On August 1, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program (HQRP) Final Rule (CMS-1835-F). This rule outlines key updates to hospice payment policy, quality reporting, and regulatory requirements effective October 1, 2025. For FY 2026,…
On August 1, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program (HQRP) Final Rule (CMS-1835-F). This rule outlines key updates to hospice payment policy, quality reporting, and regulatory requirements effective October 1, 2025.
For FY 2026, CMS finalized a 2.6% increase in the hospice base payment rate which is higher than the 2.4% increase initially proposed in April. The hospice aggregate payment cap will also rise by 2.6%, increasing from $34,465.34 to $35,361.44 for FY 2026. This update is expected to result in approximately $750 million in additional hospice payments compared to FY 2025.
CMS will maintain its policy of limiting annual decreases to the wage index to no more than 5%, helping cushion providers from drastic reimbursement drops due to geographic reclassification.
Several regulatory updates are aimed at aligning hospice policies and easing documentation burdens:
- Hospice Admission Authority: CMS clarified that the physician member of the interdisciplinary group (IDG) may now recommend hospice admission, aligning admission practices with the current certification regulations at §418.22(c)(1)(i) and the Conditions of Participation (CoPs) at §418.102(b).
- Face-to-Face Encounter Attestation: CMS revised its face-to-face (F2F) attestation requirements to further allow a signed and dated clinical note by a hospice physician or nurse practitioner to satisfy requirements at §418.22(b)(4), eliminating the need for a separate attestation form. This change reduces administrative burden while maintaining compliance and correcting a long-standing regulatory omission.
A major focus of the final rule is the implementation of the Hospice Outcomes and Patient Evaluation (HOPE) tool, which will replace the current Hospice Item Set (HIS). Despite widespread industry concerns, CMS is moving forward with an October 1, 2025, implementation date.
Data submission will transition to the Internet Quality Improvement and Evaluation System (iQIES) platform. QIES will no longer accept HIS records after February 15, 2026. Providers must ensure enrollment in iQIES and begin preparing staff and systems for compliance with HOPE and iQIES requirements.
Hospices will be required to submit at least 90% of HOPE records (admission, discharge, and up to two update visits per patient) within 30 days of the event to avoid non-compliance with timeliness. Failure to meet this threshold will result in a 4% reduction in the annual payment update. This penalty underscores the importance of timely and complete quality data reporting.
Next Steps for Hospice Providers
Given the financial and operational implications, hospice leaders should:
- Review their wage index updates to assess local payment impacts.
- Update internal policies to reflect admission and attestation clarifications.
- Begin preparing for the HOPE and iQIES transition, including system upgrades, staff training, and vendor coordination.
- Monitor compliance with HQRP requirements to avoid payment reductions.
This final rule reflects CMS’s ongoing efforts to modernize hospice care through enhanced data collection, streamlined documentation, and greater alignment of clinical operations with regulatory standards.
The final rule can be viewed at the Federal Register at: https://www.federalregister.gov/public-inspection.
