{"ref":"DC-HSP-ELC-01","title":"Election of Hospice, Election Statement Addendum and Notice of Election","category":"Hospice care","summary":"Sets how a patient or representative elects hospice care with the Agency: what the election statement must contain, the effective date, the benefits the patient waives, the election statement addendum (\"Patient Notification of Hospice Non-Covered Items, Services, and Drugs\") that every patient electing on or after October 1, 2026 receives within the first 5 days and whenever it changes, election periods, the Notice of Election, re-election, and the DC Medicaid election rules.","inShort":["Hospice starts only after the patient or representative signs a complete election statement.","The effective date can never be earlier than the date the statement is signed.","For elections on or after October 1, 2026, give every patient the addendum listing what we will not cover, within the first 5 days.","When a plan of care change affects the addendum, give the patient an update within 3 days.","Give the signed election statement to billing the same day; the Notice of Election is due within 5 calendar days."],"primaryCitation":"42 CFR §418.24","citations":["29 DCMR §939.10","29 DCMR §939.11","29 DCMR §939.12","29 DCMR §939.13","29 DCMR §939.16","29 DCMR §939.17","29 DCMR §939.25","29 DCMR §940.7","D.C. Code §21-2210"],"federalCitations":["42 CFR §418.24","42 CFR §418.21","42 CFR §418.3","42 CFR §418.22(a)(3)"],"surveyorAsks":["Show me the election statement for this patient. Where does the patient acknowledge choosing the attending physician?","Show me the election statement addendum and the date you furnished it. Was it within the first 5 days of the effective date?"],"forms":[{"ref":"DC-HSP-ELC-01-A","title":"Hospice Election Statement"},{"ref":"DC-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(a))","5. Who Signs","6. What the Election Statement Contains","7. Effective Date and Waived Benefits","8. The Election Statement Addendum","8.1 Deciding What Is Unrelated","8.2 Content of the Addendum","8.3 Timing, Signature and Filing","8.4 Updating the Addendum","9. Election Periods and Continuation","10. Notice of Election","11. Re-election","12. Responsibilities","13. Records and Compliance Monitoring","14. Staff Training","15. References","16. Related Policies and Forms","17. Approval","18. Revision History"],"version":"1.0","sample":false,"pack":"dc-hospice","state":"Washington, DC","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}}