On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule for the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Update (CMS-1835-P), detailing planned changes to Medicare hospice payment rates, regulatory guidance, and updates to the Hospice Quality Reporting Program (HQRP). These proposed changes are part of…
On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule for the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Update (CMS-1835-P), detailing planned changes to Medicare hospice payment rates, regulatory guidance, and updates to the Hospice Quality Reporting Program (HQRP). These proposed changes are part of CMS’s legally required annual updates to hospice payment policies.
Hospice providers should be aware of several significant updates and proposals that could impact operations, compliance, and payments starting in FY 2026.
Proposed Payment Rate Update
CMS proposes a 2.4% increase in hospice payments for FY 2026, translating to approximately $695 million in increased payments across the hospice sector. This update reflects a 3.2% market basket increase, reduced by a 0.8% productivity adjustment, in line with statutory requirements.
Additionally, the proposed hospice aggregate cap for FY 2026 is $35,292.51, a 2.4% increase from FY 2025.
NOTE: The percentage increase may change when the final rate update is issued, based on the latest available data for the percentage increase calculation.
Regulatory Clarifications
- Physician Admission Recommendations: CMS proposes to officially recognize that the physician member of the hospice interdisciplinary group (IDG) can recommend hospice admission, aligning this regulation with existing Conditions of Participation (CoPs).
- Face-to-Face Encounter Attestation: CMS proposes to require attestation documentation to include the physician or nurse practitioner’s signature and date, making this a formal requirement under § 418.22(b)(4).
Hospice Quality Reporting Program (HQRP) Updates
The HQRP will see several changes, with the most notable being the implementation of the Hospice Outcomes & Patient Evaluation (HOPE) tool starting October 1, 2025. This tool will replace the Hospice Item Set (HIS), with providers transitioning from the QIES database to iQIES for data submissions.
Key HQRP Timeline Highlights:
- October 1, 2025: HOPE data collection begins.
- November 2027 (FY 2028): Earliest possible date for public reporting of HOPE-based quality measures.
To remain in compliance and avoid a 4% payment reduction, hospices must submit at least 90% of all required HOPE records within 30 days of the relevant event. CMS will apply the same timely submission standards to HOPE admission, discharge, and up to two Hospice Update Visit (HUV) records as currently required for HIS submissions.
CMS acknowledges provider concerns regarding the complexity of the transition and plans to issue further sub-regulatory guidance to support implementation, especially during the initial reporting year.
Requests for Information (RFIs)
CMS is seeking public input through multiple RFIs included in the proposed rule:
- Advancing Digital Quality Measurement (dQM): Exploring tools and infrastructure needed to shift from manual to digital reporting, particularly the use of Fast Healthcare Interoperability Resources (FHIR).
- Future HQRP Quality Measures: CMS is considering new metrics related to:
- Interoperability: Assessing the readiness and ability of hospices to exchange data securely across care settings.
- Well-Being: Capturing emotional, social, and personal dimensions of end-of-life care.
- Nutrition: Promoting appropriate nutrition, exercise, and activity in hospice settings.
- Deregulation and Burden Reduction: In response to Executive Order 14192, CMS is requesting feedback on how to streamline Medicare regulations and reduce administrative burdens for hospice providers.
Comments can be submitted at CMS Regulatory Relief RFI.
What Providers Should Do Next
- Review the full proposed rule and its implications for your organization.
- Submit comments by June 30, 2025, particularly if your agency has feedback on the HOPE rollout, quality metrics, or regulatory burdens.
- Prepare for the HOPE transition by evaluating your current systems and staff readiness for iQIES and new data submission workflows.
- Stay tuned for CMS sub-regulatory guidance on HOPE data submissions and future public reporting.
In conclusion, the proposed rule reflects CMS’s continued efforts to modernize hospice care quality reporting, ensure accurate and timely payments, and reduce unnecessary administrative burdens. While the transition to HOPE poses challenges, proactive planning and engagement with CMS’s RFIs can help hospice providers shape a system that better reflects the realities of end-of-life care.
The final rule can be viewed at the Federal Register at: FR Document – 2025-06317
