CMS Moves to Strengthen Hospice Oversight With New Transparency Proposals

The Centers for Medicare & Medicaid Services (CMS) has unveiled a series of proposed measures aimed at increasing transparency, strengthening oversight, and improving accountability within the Medicare hospice program. These proposals are part of the FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program (HQRP) requirements.

New Hospice Scoring System to Flag Potential Risks

At the center of the proposal is a publicly accessible hospice scoring system designed to identify providers that may exhibit patterns of inappropriate utilization, compliance concerns, or questionable billing practices. The system introduces the Service and Spending Variation Index (SSVI), which evaluates hospices based on several key indicators, including non-hospice spending, long lengths of stay (180+ days), average care minutes per day, and patterns of live discharges.

While CMS emphasizes that a high SSVI score does not directly indicate fraud, it signals potential areas of concern that may warrant further review. Provider-level data and scores would be made available on CMS platforms, enabling greater visibility for regulators and the public.

Enhanced Consumer Transparency via Care Compare

To further empower patients and families, CMS is proposing the addition of a consumer-friendly indicator on the Medicare.gov Care Compare tool. This icon would identify hospices that fail to meet HQRP reporting requirements, alerting users when sufficient quality data is unavailable to evaluate a provider’s performance.

CMS reports that approximately 20% of hospices were non-compliant with HQRP requirements in 2025, a trend that has remained consistent in recent years. The proposed measure aims to incentivize compliance while helping beneficiaries make informed care decisions.

Mandatory Hospice Election Addendum

Another key proposal would require hospices to provide a hospice election statement addendum to all Medicare beneficiaries at the time of enrollment. Previously issued only upon request, this document outlines which services, medications, and conditions are not covered under the hospice benefit.

By making this information universally available upfront, CMS intends to reduce confusion, improve transparency, and potentially lower out-of-pocket costs for patients and their families during end-of-life care.

Ongoing Anti-Fraud Efforts

These proposals build on CMS’s broader program integrity initiatives, which include unannounced site visits and targeted oversight in high-risk states such as Arizona, California, Nevada, and Texas. These efforts have already led to over 200 hospice enrollment revocations due to non-compliance, with expanded oversight now extending to additional states.

Proposed Payment Updates for FY 2027

CMS also outlined updates to hospice payment rates for FY 2027. The agency proposes a 2.4% increase in hospice payments, equating to an estimated $785 million rise from FY 2026. This adjustment reflects a 3.2% market basket increase offset by a 0.8 percentage point productivity adjustment.

However, hospices that fail to submit required quality data would face a financial penalty. Their payment rates would be reduced by four percentage points, resulting in a 1.6% decrease compared to the previous year.
Additionally, the proposed hospice aggregate cap for FY 2027 is set at $36,210.11, limiting the total annual payments a hospice provider may receive.

Strengthening Accountability in End-of-Life Care

CMS officials state that these measures are intended to safeguard Medicare beneficiaries, curb misuse of funds, and support high-quality hospice providers delivering compassionate care. The proposed rule reflects a continued shift toward data-driven oversight and increased transparency across the healthcare system.

If finalized, these changes could significantly reshape how hospice providers are evaluated, monitored, and reimbursed under Medicare.