2027 Hospice Proposed Rule: Key Payment Updates, SSVI, and What Providers Need to Know

The Hospice 2027 Proposed Payment and Wage Index Rule has officially been released, and it’s one of the most comprehensive updates the hospice industry has seen in recent years. Issued at the beginning of April, this proposed rule goes beyond routine payment adjustments, introducing a broader range of policy updates and new considerations that providers need to understand and prepare for.

PROPOSED PAYMENT ADJUSTMENT

We’ll start with the topic everyone is most interested in: rate changes. The proposed rule includes a net increase of 2.4%, reflecting a 3.2% market basket update offset by a 0.8% productivity adjustment. This same 2.4% increase would also apply to the Hospice Cap, bringing it to just over $36,200 for 2027.

SERVICE AND SPENDING VARIATION INDEX (SSVI)

The Service and Spending Variation Index (SSVI) is a new item we haven’t seen before. It’s a newly developed index designed to assign a score to every Medicare-certified hospice, with the goal of monitoring performance and identifying outliers across a wide range of measures.

Part of this includes tracking spending on hospice patients for services not covered by the hospice itself. This refers to Part B and Part D services, which have been highlighted in OIG reports over the past several years and will now factor into the index calculation. The goal is to help identify hospices that stand out as outliers in these areas. The proposed rule also includes a summary outlining how many agencies fall into each category.

ELECTION STATEMENT ADDENDUM

The proposed rule would make the Election Statement Addendum mandatory for all Medicare patients when they elect the Hospice Benefit. Currently, this addendum is only provided upon request by the patient or their caregiver. Under the proposed change, it would be required to be given to every patient at the time of election.

DISCHARGE & FACE-TO-FACE ENCOUNTER UPDATES

Technical revisions have been proposed to clarify that physicians who are part of the Hospice Interdisciplinary Group (IDG), in addition to Medical Directors, are authorized to discharge patients. Additionally, the text is being updated to reflect the Face-to-Face Encounter policy changes introduced under the Consolidated Appropriations Act of 2026.

HOPE SUBMISSIONS

There is some good news regarding HOPE as we entered the fourth quarter of 2025, when providers were required to begin both completing and submitting HOPE data as part of the Hospice Quality Reporting Program. In the proposed rule, CMS stated that all HOPE submissions for Q4 2025 will be considered timely. This means that any challenges with submitting HOPE data during that period should not negatively impact your compliance calculations.

They are proposing to add an indicator on the Care Compare site at Medicare.gov that would flag any hospice failing to participate in and submit HOPE assessments. While it may be surprising, there are still hospices that have not complied with the Hospice Quality Reporting Program requirements, including both HIS submissions and now HOPE reporting.

REQUESTS FOR INFORMATION

Lastly, the rule includes three requests for information. These are not proposed changes for 2027, but areas where CMS is seeking feedback for potential future action. These include expanding access to community-based palliative care services under the Medicare benefit, developing a hospice-specific wage index (as the current index is based on hospital cost report data), and examining the intersection between hospice care and Medical Aid in Dying (MAID).

As mentioned earlier, this is a comprehensive and detailed proposed rule. HPS will continue to break it down and share additional insights, particularly around the Service and Spending Variation Index (SSVI). For any other support your hospice agency might need, or for assistance in understanding the Hospice Proposed Rule, please feel free to reach out to us.

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