Guides Hospice
Service-line guide
Medicare hospice
How a hospice becomes Medicare-certified, what Medicare requires of it, how it is paid, and where federal oversight and state law add their own gates. Medicare certification is a federal step for hospices that bill Medicare; it is separate from the state hospice license, which most states require.
Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Last reviewed October 17, 2026. 59 findings: 43 verified, 13 provisional, 1 disputed, 2 superseded. 11 time-sensitive, flagged with a recheck date. How findings are sourced and labelled.
1What it is
The Medicare hospice benefit pays for palliative care for a terminally ill patient who elects it in place of other Medicare services for the terminal illness. Hospices that bill Medicare meet 42 CFR Part 418; the map of Medicare-certified hospices shows where they operate.
Terminal prognosis
VerifiedThe certification must state that the patient’s life expectancy is 6 months or less if the illness runs its normal course, and clinical information supporting it must be in the medical record (42 CFR 418.22(b)).
Source: 42 CFR 418.22
Benefit periods
VerifiedHospice care is elected for an initial 90-day period, a second 90-day period, then an unlimited number of 60-day periods, used in that order (42 CFR 418.21).
Source: 42 CFR 418.21
Four levels of care
VerifiedMedicare pays for routine home care; continuous home care (“predominantly nursing”, only during brief periods of crisis, at least 8 hours of care in the day); inpatient respite care (no more than 5 consecutive days, with later days paid at the routine rate); and general inpatient care for pain or symptoms that cannot be managed in other settings (42 CFR 418.302(b)).
Source: 42 CFR 418.302
Concurrent care for children
VerifiedA Medicaid- or CHIP-eligible child under 21 who elects hospice may keep receiving curative treatment for the terminal condition (ACA §2302, effective March 23, 2010; CMS guidance SMD #10-018). Hospice eligibility, including the 6-month prognosis, is unchanged.
Source: CMS SMD #10-018 (copy)Michigan MSA 11-11Oregon OAR 410-142-0110
Medicare has no separate palliative care benefit. Community palliative care is usually delivered by a physician or nurse practitioner practice billing Part B, or by hospice- or home-health-affiliated programs under payer contracts; most states do not require a clinic license for it, and no single license covers a full interdisciplinary palliative team at home.
Not yet confirmed — check with the state health department and your legal counsel.
Source: Arnall Golden Gregory: community-based palliative care modelsCAPC listening-session document
The FY 2027 hospice final rule summarized comments on a request for information about community palliative care and finalized no policy.
Source: CMS fact sheet: FY 2027 hospice final rule (CMS-1851-F)
2Who regulates it
CMS sets the Conditions of Participation and pays; the Medicare Administrative Contractor (MAC) enrolls; a state survey agency or a CMS-approved accrediting organization surveys; the state licenses separately.
How often hospices are surveyed
VerifiedA hospice receives a standard survey by an appropriate state or local survey agency, or an approved accreditation agency, “not less frequently than once every 36 months” (42 CFR 488.1110(a)). A survey must also be conducted when complaints are reported, and the state runs a toll-free hotline (488.1110(b)).
Source: 42 CFR 488.1110 (eCFR)
Who surveys
VerifiedSurveys by more than one surveyor are conducted by a multidisciplinary team that includes a registered nurse; a single-surveyor survey is done by a registered nurse. State, federal and accreditor hospice surveyors all complete CMS Basic Hospice Surveyor Training (42 CFR 488.1115, 488.1120).
Source: 42 CFR 488 Subpart M (eCFR)
Under SSA §1865(a), CMS approves accrediting organizations whose standards and survey processes meet or exceed its own; hospices are among the providers that may be deemed. Accreditation “is voluntary and is not required for Medicare participation” (SOM ch. 2 §2003C). In 2021 CMS reported that half of all Medicare-certified hospices were deemed by ACHC, CHAP or The Joint Commission.
In practice: Each accreditor’s program: Accreditation & Surveys; how the pieces fit: Surveys and certification.
Source: CMS State Operations Manual, Chapter 2CMS QSO-22-01-Hospice
Current hospice deeming terms
VerifiedFederal Register notices give these CMS approval terms for Medicare hospice: The Joint Commission, June 18, 2025 to June 18, 2030; CHAP, November 20, 2024 to November 20, 2029; ACHC, November 27, 2025 to November 27, 2031.
Source: FR 2025-09870 (TJC)FR 2024-26123 (CHAP)FR 2026-06500 (ACHC)
Accreditation does not replace a state license. A deemed hospice must hold state licensure where state law requires it (42 CFR 418.116(a)); CMS required ACHC to align its hospice standards to that condition in its 2026 renewal.
In practice: Each state’s hospice license and certificate-of-need rules are on its state page.
Source: FR 2026-06500 (ACHC renewal)
Survey results are public
VerifiedHospice is an exception to the general bar on disclosing accreditor surveys: CMS posts state agency and accreditor hospice inspection reports conducted on or after October 1, 2022, including deficiencies and enforcement actions, on a searchable public website (42 CFR 488.7(b)–(c)). QCOR hosts hospice CMS-2567s from October 2021.
Enforcement short of termination
VerifiedSince the Consolidated Appropriations Act, 2021, CMS may impose civil money penalties, suspension of payment for new admissions, temporary management, a directed plan of correction or directed in-service training instead of, or in addition to, termination (42 CFR 488.1220). Termination follows within 23 days if immediate jeopardy is not removed, and within 6 months for other condition-level noncompliance.
Special Focus Program on hold
VerifiedThe Hospice Special Focus Program is still codified at 42 CFR 488.1135, but CMS paused it effective February 14, 2025. The FY 2027 Mission and Priority Document says it “remains on hold” and that survey procedures for all hospices continue as established until it resumes.
Time-sensitive. Recheck the next CMS Mission and Priority Document for any resumption.
Source: CMS FY 2027 Mission and Priority Document42 CFR 488.1135 (eCFR)
3Federal rules hospices run on
Who certifies, and when
VerifiedFor the first 90-day period, the hospice medical director, a physician designee or the interdisciplinary group physician certifies, together with the attending physician if there is one; later periods need only one hospice physician. Written certification is needed before billing; if it cannot be obtained within 2 calendar days after a period starts, an oral certification is required within those 2 days, and certification may not be made more than 15 days before the period begins (42 CFR 418.22(a), (c)).
Source: 42 CFR 418.22
Physician narrative
VerifiedThe certification includes a narrative written for the patient that “cannot contain check boxes or standard language used for all patients” (42 CFR 418.22(b)(3)). From FY 2026, the physician or nurse practitioner signs and dates each face-to-face attestation, and the encounter note may serve as the attestation.
Source: 42 CFR 418.22Federal Register 2025-14782: FY 2026 hospice final rule
A hospice physician or nurse practitioner sees the patient within 30 days before the third benefit-period recertification and every one after it. Telehealth is allowed for these encounters through December 31, 2027, except that from January 31, 2026 it is barred for patients in moratorium areas, patients of hospices under enhanced oversight, and encounters by practitioners not enrolled under SSA §1866(j) (42 CFR 418.22(a)(4)). The FY 2027 rule added conforming text for the Consolidated Appropriations Act, 2026 policy.
Time-sensitive. The telehealth allowance ends December 31, 2027; recheck before then.
Source: 42 CFR 418.22CMS fact sheet: FY 2027 hospice final rule (CMS-1851-F)
Conditions of Participation
VerifiedSubpart C of Part 418 covers patient rights (418.52), initial and comprehensive assessment (418.54), the interdisciplinary group, care planning and coordination (418.56), QAPI (418.58), infection control (418.60), core services (418.64), therapy services (418.72), aide and homemaker services (418.76) and volunteers (418.78). Emergency preparedness is a separate condition (418.113).
Core services are physician, nursing, medical social services and counseling (including bereavement, dietary and spiritual counseling). The hospice “must routinely provide substantially all core services directly by hospice employees”, with exceptions for contracted physicians, extraordinary circumstances and arrangements with another Medicare-certified hospice. Bereavement support is available up to 1 year after the patient’s death (42 CFR 418.64).
Source: 42 CFR 418.64
Hospice aides
VerifiedAides complete at least 75 hours of training, with at least 16 classroom hours before 16 hours of supervised practical training, and 12 hours of in-service training every 12 months. A registered nurse visits the home at least every 14 days to assess aide services (the aide need not be present) and observes each aide on site once a year (42 CFR 418.76).
Source: 42 CFR 418.76
Volunteers
VerifiedVolunteers provide administrative or direct patient care hours equal to at least 5% of the total patient care hours of paid employees and contract staff; fundraising and board activities do not count (42 CFR 418.78).
Source: 42 CFR 418.78
From October 1, 2026, every electing beneficiary receives the election statement addendum listing the conditions, items, services and drugs the hospice will not cover (before, it was given only on request). A physician designee or the interdisciplinary group physician may now discharge a patient, not only the medical director.
Source: CMS fact sheet: FY 2027 hospice final rule (CMS-1851-F)
A hospice that provides inpatient care directly meets the Life Safety Code (NFPA 101, 2012 edition), subject to waivers or an adequate state fire code (42 CFR 418.110); the fire authority usually completes a separate CMS-2567 for that survey.
Source: 42 CFR 418.110 (eCFR)CMS State Operations Manual, Chapter 2
Plan of care review
ProvisionalThe plan of care is reviewed as often as the patient’s condition requires and at least every 15 days.
Not yet confirmed — check with the current text of 42 CFR 418.56.
Source: NHPCO Volunteer CoP tip sheet
4Enrollment and oversight
Two different federal measures apply by state and are easy to confuse: the provisional period of enhanced oversight for newly enrolling hospices, and prepayment review of hospices already enrolled. Both are separate from the 2026 nationwide enrollment moratorium.
Effective May 13, 2026, CMS imposed a six-month moratorium on new Medicare enrollment of hospices (and home health agencies) nationwide, extendable in six-month increments (SSA §1866(j)(7); 42 CFR 424.570). No new initial enrollment applications or new hospice practice locations are accepted or approved while it lasts, and it reaches specified majority-ownership changes that require new enrollment. Applications received before May 13, 2026 continue and are exempt, as are enrolled hospices, purchases where the buyer assumes the existing provider agreement, and routine information changes.
Time-sensitive. The first six-month term runs to about November 13, 2026, when CMS decides whether to extend it; as of early October 2026 no decision had been announced. Recheck the Federal Register and the CMS provider enrollment moratoria page after that date.
Source: Federal Register 2026-09718: HHA and hospice enrollment moratoriaCMS FY 2027 Mission and Priority Document
The moratorium restricts Medicare enrollment only. It does not stop forming a company, obtaining a state hospice license, hiring, writing policies or preparing for enrollment; it pauses the step of becoming a Medicare provider. Medicaid and CHIP moratoria are left to each state.
Time-sensitive. The first six-month term runs to about November 13, 2026, when CMS decides whether to extend it; as of early October 2026 no decision had been announced. Recheck the Federal Register and the CMS provider enrollment moratoria page after that date.
Source: Federal Register 2026-09718: HHA and hospice enrollment moratoriaCMS FY 2027 Mission and Priority Document
Initial certification surveys for non-exempt new hospices “shall not continue for the duration of the nationwide moratorium”; exempt applicants may continue with an approved CMS-855A. CMS told survey agencies that survey planning should continue.
Time-sensitive. The first six-month term runs to about November 13, 2026, when CMS decides whether to extend it; as of early October 2026 no decision had been announced. Recheck the Federal Register and the CMS provider enrollment moratoria page after that date.
Notice of an extension
ProvisionalTrade press reports that a CMS official said in July 2026 that CMS would give 60 days’ notice of any extension, and that a September 14, 2026 CMS message said CMS was under no obligation to do so.
Not yet confirmed — check with CMS.
Time-sensitive. The first six-month term runs to about November 13, 2026, when CMS decides whether to extend it; as of early October 2026 no decision had been announced. Recheck the Federal Register and the CMS provider enrollment moratoria page after that date.
CMS applies a provisional period of enhanced oversight to hospices that newly enroll, change ownership or reactivate in Arizona, California, Nevada and Texas (from July 13, 2023) and Georgia and Ohio (from December 30, 2025).
In practice: The six states are mapped at Hospice enhanced oversight.
Source: CMS: Medical Review and Education, HospiceMorgan Lewis, January 2026 (secondary)
How long enhanced oversight lasts
ProvisionalEnhanced oversight periods are reported to last from 30 days to 1 year, with the MAC’s medical review authority continuing after the period ends.
Not yet confirmed — check with your MAC.
Separately, Expanded Prepayment Review of hospices already enrolled began September 17, 2024 in Arizona, California, Nevada and Texas, with Georgia and Ohio added December 30, 2025. This is medical review of existing providers’ claims, not the oversight period for new ones.
Source: CMS: Medical Review and Education, HospiceMorgan Lewis, January 2026 (secondary)
The 36-month rule on ownership changes
ProvisionalFrom January 1, 2024, if majority ownership (more than 50%) of a hospice changes within 36 months of its initial enrollment or its last majority change, the provider agreement and billing privileges do not transfer and the buyer enrolls as a new hospice (42 CFR 424.550).
Not yet confirmed — check with CMS.
Source: Arnall Golden Gregory: hospice 36-month rule (secondary)McDermott: CY 2024 hospice program integrity (secondary)
High-risk screening
ProvisionalFrom the CY 2024 rule, newly enrolling hospices and hospices reporting a new owner are screened at the high-risk level, with fingerprint-based background checks for owners of 5% or more; hospice administrators and medical directors are managing employees (42 CFR 424.518).
Not yet confirmed — check with CMS.
Source: LeadingAge summary (secondary)McDermott: CY 2024 hospice program integrity (secondary)
The FY 2027 rule updates the Service and Spending Variation Index, built on 9 claims-based measures, which CMS uses to target hospices for education or oversight.
Source: CMS fact sheet: FY 2027 hospice final rule (CMS-1851-F)
5Payment
Rates change every October 1. The FY 2027 rates are in force from October 1, 2026 to September 30, 2027; FY 2026 figures below are history.
FY 2027 update and cap
VerifiedThe FY 2027 final rule (CMS-1851-F) raised hospice payments 2.3% (a 3.2% market basket less 0.9 points of productivity), about $755 million. The FY 2027 aggregate cap is $36,174.75 per beneficiary.
Time-sensitive. FY 2028 rates take effect October 1, 2027; recheck when the FY 2028 final rule is published.
Source: CMS fact sheet: FY 2027 hospice final rule (CMS-1851-F)Federal Register 2026-15686: FY 2027 hospice final rule
FY 2027 per diem rates
DisputedA secondary summary of the final rule gives routine home care at $236.35 (days 1 to 60) and $186.35 (day 61 on), continuous home care $1,726.50 a day ($71.94 an hour), inpatient respite $545.98 and general inpatient $1,231.63. A CMS claims-processing transmittal shows routine home care at $236.33 and $186.33. The CMS fact sheet does not list per diem rates.
Not yet confirmed — check with the FY 2027 rate tables in the Federal Register (FR Doc 2026-15686) or your MAC.
Source: Applied Policy: FY 2027 hospice final rule (secondary)CMS Pub 100-04 R13976CPFederal Register 2026-15686: FY 2027 hospice final rule
FY 2026 rates (history)
SupersededFY 2026 (October 1, 2025 to September 30, 2026): a 2.6% update; routine home care $230.83 (days 1 to 60) and $181.94 (day 61 on), continuous home care $1,674.29 a day ($69.76 an hour), inpatient respite $532.48, general inpatient $1,199.86; aggregate cap $35,361.44.
Source: Federal Register 2025-14782: FY 2026 hospice final ruleCMS-1835-F (PDF)
Service intensity add-on
VerifiedFor routine home care days in the last 7 days of an election that ends in death, Medicare adds the continuous home care hourly rate for registered nurse or social worker direct care, up to 4 hours a day (42 CFR 418.302(b)(1)).
Source: 42 CFR 418.302
The 20% inpatient cap
VerifiedInpatient days (general inpatient and respite) may not exceed 20% of a hospice’s total Medicare patient days; days over the limit are paid at the routine home care rate (42 CFR 418.302(f)).
Source: 42 CFR 418.302
Quality reporting and HOPE
VerifiedHospices that do not meet Hospice Quality Reporting Program requirements lose 4 percentage points of the annual update (a net −1.7% for FY 2027). HOPE replaced the Hospice Item Set for admissions from October 1, 2025, with records submitted to iQIES; from FY 2027, HOPE records are due within 30 days of the admission, update visit and discharge dates.
Source: CMS fact sheet: FY 2027 hospice final rule (CMS-1851-F)CMS: HOPECMS HOPE Implementation FAQs
Medicare Advantage enrollees
VerifiedCMS ended the hospice component of the Value-Based Insurance Design model at 11:59 p.m. on December 31, 2024 and took no applications for 2025.
Medicaid hospice rates (FY 2026)
SupersededMedicaid hospice rates are published separately each year. The FY 2026 Medicaid rate letter lists routine home care at $231.13 and $182.18 for hospices that reported quality data, slightly different from the Medicare figures.
6How states differ
Most states require a state hospice license, separate from Medicare certification. A few gate entry with certificate-of-need review or a licensing moratorium.
North Carolina’s State Medical Facilities Plan sets need determinations for hospice home care offices and hospice inpatient beds (Tables 13G and 13H).
In practice: States with a confirmed hospice certificate of need: Certificate of need: hospice.
Tennessee certificate of need
VerifiedIn Tennessee, hospice certificate-of-need applications are filed with the Health Facilities Commission under hospice and residential hospice standards.
Florida certificate of need
ProvisionalIn Florida, the Agency for Health Care Administration runs hospice need determinations and certificate-of-need awards; news reporting from 2021 describes a finding of need for four additional programs.
Not yet confirmed — check with the Florida Agency for Health Care Administration.
Source: Tampa Bay Times, June 22, 2021
Other states
ProvisionalOlder reporting counts about 14 states with hospice certificate-of-need review, but no current authoritative list was found. Only North Carolina, Tennessee and Florida are confirmed here; check any other state’s planning agency directly.
Not yet confirmed — check with each state’s certificate-of-need program.
Source: Hospice News, June 28, 2022
SB 664 (2021) barred the California Department of Public Health from issuing new hospice licenses from January 1, 2022, including new locations and service-area expansions.
Source: CDPH AFL 22-28
When California’s moratorium ends
ProvisionalAB 177 extended the moratorium to the earlier of January 1, 2027 or one year after emergency regulations are adopted. CDPH’s first hospice licensing emergency regulations took effect June 22, 2026, so law firms expect the moratorium to end January 1, 2027.
Not yet confirmed — check with the California Department of Public Health.
Time-sensitive. Expected to end January 1, 2027; recheck with CDPH then.
Source: Epstein Becker Green (secondary)Hooper Lundy (secondary)CHAP: hospice and home health moratoria
7How to start
Order of steps
ProvisionalThe cited requirements put the work in this order: form the entity; obtain a certificate of need where the state has one; obtain the state hospice license; staff the medical director, interdisciplinary group, volunteer and bereavement functions and begin serving patients; file the CMS-855A (high-risk screening); complete the initial survey by the state agency or an accreditor after the MAC recommends approval; then the provider agreement and, in six states, enhanced oversight. No single official checklist sets this order.
Not yet confirmed — check with your MAC and state survey agency.
Time-sensitive. While the moratorium lasts, the Medicare enrollment step is closed to new applicants; recheck after about November 13, 2026.
Source: CMS State Operations Manual, Chapter 2CMS FY 2027 Mission and Priority DocumentCMS: Medical Review and Education, Hospice
In the FY 2027 Mission and Priority Document, initial hospice certification surveys by state agencies are Tier 3, below 36.9-month recertifications, unless CMS finds an access-to-care issue (Tier 2), so new hospices relying on the state agency may wait.
CHAP lists 5 hospice patients served, 3 active at the visit, and the CMS-855A letter as readiness minimums. No hospice-specific minimum census was found in the State Operations Manual.
Not yet confirmed — check with your accrediting organization.
Source: CHAP: Accreditation
Buying an enrolled hospice
ProvisionalWhile the moratorium lasts, a purchase where the buyer assumes the existing provider agreement is exempt. A majority purchase of a hospice enrolled less than 36 months is treated as new enrollment, which the moratorium blocks.
Not yet confirmed — check with CMS and your legal counsel.
Time-sensitive. The first six-month term runs to about November 13, 2026, when CMS decides whether to extend it; as of early October 2026 no decision had been announced. Recheck the Federal Register and the CMS provider enrollment moratoria page after that date.
Source: Federal Register 2026-09718: HHA and hospice enrollment moratoriaArnall Golden Gregory: hospice 36-month rule (secondary)Nixon Peabody, May 14, 2026 (secondary)
Timelines
ProvisionalOne law firm describes initial enrollment as able to “take up to a year or more”. No official source gives a typical overall timeline; this guide does not publish one.
Not yet confirmed — check with your MAC and accrediting organization.
Source: Arnall Golden Gregory: hospice 36-month rule (secondary)
8Common pitfalls
Template certifications
VerifiedA certification narrative built from check boxes or standard language does not meet 42 CFR 418.22(b)(3).
Source: 42 CFR 418.22
Contracting out core services
VerifiedRoutinely contracting nursing, social work or counseling breaks the requirement to provide substantially all core services through hospice employees (42 CFR 418.64).
Source: 42 CFR 418.64
Fundraising and board hours do not count toward the 5% volunteer requirement (42 CFR 418.78).
Source: 42 CFR 418.78
A hospice under enhanced oversight, or serving patients in a moratorium area, may not use telehealth for the recertification face-to-face encounter from January 31, 2026 (42 CFR 418.22(a)(4)).
Source: 42 CFR 418.22
New hospice practice locations are not accepted or approved while the moratorium lasts, so geographic growth through a new Medicare location waits.
Time-sensitive. The first six-month term runs to about November 13, 2026, when CMS decides whether to extend it; as of early October 2026 no decision had been announced. Recheck the Federal Register and the CMS provider enrollment moratoria page after that date.
Source: Federal Register 2026-09718: HHA and hospice enrollment moratoriaCMS FY 2027 Mission and Priority Document
Missing quality data
VerifiedMissing HOPE or other quality reporting costs 4 percentage points of the annual update; starting no earlier than FY 2028, Care Compare will flag hospices that submit no quality data or less than 90% of it.
Source: CMS fact sheet: FY 2027 hospice final rule (CMS-1851-F)
Official sources
- 42 CFR 418.22
- 42 CFR 418.21
- 42 CFR 418.302
- CMS SMD #10-018 (copy)
- Michigan MSA 11-11
- Oregon OAR 410-142-0110
- Arnall Golden Gregory: community-based palliative care models
- CAPC listening-session document
- CMS fact sheet: FY 2027 hospice final rule (CMS-1851-F)
- 42 CFR 488.1110 (eCFR)
- 42 CFR 488 Subpart M (eCFR)
- CMS State Operations Manual, Chapter 2
- CMS QSO-22-01-Hospice
- FR 2025-09870 (TJC)
- FR 2024-26123 (CHAP)
- FR 2026-06500 (ACHC renewal)
- 42 CFR 488.7 (eCFR)
- QCOR: Hospice 2567s
- 42 CFR 488.1220 (eCFR)
- 42 CFR 488 Subpart N (eCFR)
- CMS FY 2027 Mission and Priority Document
- 42 CFR 488.1135 (eCFR)
- Federal Register 2025-14782: FY 2026 hospice final rule
- 42 CFR 418 Subpart C
- 42 CFR 418.113 (eCFR)
- 42 CFR 418.64
- 42 CFR 418.76
- 42 CFR 418.78
- 42 CFR 418.110 (eCFR)
- NHPCO Volunteer CoP tip sheet
- Federal Register 2026-09718: HHA and hospice enrollment moratoria
- Home Care Roadmap, October 2, 2026 (secondary)
- CMS: Medical Review and Education, Hospice
- Morgan Lewis, January 2026 (secondary)
- Arnall Golden Gregory: hospice 36-month rule (secondary)
- McDermott: CY 2024 hospice program integrity (secondary)
- LeadingAge summary (secondary)
- Federal Register 2026-15686: FY 2027 hospice final rule
- Applied Policy: FY 2027 hospice final rule (secondary)
- CMS Pub 100-04 R13976CP
- CMS-1835-F (PDF)
- CMS: HOPE
- CMS HOPE Implementation FAQs
- CMS: VBID model
- CAPC: VBID hospice component ends
- Medicaid.gov: FY 2026 hospice rate letter
- NCDHHS SMFP Table 13G (2025 draft)
- TN HFC: CN2306-016 deemed complete
- Tampa Bay Times, June 22, 2021
- Hospice News, June 28, 2022
- CDPH AFL 22-28
- Epstein Becker Green (secondary)
- Hooper Lundy (secondary)
- CHAP: hospice and home health moratoria
- CHAP: Accreditation
- Nixon Peabody, May 14, 2026 (secondary)
Revision history
| Date | Change |
|---|---|
| 2026-10-17 | First published |
About this guide. Published and maintained by Paloma Health Technologies; Findings are cited to official sources, dated and status-labelled; see the editorial policy. Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Questions
Hospice: common questions
Can a new hospice enroll in Medicare now?
Not while the nationwide moratorium that began May 13, 2026 lasts, unless its application was received before that date. The first six-month term runs to about November 13, 2026, when CMS decides whether to extend it in six-month increments.
Does the moratorium stop a company from getting a state hospice license?
No. It restricts Medicare enrollment only, including new hospice practice locations and specified ownership changes. Forming the company, obtaining the state license and preparing for enrollment are not affected.
What is the provisional period of enhanced oversight?
It is CMS oversight of hospices that newly enroll, change ownership or reactivate in Arizona, California, Nevada and Texas (from July 13, 2023) and Georgia and Ohio (from December 30, 2025). It is separate from the prepayment review of hospices already enrolled in those states.
What are the FY 2027 hospice payment changes?
The FY 2027 final rule raised payments 2.3% for October 1, 2026 to September 30, 2027, and set the aggregate cap at $36,174.75 per beneficiary. Hospices that miss quality reporting lose 4 percentage points of the update.
How often is a hospice surveyed?
At least once every 36 months, by the state survey agency or a CMS-approved accrediting organization, and whenever complaints are reported (42 CFR 488.1110). Hospice inspection reports from October 1, 2022 on are posted publicly.
Must a hospice give every patient the election statement addendum?
Yes, from October 1, 2026. Before FY 2027 the addendum listing what the hospice will not cover was given only on request.