In October 2020, the FY2021 Hospice Final Rule became effective and mandated the submission of updated requirements for the hospice election statement, paving the way for the creation of an addendum. This year, the FY2022 Hospice Final Rule has made further changes on the hospice election statement addendum given some concerns raised during its first year of implementation. But what really is this document and how does it affect your hospice’s operations? To keep you up to speed on this new requirement, we answer your top six (6) questions on the hospice election statement addendum.

  1. What is the hospice election statement addendum?

The hospice election statement addendum is basically a written notification to the requesting beneficiary, non-hospice providers, or Medicare contractors of any items, drugs, or services not covered by the hospice. These out of coverage items are identified to be unrelated to the patient’s terminal illness and related conditions.

  1.     Why is it required?

The addendum aims to provide increased coverage transparency to relevant stakeholders and allow patients to make more informed decisions on their end-of-life care. This is achieved by notifying the patient or their representative of the items and services that the hospice cannot cover as they are deemed to be unrelated to the patient’s terminal illness and related conditions.

  1.     When does it need to be furnished?

Previously, the addendum can only be provided once requested (Day Zero) by Medicare beneficiaries or their representatives. If the request is made on the first date of hospice care, the agency must furnish the document within 5 days from that date. If it is however requested within the benefit period (e.g., the day after the start of hospice care), the agency must provide the document within 72 hours. Should there be changes on its content, the hospice would need to update the document and provide written updates to the beneficiary or their representative. This timeline will however have some changes come fiscal year 2022.

  1.     Does it follow a specific format?

No, there is no mandated format, and you are free to use any template provided that you meet the content requirements.

  1.     Should the addendum be signed?

Yes, a signed addendum in the beneficiary’s medical record with the hospice signifies several events. First, it means that the beneficiary requested the information. Second, the signature reflects the beneficiary’s acknowledgement and receipt of the document. Third, the payment requirement with Medicare is considered met through that signed addendum. Lastly, signed addendum signifies that its content was discussed by the hospice with the beneficiary. However, it is still expected that this discussion of the addendum at election date is documented in the hospice’s record.

  1.     What are the expected changes to the addendum as provided by the FY2022 Hospice Final Rule?

The FY2022 Hospice Final Rule makes changes to the timelines by which the addendum is furnished to a requestor. With the final rule, hospices are now allowed to provide the addendum within 5 days from the date the beneficiary or their representative requested it as long as it is made within 5 days from election date. However, if the request was made after the 5th day, the hospice must provide the addendum within 3 calendar days of the request. The hospice is however not obliged to provide the addendum if within the required timeline, the patient dies, revokes election from hospice care, or is discharged. Lastly, instead of relying on the date by which the requestor signs on the addendum as acknowledgment of receipt, the timelines instead should take into account the date by which the hospice furnished the addendum to the requestor. This “date furnished” should be reflected in the patient’s medical record and in the addendum. Should a patient or their representative refuse to sign the addendum, the hospice must document this in the medical record and in the addendum itself to avoid or lessen the possibility of a claims denial.

Data Soft Logic, as your Intelligent Care Provider, aims to bring you up to date on the latest industry happenings. We want to help you be prepared for these changes which can affect your operations and financial bottom line. As such, Hospice Centre brings you the Addendum Feature which conveniently generates the hospice election statement addendum for your agency, reflecting the non-covered items, services, and drugs as well as the reasons for non-coverage.

Schedule a demo with us now to see how we can be your Intelligent Care Partner.