On October 1, 2025, hospices stopped collecting the Hospice Item Set and started collecting the Hospice Outcomes and Patient Evaluation. One year in, most hospices have the admission record under control. The trouble is in the update visits, the symptom follow-up visit and the 30-day submission clock, because those depend on scheduling as much as on clinical work.
This guide sets out the HOPE assessment timepoints, the clocks behind each record, how the 90% threshold connects to the 4-point payment reduction, what changed in HOPE v1.03 on October 1, 2026, and a monthly audit to keep you above the line.
The HOPE Assessment Timepoints
CMS's HOPE page confirms that data collection began October 1, 2025, and hosts the current HOPE Guidance Manual v1.03, effective October 1, 2026. Hospices generally submit up to four records for each admission: an admission record, a discharge record and up to two HOPE Update Visits, depending on length of stay.
From Table 1 of the manual:
- Admission: no later than five calendar days after the effective date of the hospice election, or the date recorded in A0220 Admission Date.
- HOPE Update Visit 1 (HUV1): on or between days 6 and 15. It should not be conducted within the first five days. The election date, or the A0220 date, is day 0.
- HOPE Update Visit 2 (HUV2): on or between days 16 and 30.
- Discharge: at the time of discharge, for any reason listed in A2115.
- Symptom Follow-up Visit (SFV): an in-person visit expected within two calendar days when pain or non-pain symptom impact is rated moderate or severe at admission or an HUV. It must be a separate visit, though it can occur later the same day.
HUVs are in-person visits. The regulation behind all of this, 42 CFR 418.312(b), requires hospices to complete and submit the standardized items for each patient regardless of payer or patient age, at least at admission, the HUV and discharge.
The Clocks Behind Each Record
The manual separates completion goals, which are CMS guidance, from submission deadlines, which drive compliance:
- Completion goals: admission date plus 14 days for the admission record; assessment date plus 14 days for HUVs; discharge date plus 7 days for discharge records. The manual states these are not considered in payment update determinations.
- Submission deadlines: each record must be submitted to and accepted by CMS within 30 days of the admission date, the HUV assessment date (Z0350) or the discharge date.
A worked calendar for an election effective Monday, October 12, 2026:
- Day 0: October 12
- Admission record: assessment by October 17; submit and accepted by November 11
- HUV1 window: October 18 to October 27
- HUV2 window: October 28 to November 11
- Each HUV record: submit and accepted within 30 days of its Z0350 date
- Any SFV: within two calendar days of the moderate or severe finding
Schedule both HUVs on the day of admission. Waiting to book them until the patient "settles" is how windows close.
The 90% Threshold and the 4-Point Penalty
The FY 2027 hospice final rule states that to meet the assessment timeliness threshold for the annual payment update, hospices must achieve a timely submission rate of 90% or higher, meaning 90% of all HIS and HOPE records submitted to and accepted by CMS within 30 days. A hospice that fails quality reporting requirements has its annual update reduced by 4 percentage points.
The cycle runs two years. The manual explains that HOPE data collected, submitted and accepted on time during calendar year 2026 is processed for compliance determinations in 2027, and the payment impact falls in FY 2028, which starts October 1, 2027.
To see what 4 points means, look at FY 2027. Per CMS Transmittal 13976, routine home care for days 1 to 60 pays $236.33 a day for compliant hospices and $227.09 for non-compliant ones. The FY 2027 hospice payment rates guide turns that gap into an annual figure for a 50-patient census.
The FY 2027 rule also adds a Care Compare icon, no earlier than FY 2028, identifying hospices that submit no HOPE data or less than the required 90% within 30 days of the target dates for admission, HUVs and discharge. The 90% is now visible to families as well as to your MAC.
What Changed in HOPE v1.03
The v1.02 to v1.03 change table, effective October 1, 2026, is mostly clarification, but four changes affect operations:
- Admission date anchor. Timeframes now read "the effective date of the hospice election, or the date recorded in A0220. Admission Date," clarifying that HOPE is expected for any later admission to the same or a different hospice after a HOPE discharge.
- Late HUVs. A missed or late HUV, such as HUV1 on day 17, can still be conducted and submitted, and late records will be accepted. Only records submitted and accepted timely count positively toward the compliance rate.
- SFV in inpatient settings. The SFV can be a separate encounter in an inpatient setting, not only a home visit.
- LPN and LVN visits for the SFV. Language now refers to observations and focused clinical assessments to accommodate LPN or LVN staff completing the SFV. The J2051 Symptom Impact coding tips also add guidance: code 0 when the patient has the symptom but is not impacted by it, including when it is well controlled; code 9 when the patient is neither experiencing, treated for, nor impacted by it.
The Measures HOPE Feeds
The HQRP measure specifications for the HOPE process measures describe two measures: Timely Follow-up for Pain Impact and Timely Follow-up for Non-Pain Symptom Impact. Each captures the percentage of assessments with a symptom follow-up visit within two days after impact was assessed as moderate or severe. Up to three SFVs may be required over a stay, one for each of the admission and two HUVs.
That makes the SFV both a clinical promise and a measured one. If a nurse rates pain impact as severe at a Friday admission, someone has to be at the bedside by Sunday.
A Monthly HOPE Timeliness Audit
- 1.Pull every record due last month by type: admission, HUV1, HUV2, discharge.
- 2.Calculate the timely rate: records accepted within 30 days divided by records due. Track it by type and by team.
- 3.List every missed HUV window and the reason: not scheduled, visit missed, patient unavailable, discharged first.
- 4.List every SFV triggered and whether it happened within two calendar days.
- 5.Review the rejected and fatal-error queue weekly, not monthly. A record rejected on day 28 is effectively late.
- 6.Report the rolling 12-month rate to leadership against the 90% line.
Why HOPE Records Go Late
The audit usually surfaces the same causes:
- HUVs booked reactively. The window passes while the team waits for a routine visit to fall inside it.
- Short stays misjudged. Staff skip an HUV because they assume the patient will not still be on service. Schedule it anyway, and cancel it if the patient dies or is discharged.
- SFV not dispatched. The admitting nurse scores moderate pain impact on a Friday, and nobody owns the follow-up visit over the weekend. Every moderate or severe J2051 score should create a dated task for a named clinician.
- Records complete but not submitted. A finished record sits in a queue until batch submission day. Submit daily.
- Fatal errors found late. A rejection is discovered at day 29. Review submission results the day after every upload.
- Transfers and re-admissions. A patient transferred from another hospice, or re-admitted after revocation, needs a new admission record anchored to the A0220 date, which is exactly what v1.03 clarifies.
Build HOPE Into the Schedule
Every HOPE failure mode is a scheduling failure first. The admission visit has a five-day window, the HUVs have fixed windows from day 0, and the SFV has a two-day clock that starts when a clinician enters a score. Nuraflow is being designed with HOPE assessment workflows in clinical documentation and named review queues in quality assurance, so incomplete records surface before the 30-day deadline.
This article is general information. Confirm HOPE coding and submission questions against the current CMS guidance manual and the CMS HQRP help desk.