On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issues a proposed rule updating Medicare payment policies and rates for hospices for Fiscal Year 2026. This annual update is part of CMS's commitment to ensuring Medicare hospice care meets high-quality standards. Here's a closer look at the key elements of the proposed rule and what it means for the hospice community.
Key Points:
1. Clarifications in Hospice Payment Regulations:
- Proposed Rule outlines that the physician member of the IDG can recommend hospice admission, supporting existing certification regulations.
- F2F Encounters: Hospice face-to-face encounter attestation must include the physician’s signature and date.
2. Regulatory Text Changes:
- Proposed changes are set for the Hospice Quality Reporting Program (HQRP), and CMS is seeking public feedback on challenges related to interoperability and potential future quality measures.
3. Focus on Streamlining Regulations:
- In accordance with an Executive Order targeting the reduction of regulatory burdens, CMS is inviting public input to simplify regulations and reduce administrative complexities for Medicare participants.
Payment Rate Updates:
- A proposed 2.4% increase in hospice payment rates for FY 2026 is set, estimated to bring an additional $695 million compared to FY 2025.
- Non-compliance with quality data submission will result in a rate reduction; CMS emphasized the importance of quality reporting.
- The proposed hospice cap for FY 2026 is $35,292.51.
Quality Reporting Enhancements:
- CMS intends to amend errors in the regulatory text and reaffirm HOPE requirements, with changes taking effect on October 1, 2025.
- Input is being actively solicited on the adoption of health IT and the advancement of digital quality measurement, ensuring that the HQRP stays in step with cutting-edge technologies.
The proposed rule highlights CMS's continued dedication to enhancing the financial and regulatory structures governing hospice care with an objective to promote efficient practices and maintain high standards of care through targeted improvements and proactive community engagement. We join CMS in encouraging you all to examine the detailed proposals and share your feedback to influence the final decisions. For a thorough understanding, you can access the final rule in the Federal Register or visit the CMS hospice webpage.
Should you have additional questions or need further clarification on the proposed rules, please feel free to reach out to us at regulatory@hcraconsulting.com. CMS has also made resources and feedback channels available for those seeking further information, encouraging public participation in shaping the hospice care standards for the next year. As always, your contributions are what
