Volume 26.14
The U.S. Centers for Medicare & Medicaid Services (“CMS”) has released the Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements (“Final Rule”).
The Final Rule updates the hospice wage index, payment rates, and aggregate cap amount for fiscal year 2027 (October 1, 2026 through September 30, 2027). The Final Rule also includes an analysis of Medicare non-hospice spending, including details regarding a hospice service and spending variation index (“SSVI”), and finalizes the requirement that hospices provide the hospice election statement addendum to all Medicare beneficiaries at the time of hospice election.
Additionally, the Final Rule finalizes conforming changes to the discharge from hospice care regulations and changes to the face-to-face encounter regulations. It also includes a summary of comments received regarding community-based palliative care, the construction of a hospice specific wage index, and the overlap between hospice and medical aid in dying laws. Finally, it finalizes changes to the Hospice Quality Reporting Program.
Some of these are discussed below. More information regarding the Final Rule will be forthcoming.
Final FY 2027 hospice payment rates, subject to geographical modification, are as follows:
Routine home care (days 1-60) $ 236.35/day
Routine home care (days 61+) $ 186.35/day
Continuous home care $ 71.94/hour
Inpatient respite care $ 545.98/day
General inpatient care $ 1,231.63/day
FY 2026 payment rates are:
Routine home care (days 1-60) $ 230.83/day
Routine home care (days 61+) $ 181.94/day
Continuous home care $ 69.76/hour
Inpatient respite care $ 532.48/day
General inpatient care $ 1,199.86/day
The aggregate payment limitation (“CAP”) for FY 2027 has been set at $36,174.75. The CAP is not geographically adjusted. Hospices, regardless of location, are subject to the $36,174.75 limitation.
SSVI – CMS has developed a scoring system (“SSVI”), which is calculated using nine claims-based measures. A higher SSVI score represents a higher level of concern and may signal potential program integrity risks to CMS. According to CMS, “a high SSVI score indicates to CMS that a hospice might have more than one area of concern and may require additional targeted education or oversight, such as medical review, education, and investigations that could result in payment suspension, and revocation, if there is identified fraud, waste, or abuse”. SSVI, and the risk associated with the scoring, will be discussed at the upcoming Hospice Financial & Compliance Management Conference.
Election Statement Addendum – The Final Rule makes the election statement addendum mandatory for all hospice elections, not just upon request.
The Final Rule is available here. The Fact Sheet issued by CMS is available here.
A FEW SPOTS REMAIN FOR OUR UPCOMING PROGRAM
The 2026 “Hospice Financial & Compliance Management Conference” is now available for registration; early registration discount ends today. Early registration has been overwhelming, and the program is expected to sell out. Program space is limited to enhance the quality and networking opportunities for the attendees. The two-day program is being held at the Paris Las Vegas on October 1-2, 2026.
As always, this annual program offers the most extensive hospice financial coverage available. The integration of finance and compliance is critical for the survival and success of any hospice. This year, compliance and its associated financial risks are critical. The conference program, including registration information, is available here. Discounted room rates are available here or by calling (877) 603-4389. Make certain to inform Paris Las Vegas that you are attending The Health Group program. If you are registered but have not secured your room, you are encouraged to do so at your earliest opportunity. There are many special events occurring in Las Vegas at the same time as our program. See you in Las Vegas!