The Hospice SSVI Explained: What Your New Service and Spending Variation Index Score Means

Sep 9

3 min read

Every Medicare hospice now has a public integrity score. In the FY 2027 final rule, CMS finalized the Service and Spending Variation Index (SSVI) — a nine-measure score, built from FY 2024 and FY 2025 claims, that flags hospices with concerning utilization and non-hospice spending (CMS-1851-F). It is CMS's most direct response yet to fraud, waste, and abuse in hospice, and it puts provider-level data in the open. If you run a hospice, understanding your SSVI score — and what drives it — is now part of compliance. Here is what the index is, why CMS built it, and how to get ahead of it.

Key Takeaways

The SSVI is a finalized, provider-level score published in the FY 2027 hospice final rule (CMS-1851-F).
It combines 9 claims-based measures covering hospice utilization and non-hospice spending during a hospice election.
Scores use FY 2024 and FY 2025 claims; a higher score signals more concerning patterns.
CMS built it because non-hospice Part A/B spending under a hospice election grew substantially from FY 2020-2024.
A high score can invite targeted education, oversight, and audit attention.
The SSVI pairs with the newly mandatory election-statement addendum and tougher quality reporting.

What the SSVI Is

The Service and Spending Variation Index is a scoring system CMS calculates from hospice claims. Rather than a single metric, it aggregates nine measures — each capturing a different aspect of how a hospice delivers care and how much non-hospice spending occurs while patients are under its care.

SSVI feature	Detail	Source
Claims-based measures	9	CMS-1851-F
Data years	FY 2024 and FY 2025	CMS-1851-F
Scoring direction	Higher = more concerning	CMS-1851-F
Methodology change vs. proposal	Updated with newer data; no substantive method change	CMS-1851-F

Why CMS Built It

The comprehensive Medicare hospice benefit is designed so that a terminally ill patient's care is delivered by the hospice. CMS has said since 1983 that "virtually all" care the terminally ill need should come from the hospice. Yet non-hospice spending — Part A and Part B services billed outside the hospice while a patient is enrolled — has grown steadily.

Signal CMS is watching	Concern
Rising non-hospice Part A/B spending under an election	Care that should be the hospice's responsibility billed elsewhere
Long stays with low visit intensity	Possible admissions that don't meet the terminal-prognosis criterion
Elevated live-discharge rates	Program-integrity and quality flags

CMS finds it "unusual and exceptional" to see substantial services provided outside hospice for patients near end of life — so an outlier SSVI score is, in effect, a question the agency wants answered.

How to Get Ahead of Your Score

You can't change the published methodology, but you can understand and manage what feeds it.

Pull your own claims data for FY 2024-2025 and look at non-hospice Part A/B spending during elections — that is the metric CMS emphasizes.
Review your related vs. unrelated determinations. Services the hospice deems "unrelated" to the terminal illness are exactly where non-hospice spending shows up; getting these right is now doubly important given the mandatory addendum.
Watch length of stay and live-discharge rates against national norms.
Document medical eligibility rigorously so long stays are defensible.

Because the SSVI is built from claims, the cleaner and more accurate your billing and cost records, the easier it is to explain your position if a contractor asks. Disciplined hospice bookkeeping and cost reporting is what lets you audit yourself before CMS does.

The Bigger FY 2027 Picture

The SSVI doesn't stand alone. FY 2027 also made the election-statement addendum mandatory for every patient and tightened quality-reporting enforcement (about 20% of hospices were still non-compliant in FY 2026). Together, these signal a clear direction: more transparency, more oversight, and more weight on the accuracy of what a hospice reports.

The 2026 Enforcement Backdrop

The SSVI arrived with real teeth. A U.S. House Oversight investigation into California hospice fraud (an estimated $3.5 billion in Los Angeles County) and a national six-month moratorium on new hospice enrollments effective May 13, 2026 signal that CMS and Congress are acting on the outlier data the SSVI now makes public. In this climate, an elevated score is no longer just a statistic — it is a plausible audit trigger (U.S. House Committee on Oversight, 2026; CMS enrollment moratorium, May 2026).

Sources

Centers for Medicare & Medicaid Services (CMS), FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (CMS-1851-F), July 2026
Federal Register, FY 2027 Hospice Wage Index and Payment Rate Update (2026-15686)
Medicare Payment Advisory Commission (MedPAC), Report to the Congress: Medicare Payment Policy, Chapter 10, March 2026

Last updated: September 2026.

Soriaga & Associates, LLC is a CPA firm with 25+ years of hospice and home health accounting experience. Schedule a free consultation to review your SSVI exposure and non-hospice spending.