Hospice providers need to be aware of important changes to the Election Statement Addendum requirements that took effect October 1, 2026. Under the Final Rule, the addendum is now required for 100% of new hospice admissions, making it important for agencies to understand when it must be provided, what information it should include, and how to remain compliant with the updated requirements.
For patients who were already on service as of October 1, an addendum is not required unless one had been requested. However, for all new elections beginning October 1 or later, when a patient signs an Election Statement, the Election Statement Addendum must be provided within the five-day comprehensive assessment window.
It’s important to understand that this requirement applies to 100% of traditional Medicare patients. While other payers may choose to adopt similar requirements, the current CMS regulatory guidance specifically applies to traditional Medicare patients.
The Election Statement Addendum must be provided within the first five days. If you later identify changes that need to be made to the addendum, an updated addendum must be provided within three days of identifying those changes.
It’s also important to understand that the Election Statement Addendum is considered a Condition of Payment, not a Condition of Participation. This means compliance with the requirement is mandatory.
The addendum must be furnished to the patient within the required five-day window, or within three days when there is a change or update. Be sure to document the date the addendum was furnished and obtain the required signature. If you are unable to obtain a signature, document the reason the addendum was not signed on your copy. That documentation will satisfy the signature requirement.
When considering what should be included on the Election Statement Addendum, remember what the patient acknowledges when signing the Election Statement to elect the hospice benefit. The Election Statement explains that it should be rare and exceptional for a patient to need services outside of those provided or arranged by the hospice, since virtually all care related to the terminal illness and related conditions should be provided by the hospice.
With that in mind, there should generally be very few items, services, or drugs listed on the addendum. Carefully consider anything you include because, by listing it on the addendum, you are identifying that item, service, or drug as unrelated to the patient’s terminal illness and related conditions.
In addition to updating the addendum itself, hospices also need to update the Election Statement. Previously, the Election Statement indicated that the addendum would be provided if the patient requested it. Now that the addendum is required, that language needs to be updated as well.
The Election Statement should clearly explain that the Patient Notification of Hospice Non-Covered Services and Drugs is a required part of the election process and will be provided to the patient. It should also inform the patient that if any changes are made, an updated addendum will be furnished within three days.
CMS issued an updated model Election Statement in August 2026 that you can use as a reference to ensure patients receive the appropriate notifications and that your Election Statement includes the required language.
The Election Statement Addendum has also been updated. Both documents reflect an October 2026 effective date. The previous versions were dated March 2024, so make sure you are using the updated August 2026 examples moving forward.
Also keep in mind that when completing the addendum, you should include any items, services, or drugs that are considered unrelated to the patient’s terminal illness and related conditions.
CMS was very specific in the Hospice Final Rule that simply listing these items is not enough. You must also provide a clear explanation of why each item, service, or drug is considered unrelated to the terminal illness and related conditions. That explanation should be written in language that the patient and family members can easily understand.
Make sure you provide the appropriate BFCC-QIO information on both the Election Statement and the Election Statement Addendum. This ensures that if the patient or their representative disagrees with your determination and chooses to challenge it, they have the information needed to do so.
Lastly, as previously mentioned, the Election Statement Addendum is a Condition of Payment. However, CMS recently announced a period of relaxed enforcement from October 1 through December 31, 2026.
During this period, medical reviewers will be instructed not to deny a claim solely because of noncompliance with the new addendum requirements for Starts of Care or new elections occurring between October 1 and December 31, 2026.
CMS has essentially given hospices the final quarter of the year to make sure their processes are fully in place. Use this time to ensure every applicable patient receives the addendum when electing the hospice benefit, that required updates are furnished within the appropriate timeframe, and that your documentation is complete. If the patient does not sign the addendum, make sure you document the reason on your copy.
If you have any questions about the Election Statement Addendum or need assistance developing processes to ensure it is delivered timely and your agency remains compliant, please don’t hesitate to reach out to HPS.
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