(Medicare Benefit Policy Manual)

An individual who meets the eligibility requirements of  418.20 may file an election statement with a particular hospice. If the individual is physically or mentally incapacitated, his or her representative (as defined in  418.3) may file the election statement.   Each hospice designs and prints its election statement.  The election statement must include the following items of information:   1. Identification of the particular hospice that will provide care to the individual;  2. The individuals or representatives (as applicable) acknowledgment that the individual has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment;   3. The individuals 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, 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 elect ed hospice;   4. The effective date of the election, which may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement.  An individual may not designate an effective date that is retroactive;   5. The individuals 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, Nurse Practitioner (NP), or Physician Assistant (PA) was designated as the attending physician.  This information should include, but is not limited to, the attending physicians full name, office address, NPI number, or any other detailed information to clearly identify the attending physician.    6. The individuals acknowledgment that the designated attending physician was the individuals or representatives choice.   7. For hospice elections beginning on or after October 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 Beneficiary and Family Centered Care Quality Improvement Organization (BFCC -QIO), including the right to immediate advocacy and BFCC -QIO contact information.  8.  The signature of the individual or representative. An election to receive hospice care will be considered to continue through the initial election period and through the subsequent election periods without a break in care as long as the individual:   (1) Remains in the care of a hospice;  (2) Does not revoke the election; and (3) Is not discharged from the hospice.  For Medicare payment purposes, an election for Medicare hospice care must be made on or after the date that the hospice provider is Medicare -certified.  As with any election, the hospice must fulfill all other admission requirements, such as certification or recertification, any required face- to-face encounters, or Conditions of Participation (CoP) assessments.  See also Pub. 100- 04, Medicare Claims Processing Manual , chapter 11, section 20.1.1.  An individual may change, once in each election period, the designation of the particular hospice from which he or she elects to receive hospice care.  The change of the designated hospice is not considered a revocation of the election, but is a transfer.  To change the designation of hospice programs, the individual must file, with the hospice from which he or she has received care and with the newly designated hospice, a signed statement that includes the following information:    the name of the hospice from which the individual has received care;   the name of the hospice from which they plan to receive care; and   the date the change is to be effective.   As described in Pub. 100 -04, Medicare Claims Processing Manual, chapter 11, section 20.1.1, when a hospice patient transfers to a new hospice, the receiving hospice must file a new Notice of Election; however, the benefit period dates are unaffected.  The receiving hospice must complete all assessments required by the hospice conditions of participation as described in 42 CFR 418.54.  Because the benefit period does not change in a transfer situation, if the patient is in the third or later benefit period and transfers hospices, a face -to-face encounter is not required if the receiving hospice can verify that the originating hospice had the encounter.  A change of ownership of a hospice is not considered a change in the patients designation of a hospice and requires no action on the patients part.   Medicare beneficiaries enrolled in managed care plans may elect hospice benefits.  Federal regulations require that the Medicare contractor assigned the hospice specialty workload maintain payment responsibility for hospice services and may pay for other claims if that Medicare contractor is the geographically assigned Medicare contractor for the managed care enrollees who elect hospice; for specifics, see regulations at  42 CFR 417, subpart P, 417.585, Special Rules: Hospice Care (b), and 42 CFR 417.531 Hospice Care Services (b).  Institutional claims for services not related to the terminal illness would otherwise be the responsibility of another geographically assigned Medicare contractor.   Managed care enrollees who have elected hospice may revoke hospice election at any time, but claims will continue to be paid by fee -for-service Medicare contractors as if the beneficiary were a fee- for-service beneficiary until the first day of the month following the month in which hospice was revoked.  As specified above, by regulation, the duration of payment responsibil ity by fee -for-service Medicare contractors extends through the remainder of the month in which hospice is revoked by hospice beneficiaries.  See Pub. 100- 04, Medicare Claims Processing Manual, Chapter 2, Admission and Registration and Chapter 11, Processing Hospice Claims, for requirements for hospice reporting to the Medicare contractor.   20.2.1.2 Hospice Election Statement Addendum  (Rev. 11056; Issued: 10- 21-21; Effective: 10 -01-21; Implementation: 12 -22-21)  For Hospice elections beginning on or after October 1, 2020, in the event that the hospice determines there are conditions, items, services, or drugs that are unrelated to the individual's terminal illness and related conditions, the individual (or representative), non-hospice providers furnishing such items, services, or drugs, or Medicare contractors may request a written list as an addendum to the election statement.   If the election statement addendum is requested within 5 days from the date of a hospice election , then the hospice would have 5 days from that request date to furnish the addendum.  If the addendum is requested during the course of hospice care (that is, 5 days after the effective date of the hospice election), the hospice must provide this information, in writing, within 3 days of the request to the requesting individual (or representative), non- hospice provider, or Medicare contractor.  If there are any changes to the content on the addendum during the course of hospice care, the hospice must update the addendum and provide these updates, in writing, to the individual (or representative).   If the beneficiary dies, revokes, or is discharged within the required timeframe after requesting the addendum (i.e., within 5 days or 3 days of the request, depending on when the request was made), and before the hospice has furnished the addendum, the addendum would not be required to be furnished, and this condition for payment would be considered satisfied.  Likewise, if the beneficiary dies, revokes, or is discharged prior to signing the addendum (furnished within the required timeframe), no signature is required and this condition for payment would be considered satisfied.   The date furnished must be within the required timeframe (that is, 3 or 5 days of the beneficiary or representative request, depending on when such request was made), rather than the signature date.  The hospice must include the date furnished on the a ddendum.    Only the beneficiary (or representative) is required to sign the addendum.  The non-hospice provider is not required to sign the addendum, if they are the requesting entity. If a beneficiary (or representative) refuses to sign a requested addendum, the hos pice must document clearly on the addendum the reason the addendum is not signed.   While the addendum is not submitted with hospice claims, it is a condition for payment if the beneficiary (or representative) has requested it.  This condition for payment is satisfied when there is a beneficiary (or representative) request present, which is documented by a valid signed addendum in the requesting beneficiarys medical record with the hospice.  If the claim has been selected for medical review, and it is clear based on received documentation that the beneficiary requested but did not receive  the addendum within the time period specified at 42 CFR 418.24(c), the failure to provide such addendum would result in a claims denial.  However, the Medicare Administrative Contractor may request the addendum to accompany any additional documentation request to mitigate such denial.  A denial resulting from a violation of this specific condition for payment would be limited to only the claim subject to review (that is, it would not invalidate the entire hospice election).   The election statement addendum must include the following:   1. The addendum must be titled Patient Notification of Hospice Non -Covered Items, Services, and Drugs.   2. Name of the hospice.   3. Individual's name and hospice medical record identifier.  4. Identification of the individual's terminal illness and related conditions.   5. A list of the individual's conditions present on hospice admission (or upon plan of care update) 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 illne ss and related conditions.  6. A written clinical explanation, in language the individual (or representative) can understand, as to why the identified conditions, items, services, and drugs are considered unrelated to the individual's terminal illness and related conditions and not needed for pain or symptom management.  This clinical explanation must be accompanied by a general statement that the decision as to whether or not conditions, items, services, and drugs are related is made for each patient and that the individual should share  this clinical explanation with other health care providers from which they seek items, services, or drugs unrelated to their terminal illness and related conditions.   7. References to any relevant clinical practice, policy, or coverage guidelines   8. Information on the following:   i. Purpose of Addendum. The purpose of the addendum is to notify the individual (or representative), in writing, of those conditions, items, services, and drugs the hospice will not be covering because the hospice has determined they are unrelated to the indi vidual's terminal illness and related conditions.   ii. Right to Immediate Advocacy. The addendum must include language that immediate advocacy is available through the Medicare Beneficiary and Family Centered Care- Quality Improvement Organization (BFCC -QIO) if the individual (or representative) disagrees with the hospice's determination.   9. Name and signature of the individual (or representative) and date signed, along with a statement that signing this addendum (or its updates) is only acknowledgement of receipt of the addendum (or its updates) and not necessarily the individual's (or repres entative's) agreement with the hospice's determinations.  If the individual (or representative) refuses to sign a requested addendum, the hospice must document why (on the addendum itself) and it would become a part of the medical record.    10. The date the hospice furnished the addendum.  The date furnished must be within the required timeframe (that is, 3 or 5 days of the beneficiary or representative request, depending on when such request was made).   Example:  Mr. Brown elects hospice  on December 1st and requests the addendum on December 3rd.  The hospice must provide this information, in writing, to Mr. Brown within 5 days of the request.  Therefore, the addendum would be required to be provided to Mr. Brown on or before December 8th.   Example:  Mrs. Smiths effective date of her hospice election was November 1st, but she did not request the election statement addendum on that date.  On December 4th, Mrs. Smith requests the election statement addendum.  Since Mrs. Smith requested the election statement addendum during the course of hospice care (that is, after the first 5 days of the hospice election date), the hospice must provide this information, in writing, within 3 days of her request.  Therefore, the addendum would be required to be provided to Mrs. Smith on or before December 7th.