The hospice election statement and the addendum

What must the election statement contain?

42 CFR 418.24(b) lists the required contents. In plain terms:

• Identification of the hospice that will provide care to the patient.
• The patient's or representative's acknowledgment that they have been given a full understanding of the palliative rather than curative nature of hospice care as it relates to the terminal illness and related conditions.
• Acknowledgment that certain Medicare services are waived by the election: curative treatment for the terminal illness and related conditions, and care from another hospice or provider that the designated hospice did not arrange.
• The effective date of the election, which may be the date of signing or a later date, never earlier.
• The patient's designated attending physician, if any, with enough detail to identify them, and the acknowledgment that the choice of attending physician is the patient's.
• Information on the patient's cost-sharing responsibility for hospice services.
• For elections beginning on or after October 1, 2026, the election statement addendum itself, given in writing and filed with the election statement (for earlier elections, notice of the right to request it).
• Notice that the hospice will keep the addendum, and its updates, in the patient's record, and that the patient can also ask for information about the immediate advocacy process (the Beneficiary and Family Centered Care Quality Improvement Organization).
• The signature of the patient or representative and the date.

What is the addendum, and when is it due?

The addendum (42 CFR 418.24(c)) is a written list of the conditions, items, services and drugs the hospice has determined are unrelated to the terminal illness and related conditions, with the reason for each, so the patient knows what the hospice will not cover before the care is needed. It also explains that the patient can appeal that determination through the immediate advocacy process.

The deadlines, for elections beginning on or after October 1, 2026 (42 CFR 418.24(d)): the hospice gives every patient or representative the addendum in writing at the time of election, which means within the first 5 days of the election's effective date, and files it with the election statement where the patient, non-hospice providers and Medicare contractors can see it. If a change to the plan of care affects what is listed, the hospice updates the addendum within 3 days and gives the update in writing. If the patient dies, revokes or is discharged inside that window before the addendum is delivered, the hospice does not have to furnish it, but must note the reason in the record.

Before October 1, 2026 the addendum was a condition of payment only when the patient, the representative, a non-hospice provider or a Medicare contractor asked for it. CMS made it mandatory for every election in the FY2027 hospice final rule (CMS-1851-F), so patients and other providers can see up front what the hospice will not pay for.

What a model addendum looks like

The rule prescribes the content, not a form. These are the elements, in the order most hospices use.

The signature acknowledges receipt. It does not mean the patient agrees that the items are unrelated.

What does the patient sign, and what does the referring clinician send?

The patient signs the election statement and the addendum; if the patient declines to sign the addendum, the hospice notes the reason on it. The referring clinician does not sign either; the attending physician named in the election co-certifies the terminal illness for the first benefit period (42 CFR 418.22). What helps most at referral is the current medication list with the indication for each drug and the active problem list, so that the hospice physician's related-versus-unrelated determinations are made with the facts and the addendum is accurate the first time.

Common questions about the election statement

Related guides

Benefit periods and recertification, discharge and revocation, and the family page on what hospice does and does not provide.

Beta Hospice serves San Bernardino County, Riverside County, Los Angeles County, Orange County and Ventura County from one office in San Bernardino.

For the rule changes that took effect in 2026 and 2027, see hospice rules 2026–2027: what changed for referrers.