The U.S. Centers for Medicare & Medicaid Services (CMS) on Tuesday finalized its 2025 hospice payment rule, but some say that the base rate increase is insufficient in today’s environment.

CMS approved a 2.9% raise in per diem hospice payments, which is higher than the 2.6% the agency initially proposed. Stakeholders in the space contend that rate hikes have not kept pace with inflation, rising labor costs and other headwinds in the hospice space, as well as lingering effects of COVID.

Some have also indicated that the “insufficient” payment rates are making it more difficult for hospices to compete with other providers when it comes to hiring staff.

“​​Good hospice care is a holistic, patient- and family-centered, compassionate approach to the dying — and it can be a godsend,” Katie Smith-Sloan, president and CEO of LeadingAge, said in a statement shared with Hospice News. “We recognize that a 2.9% is an increase, but given the challenges our mission driven and nonprofit members continue to navigate, particularly a very competitive labor market especially for registered nurses, the final rule falls short of the need.”

The National Partnership for Healthcare and Hospice Innovation (NPHI) emailed a similar statement to Hospice News.

​​”NPHI is disheartened yet unsurprised by the finalized FY25 hospice payment rate update, which falls short in fairly compensating non-profit, community-based providers for their invaluable contributions to patients, families and communities,” NPHI indicated in the email. “Despite this setback, we appreciate many of the positive changes in this year’s rule and are committed to ongoing collaboration with CMS to ensure high-quality end-of-life care.”

The final rule included other provisions related to quality measurement and technical updates to the Conditions of Participation and Payment.

For instance, the rule updates the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, as of October 2025. This includes the addition of an email invitation to a web survey, with follow-up by mail to non-responders. It also pledges to “shorten and simplify” the survey, according to CMS.

It also removed three nursing home items from the survey, revised the existing Hospice Team Communication and Getting Hospice Care Training measures and added a new Care Preferences measure.

Additionally, the rule includes language to clarify that designated physician members of the hospice interdisciplinary team may certify patients for hospice if the medical director is unavailable.

Per the final rule, the Hospice Outcomes and Patient Evaluation (HOPE) tool will come to fruition in 2025 after years of development and planning.

CMS has indicated that HOPE’s dual objectives are to provide data for the Hospice Quality Reporting Program through standardized data collection and to provide clinical data that may inform potential future changes to Medicare hospice payments. Field testing of this new methodology was completed late last year, and in October 2025 the tool will replace the Hospice Item Set (HIS).

The agency also plans to develop additional measures based on the information they will be able to collect through the tool. The agency to date has named two of those potential measures: Timely Reassessment of Pain Impact and Timely Reassessment of Non-Pain Symptom Impact.

HOPE will collect data at multiple time points across the hospice stay, including admission, the HOPE Update Visit (HUV) and discharge. In addition, HOPE includes several domains that are new or expanded relative to HIS, including:

• Sociodemographic (updated)
• Diagnoses (expanded)
• Symptom Impact Assessment
• Skin Conditions
• Imminent death

Though many hospices and industry groups have supported the development of the HOPE tool, concerns linger about the potential costs of implementation, according to NAHC-NHPCO Alliance’s interim Co-CEOs Bill Dombi and Ben Marcantonio.

“While the hospice community has long supported modernization of patient quality assessment instruments and data reporting, it is concerning that CMS requires a difficult timetable for compliance with no financial support for the significant costs brought by the initiation of the HOPE instrument,” Dombi and Marcantonio said in a joint statement. “We look forward to a positive partnership with CMS to address these concerns.”