Decoding the 2026 Proposed Hospice Rule

The fiscal year 2026 proposed hospice rule brings cautious optimism to providers with a projected 2.4% payment increase, though experienced hospices know to factor in the ongoing 2% sequestration when calculating their bottom line. For those who've long struggled with regulatory inconsistencies, this rule delivers welcome clarification on who can certify hospice eligibility, aligning payment regulations with Conditions of Participation after years of confusion.

Most significantly, CMS confirms the HOPE assessment tool will launch on October 1, 2025, as scheduled. Despite earlier speculation about potential delays, hospices should maintain implementation momentum, with CMS planning one final training session this summer. Face-to-face attestation requirements also receive much-needed clarification, potentially reducing one of the top reasons for claim denials.

Beyond operational updates, CMS seeks provider input through several Requests for Information. They're exploring digital quality measurement using FHIR-based reporting, considering new quality measures around well-being and nutrition, and looking for opportunities to streamline regulations and reduce administrative burden. This represents a genuine opportunity for hospice providers to shape future requirements.

The relatively slim 62-page rule contains consequential changes that demand attention. Providers should thoroughly review the complete document, evaluate potential financial impacts, coordinate with state and national associations on comments, and ensure staff education aligns with the clarified regulations. With the comment period closing June 10 and the final rule expected in early August, the time to prepare is now. Let your voice be heard on these important changes that will influence hospice care delivery and reimbursement for years to come.

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Transcript

Introduction to FY2026 Hospice Rule

Speaker 1 0:06

Greetings. I'm Jennifer Kennedy, the lead for compliance and quality at CHAP, and welcome to this CHAPcast. So today, what we've got up on deck and I'm so thrilled to be able to talk this over with my colleague and longtime friend, Kim Skehan, who is our VP for accreditation what we're going to be talking about is the newly posted fiscal year 2026 proposed hospice rule. That's the payment update rule that did post in the Federal Register on the public inspection desk on April 11th and it looks like they're going to be posting it in the Federal Register proper on the 30th. So this is what we're going to discuss today. We'll hit on some of the highlights of the rule and give you our thoughts about some of the detail that is in there. So, Kim, thanks for being my partner on this. I know we always have robust conversations over rules, don't we?

Speaker 2 1:15

Absolutely, jennifer. This is so many years in the making, both of us with our communication, our talking through, looking at all of these rules proposed and final and regulatory changes, so this is par for the course. I'm happy to be on this ride With this particular proposed rule. It appears as though it is light in terms of there's not a lot of heavy lift. There was, of course, the wage index updates and the cap updates as well.

Speaker 2 1:47

We are not I will be the first to admit we're not finance folks and we absolutely defer to the finance experts, both within organizations and both of your finance teams, as well as the state and national associations and the consultants or firms out there. Many of them are CHAP certified consultants who can also help navigate and evaluate what the impact of any of the changes would be, which, overall, appear at the moment to be positive. But also the other parts to the proposed rule that I think we can discuss are related to the payment. I mean the clarification on some of the regulations, a couple of them, as well as clarifying the text for hope and those requests for information. So I think that this is requests for information. So I think that this is.

Payment Updates and Financial Impact

Speaker 1 3:02

You know, it's a good opportunity for providers to, you know, understand those aspects as well as be able to evaluate themselves, their impact, the impact on providers. So, kim, before we get to some of those topics, you know I have to say that I was a little bit surprised that there is a proposed increase of 4%. No, not 4%, 2.4%, sorry about that. That would be great if it was 4%, wouldn't it? Yeah, I mean. So that's great.

Speaker 1 3:28

Well, whether it holds till the final rule will remain to be seen, and CMS states that openly. You know if any other information comes to light, you know that could affect whether the 2.4 sticks or not till the final rule. And you know just a reminder too to providers out there listening that the 2% sequestration deduction will remain in place. So you have to do that calculation with the national 2.4% update, with some consideration of that sequestration and then also the wage adjustment for state and county, which may affect exactly what you're going to get on the back end. So I just felt like I was compelled to say that in terms of the rates. But you know, let's talk about some of the clarifications, kim, that CMS added into the rule, revolving around some of the regulatory text.

Speaker 2 4:37

Okay, just before we do, I just wanted to just add a couple more comments related to the wage index and just reminders, all excellent points that you have raised as well. Over the past several, the few years, CMS, it has been an overall increase year over year with hospice rates and you can see that trend, certainly the last few years, and it is anticipated, or at least they remain the same. They haven't been reduced. But that being said, that also does not include the 4% reduction that a hospice would also experience if they did not participate in the Hospice Quality Reporting Program. And if, in fact, the 2.4% overall remained in place and a hospice had a 4% reduction, they would end up with, you know, minus the 4% penalty, it would be a 1.6 reduction. In other words, instead of your 2.4% increase, you'd end up with a 1.6% reduction, not counting, factoring in the CBSA and those other factors that you had indicated. So they really, in addition, expenses have increased across all hospices.

Speaker 2 5:58

So, this is a factor that hospices need to continually be aware of and monitor, and reach out to experts to assist.

Regulatory Text Clarifications

Speaker 1 6:07

Yeah, you know, I don't know any hospice that would be able to, you know, take a 4% cut for and remember it's either consciously not submitting data right or for some reason you're not compliant with the actual data submission, meaning that submission of records doesn't equal acceptance of records. And if a hospice doesn't meet that 95% threshold I'm sorry, the 90% threshold at least for their HIS then they get the dreaded letter in June, right, that says you're going to have a cut on your rate on an alternating fiscal year. So yeah, thanks for clarifying some of that out there, but 4%, nobody can take that.

Speaker 2 6:58

Right, absolutely so. In moving on to the non-wage index, the regulatory clarifications that have been introduced in the proposed rule years ago when there was mass confusion appeared anyway between both CMS, state agencies and AOs across the board regarding who can certify a patient for eligibility, and I know many providers also were heavily involved and affected at the time. So, changing the language to include the you know, the physician member of the hospice interdisciplinary group versus just the hospice, the language that talks about the medical director or physician designee, and really to align you know the payment reg with the COPs as well, right, the regulatory language. We want to make sure that that is clear, you know, for providers. I think that this is a big relief.

Speaker 1 8:22

Yeah, it is, and it's taken so much time and effort to try to just get some of this text aligned. So, yeah, I am actually doing a happy dance you can't see me, but I am doing it. This is going to be really, I think, a benefit for providers, particularly, you know, when you get into the audit realm, and sometimes it's all about how the regulatory text reads right.

Speaker 2 8:47

Absolutely, and I know that at CHAP, you know, we will update the standards, should this, you know, once the final rule is published related to this. So that's, that's a great, that's a great point, right.

HOPE Assessment Implementation Timeline

Speaker 1 9:04

Absolutely, and you know. The next thing that appeared in the rule was, you know, indeed, the clarification that the HOPE assessment tool will implement on October 1. There were lots of rumors circulating, I think, in like March-ish, end of February, that, oh, you know, the rule isn't going to go. You know the new administration in DC is anti-regulatory, so there was rumor circulating that the HOPE tool might get pulled back because of that. But what we're seeing here in this rule is that, yeah, we're going to go. October 1, 2025 is our go date. So CMS said that they are going to at least provide one more training session for hospice providers sometime in the summer the summer. So you know, before that happens, kim, when we're talking about supporting our providers with hope, you know what are some things that come to your mind about having them stay the course so that they are ready for implementation.

Speaker 2 10:21

I mean, really, hospice providers and EMRs should be anticipating the October 1st implementation date and actively working to implement those requirements and testing the requirements, certainly from an EMR capability standpoint, but from a hospice provider standpoint, not waiting for the EMR right, you have to make sure that the staff are aware of what the hope is, what the process is going to be, what aspects of assessment and data collection they need to know and your own internal processes, you know, notwithstanding what the EMR you know will be offering. Obviously, you have to make sure that you're working with the EMR closely to know those timelines and deadlines. But can't, you know, not wait until you know you have that information available and stay tuned, because we really don't. I mean, we are saying October 1st, you know, and but I would absolutely say, stay tuned, you know, for updates from CMS as well as the state and national associations.

Face-to-Face Requirements and RFIs

Speaker 1 11:36

Absolutely, and we did see CMS update the Hope materials on the 22nd of April. So that's something that providers need to pay attention to, and CHAP has been producing a blog series about being ready for the HOPE implementation. Our next blog is going to be out shortly, and we also developed what we're calling a HOPE Q&A repository. So any Q&As that come out formally from CMS in writing, or Q&As that we've, as CHAP, have sent to the HOPE folks up at CMS and get a response back, we're putting them all in one document in a one-stop shop. So that's actually going to be updated shortly as well. So we're here to help. Kim and I have been out and about talking about HOPE in the last what like nine months, so if you have any questions, we're happy to help. But the main idea here from this rule is that we are a go and you should keep your implementation readiness going.

Speaker 2 12:49

I just wanted to touch on the face-to-face attestation clarification. Basically, here the language has not changed from the fiscal year 2011 final rule, when face-to-face was implemented for third benefit period or later. To face was implemented for third benefit period or later. However, in the fiscal year of 2012 final rule, they left out some of the instruction, if you will, some of the language that specified, you know, the completion of the attestation by the physician or NP and what the signature and date requirements. So this clarification just outlines what those requirements are or restates it. Um, so providers should be look at this closely because, because it was left off of 2012, there was some confusion and inconsistencies. Now, from a survey perspective, we don't focus on the specific content of the face-to-face so much or the technical aspects, if you will, but from a payment standpoint, you know, especially if you have an ADR or any sort of an audit, you want to make sure that you are meeting these requirements.

Speaker 1 14:05

Absolutely. And when you look at those top reasons for claims denials, the face-to-face is up there, along with other certification issues.

Speaker 2 14:19

So, jennifer, was there also a request for information?

Speaker 1 14:25

Yeah, there were several actually, Kim. I'm going to do my best with this first one because it's a little bit technical. Cms is actually asking for some feedback to advance digital quality measurement in the specific hospice quality reporting programs. So, if you remember, several years back CMS did put out an initiative for digital measure transparency and they promoted that by using interoperable health information technology called FHIR, and by the use of this they were trying to leverage technology to streamline the collection of measures. So CMS is looking at and considering opportunities using this FHIR-based reporting in the hospice realm. Specifically, they're going to be asking in this RFI many different questions that I think you're going to definitely, as a provider, need the help of your IT person to help you answer these questions, if you choose to comment. But they're looking for feedback on a variety of questions regarding how providers use IT, including their electronic health records, in the hospice realm. So I think that one is going to be important for providers to take a look at and get your IT person involved and give them the feedback that they're asking for.

Speaker 1 16:21

The next one is looking for feedback on future quality measure concepts for the HQRP program.

Speaker 1 16:31

Specifically, Kim, they're looking for feedback on interoperability, which sort of dovetails into what we just talked about well-being and nutrition, and there's various questions within the rule specifically asking about each of these areas.

Call to Action and Next Steps

Speaker 1 16:53

And then the final request for information is directly related to an executive order that President Trump put out in January around deregulation. Trump put out in January around deregulation, and what this RFI is asking for is public input on opportunities to streamline regulations and reduce administrative burden on providers, and that is you hospice providers out there in podcast land that are listening to us now. So what we always do and, Kim, please tack on to this for sure is that we encourage providers to send comments to rules. It is you giving transparent, authentic feedback about something that they're asking about, and if you don't give the feedback, CMS is going to do whatever they think they should initiate, regardless of the facts right, or regardless of reality out there in your day-to-day operations. So it's really, really important for providers to either take up the keyboard and send in their comments. Send in their comments or maybe you're going to tack on or use tucking points from either your state or your national organization if you belong to one, but it's extremely important to take the opportunity to comment. Kim, any thoughts on that?

Speaker 2 18:45

Oh, I absolutely agree and, of course, having state association experience and involvement with the National Association as a member, I absolutely believe in the power of advocacy and have seen over decades the responses and the effect of submitting comments, and I do agree with aligning also with your state and or national association in terms of submitting those requirements. A couple of things I just. I'm finding it interesting that we are that CMS is focusing on. They're asking for comment on well-being and nutrition. I think those are quality measures that are certainly worth exploring. I don't think we've had a lot of context about those up until now. But the second is regarding the deregulation Jennifer, you and I talked about this beforehand. I think folks need to understand that these are comments related to regulatory changes. What is in regulation payment or COPs, for example not process, so you know. In other words, cms or MAC, for example, administrative processes. So I just think providers need to understand that.

Speaker 1 20:13

Yeah, absolutely, that's a great point. And just some context for the wellness and nutrition. The Make America Healthy Again is the huge initiative that CMS is undertaking now. So these items asking for feedback on these two particular items sort of dovetails in with that initiative. Excellent, Excellent point. Yeah, so all right, Kim, what should providers be doing now? You know, now we've got a proposed rule. What now?

Speaker 2 20:50

Well, absolutely read the proposed rule, not just the summaries you know that have been published so that you can see the detail. And again, at only 62 or so pages it's not a heavy lift. You want to make sure that you are working on any comments that will be due, jennifer. Is it June 10th? Yep, it's June 10th. Comments due June 10th. So you want to coordinate if you're going to be working in tandem with an association. You want to evaluate your budgets, your operations, your expenses and the impact of any wage index changes, especially since this number isn't final but just some forecasting Again, looking at increased expenses anticipated during this next year, as well as evaluating the impact of these regulatory clarification changes once finalized, and ensure your policies, processes and staff education are in place. Anything else, jennifer?

Speaker 1 21:53

No, and I like the idea or I like rather your comment of you actually have to read the rule. Summaries are great and we actually did produce a summary of the rule, so feel free to read ours, but it doesn't substitute for you getting in there and rolling up your sleeves and actually reading the rule. Absolutely All right. Well, with that, we're at the end of our chat cast time today. Kim, any final thoughts you want to send away with our listeners?

Speaker 2 22:24

No, just thank you everybody for your time and for taking the time to review information that we share, not only the proposed rule itself, but our CHAPcast and also our resources. We are available here to support you.

Speaker 1 22:42

Absolutely so. The call to action today is read the rule. Send comments as you are able, and we would expect to see a final rule somewhere at the beginning of August of this year. All right, well, kim, thanks so much for talking with me today and our listeners out there about the proposed rule for hospice, and thank you all of you out there for taking time out of your day to plug into our CHAPcast From Kim, me and the entire CHAP staff. Keep your quality needle moving forward, stay safe and well, and thanks for all you do. Thank you.