The HOPE assessment and HUV visits: a guide for facility staff

The HOPE timepoints at a glance

HOPE has four timepoints, plus a symptom follow-up visit when a symptom is moderate or severe. CMS counts the effective date of the hospice election as day 0.

A patient needs an HUV only while on service in that window. A patient on service through day 15 has HUV1; a patient on service through day 30 has both.

What is the HOPE assessment in hospice?

HOPE is the standardized set of patient items that CMS requires hospices to complete for the Hospice Quality Reporting Program. Under 42 CFR 418.312, a Medicare-certified hospice completes it for each patient, regardless of payer or age, at least at admission, at the HOPE Update Visits and at discharge. CMS finalized HOPE in the FY2025 hospice rule (CMS-1810-F) to replace the Hospice Item Set (HIS).

Data collection began on October 1, 2025. For patients admitted on or after that date, CMS accepts only HOPE records. A patient admitted before October 1, 2025 and discharged after it has an HIS admission record and a HOPE discharge record, and no HUVs.

CMS says HOPE data feed care planning, quality measurement and the hospice's own quality improvement. The data are collected during the hospice's routine clinical visits.

What is an HUV visit in hospice?

An HUV is a HOPE Update Visit: an in-person visit by a hospice registered nurse to update the plan of care during the first 30 days of hospice. HUV1 falls on days 6 to 15 after the election and HUV2 on days 16 to 30, counting the election date as day 0. An LPN or LVN cannot make an HUV, because CMS treats it as an assessment that updates the plan of care.

An example: a patient elects hospice on Monday, November 2, 2026, so that is day 0. HUV1 is due between Sunday, November 8 and Tuesday, November 17. HUV2 is due between Wednesday, November 18 and Wednesday, December 2.

If an HUV is missed or late, CMS tells the hospice to make the visit as soon as it notices and submit the record. A late HUV record is still accepted.

What is a symptom follow-up visit?

At the admission and at each HUV, the nurse rates how eight symptoms have affected the patient over the past 2 days: pain, shortness of breath, anxiety, nausea, vomiting, diarrhea, constipation and agitation. If any is moderate or severe, a hospice nurse makes an in-person symptom follow-up visit within 2 calendar days. It must be a separate visit, by an RN or an LPN/LVN, and CMS does not allow it by telehealth.

The follow-up visit records how the symptom has affected the patient since the last assessment. The two new HOPE quality measures count how often this visit happens within 2 calendar days: one for pain and one for the other symptoms.

What facility staff may be asked during HOPE visits

The HOPE Guidance Manual lets the hospice nurse use information from the patient, the family and facility staff, together with the nurse's own assessment. In a nursing facility or assisted living, the nurse may ask your staff about:

• Symptoms over the past 2 days. How pain, breathing, anxiety, nausea, vomiting, bowel problems and agitation have affected sleep, concentration, daily activities and the patient's ability to interact with others. The nurse decides the rating; your observations inform it.
• As-needed medicines. Whether scheduled or as-needed opioids were given and whether a bowel regimen is in place. A current medication record and notes on as-needed doses help.
• Skin. Pressure injuries, skin tears, rashes, moisture damage and other wounds, and what is in place: pressure-reducing surfaces, turning schedules, dressings and incontinence care.
• Who helps the patient. At admission, the nurse records how much help is available from people other than hospice or facility staff. Facility staff hours do not count toward that answer.
• Changes since the last visit. Anything new between visits, so the nurse can plan the follow-up. Call the hospice right away about a new or worse symptom.

When will HOPE data appear on Care Compare?

CMS expects to start publicly reporting the HOPE-based measures in November 2027, no earlier than FY2028. Those measures are Timely Follow-up for Pain Impact and Timely Follow-up for Non-Pain Symptom Impact. CMS says the date may change after it analyzes the 2026 HOPE data, which it begins in 2027.

The Comprehensive Assessment at Admission measure already on Care Compare continues, now collected through the HOPE Admission record. The FY2027 rule also adds a Care Compare icon, no earlier than FY2028 (October 1, 2027) and based on 2026 submissions, for hospices that submit no HOPE data or fewer than 90% of their HOPE records within 30 days. See how to read hospice quality data.

Common questions about HOPE and HUV visits

Related guides

Hospice rules 2026–2027: what changed for referrers, the guides for skilled nursing facilities and assisted living and RCFEs, and how to read hospice quality data.

Short definitions of HOPE, HUV and other hospice terms are in the hospice glossary.