HIS to HOPE Transition: What Hospice Agencies Need to Know in 2026

Quick Answers: HIS to HOPE

When did HIS retire and HOPE begin?

HOPE (Hospice Outcomes and Patient Evaluation) became the required patient-assessment instrument for the Hospice Quality Reporting Program on October 1, 2025. HIS records with a target date of September 30, 2025 or earlier were accepted by QIES through February 15, 2026; after that date, QIES does not accept HIS records or corrections.

Why did CMS replace HIS with HOPE?

HIS measured only the admission and discharge timepoints, which limited CMS's ability to construct quality measures that reflect the patient experience across the hospice stay. HOPE captures data at additional timepoints during the first 30 days (the HOPE Update Visits) and expands the symptom and patient-experience items.

What stayed the same?

The seven NQF-endorsed HIS measures are preserved in HOPE. The core admission and discharge data continue to be collected. The agency's obligation to submit on time and the HQRP threshold for Annual Payment Update compliance remain.

What changed?

New HOPE Update Visit (HUV) timepoints during the first 30 days of each hospice election. Expanded symptom and preference assessment items. Submission moved from QIES to iQIES. New EMR templates required. New training needed for clinical staff on operational definitions of the HOPE items.

The HIS to HOPE Transition Timeline

• August 2024. FY 2025 Hospice Wage Index Final Rule (CMS-1810-F) finalized HOPE.
• Through September 30, 2025. HIS remained the active instrument. Agencies used QIES for submission.
• October 1, 2025. HOPE became required for all new hospice elections. Submission moved to iQIES.
• October 1, 2025 – February 15, 2026. Transition window. QIES continued to accept HIS records and corrections with a target date of September 30, 2025 or earlier.
• After February 15, 2026. QIES no longer accepts HIS records. Hospices that have not completed the transition risk HQRP non-compliance.

What Changed Operationally

Submission system

HOPE records are submitted through iQIES, the modernized successor to QIES. Agencies that previously used QIES need new iQIES user accounts. The legacy QIES login does not carry over.

Assessment cadence

HIS required two records per patient: admission and discharge. HOPE requires up to four: admission, HUV-1, HUV-2, and discharge. The HUVs are the most operationally challenging part of the transition because they occur during the active stay and require window-based scheduling.

Assessment items

HOPE retains the HIS items that fed the seven NQF measures, but adds new symptom items (with operational definitions for dyspnea, anxiety, and additional domains) and patient-preference items. Clinical staff need training on how to score the new items consistently.

EMR readiness

Some clinical EMRs released HOPE-compatible templates well in advance of October 2025; others lagged. Agencies on lagging EMRs faced double-documentation in the first months of HOPE. By mid-2026, most major hospice EMRs have full HOPE support, but agencies should verify their template includes every HOPE item including the HUVs.

The Three Most Common Transition Failures

• Treating HOPE as a HIS rename. HOPE is not HIS with new branding. The HUVs are entirely new work and require scheduling discipline that HIS did not.
• Delaying iQIES onboarding. Agencies that postponed setting up iQIES accounts found themselves scrambling in October 2025. New iQIES users still face delays getting credentials provisioned; treat this as a hiring-style timeline, not an IT ticket.
• Not retraining the IDG. HOPE items have operational definitions different from how clinicians casually describe the same findings. "Patient is in pain" is not a HOPE answer. Specific HOPE item language is.

An AI-Assisted HOPE Transition Workflow on Hathr.AI

Hathr.AI runs on AWS GovCloud (FedRAMP High) with a Business Associate Agreement included on every plan, which is the required posture for any tool that processes HOPE data. Patient data is never used to train the underlying model.

A representative transition-support workflow:

1. HOPE readiness audit. Upload a sample of recent HIS records and current visit notes. Prompt Hathr.AI: "Identify any HOPE assessment items that are not currently being captured in the underlying visit documentation. Group findings by HOPE section."
2. Clinician retraining materials. Use Hathr.AI to generate scenario-based training materials that walk clinicians through scoring HOPE items consistently.
3. Post-visit reconciliation. Each completed HOPE assessment is reconciled against the underlying visit note: "Does every HOPE item have supporting documentation? Flag any gaps."
4. iQIES submission check. Before submitting, run the HOPE record through a final reasonableness check for internal consistency.

Frequently Asked Questions

Are HIS records still accepted in 2026?

No. QIES stopped accepting HIS records and corrections after February 15, 2026. Any HIS submission errors not resolved by that date are now permanent for HQRP purposes.

If a patient was admitted before October 1, 2025, were they on HIS or HOPE?

Patients already on hospice on September 30, 2025 continued under HIS through discharge. Patients admitted on or after October 1, 2025 are on HOPE.

Are the seven NQF measures still in effect?

Yes. The seven NQF-endorsed HIS-based measures continue to be calculated using the equivalent HOPE items.

Does the HOPE transition affect the CAHPS Hospice survey?

No. CAHPS Hospice is a separate, post-death family experience-of-care survey administered by approved vendors. HOPE and CAHPS together feed the HQRP but they are distinct instruments.

Sources and Further Reading

• CMS HOPE Tool overview
• HOPE Technical Information (CMS)
• HOPE iQIES Announcement (QTSO)
• Hospice QRP Announcements & Spotlight

This article is for informational purposes only and does not constitute legal, clinical, or billing advice. Always reference the current CMS HOPE Guidance Manual for binding requirements. Last reviewed: May 2026.

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