HOPE Assessment Tool Series: Updates to HOPE Information (Special Edition)

In our last blog we reported that the Centers for Medicare and Medicaid Services (CMS) confirmed in the FY 2026 hospice payment update proposed rule which was posted in the Federal Register for public review on 4/11/2025, that the HOPE assessment tool will be implemented on October 1, 2025, as planned. We also reported that CMS posted the following updated final HOPE materials on April 22, 2025:

It is important for all hospice providers to review these updated items to determine their impact on day-to-day operations. This updated information will also be a key inclusion for training your staff. CMS stated they will provide a HOPE training session sometime this summer, so providers should regularly monitor the CMS HQRP Announcements & Spotlight webpage for training information.

As the months to the HOPE implementation date are whittling away, providers should be considering some the following questions:

How will the HOPE implementation affect…
- your policies and procedures, clinical, and administrative practices?
- your quality and compliance agendas?
- your operating budget?
- Your staffing model?
- Your CAHPS scores?
How will you measure staff competency and consistent application of the HOPE tool?

These are just a few key considerations on the road to HOPE. Hopefully most organizations have examined these questions as part of their preparation. Now, let’s take a look at update highlights in the HOPE manual v 1.01.

Highlights of HOPE manual updated items

CMS made several updates to the HOPE manual in preparation for the October 1, 2025, implementation date. This blog covers some of the highlights documented in the HOPE manual change table and suggested strategies for success.

HOPE record submission timeline

CMS revised the order and content to describe applicable patients and record submission:

For all current patients with discharges occurring through September 30, 2025, completion and submission of both the HIS Admission and Discharge are required.
For patients admitted through September 30, 2025, but discharged on or after October 1, 2025, providers will:
- Complete and submit the HIS Admission.
- Not be required to administer the HUV assessment(s).
- Complete and submit a HOPE Discharge assessment.

For all patients admitted on or after October 1, 2025, only HOPE records will be accepted by CMS.
These include the HOPE Admission, HOPE Update Visit(s), if applicable, and HOPE Discharge records.

Tips for success:

Ensure your electronic medical vendor (EMR) understands the timeline for HIS record stop submission and HOPE record start submission dates and allows you to test HOPE record submission well in advance of 10/1/2025.
Educate staff who complete admissions and discharges of the cut over date for HIS record stop submission and HOPE record start submission dates and expectations.

HOPE record submission – special circumstances

HOPE Update Visit (HUV) Timepoints – Added language:

If an HUV is missed or late for any reason (e.g., HUV1 conducted on day 17 or HUV2 conducted on day 33), conduct the visit as appropriate and submit the record once completed, including any SFV if applicable.

Symptom Follow-up Visit (SFV) Timepoints – Added language:

It may occur anytime within two calendar days, or later on the same day as the assessment where the initial finding of a moderate or severe symptom was determined during the Admission or HUV.
Depending upon timing and responses to J2051. Symptom Impact, at Admission, or either of the two HUV timepoints, the SFV could stretch beyond the assessment timeframe.
For the HUV timepoints, Z0350.
- Date Assessment was Completed would be the date the HUV was completed, including any SFV where applicable.
- Depending on the length of stay (LOS), up to three SFVs may be required over the course of the hospice stay (Admission, HUV1 and/or HUV2).
Since the clinician has two days to complete the SFV, completion of this visit could stretch beyond the specified Admission or HUV assessment timeframes (J2052. Symptom Follow up Visit (SFV) Item-specific Instructions)

Added language: Traveling Patients

In rare circumstances where a newly admitted hospice patient travels during the first month of hospice service, the home hospice may request the host hospice to conduct and provide the documentation for HUV1 and/or HUV2.

Tips for success:

Ensure you develop a tracking method for HUVs and SFVs, so they are completed within the compliance timeframes.
- Tracking is by calendar days regardless of holidays
Educate staff who complete HUVs and SFVs about the purpose of each visit and the completion compliance timeframes
- Hold staff responsible for meeting visit compliance timeframes
Coordinate with EMRs about how the HOPE tool will accommodate these visits if they are made after the compliance timeframes. Ensure this is covered in EMR education to staff in your organization.

Item clarifications

Replaced A0800. Gender item with A0810. Sex item. Added Coding Tips:

This Item assists in correct identification.
Provides demographic sex -specific health trend information.
Please Note: Patient sex must match what is in the Social Security system.

3- 3.5. HOPE Correction Policy, Adjusted language in paragraph 2.

Any corrections or changes made to the provider’s copy of the HOPE record after the record is accepted by CMS will not be recognized by the system.
The same corrections or changes must also be made to the electronic version of the HOPE record, and that record must be submitted to and accepted by the system.
It is the provider’s responsibility to correct any errors that exist in an accepted HOPE record according to the HOPE Record Correction Policy.
A correction can be submitted for any accepted record, up to 24 months from the Discharge Date, even if there has been a submission and acceptance of subsequent records for the patient.
It is the provider’s responsibility to ensure the record is complete and accurate prior to submission to CMS.

2- I0010. Principal Diagnosis Comorbidities and Coexisting Conditions, added language and added one example:

Do not include the principal diagnosis, except if the patient has a secondary cancer.
Clarification for addressing any circumstance where a hospice patient may have both a primary and a secondary cancer (comorbidity).
Example: During the admission assessment, the patient explains that she has a history of diabetes which is well controlled and also had breast cancer 25 years ago. She was treated for the breast cancer at that time and has scarring from a left breast mastectomy. At the time of the hospice admission, the terminal diagnosis is stage four colon cancer.
- Coding: I0010. Principal Diagnosis would be coded 01. Cancer, and I0100. Cancer, and I2900. Diabetes Mellitus (DM) would be checked for Comorbidities and Coexisting Conditions.
- Rationale: Based upon the clinician’s assessment and patient report, the nurse records Cancer for both the Principal Diagnosis and the Comorbidities and Coexisting Conditions category.

New items and corrections

3- 3.7.1 Modification Requests Patient and Event Identifiers

Adjusted patient identifier to eliminate A0800. Gender and include A0810. Sex item. Added event identifier to include the HUV completion date.

3- 3.7.2. Inactivation Requests

Adjusted reference for Record Event Identifiers to include Z0350: Date Assessment was Completed (for HUV records A0250 = 2 or 3).
Adjusted patient identifier to eliminate A0800 Gender and include A0810. Sex item. Added event identifier to include the or HUV completion date.

Additional updates

The HOPE manual change table contains additional corrections (coding, skip patterns, etc.) language clarifications, and item application examples. Be sure to review the change table carefully to note all updates in the HOPE v 1.01 manual.

Tips for Success:

Ensuring the accuracy and consistency of your entries can significantly impact the quality of your assessments. Here are some tips for successful completion of the Hospice HOPE assessment tool:

Thoroughly review the updated HOPE manual: Familiarize yourself with the coding guidelines, skip patterns, and item application examples provided in the manual. This will help you understand how to complete items accurately.
Verify patient and event identifiers: Ensure that patient identifiers are correctly recorded, including the updated A0810. Sex item, and that event identifiers include the HUV completion date.
Follow coding corrections: Pay attention to the coding corrections and modifications mentioned in the change table to ensure compliance with the latest guidelines.
Consistency in data entry: Maintain consistency in how you enter data across different sections to prevent discrepancies that could affect the evaluation.

Stay tuned for the next installment in the HOPE Assessment Tool blog series and keep your actions and momentum moving forward for the October 1, 2025 implementation.

References

The Centers for Medicare and Medicaid Services. (2025, Oct 1). Hospice outcomes and patient evaluation (HOPE) guidance manual – v1.01. https://www.cms.gov/files/document/hope-guidance-manualv101.pdf-0

The Centers for Medicare and Medicaid Services. (2025, Oct 1). HOPE guidance manual change table v1.00 to v1.01. https://www.cms.gov/files/document/hope-guidance-manualchange-tablev100-v101.pdf