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.
• Notice of the right to request the election statement addendum, and a statement that the hospice will give it on request, with the deadlines.
• Notice that the hospice will keep the addendum, and its updates, in the patient's record, and that the patient can also ask for a copy of 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: if the patient or representative requests the addendum at the time of election, the hospice must provide it within 5 days of the election date. If the request comes during the course of care, the hospice must provide it within 3 days of the request. If the patient dies, revokes or is discharged within the 5- or 3-day window before the addendum is delivered, the hospice need not furnish it. The addendum must be updated when the hospice's determinations change, and the hospice keeps the signed addendum and updates in the record.

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, if requested and furnished, the addendum. 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, if requested, 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.