Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (CMS-1835-F)
On August 1, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1835-F) that updates Medicare hospice payment rates and the aggregate cap amount for fiscal year (FY) 2026 in accordance with existing statutory and regulatory requirements. This fact sheet outlines the key provisions of the final rule.
This rule finalizes in the hospice payment regulations that the physician member of the interdisciplinary group (IDG) may recommend admission to hospice care, which aligns with the certification of terminal illness payment regulations and medical director Conditions of Participation (CoPs) regulations. The rule also clarifies that hospice face-to-face encounter attestations must include the signature and date of the signature of the physician or nurse practitioner and adds additional flexibility by allowing a signed and dated clinical note to satisfy the attestation requirement.
In addition, the rule finalizes a regulatory text change for the Hospice Quality Reporting Program, as discussed further below.
FY 2026 Routine Annual Rate Setting Changes
CMS strives to safeguard access to top-quality hospice programs and services for Medicare beneficiaries. Since the inpatient hospital market basket will be rebased and revised to a 2023 base year in the FY 2026 Inpatient Prospective Payment System (IPPS) final rule, the hospice rule will align with these proposed IPPS updates. The current inpatient hospital market basket reflects a 2018 base year.
For FY 2026, CMS will update the hospice payment rate by 2.6% (an estimated increase of $750 million in payments from FY 2025). This results from the 3.3% inpatient hospital market basket percentage increase reduced by a proposed 0.7 percentage point productivity adjustment, required by law. The FY 2026 rates for hospices that do not submit the required quality data would reflect the FY 2026 hospice payment update percentage of 2.6% minus four percentage points as required by law, which would result in a 1.4% reduction over the previous year’s payment rate. These payment rates reflect the most accurate, updated data available on the cost of goods, services, and labor.
Hospice payments are subject to a statutory aggregate cap, which limits the overall payments made to a hospice annually. The hospice cap amount for FY 2026 is $35,361.44 (FY 2025 cap amount of $34,465.34 increased by the FY 2026 hospice payment update percentage of 2.6%).
Admission to Hospice Care
This rule also finalizes changes to the hospice payment regulations at § 418.25 to add that the physician member of the interdisciplinary group (IDG) may recommend admission to hospice care. This aligns with the current certification regulations at § 418.22(c)(1)(i) and the Conditions of Participation (CoPs) at § 418.102(b).
Face-to-Face Attestation
To correct an inadvertent regulatory omission in the FY 2012 hospice final rule, this final rule amends § 418.22(b)(4) to restore the signature and date requirements for the face-to-face attestation. Additionally, in response to commenter concerns, CMS is finalizing changes to reduce administrative burden by also eliminating the requirement that the attestation must be a separate and distinct document and clarifying that the attestation requirement may be fulfilled not only as either a clearly titled section of or an addendum to the recertification form, but also as part of a signed and dated clinical note within the medical record.
Hospice Quality Reporting Program (HQRP)
In this final rule, CMS corrected a typographical error in the regulations text at 42 C.F.R. §418.312(j). CMS responded to public comments related to the October 1, 2025, implementation of the Hospice Outcomes and Patient Evaluation (HOPE) tool and reviewed input for two RFIs regarding future quality measure concepts and advancing digital quality measurement for HQRP.
The final rule can be viewed at the Federal Register at: https://www.federalregister.gov/public-inspection.
For further information, see the hospice webpage here: http://www.cms.gov/Center/Provider- Type/Hospice-Center.html.
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