Regulatory Watch

Never find out about a rule change late.

Connect Shield monitors the Federal Register for every CMS hospice rule, a human reviews each one, and the update lands in every client dashboard with a what-it-means-for-you note.

Federal Register · CMS · Human-reviewed

01Monitored

Every CMS hospice rule, proposed rule, and notice pulled from the Federal Register weekly.

02Reviewed

A human reads each document against the source before anything is published. No auto-posts.

03Pushed

Cleared updates land in every client dashboard with a what-it-means-for-you note and a checklist.

Latest reviewed updates

Straight from the review queue.

medium impactCMS · Notice

Sep 9, 2026

Privacy Act of 1974; System of Records

HHS and CMS are modifying an existing Privacy Act system of records previously known as the Hospice Item Set system, renaming it the Hospice Outcomes and Patient Evaluation system. The changes add real-time data collection at the point of patient assessment to better capture care needs and support care coordination. The updated system continues to collect standardized hospice patient data for quality measurement, regulatory reporting, and research purposes.

What it means for you: Hospice agencies should expect updated data submission requirements tied to the renamed HOPE system, including real-time patient assessment data collection that may affect clinical workflows and reporting processes.

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low impactCMS · Notice

Aug 11, 2026

Medicare Program; Regulatory Alignment for Predictable and Immediate Device (RAPID) Coverage Pathway

CMS is introducing the RAPID coverage pathway, a new process designed to accelerate national Medicare coverage for innovative medical devices and technologies. The pathway leverages existing CMS processes to provide expedited coverage decisions. CMS is soliciting public comment on the proposed pathway during this notice period.

What it means for you: Hospice agencies should monitor this pathway as it may affect the speed at which new medical devices become covered under Medicare, potentially influencing care planning and equipment options for hospice patients; however, specific eligibility criteria and operational details should be confirmed against the source document.

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low impactCMS · Rule

Aug 4, 2026

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2027 Rates; Requirements for Quality Programs; Other Policy Changes; and Adoption of Updated Versions of Certain Health Information Technology Standards

This final rule updates Medicare payment rates and policies for acute care hospitals under the Inpatient Prospective Payment System and for long-term care hospitals under their prospective payment system for fiscal year 2027. It also makes changes to graduate medical education policies for teaching hospitals, revises quality program requirements, and adopts updated health information technology standards on behalf of HHS. Full rate and policy specifics should be confirmed against the source document.

What it means for you: While focused on acute care and long-term care hospitals rather than hospice directly, compliance officers should review any updated quality program requirements or health IT standards that may intersect with hospice operations or referral partner obligations.

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low impactCMS · Rule

Aug 3, 2026

Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality Reporting Program

This final rule updates Medicare prospective payment rates for inpatient rehabilitation facilities for federal fiscal year 2027, including revised case-mix group classifications and weighting factors. It finalizes the third and final year of the rural adjustment phaseout that began in FY 2025, establishes that therapy treatments or evaluations must begin no later than 36 hours from midnight on the day of admission, and requires the initial Interdisciplinary Team meeting to occur on or before 4 days from the admission date. The rule also updates the IRF Quality Reporting Program and makes changes to the DMEPOS Competitive Bidding Program.

What it means for you: Although this rule targets inpatient rehabilitation facilities rather than hospice agencies directly, compliance officers should monitor it for any downstream effects on patient transitions, DMEPOS billing, and quality reporting expectations that may intersect with hospice operations.

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high impactCMS · Rule

Aug 3, 2026

Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements

This final rule updates the hospice wage index, payment rates, and aggregate cap amount for fiscal year 2027. It also requires that hospices provide the election statement addendum to all Medicare beneficiaries at the time of hospice election, and finalizes changes to discharge regulations, face-to-face encounter regulations, and the Hospice Quality Reporting Program. The rule additionally includes analysis of Medicare non-hospice spending and a hospice service and spending variation index, along with summaries of comments on community-based palliative care, a hospice-specific wage index, and the overlap between hospice and medical aid in dying laws.

What it means for you: Hospice agencies must update payment, billing, and intake processes to reflect the new FY 2027 rates and cap amount, ensure the election statement addendum is provided to all Medicare beneficiaries at election, and comply with revised discharge and face-to-face encounter requirements.

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low impactCMS · Rule

Jul 31, 2026

Medicare Program; FY 2027 Inpatient Psychiatric Facilities Prospective Payment System-Rate Update

This final rule updates Medicare payment rates, the outlier threshold, and the wage index for Inpatient Psychiatric Facilities for fiscal year 2027, covering discharges from October 1, 2026 through September 30, 2027. It also refines the IPF outlier payment policy, finalizes implementation of a standardized IPF patient assessment instrument, and removes two measures from the IPF Quality Reporting Program. Details on specific rate amounts and measure names should be confirmed against the full Federal Register text.

What it means for you: Hospice agencies are generally not directly reimbursed under the IPF PPS, but those operating or affiliated with inpatient psychiatric units should review the updated payment rates, outlier policy changes, and quality reporting measure removals to ensure billing and documentation practices remain compliant effective October 1, 2026.

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low impactCMS · Rule

Jul 31, 2026

Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027

This final rule updates payment rates and policies under the Skilled Nursing Facility Prospective Payment System for federal fiscal year 2027. It also revises requirements for the SNF Quality Reporting Program and the SNF Value-Based Purchasing Program. Hospice agencies should confirm specific details against the source document as the abstract does not detail all provisions.

What it means for you: Although directed at skilled nursing facilities, hospice agencies that coordinate care or share patients with SNF settings should monitor these payment and quality reporting changes for potential downstream effects on care transitions and billing.

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low impactCMS · Notice

Jul 16, 2026

Agency Information Collection Activities: Submission for OMB Review; Comment Request

CMS is publishing a notice inviting public comment on a proposed information collection activity as required by the Paperwork Reduction Act of 1995. The notice provides a second opportunity for the public to comment on the burden estimate, necessity, and utility of the information collection before it is submitted to OMB for review. Specific details about which collection instrument or form is involved are not identified in this abstract and should be confirmed against the full source document.

What it means for you: Hospice agencies should review the full Federal Register notice to determine whether the information collection in question applies to their reporting or documentation obligations and consider submitting comments if the burden estimate appears inaccurate.

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medium impactCMS · Proposed Rule

Jul 16, 2026

Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program

CMS has issued a proposed rule that would update the Physician Fee Schedule and numerous other Medicare Part B payment and coverage policies for calendar year 2027. The rule addresses relative value unit changes, drug and biological product payment updates, Medicare Shared Savings Program requirements, Quality Payment Program updates, and codification of Inflation Reduction Act and Consolidated Appropriations Act 2026 provisions, among other topics. Because this is a proposed rule, final payment rates and policy details have not yet been established and should be confirmed against the published source and any subsequent final rule.

What it means for you: Hospice agencies that bill under Medicare Part B for physician services or receive Part B-covered drugs and biologicals should monitor this proposal for any changes that may affect reimbursement rates or coverage requirements applicable to their operations.

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low impactCMS · Notice

Jul 9, 2026

Secretarial Comments on the Consensus-Based Entity's (CBE) (Battelle Memorial Institute) 2025 Activities: Report to Congress and the Secretary of the Department of Health and Human Services

This notice announces that the HHS Secretary has received and reviewed Battelle Memorial Institute's 2025 Annual Activities Report, fulfilling a statutory requirement under section 1890(b)(5) of the Social Security Act. The Secretary is publishing the report in the Federal Register along with comments within the required six-month timeframe. Publication does not constitute endorsement of the report or its recommendations.

What it means for you: This is an informational notice with no direct regulatory changes to hospice operations, but compliance officers should review the CBE's 2025 report for any quality measure recommendations that may signal future rulemaking.

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low impactCMS · Proposed Rule

Jul 7, 2026

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; Including the Hospital Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Program; Request for Information on Strengthening the Standardization and Comparability of Hospital Price Transparency (HPT) Data; Prior Authorization; Accrediting Organization (AO) Deeming for Emergency Medical Treatment and Labor Act (EMTALA); and Notices of Closure of Teaching Hospitals and Opportunities To Apply for Available Slots

CMS is proposing updates to the Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center payment system for calendar year 2027, including revised payment rates and quality reporting requirements. The rule also proposes expanding prior authorization to additional Botulinum Toxin Injection services, implementing certain Consolidated Appropriations Act 2026 provisions for off-campus outpatient departments, and requesting information on improving hospital price transparency data standardization. Additional proposals address EMTALA compliance assessments by accrediting organizations and solicit comments on separate IPPS payment for domestic procurement of personal protective equipment and essential medicines. Details should be confirmed against the full proposed rule text.

What it means for you: Although this rule is primarily directed at hospital outpatient and ASC settings rather than hospice providers, compliance officers should monitor any downstream effects on payment policy, prior authorization expansion, and quality reporting standards that could indirectly affect hospice-related outpatient services.

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medium impactCMS · Proposed Rule

Jul 6, 2026

Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Expanded HH Value-Based Purchasing Model; Medicare Provider Enrollment, Durable Medical Equipment (DME), and DME, Prosthetics, Orthotics, and Supplies (DMEPOS) Policies

CMS has issued a proposed rule that would update Medicare home health payment rates for calendar year 2027, including recalibration of case-mix weights, functional impairment levels, comorbidity subgroups, and LUPA thresholds, along with a proposed temporary behavior adjustment. The rule also proposes changes to the Home Health Quality Reporting Program and the expanded Home Health Value-Based Purchasing Model, and includes a request for information on a home health specific wage index. Additional provisions address DMEPOS face-to-face encounter requirements, provider enrollment changes, DME benefit expansion for infusion pumps, and competitive bidding country-of-origin reporting.

What it means for you: Hospice agencies that also operate or affiliate with home health services should review the proposed payment rate changes, quality reporting updates, and palliative care provisions, as these could affect care coordination, reimbursement, and compliance obligations for any home health lines of service.

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low impactCMS · Proposed Rule

Jun 26, 2026

Medicare Program; CY 2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury Dialysis (AKI) Payment, and ESRD Quality Incentive Program

This proposed rule would update the End-Stage Renal Disease Prospective Payment System for calendar year 2027, revise payment rates for renal dialysis services provided to patients with acute kidney injury, and modify requirements for the ESRD Quality Incentive Program. The changes are currently in proposed form and subject to public comment before finalization. Details on specific rate changes and quality measure updates should be confirmed against the full Federal Register document.

What it means for you: This rule primarily affects ESRD dialysis facilities and does not directly alter hospice payment or coverage requirements, though hospice agencies serving patients with ESRD should monitor any downstream policy changes that could affect coordination of care.

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medium impactCMS · Rule

Jun 16, 2026

Medicare Program; Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflicts of Interest, and Related Provisions

This final rule strengthens CMS oversight of Medicare accrediting organizations by addressing conflicts of interest, standardizing accreditation processes and definitions, and updating validation and performance standards systems. It also revises psychiatric hospital survey requirements, limits reentry into Medicare for previously terminated deemed providers and suppliers, and makes technical corrections for ESRD facilities and Transplant Programs. Hospice agencies that rely on accrediting organizations for deemed status should be aware that the oversight framework governing those organizations is being tightened.

What it means for you: Hospice agencies accredited by a CMS-approved accrediting organization may face changes in survey processes and standards as those organizations come into compliance with the new conflict-of-interest and oversight requirements.

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The current landscape

The rules that matter right now.

Three things every hospice leadership team should have on the whiteboard this quarter — each verifiable at the source.

Final rule · effective Oct 1, 2026

FY2027 Hospice Wage Index final rule (CMS-1851-F)

Issued July 30, 2026. Beyond the 2.3% payment update and the $36,174.75 aggregate cap amount, this is the rule that finalized the SSVI — CMS now publishes a Service and Spending Variation Index score for every US hospice. Your agency has a number whether you have looked it up or not.

Federal Register, 91 FR 49118 Look up your SSVI score

Report · relaunched Jun 2026

PEPPER is back after a 2.5-year pause

CMS resumed the hospice Program for Evaluating Payment Patterns Electronic Report in June 2026, ending a pause that began in early 2024. PEPPER benchmarks your billing against national percentiles on the target areas reviewers watch — long lengths of stay and live discharges among them. If nobody has pulled your report since 2023, that is the first move.

PEPPER release schedule Read your PEPPER report

Deadline · ongoing

HOPE's 90% timely-submission threshold

Since October 1, 2025, every required HOPE record — admission, update visits, discharge — must be accepted into iQIES within 30 days, at least 90% of the time. Miss the threshold and the penalty is a 4-percentage-point cut to your annual payment update. This one is not news; it is a standard your agency has to keep hitting every month.

CMS timeliness fact sheet

Informational only, built from published CMS and Federal Register documents. Not legal advice, and not a compliance determination — decisions about your agency remain yours.

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