{"ref":"FL-HSP-ELC-01","title":"Election of Hospice, Election Statement Addendum and Notice of Election","category":"Hospice care","summary":"Explains how a Medicare or Medicaid patient elects hospice care with the Agency: the content of the election statement (42 CFR §418.24(b)); the mandatory election statement addendum titled \"Patient Notification of Hospice Non-Covered Items, Services, and Drugs\" for every election beginning on or after October 1, 2026, given within the first 5 days of the effective date and updated within 3 days of plan of care changes (§418.24(c)-(d)); filing the Notice of Election within 5 calendar days (§418.24(e)); benefit periods; and how the election relates to Florida admission consent.","inShort":["Complete the election statement (Form FL-HSP-ELC-01-A) with the patient’s chosen attending physician and an effective date no earlier than the signature.","Every election from October 1, 2026 needs the addendum (Form FL-HSP-ELC-01-B), in writing, within the first 5 days. Write \"None\" if nothing is unrelated.","When a plan of care change affects what we do not cover, update the addendum within 3 days and give the update in writing.","If the patient will not sign the addendum, write the reason on it.","Give the effective date to billing the same day. The Notice of Election is due within 5 calendar days."],"primaryCitation":"42 CFR §418.24","citations":["s. 400.6095(2), F.S.","Rule 59G-4.140, F.A.C.","s. 400.611(2), F.S."],"federalCitations":["42 CFR §418.24","42 CFR §418.21","42 CFR §418.20","42 CFR §418.104(a)(2)","42 CFR §418.3"],"surveyorAsks":["Show me this patient’s election statement. Does it name the attending physician, with the patient’s acknowledgment that this was their choice?","Show me the addendum. When was it given, compared with the effective date of the election?"],"forms":[{"ref":"FL-HSP-ELC-01-A","title":"Hospice Election Statement"},{"ref":"FL-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)","5. Benefit Periods","6. The Election Statement","7. Completing the Election","8. The Election Statement Addendum","8.1 Giving and updating the addendum","9. Notice of Election","10. Waiver of Other Benefits and Re-election","11. Patients Who Do Not Use Medicare or Medicaid","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":"fl-hospice","state":"Florida","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}}