{"ref":"GA-HSP-ELC-01","title":"Election of the Hospice Benefit, Election Statement Addendum and Notice of Election","category":"Hospice care","summary":"Sets out how a Medicare patient (or representative) elects the hospice benefit: the eight required parts of the election statement, the election statement addendum \"Patient Notification of Hospice Non-Covered Items, Services, and Drugs\" required for elections beginning on or after October 1, 2026, and its 5-day and 3-day time frames, the Notice of Election filed within 5 calendar days, election periods, the waiver of other Medicare benefits and re-election.","inShort":["Every Medicare patient signs a complete election statement (Form GA-HSP-ELC-01-A). The effective date is never before the signing date.","For elections from October 1, 2026, give the addendum \"Patient Notification of Hospice Non-Covered Items, Services, and Drugs\" within 5 days of the effective date.","If the plan of care changes what we cover, update the addendum and give it to the patient within 3 days.","Signing the addendum only shows it was received. If the patient will not sign, write the reason on it.","Tell billing the same day so the Notice of Election is filed within 5 calendar days."],"primaryCitation":"42 CFR §418.24","citations":["Ga. Comp. R. & Regs. 111-8-37-.14(2)(c)","Ga. Comp. R. & Regs. 111-8-37-.10(1)(a), (i), (o)"],"federalCitations":["42 CFR §418.24","42 CFR §418.21","42 CFR §418.20","42 CFR §418.3","42 CFR §418.104(a)(2)"],"surveyorAsks":["Show me this patient’s election statement. Where are the attending physician choice, the palliative care acknowledgment, the waiver, the effective date, the cost-sharing and the BFCC-QIO information?","This patient elected hospice after October 1, 2026. Show me the addendum, the date you gave it, and the signature or the reason it was not signed."],"forms":[{"ref":"GA-HSP-ELC-01-A","title":"Hospice Election Statement"},{"ref":"GA-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. Content of the Election Statement","6. Completing the Election","7. Election Statement Addendum (Elections on or After October 1, 2026)","7.1 Addendum Time Frames and Updates","8. Notice of Election","9. Election Periods, Waiver and Re-election","10. Georgia Medicaid and Other Payers","11. Responsibilities","12. Records and Compliance Monitoring","13. Staff Training","14. References","15. Related Policies and Forms","16. Approval","17. Revision History"],"version":"1.0","sample":false,"pack":"ga-hospice","state":"Georgia","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}}