Required Election Statement Elements (42 CFR 418.24(b))
Element
Requirement
Post Oct 1, 2020?
Hospice identification
Name of specific hospice elected
Always required
Attending physician choice
Beneficiary's choice of attending (MD, DO, NP, PA); acknowledgement it is beneficiary's choice
Always required
Palliative care acknowledgement
Understanding that hospice care is palliative in nature
Always required
Waiver of curative services
Waiver of Medicare-covered services for terminal illness and related conditions
Always required
Effective date
Date election takes effect - may not be earlier than signature date
Always required
Beneficiary signature
Signature of individual or authorized representative
Always required
Cost-sharing information
Required disclosure about applicable cost-sharing
Oct 1, 2020+ only
BFCC-QIO contact
Contact info and notice about immediate advocacy rights
Oct 1, 2020+ only
Effective Date Rule: The effective date may equal the signature date or be later. It may never be earlier than the date the statement is signed. Backdating the effective date creates a non-covered billing period.
Election Statement Addendum (Oct 1, 2020+)
If the hospice determines there are non-covered conditions, items, services, or drugs, any party may request a written addendum. 42 CFR 418.24(c)–(d)
Rule
Requirement
Mandatory title (exact)
"Patient Notification of Hospice Non-Covered Items, Services, and Drugs"
Content
Patient-friendly explanation of why each item is unrelated to terminal illness
If requested within first 5 days
Furnish addendum within 5 calendar days of request
If requested after first 5 days
Furnish addendum within 3 calendar days of request
Required acknowledgement
Recipient name, signature, date signed; date hospice furnished addendum
Notice of Election (NOE) Filing Rules
5-Calendar-Day Rule - Financial Consequence: The hospice must file the NOE with the MAC within 5 calendar days after the election effective date. MAC acceptance - not mere submission - must occur by Day 5. Late NOE without an accepted exception = provider-liable days. The hospice cannot bill the beneficiary.
Day
Required Action
Authority
Day 0 (election effective)
Election statement signed; begin NOE preparation
42 CFR 418.24(b)
Day 0–1 (target)
Submit NOE to MAC; confirm acceptance; document acceptance confirmation
42 CFR 418.24(e)
By Day 5 (deadline)
NOE must be accepted by MAC; if rejected and corrected, resubmission must be accepted by Day 5
42 CFR 418.24(e); Claims Manual Ch. 11
After Day 5 (late)
Document exception category; all days from election to acceptance are provider-liable unless exception accepted
Claims Manual Ch. 11 §20.1.1
Educational Use Only. Not legal advice. Verify against current primary sources.