The Centers for Medicare & Medicaid Services (CMS) posted HOPE Guidance Manual Version 1.03 on October 6, 2026, along with updated Admission, HOPE Update Visit, Discharge, and combined item sets. The manual and change table identify October 1, 2026, as the effective date.
CMS says the revisions respond to questions and suggestions received through its Help Desk during the first year of implementation. The changes do not affect the current HOPE Data Specifications.
For hospice providers, the useful next step is a focused comparison of the updated guidance with the procedures staff actually use. A clarification may call for staff education or a workflow adjustment without requiring a complete policy rewrite.
Background: What Is HOPE?
The Hospice Outcomes and Patient Evaluation (HOPE) tool replaced the Hospice Item Set (HIS) on October 1, 2025, within the Hospice Quality Reporting Program. HOPE includes Admission and Discharge records, applicable HOPE Update Visits (HUVs), and symptom follow-up information.
Keep visit scheduling, clinical documentation, record completion, and submission tracking connected. A process that works in one department can still leave gaps if responsibilities are unclear at the handoff.
What Does Version 1.03 Clarify?
The following examples highlight practical areas to review. They are not a substitute for the complete manual and item-specific instructions.
1. Symptom Follow-up Visits
An SFV must be separate from the Admission or HUV; CMS now expressly includes a separate inpatient encounter. Its new scheduling-error example uses J2052C code 9 when an SFV was missed for reasons other than patient refusal or access.
Review who schedules follow-up, who identifies an uncompleted visit, and who verifies that the recorded reason matches what happened. Staff should consult the manual for timing and qualified nursing personnel, alongside applicable professional practice requirements.
2. Late Visits and Timely Submissions
Late HUV records remain accepted. CMS distinguishes visit timing from record submission: timely submitted and accepted HUV records count positively toward compliance.
Track both dates. Acceptance of a record should not be treated as proof that a visit occurred within its expected window. A late visit and a missed visit also require different factual documentation; do not record a visit as completed when it did not occur.
3. Transfers and Administrative Discharges
Transfers between different CMS Certification Numbers, including general inpatient care transfers, require each hospice’s own Admission, applicable HUV, and Discharge records. Administrative billing discharges generally do not require HOPE-Discharge when care continues uninterrupted.
Have clinical and reporting staff review transfer scenarios together. The patient’s movement, the provider responsible for care, and the billing action should be understood before selecting a reporting response.
4. Opioid Documentation at Different Timepoints
For N0500 and N0510, CMS distinguishes Admission order dates from HUV documentation: an opioid initiated or confirmed as continued during an HUV uses the HUV date, rather than the original order date.
Review staff reference sheets and software prompts for these items. A copied-forward date deserves particular attention when staff complete a new timepoint.
Does This Require Hospice Policy Changes?
Not necessarily. Start with the gap, then choose the appropriate response. If an existing policy already covers the process, a staff instruction, tracking tool, or targeted educational update may be sufficient. If responsibilities or documentation expectations are missing, revise the relevant procedure.
The unchanged data specifications should not be taken to mean that every current workflow is already aligned with the revised instructions.
What Should Hospice Providers Do Now?
- Compare the versions. Use CMS’s change table to identify which revisions affect your agency’s practices.
- Review follow-up workflows. Check scheduling, documentation of missed visits, nursing responsibilities, and escalation.
- Track visits and submissions separately. Identify who monitors each deadline and resolves incomplete records.
- Walk through transfer scenarios. Review how clinical care, administrative actions, and HOPE records connect.
- Provide targeted education. Focus on the items staff complete and the situations they encounter.
- Update documents where a gap exists. Record the change and communicate it to the people responsible for carrying it out.
How Does This Relate to the Hospice Conditions of Participation?
This is an update to HOPE assessment and quality-reporting guidance. It does not, by itself, comprehensively revise the Hospice Conditions of Participation. Keep review of HOPE instructions separate from review of broader federal health and safety requirements.
Staying Current
Review the official guidance, identify the practical gaps, and document how your agency addresses them. SouthStart Policy will continue monitoring hospice developments affecting documentation and operational practices.