Regulatory Updates to The Hospice CoP Handbook

The Hospice CoP Handbook: Meeting Federal Mandates from Admission to Audit reflects the requirements in 42 CFR Part 418 and CMS guidance. This page tracks verified changes to hospice regulations after publication. This page was last reviewed and updated on Sunday, October 11, 2026.

Check this page before applying any deadline, penalty figure, or documentation requirement from the book to your agency’s practice.

Current Book Edition

Second Edition — Published February 2026

HOPE Updates

All regulatory and technical updates affecting HOPE — and the chapters and appendices in this book that cover HOPE — are maintained at https://compassioncrossing.info/hope-updates/

Regulatory Updates — Newest First

October 8, 2026 – CMS Restarts the Long-Stay Hospice Claim Edits and Adds Two Exceptions

CMS issued Transmittal 13997 (Change Request 14622) on October 8, 2026. The effective date is April 1, 2027, and the implementation date is April 5, 2027.

Here is the short version of the story. Last December, CMS created two claim edits, U5565 and U5566, under Change Request 14227. Their job was to catch overpayments on long hospice stays. The edits return hospice claims to the provider and reject all adjustment claims when the claim’s admission date does not match the start date of the matching election period. The edits apply to Types of Bill 813, 814, 823, and 824.

The edits worked too broadly. They also caught two situations where a mismatch is correct and expected. When a patient transfers from one hospice to another, the receiving hospice uses its own admission date. When a hospice changes ownership, the new owner uses the effective date listed on the change-of-ownership notice. In both cases, the admission date legitimately did not align with the original election period start date, and clean claims were being kicked back.

CMS told the Common Working File to temporarily turn off edits on June 18, 2026, while it worked on a fix. Transmittal 13997 is that fix. It adds a bypass condition for claims that follow a transfer, adds a second bypass condition for claims that follow a change of ownership, and then turns both edits back on with those bypasses in place.

What this means in practice: if your billing office saw long-stay claims returned in the spring and then stopped seeing them after mid-June, this transmittal explains both halves of that. Plan for the edits to be live again for dates of service on or after April 1, 2027. Between now and then, make sure your billing staff knows which admission date belongs on a post-transfer claim and which one belongs on a post-sale claim, because once the bypasses are in, an admission date that is simply wrong will still be returned to you.

Source: CMS Transmittal 13997 / CR 14622: https://www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13997otn

October 1, 2026 – CMS Grants a Three-Month Grace Period on the Mandatory Election Statement Addendum

CMS used the October 1, 2026 MLN Connects newsletter to spell out how the mandatory election statement addendum works and to announce a grace period. The requirement itself did not change. The enforcement did.

From October 1 through December 31, 2026, hospices must still furnish the addendum to every electing beneficiary, but Medicare Administrative Contractors will not deny claims solely because the addendum is missing or incomplete. CMS says MACs will focus on educating hospices during this window instead. On January 1, 2027, that cushion goes away.

Here is what CMS laid out, drawn from the newsletter and confirmed against the regulation text at 42 CFR 418.24:

• The addendum is mandatory for all hospice elections starting on and after October 1, 2026.
• It must be furnished in writing, on paper or electronically, to the beneficiary or their representative.
• It must be titled “Patient Notification of Hospice Non-Covered Items, Services, and Drugs” and carry the content listed in section 418.24(c).
• It must be furnished within 5 calendar days of the effective date of the hospice election.
• Any update to the addendum must be furnished within 3 calendar days of the plan of care change that triggered it.
• The condition for payment is met when a valid signed addendum sits in the beneficiary’s medical record at the hospice.
• The signature acknowledges receipt only. It is not agreement with the hospice’s determinations. Section 418.24(c)(9) requires that sentence to appear on the form itself.
• If the patient or representative refuses to sign, the hospice documents the reason in the addendum, which still becomes part of the medical record.
• Section 418.24(d) carves out one exception: if the patient dies, revokes, or is discharged before signing, the signature is not required for the hospice to be paid.

CMS also posted an updated model form, “Model Example of Patient Notification of Hospice Non-Covered Items, Services, and Drugs,” dated August 2026.

Starting October 1, hospice agencies must provide the mandatory Patient Notification of Hospice Non-Covered Items, Services, and Drugs. Please see the FY 2027 Hospice Coverage Compliance Toolkit for clinical guidelines and a template form you can adjust.

September 30, 2026 – CMS Publishes the FY 2027 Wage Index Correction Notice (CMS-1851-CN)

CMS published the correction notice on September 30, 2026, effective October 1, 2026. It appears at 91 FR 61791.

The cause: hospital CMS Certification Number 250078 was inadvertently treated as a hospital that had converted to Rural Emergency Hospital status, so its data was incorrectly excluded from the wage index calculation. CMS had to recalculate FY 2027 hospice wage index values for every CBSA and rural area.

What CMS corrected:

• CBSA 25980 (Hinesville, Georgia) wage index: 0.8915 corrected to 0.8916
• Rural North Dakota wage index: 0.8297 corrected to 0.8298
• Tables 1 and 2 (page 49127) and Tables 3 and 4 (page 49128), all reprinted
• Table 22, the impact analysis (page 49170)
• The impact figure for hospices with more than 20,000 RHC days (page 49175): 2.3 percent corrected to 2.2 percent

CMS also republished the wage index file on its website. The CMS-1851-F page now lists it as “FY 2027 Final Hospice Wage Index – Updated 09/29/2026.” If your agency downloaded the file in August, download it again.

Corrected FY 2027 payment rates for hospices that meet HQRP requirements:

• Routine home care, days 1-60: $236.33
• Routine home care, days 61 and after: $186.33
• Continuous home care, 24 hours: $1,726.16, which is $71.92 per hour
• Inpatient respite care: $545.93
• General inpatient care: $1,231.51

FY 2027 aggregate cap: $36,174.75. That is the FY 2026 cap of $35,361.44 raised by the 2.3 percent FY 2027 payment update. Affects: Chapter 6 and Chapter 11 of The Hospice CoP Handbook: Meeting Federal Mandates from Admission to Audit.

September 30, 2026 – Transmittal 13976 Rescinds and Replaces Transmittal 13924 (CR 14557)

CMS reissued the FY 2027 hospice rate transmittal. The cover note reads: “Transmittal 13924 issued August 18, 2026, is being rescinded and replaced by Transmittal 13976, dated September 30, 2026, to update the FY 2027 payment tables (tables 1 and 2) after the recalculation to the FY 2027 hospice wage index.”

Subject: Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for Fiscal Year (FY) 2027. Change request 14557. Implementation date: October 5, 2026.

This matters for billing staff. The Pricer update lands October 5, four days into the fiscal year. Claims submitted in that window are worth a second look.

September 2, 2026 — Telehealth Face-to-Face Recertification Reporting (CR 14495): HHS issued guidance implementing the hospice telehealth provision requiring a modifier or G-code on hospice claims when a hospice physician or hospice nurse practitioner conducts the face-to-face recertification encounter via telecommunications technology, effective January 1, 2027. Hospices must report the encounter using HCPCS code G0679, which describes a hospice face-to-face encounter conducted by a hospice physician or hospice nurse practitioner for recertification via telecommunications technology and is treated as an administrative expense. MACs will return claims containing G0679 when the bill type is anything other than 81X or 82X. The statutory basis is section 1814(a)(7)(D)(i)(II) of the Social Security Act, which requires one or more modifiers or codes when the practitioner contracts with an entity owning a virtual platform, has a payment arrangement with an entity for using virtual platforms, or provides telehealth service claims incident to their professional service. This is a claims-reporting requirement layered on top of the §418.22(a)(4)(ii) telehealth flexibility, which the Consolidated Appropriations Act, 2026 extended through December 31, 2027. (Affects Ch. 1, Ch. 9) — https://www.hhs.gov/guidance/document/reporting-face-face-encounter-conducted-hospice-physician-or-hospice-nurse-practitioner-0

August 26, 2026 — HQRP Public Reporting Quarterly Refresh (Care Compare): CMS released the August 2026 quarterly refresh for the Hospice Quality Reporting Program on the Medicare.gov Care Compare tool, updating the hospice quality scores visible to the public. Hospice assessment measure scores in this refresh are based on data submitted from Quarter 4, 2024 through Quarter 3, 2025;s CAHPS Hospice Survey measures and Star Ratings use data from Quarter 4, 2023 through Quarter 3, 2025, and claims‑based measures reflect Medicare claims data from Quarter 1, 2023 through Quarter 4, 2024. Agencies should use these specific data windows when comparing their internal QAPI metrics and survey‑readiness indicators to publicly reported scores (affects Ch. 6 and Ch. 11).

August 18, 2026 — MLN Matters MM14557, Hospice Payments: FY 2027 Update: CMS released the operational article for CR 14557, effective October 1, 2026, with an implementation date of October 5, 2026, under Transmittal Numbers R13872CP and R13924CP. The article confirms the FY 2027 payment update of 2.3%, derived from a 3.2% inpatient hospital market basket update reduced by a 0.9 percentage-point multifactor productivity adjustment, and a–1.7% figure for hospices that do not submit required quality data. The FY 2027 cap amount is $36,174.75 and the FY 2027 cap year runs October 1, 2026, through September 30, 2027. Labor shares are unchanged from the FY 2022 final rule: routine home care 66%, continuous home care 75.2%, inpatient respite care 61%, and general inpatient care 63.5%. CMS will continue calculating the 5% cap on wage index decreases at the county level for FY 2027, and counties that required a transition code for FY 2025 may continue using the same code as necessary. CMS notes that it finalized the cap update policy through the FY 2027 hospice final rule and section 6218 of the Consolidated Appropriations Act, 2026. (Affects Ch. 6, Ch. 11) — https://www.cms.gov/files/document/mm14557-hospice-payments-fy-2027-update.pdf

August 5, 2026 — HQRP Non‑Compliance Notifications (FY 2027 APU): CMS announced that hospices determined to be out of compliance with HQRP requirements for calendar year 2025 will receive non‑compliance notifications in their iQIES My Reports folders on August 5, 2026, with reconsideration requests due by September 4, 2026. This enforcement cycle affects the FY 2027 Annual Payment Update but does not change the four percent HQRP payment reduction.

CMS is notifying hospices of noncompliance with the Hospice Quality Reporting Program (HQRP) for CY 2025, which will affect their FY 2027 Annual Payment Update (APU). Non-compliance notices will be in My Reports in iQIES on August 5, 2026, and MACs will send letters. Hospices can request reconsideration by email by September 4, 2026, following the instructions in the notice and on the Reconsideration Requests webpage.

August 3, 2026 — FY 2027 Final Rule (CMS‑1851‑F): CMS issued the FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements final rule, scheduled for publication in the Federal Register on August 3, 2026. This rule updates FY 2027 HQRP requirements and is associated with the addition of a quality icon on the Medicare.gov Compare Tool.

July 30, 2026 — FY 2027 Final Rule (CMS-1851-F): FY 2027 hospice payment rate increased by 2.3%, and the aggregate hospice cap rises to $36,174.75, up from $35,361.44 in FY 2026. Agencies out of compliance with HQRP receive a net –1.7% adjustment instead of the full update. (Affects Ch. 6, Ch. 11) — https://www.cms.gov/medicare/payment/fee-for-service-providers/hospice/hospice-regulations-and-notices/cms-1851-f :=> See the August 2026 wage index technical error entry above; the 2.3% update and $36,174.75 cap remain in effect, but the underlying wage index values and standardization factors have been recalculated, and a correction notice is pending.

July 30, 2026 — FY 2027 Final Rule (CMS-1851-F): § 418.24(b)(6), (c), (d) — The election statement addendum is now mandatory for all Medicare hospice elections at the time of election, effective October 1, 2026. This finalizes the proposal from CMS-1851-P without modification. (Affects Ch. 1, Appendix A) — https://www.federalregister.gov/documents/2026/08/03/2026-15686/medicare-program-fy-2027-hospice-wage-index-and-payment-rate-update-and-hospice-quality-reporting

July 30, 2026 — FY 2027 Final Rule (CMS-1851-F): CMS finalized the Service and Spending Variation Index (SSVI) exactly as proposed, a 0–16 point composite score built from nine claims-based metrics, including non-hospice Medicare spending, absence of continuous home care or general inpatient days, high nursing-facility routine home care utilization, low visit intensity, and high live-discharge rates. CMS declined to modify the scoring methodology in response to public comments and will recalculate scores annually. (Affects Ch. 6, Ch. 11) — https://www.cms.gov/medicare/payment/fee-for-service-providers/hospice/hospice-regulations-and-notices/cms-1851-f

July 30, 2026 — FY 2027 Final Rule (CMS-1851-F): § 418.26(b) — Discharge orders may now be signed by the hospice medical director, physician designee, or IDG physician member, finalizing the proposed alignment between the CoP and payment regulations on who may discharge a patient. (Affects Ch. 4, Ch. 7) — https://www.federalregister.gov/documents/2026/08/03/2026-15686/medicare-program-fy-2027-hospice-wage-index-and-payment-rate-update-and-hospice-quality-reporting

July 30, 2026 — FY 2027 Final Rule (CMS-1851-F): HQRP/Care Compare — A non-compliance icon is finalized for the Care Compare tool, identifying hospices that fail to submit required HQRP quality data. Effective no earlier than FY 2028. (Affects Ch. 6; see also hope-updates/) — https://www.cms.gov/medicare/payment/fee-for-service-providers/hospice/hospice-regulations-and-notices/cms-1851-f

May 20, 2026, CMS clarifies the scope and mechanics of the already announced nationwide hospice enrollment moratorium per https://www.cms.gov/files/document/qso-26-11-hha-hospice-original-release-2026-05-20.pdf

May 16, 2026 — iQIES Scheduled Maintenance: CMS announced that the iQIES databases will undergo scheduled maintenance on Saturday, May 16, 2026, from 10:00 AM to 2:00 PM EST. During this window, HOPE assessment submission and all hospice quality reporting functions in iQIES, including access to validation reports, quality measure reports, and review-and-correct functions, will be unavailable. Agencies that need to submit time-sensitive HOPE records or access compliance-related reports should plan around this window. (Affects Ch. 11 and any compliance-monitoring workflows tied to HQRP submission deadlines.)

May 13, 2026, CMS imposed a six-month nationwide moratorium on Medicare enrollment for new hospices and practice locations, leaving existing Medicare-certified hospices unaffected. Applications received before this date are exempt. The moratorium also covers certain ownership changes that would normally trigger initial enrollment under the 36-month rule at 42 CFR §424.550(b). CMS can extend the moratorium in six-month increments if needed. The restrictions are based on 42 CFR §§ 424.570 and 424.550, not on 42 CFR Part 418, which remains unchanged. Agencies must still fully comply with all Part 418 Conditions of Participation during this period. Please refer to Federal Register Notice 91 FR 27946 (2026-09718) and the CMS Moratorium FAQ.

March 5, 2026 — Manual Guidance Aligned With FY 2026 Final Rule: It does not change 42 CFR Part 418 itself, but it explicitly interprets and operationalizes several CoP-linked regulations, especially 42 CFR 418.22(b)(4), 418.26(c)(3), 418.28(c)(3), and 418.54.

• Face-to-face attestation: a signed, dated clinical note may satisfy attestation requirements if it documents the visit, findings, and the practitioner’s signature/date.
• Transfers: no new NOE for receiving hospice; receiving hospice must complete all 418.54 assessments and may rely on prior F2F when verifiable. Revocation and discharge: no waiting period before re-election; patient may re-elect immediately if still eligible, per 418.28(c)(3) and 418.26(c)(3).

October 1, 2025 — FY 2026 Final Rule: FY 2026 aggregate hospice cap increased to $35,361.44, up from $34,465.34 in FY 2025. (Affects Ch. 6, Ch. 11) — https://www.cms.gov/files/document/mm14190-hospice-payments-fy-2026-update.pdf

October 1, 2025 — FY 2026 Final Rule: FY 2026 payment rate increased by 2.6%; agencies out of compliance with HQRP receive a net –1.4% adjustment instead. (Affects Ch. 6, Ch. 11) — https://www.cms.gov/newsroom/fact-sheets/fy-2026-hospice-wage-index-and-payment-rate-update-and-hospice-quality-reporting-program

October 1, 2025 — FY 2026 Final Rule: IDG physician member is now formally authorized to recommend hospice admission, aligning the Conditions of Participation with existing certification and payment regulations. (Affects Ch. 1, Ch. 7) — https://www.federalregister.gov/documents/2025/08/05/2025-14782/medicare-program-fy-2026-hospice-wage-index-and-payment-rate-update-and-hospice-quality-reporting

October 1, 2025 — FY 2026 Final Rule: Face-to-face encounter attestation requirement updated; a signed, dated clinical note now satisfies the requirement. A separate attestation form is no longer required. (Affects Ch. 1, Appendix A) — https://www.federalregister.gov/documents/2025/08/05/2025-14782/medicare-program-fy-2026-hospice-wage-index-and-payment-rate-update-and-hospice-quality-reporting

October 1, 2024 — FY 2025 Final Rule: HQRP payment reduction confirmed at 4% for non-compliant agencies; CAHPS Hospice Survey items revised. (Affects Ch. 6, Ch. 11) — https://www.federalregister.gov/documents/2024/08/06/2024-16910/medicare-program-fy-2025-hospice-wage-index-and-payment-rate-update-and-hospice-quality-reporting

October 1, 2024 — FY 2025 Final Rule: “Physician designee” definition clarified in §418.3 and in certification regulations. (Affects Ch. 1, Ch. 7) — https://www.federalregister.gov/documents/2024/08/06/2024-16910/medicare-program-fy-2025-hospice-wage-index-and-payment-rate-update-and-hospice-quality-reporting

FY 2025, ongoing: Hospice Special Focus Program formally established. CMS now publicly identifies poor-performing agencies. (Affects Ch. 11) — https://www.cms.gov/medicare/health-safety-standards/certification-compliance/hospice-special-focus-program

Verify Any Citation in This Book

Every §418 citation in the handbook can be confirmed against current regulatory text here: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418