CMS Begins Major Review of Hospice Conditions of Participation

For the first time in nearly two decades, the Centers for Medicare & Medicaid Services has begun a broad review of the federal Hospice Conditions of Participation.

The Conditions of Participation at 42 CFR Part 418 establish the federal health and safety requirements a hospice must meet to participate in the Medicare program. They address core areas of hospice operations including patient rights, interdisciplinary care, assessments, plans of care, clinical services, quality management, infection control, emergency preparedness, and organizational oversight.

CMS has not issued new hospice CoPs as part of this initiative. Instead, the agency is beginning the review process by gathering feedback from hospice providers, direct-care staff, patients, caregivers, and families.

Why Is CMS Reviewing the Hospice CoPs?

The hospice Conditions of Participation have not undergone a comprehensive revision in nearly 20 years.

CMS is now asking stakeholders whether existing requirements still reflect how hospice care is delivered today and whether some provisions should be modernized.

The agency is also looking beyond clinical care alone. Topics CMS has identified for discussion include workforce challenges, contracting barriers, hospice medical director involvement, access to Medicare-covered services, hospice eligibility controls, and opportunities to strengthen program integrity.

That means the review could eventually affect both clinical practice and agency operations.

What Is CMS Asking Hospices About?

Among the issues CMS is seeking feedback on are:

• Whether existing CoPs still reflect current hospice practice
• Operational barriers affecting the delivery of hospice services
• Workforce challenges
• Difficulties establishing contracts with hospitals, therapists, and other providers
• Controls used to prevent enrollment of patients who do not meet hospice eligibility criteria
• Barriers preventing hospices from providing all Medicare-covered hospice services
• The role and involvement of the hospice medical director
• Policy changes that could improve patient care while reducing fraud or inappropriate enrollment

The breadth of these questions suggests CMS is examining not only whether individual requirements should change, but whether the current regulatory framework adequately reflects how hospice organizations operate today.

CMS Listening Sessions Are Scheduled for October

CMS is beginning the process with stakeholder listening sessions.

The currently announced sessions include:

• October 6, 2026: Hospice administrators, management, and hospice associations
• October 7, 2026: Hospice direct-care staff
• October 14, 2026: Hospice patients, caregivers, and families

The October 6 administrative session is scheduled from 2:00 p.m. to 3:00 p.m. Eastern Time.

The feedback CMS receives during these sessions may help shape future regulatory proposals.

Have the Hospice CoPs Changed Yet?

No.

This distinction is important.

CMS has begun a review of the Conditions of Participation, but the agency has not yet replaced the current hospice CoPs as part of this initiative.

Hospices should continue operating under the federal requirements currently in effect.

CMS has made targeted changes to hospice regulations in recent rulemaking. For example, the FY 2026 hospice final rule addressed physician admission recommendations and face-to-face encounter attestation requirements. Those targeted regulatory changes are different from the broader CoP review now beginning.

A broader revision would ordinarily involve additional regulatory steps before new requirements become effective.

What Should Hospice Providers Do Now?

At this stage, hospices do not need to rewrite their policy manuals solely because CMS has announced this review.

Instead, agencies should:

• Continue following the current Conditions of Participation.
• Watch CMS communications and Federal Register activity.
• Participate in CMS stakeholder sessions when appropriate.
• Avoid changing policies based solely on speculation about what CMS may eventually propose.
• Be prepared to conduct a policy crosswalk once proposed or final regulatory language is released.

This is particularly important because headlines announcing that CMS is “updating” the CoPs can make it sound as though new requirements have already taken effect.

They have not.

Why This Matters for Hospice Policy Manuals

When federal regulations change, simply adding a new policy is not always enough.

A change to one Condition of Participation can affect multiple parts of a hospice manual, including clinical procedures, job responsibilities, documentation requirements, quality management activities, personnel expectations, and survey preparation.

For that reason, regulatory changes should be reviewed against the entire policy framework, not addressed as isolated edits.

A structured crosswalk between the existing regulation, new requirement, affected policies, and operational documents helps ensure that the manual continues to reflect how the hospice is expected to operate.

What Comes Next?

CMS's current listening sessions represent an early stage in the process.

Future steps could include additional stakeholder engagement, proposed regulatory language, a formal public-comment period, and ultimately a final rule with an implementation date.

Until then, hospice providers should continue complying with the existing federal Conditions of Participation while watching closely for further CMS action.

SouthStart will continue monitoring the CMS hospice CoP review and will provide updates as additional regulatory information becomes available.