Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements

What it is

This is a final rule from the Centers for Medicare & Medicaid Services (CMS) updating how Medicare pays hospice providers for Fiscal Year 2026, which begins October 1, 2025. It adjusts the payment rates, the regional wage adjustment factors used to calculate those payments, and the maximum dollar cap on total payments a hospice can receive per patient per benefit period.

What it changes

Payment rates increase by 2.6 percent across all four levels of hospice care (routine home care, continuous home care, inpatient respite care, and general inpatient care), and the annual aggregate payment cap per patient rises by the same 2.6 percent. The regional wage index — which scales payments up or down based on local labor costs — is updated using hospital wage data from cost reports filed in FY 2022, and a protective rule continues to limit any single-year wage index decrease for a given area to no more than 5 percent. A rule previously requiring the hospice physician or nurse practitioner to submit a separate written attestation after each face-to-face visit (required before recertifying a patient as terminally ill) is clarified: the clinical note from that visit itself can now satisfy the attestation requirement, as long as it contains the clinician’s signature and the date. Physicians who are members of the hospice’s own interdisciplinary care team are explicitly added to the list of physicians who may recommend a patient’s admission to hospice. The deadline through which telehealth visits can substitute for in-person face-to-face encounters for recertification purposes is corrected in the regulation text to match the statutory deadline of September 30, 2025.

Who is affected

Medicare-certified hospice providers — freestanding hospices, hospital-based programs, and skilled nursing facility-based programs — will see higher per-diem reimbursement rates, amounting to an estimated $750 million in additional Medicare payments nationally for FY 2026. Medicare patients who have elected the hospice benefit are indirectly affected because payment levels influence which providers operate in a given area and what services they can sustain. Hospice physicians and nurse practitioners face a procedural change: the face-to-face encounter clinical note now doubles as the required attestation document, reducing duplicative paperwork.