Hospice Election Statement Addendum

Mandatory From October 1, With a 90-Day Enforcement Grace Period

Rcmaxis Billing & Policy Update  ·  Posted October 1, 2026  ·  Effective: October 01, 2026 (enforcement discretion through December 31, 2026)

Summary of the Rule or Edit Change

The FY 2027 hospice final rule (CMS-1851-F) makes the hospice election statement addendum mandatory for every Medicare hospice election that takes effect on or after October 1, 2026. The requirement sits in 42 CFR 418.24(c). The addendum is a written document that tells the patient or their representative which items, services, drugs and conditions the hospice has decided are not related to the terminal illness and related conditions, and so aren't covered under the hospice benefit.

The regulation is specific about what goes in the document. It has to be titled "Patient Notification of Hospice Non-Covered Items, Services, and Drugs." It has to name the patient's terminal illness and related conditions, list the conditions present on admission (or at a plan of care update) with the items, services and drugs the hospice won't cover, and give a written clinical explanation in plain language of why each is unrelated and not needed for pain or symptom management. It also has to cite any relevant clinical practice, policy or coverage guidelines and explain that immediate advocacy is available through the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) if the patient disagrees.

The timing is tight. The hospice has to give the addendum in writing at the time of election, which the rule defines as within the first 5 days of the effective date of the election (CMS's October 1 article says calendar days). If a change to the plan of care affects the determinations, the hospice has to update the addendum within 3 days and give the updated version to the patient or representative. The signature line only acknowledges receipt, not agreement, and if the patient refuses to sign, the hospice documents the reason on the addendum. The addendum is filed with the election statement and has to be available to non-hospice providers and Medicare contractors. If the patient dies, revokes or is discharged before the addendum is due or signed, it isn't required, but the hospice has to note the reason in the record.

CMS posted updated model election statement and model addendum documents on September 11, 2026, and the October 1 MLN Connects newsletter announced a transition period. From October 1 through December 31, 2026, Medicare Administrative Contractors won't deny claims solely because the addendum is missing or incomplete. After that, a missing addendum becomes a denial risk.

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