The Centers for Medicare & Medicaid Services (CMS) has released the 2026 Hospice Proposed Rule, outlining important updates that will impact providers across the industry. The proposed changes reflect CMS’s continued focus on quality, transparency, program integrity, and payment updates. Below are the key takeaways your hospice agency needs to know to prepare for the changes ahead.
Proposed Payment Rate Increase
CMS proposes a 2.4% payment increase for hospices in FY 2026, translating to approximately $695 million in additional payments industry-wide. This increase is based on a 3.2% market basket update, offset by a 0.8 percentage point productivity adjustment.
Key Insight: While a positive adjustment, providers must still account for inflationary pressures and workforce challenges that continue to affect operating costs, as well as the cap amount which also increased 2.4%.
Hospice Outcomes & Patient Evaluation (HOPE) Update
CMS reaffirmed its plan to implement HOPE as the new standardized patient assessment tool to replace the current HIS (Hospice Item Set). HOPE is intended to improve the collection of clinical data throughout the patient’s stay.
Key Insight: Providers should continue preparing for HOPE by training clinicians, updating documentation workflows, and understanding how this tool will influence quality measures and care planning.
Check out the HOPE Success Center, a centralized web page to help guide your hospice organization through the transition to the HOPE tool. This page includes insights, links, and education from the Netsmart, McBee, and Simple teams to support accurate coding, compliance, and care quality as the HOPE implementation approaches on October 1st, 2025.
Quality Reporting Program (QRP) Enhancements
CMS is requesting information for the addition of new quality measures and modifications to the Hospice Quality Reporting Program (HQRP). These updates include requests for information on EHR capabilities and aim to enhance patient-centered care and ensure a better evaluation of hospice services.
Key Insight: Stay alert for new measure specifications and begin assessing how your current performance data aligns with upcoming expectations. CMS announced new information will be added to the HQRP manual soon.
Changes Regarding Admission and Face-to-Face
The proposed rule describes the physician who can certify terminal illness and determine patient admission to hospice care to include the physician member of the IDG.
CMS inadvertently omitted from the Face-to-Face encounter regulatory text at § 418.22(b)(4) the explicit requirements that the attestation include the accompanying signature of the practitioner who performed the face-to-face encounter, and the date signed. That omission will be corrected according to the proposed rule.
Advancing Health Equity Through Data Collection
The proposed rule outlines CMS’s intent to require standardized patient assessment data elements (SPADEs) related to health equity, including race, ethnicity, language, and social determinants of health (SDoH).
Key Insight: Agencies will need to develop processes for collecting and reporting these data points accurately and consistently.
Increased Oversight and Transparency
CMS continues to prioritize program integrity and proposes measures to strengthen oversight of hospice agencies. This includes public reporting initiatives and potential updates to survey and enforcement processes.
Key Insight: With growing scrutiny in the hospice space, especially around eligibility and billing practices, now is the time to reinforce compliance programs and audit documentation processes.
Rebasing Payment Rates (Anticipated Future Change)
Though not implemented in this rule, CMS signaled interest in rebasing the hospice payment rates in future years to ensure payments more accurately reflect the cost of providing care.
Key Insight: Providers should begin evaluating their cost structures and care delivery models to prepare for potential rebasing impacts in future rulemaking. Additionally, a review of their cost reporting process can also add value.
Final Thoughts
The 2026 Hospice Proposed Rule reflects CMS’s ongoing efforts to improve hospice care delivery, ensure payment accuracy, and increase transparency across the board. Hospice agencies should proactively assess how these changes will affect operations, quality reporting, and compliance readiness.
Stay tuned for the final rule later this year, and in the meantime, consider how your organization can prepare—from staff training and data tracking to coding accuracy and documentation improvement.
Need help navigating the proposed changes? McBee is here to support your hospice with compliance, education, and strategic guidance.
About the Author
Lisa Selman-Holman, VP of Clinical Services
Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, is the VP of Clinical Services at McBee, bringing over 35 years of expertise in home health and hospice. As a registered nurse and home care attorney, she specializes in regulatory compliance. Lisa has held various roles, from field nurse to executive, managing accreditation surveys, acquisitions, and regulatory crises. In 2004, she founded Selman-Holman & Associates, offering consulting, coding and OASIS review services. Lisa is a renowned educator, known for turning challenges into achievements. Joining McBee in 2021, she leads education initiatives at the Post-Acute Academy, providing courses for home health and hospice staff and executives, including clinical, regulatory and onboarding requirements.
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