HOPE Resource Library

Yes, an LVN or an LPN can perform Symptom follow UP visits, or other routine visits as directed in the patient’s plan of care.  

Based on CMS regulations, a supervisory visit can be conducted during a HOPE Update Visit (HUV). These are two distinct visit types that can happen during the same trip to the patient's home, as long as the requirements for both are met and documented appropriately.  

Here is a breakdown of the requirements for each visit type: 

HOPE Update Visit (HUV) 

• Purpose: The HUV is a required assessment using the HOPE Tool to collect data on the patient's condition at specific points during their hospice stay. 

• Trigger: An HUV is triggered by certain milestones, such as between days 6 and 15 of a hospice stay, based on the length of stay. 

• Documentation: The HUV must be completed and documented according to the specific instructions in the CMS HOPE Guidance Manual.  

RN Supervisory Visit 

• Purpose: An RN supervisory visit is required when a patient is receiving hospice aide services to assess the quality of care being provided. 

• Trigger: A supervisory visit must occur at least once every 14 days. 

• Documentation: The supervisory visit must be documented separately, including the assessment of the aide's services and the patient's plan of care.  

Conducting both during the same trip 

A single trip to the patient's home can serve as both an HUV and a supervisory visit. A supervising registered nurse (RN) can perform both required assessments during the same visit.  

• Simultaneous actions: During the visit, the RN would complete the HUV assessment while also performing the supervisory tasks to ensure the hospice aide services meet the patient's needs. 

• Separate documentation: For compliance, the documentation for each visit type must be distinct and include all the specific required elements.  

Day 0 is the date of hospice election, regardless of the RN visit date. The comprehensive admission assessment, including the HOPE Admission, must be completed within 5 calendar days by an RN. If the patient was admitted on Wednesday and the effective date of hospice election was on Wednesday, Wednesday is Day 0, Thursday is Day 1, and so on. 

Yes. HUV1 and HUV2 are RN-only visits.

No additional SFVs are required for HQRP. However, continued clinical follow-up is expected based on the patient’s condition.

No. Symptom impact refers to how the symptom affects the patient’s function or well-being — not severity, intensity, or frequency. It is determined by clinician observation, interview, and judgment.

• Admission (A0250 = 1): Submit within 30 days of Admission Date (A0220)

• HUV1 or HUV2 (A0250 = 2 or 3): Submit within 30 days of the visit date (Z0350)

• Discharge (A0250 = 9): Submit within 30 days of the Discharge Date (A0270)

It is encouraged to submit earlier than 30 days to avoid any issues with meeting the 30-day target. 

CMS recommends completion within 7 days, but the required submission deadline is 30 days post-discharge.

If a hospice patient dies before the Symptom Follow-Up Visit (SFV) is completed, you should submit the HOPE Admission record and the HOPE Discharge record. You may also need to submit HOPE Update Visit (HUV) records that were completed before the death, but no additional SFV record is required for the death itself.  

Yes. The required HOPE Admission and Discharge records would be completed; no further HOPE events (like SFV) would be submitted.

Some elements may be collected during the admission, but HOPE requires specific clinical and administrative data that must be documented appropriately. Each individual contributing must sign in Section Z (Record Administration).

Yes. HOPE data must be submitted in XML ZIP format. This requires a software application (like an EMR or vendor system). CMS will not offer submission software after HIS retires.

Agencies must use vendor software to collect HOPE data. Submission to iQIES can be done internally or via third party, as long as proper file formatting is followed.