Hospices must provide all patients with an addendum to the election statement when they enroll in services to comply with a new requirement that took effect on Thursday.
The U.S. Centers for Medicare & Medicaid Services (CMS) mandated the requirement in the final hospice payment rule for FY 2027. The addendum outlines what is and is not included under the Medicare Hospice Benefit and provides greater clarity around patients’ costs. Previously, hospices were required to provide the addendum upon request.
CMS recently announced that hospices will have until the end of this year to fully comply with the new requirement.
“To help hospices adjust to the new requirement, from October 1, 2026 to December 31, 2026, while hospices are required to furnish the addendum to every electing beneficiary, CMS will exercise enforcement discretion during this three-month window,” the agency said in a statement. “During this time, Medicare Administrative Contractors (MACs) will not deny claims solely because the addendum is missing or incomplete and will focus on educating hospices to help them come into full compliance.”
The addendum includes information about items, services and medications that are unrelated to an individual’s terminal illness and are not covered by the Medicare Hospice Benefit. The statement also explains the process for a patient, or their representative, to appeal coverage decisions.
Hospices that do not comply with the new addendum requirement after Dec. 31 face risks of claim denials and further regulatory scrutiny. Providers must document that staff discussed what would be covered at the time of hospice election.
The addendum change is in part designed to improve non-hospice spending, which saw “dramatic increases” from FY2020 to FY2024, CMS previously stated.
Previously, CMS required hospices to provide families with the addendum only upon request, pursuant to the agency’s 2020 final hospice rule. Some hospices expressed concern at the time with their ability to comply alongside labor and operational strains during the COVID-19 pandemic. Among the issues previously raised were complexities with the electronic filing processes and increased staff training around the new requirement.
Hospices are now furrowing their brows at the potential for administration and operational burden under the new mandate, according to advocacy groups like the National Partnership for Healthcare and Hospice Innovation (NPHI). The requirement could create “undue burden” for providers and add “limited value” for patients and their families, NPHI CEO Tom Koutsoumpas previously said.
Companies featured in this article:
National Partnership for Healthcare and Hospice Innovation, U.S. Centers for Medicare & Medicaid Services
