Documentation Requirements for the Medicare Hospice Election Statement

Election of Hospice

Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, the beneficiary must be entitled to Part A of Medicare and be certified as being terminally ill.

The beneficiary must also elect the hospice benefit by signing an election statement provided by the hospice agency. The fiscal year 2021 Hospice Final Rule (42 CFR 418.24[b]) finalized modifications to the election statement adding new requirements that include the hospice election statement addendum. The new requirements are effective for all hospice elections beginning on or after 10/1/2020.

The hospice's election statement must include the following items of information:

Identification of the particular hospice agency that will provide care to the beneficiary;
The beneficiary or their representative's (as applicable) acknowledgment that they have been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment;
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 10/1/2020, this would include 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;
The effective date of the election, which may be the first day of hospice care or a later date, but cannot be a retroactive date. An individual may not designate an effective date that is retroactive;
The beneficiary’s designated attending physician (if any). Information identifying the attending physician recorded on the election statement should provide enough detail so that it is clear which physician, NP or PA was designated as the attending physician. This information should include, but is not limited to, the attending physician’s full name, office address, NPI number, or any other detailed information to clearly identify the attending physician;
The beneficiary or their representative's acknowledgement that the designated attending physician was their choice.

For hospice elections beginning on or after 10/1/2020 the hospice 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 BFCC-QIO , including the right to immediate advocacy and BFCC-QIO contact information.
The signature of the beneficiary or their representative.

Each hospice agency designs and prints its own election statement. CMS has provided examples for developing a hospice election statement Model Example of Hospice Election Statement.

Change in Attending Physician

If the beneficiary or their representative chooses to change their designated attending physician, they must file a signed statement with the hospice.

The statement must include the following information:

Identification of the new attending physician. Include enough detail to clearly identify the new attending physician. This may include, but is not limited to, the physician's full name, office address or the NPI;
The date the change is effective;
An acknowledgement that the change in attending physician was the beneficiary or their representatives choice;
The beneficiary or their representative's signature; and
The date the statement was signed.

Note: Any hospice election statement changing the designated attending physician or missing any one of the bulleted items above, is considered incomplete, and may result in the claim being denied.