HOPE Assessment Requirements for Hospice in 2026

Updated October 2026: the item breakdown now matches the HOPE v1.03 item set, effective October 1, 2026 (HOPE has no Section GG functional items and no social determinants items). We added the Symptom Follow-up Visit, late HUV handling, and the planned Care Compare icon from the FY2027 hospice final rule, and removed product claims not matching what Lime offers.

What Is the HOPE Assessment?

The Hospice Outcomes and Patient Evaluation (HOPE) is a standardized patient assessment instrument CMS developed for hospice. HOPE collects data on patient characteristics, symptoms, and care processes for quality measurement under the Hospice Quality Reporting Program (HQRP).

For hospice agencies, HOPE is the biggest documentation change in years. It replaced the Hospice Item Set (HIS) on October 1, 2025. HIS was abstracted from the record at admission and discharge. HOPE keeps key HIS items and adds data collected during patient visits at defined points in the stay. The current version, HOPE v1.03, took effect on October 1, 2026.

Why CMS Developed HOPE

Home health has OASIS and skilled nursing has the MDS. Before HOPE, hospice had no comparable patient assessment tool, only the HIS process items.

The IMPACT Act of 2014 called for standardized patient assessment data across post-acute care settings. HOPE gives CMS hospice data to measure quality and compare outcomes across hospices.

HOPE also responds to concerns about hospice utilization. With standardized clinical data, CMS sees whether patients get timely symptom management and appropriate levels of care.

What HOPE v1.03 Covers

The HOPE v1.03 item set has seven sections. Not every item is completed at every timepoint.

Section A, Administrative Information: demographics, admission and discharge dates, language (A1110), where the patient was admitted from, living arrangements, and reason for discharge.

Section F, Preferences: CPR preference, other life-sustaining treatment preferences, hospitalization preference, and spiritual or existential concerns. Some of these items are abstracted from the clinical record.

Section I, Active Diagnoses: the patient’s principal and other active diagnoses, such as cancer, heart failure, COPD, dementia, and renal disease.

Section J, Health Conditions: whether death is imminent, pain screening and assessment, neuropathic pain, shortness of breath screening and treatment, and Symptom Impact (J2051), which rates how much pain and other symptoms affect the patient.

Section M, Skin Conditions: skin conditions present, their types, and skin and ulcer or injury treatments.

Section N, Medications: scheduled and PRN opioids, and a bowel regimen for patients on opioids.

Section Z, Record Administration: signatures and completion dates.

HOPE v1.03 has no Section GG functional items, no cognition or mood sections, and no social determinants of health items. CMS asked for input on possible future SDOH items in the FY2025 hospice rule, but none are in the current item set.

When HOPE Records Are Required

HOPE data collection began on October 1, 2025. Each patient generates up to four records: a HOPE Admission, up to two HOPE Update Visits (HUVs), and a HOPE Discharge.

• Admission: completed no later than five calendar days after the effective date of the hospice election, or the admission date in A0220.
• HUV1 and HUV2: in-person update visits early in the stay. HUV1 falls on days 6 through 15 and HUV2 on days 16 through 30, depending on length of stay.
• Symptom Follow-up Visit (SFV): when Symptom Impact is moderate or severe at admission or an HUV, an in-person SFV is expected within two calendar days. HOPE v1.03 clarifies an LPN/LVN may conduct the SFV, and the SFV may be an encounter in an inpatient setting.
• Discharge: completed for any discharge reason listed in A2115.

If an HUV is late, conduct it anyway and submit the record. CMS still accepts late HUV records, and records submitted and accepted on time count toward your compliance rate.

Each record has a submission clock. The FY2027 hospice final rule restates it: submit HOPE data within 30 days of the HOPE admission, HUV, or discharge date. Hospices must meet a 90% timely submission threshold, and failure results in a 4% reduction in the annual payment update under the HQRP.

How to Strengthen HOPE Compliance Now

HOPE is in its second year, so the work has shifted from preparation to accuracy and timeliness.

Train clinicians on the item conventions. The Symptom Impact, pain, and shortness of breath items follow specific coding rules. Clinicians need the scoring guidance, not only the item names. HOPE-specific training and credentials such as the CHS-C are now available.

Track HUV windows, SFVs, and submission clocks. Build HUV due dates, the two-day SFV window, and the 30-day submission deadline into your admission and scheduling workflows. Review missed or late records every week.

Review your EMR capabilities. Your electronic medical record system needs to support HOPE data collection and transmission. Confirm it flags upcoming HUVs and SFVs, tracks the 30-day window for each record, and reports rejected submissions.

Audit accuracy, not only completion. Compare a sample of submitted HOPE records against visit documentation to catch symptom scoring errors. Visit-note QA such as Sentinel QA, which reviews every hospice visit note within about 10 minutes of submission, helps your team find note gaps before they reach a HOPE record.

Connect HOPE to your quality program. HOPE data feeds hospice quality measures. When clinicians see how an item affects a measure, accuracy improves.

HOPE and Hospice Quality Reporting

HOPE data is now the HQRP’s assessment data source, replacing HIS. HOPE feeds the Comprehensive Assessment at Admission composite measure, and the Symptom Impact and SFV items show whether moderate or severe symptoms got a timely follow-up visit. As HOPE-based measures move into public reporting on Care Compare, your assessment accuracy shows up in your public scores.

Agencies investing in accurate HOPE completion will be better positioned as quality transparency shapes referral patterns and payer relationships.

What the FY2027 Hospice Final Rule Changed

CMS issued the FY2027 hospice final rule on July 30, 2026, effective October 1, 2026. The changes hospice compliance teams need to know:

• Payment: a 2.3% update (about $755 million), from a 3.2% market basket increase less a 0.9 percentage point productivity adjustment.
• Aggregate cap: $36,174.75 for FY2027.
• Election statement addendum: now mandatory for every patient electing hospice, not only patients who request it.
• Service and Spending Variation Index (SSVI): a new claims-based score in which a higher score signals potentially concerning hospice utilization and non-hospice spending.
• HOPE submission timing: HOPE data is due within 30 days of the HOPE admission, HUV, and discharge dates.
• Care Compare icon: CMS will add an icon on Care Compare for hospices that submit no quality data, or less than the required 90%, effective no earlier than FY2028.

Source: CMS FY2027 hospice final rule fact sheet. HOPE item details come from the CMS HOPE page and the HOPE v1.03 item set and change table.

Year Two of HOPE

The shift to HOPE follows a pattern other post-acute settings already went through with OASIS and MDS. Agencies treating it systematically, with training, submission tracking, and quality review, keep penalties off the table and their public scores accurate.

HOPE Assessment Resources

• Hospice Recertification Checklist, What each recertification needs on file
• Sentinel QA, Automated QA for every home health and hospice visit note
• Hospice Documentation Best Practices, Strengthen your overall hospice documentation program
• Best Hospice Compliance Tools, Compliance tools compared for 2026