Hospice Care In Nursing Homes Final Rule
July 9, 2025
Regulatory Advances and Standards in Hospice Care within Nursing Homes
Understanding the New Regulatory Framework for Hospice Services in LTC Settings
The landscape of hospice care in nursing homes is evolving with recent federal regulations designed to enhance quality, improve coordination, and ensure compliance with stringent standards. The final rule introduces comprehensive policies that guide hospice operations within long-term care facilities, emphasizing collaboration, transparency, and patient-centered care. This article explores the key elements of the Hospice Care in Nursing Homes Final Rule, covering regulatory updates, payment policies, operational impacts, and future directions to inform providers, staff, and stakeholders committed to delivering high-quality end-of-life care.
Overview of the Final Rule and Its Purpose
Goals of the final rule
The final rule introduced by CMS aims to improve hospice care quality within long-term care facilities such as nursing homes and assisted living centers. It seeks to strengthen the coordination of care, optimize communication, and eliminate redundant services, ultimately enhancing patient well-being.
Enhancing coordination and communication
A fundamental aspect of the new regulations involves establishing formal, written agreements between LTC facilities and hospice providers. These agreements specify roles, responsibilities, and communication protocols, ensuring everyone involved is on the same page. This structured approach fosters better collaboration, aiding in more timely and effective patient care.
Reducing service duplication
By clarifying roles and establishing standardized procedures, the rule aims to cut down on overlapping services. This not only streamlines care delivery but also helps control healthcare costs, providing a more efficient system for delivering hospice services in nursing home settings.
What key regulations and policies are outlined in the final rule?
The Hospice Care in Nursing Homes Final Rule sets forth numerous policies to uphold standards and improve care. Key elements include:
- Requiring written agreements, such as MOUs, between hospices and LTC facilities, detailing roles and responsibilities.
- Updating payment structures, with the FY 2025 hospice cap set at $34,465.34 and rate adjustments reflecting a 2.9% increase.
- Adoption of the Hospice Outcomes and Patient Evaluation (HOPE) as a new data collection tool, replacing the Hospice Item Set (HIS), starting October 2025.
- Clarifying the roles of medical directors and personnel in certification and recertification processes.
- Making technical updates to the Conditions of Participation, especially concerning staff qualifications.
- Enhancing transparency by requiring facilities to publicly post staffing data and exemption statuses.
- Introducing new quality measures focused on timely follow-up for pain and symptoms to better monitor patient care outcomes.
These policies collectively work toward fostering a more transparent, coordinated, and patient-centered hospice care environment in long-term care facilities.
More Information
For detailed policies and regulations, searching "Hospice Care In Nursing Homes Final Rule regulations and policies" will provide comprehensive insights into the full scope of updates and requirements.
Financial and Payment Policy Changes for FY 2025
How does the final rule influence hospice payment rates and financial aspects?
The final rule for fiscal year (FY) 2025 introduces a 2.9% increase in Medicare hospice payment rates. This adjustment translates to an estimated $790 million boost in reimbursement compared to FY 2024, providing more financial support for hospice providers.
The hospice cap amount, which limits the total payments a hospice can receive per year, has been increased to $34,465.34 from $33,494.01 in the previous year. This cap ensures that increased payment rates are balanced with overall spending limits.
Additionally, the rule revises the hospice wage index, which is used to calculate reimbursements based on regional wage differences. The update aligns with the latest Office of Management and Budget (OMB) statistical area delineations, affecting geographic adjustments in payments.
These policy changes are designed to ensure hospice providers, especially those serving residents in nursing homes and other long-term care settings, receive adequate funding. The updates aim to enhance the financial stability of hospice organizations, address regional wage disparities, and support high-quality end-of-life care.
| Payment Element | FY 2024 Value | FY 2025 Value | Notes |
|---|---|---|---|
| Hospice payment rate increase | N/A | 2.9% | Percentage increase applied to rates |
| Hospice cap amount | $33,494.01 | $34,465.34 | Updated to reflect rate change |
| Geographic wage index updates | No | Yes | Based on latest OMB delineations |
Overall, these financial adjustments aim to bolster hospice services financially while maintaining regulatory balance.
Operational and Regulatory Adjustments in Hospice Care
What responsibilities do staff, including medical directors, have under the hospice care regulations?
Staff members involved in hospice care play vital roles in delivering compassionate, patient-centered services while complying with federal guidelines. Medical directors and attending physicians are tasked with managing symptom relief, overseeing patient assessments, and certifying the terminal illness, ensuring that all actions align with updated procedural requirements. These roles also include clarifying responsibilities in certification and recertification processes within interdisciplinary teams, promoting consistency and accuracy.
Support staff such as nurses, social workers, counselors, and aides contribute by providing psychosocial support, spiritual care, and practical assistance. They are responsible for maintaining detailed, accurate documentation of patient care, which supports ongoing treatment decisions and legal compliance. All personnel are required to work cohesively, communicating effectively within the team to uphold quality standards and ethical practices.
By defining these roles clearly, the regulations aim to foster a healthcare environment that prioritizes the dignity and comfort of terminally ill patients while maintaining rigorous adherence to federal and state requirements.
What documentation and reporting requirements are established by the final rule?
Hospice providers are mandated to create individualized care plans that are comprehensive and developed collaboratively by an interdisciplinary team. These plans must incorporate detailed clinical findings, including disease progression, symptoms, proposed treatments, and the basis for a prognosis of six months or less. Regular updates to these documents are essential to reflect changes in the patient’s condition and to guide care delivery.
Accurate and complete medical records are critical. They should be accessible for review and include documentation of all clinical assessments, interventions, patient responses, and certification or recertification details. The final rule emphasizes precise recording to support billing, quality measurements, and compliance with certification requirements.
Reporting extends beyond patient records. Hospice agencies are required to submit data related to quality measures like pain management follow-ups and symptom control, as well as performance metrics under the Hospice Quality Reporting Program. These reports help ensure transparency, uphold standards, and aid in continuous quality improvement efforts.
Quality Measurement and Improvement Initiatives
What is the Hospice Outcomes and Patient Evaluation (HOPE)?
The Hospice Outcomes and Patient Evaluation, or HOPE, is a new standardized data collection tool mandated by CMS to be implemented starting October 1, 2025. It replaces the existing Hospice Item Set (HIS) and aims to provide a comprehensive view of patient outcomes during hospice care.
HOPE gathers detailed patient data across various domains, including sociodemographics, diagnoses, symptoms, skin conditions, and indications of imminent death. Its design allows for collection at multiple points during the hospice episode, providing continuous insights into patient progress and care quality.
This new instrument is expected to refine quality measurement, enabling providers and regulators to better assess care effectiveness and patient experience.
How are updates to the Hospice CAHPS Survey progressing?
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) hospice survey has undergone significant revisions, finalized by CMS. Notable updates include the addition of a web-mail mode, a shortened survey format, and updated protocols and measures.
Originally scheduled for earlier implementation, CMS delayed these updates until April 1, 2025, to allow more time for developing the web-based delivery system and to encourage higher participation rates.
These enhancements aim to obtain clearer, more actionable patient feedback, which can then inform continuous quality improvements in hospice services.
What are the new quality measures being developed?
Building on the updates to data collection tools, CMS is also working on new quality measures to pinpoint and improve specific aspects of hospice care. Among these are measures related to timely follow-up for pain management and non-pain symptoms, which are expected to be introduced formally starting in FY 2028.
Stakeholder input, including public comments, supports integrating social determinants of health (SDOH) into these quality metrics. This integration aims to address health disparities and promote equitable hospice care, particularly for underserved populations.
Overall, these advancements reflect CMS’s ongoing commitment to elevating hospice quality by utilizing robust data collection, patient feedback, and focused outcome measures.
| Initiative | Focus Area | Implementation Timeline | Purpose |
|---|---|---|---|
| HOPE | Patient outcomes | October 2025 | To replace HIS and improve outcome tracking |
| CAHPS Updates | Patient feedback | April 2025 | To enhance survey data collection and participation |
| New Quality Measures | Pain and symptom follow-up | FY 2028 | To improve symptom management and health equity |
As these initiatives unfold, stakeholders anticipate a more precise and patient-centered approach to hospice care quality improvement.
Coordination of Hospice in Nursing Home Settings
How does the final rule influence hospice care agreements and relationships within nursing homes?
The final rule from CMS marks a significant step toward improving how hospices and long-term care (LTC) facilities, including nursing homes, collaborate to provide hospice services. It emphasizes the importance of establishing clear, written agreements—often in the form of memoranda of understanding (MOUs)—before hospice care begins in these settings. These agreements are designed to clearly define each party’s roles, responsibilities, and communication protocols to ensure coordinated and seamless patient care.
One of the key changes involves detailed documentation of how hospice and LTC staff will coordinate care, such as sharing patient information, managing treatment plans, and responding to patient needs. This is especially vital during patient transfers or when care needs change, requiring timely notifications and joint decision-making.
The rule has also introduced updates to certification and recertification procedures, including clarifying who can certify a patient’s terminal illness. This promotes more consistent and accountable practices across providers.
Hospices are now required to include specific terms about medical management, medication administration, and emergency response in their agreements with nursing homes. Furthermore, facilities must conduct and document ongoing assessments to inform resource allocation and staffing levels, fostering a more integrated approach to patient care.
While these reforms aim to improve service quality and patient safety, they also increase operational responsibilities for both parties. Establishing comprehensive agreements could lead to more collaborative relationships but may also introduce complexities, such as potential disagreements on responsibilities or response times.
To support this shift, CMS mandates transparency, requiring facilities and hospices to post their agreement status and staffing data publicly. This transparency helps hold both entities accountable and promotes trust with patients and families.
Overall, the rule encourages more standardized, detailed, and collaborative partnerships between hospices and nursing homes, which is expected to enhance the quality and continuity of hospice care for residents in LTC settings.
Looking Ahead: Shaping the Future of Hospice Care in Nursing Homes
The Hospice Care in Nursing Homes Final Rule signifies a pivotal step toward more integrated, transparent, and quality-focused end-of-life care. By establishing clear regulatory standards, enhancing quality measurement, updating payment policies, and fostering collaborative relationships, the rule aims to address longstanding challenges and improve outcomes for residents and their families. Continuous developments in assessment tools, quality reporting, and operational oversight will guide the sector into a new era of accountability and compassion. Stakeholders are encouraged to stay informed and adaptable to this evolving regulatory landscape to ensure compliant and effective hospice services that honor the dignity and preferences of every patient.
References
- Final Rule for Hospice and Nursing Home Agreements
- Fiscal Year (FY) 2025 Hospice Payment Rate Update Final Rule ...
- Medicare Program; FY 2025 Hospice Wage Index and Payment ...
- [PDF] Hospice Regulations for Hospice Care in a Skilled Nursing Facility ...
- Variation in hospice services by location of care: Nursing home vs ...
- Understanding the FY 2023 Hospice Final Rule and the Home ...
- Hospice Payment Rate Update Final Rule FY25 - LeadingAge
- CMS Posts FY 2025 Hospice Final Payment Rule
- Medicare and Medicaid Programs; Minimum Staffing Standards for ...
- Skilled nursing, hospice and rehab facilities see payment increases ...
