For physicians, discharge planners and facility staff
Hospice rules 2026–2027: what changed for referrers
The FY2027 hospice final rule (CMS-1851-F) took effect on October 1, 2026. It made the election statement addendum mandatory for every new election, let a physician designee or a physician on the care team sign a discharge order, kept telehealth face-to-face recertification through December 31, 2027, and set new rates and a $36,174.75 cap. A federal enrollment moratorium and a California license moratorium also limit new hospices. The table gives each change, its date and its source.
Medically reviewed by Oscar Chien, MD, Medical Director, November 6, 2026
On this page (4 sections)
What changed, when, and where it is written
Checked against each primary source on November 6, 2026. Dates are effective dates unless the row says otherwise. Each row links to the Beta page that explains the rule in full.
| Rule | What changed | Effective date | Source |
|---|---|---|---|
| Election statement addendum | Mandatory for every election. The hospice gives the patient or representative, in writing, a list of the conditions, items, services and drugs it has decided are unrelated to the terminal illness and will not cover, with the reasons. Before, it was given only on request. | Elections beginning on or after October 1, 2026. Due within the first 5 days of the election; updates within 3 days of a plan-of-care change | 42 CFR 418.24(b)(6), (c), (d); CMS-1851-F |
| Discharge order | The written discharge order may come from the hospice medical director, a physician designee or a physician member of the interdisciplinary group. If the patient has an attending physician, that physician should be consulted before discharge, and the discharge note records their review and decision. | October 1, 2026 | 42 CFR 418.26(b); CMS-1851-F |
| Telehealth face-to-face for recertification | Allowed by two-way, real-time audio and video when the encounter is only for recertification. Not allowed if the patient is in an area under a hospice enrollment moratorium, the hospice is under enhanced oversight, or the physician or nurse practitioner is neither enrolled in Medicare nor an opt-out practitioner. CMS says hospices already enrolled in Medicare can keep using telehealth for these encounters under the 2026 nationwide moratorium. From 2027 the hospice reports a telehealth encounter on the claim. | Through December 31, 2027. Exclusions from January 31, 2026. Claim reporting for encounters on or after January 1, 2027 | 42 CFR 418.22(a)(4)(ii); CMS-1851-F |
| FY2027 payment rates and cap | Routine home care $236.33 a day for days 1 to 60 and $186.33 from day 61; continuous home care $1,726.16 for a full day; inpatient respite $545.93; general inpatient $1,231.51. Aggregate cap $36,174.75 per beneficiary. A hospice that does not report quality data loses 4 percentage points of its update. | October 1, 2026 to September 30, 2027 | CMS-1851-F as corrected by CMS-1851-CN; CMS fact sheet |
| HOPE replaced HIS | The Hospice Outcomes and Patient Evaluation (HOPE) replaced the Hospice Item Set. HOPE adds up to two HOPE Update Visits (HUVs) by a hospice registered nurse, depending on how long the patient is on service: HUV1 on days 6 to 15 and HUV2 on days 16 to 30, counting the election date as day 0. | Data collection began October 1, 2025 | CMS HOPE page; CMS HOPE implementation FAQs; CMS-1810-F |
| Federal hospice enrollment moratorium | No new hospices or new hospice practice locations are enrolled in Medicare nationwide. Hospices already enrolled keep their enrollment. CMS may extend the moratorium in 6-month steps and announces any extension in the Federal Register. | From May 13, 2026, for an initial 6 months. No extension notice had appeared in the Federal Register as of November 6, 2026. Check current status | Federal Register 2026-09718 (CMS-6102-N); 42 CFR 424.570 |
| California hospice license moratorium | The state issues no new hospice licenses and approves no new locations for an existing license, except where it finds a need in the area. Renewals and changes of ownership are not affected. | Since January 1, 2022. CDPH says the moratorium lasts no later than January 1, 2027. Check current status with CDPH | SB 664; AB 177; CDPH AFL 21-53, AFL 25-04 and AB 2673 FAQ |
| Medicare contractor for California | The Medicare Coverage Database names the contractor for LCD L33393 as Wellpoint Federal, formerly National Government Services. The eligibility guidance in the LCD did not change because of the name. | LCD version effective April 1, 2026 | CMS MCD, LCD L33393 |
This table is a summary for referrers, not legal or billing advice. Read the source before relying on a row. Rates are national base rates before the wage index adjustment.
What the referrer does differently
One line per rule, in the same order as the table.
- Addendum. Expect the patient or family to receive a written list of what the hospice will not cover within the first 5 days of the hospice election, and an update within 3 days if the plan of care changes it. If you keep treating a condition the hospice lists as unrelated, ask the hospice for a copy: it must be available to non-hospice providers, and you do not sign it.
- Discharge order. If you are the attending physician, the hospice should consult you before any discharge, and your review and decision go in the discharge note. The order itself may now come from a physician designee or a physician on the hospice team, not only the medical director.
- Telehealth face-to-face. Before the third benefit period and each one after it, a hospice physician or nurse practitioner must see the patient. If you care for that patient, you can ask whether the visit will be by video or in person. CMS says a hospice already enrolled in Medicare can still use video despite the nationwide enrollment moratorium.
- Rates and cap. Nothing changes for the patient's cost share: under Medicare it is still up to $5 per prescription and 5% of the respite rate. The level of care follows the patient's clinical need, not the rate; the levels of care criteria say what qualifies for general inpatient care, continuous home care and respite.
- HOPE. Expect a hospice registered nurse to make up to two update visits in the first 30 days, around days 6 to 15 and 16 to 30. In a nursing facility or assisted living, it helps if staff who know the patient can share recent symptoms at those visits.
- Federal moratorium. While it lasts, a new hospice or a new hospice location cannot enroll in Medicare unless its application reached the Medicare contractor before May 13, 2026. Before you refer, check that the hospice is enrolled in Medicare and licensed by the state. See how to verify a hospice.
- California license moratorium. In the state facility file dated October 16, 2026, 1,926 of the 1,961 active hospice licenses were first issued before 2022. Check the hospice's license status in the state's records before choosing a hospice for a patient.
- Contractor name. Use Wellpoint Federal when you look up the LCD or contact the contractor. The eligibility guidelines follow the current LCD.
What is not on this table
The FY2027 rule also asked for comments on community-based palliative care, a hospice-specific wage index, and the overlap between hospice and medical aid in dying. Those were requests for information, not rule changes, so they are not listed here.
The rule also adds an icon on Medicare's Care Compare for hospices that submit no HOPE data, or fewer than the required 90% of HOPE records on time, in a year. CMS finalized it for no earlier than FY2028 (October 1, 2027), based on 2026 data, so it is not dated here yet.
Common questions about the 2026–2027 rule changes
Is the hospice election statement addendum required for every patient now?
Yes, for every hospice election beginning on or after October 1, 2026. The hospice must give the addendum in writing within the first 5 days of the election and update it within 3 days when the plan of care changes what is covered (42 CFR 418.24(b)(6), (d)).
Can the face-to-face encounter still be done by telehealth in 2027?
Yes, through December 31, 2027, when the encounter is only for recertification and uses two-way audio and video, unless one of the exclusions applies. For encounters on or after January 1, 2027, the hospice reports the telehealth encounter on the claim (42 CFR 418.22(a)(4)(ii)).
Does the nationwide enrollment moratorium affect hospices that are already enrolled?
No. It stops new hospices and new hospice practice locations from enrolling in Medicare. CMS has said enrolled hospices can keep using telehealth for recertification face-to-face encounters.
What is the FY2027 hospice cap?
$36,174.75 per beneficiary for the cap year from October 1, 2026 to September 30, 2027, up from $35,361.44. The full rate table is on the levels of care criteria page.
When will this page be updated?
When CMS publishes the FY2028 proposed rule (usually in the spring), when CMS extends or lifts the enrollment moratorium, and in January 2027 for the California license moratorium and the telehealth claim reporting.
About this page
- Written by
- Beta Hospice care team
- Medically reviewed by
- Oscar Chien, MD, Medical Director
- Last reviewed
- November 6, 2026
- Next review
- May 6, 2027
How we write and review this site
Sources
- Federal Register, FY2027 hospice final rule (CMS-1851-F), August 3, 2026 (effective October 1, 2026) (opens in a new tab)
- 42 CFR 418.24: Election of hospice care, including the election statement addendum (opens in a new tab)
- 42 CFR 418.26: Discharge from hospice care (opens in a new tab)
- 42 CFR 418.22: Certification of terminal illness (face-to-face encounter) (opens in a new tab)
- CMS: Fiscal Year 2027 hospice wage index and payment rate update (final rule fact sheet) (opens in a new tab)
- CMS: Hospice Outcomes and Patient Evaluation (HOPE) (opens in a new tab)
- CMS: HOPE implementation FAQs (HOPE Update Visit timepoints) (opens in a new tab)
- Federal Register, nationwide temporary moratorium on enrollment of hospices (CMS-6102-N), May 15, 2026 (opens in a new tab)
- CMS: Home health and hospice nationwide moratorium FAQs (opens in a new tab)
- 42 CFR 424.570: Moratoria on newly enrolling Medicare providers and suppliers (opens in a new tab)
- CDPH AFL 21-53: hospice licensure, moratorium on new licenses (opens in a new tab)
- CDPH AFL 25-04: AB 177, extension of the hospice licensure moratorium (opens in a new tab)
- CDPH: AB 2673 hospice agency FAQ (moratorium no later than January 1, 2027) (opens in a new tab)
- CHHS Open Data: CDPH Licensed and Certified Healthcare Facility Listing (data date October 16, 2026) (opens in a new tab)
- CMS Medicare Coverage Database: LCD L33393, Hospice: Determining Terminal Status (opens in a new tab)
These sources support the general information on this page. For one person’s care and coverage, talk with the hospice team.
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