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    Hospice Election Statement Addendum Readiness Assessment

    15 questions. 2 minutes. See how ready your agency is before CMS's grace period ends.

    88 days left in CMS's enforcement discretion windowNo login. No PHI. Agency process questions only.
    0 of 15 answered0%

    Delivery & Timing

    Question 1 of 15

    Question 1 of 15

    Every Medicare patient electing hospice on or after Oct 1, 2026 receives the addendum, not only those who ask.

    Question 2 of 15

    Question 2 of 15

    The addendum is delivered in writing within 5 days of the election effective date.

    Question 3 of 15

    Question 3 of 15

    We record the "date furnished" as the date the patient or representative receives it, not the signature date.

    Question 4 of 15

    Question 4 of 15

    When plan-of-care changes affect non-covered items, we provide an updated addendum within 3 days.

    Content

    Question 5 of 15

    Question 5 of 15

    Our addendum lists diagnoses both related and unrelated to the terminal illness.

    Question 6 of 15

    Question 6 of 15

    It lists unrelated items, services, and drugs, each with a plain-language reason for non-coverage.

    Question 7 of 15

    Question 7 of 15

    It includes the patient's Right to Immediate Advocacy through the BFCC-QIO, with contact information.

    Question 8 of 15

    Question 8 of 15

    Staff explain that signing acknowledges receipt only, not agreement.

    Filing & Retrieval

    Question 9 of 15

    Question 9 of 15

    The addendum and every update are filed with the election statement.

    Question 10 of 15

    Question 10 of 15

    We can quickly pull a complete addendum, with all updates, for an ADR response.

    Workflow & Training

    Question 11 of 15

    Question 11 of 15

    Our admission packet and election statement no longer describe the addendum as "upon request".

    Question 12 of 15

    Question 12 of 15

    Our EHR or admission workflow flags the 5-day and 3-day deadlines.

    Question 13 of 15

    Question 13 of 15

    Intake staff, clinicians, and the medical director have been trained on the requirement.

    Question 14 of 15

    Question 14 of 15

    Staff document the coverage discussion at the time of election.

    Question 15 of 15

    Question 15 of 15

    We audit a sample of new elections every week through December 31.

    What changed on October 1, 2026

    Starting October 1, 2026, hospices must give every patient, or their representative, a written hospice election statement addendum for each hospice election; before this, it was only required on request. The change was finalized in the FY2027 hospice final rule (91 FR 49118). The addendum must be provided within 5 days of the election effective date and filed with the election statement, so it is available to the patient, non-hospice providers, and Medicare contractors. If plan-of-care changes affect the addendum determinations, an updated written addendum must be provided within 3 days. The date furnished is when the patient or representative receives the addendum, and signing only acknowledges receipt. From October 1 to December 31, 2026, MACs will not deny claims solely because the addendum is missing or incomplete; after that, expect full scrutiny.

    FAQ: Hospice Election Statement Addendum

    Does this apply to elections before October 1, 2026?

    The requirement to give every patient a written addendum applies to hospice elections on or after October 1, 2026. Before that date, the addendum was only required when a patient or representative asked for it.

    What happens after December 31, 2026?

    From October 1 to December 31, 2026, CMS is exercising enforcement discretion: MACs will not deny claims solely because the addendum is missing or incomplete, and will focus on education. After December 31, expect full scrutiny.

    Is the signature date the same as the date furnished?

    No. The date furnished is the date the patient or representative receives the addendum, not the date it is signed. Signing only acknowledges receipt and does not mean the patient agrees.

    When must the addendum be updated?

    If plan-of-care changes affect the addendum determinations, an updated written addendum must be provided within 3 days and filed with the election statement.

    What is the BFCC-QIO Immediate Advocacy right?

    The addendum includes the patient's Right to Immediate Advocacy through the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), along with how to contact them.

    Sources

    This self-assessment is general guidance, not legal or billing advice. Confirm requirements with your MAC and compliance counsel.