On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that proposes updates to Medicare payment policies and rates for hospices under the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Updated Proposed Rule (CMS-1835-P). CMS is publishing this proposed rule consistent with the legal requirements to update Medicare payment policies for hospices annually. This fact sheet discusses the major provisions of the proposed rule.
This rule also proposes to clarify in the hospice payment regulations that the physician member of the interdisciplinary group (IDG) may recommend admission to hospice care, which would align with certification regulations and the Conditions of Participation (CoPs). CMS also proposes to clarify that the hospice face-to-face encounter attestation must include the physician’s/practitioner’s signature and date.
In addition, CMS proposes to provide a regulatory text change for the Hospice Quality Reporting Program. CMS is seeking public input through requests for information (RFIs) on barriers to interoperability and future quality measures concepts.
RFI on Streamlining Regulations and Reducing Administrative Burdens in Medicare
On January 31, 2025, President Trump issued Executive Order (EO) 14192 "Unleashing Prosperity Through Deregulation," which states the Administration’s policy to significantly reduce the private expenditures required to comply with Federal regulations to secure America’s economic prosperity and national security and the highest possible quality of life for each citizen. To comply with the Executive Order, CMS, is including in the proposed rule a RFI seeking public input on approaches and opportunities to streamline regulations and reduce burdens on those participating in the Medicare program. The RFI is available at https://cms.gov/medicare-regulatory-relief-rfi and the public should submit all comments in response to this RFI through the provided weblink.
FY 2026 Routine Annual Rate Setting Changes
CMS strives to ensure that people receiving Medicare hospice care have access to top-quality hospice programs and services. Since the inpatient hospital market basket is being proposed to be rebased and revised to a 2023 base year in the FY 2026 Inpatient Prospective Payment System (IPPS) proposed rule, the hospice rule will align with these proposed IPPS updates. The current inpatient hospital market basket reflects a 2018 base year.
For FY 2026, CMS proposes to update the hospice payment rate by 2.4% (an estimated increase of $695 million in payments from FY 2025). This results from the proposed 3.2% inpatient hospital market basket percentage increase reduced by a proposed 0.8 percentage point productivity adjustment, required by law. The proposed FY 2026 rates for hospices that do not submit the required quality data would reflect the proposed FY 2026 hospice payment update percentage of 2.4% minus four percentage points as required by law, which would result in a 1.6% reduction over the previous year’s payment rate. These proposed payment rates reflect the most accurate, updated data available on the cost of goods, services, and labor.
Hospice payments are subject to a statutory aggregate cap which limits the overall payments made to a hospice annually. The proposed hospice cap amount for FY 2026 is $35,292.51 (FY 2025 cap amount of $34,465.34 increased by the FY 2026 hospice payment update percentage of 2.4%).
Hospice Quality Reporting Program (HQRP)
For FY 2026, CMS proposes to correct a typographical error in the regulations text at § 418.312(j), restate the HOPE requirements that will be implemented starting October 1, 2025, and solicit public comments related to two RFIs on future quality measure concepts for HQRP.
To seek feedback on current adoption of health information technology (IT) and standards, including Fast Healthcare Interoperability Resources (FHIR), CMS is seeking feedback on two RFIs: 1) Future measure on the topics of interoperability, nutrition, and well-being; and 2) Advancing digital quality measurement.
The final rule can be viewed at the Federal Register at: https://www.federalregister.gov/public-inspection.
For further information, see the hospice webpage here: http://www.cms.gov/Center/Provider- Type/Hospice-Center.html.
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