-cost patients.
• Adds home respite care to the Medicare hospice benefit, allowing individuals to receive respite care at home rather than in a facility, which is a key benefit for families and caregivers that are taking care of loved ones at the end-of-life.
• Creates a new transitional inpatient respite benefit to support patients and families through their transition from a hospital into hospice care in the setting of their choice, allowing patients to move from hospital to general inpatient care to transitional respite, when appropriate. This new transitional payment seeks to eliminate the current pattern of care whereby terminally ill individuals are discharged from the hospital and inappropriately admitted to a skilled nursing facility in lieu of electing hospice care.

The full bill is available here.

"The American Academy of Hospice and Palliative Medicine (AAHPM) greatly supports the work being done on the need to address hospice fraud," said Kristina Newport, MD, FAAHPM, HMDC, chief medical officer for AAHPM. "Patients and families in need of the care, comfort and quality of life that hospice care provides need to trust that they are receiving the best possible services. We look forward to working with Representative Sánchez and Senator Warner on these important issues and to ensure that all patients have access to this vital care."

"The Alliance thanks Representative Sánchez and Senator Warner for their commitment to ensuring Americans have access to high-quality hospice care. The reintroduction of the Hospice CARE Act reflects their dedication to meeting the evolving needs of our aging population and strengthening the long-term sustainability and integrity of the hospice benefit," said Jennifer Sheets, chief executive officer for the National Alliance for Care at Home. "Hospice care is one of the most profound services our healthcare system offers, providing patients and families with compassionate, dignified care during life's most difficult moments. As the number of Americans turning to hospice continues to grow, it is critical that the benefit keeps pace with how care is delivered today and what patients, families, and providers actually need. The Alliance looks forward to working with Representative Sánchez and Senator Warner and their congressional colleagues on this legislation. We are committed to being a constructive partner in any effort to protect what's working, address what isn't, and modernize the Medicare hospice benefit in ways that serve patients, families, and the future of care in our country."

"Hospice is a vital and deeply valued benefit, with a critical role in America's health care system," said Katie Smith Sloan, president and CEO of LeadingAge. "At its best, compassionate, high-quality, person-centered care is delivered to beneficiaries and families by ethical, forward-thinking, competent providers, in keeping with the sector's nonprofit origins, which established a standard of quality care. Currently, however, hospice is at an inflection point. Increased scrutiny - an appropriate response to fraudulent behavior of a limited group of bad actors - highlights the need for modernization. This moment calls for thoughtful reform to ensure this valuable benefit continues to serve patients and families, support high-quality providers, protect against the rise of dishonest players, and preserve the core promise of hospice care. Done right, changes will expand the benefit to support the realities of modern-day hospice care, address the benefit's vulnerabilities now being exploited, and help ensure quality to support strong funding. We thank Congresswoman Sánchez and Senator Warner for their leadership on this bill and their longstanding commitment to the need for high quality care for people with serious illness and at the end of life. There is more work to do, and we look forward to continuing to work with Congresswoman Sánchez and Senator Warner to ensure this bill achieves these goals."

"In addition to significant payment reforms and program integrity measures, this bill takes important steps towards improving access to care for individuals on hospice," said David Lipschutz, co-director of the Center for Medicare Advocacy. "This includes incentivizing in-person clinical visits and care to higher-cost patients and allowing respite care to be provided in the home. It also would create a transitional 15-day inpatient respite period to give eligible patients and their families adequate time to arrange for a safe transition into receive hospice at home following a hospital stay."

"The National Partnership for Healthcare and Hospice Innovation (NPHI) thanks Senator Mark Warner and Congresswoman Linda Sánchez for their continued leadership on improving the experience for patients and families at the end-of-life, including with today's introduction of the Hospice CARE Act of 2026," said Tom Koutsoumpas, founder and CEO of NPHI. "This legislation provides an important opportunity to pursue thoughtful reforms to the Medicare hospice benefit that both preserve patient access and address ongoing concerns related to program integrity. While the bill represents meaningful progress toward modernizing the benefit and reducing incentives for fraud, waste, and abuse, NPHI believes certain provisions - particularly those related to payment reform - present opportunities for further discussion and refinement. We look forward to working closely with Senator Warner, Representative Sánchez, the Senate Finance Committee, and the House Ways and Means Committee to ensure the legislation delivers thoughtful reforms that strengthen the hospice benefit for mission-driven providers and the patients they serve."

###