{"ref":"PA-HSP-ELC-01","title":"Election of Hospice, Election Statement Addendum and Notice of Election","category":"Hospice care","summary":"Explains who may elect hospice, what the election statement must contain, how the effective date is set, how and when the Agency gives the election statement addendum \"Patient Notification of Hospice Non-Covered Items, Services, and Drugs\" for elections beginning on or after October 1, 2026, how the addendum is updated, how the Notice of Election is filed, and the additional Pennsylvania Medical Assistance election statement and County Assistance Office notice.","inShort":["Explain every part of the election statement out loud before the patient or representative signs. The effective date can never be before the signature date.","The patient chooses the attending physician. Write the name exactly and get the acknowledgment.","For elections from October 1, 2026, give the \"Patient Notification of Hospice Non-Covered Items, Services, and Drugs\" within 5 days of the effective date. Update it within 3 days if the plan of care changes what is covered.","Signing the addendum only shows receipt. If the patient will not sign, write the reason on the addendum.","Tell the office the same day so the Notice of Election (5 calendar days) and, for Medical Assistance, the County Assistance Office notice (7 calendar days) go in on time."],"primaryCitation":"42 CFR §418.24","citations":["55 Pa. Code §1130.41","55 Pa. Code §1130.21(4)","55 Pa. Code §1130.52(c)","20 Pa.C.S. §5422"],"federalCitations":["42 CFR §418.24","42 CFR §418.21","42 CFR §418.3","42 CFR §418.104(a)(2)","42 CFR §418.400"],"surveyorAsks":["Show me the election statement for this patient. Does it contain every element 42 CFR §418.24(b) requires?","This election began on or after October 1, 2026. Where is the addendum, when was it furnished, and was it signed or the reason documented?"],"forms":[{"ref":"PA-HSP-ELC-01-A","title":"Hospice Election Statement"},{"ref":"PA-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","6. Contents of the Election Statement","7. Completing the Election","8. What the Election Waives","9. The Election Statement Addendum (Elections on or After October 1, 2026)","9.1 Contents","9.2 Who decides what is unrelated","9.3 When it is given","9.4 Updates","9.5 If the patient dies, revokes or is discharged first","10. Notice of Election","11. Duration of the Election and Re-Election","12. Pennsylvania Medical Assistance Elections","13. Responsibilities","14. Records and Compliance Monitoring","15. Staff Training","16. References","17. Related Policies and Forms","18. Approval","19. Revision History"],"version":"1.0","sample":false,"pack":"pa-hospice","state":"Pennsylvania","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}}