{"ref":"CA-HSP-ELC-01","title":"Election of the Hospice Benefit, Election Statement Addendum and Notice of Election","category":"Hospice care","summary":"Sets out how a patient elects the hospice benefit with the Agency: who may counsel and complete the election, what the election statement must contain, the election statement addendum (\"Patient Notification of Hospice Non-Covered Items, Services, and Drugs\") that must be given in writing for every election beginning on or after October 1, 2026 and updated within 3 days of plan of care changes that affect it, and filing the Notice of Election within 5 calendar days.","inShort":["Only a nurse, LVN, medical social worker, chaplain or counselor employed by the Agency may complete the election.","The election date can never be earlier than the date the patient signs.","Give the \"Patient Notification of Hospice Non-Covered Items, Services, and Drugs\" in writing within the first 5 days of the election.","If a plan of care change affects that notice, update it within 3 days and give the patient the update.","Send the signed election to billing the same day so the Notice of Election is filed within 5 calendar days."],"primaryCitation":"42 CFR §418.24","citations":["Cal. Health & Safety Code §1746.50","22 CCR §74892(a)(16)","22 CCR §74868(g)"],"federalCitations":["42 CFR §418.24","42 CFR §418.21","42 CFR §418.20","42 CFR §418.3","42 CFR §418.104(a)(2)"],"surveyorAsks":["Who completed this patient's election, and were they employed by the hospice?","Show me the election statement. Does it identify the attending physician and the effective date, and include the BFCC-QIO information?"],"forms":[{"ref":"CA-HSP-ELC-01-A","title":"Hospice Election Statement"},{"ref":"CA-HSP-ELC-01-B","title":"Patient Notification of Hospice Non-Covered Items, Services, and Drugs"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.24; Health & Safety Code §1746.50(c))","5. Election Counseling","6. The Election Statement","7. The Election Statement Addendum","8. Notice of Election","9. Duration, Re-election and Other Payers","10. Responsibilities","11. Records and Compliance Monitoring","12. Staff Training","13. References","14. Related Policies and Forms","15. Approval","16. Revision History"],"version":"1.0","sample":false,"pack":"ca-hospice","state":"California","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}