NHPCO NewsLine Fall 2021 - 23

Hospice Election Statement
Addendum
The FY 2022 Hospice Final Rule includes proposed
clarifying regulation text changes for the Hospice
Election Statement Addendum. Based on questions
from stakeholders, and hospice providers'
experiences with using the election statement
addendum, CMS is making several changes to the
regulation text regarding the addendum.
A. 5 days: CMS is implementing the proposal to
allow the hospice to furnish the addendum
within 5 days from the date a beneficiary or their
representative requests it if the request is within
5 days from the date of a hospice election.
B. If the patient dies: CMS has clarified that if the
beneficiary requests the election statement
addendum at the time of hospice election but
dies within 5 days, the hospice would not be
required to furnish the addendum as the
requirement would be deemed as being met in
this circumstance. If the patient is furnished an
addendum but dies before signing it, hospices
should note that in the patient record and
include the addendum in the record. This final
rule implements regulatory text changes at §
418.24(c) to reflect this policy.
C. 3 days rather than 72 hours: CMS confirmed
regulatory text changes at § 418.24(c) in
alignment with subregulatory guidance
indicating that hospices have " 3 days, " rather
than " 72 hours " to meet the requirement when a
patient requests the addendum during the
course of a hospice election.
D. Mailing the addendum: CMS responded to a
question about whether a mailed copy of the
addendum form would be acceptable. The
commenter stated that they believe their
patients and their representatives would
welcome this option; however, it is unclear
whether mailing the form is acceptable for CMS.
Response: There is nothing precluding hospices
from furnishing an addendum through mail. We
expect that hospices would take steps in working
with patients and their representatives to better
understand which methods (that is, in person,
mail, etc.) of delivery would work best in
furnishing the addendum.
E. Updated model election statement addendum:
Many commenters encouraged CMS to update
the model hospice election statement addendum
on the CMS hospice center webpage to illustrate
these clarifications. Response: We will post an
updated model election statement addendum on
the Hospice Webpage, along with the publication
of this FY 2022 Hospice Wage Index and
Payment Rate Update final rule. This is an
illustrative example for hospices to modify and
develop their own forms that meet the content
requirements at § 418.24.
F. Date clarification: CMS also clarified that the
date the hospice furnishes the addendum must
be within the required time frame (e.g., 3 days or
5 days), rather than the signature date. The
hospice would include the " date furnished " in the
patient record and on the addendum. If the
patient/representative refuses to sign the
addendum, hospices must document the reason
it is not signed.
G. Non-hospice provider requests addendum: If a
non-hospice provider requests an addendum,
CMS does not expect a signed copy in the patient
medical record. Hospices can develop processes
to address this, and how to document it.
H. Effective date: October 1, 2021.
CMS is making several changes to the
regulation text regarding the addendum.
Newsline / Fall 2021 23
NHPCO NewsLine Fall 2021

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