FY 2026 Proposed Hospice Rule: Key Updates and Impacts from SimiTree Webinar

The Centers for Medicare & Medicaid Services (CMS) has released the Fiscal Year 2026 Proposed Hospice Rule. In a recent webinar hosted by SimiTree, experts Michael Simione, VP of Post-Acute Data Analytics, and Maureen Kelleher, Consulting Senior Manager, broke down the major changes and impacts hospices should prepare for in the coming year.

Payment Rate Updates for FY 2026

CMS has proposed a 2.4% payment increase for hospice services in FY 2026, representing approximately $695 million in additional Medicare spending compared to FY 2025. As Simione explained during the webinar, “This comes from a 3.2% market basket update with a negative 0.8% productivity adjustment.”

Key rate changes include:

  • Routine Home Care (Days 1-60): Increasing from $224.62 to $230.33
  • Routine Home Care (Days 61+): Increasing from $176.92 to $181.51
  • Continuous Home Care: Increasing from $1,618.59 ($67.44/hour) to $1,665.23 ($69.38/hour)
  • Inpatient Respite Care: Increasing from $518.78 to $531.60
  • General Inpatient Care: Increasing from $1,170.04 to $1,197.40

The hospice cap amount will also increase to $35,292.51, up from $34,465.34 in FY 2025.

Simione emphasized that while the rate increase is welcome, cost report data shows hospice expenses are rising faster than reimbursement rates. “The reality is that the rate of increase is not matching costs,” he noted, pointing to data showing routine home care costs increased from $143 to $152 per day between 2022 and 2023.

Wage Index Updates

The webinar highlighted how the wage index changes will affect hospices differently across regions. CMS will maintain the 5% cap on wage index losses from the FY 2025 Final Rule, but there is no cap on wage index increases.

Using specific examples, Simione demonstrated how these changes will impact providers in different locations:

  • Albany, GA (with a -5% wage index change): Will see an actual rate decrease of about 0.8%
  • Newark, NJ (with a -0.1% wage index change): Will see an increase of about 2.5%
  • Toledo, OH (with a +5% wage index change): Will see increases between 5.7-6.6%

“It’s important to look at it locally, not just nationally, and understand the impact on your particular agency,” Simione advised webinar attendees.

Face-to-Face Attestation Requirements

Kelleher explained that the proposed rule includes clarifying language regarding face-to-face attestation requirements. “There was inconsistency in the language regarding the signature and date of the attestation by the nurse practitioner on prior rules,” she noted.

Key updates include:

  • The attestation must be a separate and distinct section of the recertification form
  • It must include the signature of the physician or NP who conducted the face-to-face encounter
  • If performed by someone other than the certifying physician, the attestation must state that clinical findings were provided to the certifying physician

“Most EMR systems already have this built into the certifications,” Kelleher said, “but please make sure that yours is correct.”

Clarification on Hospice Admission Eligibility

The proposed rule clarifies which physicians can determine patient eligibility for hospice care. “There was apparently a lot of confusion on the term ‘physician designee’,” Kelleher explained. The revised language explicitly states that physician members of the hospice interdisciplinary group can certify terminal illness.

Hospice Quality Reporting Program Updates and HOPE Implementation

The webinar dedicated significant time to discussing the transition from the Hospice Item Set (HIS) to the new Hospice Outcomes & Patient Evaluation (HOPE) tool:

  • HIS will end on September 30, 2025
  • HOPE implementation begins October 1, 2025
  • HIS records must be submitted through QIES
  • HOPE data must be submitted through the iQIES system
  • QIES will stop accepting HIS records on February 15, 2026

Kelleher stressed the importance of establishing iQIES accounts before October 2025: “The last thing you want to do is find out that your facility ID was wrong, or that it’s not connecting, or your files are going into cyberspace, and nobody is seeing them.”

HOPE Visit Requirements

The webinar highlighted how HOPE will increase visit requirements:

  • Admission assessment (within 5 days of effective date)
  • First update visit (days 6-15)
  • Second update visit (days 16-30)
  • Symptom-focused visits within 48 hours when moderate or severe symptoms are identified
  • Up to three symptom-focused visits may be required

“This is going to impact staffing availability,” Kelleher warned, noting that providers could need to conduct 6-7 visits in a 30-day period for some patients.

Get Ready for the HOPE Tool — Webinar July 30, 2025 

As you already know, the HOPE tool goes into effect on October 1, 2025. 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 

Register now to receive the recording and handout. And if you’re reading this after October 1st, don’t worry! The recording is available on our webinars page.

Free Resources Available to you NOW

HOPE introduces significant changes in hospice documentation and assessment. Success will require careful planning, comprehensive staff training, and robust tracking systems.
Still have questions? Watch the full webinar recording to hear our experts address common concerns.
Don’t wait until October 2025. Start your HOPE preparation now. Schedule a consultation with our experts.

And as hospices navigate these regulatory changes, SimiTree offers comprehensive consulting services to help providers:

SimiTree’s experts can also assist hospices in providing data-driven comments to CMS during the open comment period, helping to advocate for rates that better reflect rising operational costs.

Let us help you develop your HOPE implementation strategy.

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The webinar presenters encouraged hospices to begin preparing now for these changes, particularly the implementation of the HOPE tool. With public reporting of HOPE measures set to begin in Fall 2027, providers have limited time to adapt their operations and ensure compliance with these new requirements.

For more information on how SimiTree can help your hospice prepare for these regulatory changes, contact us at ContactUs@SimiTreeHC.com or call 800.949.0388.

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