PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, and the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
No official summary is available in the imported record yet.
People & committees
Rep. Tenney, Claudia [R-NY-24] · R–NY
Legislative record
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Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, and the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, and the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, and the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Oct 16, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-10-13 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
This proposal would tighten Medicare screening and inspections of home health agencies and change how their payments are calculated. Agencies considered at extreme risk of fraud would face added enrollment requirements, while newly enrolled agencies and some others would face more frequent inspections. The bill would also reset the standard payment amount for 2027 and require unreliable billing data to be excluded or accounted for in specified payment calculations.
in the case of a home health agency applying for enrollment under this title that is at an extreme risk of fraud (as determined under subparagraph (G)), shall, in addition to any other screening required under this subparagraph
a standard survey of such agency shall be conducted not less frequently than once every month during the 36-month period immediately following such enrollment, change of ownership, or reactivation of billing privileges
the Secretary shall establish a revised standard prospective payment amount for calendar year 2027
the Secretary shall exclude or adjust for suspect claims when computing any such adjustments to payments to home health agencies under this section
Starting one year after enactment, agencies applying for Medicare enrollment that are classified as at extreme risk of fraud would have to show comprehensive liability insurance. Their administrators would also have to be fingerprinted if fingerprinting is included in the applicable agency screening.
beginning 1 year after the date of enactment of this clause, in the case of a home health agency applying for enrollment under this title that is at an extreme risk of fraud (as determined under subparagraph (G)), shall, in addition to any other screening required under this subparagraph— (I) in the case where fingerprinting is included in such screening with respect to home health agencies pursuant to clause (ii)(II), require fingerprinting of the administrator of such home health agency; and (II) require obtaining evidence that such home health agency has a comprehensive liability insurance policy, as determined by the Secretary.
The Secretary of Health and Human Services would assess extreme fraud risk using significant growth in the number of agencies in a State or county, plus any other factors the Secretary specifies. The geographic comparison would use the latest available year and the preceding year.
the Secretary shall determine whether a home health agency is at an extreme risk of fraud based on— (I) the determination made under clause (ii); and (II) such other factors as the Secretary may specify.
the Secretary shall determine whether a home health agency is located in a State or county with respect to which, during the most recent year for which data is available, the total number of home health agencies located in such State or county significantly exceeded the total number of such agencies located in such State or county during the preceding year.
Beginning one year after enactment, newly enrolled agencies, agencies changing ownership, and agencies reactivating billing privileges would face standard surveys—compliance inspections—at least monthly for the 36 months immediately after the triggering event.
beginning 1 year after the date of enactment of this clause, in the case where an agency is newly enrolled under this title, has undergone a change of ownership (as defined by the Secretary), or has reactivated billing privileges under this title in accordance with section 424.540(b) of title 42, Code of Federal Regulations (or a successor regulation), a standard survey of such agency shall be conducted not less frequently than once every month during the 36-month period immediately following such enrollment, change of ownership, or reactivation of billing privileges
Beginning one year after enactment, an agency missing required quality data for the latest available year would have to receive a standard inspection within 18 months of its previous inspection.
beginning 1 year after the date of enactment of this clause, a standard survey of an agency shall be conducted— (I) in the case where the agency does not submit quality data to the Secretary in accordance with subclauses (II) and (IV) of section (b)(3)(B)(v) for the most recent year for which data is available (as determined by the Secretary), not later than 18 months after the date on which the most recent such survey was conducted with respect to such agency
The same inspection deadline would apply to agencies with unusually high or otherwise abnormal admission rates compared with peers, or other specified signs of potentially fraudulent or abnormal behavior. The Secretary would consult stakeholders and the Inspector General on those other indicators and revisit them at least every three years. Clause (iii), which also covers missing quality data, would allow no more than one inspection under that clause in an 18-month period.
in the case where the agency has a beneficiary admission rate that is aberrant compared to peers (as determined by the Secretary) or otherwise displays characteristics or engages in practices that may indicate fraudulent or aberrant behavior (as specified by the Secretary after consultation with stakeholders, such as beneficiary advocates and representatives of the home health industry, and the Inspector General of the Department of Health and Human Services, and updated as necessary after additional consultation with such stakeholders not less often than once every 3 years), not later than 18 months after the date on which the most recent such survey was conducted with respect to such agency, except that an agency shall not be subject to more than 1 survey under this clause within any 18-month period.
For failure to submit quality data, the bill would amend the existing payment-adjustment provision to specify an adjustment of 15 percentage points for 2029 and later. The supplied text does not reproduce the underlying calculation, so it does not establish a 15 percent cut to an agency's total payments.
(b) Payment adjustment if quality data not submitted Section (b)(3)(B)(v) of the Social Security Act (42 U.S.C. fff(b)(3)(B)(v)) is amended— (1) in subclause (I), in the first sentence, by inserting the following before the period: for years before 2029, and by 15 percentage points for 2029 and subsequent years
For 2029 and later, the Secretary would have to establish processes allowing agencies that demonstrate a good-faith effort to submit required quality data on time to receive up to 30 additional days. An extension would be discretionary, not automatic.
For 2029 and each subsequent year, in specifying a time for the submission of such data pursuant to the previous sentence, the Secretary shall establish a process under which any home health agency that has demonstrated a good faith effort to submit such data by such time may be granted additional time (not to exceed 30 days) to complete such submission.
Beginning one year after enactment, approval under the amended accreditation provision would require a national accreditation body's inspection procedures to meet or exceed applicable State and local agency standards. Surveyors would have to complete relevant Centers for Medicare and Medicaid Services basic training before joining an inspection team.
Beginning 1 year after the date of enactment of this subparagraph, the Secretary may not approve a request for a finding under paragraph (1) with respect to a national accreditation body unless the survey procedures of such accreditation body— (I) met or exceeded the standards applicable to the survey procedures that State and local agencies that have entered into an agreement with the Secretary under section 1864(a) are required to use; and (II) require surveyors to complete the relevant basic surveyor training courses offered by the Centers for Medicare and Medicaid Services before serving as a member of a survey team.
Previously approved accreditation findings for home health agencies could remain effective only if the Secretary determined, before the one-year deadline, that the accreditation body's procedures met the new standards and training requirements.
The Secretary may only continue to give effect to any such finding made prior to the date that is 1 year after the date of enactment of this subparagraph with respect to a national accreditation body with respect to the accreditation of home health agencies if the Secretary determines before such date that the survey procedures of such accreditation body meet the conditions described in clause (i).
Within one year of enactment, the Secretary would have to establish periodic performance assessments of approved home health accreditation bodies. Deficient performance would require an appropriate remedy, potentially including a corrective action plan, continued monitoring, or termination of approval to accredit home health agencies.
Not later than 1 year after the date of enactment of this subsection, the Secretary shall establish and implement a mechanism for periodically assessing the performance of an accreditation body that has received approval from the Secretary under subsection (a)(3)(A) for accreditation of home health agencies.
the Secretary shall provide for an appropriate remedy, which may include the imposition of a corrective action plan, ongoing monitoring of the accreditation body, and the termination of such approval with respect to the accreditation body for accreditation of home health agencies.
The bill would end the existing clause (iii)'s stated application after 2026 and require a revised standard prospective payment amount—the standard amount set in advance—for 2027 within 90 days of enactment. The calculation would begin with the 2020 amount and apply each subsequent year's adjustments under existing subparagraph (B).
in clause (iii)— (A) in the heading, by striking and subsequent years and inserting through 2026; and (B) in subclause (I), by striking and subsequent years and inserting through 2026
Not later than 90 days after the date of enactment of this clause, the Secretary shall establish a revised standard prospective payment amount for calendar year 2027. In establishing such amount, the Secretary shall calculate the standard prospective payment amount beginning with the amount applicable for calendar year 2020, adjusted for each subsequent year under subparagraph (B).
The revised payment calculation would use methods and claims data suited to measuring provider behavior changes caused by the Patient-Driven Groupings Model, the home health payment model named in the bill. It would exclude data tied to billing patterns the Secretary determines are fraudulent, wasteful, abusive, abnormal, or otherwise unreliable.
the Secretary shall use a methodology and claims data that are appropriate to measure changes in provider behavior attributable to the implementation of the Patient Driven Groupings Model. Such methodology shall— (aa) exclude claims data associated with fraudulent, wasteful, abusive, aberrant, or otherwise unreliable billing patterns, as determined by the Secretary
The calculation would also have to account for the COVID-19 public health emergency and other circumstances that materially changed home health use or spending but were outside the model's original assumptions about provider behavior.
account for the effects of the public health emergency declared under section 319 of the Public Health Service Act with respect to COVID–19 and other circumstances that materially affected home health utilization or spending but were not within the behavioral assumptions used to establish the Patient-Driven Groupings Model
For 2028 and later, the bill would direct use of the preceding year's standard payment amount, updated under existing subparagraph (B). The supplied bill does not reproduce that update formula.
For 2028 and each subsequent year, the standard prospective payment amount shall be the amount established under subclause (I) for the preceding year, updated under subparagraph (B).
For 2027 and later, the Secretary would be prohibited from imposing the specified permanent or temporary payment adjustments to offset spending differences caused by assumed versus actual provider behavior under the Patient-Driven Groupings Model. The prohibition covers offsets for both increases and decreases in estimated spending.
Notwithstanding any other provision of law, for 2027 and subsequent years, for purposes of making any adjustment under this subparagraph, the Secretary shall not impose any adjustment under clause (ii) or (iii) to offset increases or decreases in estimated expenditures attributable to the difference in assumed versus actual behavioral changes due to the implementation of the Patient-Driven Groupings Model
For 2027 and later, the Secretary would have to exclude or account for suspect claims when calculating payment adjustments based on quality, value, or benchmarks—comparison standards. A claim could qualify because its data are unreliable or because its provider may have engaged in fraud, waste, or abuse; a proven fraud finding would not be required by this definition.
For 2027 and each subsequent year, in order to ensure that fraudulent and suspected fraudulent entities do not impact benchmarks or the application of any quality, value-based, or benchmarked adjustments for legitimate providers of home health services, the Secretary shall exclude or adjust for suspect claims when computing any such adjustments to payments to home health agencies under this section.
the term suspect claim means any claim for home health services submitted under this title that the Secretary determines contains unreliable data or data from a provider that may have engaged in fraud, waste, or abuse.
Within 180 days of enactment, the Secretary would have to report to Congress on how suspect claims and cost reports influenced payments after 2020. The report would examine excluding suspect claims from rates, weights used to account for differences among patients, assumptions about provider behavior, and adjustments, and recommend permanent safeguards against unreliable data.
Not later than 180 days after the date of enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report— (1) identifying the degree to which suspect claims and cost reports influenced payments made to home health agencies under section 1895 of the Social Security Act (42 U.S.C. 1395fff) after 2020; (2) analyzing the effect of excluding suspect claims (as defined in subsection (f) of such section 1895) from the calculation of payment rates, case-mix weights, behavioral assumptions, and adjustments under such section 1895; and (3) including recommendations for permanent data-integrity safeguards for home health agencies to prevent the inclusion and application of utilization, cost, and payment data from home health agencies that the Secretary determines are at risk of providing unreliable and inaccurate data.
The Secretary would have to implement Titles I and II through notice-and-comment rulemaking, a process that provides public notice of proposed rules and an opportunity to comment.
The Secretary of Health and Human Services shall implement the amendments made by titles I and II of this Act through notice and comment rulemaking under section 553 of title 5, United States Code.
The bill would appropriate $300 million to the Centers for Medicare & Medicaid Services for fiscal years 2027 through 2031 to implement the screening, oversight, and accreditation changes in sections 101–103. This would be additional funding, not merely permission to seek future appropriations.
In addition to any other funds otherwise available, there are appropriated to the Centers for Medicare & Medicaid Services, out of any amounts in the Treasury not otherwise appropriated, $300,000,000 for fiscal years 2027 through 2031 for the implementation of the amendments made by sections 101, 102, and 103.
The bill would appropriate a combined $150 million to the Department of Justice and the Health and Human Services Inspector General for fiscal years 2027 through 2031. It would support organized home health fraud investigations, forensic accounting, interstate investigations, Medicare fraud prosecutions, and federal law-enforcement coordination; the text does not divide the amount between the two recipients.
In addition to any other funds otherwise available, there are appropriated to the Department of Justice and the Office of Inspector General of the Department of Health and Human Services, out of any amounts in the Treasury not otherwise appropriated, $150,000,000 for fiscal years 2027 through 2031 for investigation of organized home health fraud schemes, forensic accounting, interstate fraud investigations, prosecution of Medicare fraud, and coordination with Federal law enforcement agencies.
The bill would appropriate another $100 million to the Centers for Medicare and Medicaid Services for fiscal years 2027 through 2031 to support State agencies' accelerated inspections, enrollment validation, unannounced visits, and verification that home health agencies are operating.
In addition to any other funds otherwise available, there are appropriated to the Centers for Medicare and Medicaid Services, out of any amounts in the Treasury not otherwise appropriated, $100,000,000 for fiscal years 2027 through 2031 to support State survey agency activities relating to conducting accelerated surveys, enrollment validation, unannounced site visits, and operational verification of home health agencies.
The bill would preserve existing authority to suspend payments, revoke enrollment, temporarily halt new enrollments, conduct visits and audits, and exclude or deny payment for suspect home health claims.
Nothing in the provisions of, or amendments made by, this Act shall be construed to limit the authority of the Secretary of Health and Human Services to suspend payments to home health agencies under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), revoke enrollment or impose a moratorium on the enrollment of such agencies under such title, conduct site visits of such agencies, audit such agencies, or exclude or deny payment for suspect claims for home health services under such title.
The supplied official-actions snapshot, updated October 16, 2026, records introduction in the House on October 13, 2026, and referral that day to Ways and Means, Energy and Commerce, and Judiciary for provisions within their respective jurisdictions.
Source snapshot updated 2026-10-16T11:50:18Z.
2026-10-13: Introduced in House
2026-10-13: Referred to the Committee on Ways and Means, and in addition to the Committees on Energy and Commerce, and the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
A closer look
Reviewed version: Introduced in House · 2026-10-13. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or separate policy rider attached to appropriations was identified in the complete supplied introduced text. Its substantive changes and implementation funding address the same home health payment and oversight subject. This conclusion does not establish absence in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for a particular local project or specially selected recipient was identified in the complete supplied introduced text. General agency and program appropriations alone do not establish earmarks. This conclusion is limited to this version; formal earmark status cannot be fully assessed without accompanying disclosure and legislative materials.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow preferential carve-out was identified in the complete supplied introduced text. Broad program payment rules and generally available administrative relief do not alone qualify as targeted benefits. This conclusion is limited to this version and does not establish absence in other versions or accompanying materials.
Full text preserved for this analysis. Legislative record snapshot: Oct 16, 2026. How PlainBill uses AI