The HOPE Tool: What Hospice Agencies Need to Know in 2026

Quick Answers: The HOPE Tool

What is the HOPE tool in hospice?

HOPE (Hospice Outcomes and Patient Evaluation) is the standardized patient-assessment instrument that replaced the Hospice Item Set (HIS) for the Medicare Hospice Quality Reporting Program (HQRP) on October 1, 2025. It was finalized in the FY 2025 Hospice Wage Index Final Rule (CMS-1810-F) and is submitted through CMS's iQIES system rather than the legacy QIES system that received HIS records.

When did HOPE replace HIS?

HOPE data collection began for all patients admitted on or after October 1, 2025. CMS continued to accept HIS records with a target date of September 30, 2025, or earlier through February 15, 2026; after that date, QIES does not accept HIS records or corrections. Every hospice agency operating in 2026 should already be submitting HOPE.

How is HOPE different from HIS?

HOPE adds patient-level data collection during the hospice stay — not just at admission and discharge. Hospices submit up to two HOPE Update Visits (HUVs) during the first 30 days of the hospice election, in addition to the admission and discharge assessments. HOPE also expands the symptom and pain assessment items and collects more granular data on the patient experience of care.

What is the submission deadline for a HOPE record?

Each HOPE assessment must be submitted to CMS through iQIES within 30 calendar days of completion. Late submissions are tracked under the HQRP and can affect the agency's Annual Payment Update.

Why HOPE Matters for Hospice Agencies in 2026

HOPE is the single largest operational change to hospice quality reporting in more than a decade. The old HIS instrument was a two-point measurement — admission and discharge — that did not reflect what was happening during the hospice stay. HOPE was built to fix that: by capturing data at additional timepoints, CMS aims to construct quality measures that reflect the patient experience across the full hospice episode, not just at its endpoints.

For hospice clinicians, that translates into more assessment work per patient. For administrators, it translates into a new submission cadence, new training requirements, and new iQIES login workflows. For QAPI and compliance leaders, it translates into a new set of quality measures that will eventually feed publicly reported star ratings on Care Compare.

The HOPE Assessment Timepoints

HOPE collects data at four timepoints during a hospice stay:

• HOPE Admission. Completed within five calendar days of the hospice election. Replaces the HIS-Admission record.
• HOPE Update Visit 1 (HUV-1). A new timepoint introduced by HOPE. The visit window opens during the first half of the first 30 days of the hospice stay.
• HOPE Update Visit 2 (HUV-2). A second update visit later in the first 30 days of the stay.
• HOPE Discharge. Completed at the end of the hospice election (death or live discharge). Replaces the HIS-Discharge record.

The exact HUV target-date windows are specified in the CMS HOPE Guidance Manual. Agencies should configure their EMRs to flag patients approaching each HUV window so that no patient passes through the first 30 days of hospice without the required updates.

What HOPE Collects That HIS Did Not

HOPE retains the core HIS items (the seven NQF-endorsed measures, for example) but adds new sections. Notable additions include:

• Expanded pain and symptom assessment items, including symptom impact on function.
• Patient-centered assessment of dyspnea, anxiety, and additional symptom domains.
• Patient and caregiver preferences captured at multiple points in the stay rather than only at admission.
• Items intended to support future hospice care experience measures.

None of this changes the underlying clinical work — hospices have always assessed symptoms and preferences — but HOPE formalizes the documentation. If your clinicians are assessing dyspnea verbally but not recording it in the EMR in a way that maps to HOPE, the assessment effectively did not happen for federal reporting purposes.

Common HOPE Implementation Challenges

Seven months into HOPE, the implementation pain points are consistent across the agencies that have shared their experiences publicly:

• HUV scheduling discipline. Missing a HUV window is the most common compliance issue. EMR alerting and a single accountable owner (often the QAPI coordinator) are needed.
• iQIES access. Submitting HOPE requires iQIES credentials. Agencies that previously had only one or two QIES users have needed to expand iQIES access and train new submitters.
• EMR mapping gaps. Some clinical EMRs were slow to release HOPE-compatible templates. Where the template is missing or incomplete, clinicians must double-document.
• Symptom item interpretation. The new symptom items use specific operational definitions; clinical staff need explicit training on how to score them consistently across disciplines.
• Late submission risk. The 30-day submission clock starts at assessment completion, not at the end of the month. Agencies that batched HIS submissions monthly are recalibrating.

An AI-Assisted HOPE Workflow on Hathr.AI

HOPE assessments are clinical documents — they must be completed by a qualified clinician based on direct assessment. AI cannot replace the visit. What a HIPAA-compliant AI tool can do is shorten the gap between clinical observation and HOPE entry, surface inconsistencies between the HOPE record and the underlying visit notes, and prepare submission-ready data for the iQIES upload.

Hathr.AI runs on AWS GovCloud (FedRAMP High) — the same infrastructure used by the Department of Health and Human Services — and signs a Business Associate Agreement with every plan. Patient data is never used to train the underlying model. This is the architectural posture required for a tool that touches HOPE data.

A representative Hathr.AI workflow for a HUV visit:

1. Upload the visit note. The case manager uploads the RN visit note and the most recent IDG summary into a private Hathr.AI session.
2. Generate a HOPE-mapped summary. Prompt: "From this visit note, extract every finding that maps to a HOPE assessment item. Group findings by HOPE section. Flag any HOPE item not addressed in the note."
3. Reconcile. The clinician reviews the AI summary against the visit, fills in any gaps directly in the EMR, and confirms the HOPE record is complete.
4. Submit through iQIES. The QAPI coordinator submits the HOPE record within 30 days of completion.

This workflow does not change clinical responsibility. The clinician remains the assessor; AI surfaces evidence and gaps. The result is fewer missing items, faster HOPE completion, and a cleaner submission record.

Frequently Asked Questions

Does HOPE apply to all hospice patients?

HOPE applies to all Medicare-certified hospice elections beginning on or after October 1, 2025. Patients already on hospice at that date continued under HIS until discharge.

What happens if an agency misses a HOPE submission deadline?

Missed or late HOPE submissions are tracked under the HQRP. Agencies that fall below threshold compliance face a reduction to their Annual Payment Update. Persistent non-submission can also affect Care Compare reporting once HOPE-derived quality measures begin public reporting.

Can nurse practitioners complete HOPE assessments?

HOPE is completed by qualified clinical staff per the CMS HOPE Guidance Manual. Specific role assignment depends on the assessment item and the hospice's policies; the HOPE manual identifies acceptable assessor roles for each section.

How is HOPE different from CAHPS Hospice?

HOPE is a clinical patient-assessment instrument completed by hospice staff. CAHPS Hospice is a family experience-of-care survey administered after the patient's death by an approved CAHPS vendor. Both feed into HQRP but they measure different things.

Can AI complete HOPE for the clinician?

No. HOPE requires direct clinical assessment. AI can help organize source documents, surface gaps, and accelerate post-visit documentation, but the clinician completes the assessment and is responsible for its accuracy.

Sources and Further Reading

• CMS HOPE Tool overview
• HOPE Technical Information (CMS)
• CMS HOPE Implementation FAQs (PDF)
• 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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