Election of Hospice Care, Election Statement Addendum and Notice of Election
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.
About this policy
- Policy number
- NC-HSP-ELC-01
- Version
- 1.0
- Main rule
- 42 CFR §418.24
- Library
- North Carolina hospice · 60 policies
- Category
- Hospice care
- Sections
- 22
In short
- 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.
What's inside
22 sections. The full text comes with the One-time Policy Pack.
- 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
An inspector may ask
- 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.
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