Preparing for HOPE: Your Complete Guide to CMS’s New Hospice Assessment Tool

The Centers for Medicare & Medicaid Services (CMS) is implementing a major change in hospice documentation requirements. The Hospice Outcomes and Patient Evaluation (HOPE) tool will replace the Hospice Item Set (HIS) on October 1, 2025. This change aims to enhance data collection, support quality improvement, and refine hospice care processes. In a recent webinar, SimiTree experts Claudia Baker, RN, MHA, HCS-D, HCS-O, and Maureen E. Kelleher, RN, MBA, provided an in-depth guide to the new requirements.

Miss the live webinar? Watch the full recording and download the handout to get all the details.

Ready to prepare your organization for HOPE? Schedule a consultation with our implementation experts today.

What Is the HOPE Tool?

HOPE is designed to replace the HIS with new, standardized data collection points for CMS’s Hospice Quality Reporting Program (HQRP). It focuses on gathering data to:

• Provide quality metrics
• Support survey and certification processes
• Inform future payment and quality improvement initiatives

HOPE collects baseline and ongoing status data at key time points to enhance hospice care plans and support quality assurance and performance improvement (QAPI) efforts.

Understanding the HOPE Tool: Core Requirements

Required Assessment Schedule

The HOPE tool introduces four key data collection points:

• Admission Assessment: Completed within days 0-5 after hospice election
• HOPE Update Visit 1 (HUV1): Days 6-15
• HOPE Update Visit 2 (HUV2): Days 16-30
• Discharge Assessment: Completed at discharge

Additionally, Symptom Follow-up Visits (SFVs) must be completed within two calendar days of identifying moderate or severe symptoms.

Admission Requirements

To be considered admitted for HOPE purposes, all three of these conditions must be met:

1. A signed election statement (or other agreement for non-Medicare patients)
2. The patient must not have expired before the effective date of election
3. A visit must be made to the patient where hospice services will be provided.

Expanded Documentation and Follow-up Visit Requirements

Symptom Follow-up Visit Details

SFVs are triggered by moderate or severe symptom impacts identified during Admission or HUV assessments. These in-person visits must:

• Occur within 2 calendar days or later on the same day as the triggering assessment
• Be conducted separately from Admission or HUV visits
• Be limited to a maximum of 3 SFVs per hospice stay

Compliance Requirements

• Data Collection and Submission: Each data point must be submitted to QIES within 30 days.
• Staff Roles: RNs are responsible for clinical assessments, but administrative data can be collected by other staff. Each individual contributing to HOPE must sign off in Section Z.
• Documentation Standards: If a care process is not documented, it will be considered not to have occurred.

Questions Asked During The Webinar

• Q: The HOPE Admission has 3 requirements: Election Statement, Actual Visit, and Pt not dead before admission. How will these be tracked?
  A: By comparing NOE dates with the Admission date on the HOPE tool.
• Q: Why does J2053 (SFV Symptom Impact) have to be completed on Admission when this is supposedly the first time J2051 (Symptom Impact) was assessed? It just seems unreasonable to have an SFV required right after a Symptom Impact was just identified.
  A: The Symptom Impact is part of an RN assessment. If a patient rates a symptom as moderate or severe, a follow-up visit will be required within 2 calendar days.
• Q: Can I get a copy of the slides?
  A: Head over to our webinars page, locate this webinar, and you will see a link to the handout in the description.
• Q: Does the person verifying the information need to be an RN? I thought it did not.
  A: It is verified that it does not need to be a clinician. It is best practice to have a nurse sign off on verification of completion of the record. However, it is not required. Anyone who completes a section of the HOPE tool will be required to sign off on that section.
• Q: Based on the CMS templates, will the HUV version be used to complete an SFV?
  A: No, only the SFV section will be needed. It depends on the EMR system as to how they code this into a visit.
• Q: If an SFV goes from Severe to Moderate, will there be another SFV due in 2 days?
  A: If there is evidence of ongoing moderate or severe symptoms during an SFV, no additional SFV is required for HOPE. However, hospice staff is expected to continue following up with the patient based on their clinical and symptom management needs.
• Q: When will the HOPE Validation Tool be released?
  A: Check the CMS website for updates.
• Q: If we have a patient who had the HIS and we are discharging on October 3rd, would we do a discharge using HOPE?
  A: Further clarification is pending.
• Q: Not 6 visits—still only 4. The SFV is combined with the ADM, HUV1, and HUV2.
  A: The Follow-up visit is a separate visit from the ADM, HUV1, and HUV2. There will be a separate note for the date of the follow-up visit that will include the SFV impact.
• Q: Do the HUV1, HUV2, and symptom follow-up assessments need to be done by an RN?
  A: Per the manual, an LPN/LVN may complete the follow-up visit.
• Q: After the 30 days and a patient starts with a moderate or severe symptom, is an SFV required?
  A: So far, this only correlates to the ADM, HUV1, and HUV2 visit findings. There are no other HOPE assessment documentation requirements after 30 days until discharge.
• Q: Do agencies establish standards for “moderate” or “severe” impact responses?
  A: Using a scale of 0-10 (such as the ESAS scale or Pain scales), the standard is 4-6 for moderate and 7-10 for severe.
• Q: Can the follow-up visit be a phone call, or does it have to be in person?
  A: Per CMS, this must be an in-person visit.

Implementation Checklist

1. EMR System Preparation: Confirm readiness and test documentation templates.
2. Staff Training: Train all staff on new requirements and symptom impact assessments.
3. Process Updates: Develop tracking systems and QA protocols for timely submissions.
4. Read our recent blog that features a more detailed step-by-step on implementation.

Let us help you develop your HOPE implementation strategy.

Next Steps

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.

About the Presenters:
Claudia Baker, RN, MHA, HCS-D, HCS-O, and Maureen E. Kelleher, RN, MBA, are experts in hospice compliance and operations with over 50 years of combined experience.