HOPE Tool in 2026: What Hospice Agencies Are Getting Wrong in the First Year

The HOPE Tool replaced the Hospice Item Set on October 1, 2025. Six months later, agencies are still working out the compliance details. The consequences are real.

CMS has set a 90% timely submission threshold for HOPE data. Agencies that miss it face a 4% payment reduction in FY 2028. That's not a future risk. The data you're collecting right now is what determines your FY 2028 payment rate.

What HOPE Changed - and Why It's More Work Than HIS Was

The Hospice Item Set was essentially a retrospective chart abstraction. HOPE is a real-time patient assessment tool. That's a fundamental shift in how clinical staff interact with quality reporting.

HOPE requires structured assessments at four specific timepoints:

• Admission Assessment (days 0–5 after hospice election)
• HOPE Update Visit 1 (HUV1) — within the first 30 days
• HOPE Update Visit 2 (HUV2) — if the patient remains enrolled
• Discharge Assessment

On top of those fixed timepoints, Symptom Follow-up Visits (SFVs) are triggered any time a patient scores moderate (4+) or severe (7-10) on pain or other symptom impact items during an Admission or HUV assessment. The SFV must happen within 2 calendar days of the triggering assessment, in person. Not by phone.

This is where most agencies are struggling.

The Four Problems Agencies Are Hitting Right Now

1. SFV timing is getting missed

Two calendar days is tight when your field team is at capacity. If a nurse assesses moderate pain on a Monday admission and the SFV doesn't happen by Wednesday, you have a compliance gap, even if the patient's symptoms improved in the meantime.

Build SFV triggers into your clinical workflow as an automatic task, not something the nurse tracks manually. It needs to follow the nurse from assessment to scheduling.

2. iQIES submissions are generating fatal errors

The transition from QIES to iQIES has been rocky. In the first months of HOPE implementation, agencies reported submission errors, iQIES configuration issues, and help desk delays that were compounded by the federal government shutdown in late 2025.

LeadingAge and other industry groups formally requested that CMS waive the timeliness requirement for the first quarter of HOPE implementation. Check your current iQIES account status and run a submission test if you haven't already. Don't assume your setup is working correctly.

3. Staff don't know which sections they're responsible for

HOPE requires sign-off from every staff member who contributes to the assessment (Section Z). RNs are responsible for clinical assessment sections, but administrative data can be collected by other staff.

If your team doesn't know who owns what, sections get left incomplete or unsigned. That fails the submission.

4. The FY 2028 payment connection isn't on everyone's radar

HOPE data collected in 2026 will be processed for compliance in 2027 and will affect payments in FY 2028. Many clinical staff don't understand the payment downstream. When they do, compliance tends to improve.

Brief your IDG on the payment timeline. It changes how seriously people treat timeliness.

What Good HOPE Compliance Looks Like

• SFV triggers generate an automatic clinical task within the same day as the triggering assessment
• Every HOPE assessment is submitted to iQIES within 30 days of completion
• A designated person monitors iQIES submission status and follows up on fatal errors before the window closes
• Section Z sign-off is built into the post-assessment workflow

WorldView's document management and workflow tools give hospice teams real-time visibility into documentation status — which assessments are complete, which are pending sign-off, and which are approaching submission deadlines. Schedule a demo to see how it supports HOPE compliance.