FY 2027 SSVI: What Hospices Need to Know

CMS has finalized the hospice Service and Spending Variation Index (SSVI) as part of the FY 2027 Hospice Wage Index and Payment Rate Update final rule (CMS-1851-F), published in the Federal Register on August 3, 2026, with regulations effective October 1, 2026. Every Medicare hospice with claims now has a public score. If you own, run, or bill for a hospice, you should know what your score is and what is driving it.

This post walks through what the SSVI measures, how the score is built, what a high score means, and what you can do now.

What Is the SSVI?

The SSVI is a claims-based score that CMS calculates for each hospice. According to the CMS FY 2027 Final SSVI Overview, the intent is "to identify hospices that may be outliers compared to their peers." It combines two things:

  1. Non-hospice spending: Medicare Part A, Part B, and Part D spending that happens for your patients while they are on your hospice election.
  2. Utilization patterns: levels of care, site of service, visits, length of stay, and discharges.

CMS publishes the scores in an Excel file alongside the Overview document. The file shows each hospice's FY 2024 and FY 2025 non-hospice spending score, utilization score, and total SSVI score, plus the underlying data and which components earned points.

What Is Final for FY 2027

In the final rule, CMS stated it is "maintaining the design of the SSVI using the current measures and scoring assignments." In other words, the methodology from the proposed rule stayed the same. What did change is the data. The proposed version used FY 2025 claims pulled on January 15, 2026. The final version uses FY 2025 claims pulled on May 12, 2026, which moved some thresholds slightly (for example, the FY 2025 live discharge threshold went from 46.7% to 47.0%).

The final FY 2025 SSVI covers 6,773,919 hospice claims, 6,673 hospices, and 156,995,825 hospice days. The FY 2024 SSVI covers 6,409,155 claims, 6,735 hospices, and 148,012,785 hospice days. CMS says it plans to publish an updated SSVI with each future final rule using the most recent claims data.

How the Score Works

The total SSVI score is the sum of two parts, for a range of 0 to 16.

Non-Hospice Spending Score (0 to 8 points)

Hospices with no non-hospice spending get 0. Everyone else is split into 8 roughly equal groups by total non-hospice spending. For FY 2025, the cutoffs are:

Points FY 2025 total non-hospice spending
1 Above $0 up to $6,532.96
2 Up to $21,341.05
3 Up to $44,437.57
4 Up to $79,420.80
5 Up to $138,572.14
6 Up to $253,592.84
7 Up to $538,406.00
8 Above $538,406.00

Note that this is total spending, not spending per day, so census matters.

Utilization Score (0 to 8 points)

A hospice earns 1 point for each of these eight measures it triggers. FY 2025 thresholds are shown:

  • No CHC and no GIP provided during the year.
  • 40% or more of RHC days provided in a nursing home or SNF.
  • Skilled visits in the last two RHC days of life at or below the 25th percentile (87.5% or less).
  • Discharges with a length of stay of 180 days or more at or above the 75th percentile (33.3% or more).
  • Live discharge rate at or above the 75th percentile (47.0% or more).
  • Average skilled nursing minutes per RHC day at or below the 25th percentile (9.9 or less).
  • Weekend RHC days with a skilled visit at or below the 25th percentile (4.8% or less).
  • Live discharges returning to the same hospice within seven days at or above the 75th percentile (18.2% or more).

Skilled visits here mean nursing, medical social services, or therapy. Transfers (discharge status 50 or 51) are not counted as live discharges, except in the seven-day return measure.

Where Hospices Land

For FY 2025, most hospices scored in the middle of the range. Scores of 5 through 8 each held about 13% to 14% of hospices, and the median hospice scored about 6. Fewer hospices sit at the top:

  • Score of 10: 397 hospices (5.9%)
  • Score of 11: 241 hospices (3.6%)
  • Score of 12: 127 hospices (1.9%)
  • Score of 13 or higher: 69 hospices (about 1%)

In the final rule, CMS said it "would consider a hospice with 13 or more points an outlier," which puts it at roughly the 99th percentile.

What a High Score Means

The Overview document itself describes the SSVI as a way to spot outliers. The final rule goes further. CMS wrote that a high SSVI score "indicates to CMS that a hospice might have more than one area of concern and may require additional targeted education or oversight, such as medical review, education, and investigations that could result in payment suspension, and revocation, if there is identified fraud, waste, or abuse." CMS also said the SSVI "will be one of several sources of information that contributes to program integrity actions."

CMS also acknowledged that triggering one threshold "does not necessarily indicate poor performance or improper practices." The concern is a pattern across several measures. Because the scores are public, families and referral sources can see them too.

Also worth knowing: CMS said it is unclear how a reconsideration process or provider-specific preview would work, since the score comes straight from your finalized claims. Your claims are your record.

Practical Steps for Your Agency

  1. Look up your score. Download the SSVI file from the CMS-1851-F page and find your CCN. Check both FY 2024 and FY 2025 and see which components earned points.
  2. Attack non-hospice spending. Up to half the total score comes from it. Review how you determine related conditions, how your election statement addendum is handled, and how you coordinate with outside providers, pharmacies, and facilities so services that belong to the hospice are covered by the hospice.
  3. Audit visits near death. The last-two-days and weekend skilled visit measures reward consistent presence. Make sure visits are made, documented, and coded on the claim.
  4. Watch live discharges and long stays. Review eligibility at admission and recertification, and document clearly when a discharge is the patient's choice or a true change in prognosis.
  5. Check level of care and site mix. If you never provide GIP or CHC, or most of your RHC days are in facilities, know why and be ready to explain it.
  6. Clean up billing data. Revenue codes, visit lines, minutes, discharge status codes, and site of service codes all feed the SSVI. Coding errors can cost points.

FAQ

What does SSVI stand for? Service and Spending Variation Index.

What is the score range? 0 to 16: up to 8 points for non-hospice spending and up to 8 for utilization.

What score does CMS consider an outlier? In the final rule, CMS said 13 or more points, roughly the 99th percentile. For FY 2025, 69 hospices were at that level.

Can I appeal my score? CMS did not finalize a reconsideration process and said it is unclear how one would work, since the score is built from your finalized claims.

How often will it update? CMS plans to publish an updated SSVI with each future final rule using the most recent claims data.

How Hospice Engine Can Help

Hospice Engine helps agencies check their SSVI score, find which measures are driving it, and tighten the documentation and billing behind every claim. To get started, visit hospice.us.com or call (866) 522-1138.

Sources