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Written notice listing items the hospice considers unrelated
The written notice, furnished only on request by the patient/representative, a non-hospice provider, or a Medicare contractor — within five days if requested in the first five days of election or three days if requested later — listing the items, services, or drugs the hospice considers unrelated to the terminal illness and therefore not covered under the per diem.
The hospice election statement addendum, titled "Patient Notification of Hospice Non-Covered Items, Services, and Drugs," is a written notice a hospice must furnish on request that lists the conditions, items, services, and drugs the hospice has determined are unrelated to the terminal illness and therefore not covered under the hospice benefit. It is required for hospice elections beginning on or after October 1, 2020 (42 CFR 418.24(c), https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-B/section-418.24).
For elections beginning on or after October 1, 2020, the hospice must notify the patient (or representative) of the right to request the addendum whenever there are conditions, items, services, or drugs the hospice has determined to be unrelated to the terminal illness and related conditions (42 CFR 418.24(c), https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-B/section-418.24; CMS MLN Matters MM12491, https://www.cms.gov/files/document/mm12491-manual-updates-clarification-election-statement-addendum-and-extension-hospice-cap.pdf). The addendum may be requested by the patient or representative, a non-hospice provider treating the patient, or a Medicare contractor. If it is requested within the first five days of the election, the hospice must furnish it in writing within five days of the request; if it is requested during the course of care after those first five days, the hospice must furnish it within three days (42 CFR 418.24(c), https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-B/section-418.24). The addendum must list the conditions present on admission (or upon a plan-of-care update) and the associated non-covered items, along with a written clinical explanation, in language the patient can understand, of why each is considered unrelated to the terminal illness and not needed for pain or symptom management. The patient's or representative's signature acknowledges only receipt of the addendum, not agreement with the hospice's determinations, and the addendum must be updated when the non-covered items change.
The addendum is a transparency and liability instrument, and how it is handled directly affects who pays for disputed items. Furnishing it late — outside the five-day or three-day windows — is a compliance failure that also weakens the hospice's position when a patient or a non-hospice provider challenges charges the hospice deemed unrelated. The opposite trap is over-designating items as "unrelated" to shed cost: for a terminally ill patient, CMS and its contractors start from the premise that most conditions are related to the terminal prognosis, so a broad unrelated list invites scrutiny and potential recoupment when related care was pushed onto Medicare Part D or the beneficiary. The addendum requirement means that the relatedness determination must carry documented clinical rationale from admission and be updated at each plan-of-care revision.
Only on request — the hospice must notify patients of the right to it, then furnish it within five days if requested in the first five days of election, or within three days if requested afterward (42 CFR 418.24(c), https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-B/section-418.24).
No; the signature confirms only that the patient or representative received the addendum, not that they agree with the hospice's determinations.
A list of the patient's conditions and the associated items, services, and drugs the hospice deems unrelated to the terminal illness, plus a plain-language clinical explanation of why each is unrelated and not needed for pain or symptom management.
Vitalis Care is the end-of-life care app that helps hospices deliver compassionate care — while staying on top of schedules, field operations, documentation, compliance, and reimbursement.
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