The Hospice Outcomes and Patient Evaluation Tool, or HOPE Tool, is a clinical assessment tool that will completely replace the HIS, and will be mandatory for all patients, regardless of their payer or age. The HOPE Tool has been in development for quite some time and, although it was finalized in the 2025 Hospice Final Rule, it won’t officially take effect until October 1, 2025. It will require up to four visits per patient, depending on the length of stay.
The HOPE Tool will require an admission assessment to be completed within the first 5 days after a patient is admitted to hospice care. Following this, there will be two update visits: one between days 6 and 15, and another between days 16 and 30, provided the patient remains in hospice care for at least 16-17 days.
There will also be a HOPE discharge assessment. Unlike the current HIS, which is only completed at admission and discharge, the new HOPE Tool will require two additional update visits if the patient remains on hospice service for at least 17 days.
The implementation of the HOPE Tool will start on October 1, 2025. However, it will not affect outcome scoring and public reporting until the fiscal year 2028, which begins on October 1, 2027.
The HOPE Tool will be included in the compliance requirements for the Hospice Quality Reporting Program. It will fully replace the HIS, which currently mandates that 90% of HIS data be transmitted and accepted into the database within 30 days of completion. With the HOPE Tool, transmission will need to occur within 30 days of the event or completion date—events being admission and discharge, and the completion date being within 30 days from the update visits, depending on when those assessments are actually completed within the specified time frames.
If you do not achieve 90% compliance with timely transmission of the HOPE Tool, you will face a 4% payment reduction in subsequent years. It’s important to note that the Annual Payment Update (APU) is based on the fiscal year, while compliance is calculated on a calendar year basis. For example, for the HIS in calendar year 2023 (January through December), the compliance affects the payment update for fiscal year 2025, which begins on October 1, 2024. Similarly, when the HOPE Tool starts in October 2025, it is expected that the 90% compliance requirement will apply to both HIS and HOPE data from January 1 to December 31, 2025. The results of this compliance period will affect the payment update for fiscal year 2027, which begins on October 1, 2026.
It’s also important to remember that the CAHPS Hospice Survey is part of the quality compliance requirements. To be compliant, you need to use a CMS-approved vendor to conduct your CAHPS surveys, and the vendor must submit the data on your behalf in a timely manner. The CAHPS Survey is also based on the calendar year; however, it is one year behind the calendar year data used for the HIS and the upcoming HOPE Tool.
I also want to point out that the HIS will impact outcome measures related to symptom management. Specifically, two measures—the Timely Reassessment of Pain Impact and the Timely Reassessment of Non-Pain Impact of Symptoms—will rely on data from the HOPE Tool. If a patient has any symptoms, whether pain-related or not, that are marked as moderate or severe, you will need to follow up and document your actions within two calendar days to meet the required timeframe.
Patients will be excluded from these calculated measures in several situations: if the patient dies or is discharged within two days, if the reassessment visit is refused after an attempt to conduct it within the two-day window, if the patient cannot be contacted or located, if the patient is in the ER or hospital, or if the patient has traveled outside of your service area and is essentially considered discharged.
October 2025 will be here before you know it, and it’s important to ensure that your staff is thoroughly trained well before October 1, 2025, to meet compliance requirements. This preparation will help you stay compliant with transmission requirements for both the HIS and the upcoming HOPE Tool.
Should you need more information regarding the HOPE Tool, or have specific requests HPS can help, please feel free to reach out to us.
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