90 Days to January 1: An Addendum Readiness Plan for Hospice Admissions Teams

Why the Next 90 Days Matter

The election statement addendum became an every-election requirement on October 1, 2026. Every Medicare hospice patient with an election on or after that date must receive it in writing within 5 days of the election effective date, and an updated copy within 3 days when a plan-of-care change affects related or unrelated determinations.

CMS gave hospices a short runway. From October 1 to December 31, MACs will not deny claims solely because the addendum is missing or incomplete, and they will focus on education. The requirement is still in force during that time. Only the denial consequence is paused. After December 31, expect full scrutiny.

That makes this quarter unusually valuable. You can find and fix gaps on real admissions while the cost of a mistake is still low. The plan below divides the work into three months, each with a clear goal and a finish line.

October: Forms, Packet, Training, and Workflow Triggers

The goal for October is simple: every new election gets an addendum, on time, from a process that does not depend on memory.

Adopt the CMS model format

Start from the CMS model addendum published in August 2026. Adapting it is safer than writing your own from scratch, because reviewers will recognize the structure. Confirm your version includes unrelated conditions, items, services, and drugs, plain-language reasons, and how to dispute or appeal.

Update the admission packet

Remove any language that describes the addendum as available upon request. Place the addendum directly after the election statement so staff complete them together, and file them together.

Train intake and clinical staff

Keep training short and practical. Cover what the addendum is, why every patient now receives it, how to explain unrelated care in plain language, and how to document that coverage was discussed at election. Role-play the conversation once with a family member who disagrees with a determination.

Build the triggers

Put the 5-day deadline into your EHR or tracking sheet, calculated from the election effective date. Add a standing question to the IDG agenda: did anything today change what we consider related or unrelated? A yes should open a 3-day task for an updated addendum.

November: Weekly Audits, Fixing Gaps, and Change Triggers

The goal for November is to prove the October process works, using evidence instead of assumptions.

Audit every new election weekly

Review each election from the prior week against the checklist below. For small agencies this may be three or four charts. For larger agencies, review all of them if you can, or a meaningful sample from every admitting team if you cannot. The point is to catch patterns, such as one location that consistently files late.

Fix gaps immediately

When an audit finds a missing or late addendum, correct it, document the correction honestly, and coach the staff member the same week. Never backdate. A late addendum with a clear explanation is far better than a document whose dates do not match the record.

Test plan-of-care change triggers

Pick three patients with plan-of-care changes during the month. Check whether each change affected related or unrelated determinations, and if it did, whether an updated addendum was provided within 3 days and filed. This is the step most agencies discover is weakest.

December: Mock ADR Pull, Retrieval Test, and Sign-Off

The goal for December is to see your records the way a reviewer will see them after January 1.

Run a mock ADR pull on 10 elections

Choose 10 recent elections, ideally spread across teams and locations. Ask someone outside admissions to assemble the election statement, addendum, any updated addendums, and the coverage discussion note for each, exactly as they would for a real ADR.

Time the retrieval

Record how long each pull takes. If anyone has to hunt across systems or ask a colleague where a file lives, you have a retrieval gap. Retrieval speed matters because ADR responses have firm deadlines, and missed deadlines produce avoidable denials such as denial code 56900.

Sign off before January 1

Hold a short readiness meeting with intake, clinical, the medical director, and compliance. Review audit results, mock pull findings, and open fixes. Document a sign-off decision, including any remaining risks and who owns them.

Weekly Audit Checklist

Use this table for every weekly election audit from October through December.

What Good Looks Like on January 1

It helps to define the finish line in concrete terms so the sign-off meeting is a decision, not a debate. By January 1, a ready hospice can say yes to each of these statements:

If any statement is a no, it does not mean the agency failed. It means you know exactly what to fix in January, before a reviewer finds it for you. Write down the gap, assign it, and keep the weekly audit running until the item is closed.

Keeping the gains after January

Readiness tends to fade once the deadline passes. Keep a lighter version of the routine going: a monthly sample of new elections, a quarterly retrieval test, and an annual refresh of training. Add the addendum to new-hire orientation so the process survives staff turnover, which is often the real reason a working process breaks down.

Keep the weekly summaries together in one folder. Over the quarter they become a simple record that the agency took the new requirement seriously and corrected problems as it found them.

Roles and Accountability

Give each part of the plan a single owner. Shared ownership is the most common reason readiness work stalls.

A sample week for a mid-sized hospice

To make the routine concrete, here is how one week might run for an agency admitting around fifteen patients. On Monday, the compliance lead pulls last week's elections and checks each against the audit table. On Tuesday, results go to the admissions lead and clinical manager with specific fixes. On Wednesday, the IDG meeting asks the related or unrelated question for every patient discussed. On Thursday, open fixes are confirmed closed. On Friday, a two-line summary goes to the administrator: how many elections, how many passed, and what changed. The whole cycle takes a few hours and produces a clear paper trail of good-faith effort.

Common Implementation Mistakes to Avoid

The addendum also connects to how CMS watches spending patterns through the new Hospice SSVI, and to the wider audit climate described in our moratorium guide. Hospices in PPEO states should also review our PPEO guide, because prepayment review raises the cost of any missing document.

A final note on timing. HOPE replaced HIS on October 1, 2025, so many admissions teams already track HOPE windows from the election date. The addendum adds another clock that starts at the same moment. Build both into one admission timeline so staff see every election-based deadline together.