Hospice Election & Addendum Requirements
Medicare Benefit Policy Manual (Pub. 100-02), Chapter 9, sections 10, 20.2.1 and 40.1.3.1
To receive hospice services under the Medicare Hospice Benefit, the patient (or authorized representative) must elect hospice care by signing an election statement. Each hospice designs and prints its own election statement.
The fiscal year 2027 final rule (CMS-1851-F) and related manual updates include mandatory hospice election statement and addendum requirements for all hospice elections beginning on or after October 1, 2026.
As you develop your hospice election statements and addendum templates, please review the revised CMS Model Statements:
Model Example of Hospice Election Statement
Key changes:
- Hospices must give the beneficiary (or representative) a written "Patient Notification of Hospice Non-Covered Items, Services, and Drugs" addendum listing all conditions, items, services, and drugs the hospice determined are unrelated to the terminal illness and, therefore, not covered.
- The hospice must furnish the addendum within 5 days of the election start date and any updated addendum within 3 days when changes to the plan of care affect the unrelated items, services, or drugs list.
Model Example of "Patient Notification of Hospice Non-Covered Items, Services, and Drugs"
Key changes:
- Updated purpose statement to reflect its mandatory use for all elections beginning October 1, 2026
- Clarified the "date furnished" requirement:
- When the beneficiary or representative receives the addendum (or update), not the signature date
- Must be within required timeframes (5 days for initial election; 3 days for updates)
- Updated signature section with acknowledgment-only language
Hospice Election Statement Form Requirements
The hospice's election statement forms must include:
- Identification of the hospice that will provide care
- The patient's or representative's acknowledgment of understanding hospice care, especially its palliative (not curative) nature
- Acknowledgment that the patient understands certain Medicare services are waived when electing hospice, services unrelated to the terminal illness and related conditions are exceptional and unusual, and the hospice should provide virtually all necessary care for the patient
- The election effective date (may be the first day of hospice care or a later date, but not retroactive)
- The patient's designated attending physician, if applicable, clearly identified with full name, office address, or National Provider Identifier (NPI)
- Acknowledgement that the selected attending physician was the patient's choice
- The hospice must provide information about:
- Individual cost-sharing for hospice services
- The Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), including the beneficiary's right to immediate advocacy and BFCC-QIO contact information
- For hospice elections beginning on or after October 1, 2026, the hospice must provide the individual or representative with an election statement addendum (and any updates), as required under 42 CFR 418.24(c) and (d)
. This addendum must list any conditions, items, services, or drugs the hospice determines are unrelated to the terminal illness and related conditions and, therefore, not covered by the hospice benefit. - Patient or representative signature
Changing the Designated Attending Physician
If the patient or representative wants to change the designated attending physician, they must file a signed statement that includes:
- Identification of the new attending physician (full name, office address, or NPI)
- The effective date of the change
- Acknowledgement that the change was their choice
- Signature and date
Any election statement or attending physician change statement missing required elements may result in claim denial.
Election Addendum Form Requirements for Hospice Elections Beginning on or After October 1, 2026
Medicare Benefit Policy Manual (Pub. 100-02), Chapter 9, section 20.2.1.2
Hospices must:
- Complete the Election Statement Addendum as described in 42 CFR 418.24(c) and (d).
- Furnish the addendum in writing to the beneficiary or representative within 5 days of the election effective date.
- File the addendum with the election statement in the medical record.
- Make the addendum available to the beneficiary or representative, non-hospice providers, and Medicare contractors.
- Provide updated addendum within 3 days when conditions or unrelated determinations change.
- Include a clear clinical explanation for unrelated determinations, references to supporting guidelines, and required notifications.
- Obtain the beneficiary or representative signature (or document if there's a refusal).
- Ensure the date furnished is included and compliant with required timeframes.
A valid, timely, properly filed addendum (and updates) is a condition of payment.
If a hospice fails to provide the addendum within required timeframes and the claim is selected for review, the claim under review may be denied. This denial applies only to the claim reviewed, not the entire election.
Hospice Addendum Form Requirements
Medicare Benefit Policy Manual (Pub. 100-02), Chapter 9, section 20.2.1.2
The election statement addendum must include:
- Document title, "Patient Notification of Hospice Non-Covered Items, Services, and Drugs"
- Hospice's name
- Patient's name and hospice medical record ID
- A statement identifying the patient's terminal illness and related conditions
- A list of the patient's current conditions (at admission or plan of care update) and the specific items, services, and drugs the hospice will not cover because they're considered unrelated to the terminal illness and related conditions
- A plain-language clinical explanation describing why these conditions, items, services, and drugs are considered unrelated and not needed for pain or symptom management, along with a reminder that determinations are individualized and should be shared with any non-hospice providers
- References to any clinical practice guidelines, policies, or coverage rules used in making these determinations
- Information explaining:
- Purpose of the Addendum – To notify the patient (or representative) which items, services, and drugs the hospice won't cover because they're deemed unrelated
- Right to Immediate Advocacy through the BFCC-QIO if the patient disagrees with the hospice's determination
- Patient (or representative) name, signature, and date signed, accompanied by a statement that signing only acknowledges receipt – not agreement. If the patient refuses to sign, the hospice must document the reason on the form.
- The date the hospice furnished the addendum, which must meet required deadlines (within 5 days of starting hospice care and within 3 days of any plan of care changes that affect the determinations)
Note: When completing the addendum form, if there are no applicable non-covered items, services, or drugs for the beneficiary, it's recommended to enter "N/A" (or a similar notation). This helps clearly show that all required sections were reviewed and addressed at the time of signature.
Special Circumstances Related to the Addendum
If the beneficiary dies, revokes, is discharged:
- Before the required 5-day (initial) or 3-day (update) addendum timeframe expires,
- The addendum is not required, and the condition of payment is considered satisfied.
- After the addendum is furnished but before signing,
- The signature requirement is waived.
Updated: 10.19.2026
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