CMS Final Rule for FY 2027 Hospice
Hospice Finalized Mandatory Hospice Election Statement Addendum
The hospice election statement addendum is a written addendum to a Medicare hospice election statement that lists and explains what conditions, items, services, or drugs the hospice has determined are not related to the beneficiary’s terminal illness and related conditions — and will therefore not be covered under the Medicare hospice benefit. In the FY 2020 Hospice Final Rule (84 FR 38484), CMS finalized the requirement that a hospice provide a hospice election statement addendum to a beneficiary upon request to increase coverage transparency and potentially help ensure that Medicare beneficiaries who elect the hospice benefit are provided comprehensive and holistic services. Hospices are also required to provide the hospice election statement addendum to requesting non-hospice providers who furnish services to a beneficiary under hospice.
Despite this addendum requirement being finalized in FY 2020, Medicare non-hospice spending for beneficiaries who have elected the hospice benefit has shown substantial and consistent growth from FY 2020 through FY 2024, with particularly dramatic increases in Part A and B spending. This may suggest that the policy requirement stipulating that hospices only provide the addendum to beneficiaries (or their representatives) that request it — rather than every beneficiary who elects the benefit — has not achieved the intended accountability objective of ensuring that hospices provide virtually all care needed by terminally ill individuals as required under the comprehensive and holistic Medicare hospice benefit. Additionally, many beneficiaries or their representatives may not realize the importance of asking for the addendum and may continue to bear more financial burden as a result.
In this final rule, CMS made the addendum mandatory for all those electing hospice and not just those who request the addendum. This change ensures that all beneficiaries have greater transparency into non-covered items, services, or drugs to make care decisions that align with their treatment preferences and goals, potentially leading to a decrease in beneficiary out-of-pocket costs. This requirement may hold hospices more accountable for the items, services, and drugs they are required to provide. The addendum also will provide needed information to non-hospice providers for claims submission.