Home Health Brief
Hospice

Hospices must now give every Medicare patient the election statement addendum, but MACs won't deny claims over it through Dec. 31

The short answer: Yes. For hospice elections starting on or after Oct. 1, 2026, hospices must give every patient the election statement addendum within five calendar days. It lists items, services and drugs the hospice found unrelated to the terminal illness. Through Dec. 31, 2026, MACs won't deny claims solely because it is missing or incomplete.

For elections starting Oct. 1 or later, hospices must give each patient a written notice of the items, services and drugs the hospice has determined are unrelated to the terminal illness. CMS is holding off on claim denials for three months.

By Published Last updated 6 sources linked
Pen resting on a printed contract ready for signature
File photo: Pen resting on a printed contract ready for signature. Photo: Blogtrepreneur / Wikimedia Commons, CC BY 2.0 (cropped) · Creative Commons Attribution 2.0 Generic (CC BY 2.0)

At a glance

The FY 2027 hospice final rule makes the election statement addendum mandatory for all hospice elections on or after Oct. 1, 2026. Sources below

For Medicare hospice elections that began on or after October 1, 2026, the hospice election statement addendum is no longer optional. The FY 2027 hospice final rule requires hospices to give it to every beneficiary who elects hospice, within five calendar days of the election's effective date. Before, they had to give it only on request.

What the addendum is

The addendum is a written notice titled "Patient Notification of Hospice Non-Covered Items, Services, and Drugs." It identifies the items, services and drugs that the hospice has determined are unrelated to the terminal illness and related conditions, and that it therefore won't cover. It also explains the patient's right to ask the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for immediate help if they disagree. The full list of required content is in 42 CFR § 418.24(c).

CMS first finalized the addendum in its FY 2020 hospice rule, as a document hospices had to provide on request.

The timing rules

According to CMS's October 1 MLN Connects:

  • The addendum must be given in writing, on paper or electronically, to the beneficiary or their representative.
  • It must be given within 5 calendar days of the election's effective date.
  • Any update must be given within 3 calendar days of a plan of care change that affects it.
  • The condition for payment is met when a valid, signed addendum is in the hospice's medical record for that beneficiary.

The rule's required content includes a statement that signing the addendum is only an acknowledgement of receipt. In the final rule's discussion of signatures, CMS says electronic or written signatures are acceptable, but a hospice can't require an electronic signature if the beneficiary or representative lacks the resources or understanding to sign that way. CMS's rule text also says an addendum is not required if the beneficiary dies within the first five days of the election.

Some commenters asked CMS to extend the five-day timeframe, with requests ranging up to 15 days, and many asked for a delayed start. CMS declined, noting that hospices have had since FY 2020 to implement the addendum.

Three months of leniency

From October 1 through December 31, 2026, CMS is using enforcement discretion. During that window, Medicare Administrative Contractors won't deny claims solely because an addendum is missing or incomplete, and they'll focus on education instead. The requirement itself still applies. CGS (J15), Palmetto GBA (JM, which covers Illinois) and Wellpoint Federal (J6) each posted a notice of the window. CGS and Wellpoint say that when it ends, all conditions of payment continue to apply.

A wording gap on Medicare.gov

As of October 19, Medicare.gov's hospice coverage page, written for patients, still says "You can ask for an addendum" to the hospice election statement. Under the new rule, hospices must provide it without being asked.

Dates to know

  • October 1, 2026: the requirement applies to elections that begin on or after this date.
  • December 31, 2026: the enforcement-discretion window ends.

Sources

Related: FY 2027 hospice payment rates and cap · Hospice long-stay edits return in April 2027 · Medicare jurisdictions tracker

It is general information, not clinical, billing or legal advice.*

Drafted with AI assistance from primary sources and reviewed by Monsaur Othman before publication. Read how we use AI, our editorial policy and our corrections policy.

Informational only, not billing, legal or clinical advice. Check the linked primary source and your Medicare Administrative Contractor.

Key facts and where they come from

  • The FY 2027 hospice final rule makes the election statement addendum mandatory for all hospice elections on or after Oct. 1, 2026. source 1 · source 2 · source 3
  • Must be furnished in writing (paper or electronic) within 5 calendar days of the election's effective date; updates within 3 calendar days of a plan of care change; the condition for payment is met with a valid signed addendum in the hospice's medical record. source 1 · source 2
  • Oct. 1 to Dec. 31, 2026: MACs won't deny claims solely because the addendum is missing or incomplete, and will focus on education. source 1 · source 2 · source 3
  • Before Oct. 1, the addendum was required only on request (within 5 days of election, or 3 days if asked later); the addendum was first finalized for FY 2020; CMS rejected commenters' requests for a longer window; signing acknowledges receipt, not agreement; a hospice can't require an electronic signature if the patient lacks the means. source 1 · source 2
  • Medicare.gov's hospice page, read Oct. 19, 2026, says beneficiaries 'can ask for an addendum.' source 1