Frequently asked questions

The Service and Spending Variation Index is a 0–16 score CMS now assigns every hospice, built from nine claims-based measures: eight utilization measures worth one point each, plus a non-hospice spending score worth up to eight. CMS finalized it in the FY2027 hospice final rule on July 30, 2026, and it takes effect October 1, 2026. A higher score means an agency's claims patterns diverge further from peer norms.

Lower is better. Across the 6,643 scored US hospices, the national average is 6.42 and the median is 7, so a score at or below 7 sits with the majority of the field. Scores of 10 or higher — about 12.5% of hospices — are the range most likely to draw program-integrity attention.

No. CMS is explicit that the SSVI is not a determination of fraud, waste, or abuse. A high score means your claims patterns diverge from peer norms, which makes review more likely — treat it as a reason to understand which measures flagged you, not as a finding against your agency.

The Program for Evaluating Payment Patterns Electronic Report compares your hospice's billing against national percentiles across target areas known to attract audit attention — long lengths of stay and live discharges among them. Sitting above the 80th percentile on a target area doesn't prove anything is wrong, but it does put you on the map for review. PEPPER relaunched in June 2026 after a 2.5-year pause, so fresh reports are landing again.

The aggregate cap is the annual ceiling on total Medicare payments a hospice can receive: your beneficiary count multiplied by a per-beneficiary cap amount CMS updates each year. It exists to keep hospice spending in line with the cost of conventional end-of-life care. Your Beneficiary Count report holds the number that drives the calculation.

You repay the difference. Payments above the cap are treated as an overpayment, and your Medicare Administrative Contractor issues a repayment demand — often months after the cap year closes. Running the calculation during the year, while admissions and census can still be managed, is how agencies see it coming.

Form CMS-2567 is the Statement of Deficiencies — the official document issued after a survey, listing each deficiency found and the requirement it falls under. Your agency responds on the same form with a plan of correction. Condition-level deficiencies are the serious ones: they can put Medicare certification at risk until corrected.

CHAP — Community Health Accreditation Partner — is a CMS-approved accrediting organization for hospices. A CHAP-accredited agency is surveyed by CHAP under its deeming authority in place of the state survey agency, against standards that meet or exceed the Medicare Conditions of Participation. Accreditation is voluntary, and it does not exempt an agency from CMS oversight.

On different cycles per dataset. Hospice quality data on Care Compare refreshes quarterly, PEPPER is released annually, and the published SSVI file — FY2024 and FY2025 scores so far — follows the annual rulemaking cycle. Connect Shield loads each new CMS release as it lands.