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Election of Hospice, Election Statement Addendum and Notice of Election

Explains how a Medicare or Medicaid patient elects hospice care with the Agency: the content of the election statement (42 CFR §418.24(b)); the mandatory election statement addendum titled "Patient Notification of Hospice Non-Covered Items, Services, and Drugs" for every election beginning on or after October 1, 2026, given within the first 5 days of the effective date and updated within 3 days of plan of care changes (§418.24(c)-(d)); filing the Notice of Election within 5 calendar days (§418.24(e)); benefit periods; and how the election relates to Florida admission consent.

Preview: full text with a package
About this policy
Policy number
FL-HSP-ELC-01
Version
1.0
Main rule
42 CFR §418.24
Library
Florida hospice · 60 policies
Category
Hospice care
Sections
20

In short

  • Complete the election statement (Form FL-HSP-ELC-01-A) with the patient’s chosen attending physician and an effective date no earlier than the signature.
  • Every election from October 1, 2026 needs the addendum (Form FL-HSP-ELC-01-B), in writing, within the first 5 days. Write "None" if nothing is unrelated.
  • When a plan of care change affects what we do not cover, update the addendum within 3 days and give the update in writing.
  • If the patient will not sign the addendum, write the reason on it.
  • Give the effective date to billing the same day. The Notice of Election is due within 5 calendar days.

What's inside

20 sections. The full text comes with the One-time Policy Pack.

Full text with a package
  • Terms of Reference
  • 1. Purpose
  • 2. Scope
  • 3. Definitions
  • 4. Policy Statement (42 CFR §418.24)
  • 5. Benefit Periods
  • 6. The Election Statement
  • 7. Completing the Election
  • 8. The Election Statement Addendum
  • 8.1 Giving and updating the addendum
  • 9. Notice of Election
  • 10. Waiver of Other Benefits and Re-election
  • 11. Patients Who Do Not Use Medicare or Medicaid
  • 12. Responsibilities
  • 13. Records and Compliance Monitoring
  • 14. Staff Training
  • 15. References
  • 16. Related Policies and Forms
  • 17. Approval
  • 18. Revision History

An inspector may ask

  • Show me this patient’s election statement. Does it name the attending physician, with the patient’s acknowledgment that this was their choice?
  • Show me the addendum. When was it given, compared with the effective date of the election?

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