CMS 2026 Proposed Rule: Key Highlights for Hospice Providers
The CMS Proposed Rule for FY 2026 (CMS-1835-P) introduces important changes that will affect hospice providers. To help you navigate these updates, here's a breakdown of the essential information.
Payment Updates
The proposed rule includes a 2.4% overall payment update. This translates to different averages for urban and rural hospices (2.4% and 2.7%, respectively), with regional variations. For instance, New England sees the highest proposed increase (3.8%), while the Pacific region has the lowest (1.4%). The Hospice Cap for FY 2026 is set at $35,292.51. It's critical to note that failure to submit required quality data can result in a negative 1.6% payment adjustment.
Regulatory Changes
Significant regulatory changes are proposed, particularly concerning hospice admissions. Physicians within the interdisciplinary group (IDG) may recommend hospice admission, aligning with existing certification rules. The rule also clarifies face-to-face attestation requirements, emphasizing the need for a separate and clearly titled section or addendum that includes the date and signature. Documentation must clearly support the patient's continued eligibility for hospice care.
Quality Reporting Updates
Quality reporting is also undergoing changes, most notably the transition to the HOPE assessment tool, which will fully replace HIS for data collection. This transition begins on October 1, 2025, with public reporting slated for no earlier than FY 2028. Additionally, the iQIES system will become the required platform for HOPE data submission on October 1, 2025, and QIES will stop accepting HIS records on February 15, 2026.
Next Steps
To ensure your agency's readiness, consider the following actions. Submitting comments during the comment period to address concerns about the adequacy of the proposed payment adjustment in relation to current costs and inflation is advisable. Communication with your EMR vendor is essential to confirm their preparedness for HOPE and iQIES submission testing. It is also important to review current processes and documentation/EMR forms to ensure alignment with the current Medicare Benefit Policy Manual, Chapter 9 guidance and the proposed regulation updates.
By staying informed and taking proactive steps, hospice providers can successfully adapt to these changes and continue delivering high-quality care.
