New Rules Reshape Hospice Election Process
By: Susan Mills, RN, Senior Program Director
Susan Mills worked more than three decades as a registered nurse serving home health and hospice organizations. In her current role at ACHC, she guides Hospice, Home Health, and Home Infusion Therapy Accreditation. She also manages ACHC staff who oversee Assisted Living, Behavioral Health, Home Care, Palliative Care, and Renal Dialysis Accreditation.
Posted: September 3, 2026
Hospice admission rules are significantly changing this fall as the Hospice Election Statement Addendum becomes mandatory for all Medicare patients requesting care.
This marks a pivotal shift from current rules that require hospices to provide the addendum only if requested by a patient or their representative. The new requirement is part of the broader Fiscal Year 2027 Hospice Final Rule issued by the Centers for Medicare & Medicaid Services (CMS).
Beginning on or after October 1, 2026, Medicare-certified hospices or agencies seeking certification must provide the addendum upon a patient’s election of hospice care. The document details the items, services, medications, and conditions the hospice determines are not related to the patient’s terminal illness and, as a result, are not covered by Medicare.
Addendum timeline
Hospices must provide the addendum, in writing, to every Medicare patient or their representative at the time of care election. CMS defines this time frame as within the first five days of the effective date of the hospice election. The addendum must be filed with the election statement.
Hospices are also required to provide the addendum to requesting Medicare contractors or non-hospice providers who furnish services to a patient.
If a change to the patient’s plan of care affects the hospice’s determination of related or unrelated status, the hospice must update the addendum within three days of the change, provide a written copy to the patient or their representative, and maintain the updated addendum on file.
Key items to include
In addition to basic patient information, the addendum and any updates must contain certain elements, including:
- A list of the patient’s conditions present at hospice admission or identified through a plan-of-care update that the hospice has determined are unrelated to the terminal illness and related conditions.
- The associated items, services, and drugs that will not be covered by the hospice because they have been determined to be unrelated.
- A written clinical explanation for each determination, stated in language the patient or their representative can understand.
- The name and signature of the patient or their representative and the date signed.
Responsibility for determinations
The determination of whether a condition, item, service, or drug is related or unrelated to the terminal illness and related conditions must be individualized, clinically supported, and documented by the hospice.
The hospice medical director or physician designee is responsible for the medical component of the hospice’s patient care program and considers both related and unrelated conditions when reviewing the patient’s eligibility and medical management.
When everything is covered
The addendum must still be addressed even if your hospice determines that all items, services, and drugs are related to a patient’s terminal illness and conditions, and are covered by Medicare. The addendum should clearly document that your hospice completed an individualized review and determined that all identified care is related and covered.
Death, revocation, or discharge
If a patient dies, revokes the hospice benefit, or is discharged within the required five-day or three-day time frame and before the hospice provides the addendum or an update, the hospice is not required to furnish the addendum to the patient or their representative.
However, the hospice must document why the addendum or update was not completed or provided. That documentation must become part of the patient’s medical record.
Discharge process changes
CMS hospice discharge requirements are also changing October 1, 2026. The Final Rule expands who may provide the written physician discharge order required before a patient is discharged from hospice care. The order may be obtained from the hospice medical director (or physician designee, as defined at § 418.3) or a physician member of the interdisciplinary group.
Resource available
Get expert insights to help your agency comply with updated Medicare Hospice Election Statement Addendum requirements.
An ACHC resource, Understanding the Medicare Hospice Election Statement Addendum, takes you step-by-step through the process. Look for it under the “Resources” section on your customer portal or request it from your ACHC Account Advisor.
(Healthcare information is ever evolving. Ensure you have the most up-to-date version of this resource by asking your account advisor.)
--
Discover more articles about Hospice Accreditation.