{"ref":"NC-HSP-ELC-01","title":"Election of Hospice Care, Election Statement Addendum and Notice of Election","category":"Hospice care","summary":"Sets how a Medicare or NC Medicaid patient elects hospice care: who may sign, the required content of the election statement, the mandatory election statement addendum (\"Patient Notification of Hospice Non-Covered Items, Services, and Drugs\") for elections on or after October 1, 2026, the waiver of other benefits, benefit periods, the 5-day notice of election and the NC Medicaid six-day upload of the election statement.","inShort":["The patient signs the election statement. A representative signs only if the patient cannot, and only with legal authority.","Go through every part of Form NC-HSP-ELC-01-A. The effective date can never be before the signing date.","For elections from October 1, 2026, give the addendum (Form NC-HSP-ELC-01-B) within the first 5 days.","When the plan of care changes what is related or unrelated, update the addendum within 3 days.","Tell billing the election date the same day: Medicare notice within 5 calendar days, NC Medicaid upload within 6 calendar days.","Never sign for a patient and never pressure anyone to elect hospice."],"primaryCitation":"42 CFR §418.24","citations":["NC Medicaid Clinical Coverage Policy 3D, sections 5.2.2.1, 5.6, 5.7, 5.8, 5.10, 5.12.4","10A NCAC 13K .0102(14)","G.S. 131E-201(4)"],"federalCitations":["42 CFR §418.20","42 CFR §418.21","42 CFR §418.24(a)-(g)","42 CFR §418.3","42 CFR §418.104(a)(2)","42 CFR §418.52(c)(4)"],"surveyorAsks":["Show me this patient's election statement. Does it contain every element 42 CFR §418.24(b) requires?","For an election on or after October 1, 2026, show me the addendum and the date you furnished it."],"forms":[{"ref":"NC-HSP-ELC-01-A","title":"Hospice Election Statement"},{"ref":"NC-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. Who May Elect and Sign","6. Election Periods","7. Content of the Election Statement","7.1 Explaining the election","8. The Election Statement Addendum","8.1 Content of the addendum","8.2 Time frames and process","9. Waiver of Other Benefits","10. Notice of Election and NC Medicaid Filing","11. Filing in the Record","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":"nc-hospice","state":"North Carolina","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}}