October 2026 Memos
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HOPE Has Changed Again. The Real Question Is Whether Your Staff Has Changed With It.
October 12, 2026 • 6 Minute Read
Executive Summary
CMS has released version 1.03 of the Hospice Outcomes and Patient Evaluation (HOPE) Guidance Manual along with updated assessment item sets. Although CMS describes the revisions as clarifications rather than changes to data specifications, hospice organizations should use this opportunity to evaluate clinical documentation, staff understanding, and organizational processes. The larger issue is not simply whether assessments are completed, but whether documentation accurately reflects the patient's condition, supports appropriate interventions, and demonstrates that patient needs were addressed. Organizations that review the updated guidance, audit completed assessments, and strengthen ongoing education will be better prepared for the continued evolution of hospice quality reporting.
Version 1.03 includes clarifications based on implementation questions.
Completed assessments must accurately reflect patient condition and care.
Required assessments and follow-up visits must occur within established time frames.
HOPE data should support patient care and QAPI efforts, not just reporting.
HOPE Has Changed Again — But Have You Updated Your Hospice Staff?
Hospice leaders should be asking a simple question: Are we confident our clinicians understand what CMS expects, or are we assuming that because the documentation is completed, it is correct?
Just when hospice providers thought they had mastered HOPE, CMS has given us another reason to revisit our processes! On October 6, 2026, CMS released version 1.03 of the Hospice Outcomes and Patient Evaluation (HOPE) Guidance Manual, along with updated admission, HOPE Update Visit, discharge, and consolidated item sets. These updates reflect questions and concerns raised during the first year of implementation. While CMS indicates that the revisions are clarifications rather than changes to the HOPE data specifications, that doesn't mean agencies can simply file the announcement away and move on. We have learned over the years that even small clarifications can uncover significant gaps in clinical documentation, staff understanding, and agency processes. The question hospice leaders should be asking is simple: Are we confident our clinicians understand what CMS expects, or are we assuming that because the documentation is completed, it is correct?
HOPE Is More Than a Reporting Requirement
HOPE is much more than another reporting requirement. It gives CMS standardized information about patient assessments, symptom impact, and follow-up care. Hospice clinicians must understand not only when assessments are required but also how their documentation supports the patient's actual condition and the care provided. A completed assessment doesn't necessarily mean the patient's needs were appropriately addressed.
This is where clinical leadership and quality assurance become especially important. Agencies should be evaluating whether symptom findings lead to appropriate interventions, whether follow-up assessments are completed within required time frames, and whether documentation demonstrates the patient's response to care.
Technology can help. For example, Axxess Hospice provides HOPE tracking, symptom monitoring, assessment review, and data-validation tools that can help agencies identify missing information and manage required workflows. However, technology cannot replace sound clinical judgment or the responsibility of leadership to verify that care and documentation are appropriate.
Use the Update as an Opportunity
My concern is that some hospice organizations may be concentrating so heavily on completing HOPE assessments and meeting submission deadlines that they are overlooking the opportunity to improve patient care. CMS has now provided additional guidance, and agency leadership should use this opportunity to examine their processes rather than waiting for problems to appear in quality reports or surveys.
Review the revised guidance, evaluate a sample of completed assessments, and determine whether staff need additional education. Axxess Training and Certification+ and the HOPE education resources available through Axxess can support ongoing staff development.
Remember, compliance isn't demonstrated simply because a box was checked or an assessment was submitted. It is demonstrated through accurate documentation, appropriate interventions, and evidence that the patient's needs were addressed. The agencies that recognize this distinction will be better prepared for the continued evolution of hospice quality reporting.
5 Recommendations for Hospice Organizations
- Review the CMS HOPE Changes NOW! Download the version 1.03 Guidance Manual and the comparison table identifying changes from version 1.02. Assign a clinical leader to review the clarifications and identify whether agency policies, assessment instructions, or educational materials need revision. Don’t assume your staff will discover these changes independently.
- Audit HOPE Assessments for Clinical Accuracy. Don’t limit your review to completed fields. Evaluate whether symptom assessments accurately reflect the patient’s condition, whether interventions were appropriate, and whether follow-up care was documented. Use the HOPE Center and assessment scrubber in Axxess Hospice to assist with identifying missing information and inconsistencies before submission.
- Monitor Required Visit Time Frames. Review your processes for HOPE Update Visits and symptom follow-up visits. Ensure staff understand when additional assessments are required and that scheduling supports timely completion. Axxess Hospice provides symptom tracking and HOPE workflow tools that can help clinical managers monitor these requirements. Remember that a completed visit isn’t enough if required assessment information is missing.
- Make Education an Ongoing Process. Provide focused education on the CMS clarifications and test staff understanding through case examples and documentation reviews. Axxess Training and Certification+ and Axxess HOPE educational resources can support consistent training for clinical and administrative staff. Education should be followed by competency validation, not simply attendance at a training session.
- Use Your Data to Improve Care — Not Just Meet Reporting Requirements. Incorporate HOPE assessment findings, symptom follow-up performance, documentation accuracy, and submission outcomes into your QAPI program. Use available Axxess Hospice reports and tracking tools to identify trends, then establish measurable corrective actions. Your goal should be to identify weaknesses before they become survey deficiencies, reporting problems, or concerns about the quality of care provided.
💬 Discussion Question
Are your clinicians demonstrating an understanding of CMS HOPE expectations through accurate documentation, appropriate interventions, and timely follow-up assessments, or is leadership assuming compliance based solely on completion rates?
Will Your Patients Still Have Access to You in January?
October 5th, 2026 • 6 Minute Read
Arlene Maxim RN,HCS-C
Executive Summary
Medicare Advantage enrollment changes expected for 2027 may create significant challenges for home health providers and their patients. Major insurers are discontinuing plans, some carrier networks are becoming more limited, and beneficiaries may make enrollment decisions without fully understanding how those decisions could affect access to physicians, specialists, prescription coverage, and home health services. Organizations should identify affected patients now, verify participation in specific plans rather than relying on insurer-level relationships, educate staff on insurance verification requirements, and establish processes to monitor unresolved coverage issues before January arrives.
Approximately one million enrollees may be affected.
Confirm the exact plan, not just the insurer.
January transitions require advance planning.
Use reporting tools to monitor unresolved issues.
Introduction
A patient may want to stay with your agency but face a coverage change that complicates that choice.
A patient may want to stay with your agency but face a coverage change that complicates that choice. Quartz reported October 2 that UnitedHealth and Humana are discontinuing Medicare Advantage plans affecting roughly one million enrollees. For home health leaders, this raises an immediate question- Which of our patients could face a disruption in care when January arrives? Waiting until a claim is denied or a scheduled visit requires a new authorization is too late to begin that conversation.
Network Participation Matters
The concern extends beyond plans leaving a market. Reuters reported that UnitedHealthcare and Aetna are shifting their 2027 offerings toward more limited provider networks. A lower premium alone doesn’t tell patients whether their physicians, specialists, or home health agency will remain available. Organizations need to review contracts and referral relationships now, confirming participation in each specific plan that patients may select. You will need to educate your staff on this process since visiting staff will need to confirm insurance and any changes.
An existing relationship with an insurance company should never replace verification of the patient’s actual coverage.
Preparing for Coverage Transitions
UnitedHealthcare’s provider guidance confirms that affected beneficiaries who don’t select another Medicare Advantage plan will return to ‘Traditional Medicare’ January 1, 2027. For beneficiaries whose discontinued plans included prescription coverage also need to address their Part D coverage. Returning to Original Medicare does not mean losing Medicare. It does, however, require careful coordination. My concern is the patient who assumes everything will continue as it always has. Our responsibility is to identify potential problems early, explain what our agency can verify, and connect patients with qualified help before coverage changes interrupt needed care.
Open Enrollment Risks
We should also anticipate aggressive Medicare Advantage marketing campaigns during open enrollment, with advertisements emphasizing low premiums and additional benefits. ALL Medicare beneficiaries need to be alert, including those currently covered by traditional Medicare who may be persuaded to switch plans without fully understanding how that decision could affect access to their current providers. Our education and verification efforts should include every Medicare patient we serve. Encourage patients and caregivers to confirm provider participation, coverage requirements, and potential costs before making a change—and to notify the agency promptly if they do.
5 Tips for Success
1. Identify affected patients now. Review your Medicare Advantage census by insurer, specific plan, and county. Ask patients or caregivers whether they’ve received a nonrenewal notice or notice of coverage changes. Assign someone to follow each unresolved case. It would be a very good idea to create a ‘project’ around these verifications and assign one staff member to resolve each verification.
2. Verify the exact plan—not just the insurance company. Confirm your agency’s participation in each individual patient’s plan selected for 2027. Share verified information with referral partners such as hospitals, physician offices, etc. so everyone understands which patients your agency can accept.
3. Make coverage transitions part of care coordination. For patients expected to remain on service into January, document the new payer, effective date, required authorizations, and any unresolved coverage questions. Coordinate intake, clinical, scheduling, and billing staff before the first visit under the new coverage.
4. Help patients act on their notices. Encourage patients to review provider access, prescription coverage, and costs with Medicare or their State Health Insurance Assistance Program. It would be a good idea to include Social Work visits on the POC of affected beneficiaries. Medicare provides a special enrollment period for plan nonrenewals from December 8 through the last day of February; patients should confirm the deadline and effective date that apply to their situation. Staff need to be educated on this process, and a plan developed to track any changes with your patient base. Remember some ‘traditional Medicare’ clients may switch to an Advantage plan.
5. Put your data to work. Use available Axxess reports and Axxess BI (business intelligence) tools to track affected patients, pending coverage verification, authorization delays, and changes in referral volume. Review this information weekly throughout the transition period. Every unresolved item should have an ‘project manager’ assigned with a firm follow-up date.
5 Recommendations for Organizations
- Identify patients who may be affected by Medicare Advantage plan discontinuations and assign ownership for follow-up.
- Verify participation in the exact Medicare Advantage plans patients select for 2027.
- Incorporate payer transition planning into care coordination activities before January.
- Educate staff, patients, and caregivers regarding enrollment changes, provider participation, and coverage requirements.
- Use Axxess reporting and business intelligence tools to monitor verification status, authorization concerns, and referral impacts throughout the transition period.
💬 Discussion Question
What process can your organization implement now to identify, verify, and monitor Medicare beneficiaries who may experience coverage changes before January 1, 2027?