NHPCO NewsLine Fall 2019 - 15

What is the right to
immediate advocacy
mentioned in the list of
required elements for the
addendum?

Can we use the addendum
to communicate items,
services and drugs that are
related but that the hospice
is not paying for?

A: The addendum must include
language that immediate
advocacy is available through the
Medicare Beneficiary and Family
Centered Care-Quality
Improvement Organization
(BFCC-QIO) if the individual (or
representative) disagrees with
the hospice's determination.

A: While some commenters
stated that addendum should
also address those items,
services, and drugs that may be
related, but that the hospice is
not covering, for example a brand
name drug as opposed to a
hospice formulary drug, or if a
patient requests to continue
using a specific drug that the
hospice determines is no longer
providing medical benefit to the
patient, we [CMS] do not think
the addendum is the appropriate
mechanism to communicate this
information.

How would a hospice update
the addendum?
A: Hospices have the option to
make updates to the addendum,
if necessary, to include such
conditions, items, services and
drugs they determine to be
unrelated throughout the course
of a hospice election. We believe
that the requirements proposed
and these suggestions would
mitigate hospices' concerns
regarding any items, services, or
drugs that may have been
inadvertently excluded when
completing the addendum. The
IDG should be proactive in
developing each patient's plan of
care by planning ahead for
anticipated patient changes and
needs. Decisions should reflect
patient/family preferences and
should not solely be a response to
a crisis.

What is the requirement for
a signature on the
addendum?
A: The addendum would include a
statement that signing the
addendum (and any updates) is
only an acknowledgement of
receipt of the addendum and not
necessarily the beneficiary's
agreement with the hospice's
determinations (84 FR 17595).

How would a hospice
implement this new
requirement?
A: CMS encourages hospices to
"review their current admission
processes to see how the
addendum could assimilate into
their procedures to help

ameliorate any issues upon
implementation. We [CMS]
believe that because hospices
already should have processes in
place to make determinations
about those items, services, and
drugs that they will not cover
because they are unrelated to the
terminal illness and related
conditions, hospices will be able
to adapt the addendum into their
current processes."

Is there a specific format for
the addendum?
A: We [CMS] did not propose a
specific format in which to
document such conversations and
hospices can develop their own
processes to incorporate into
their workflow. We [CMS] believe
that careful documentation that
the addendum was discussed and
whether or not it was requested
would be an essential step a
hospice could take to protect
themselves from claims denials
related to any absence of an
addendum (or addendum update)
in the medical record.

Will an addendum form be
developed by CMS?
A: CMS suggests that "each
individual hospice develop and
incorporate the addendum into
their current admissions process
in a way that best meets the
hospices' needs, as well as
providing this information as
quickly as possible considering
the potential for beneficiary
cost-sharing. Likewise, nonhospice providers should have

Newsline / Fall 2019

15
NHPCO NewsLine Fall 2019

Table of Contents for the Digital Edition of NHPCO NewsLine Fall 2019
