{"ref":"OH-HSP-ELC-01","title":"Election of Hospice, Election Statement Addendum and Notice of Election","category":"Hospice care","summary":"Sets out how a patient elects hospice care under Medicare and Ohio Medicaid: the required content of the election statement, the election statement addendum that applies to elections on or after October 1, 2026, the Medicare notice of election, the Ohio Medicaid election steps and portal upload, benefit periods, the services waived by election, and re-election.","inShort":["The patient or representative signs the election statement before hospice care begins. The effective date is never before the signing date.","Record the attending physician the patient chose, and their acknowledgment that it was their choice.","For elections on or after October 1, 2026, give the non-covered items addendum within the first 5 days, and update it within 3 days of a related plan change.","Tell billing the same day so the notice of election is filed within 5 calendar days.","For Ohio Medicaid, give the grievance procedure and advance directive information, and upload the election statement to the ODM portal."],"primaryCitation":"42 CFR §418.24","citations":["OAC 5160-56-01(F), (N), (Q)","OAC 5160-56-02(B)-(C)","OAC 5160-56-02(G)-(K)","OAC 5160-56-03(C)-(D)","OAC 5160-56-03.3","OAC 3701-19-20(C)"],"federalCitations":["42 CFR §418.24","42 CFR §418.21","42 CFR §418.3","42 CFR §418.20","42 CFR §418.104(a)(2)","42 CFR §418.400"],"surveyorAsks":["Show me this patient's election statement. Where is the acknowledgment of the attending physician choice and of the palliative nature of hospice care?","For an election on or after October 1, 2026, show me the addendum, when it was furnished and how it is updated."],"forms":[{"ref":"OH-HSP-ELC-01-A","title":"Hospice Election Statement (Medicare and Ohio Medicaid)"},{"ref":"OH-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; OAC 5160-56-02(G)-(H))","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 (Medicare)","9. Ohio Medicaid Election Steps","10. Duration, Waiver and Re-election","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":"oh-hospice","state":"Ohio","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}}