Hospice Election Statement

20.2.1.1 - Hospice Election Statement (Rev. 10437, Issued: 11-06-20, Effective: 10-01-20, Implementation: 12-09-20) An individual who meets the eligibility requirements of § 418.20 may file an election statement with a particular hospice. If the individual is physically or mentally incapacitated, his or her representative (as defined in § 418.3) may file the election statement. Each hospice designs and prints its election statement. The election statement must include the following items of information: 1. Identification of the particular hospice that will provide care to the individual; 2. The individual’s or representative’s (as applicable) acknowledgment that the individual has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment; 3. The individual’s acknowledgement that the individual has been provided information on the hospice's coverage responsibility and that certain Medicare services are waived by the election. For hospice elections beginning on or after October 1, 2020, this would include providing the individual with information indicating that services unrelated to the terminal illness and related conditions are exceptional and unusual and the hospice should be providing virtually all care needed by the individual who has elected hospice; 4. 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. An individual may not designate an effective date that is retroactive; 5. 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, Nurse Practitioner (NP), or Physician Assistant (PA) 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. 6. The individual’s acknowledgment that the designated attending physician was the individual’s or representative’s choice. 7. For hospice elections beginning on or after October 1, 2020 the hospice must provide: • Information on individual cost-sharing for hospice services; • Notification of the individual's (or representative's) right to receive an election statement addendum if there are conditions, items, services, and drugs the hospice has determined to be unrelated to the individual's terminal illness and related conditions and would not be covered by the hospice; • Information on the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), including the right to immediate advocacy and BFCC-QIO contact information. 8. The signature of the individual or representative. An election to receive hospice care will be considered to continue through the initial election period and through the subsequent election periods without a break in care as long as the individual: (1) Remains in the care of a hospice; (2) Does not revoke the election; and (3) Is not discharged from the hospice. For Medicare payment purposes, an election for Medicare hospice care must be made on or after the date that the hospice provider is Medicare-certified. As with any election, the hospice must fulfill all other admission requirements, such as certification or recertification, any required face-to-face encounters, or Conditions of Participation (CoP) assessments. See also Pub. 100-04, Medicare Claims Processing Manual, chapter 11, section 20.1.1. An individual may change, once in each election period, the designation of the particular hospice from which he or she elects to receive hospice care. The change of the designated hospice is not considered a revocation of the election, but is a transfer. To change the designation of hospice programs, the individual must file, with the hospice from which he or she has received care and with the newly designated hospice, a signed statement that includes the following information: • the name of the hospice from which the individual has received care; • the name of the hospice from which they plan to receive care; and • the date the change is to be effective. As described in Pub. 100-04, Medicare Claims Processing Manual, chapter 11, section 20.1.1, when a hospice patient transfers to a new hospice, the receiving hospice must file a new Notice of Election; however, the benefit period dates are unaffected. The receiving hospice must complete all assessments required by the hospice conditions of participation as described in 42 CFR 418.54. Because the benefit period does not change in a transfer situation, if the patient is in the third or later benefit period and transfers hospices, a face- to-face encounter is not required if the receiving hospice can verify that the originating hospice had the encounter. A change of ownership of a hospice is not considered a change in the patient’s designation of a hospice and requires no action on the patient’s part. Medicare beneficiaries enrolled in managed care plans may elect hospice benefits. Federal regulations require that the Medicare contractor assigned the hospice specialty workload maintain payment responsibility for hospice services and may pay for other claims if that Medicare contractor is the geographically assigned Medicare contractor for the managed care enrollees who elect hospice; for specifics, see regulations at 42 CFR 417, subpart P, 417.585, Special Rules: Hospice Care (b), and 42 CFR 417.531 Hospice Care Services (b). Institutional claims for services not related to the terminal illness would otherwise be the responsibility of another geographically assigned Medicare contractor. Managed care enrollees who have elected hospice may revoke hospice election at any time, but claims will continue to be paid by fee-for-service Medicare contractors as if the beneficiary were a fee-for-service beneficiary until the first day of the month following the month in which hospice was revoked. As specified above, by regulation, the duration of payment responsibility by fee-for-service Medicare contractors extends through the remainder of the month in which hospice is revoked by hospice beneficiaries. See Pub. 100-04, Medicare Claims Processing Manual, Chapter 2, “Admission and Registration” and Chapter 11, “Processing Hospice Claims,” for requirements for hospice reporting to the Medicare contractor.