HOPE Assessment Requirements for Hospice Agencies

What Is the HOPE Assessment?

The Hospice Outcomes and Patient Evaluation (HOPE) is a standardized patient assessment instrument developed by CMS specifically for the hospice setting. HOPE is designed to collect data on patient characteristics, care needs, and outcomes in a way that allows for quality measurement and cross-setting comparisons under the IMPACT Act.

For hospice agencies, HOPE represents the most significant documentation change in years. Unlike the existing hospice quality measures that rely primarily on claims data and the Hospice Item Set (HIS), HOPE introduces a comprehensive clinical assessment that must be completed at defined points during a patient’s hospice stay.

Why CMS Developed HOPE

CMS has long identified a gap in standardized clinical data collection for hospice care. While home health has OASIS and skilled nursing has the MDS, hospice has operated without a comparable patient assessment tool.

The IMPACT Act of 2014 mandated the development of standardized patient assessment data across all post-acute care settings. HOPE fulfills this requirement for hospice, creating a mechanism for CMS to measure quality, compare outcomes, and eventually link payment to patient characteristics and outcomes.

HOPE also addresses growing concerns about hospice utilization patterns. By collecting standardized clinical data, CMS gains the ability to analyze whether patients are receiving appropriate levels of care and whether their clinical trajectories align with hospice eligibility criteria.

Key HOPE Assessment Components

HOPE covers several clinical domains that hospice agencies need to understand and prepare for.

Patient Demographics and History — Baseline information about the patient’s diagnosis, prognosis, and care setting. These items establish the context for the rest of the assessment.

Functional Status — Standardized functional assessment items that align with the GG items used in other post-acute settings. This includes self-care abilities, mobility, and the need for assistance with daily activities.

Symptom Assessment — Comprehensive evaluation of pain, dyspnea, nausea, and other symptoms common in hospice patients. These items support quality measurement around symptom management — a core hospice competency.

Cognitive and Behavioral Status — Assessment of cognitive function, communication ability, and behavioral symptoms. These items help characterize the complexity of the patient’s care needs.

Care Preferences and Goals — Items that capture the patient’s and family’s goals of care, advance care planning status, and preferences for symptom management. These reflect CMS’s emphasis on patient-centered care measurement.

Social Determinants — Similar to OASIS-E, HOPE includes items related to social isolation, caregiver availability, and health literacy. These data points support CMS’s broader focus on understanding how non-clinical factors affect patient outcomes.

When HOPE Assessments Are Required

CMS finalized the HOPE implementation date as October 1, 2025. Beginning on that date, hospice agencies must complete HOPE assessments at admission, during HOPE Update Visits (HUVs) within the first 30 days post-election, and at discharge.

HUVs are a new concept introduced with HOPE. These are scheduled assessment points early in the hospice stay that capture changes in patient status during the critical initial period. Agencies may be required to complete up to two HUVs within the first 30 days, depending on the patient’s care trajectory.

Understanding these timing requirements is critical. Late or missing assessments create compliance exposure, similar to how late OASIS assessments affect home health agencies. Agencies must meet a 90% submission threshold to avoid penalties — failure to comply results in a 4% reduction in the annual payment update under the Hospice Quality Reporting Program. Agencies should build HOPE assessment completion into their existing workflow and tracking systems well before the October 2025 deadline.

How to Prepare Your Agency

Preparation for HOPE should begin well before the compliance deadline. Agencies that wait until the last minute risk clinician confusion, workflow disruption, and early compliance issues.

Train clinicians on standardized assessment methodology. Many of the HOPE items use assessment conventions that may be unfamiliar to hospice clinicians, particularly the standardized functional items. Clinicians need to understand the scoring methodology, not just the item definitions.

Update your documentation workflows. HOPE assessments will need to be integrated into existing admission, recertification, and discharge processes. Map out where HOPE fits in your current workflow and identify potential bottlenecks.

Review your EMR capabilities. Your electronic medical record system needs to support HOPE data collection and transmission. Confirm that your EMR vendor has a HOPE implementation plan and timeline that aligns with the October 2025 deadline.

Build QA processes early. Do not wait for the first HOPE submission to discover accuracy issues. Develop internal quality review processes that can catch errors during the learning curve. Tools like Lime’s OASIS & HOPE QA platform can automate this review process.

Connect HOPE to your existing quality program. HOPE data will feed into hospice quality measures. Understanding the connection between individual HOPE items and quality outcomes helps clinicians see the purpose behind the assessment, improving engagement and accuracy.

HOPE and Hospice Quality Reporting

HOPE data will become a primary input for the Hospice Quality Reporting Program (HQRP). Quality measures derived from HOPE will affect public reporting on Hospice Compare and, potentially, future payment adjustments.

Agencies that invest in accurate HOPE completion will be better positioned in an environment where quality transparency increasingly drives referral patterns and payer relationships.

Preparing for the October 2025 Deadline

The shift to HOPE is significant, but it follows a pattern that other post-acute settings have already navigated with OASIS and MDS. Agencies that approach it systematically — with training, workflow integration, and quality assurance — will manage the transition effectively.

HOPE Assessment Resources

• HOPE Assessment Tools — How AI-powered tools support accurate HOPE completion
• OASIS & HOPE QA — Quality assurance across both assessment types
• Hospice Documentation Best Practices — Strengthen your overall hospice documentation program