CMS will switch hospice long-stay edits back on in April 2027, with carve-outs for transfers and ownership changes

CMS issued Change Request 14622 on October 8, 2026, telling Medicare's Common Working File to re-implement hospice edits U5565 and U5566 with two new bypass conditions: claims after a hospice-to-hospice transfer, and claims after a change of ownership. The change takes effect April 1, 2027, with implementation on April 5, 2027. CMS notes that, unless it says otherwise, the effective date is the date of service (transmittal R13997OTN, PDF). CMS revised the matching MLN Matters article, MM14227, on October 9 and flagged it in the October 15 MLN Connects (MM14227, PDF; MLN Connects, Oct. 15).

What the edits do

The edits first arrived under CR 14227, released December 5, 2025 and effective April 1, 2026. They return hospice bill types 813, 814, 823 and 824, and reject adjustment claims, when the claim's admission date doesn't match the election period start date on file.

The backstory is in MM14227. A MAC reviewing hospice claims for long stays past 270 days found that claims sent with matching "admission" and "from" dates slipped past the system's long-stay checks, because the shared system calculates those checks from the gap between the two dates. CMS says that gap allowed claims to pay at a higher rate.

Why they were switched off

The first version also caught claims it was never meant to stop. In a transfer, the receiving hospice uses its own admission date; after a change of ownership, the date that matters is the effective date on the ownership-change notice. Neither lines up with the original election start date. On June 18, 2026, CMS told the Common Working File to turn both edits off until it could write exceptions. CR 14622 is those exceptions.

Timeline

• December 5, 2025: CR 14227 released.
• April 1, 2026: edits U5565 and U5566 take effect.
• June 18, 2026: CMS has the edits turned off.
• October 8, 2026: CR 14622 issued with transfer and change-of-ownership bypasses.
• April 1, 2027: re-implementation effective for dates of service from that day (implementation April 5).

What to watch

The documents don't set out any reprocessing of claims returned while the first version was live. If your hospice had transfer or ownership-change claims returned with U5565 or U5566 between April and June 2026, your MAC is the place to ask. For Illinois hospices that's Palmetto GBA, Jurisdiction M (CMS JM page).

Sources

• CMS, MM14227 (revised October 9, 2026)
• CMS, transmittal R13997OTN / CR 14622
• CMS, transmittal listing
• CMS, MLN Connects, October 15, 2026
• CMS, A/B MAC Jurisdiction M (covers Illinois home health and hospice)
• Independent listing: Integral Healthcare Solutions regulatory changes log

Track every MAC change: our Medicare jurisdictions tracker lists CMS and MAC bulletins by jurisdiction, including Palmetto GBA, Jurisdiction M for Illinois.

It is general information, not clinical, billing or legal advice.*

Drafted with AI assistance from primary sources and reviewed by Monsaur Othman before publication. Read how we use AI, our editorial policy and our corrections policy.

Informational only, not billing, legal or clinical advice. Check the linked primary source and your Medicare Administrative Contractor.