20 Aug The 2026 Hospice Final Rule
What Hospice Agencies Should Do to Prepare for the 2026 Final Rule
CMS has issued the FY 2026 Hospice Wage Index and Payment Rate Update and HQRP Final Rule, which contains a 2.6 percent payment rate update, a higher aggregate cap, clarifications on admission and face-to-face attestation requirements, and the path forward for the HOPE transition beginning October 1, 2025. This article highlights the key takeaways to be aware of, and actions to take now.
Rates and Caps for the 2026 Hospice Final Rule
CMS finalized a 2.6 percent update to hospice reimbursement rates for the fiscal year from October 1, 2025 through September 30, 2026. The new rate is the result of a 3.3 percent market basket increase, offset by a 0.7 point productivity adjustment. The aggregate cap rises to $35,361.44.
Hospice providers that do not comply with HQRP reporting are penalized with a 4 percent rate reduction under this rule. Netted against the 2.6 percent increase, the 4 percent penalty results in a 1.4 percent payment reduction for 2026 for hospices that fail to report quality measures. This aspect of the rule should be reflected in hospice organizations’ 2026 budgets, and any EMR rate loading activities prior to October 1, 2025.
The rule also maintains the 5 percent cap on wage-index decreases and confirms the county-level application adopted in FY 2025—important in markets with OMB delineation shifts.
Two Compliance Clarifications Impacting Operations
CMS aligned regulation text to confirm that in addition to the medical director or designee, the physician member of the hospice IDG may recommend admission to hospice. This improves access to care and timeliness of admissions, especially for multi-site models. Hospice agencies should ensure that their intake workflow and EMR permissions reflect IDG physician routing and electronic sign-off.
The other clarification relates to face-to-face attestation signatures and format. CMS clarified that the face-to-face attestation must include the practitioner’s signature and the date signed, but allows flexibility: the attestation can live as a clearly titled section, an addendum, or a signed and dated clinical note documenting the encounter. That last option is the practical win, hospice software and EMR systems for Hospice Care should make the compliant choice the easy choice. Configure structured fields to capture the date of the visit, practitioner, and signature and date data inside the clinical note template.
Stakeholders also asked CMS to preserve telehealth flexibility for F2F recerts. CMS notes that Congress extended the authority through September 30, 2025. Hospice organizations should plan staffing and visit logistics based on the assumption that in-person requirements will resume.
HOPE: Timeline and Technology
The 2026 Hospice Final Rule reiterates that HOPE data collection begins October 1, 2025. Expect HOPE Update Visits (HUVs) within the first 30 days post-election (up to two, depending on length of stay). Public reporting of HOPE-based measures starts no earlier than fiscal year 2028, with first potential public display no earlier than November 2027 after 2026 data has been analyzed. HOPE replaces HIS and anchors future quality and potential payment refinements.
At the same time, CMS is shifting submission and reporting to iQIES. Providers must have iQIES access by October 1, 2025 to submit HOPE data. iQIES stops accepting HIS records after February 15, 2026 for pre-October 2025 admissions/discharges. Hospices should plan for user training, identity provisioning, and submission testing.
Hospice Leadership Action Items
Action items for hospice leaders include:
- Name a cross-functional HOPE/iQIES team, including clinical operations, quality, IT, compliance, and training and education. Assign an executive sponsor.
- Provision iQIES now and complete end-to-end test submissions by late September. Confirm the security official, user counts, and role mapping.
- Finalize F2F attestation policy and templates. Update SOPs and training regarding signature and date requirements. Audit after week two of Q1 FY 2026.
- Make sure the FY 2026 budget reflects the 2.6 percent update and local wage-index impacts. Re-model cap exposure against the new $35,361.44 threshold.
- Provide HOPE education (for clinicians, intake teams, and IDG physicians) with HUV timing and documentation standards. Track completion and first-month compliance.
Strategic implications of the 2026 Hospice Final Rule for Agencies
Below are the strategic implications of the 2026 Hospice Final Rule:
- Throughput and access. Clarified IDG physician admission authority can shorten the time from intake to first visit when medical directors are spread thin. Use EMR routing rules to leverage this flexibility without losing governance.
- Documentation burden vs. integrity. The attestation clarification is a practical way to reduce administrative burdens without giving up program integrity. Build templates that convert required elements into structured data—and make sure it is auditable and reportable.
- Quality transparency runway. With the public display of HOPE measures no earlier than FY 2028, hospices have about 24 to 30 months to get their data quality right. Hospice leaders should treat 2026 as a rehearsal.
- Data matters. The simultaneous flip to iQIES plus HOPE presents both risk and opportunity. Organizations that master clean assessment capture, error handling, and on-time submissions will avoid the 4 percentage point penalty and be better positioned for any future payment refinements tied to HOPE.
The Take-Away
In summary, the 2026 fiscal year brings a rate increase of 2.6 percent, and an increase to the hospice cap. Hospices that fail to meet quality reporting requirements will face a net payment reduction of 1.4 percent. Hospices should make sure the compliance clarifications have been operationalized and will hopefully see improved access from the IDG physician clarifications. HOPE is on track to go live soon, and hospice agencies should prepare accordingly.
Related blogs:
- What are the key performance indicators for hospice agencies?
- The 2025 Medicare Hospice Final Rule
- What are the top strategies to grow your hospice referrals?
- What are the crucial skills for home health and hospice hiring?
- Selecting the best caregiver for end-of-life care
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