Announcing “SSVI 2026 Plus”

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Concerned about your SSVI scores for 2026? 

CMS first introduced the Hospice Services and Spending Variation Index (SSVI) scoring in the FY 2027 Hospice Wage Index and Payment Rule Proposed Rule in the Federal Register on April 6, 2026. The proposed rule was finalized on June 30, 2026, with an effective date of October 1, 2026. It’s real NOW! Hospices across the country are examining their 2024 and 2025 scores and looking for ways to reduce the flagged metrics to get into better operational status the next few months. 

But 2025 scores are old news. Unfortunately, the scoring for FY 2026 will not be released by CMS until the first quarter of next year. The problem? Contractors already have access to the underlying algorithms. They can see where the hospice is in real time. This places the provider in an unknown status headed into a season of uncertainty.

MJS developed SSVI 2026 Plus as a methodology to test performance scoring for 2026 

and to prepare the hospice for what might be coming in 2027. FY 2026 date range has closed; but your scoring for at least the utilization portion of the scoring can be determined now from the data stored in your claims.

SSVI 2026 Plus analyzes all utilization scoring for October 1, 2025 through September 30, 2026 using similar algorithms as those in place by CMS. But we do more. We analyze additional data from your clinical records to perform root cause analyses for potentially “at risk” scores to give opportunities to implement comprehensive performance improvement plans in real time. This is a pro-active approach that will help your hospice achieve a safe zone against contractor audits now.

What about the non-hospice spending costs for 2026?

Unfortunately, the non-hospice spending data is not available for data retrieval online. The MJS SSVI 2026 Plus is designed to extract key data from H&P, medication profiles, and CTIs to project non-hospice spending using methodologies believe will allow you to predict scoring in the 8 octiles currently used by CMS to drive non-hospice spending points.

Why is it important to know your non-hospice spending if you can’t change the outcomes for 2026 now?

Hospice providers in Texas had a significant spending distortion in 2025. In our analysis of the 998 hospice agencies scored in Texas, one in five Texas hospices (18.8%) were in the highest octile for the non-hospice spending. The top two tiers (Octiles 7 and 8) account for 33% of the entire state’s hospice population in an “above average” to “severe national outlier” status. That’s 333 hospices out of the 998 scored in Texas alone!

This has established the state as a focal point for Targeted Probe and Education (TPE) auditing, unified program integrity contractor (UPIC) actions, and terminal relatedness oversite. There is no question – if the non-hospice spending in your hospice remains at a 7 or 8 in 2026, you will have a high risk for audit in 2027.

In the analysis performed by MJS of the non-hospice spending, the primary technical catalyst behind Texas’s elevated spending scores is uncoordinated Medicare Part D pharmacy billing. While Part A and Part B spending did rise in 2025, Medicare Part D non-hospice drug spending spiked to $813 million nationwide, heavily concentrated in the Texas market. 

While the mandatory Election Addendum for Non-Related Items and Services should have an impact on the question of related vs non-related costs, it alone will not curb non-covered spending. The hospices in the high-risk area must implement immediate controls to minimize continued risks in this area. The spending estimates in the MJS SSVI 2026 Plus will not only project the non-hospice spending but will provide enrollees with root cause analyses specific to your hospice to aid in achieving overall reductions in this metric going forward.

MJS offers a full package of services related to monitoring SSVI scores and its impact on the hospice operational and financial picture in the future. Enrolling for this service can be a one-time option or the hospice can choose to have MJS partner in providing on-going monitoring on a monthly basis following the initial 2026 review. That’s the PLUS to the program. 

Can’t software EMRs track and trend the SSVI scores for the hospice going forward?

Certainly, EMR platforms are gearing up to provide such services. Most are offering reporting through AI and internal claim algorithmic analysis. In general, these are not offered at the base EMR fee schedule but are an add-on to existing baseline costs. For the most part, these are available for future reporting starting October 1, 2026. Additionally, these AI driven platforms do not offer one-to-one operational guidance for root cause analysis or for development of a PIP tailored to the hospice’s needs. That’s the human hands-on base for the MJS SSVI 2026 Plus consulting service to the hospice community. 

The fee for the one-time analysis of FY 2026 data is nominal to the loss of even one claim to a contractor denial. Discounts are available for multiple provider number agencies. 

For information or to get an estimate of the price for your hospice, contact MJS at 936-559-7234 or complete the information request on the mjsassociatesllc.org website.