CMS Releases Proposed 2026 Hospice Rule: What It Means for Hospice Billing, Compliance & Care
The Centers for Medicare & Medicaid Services (CMS) has released its proposed 2026 hospice rule on Friday, April 11, 2025, outlining payment increases, updated hospice quality reporting requirements, and stricter compliance oversight. For providers navigating the complexities of hospice billing, hospice consulting, and regulatory planning, this rule presents both challenges and opportunities.
This post breaks down CMS’ proposal including insights originally reported by Hospice News.
Proposed Payment Changes: Limited Relief for Providers
CMS proposes a 2.4% increase in per diem payments, totaling an estimated $695 million in additional hospice payments for FY 2026. While this may offer slight financial relief, the increase is lower than the 2.9% finalized for 2025, raising concerns about sustainability amid rising costs.
The hospice cap amount would increase to $35,292.51, and wage index caps would remain at 5%. These updates directly impact hospice revenue cycle management efforts, especially for agencies operating in high-wage markets.
Regulatory & Compliance Updates for Hospice Providers
For those involved in hospice compliance consulting or managing home health and hospice compliance programs, several regulatory changes require close attention:
- Only a hospice medical director or interdisciplinary team physician may recertify a patient during subsequent care periods.
- A face-to-face, in-person visit by a physician or nurse practitioner is required to complete each recertification.
- CMS seeks to better align Conditions of Participation (CoPs) with Conditions of Payment.
These updates emphasize the need for robust internal processes and training—an area where experienced hospice consulting partners can provide essential support.
Hospice Quality Reporting: HOPE Tool Takes Center Stage
CMS is advancing the implementation of the Hospice Outcomes and Patient Evaluation (HOPE) tool by October 2025. The new system will eventually replace the current Hospice Item Set (HIS), aiming to improve hospice quality reporting and patient assessments.
The tool will track critical care metrics such as:
- Pain assessment and treatment
- Dyspnea screening and management
- Opioid bowel regimens
- Patient values and treatment preferences
However, provider groups have expressed concern that CMS hasn’t offered enough clarity around the HOPE tool rollout, leaving hospices and vendors scrambling to prepare. Thoughtful implementation will be key to maintaining care quality without disrupting operations. Get help with HOPE now.
Hospice Program Integrity: Growing Oversight and Audits
CMS is continuing its crackdown on fraud and abuse, especially in regions like Arizona, California, Nevada, and Texas. With rising audit activity and inconsistent enforcement outcomes, hospice providers face increasing administrative burdens.
This climate highlights the importance of working with a trusted hospice compliance consulting team to stay ahead of documentation requirements, eligibility rules, and evolving audit protocols.
What Should Hospice Providers Do Now?
To prepare for the changes outlined in the 2026 hospice proposed rule, SimiTree recommends providers:
- Evaluate hospice billing and revenue cycle strategies
- Prepare for HOPE tool integration
- Train teams on revised recertification protocols
- Strengthen compliance documentation and audit readiness
Want to ensure your agency is fully prepared for 2026? SimiTree’s hospice consulting experts are ready to support you with regulatory insights, hospice billing solutions, and full-spectrum compliance consulting.
Not sure where to begin? Contact us to schedule a consultation.
Get Ready for the HOPE Tool — Webinar July 30, 2025
As you already know, the HOPE tool goes into effect October 1. Is your hospice team prepared? Join SimiTree’s Claudia Baker and Maureen Kelleher for a practical, in-depth look at what the HOPE tool means for your operations, including assessment timing, documentation workflows, and strategies for a smooth rollout. Register Now!
You’ll learn:
- What the HOPE tool looks like and how it works
- What’s changing from your current processes
- How to prepare your clinicians and QA teams