CMS Clarifies Penalty Targets for Hospice Election Statement, Addendum 

Situation Report | September 21, 2020

The U.S. Centers for Medicare and Medicaid Services (CMS) has clarified what payment penalties would apply in relation to the modified hospice election statement and addendum requirements effective October 1.

Our colleagues at the National Association for Home Care and Hospice (NAHC) confirmed from CMS that only one financial penalty is applicable: when an addendum has been requested and there is not evidence in the medical record of the addendum being provided to the beneficiary/legal representative.

According to NAHC, CMS, its Medicare Administrative Contractors (MACs) and other reviewers should be looking for evidence of whether the addendum was requested and, if it was, evidence that the addendum was provided to the beneficiary/legal representative and that the beneficiary/legal representative signed the document.

CMS told NAHC that it will not be looking to determine if the addendum was provided within the required number of days or if all content requirements are met.

NAHC says that CMS reiterated its intent for the election statement addendum: to improve transparency between the hospice and the beneficiary (or legal representative), not another route by which to deny payment. Therefore, the condition of payment is met if there is a signed addendum (and any signed updates) in the requesting beneficiary’s medical record with the hospice, reports NAHC.

CMS also confirmed to NAHC that if the beneficiary/legal representative refuse(s) to sign the addendum, the hospice should explain that the signature is simply an acknowledgement of receipt and not indication of agreement with the contents of the addendum. If the beneficiary/legal representative still refuse(s) to sign, the hospice should document this in the record.

While this is welcome news, HCA has not separately confirmed CMS’s position in this regard and, as of yet, HCA has not obtained a formal communication from CMS affirmatively stating this position regarding the applicability of penalties. We therefore advise HCA hospice members to follow all CMS requirements related to the hospice election statement and addendum.