CMS Issues Updated Manual Guidance for the Hospice Election Statement and Addendum

Situation Report | November 16, 2020

The U.S. Centers for Medicare and Medicaid Services (CMS) recently updated the Medicare Benefit Policy Manual, Chapter 9 to reflect changes to the hospice election statement and the new election statement addendum. See CMS Transmittal 10437/Change Request (CR) 12015.

The new election statement content requirements were finalized in the fiscal year (FY) 2020 hospice final rule. Reflecting those changes, Chapter 9 of the Benefit Manual now adds the following information that must be included in the election statement requirement:

  • The individual’s acknowledgement that the individual has been provided information on the hospice’s coverage responsibility and that certain Medicare services are waived by the election. For hospice elections beginning on or after October 1, 2020, hospices are responsible for providing the individual with information indicating that services unrelated to the terminal illness and related conditions are exceptional and unusual and the hospice should be providing virtually all care needed by the individual who has elected hospice.

For hospice elections beginning on or after October 1, 2020, the hospice also must provide:

  • Information on individual cost-sharing for hospice services.
  • Notification of the individual’s (or representative’s) right to receive an election statement addendum if there are conditions, items, services, and drugs the hospice has determined to be unrelated to the individual’s terminal illness and related conditions and would not be covered by the hospice.
  • Information on the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), including the right to immediate advocacy and BFCC-QIO contact information.