The Medicare hospice rules for the 2026 fiscal year are now in force. For day-to-day documentation, the change that matters most is the hospice face-to-face attestation. CMS issued the FY 2026 Hospice Final Rule (CMS-1835-F) on August 1, 2025, and it took effect on October 1, 2025. Here is what changed, in plain language.
The payment update
For FY 2026, CMS increased hospice payment rates by 2.6% (a 3.3% market basket increase, reduced by a 0.7 percentage point productivity adjustment). The aggregate hospice cap rose by the same 2.6%, to $35,361.44. Hospices that do not submit the required quality data get the 2.6% update minus four percentage points. That works out to a 1.4% cut. Those figures are useful for budgeting, but the operational changes below are what you actually have to act on. The full detail is in the CMS fact sheet for the final rule.
The hospice face-to-face attestation change
Some patients need a face-to-face encounter before you can recertify them. A hospice physician or hospice nurse practitioner must see each patient whose stay is expected to reach the third benefit period. Under 42 CFR 418.22, the encounter must take place no more than 30 calendar days before the third benefit period recertification. The same applies before every recertification after that. The practitioner must then attest to it. The 2026 rule clarifies two things:
- The attestation must be signed and dated by the physician or nurse practitioner who performed the encounter.
- A signed, dated clinical note can satisfy the attestation requirement. If your face-to-face encounter note is clearly identified as the face-to-face encounter and carries the practitioner's signature and date, that can do the job. You do not necessarily need a separate standalone attestation document.
This sounds small, but it removes a common source of technical denials. Missing signatures, missing dates, and confusion over whether the clinical note "counted" tripped up many hospices. The rule now makes the expectation explicit.
How to document the hospice face-to-face attestation
The practical lesson: build a template that captures the signature and date every time. Then train your clinicians to use it without exception. Label the note clearly as the face-to-face encounter, so a reviewer can find it without guessing.
One more point to check: telehealth. The current regulation allows the recertification encounter by telehealth through December 31, 2027. Since January 31, 2026, though, it bars telehealth for that encounter when the patient is located in an area subject to a hospice enrollment moratorium. A nationwide hospice enrollment moratorium has been in effect since May 13, 2026. Confirm with your Medicare Administrative Contractor before you rely on telehealth for these encounters.
Who can admit a patient
The rule also confirms that any physician member of the interdisciplinary group (IDG) may recommend admission to hospice care, not only the medical director. That physician may also confirm that the admission criteria are met. This aligns the admission rules with the certification rules. It also gives hospices a little more practical flexibility in how they staff the admission process.
The HOPE assessment
Alongside these changes, CMS has moved the hospice quality program onto the new HOPE tool (Hospice Outcomes and Patient Evaluation). HOPE replaces the older assessment instrument. HOPE data collection began on October 1, 2025. Under the Hospice Quality Reporting Program, your team must submit a high proportion of required HOPE assessments within the set timeframe. Otherwise your agency risks a payment penalty. If your team's HOPE training is not already well underway, that is the most urgent item on this list.
What hospice owners should do now
- Update your face-to-face template so it always captures the practitioner's signature and date, and is clearly labeled as the face-to-face encounter.
- Confirm your HOPE workflow: who completes assessments, how your team submits them, and how you track the submission deadlines.
- Review your admission policy to reflect that any IDG physician may recommend admission.
- Refresh your policies and procedures generally. Hospice rules change every year, and a documentation policy written to older rules is a quiet compliance risk. Our policies and procedures service keeps your manual current.
Keeping all of this current is unglamorous but essential. It is also exactly the kind of work that should not cost a fortune. We build and update hospice compliance documentation at a fixed, published price, delivered entirely online. You always know what you are paying, and your program always reflects the current rules. If you are opening a new hospice, see our Texas hospice license support or our guide to why new agencies need accreditation.
Need your hospice documentation brought in line with the 2026 rules? See our fixed-price compliance services, or book a paid Discovery Call. We will tell you exactly what needs updating, honestly, even if that means pointing you elsewhere.
This article is general information, not legal advice. Federal rules change; we confirm the current detail as part of every project.
