Eli's Hospice Insider

Published on Wed Sep 18, 2019 PDF

You need to become an expert on what’s related — and what’s not.

You’ve got about a year to get yourself in line with the newly finalized election statement addendum requirements, and learning about them is the first step.

Despite numerous concerns about the new election statement addendum that the Centers for Medicare & Medicaid Services proposed back in April, the agency plans to forge ahead with the new requirement virtually as proposed.

In a final rule published in the Aug. 6 Federal Register, CMS confirms that the addendum that takes effect in October 2021 must include:

1. Name of the hospice;

2. Beneficiary’s name and hospice medical record identifier;

3. Identification of the beneficiary’s terminal illness and related conditions;

4. A list of the beneficiary’s current diagnoses/conditions present on hospice admission (or upon plan of care update, as applicable) 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 illness and related conditions;

5. A written clinical explanation, in language the beneficiary and his or her representative can understand, as to why the identified conditions, items, services, and drugs are considered unrelated to the terminal illness and related conditions and not needed for pain or symptom management. This clinical explanation would 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 beneficiary should share this clinical explanation with other health care providers from which they seek services unrelated to their terminal illness and related conditions;

6. References to any relevant clinical practice, policy, or coverage guidelines;

7. Information on the following domains: a. Purpose of Addendum b. Right to Immediate Advocacy;

8. Name and signature of Medicare hospice beneficiary (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 beneficiary’s agreement with the hospice’s determinations.