Hospice Gets Medicare Pay Bump and Report Card Changes
Published Date: 4/30/2025
Proposed Rule
Summary
This proposed rule updates how much Medicare pays hospices in 2026, including changes to wage rates and payment limits. It also tweaks rules about hospice admissions and quality reporting, aiming to improve care for patients nearing the end of life. Hospices and patients will see these changes starting in FY 2026, with feedback open until June 30, 2025.
Analyzed Economic Effects
7 provisions identified: 3 benefits, 3 costs, 1 mixed.
FY2026 hospice rates: 2.4% update and dollar rates
Medicare proposes a 2.4 percent hospice payment update for FY 2026. Proposed daily rates include Routine Home Care (RHC) $230.33 for days 1–60 and $181.51 for days 61+, Continuous Home Care full rate $1,665.23 ($69.38 per hour), Inpatient Respite Care $531.60, and General Inpatient Care $1,197.40.
Estimated FY2026 increase: $695 million to hospices
CMS estimates the overall economic impact of the proposed FY 2026 rule to be $695 million in increased payments to hospices in FY 2026.
Penalty for not reporting HQRP data: -1.6% update
Hospices that do not submit required Hospice Quality Reporting Program (HQRP) data would have their FY 2026 payment update reduced by 4 percentage points, resulting in an effective update of -1.6 percent (2.4% minus 4%). Example reduced rates shown include RHC days 1–60 at $221.34 and days 61+ at $174.42.
Wage-index rules continue; county-level 5% cap retained
CMS proposes to base the FY 2026 hospice wage index on FY 2022 hospital pre-floor, pre-reclassified data (cost reports beginning Oct 1, 2021 and before Oct 1, 2022), retain the hospice floor (15% increase up to 0.8000) and continue the permanent 5 percent cap on year-over-year decreases calculated at the county level. CMS publishes specific proposed county values, for example: Hinesville, GA (CBSA 25980) 0.8892; rural North Dakota (99935) 0.8486; rural Puerto Rico proposed at 0.4200.
HQRP updates, HOPE instrument, and iQIES transition
The proposed rule provides updates to the Hospice Quality Reporting Program (HQRP), the Hospice Outcomes and Patient Evaluation (HOPE) instrument, public reporting, and the planned transition of hospice providers from the Quality Improvement and Evaluation System (QIES) to the internet-based iQIES. CMS also solicits requests for information on future quality-measure concepts including digital measures, nutrition, and well-being.
Physician IDG member may recommend hospice admission
The proposed rule would clarify that the physician member of the hospice interdisciplinary group (IDG) is among the types of physicians who can recommend a patient's admission to hospice and CMS proposes to add that physician role to regulatory text at 42 CFR 418.25.
Face-to-face attestation must include signature and date
CMS proposes to require that each face-to-face encounter attestation include the physician's or nurse practitioner's signature and date, and that the attestation, signature, and date be a separate, clearly titled section of, or addendum to, the recertification form.
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Key Dates
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