CMS Proposes Increases to Hospice Care Rates for FY 2026

[author: Brittni Hamilton]

On April 11, 2025, CMS issued a proposed rule that “would update the hospice wage index, payment rates, and cap amount for FY 2026” as required under the Social Security Act, clarify payment regulations on admission to hospice, and realign attestation requirements for the certification of termination illness, among other things. According to CMS, the proposed rule is estimated to result in $695 million in increased payments to hospices in FY 2026. Comments on the proposed rule are due by June 10, 2025.

The proposed rule has seven major provisions:

1. Section III.A.1. Includes updates to the hospice wage index and “makes the application of the updated wage data budget neutral for all four levels of hospice care.” Payment rates for hospices under Medicare are based on the location where services are provided. The proposed updates to the hospice wage index are based on the July 21, 2023 the Office of Management and Budget (OMB) Bulletin No. 23-01. In general, OMB revises metropolitan statistics based on the census. OMB Bulletin No. 23-01 changed a number of urban counties to rural and some rural counties to urban, among other things.
2. Section III.A.2. Proposes increasing the FY 2026 hospice payment percentage by 2.4 percent. This percentage is based on the 3.2 percent inpatient hospital market basket increase and the proposed 0.8 percent productivity adjustment as required by law.
3. Section III.A.3. Notes the proposed FY 2026 hospice payment rates. There are four payment categories that are based on the location and intensity of the hospice services:

• RHC (routine home care) days 1-60: $230.33 (previously $224.62)
• RHC days 61+: $181.51 (previously $176.92)
• CHC (continuous home care): $1,665.23 (previously $1,618.59)
• IRC (inpatient respite care): $531.60 (previously $518.78)
• GIP (general inpatient care): $1,197.40 (previously $1,170.04)

4. Section III.A.4. Suggests that the hospice cap amount be updated by the hospice payment update percentage of plus 2.4 percent for FY 2026.
5. Section III.B. Proposes to “clarify that the physician member of the interdisciplinary group is among the types of physicians who can recommend a patient’s admission to hospice care.” Previously, Medicare allowed only the medical director or the physician designee to recommend that a patient be admitted to hospice.
6. Section III.C. Aims to re-align the attestation requirements for the certification of terminal illness regulations, by including signatures from the physician’s or nurse practitioner’s signature as meeting the attestation requirements.
7. Section III.D. Proposes a technical correction to a typo in the FY 2024 Hospice final rule at § 418.312(j) (previously referenced § 412.306(b)(2) instead of § 418.306(b)(2)), which is a section that provides updates on the HOPE instrument, HQRP measures, and the transition to the Quality Improvement and Evaluation System (QIES).

CMS is seeking public input through requests for information on approaches to streamline the proposed regulations in accordance with the January 31, 2025 Trump Executive Order No. 14192, “Unleashing Prosperity Through Deregulation.” A copy of the proposed rule can be found here.