CMS’s FY 2027 hospice proposed rule is more than a routine annual payment update. Published in the Federal Register on April 6, 2026, the proposal includes a new Service and Spending Variation Index, or SSVI, a proposal to require the hospice election statement addendum for all Medicare beneficiaries at election, and a proposal to add a Medicare.gov Compare Tool icon for hospices that fail certain HOPE reporting requirements. The rule is still proposed, not final, and comments are due by June 1, 2026.
At a high level, CMS is signaling a more transparent and more data-driven approach to hospice oversight. In CMS’s own description, the SSVI is intended to use claims-based metrics that can signal potential inappropriate utilization, quality-of-care concerns, or compliance concerns, while the other proposals focus on beneficiary-facing transparency and public reporting visibility.
What is the SSVI?
The SSVI is a claims-based scoring model, not a narrative documentation score. CMS says it monitors nine claims-based metrics and produces a provider score that can be used to compare hospices and support program integrity efforts. The CMS SSVI overview shows that the total score is the sum of two parts: a non-hospice spending score and a utilization score, for a total possible score of 0 to 16.
How is the SSVI generated?
The first part is the non-hospice spending score. CMS’s SSVI overview explains that hospices receive 0 to 8 points based on their level of non-hospice spending. Hospices with no reported non-hospice spending receive 0 points. The remaining hospices are divided into eight groups of roughly equal size based on spending, with higher spending resulting in more points. In the FY 2025 CMS overview, the top threshold begins above $517,204.41 and receives 8 points.
The second part is the utilization score. CMS assigns 1 point for each of eight utilization conditions met, for a maximum of 8 points. In the FY 2025 overview, those conditions are: no CHC and no GIP during the year; 40 percent or more of RHC days in a nursing home or SNF; skilled visits during the last two RHC days of life at or below 87.5 percent; live discharge rate at or above 33.3 percent; discharge rate for beneficiaries with a length of stay over 180 days at or above 46.7 percent; average skilled nursing minutes on RHC days at or below 9.9; weekend RHC days with a skilled visit at or below 4.8 percent; and live discharges where the beneficiary returns to the same hospice within seven days at or above 18.2 percent. CMS also explains that several of these thresholds are based on the 25th or 75th percentile of the distribution for the year examined.
Why is CMS proposing this now?
CMS ties these proposals to rising non-hospice spending during hospice elections. In the proposed rule, CMS says Medicare paid over $2.8 billion in non-hospice spending during a hospice election in FY 2024 across Parts A, B, and D. CMS also states that non-hospice Part A and Part B spending increased from nearly $790 million in FY 2020 to over $2 billion in FY 2024.
What else is included in the proposal?
CMS is proposing to require that hospices provide the hospice election statement addendum to all Medicare beneficiaries at the time of hospice election for elections beginning on or after October 1, 2026, instead of only providing it upon request. The proposed rule says the addendum must include the conditions, items, services, and drugs the hospice has determined to be unrelated to the individual’s terminal illness and related conditions and therefore not covered by the hospice.
CMS is also proposing a new icon on the Medicare.gov Compare Tool for hospices that fail to submit any HOPE data or submit less than the required 90 percent of quality data within 30 days of the patient’s admission or discharge date. CMS says this icon would be added no earlier than FY 2028 and updated annually.
Why this matters to hospices
Taken together, these proposals point to a broader transparency model for hospice. One part focuses on claims-based spending and utilization patterns through the SSVI. Another focuses on beneficiary-facing transparency through the election statement addendum. A third focuses on public reporting transparency through the proposed Compare Tool icon tied to HOPE submission compliance. Even though the rule is still proposed, it gives providers a clearer view of the kinds of patterns and reporting behaviors CMS is increasingly watching. That is an inference from the structure of the proposal and CMS’s stated goals around accountability, consumer information, and program integrity.
A note from HospiceWorks
At HospiceWorks, we believe this proposed direction reinforces the importance of stronger operational and documentation workflows before issues appear in claims history or public transparency measures. Our focus is on helping hospices strengthen admission documentation, support clearer coverage and relatedness decisions, improve ongoing visit workflows, and surface compliance concerns earlier in the care process.
Sources and Disclaimer
This article is based on publicly available materials from the Centers for Medicare & Medicaid Services and the Federal Register, including CMS’s press release on the FY 2027 hospice proposed rule, the CMS fact sheet for the proposed rule, the published proposed rule in the Federal Register, and CMS’s SSVI overview materials.
This article is provided for educational purposes only and does not constitute legal advice or regulatory guidance. Providers should review the proposed rule directly and consult qualified legal or compliance advisors regarding implementation and operational impact. As a general legal principle, copyright protection is not available for works of the United States Government under 17 U.S.C. § 105, but USA.gov notes that federal websites may still contain restricted third-party material and that government names, logos, or materials should not be used in a way that implies endorsement.
About the Author
Ramon Sanchez is the Founder & CEO of HospiceWorks, a hospice-focused EMR and compliance workflow platform designed to help hospice providers strengthen documentation, support compliance, and improve operational workflow.
