Observation Stays Bill Introduced in Senate
Senators Susan Collins (R-ME) and Peter Welch (D-VT) introduced legislation on May 22 to protect seniors from the high costs of post-acute care. S 4641 would require that all days spent in the hospital, regardless of inpatient or outpatient observation status would count toward the three-day qualifying stay required for skilled nursing facility (SNF) services under Medicare fee-for-service. This bipartisan bill joins the Improving Access to Medicare Coverage Act (HR 3954) that was introduced by Representative Joe Courtney (D-CT) in June 2025. LeadingAge has supported the Improving Access to Medicare Coverage Act and is pleased to see the introduction of the Senate bill. We continue to work with coalition partners to help advance this legislation.
CMS Relaunching Hospice PEPPER Report in June 2026
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is an excel file issued to individual hospice providers summarizing provider-specific Medicare data statistics for target areas determined by the Centers for Medicare and Medicaid Services (CMS) often associated with Medicare improper payments due to utilization issues. In January 2024, CMS announced a temporary pause to the PEPPER reports in order to update the program and reporting system. Over the last several months, CMS has released updated PEPPER reports for other Medicare provider settings such as critical access hospitals and short-term acute care hospitals.
In an email to LeadingAge on May 26, CMS shared that the Hospice PEPPER will be available through the PEPPER Portal in early June 2026. CMS is asking providers prepare for this release by following the outlined instructions to ensure access to the online PEPPER Portal:
How to Download Your PEPPER: Staff End User (SEU) Access
The Hospice PEPPER will be available through the PEPPER Portal to Authorized Officials (AOs), Access Managers (AMs), and Staff End Users (SEUs) who have been granted the PEPPER business function in the CMS Identity & Access Management (I&A) System.
To become a Staff End User (SEU) and access your organization’s PEPPER:
- Log in to the CMS I&A System using your existing NPPES or PECOS credentials.
- Request the PEPPER business function under your organization.
- Obtain approval from your organization’s AO or AM (only AOs and AMs can approve SEU access).
- Once approved, log in to the PEPPER Portal using the same credentials to download your organization’s PEPPER.
Authorized Officials and Access Managers can find step-by-step instructions in the I&A Quick Reference Guide and Frequently Asked Questions (FAQs).
If users need help identifying their AO or AM, or have questions about their request, they may contact the PECOS External User Services (EUS) Help Desk.
Reminder // Member Call: Exploring Impact of National Hospice and Home Health Moratoria
The Centers for Medicare and Medicaid Services (CMS) announced six-month, nationwide moratoria on new Medicare enrollment for hospice and home health agencies. Join LeadingAge policy experts on May 28 at 1 p.m. CT for a members-only discussion on what this means for all providers—topics include whether similar actions could extend to other CMS settings and what this moment means for organizations considering expansion. We’ll also explore strategies to strengthen nonprofit collaboration, community-based ownership, and keeping services aligned with your mission. Experts from Husch Blackwell will join the panel to discuss legal and compliance implications. Register now!
Small Business Labor Roundtable on Joint Employer Rule
The Small Business Administration’s Office of Advocacy has scheduled a Small Business Labor roundtable on May 28, 2026 to discuss the U.S. Department of Labor’s (DOL) 2026 proposed rule on the definition of “joint employer” and employer liability. The rule would provide regulatory guidance for determining joint employer status under the Fair Labor Standards Act (FLSA), Family and Medical Leave Act, and Migrant and Seasonal Agricultural Worker Protection Act. DOL is proposing to reinstate its 2020 final rule, which was rescinded in 2021, with a few changes. The Office of Advocacy is responsible for monitoring compliance with the Regulatory Flexibility Act, which seeks to minimize the regulatory burden on small entities. Small entities consist of small businesses, small governmental jurisdictions, and small organizations—the latter of which are generally defined as any not-for-profit enterprise which is independently owned and operated and is not dominant in its field. The Roundtable affords small entities potentially impacted by the proposed rule the opportunity to share their opinion on the rule with the Office of Advocacy virtually.
Senate Finance Committee Democrats Announce Long-Term Care Initiative
The Small Business Administration’s Office of Advocacy has scheduled a Small Business Labor roundtable on May 28, 2026 to discuss the U.S. Department of Labor’s (DOL) 2026 proposed rule on the definition of “joint employer” and employer liability. The rule would provide regulatory guidance for determining joint employer status under the Fair Labor Standards Act (FLSA), Family and Medical Leave Act, and Migrant and Seasonal Agricultural Worker Protection Act. DOL is proposing to reinstate its 2020 final rule, which was rescinded in 2021, with a few changes. The Office of Advocacy is responsible for monitoring compliance with the Regulatory Flexibility Act, which seeks to minimize the regulatory burden on small entities. Small entities consist of small businesses, small governmental jurisdictions, and small organizations—the latter of which are generally defined as any not-for-profit enterprise which is independently owned and operated and is not dominant in its field. The Roundtable affords small entities potentially impacted by the proposed rule the opportunity to share their opinion on the rule with the Office of Advocacy virtually.
Senate Finance Committee Democrats Announce Long-Term Care Initiative
Senator Ron Wyden (D-OR) and select members of the Senate Finance Committee announced a new initiative in long-term care on May 20. In a Dear Colleague letter, the third in a series aimed at improving the healthcare system, Committee members outline an initiative focused on three pillars: making home care accessible and affordable, improving the quality of care in nursing homes, and strengthening the long-term care workforce.
It is important to note that no policies have been proposed at this time; however, the Committee will be seeking feedback on current policy issues. For nursing homes, this means exploring ways to: ensure government funds are spent on direct care compensation, strengthen nursing home staffing through standards and other incentives, and improve transparency and oversight. For home care, the goals are to both strengthen access to Medicaid home and community-based services and ensure affordable access to home care for Medicare beneficiaries — though given the broad scope of the project, discussions around financing this type of expansion will likely not be limited to Medicare. The long-term care workforce pillar includes a mention of immigration as well as training, retention, and wages.
The Committee intends this to be a multi-year initiative during which information and input is obtained from a variety of sources, including stakeholders, that will then be used to inform the development of policies and incentives to advance the initiative. LeadingAge will be deeply engaged in this effort to ensure that Senators engaged in this effort are educated on the implications of these issues and policy approaches for our members and to share our vision and long-term goals for supporting, shaping, and improving our sector and informing the direction of this future roadmap.
CMS Releases Proposed Rule Limiting State Directed Payments
On May 20, the Centers for Medicare and Medicaid Services (CMS) posted a proposed rule for public inspection. The rule, Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-For-Service Targeted Medicaid Practitioner Payments, (CMS-2449-P), proposes to codify limitations on state directed payments (SDPs) enacted in section 71116 of HR 1. The rule, if finalized as proposed, would cap certain SDP provider payment rates for four services (inpatient hospital, outpatient hospital, nursing home, and qualified practitioner services at academic medical centers) at 100% of Medicare payment rates for expansion states and 110% of Medicare payment rates for non-expansion states (or 100% of the Medicaid state plan rate if a comparable Medicare rate is not available) and apply similar limits to certain targeted Medicaid fee-for-service payments. Applicable directed payments for which members may be affected include value-based payment incentives such as shared savings models, pay for performance, and quality improvement programs, among others. CMS notes that the majority of funding spent through SDPs is disproportionately borne upon hospitals, though as a percentage of total SDP spending, nursing facility SDPs doubled from less than 4% to 8% from 2021 to 2024. More information on SDPs is available from the Medicaid and Chip Payment Access Commission (MACPAC) here. The proposed rule is available here and posted for a 60-day comment period closing on July 21. LeadingAge will complete further analysis and prepare comments on the proposal.
