HOPE

HOPE

About this Page

This page provides information and resources specific to Hospice Outcomes and Patient Evaluation (HOPE), the new assessment tool for hospices. On this page are direct links to the HOPE tool item sets, the HOPE Guidance Manual, and related materials. News related to HOPE activities (such as OMB approval) is also posted here.

Background of HOPE

The Centers for Medicare & Medicaid Services (CMS) developed the new patient assessment tool to replace the Hospice item Set (HIS) as part of the HQRP. HOPE was finalized in the in the FY 2025 Hospice Wage Index Final Rule (CMS-1810-F).  To access the FY2025 Hospice Final Rule, use this link: Hospice Final Rule: Hospice Regulations and Notices | CMS.

HOPE will provide assessment-based quality data to enhance the HQRP through standardized data collection, provide a better understanding of patient care needs, contribute to the patient’s plan of care, and provide additional clinical data that could inform future payment refinements. CMS retained key items from the HIS in HOPE v1.0 and will continue to collect information to inform the Comprehensive Assessment at Admission (CBE #3235) while gathering additional data to support new quality measures. 

Objectives of HOPE

CMS finalized two HOPE-based quality measures. Additional quality measures may be developed in the future based on data elements added to future versions of the tool. More information about the development of quality measures can be found on the Quality Measure Development page. 

HOPE is expected to provide hospices with information to help them identify opportunities to adjust their practices and improve patient- and agency-level decisions about the care they provide. Furthermore, patients and their families will be more informed about the hospice they choose based on potential public reporting of the HOPE assessment-based quality measures. 

Differences between Hospice Item Set (HIS) and HOPE

Until September 30, 2025, CMS will continue to collect data only at admission and discharge from hospice via the HIS. These data are used to calculate measures for the HQRP. However, while the HIS is a standardized mechanism for abstracting medical record data, it is not a patient assessment tool because HIS data are not collected during a patient assessment. Instead, HIS focuses on whether hospices have performed care processes using retrospective data from chart abstraction. CMS’ goal for HOPE is to be more comprehensive than the HIS by capturing patient and family care needs in real-time and at additional timepoints during the hospice stay with the flexibility to accommodate patients with varying clinical needs. 

Beginning October 1, 2025, HOPE will collect quality data by introducing additional timepoints, referred to as the HOPE Update Visits (HUVs). The HUVs enable CMS to gather patient level data during the first 30 days after a beneficiary elects hospice. Hospice providers will be required to submit up to two HUVs, each at specified timeframes, depending on the length of the hospice stay. HOPE takes into consideration the hospice workflow and the Medicare Conditions of Participation. Data on patients’ baseline status and changes in their outcomes collected via HOPE will contribute to care planning, inform quality measurement for the HQRP, and support providers’ quality improvement efforts. To better understand the data collection timepoints for HOPE, providers can access this newly released video explainer by visiting the HQRP Training and Education Library page. 

Process for Developing HOPE

The general process leading to the development of HOPE included, but was not limited to the following activities: information gathering, stakeholder and Technical Expert Panel (TEP) engagement, and testing of HOPE. Summaries of the TEP reports can be found in the Downloads section on the Provider and Stakeholder Engagement webpage. The testing phases for HOPE included cognitive, pilot, alpha testing, and national beta field testing.  National beta testing, completed at the end of October 2022, allowed CMS to obtain input from participating hospice teams about the assessment instrument and field testing to refine and support the final draft items and data collection timepoints for HOPE. Refer to the HOPE Development and Testing Report (PDF) below for more information. CMS proposed the HOPE tool in rulemaking and sought public comments. Once implemented in FY 2026 (October 1, 2025) HOPE will provide value to hospice providers, patients, and families.

Stakeholder Engagement 

CMS actively seeks to engage with stakeholders as it continues to develop new quality measures, including those from HOPE. Relevant opportunities, information gathering reports, and Technical Expert Panel (TEP) reports are available on this website on the Provider and Stakeholder Engagement (PDF) page. You will also find HQRP Forum materials on this same page. 

If you would like to communicate with CMS about HOPE or quality measures, please email the Hospice Quality Help Desk at HospiceQualityQuestions@cms.hhs.gov.

Hospice Quality Reporting Program Archives (PDF)