2026 Hospice Proposed Rule Released

The proposed rule is currently in its unpublished format, can be viewed here. It is scheduled to be published in the Federal Register on April 30th. Once it’s published, there will be a 60-day comment period. Make sure to submit comments on any concerns you may have. Positive feedback is welcome, but it’s especially important to raise any issues or objections. You can share your comments through your state association, through the National Alliance, or submit them directly online. Please note, the option to submit comments will only be available after the official publication on April 30th.

PROPOSED PAYMENT ADJUSTMENT

The first major update is a 2.4% increase in Hospice payment rates across all levels of care. Additionally, as finalized previously, the Hospice Cap will also rise by the same percentage as the annual payment update. This results in a new Hospice Cap amount of $35,292.51.

FACE-TO-FACE ENCOUNTERS

The current face-to-face encounter attestation requirements state that the physician or nurse practitioner must confirm that the encounter has taken place. However, the existing regulation does not clearly specify that this attestation must be signed and dated. The updated regulation will clarify this by specifically requiring a signature.

HOSPICE ADMISSION REQUIREMENTS

The proposed rule also includes changes to the Hospice admission requirements. As you may know, it was recently clarified that the Certificate of Terminal Illness could be signed by either the Medical Director or the Physician Member of the IDG, not just the Medical Director. If finalized, the updated rule would expand the admission requirements, allowing a Hospice Physician Member of the IDG, in addition to the Attending Physician named by the patient and the Hospice Medical Director, to recommend a patient for admission to Hospice.

HOSPICE QUALITY REPORTING PROGRAM

The request for information included in this proposed rule pertains specifically to the Hospice Quality Reporting Program. We will provide further updates on this in a future Monday Minute.

THE HOPE TOOL

There was no mention of any issues related to the implementation of the HOPE Tool, which is currently scheduled for October 1, 2025. While the proposed rule doesn’t address any concerns, there are still concerns. The HOPE Tool is expected to be operational on October 1, 2025, but the main issue is the required transition from the QIES system, currently used for transmitting HIS, to the iQIES system, which will be used for the HOPE Tool.

The transition has not yet been finalized, meaning hospices have not received definitive information on when it will happen, how it will take place, or what steps they need to take to prepare. It can be a complicated process, and previous transitions from QIES to iQIES for other healthcare entities have not been smooth.

There is also a software application that will be used within EMR systems to extract the HOPE file, which will then be transmitted through the iQIES system. To my knowledge, that application has not yet been finalized.

It’s important to ensure that if your EMR systems are providing any updates regarding the transition to HOPE in October, you are actively participating in those updates and staying closely aligned. Be sure to continue or start, if you haven’t already, educating your staff on the content of the HOPE Tool. This assessment must be completed based on a true clinical evaluation of the patient, preferably while the clinician is in their home. The HOPE will require more frequent completion than the HIS, and the questions are more clinically focused than some of the HIS details. Ensure you begin educating your field staff on the HOPE content and how these assessments will need to be carried out.

Should you need assistance in understanding or commenting on the Hospice Proposed Rule, or if you need any assistance with HOPE Tool education, please feel free to reach out to us.

We will be holding a 2-day Hospice workshop in Nashville, TN this June, where we will offer two full sessions on HOPE education. To register for this year’s HPS Alliance Hospice Workshop, click here.

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