{"ref":"MO-HSP-ELC-01","title":"Election of Hospice, 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 elect, the content of the election statement under Medicare (42 CFR §418.24(b)) and MO HealthNet (13 CSR 70-50.010(3)(B)), the effective date, the election statement addendum that every Medicare patient must receive for elections on or after October 1, 2026 and its update within three days of a plan of care change, the notice of election filed within five calendar days, election periods, the waiver of other benefits, and re-election.","inShort":["The election statement must name our hospice and the attending physician the patient chose, and the patient must say the choice of doctor was theirs.","The effective date can never be earlier than the date the patient or representative signs. Never backdate.","If a representative signs, get a witness signature too.","Give every Medicare patient electing on or after October 1, 2026 the addendum listing what we will not cover, within five days of the effective date, and update it within three days when the plan of care changes it.","Bring the signed election to the office the same day so billing can file the notice of election on time."],"primaryCitation":"42 CFR §418.24","citations":["13 CSR 70-50.010(3)(B)","13 CSR 70-50.010(2)","19 CSR 30-35.010(1)(C)","19 CSR 30-35.010(1)(A)1, 19","19 CSR 30-35.010(2)(K)5"],"federalCitations":["42 CFR §418.24","42 CFR §418.21","42 CFR §418.3","42 CFR §418.20","42 CFR §418.400","42 CFR §418.402","42 CFR §418.104(a)(2)"],"surveyorAsks":["Show me this patient's election statement. Does it identify your hospice and the attending physician, and is the effective date no earlier than the date it was signed?","For this election on or after October 1, 2026, where is the addendum, when was it given, and was it filed with the election statement?"],"forms":[{"ref":"MO-HSP-ELC-01-A","title":"Hospice Election Statement"},{"ref":"MO-HSP-ELC-01-B","title":"Election Statement Addendum: Conditions, Items, Services and Drugs Not Covered"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.24; 13 CSR 70-50.010(3)(B))","5. Who May Elect","6. Content of the Election Statement","7. Completing the Election","8. Election Statement Addendum (Elections on or After October 1, 2026)","8.1 Content of the addendum","8.2 Time frames and updates","9. Notice of Election (Medicare)","10. Election Periods, Waiver and Re-election","11. MO HealthNet and Other Payers","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":"mo-hospice","state":"Missouri","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}}