HOPE Assessment Tool Series: Let’s Talk HOPE Items – Administration & Preferences

HOPE Assessment Tool Series: Let’s Talk HOPE Items – Administration & Preferences

HOPE Assessment Tool Series: Let’s Talk HOPE Items – Administration & Preferences 

Let’s begin this blog with some updates.  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.  So, providers need to continue their preparation for readiness and compliance.  CMS also posted the following updated final HOPE materials on April 22, 2025: 

The road to HOPE assessment tool readiness includes a competent understanding of each item in the tool and how to answer it.  While many of the items in the HOPE tool are the same or similar to items in the Hospice Item Set (HIS), reviewing these items with your staff is an important piece of the HOPE implementation journey.  The HOPE assessment tool is a standardized data set, and it is optimal for all of your staff to administer the questions in the same way to ensure consistency.  Hopefully, you have identified completion gaps in the HIS (if any) and are improving performance in those areas before the implementation of the HOPE tool. 

Section A: Administrative Information 

This section gathers essential information that uniquely identifies each patient, hospice, and potential patient care requirements.  Some of this data will be duplicative of information on the claim form for a patient such as demographic information and site of service.  Any assessing discipline in the hospice team may collect data in this section, which is helpful to providers.  Now, let’s take a look at some of the highlights in the administrative section. 

Race and ethnicity 

The HIS v3.00 merges race and ethnicity into a single item (A1000), whereas the HOPE v1.00 separates these categories and expands the available selections. This modification was implemented to ensure consistency with the finalized Standardized Patient Assessment Data Elements used in other post-acute care (PAC) settings. CMS also added a language item which asks about preferred language and if the patient/representative needs/wants an interpreter which providers are already required to do per the federal hospice regulations at § 418.52(a)(1) Condition of participation: Patient’s rights.  This item was adopted in other PAC settings and now is approved for hospice care. 

Healthcare providers should let patients self-identify their race and ethnicity, explaining the purpose of collecting this data. Focus on quality of care, personalized care, and the identification of potential disparities as the purpose for obtaining the information for CMS.  Clear communication, respect for autonomy, and offering options, including declining to answer, are crucial.  Additional considerations for collecting race and ethnicity information include: 

  • Asking open-ended questions.  Instead of asking “What race are you?”, use questions like “Can you tell me what race and ethnicity you identify with?” or “How do you identify in terms of race?  The HOPE manual suggests introducing this item as follows, “We want to make sure that all our patients get the best care possible, regardless of their racial background.” 
  • Respect for autonomy.    Acknowledge that patients are not obligated to answer these questions and respect their decision to decline. There are selections in both items if the patient is unable or declines to respond.    
  • Cultural competence.  Be mindful of cultural differences and how they may influence patients’ willingness to disclose this information. 
  • Training for staff.  Train staff on how to collect this data respectfully and effectively. 

By following these guidelines, healthcare providers can ensure that they are collecting valuable data on race and ethnicity while respecting the autonomy and dignity of their patients. The HOPE Guidance Manual contains examples and prompts for HOPE tool item completion, so be sure to review the manual for additional information. 

New data elements 

CMS added several new data items to the administrative section to gain a better understanding of the patient’s living situation.   

  • A1905. Living Arrangements Identify the patient’s living arrangement at the time of this      admission.  This item contains a selection of living types including living alone, congregate homes, and unstable housing. 
  • A1910. Availability of Assistance Code the level of in-person assistance from available and willing caregiver(s), excluding hospice and facility staff, at the time of this admission.  This item contains a selection of various caregiver assistance options the patient receives including none. 

As a reminder, federal regulations cover Medicare hospice care wherever the patient calls home and regardless of the availability of assistance from a caregiver as long as they meet Medicare    Hospice Benefit eligibility criteria. Addressing patient safety concerns in current living situations and as the patient’s status declines is part of the hospice care process. 

Section F: Preferences 

This section concerns the patient’s preferences regarding life-sustaining treatments and spiritual care.  Providing care that is aligned with their values leads to improved patient and family outcomes, including greater satisfaction with care.  Items in this section aim to capture the process of stimulating patient preferences and evidence of discussions or communications about these preferences.  While CMS considers in person visits as the optimal method for collecting patient information, phone conversations may be the how data is obtained by the hospice team member based on patient and family wishes. 

Discussion about patient preferences is included in the HIS so providers should have processes established to collect this information.  The conversation still encompasses the patient’s preference for the use of cardiopulmonary resuscitation (CPR) and other life-sustaining treatment, and their wishes about hospitalization.  CMS does not dictate who should have the preferences discussion; therefore, the hospice provider determines the best interdisciplinary team member to collect this data.   

The preference section also contains items about the patient’s spiritual concerns and needs.  The completion of this data is based on conversations with the patient (as they are able) and information in the clinical record.  End of life can lead to changes in spiritual beliefs, increased engagement in religious practices, and efforts to add meaning to life and relationships. However, it can also result in spiritual challenges, discomfort, or distress. Spiritual growth and struggle often occur simultaneously.  Inquiring about a patient’s spiritual concerns is an essential component of hospice care. This process includes establishing a secure environment for open and non-judgmental discussions, actively listening to the patient and their family members, and adapting the approach to suit individual needs.  Hospice spiritual care counselors are the optimal interdisciplinary team members to gather this data, offer spiritual guidance, and connect patients with appropriate resources.  Again, CMS does not dictate which team member should discuss spiritual preferences with the patient and it is at the providers’ discretion to determine the best interdisciplinary team member to collect this data.   

Hospice providers may encounter logistical questions when they start regularly using the HOPE assessment tool, which CMS will address as it did when the HIS was introduced to the hospice community.  As the questions and answers are posted, CHAP will add them to the HOPE CMS Question and Answer Repository we developed.  This repository will group questions into one place with a source link for each one so that providers can search easily for information.  Stay tuned for the next installment in the HOPE Assessment Tool blog series. 

Read the CHAP summary about the FY 2026 hospice payment update proposed rule. 

References 

American Medical Association. (2020, Sep 9). Gathering race, ethnicity info can help fight inequity. How to do it well. https://www.ama-assn.org/delivering-care/hypertension/gathering-race-ethnicity-info-can-help-fight-inequity-how-do-it-well#:~:text=Create%20scripts%20and%20procedures,including%20how%20to%20use%20scripts. 

The Centers for Medicare and Medicaid Services. (2025, Oct 1). Hospice outcomes and patient evaluation (HOPE) guidance manual – v1.00. https://www.cms.gov/files/document/hope-guidance-manualv100.pdf 

The Centers for Medicare and Medicaid Services. (2025, Apr 11). Fiscal year 2026 hospice wage index and payment rate update and hospice quality reporting program requirements [CMS-1835-P]. https://public-inspection.federalregister.gov/2025-06317.pdf 

The Centers for Medicare and Medicaid Services. (2025, Oct 1).  Hospice item set (HIS) version(v)3.00 to hospice outcomes and patient evaluation (HOPE) v1.00 item set change table effective October 1, 2025. https://www.cms.gov/files/document/his-v300-hope-v100-all-item-set-change-table.pdf 

Kiran T, Sandhu P, Aratangy T, Devotta K, Lofters A, Pinto AD. Patient perspectives on routinely being asked about their race and ethnicity: Qualitative study in primary care. Can Fam Physician. 2019 Aug;65(8):e363-e369. PMID: 31413042; PMCID: PMC6693598.