CMS to Change Hospice Election Statement for 2020

Hospices in Fiscal Year 2020 would be required to provide an election statement addendum upon request from the U.S. Centers for Medicare & Medicaid Services (CMS), if the agency makes final provisions in a recently proposed rule.

If the agency were to request such an addendum from a hospice, submission of that document would become a condition for payment.

Such an addendum would include a list and rationale for items, drugs, and services that the hospice has determined to be unrelated to the terminal illness and related conditions to the patient or patient’s representative, as well as any other providers caring for the patient, and to Medicare contractors.


“In the Medicare Hospice Benefit FY2020 proposed rule we are modifying existing hospice election statement requirements to increase coverage transparency for patients under a hospice election, demonstrating our continued commitment to empowering patients,” CMS Administrator Seema Verma said in a tweet.

According to the agency, the addendum would give patients a clearer picture of what care, treatment, or services they could continue to receive as well as those they would have to discontinue upon electing to enroll in hospice.

Hospice industry organizations have said they are reviewing the final rule and considering their response, but initial reactions sought to balance the recognized need for transparency about services and coverage available to patients with concerns about making the addendum a condition for payment.


“We do have concerns regarding CMS’s plans for making [the election statement addendum] a condition for payment, as well as other requirements associated with this proposal,” Katie Wehri, director of Home Care & Hospice Regulatory Affairs at NAHC told Hospice News. “Discussions of patient wishes and desires and how these translate into what items and services are not covered under the Medicare Hospice Benefit are complex and delicate. They must be handled in the same way.”

Extensive documentation for hospice election is already challenging for some providers.

“We always support the patient’s right to elect hospice, to revoke hospice, and to have the care that they need. It’s very concerning to see when services and drugs and DME are paid for by someone other than the hospice when they clearly are linked to the terminal prognosis,” said Judi Lund Person, vice president, Regulatory and Compliance, National Hospice and Palliative Care Organization. “But we are worried about the extra burdens on the hospice staff, especially the hospice nurse who would be primarily responsible for this.”

We want hospices to do the right thing and do whatever it takes to help providers know what the right thing is.

According to a January report from the Office of the Inspector General, one-third of election statements lacked required information for general hospice inpatient care, including documentation that the beneficiary waived coverage of curative services by electing hospice, or the physician’s narrative in documents certifying that the patient is terminally ill.

“They did not always mention—as required—that the beneficiary was waiving coverage of certain Medicare services by electing hospice ]care or that hospice care is palliative rather than curative,” OIG indicated. “Further, in 14 percent of GIP, the physician did not meet appropriately receiving requirements—such as composing narrative—when certifying that the beneficiary was terminally ill.”

Currently, CMS requires hospices to include the following information in an election statement:

  • Identification of the particular hospice that will provide care to the individual;
  • The individual’s or representative’s (as applicable) acknowledgement that the individual has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment;
  • The individual’s or representative’s (as applicable) acknowledgement that the individual understands that certain Medicare services are waived by the election;
  • 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;
  • The individual’s 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 or Nurse Practitioner (NP) was designated as the attending physician. This information should include, but is not limited to, the attending physician’s full name, office address, NPI number, or any other detailed information to clearly identify the attending physician;
  • The individual’s acknowledgment that the designated attending physician was the individual’s or representative’s choice;
  • The signature of the individual or representative.