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CMS Expectations for Updated Hospice Election Statement

2018 Hospice Cap Filing Due February 28, 2019
Tiffany Karlin

September 04, 2020

Does your agency fully understand CMS’s expectations on the updated hospice election statement and the new addendum?

 Hospice final rule of 2020 included modifications of the hospice election statement content requirements at 418.24(b) and adding a new addendum requirement to the hospice election statement to increase coverage transparency for patients and their representatives, and to promote communication between hospice and non-hospice providers.  On July 31, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1733-F) that updates fiscal year (FY) 2021 Medicare payment and rates and the wage index for hospices serving Medicare beneficiaries. In this rule, CMS finalized the modifications to the hospice election statement content at 418.24(b) and the requirement for the hospice elections statement addendum.

The Hospice Election Statement modifications apply to ALL hospice admissions on or after October 1, 2020. The Hospice Election Statement Addendum is only required if requested and would be provided to the beneficiaries, their representative, and non-hospice providers.   If the Hospice Election Statement Addendum is requested at the start of care the hospice has 5 days to provide this document to the requesting party.  If the Hospice Election Statement after the start of care the hospice has 72 hours to provide this document to the requesting party.

The following elements must be added to the Election Statement for a hospice to be compliant:

  • Information about the holistic, comprehensive nature of the Medicare hospice benefit;
  • A statement that, although it would be rare, there could be some necessary items, drugs, or services that will not be covered by the hospice, because the hospice has determined that these items, drugs, or services are to treat a condition that is unrelated to the terminal illness and related causes;
  • Notification of the beneficiary’s right to request in writing, the “Patient Notification of Hospice Non-Covered Items, Services, and Drugs” addendum that includes information and rationale for why the hospice has determined items, drugs, or information and rationale for why the hospice has determined items, drugs, or services unrelated to terminal illness and that immediate advocacy is available through the Beneficiary and Family-Centered Care Quality Organization (BFCCQIO) if the beneficiary disagrees with the hospice’s determination; and
  • Information about beneficiary cost‐sharing for hospice services.

Click here for an example of updated Election Statement.

A hospice can design their own addendum, but it must be titled, “Patient Notification of hospice Non-Covered Items, Services, and Drugs and include MUST include:

  • The Name of the hospice;
  • The Beneficiary’s name and hospice medical record identifier;
  • The Identification of the beneficiary’s terminal illness and related conditions;
  • A list of the beneficiary’s current diagnoses/conditions present on hospice admission (or upon plan of care update, as applicable) and the associated items, services, and drugs, not covered by the hospice because they have been determined by the hospice to be unrelated to the terminal illness and related conditions;
  • A written clinical explanation, in language the beneficiary or his/her representative can understand, as to why the identified conditions, items, services, and drugs are considered unrelated to the terminal illness and related conditions;
  • References to any relevant clinical practice, policy, or coverage guidelines;
  • Information on the Purpose of the Addendum and the Right to immediate advocacy; and
  • Name and signature of the beneficiary (or representative) and date signed, along with a statement that signing this addendum (or its updates) is only with a statement that signing this addendum (or its updates) is only the beneficiary’s agreement with the hospice’s determinations.

Click here for an example of the hospice addendum.

CMS Finalized that the signed addendum and updates become a new condition for payment. The addendum will not be required to be submitted with any hospice claims.  Separate consent will not be needed to release this information to non-hospice providers furnishing services for unrelated condition.

Your agency should make sure that your agency’s Policies and Procedures are updated with the new Election Statement and Addendum Requirements.  Your agency will need to make sure all hospice staff understands the new requirements and can explain them to patients and their families.  Most of all your agency will need to put an audit process in place to ensure that all elements of the updated election statement are being met, and that the addendum are being provided in a timely manner.

If you need help with educating your hospice staff or put audit processes in place, contact our Healthcare Team at Mueller Prost.

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