Election Statement & Notice of Election

42 CFR 418.24 · MBPM Ch. 9 §20.2.1 · Claims Manual Ch. 11 §20.1.1 · MLN MM12015 / MM12491

Hospice CoP Training

Educational Use Only

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.