With the start of 2026, it’s time to file hospice cap reports for the 2025 cap year. By the end of February 2026, Medicare-certified hospices must submit a self-determined aggregate hospice cap report to their Medicare Administrative Contractor (MAC) for the 12-month reporting period of October 1, 2024 through September 30, 2025.
Hospices certified during the 2024 cap year (October 1, 2023 through September 30, 2024) will submit their initial report in February 2026, using a weighted-average cap amount for the 2024 and 2025 cap years based on the days since certification through September 30, 2025.
New hospices certified during the 2025 cap year will not file their initial cap report until the end of February 2027, as Medicare requires at least 12 months of operation for the first reporting period.
For hospice agencies that have closed, do not forget that a final cap report must be submitted after the provider number has been officially terminated.
The statutory cap amount for the 2025 cap year is $34,465.34, which reflects a 2.9% increase from the 2024 cap. Under the predominant Proportional Method, the aggregate cap is calculated by multiplying the statutory cap amount by the number of proportional hospice beneficiaries served during the cap year, then comparing that total to Medicare payments from claims within the same period. Hospices that exceed the cap must repay the excess to their MAC and may request an extended repayment plan if needed.
Because the cap calculation changes daily until all hospice beneficiaries served in the cap year are no longer on service, MACs will continue to re-calculate prior cap year amounts using current data and issue demand letters if updated calculations show the cap has been exceeded.
Hospice cap reports require Provider Statistical & Reimbursement (PS&R) and beneficiary reports from CMS’ Identity Management (IDM) system. Hospices must have IDM access and know which beneficiary method was elected—Proportional or Streamlined—to run the correct data for the cap report.
If you need assistance preparing your hospice self-determined aggregate cap report or need help tracking potential hospice cap liabilities throughout the year, contact a Home Care & Hospice advisor at Forvis Mazars.