Compliance requirements can change, but your responsibility to meet them remains the same. If you manage a hospice agency, make sure your clinical and administrative teams understand what CMS expects. The introduction of the Hospice HOPE assessment in October 2025 changed how agencies collect and report patient information. Now, the October 2026 regulatory updates have brought renewed attention to quality reporting. What should your team be doing differently, and which existing requirements still apply? Let’s examine what these changes mean for your agency.
What Is the Hospice HOPE Assessment?
The Hospice Outcomes and Patient Evaluation (HOPE) is a standardized data collection tool CMS developed to gather information about hospice patients and the care they receive.
It replaced the Hospice Item Set (HIS) on October 1, 2025, as part of the Hospice Quality Reporting Program (HQRP).
Unlike HIS, which mainly collected patient information at admission and discharge, HOPE also requires hospice teams to assess and document patients’ conditions at specific points during the first 30 days of hospice care.
Hospice agencies generally complete HOPE records at the following time points:
- Admission: Within five calendar days after the applicable hospice election or admission date.
- HOPE Update Visit 1 (HUV1): Between days 6 and 15.
- HOPE Update Visit 2 (HUV2): Between days 16 and 30.
- Discharge: At the time of discharge.
The number of update visits required depends on how long the patient remains in hospice care.
HOPE helps CMS collect consistent information about patient needs, symptom impact, and hospice care. It also supports quality reporting and provides information hospice teams can use to review patient care plans.
Why Is the HOPE Assessment Important for Hospice Agencies?
Hospice patients may experience changes in pain, breathing, nausea, anxiety, or other symptoms during their care. Healthcare professionals need to recognize these changes and respond appropriately.
HOPE introduces standardized questions and reporting timepoints that help capture information about patients’ experiences throughout their hospice stay. For hospice agencies, this creates an opportunity to review how consistently teams assess symptoms, document findings, and arrange follow-up care.
However, HOPE does not replace the comprehensive clinical assessment required under Medicare hospice regulations. Agencies must continue meeting their existing clinical assessment and care planning responsibilities.
Accurate HOPE reporting also matters because CMS uses submitted data to evaluate whether hospice providers meet federal quality reporting requirements.
What Changed in the Hospice HOPE Assessment in October 2026?
On October 6, 2026, CMS announced the release of HOPE Guidance Manual version 1.03, effective October 1, 2026. The updated manual addresses questions and suggestions CMS received during the first year of HOPE implementation. It mainly clarifies existing instructions rather than introducing new assessment requirements.
Here are four important changes hospice agencies should understand.
1. Clearer Admission Date Rules for Returning Hospice Patients
The updated guidance clarifies which admission date hospice agencies should use when completing HOPE records.
Previously, the instructions focused on the effective date of the patient’s initial hospice election. CMS has now clarified that agencies must also consider the admission date recorded in Section A0220, when applicable.
This is particularly important when a patient leaves hospice and later returns to the same agency or enters another hospice. The agency must use the applicable date for that admission to calculate the HOPE assessment deadlines.
Hospice staff should check these dates carefully, as an incorrect admission date can affect when assessments are scheduled and completed.
2. Additional Guidance on Missed or Late HOPE Update Visits
CMS has provided clearer instructions for handling HOPE Update Visits (HUVs) that take place outside their required timeframes.
Hospice agencies can still complete and submit a late HUV record. For example, if the first update visit takes place on day 17 instead of within the required days 6–15, the agency can submit the completed record.
CMS also clarifies that records submitted and accepted within the applicable reporting deadline count positively toward the hospice’s reporting compliance rate.
However, accepting a late visit record does not mean the agency completed the visit within the required timeframe. Hospice managers should continue monitoring missed visits and addressing scheduling problems.
3. Clarification of Symptom Follow-up Visits in Inpatient Settings
Hospice teams must arrange a Symptom Follow-up Visit (SFV) when a HOPE assessment identifies moderate or severe pain or other symptom impact.
The updated guidance clarifies that the follow-up must take place during a separate visit or, for patients receiving inpatient hospice care, a separate clinical encounter. It should occur within two calendar days of the initial assessment.
CMS also provides clearer guidance on the assessment activities that registered nurses and licensed practical or vocational nurses may perform during these follow-ups, subject to their professional scope of practice.
Hospice agencies should ensure that staff understand when a follow-up is needed, who can complete it, and how to document the encounter.
4. More Detailed Instructions for Symptom Coding and Missed Visits
The October update also includes additional examples to help hospice staff document symptoms and missed follow-up visits correctly.
For example, when a patient has constipation that is well controlled through treatment, staff should record that the symptom is not currently affecting the patient rather than marking it as not applicable.
CMS also explains how to document a Symptom Follow-up Visit missed because of an internal scheduling problem. Staff should select the code that accurately reflects the situation instead of recording patient refusal or unavailability.
These clarifications help hospice teams avoid incorrect coding and ensure that submitted records reflect what happened during patient care.
How Do the October 2026 HOPE Updates Affect Hospice Compliance?
The updated guidance gives hospice agencies a clearer understanding of how to handle situations that may occur during patient care and reporting. However, the existing reporting deadlines still require attention.
Under the Hospice Quality Reporting Program, agencies must submit and have CMS accept at least 90% of required HOPE records within the applicable 30-day submission deadlines.
Failing to meet HQRP reporting requirements can reduce the hospice’s annual payment update by four percentage points. This means hospice compliance involves more than completing assessments. Agencies also need reliable processes to review records, correct errors, and submit information on time. A missed visit, unclear documentation, or delayed submission should prompt managers to examine what happened and whether the same problem could affect other patient records.
How Can Hospice Agencies Prepare for the Updated HOPE Requirements?
Review your assessment schedule. Make sure clinical staff understand when admission assessments, HOPE Update Visits, symptom follow-up visits, and discharge assessments apply. Use a scheduling process that identifies upcoming deadlines.
Train staff on HOPE documentation. Nurses and other responsible employees should understand the required assessment items, documentation expectations, and reporting procedures. Training should include practical examples that reflect situations they encounter during patient visits.
Monitor iQIES submissions. Assign responsibility for reviewing submission status, validation reports, and rejected records. Completing an assessment does not automatically mean CMS has accepted the submitted record.
Conduct regular documentation audits. Review selected patient records to identify missing assessments, inconsistent information, and reporting delays. Use the findings to improve staff training and internal procedures.
Include HOPE reporting in quality improvement discussions. Hospice leaders can use assessment and reporting findings during Quality Assessment and Performance Improvement (QAPI) activities to identify recurring problems and develop corrective actions.
These steps can help hospice organizations maintain reporting compliance while keeping patient care at the center of their work.
Final Thoughts
The October 2026 HOPE update does not introduce an entirely new assessment system. It provides clearer instructions for handling admission dates, late update visits, symptom follow-ups, and documentation. Hospice agencies should use these clarifications to review their current practices and address areas where staff may need additional guidance.
Review Your Hospice HOPE Reporting Practices Before Gaps Become Problems
As hospice reporting requirements continue to evolve, it is worth reviewing how your team manages assessments, documentation, and submission deadlines. If you are unsure whether your current processes meet CMS requirements, Shannon Jackson, The People’s Nurse, can help you review your hospice documentation and reporting practices, identify areas that need attention, and provide staff training to address them.
Connect with Shannon Jackson to discuss your hospice compliance concerns and the support your team needs.
Disclaimer: This blog is for educational and informational purposes only and reflects CMS guidance available as of October 2026. Hospice regulations, assessment requirements, and reporting guidelines may change. Hospice agencies should refer to the latest official CMS HOPE Guidance Manual and applicable regulations for accurate, up-to-date information. This content does not replace professional regulatory or compliance advice
