LeadingAge joined the National Alliance for Care at Home, and the National Partnership for Healthcare and Hospice Innovation to urge the Centers for Medicare and Medicaid Services (CMS) to take specific actions regarding the Hospice Outcomes and Patient Evaluation (HOPE) Tool, including updates to the tool itself and the guidance manual.

In the March 30, 2026  letter, which follows the February 26 CMS Forum meeting with the agency and its contractor, Abt Associates, the associations first and foremost reiterate previous requests that CMS waive the compliance threshold for the first quarter of HOPE reporting. Because the tool’s implementation coincided with the October 2025 government shutdown, the groups have credible concerns that many hospices might not have met this threshold due to CMS supports being affected by the government shutdown. Because CMS has not explicitly conveyed that is willing to waive the threshold, the advocacy push continues.

Second, the letter asked CMS to clearly define assessment throughout the manual specifically because many states do not allow licensed practical nurses (LPNs) or licensed vocational nurses (LVNs) to complete assessments in their scope of practices, making it difficult to complete the symptom follow up visits as intended by CMS.

Finally, the letter presses CMS for clear directions on the symptom follow up visit and what is allowed in the reasons a visit might be missed, including inclement weather as well as situations where a patient may be traveling outside their home hospice’s service area.