FY2026 Hospice Final Rule · CMS-1835-F

From HIS to HOPE: the assessment timeline that now drives your billing

Here is the short answer. As of October 1, 2025, the Hospice Outcomes and Patient Evaluation (HOPE) tool replaced the Hospice Item Set (HIS) as the mandatory patient assessment for the Hospice Quality Reporting Program. HOPE is no longer a one-and-done admission form. It adds timed update visits and symptom follow-up visits across the stay, and every one of those timepoints is a date your compliance, your per-diem, and your Service Intensity Add-On now hang on.

HIS · admission + discharge → HOPE · admission + timed HUVs + SFV + discharge

Oct 1 2025

HOPE became mandatory, retiring HIS for all Medicare-certified hospices

FY2025/FY2026 Rules

4 pts

Reduction to your annual payment update if HQRP thresholds are missed

HQRP Penalty

4 hrs

Max SIA-payable RN or social worker time per day, last 7 days of life

Service Intensity Add-On

2.6%

FY2026 hospice payment update; the aggregate cap escalates with it

Wage Index Final Rule

The Timeline

Every HOPE timepoint, and what breaks in billing if you miss it

HOPE is anchored to the date of election. Miss a window and you do not just lose a data point, you drop below the HQRP completion threshold that protects your full payment update, and you can forfeit add-on dollars you actually earned at the bedside. Read top to bottom the way a patient moves through the benefit.

0-5

Days 0 to 5 · Admission

HOPE Admission assessment

Completed no later than 5 calendar days after the hospice election date. This is the baseline symptom and status record that anchors the whole stay and sets up the per-diem under Routine Home Care.

Ripple: RHC pays on a two-tier per-diem, the higher rate for days 1 to 60 and the lower rate from day 61. A late or incomplete admission record is the first crack in your HQRP completion percentage.

6-15

Days 6 to 15 · HUV1

HOPE Update Visit 1

The first timed reassessment during a continuous stay, captured in the days 6 to 15 window. HOPE moved hospices off a static picture and onto a moving one, so the record has to be refreshed on schedule.

Ripple: Miss the window and the visit no longer counts toward HQRP compliance for that patient, pulling your facility completion rate toward the 4-point payment-update cliff.

16-30

Days 16 to 30 · HUV2

HOPE Update Visit 2

The second timed update, for patients still on service, captured in the days 16 to 30 window. Together the two HUVs are the visits that did not exist under HIS and are the most common new miss.

Ripple: Same HQRP exposure as HUV1. Two missed windows on the same chart compound the shortfall against the annual reporting threshold.

Trigger-based · Within 2 days

Symptom Follow-Up Visit (SFV)

When a HOPE assessment flags a symptom at moderate or severe impact, a follow-up visit is required within 2 calendar days to reassess it. This is HOPE putting a clock on symptom response, not just symptom documentation.

Ripple: A missed SFV is both a quality flag and a documentation gap that undercuts medical-necessity support for the visits you are billing.

Last 7 days of life · SIA window

Service Intensity Add-On earning window

During the final 7 days of life, direct RN and medical social worker visits under Routine Home Care earn the Service Intensity Add-On, paid at the Continuous Home Care hourly rate, up to 4 hours per patient per day, billed in 15-minute increments.

Ripple: SIA is only paid when the visit is documented and coded correctly. Undocumented RN or social worker time in this window is add-on revenue you performed and simply did not capture.

Dis

Discharge or death · Within 2 days

HOPE Discharge assessment

Completed within 2 calendar days of discharge or death. It closes the record and, aggregated across the year, feeds the completion percentage CMS uses to decide whether you keep your full payment update.

Ripple: The discharge record is also where per-beneficiary spend meets the aggregate cap. Payments above the cap are recouped as an overpayment after year-end reconciliation.

How the SIA actually turns into dollars

The Service Intensity Add-On is the clearest place where a HOPE timepoint and a bedside visit become billable revenue. Miss the documentation and the money is gone, even though the care happened.

01 · WHO

RN or MSW visit

Only registered nurse and medical social worker visits qualify. Aide and volunteer time does not.

02 · WHEN

Last 7 days of life

The visit must fall within the final 7 days, under Routine Home Care, not GIP or CHC days.

03 · HOW MUCH

Up to 4 hrs/day

Paid at the CHC hourly rate in 15-minute increments, capped at 4 hours per patient per day.

CHC rate × time

04 · PROOF

Documented visit

Time, discipline, and visit date must be captured cleanly or the add-on is denied on audit.

+ per-diem

The Ripple

One missed timepoint, three places it shows up on the remit

A missed visit rarely stays a single problem. Here is the chain from a HOPE miss to the dollar impact, tied to the FY2026 payment framework.

What was missed	What it breaks	Where it hits your money
HOPE Admission late or incomplete	Baseline record and HQRP completion count	Drops facility completion %; risks 4-pt APU cut
HUV1 or HUV2 outside its window	Timed update no longer counts for that patient	Same 4-pt payment-update exposure, compounding
Symptom Follow-Up Visit not done in 2 days	Quality flag and medical-necessity support	Weakens defense of billed visits on audit
SIA visits not documented in last 7 days	No Service Intensity Add-On paid	Lose up to 4 hrs/day RN/MSW at CHC hourly rate
Per-beneficiary spend over the cap	Aggregate cap exceeded at reconciliation	Repay every dollar above the FY2026 cap amount

Your assessment calendar and your revenue cycle are now the same system

ASP-RCM Solutions runs hospice billing where the HOPE timeline is wired straight into the claim. We track admission, HUV1, HUV2, symptom follow-up, and discharge windows against the clock, flag the SIA-eligible visits before the claim drops, and reconcile against the aggregate cap before it becomes an overpayment. You keep your full payment update and you bill the add-on you earned.

Talk to our hospice billing team →

Guidelines referenced

FY2026 Hospice Wage Index and Payment Rate Update Final Rule (CMS-1835-F), including the hospice payment update percentage and aggregate cap escalation.
Hospice Outcomes and Patient Evaluation (HOPE) assessment tool, replacing the Hospice Item Set (HIS) effective October 1, 2025, under the Hospice Quality Reporting Program (HQRP).
Hospice aggregate per-beneficiary cap, updated annually by the hospice payment update percentage (FY2025 cap of record: $34,465.34).
Service Intensity Add-On (SIA) policy: RN and medical social worker visits during the last 7 days of life under Routine Home Care, paid at the Continuous Home Care hourly rate, up to 4 hours per day in 15-minute increments.