CMS Makes Hospice Election Statement Addendum Mandatory: Key Requirements and Enforcement Period

The Centers for Medicare & Medicaid Services (CMS) announced that, starting on October 1, 2026, hospices must provide a written hospice election statement addendum to each Medicare beneficiary, or their representative, for every new hospice election made by or on behalf of such beneficiary. Previously, hospices had to provide the addendum only upon request. CMS finalized this change in its August 2026 final rule, now codified in the hospice conditions of participation at 42 CFR § 418.24.

Under the final rule, the addendum must be provided at the time of the hospice election (i.e., within the first five days of the effective date of a hospice election). If there are changes to the plan of care that impact any particular addendum, updates to the affected addendum must be provided in writing within three days of those changes. Hospices must also make the addendum available to nonhospice providers and Medicare contractors as part of their general documentation file for a beneficiary, along with the election statement and other required documentation.

A critical policy reason behind the addendum is to ensure that beneficiaries are aware of the items and services prescribed as part of their plan of care but not covered by their Medicare hospice benefit, as those are items and services that may be separately payable by other aspects of the Medicare program, other payers, or the beneficiary themselves. To support that goal, under the final rule, the addendum must include the following key components:

• The title “Patient Notification of Hospice Non-Covered Items, Services, and Drugs”
• The name of the hospice
• The individual’s name and hospice medical record identifier
• Identification of the individual’s terminal illness and related conditions
• A list of the individual’s conditions present on hospice admission (or plan of care update) and the associated items, services, and drugs not covered by the hospice
• A written clinical explanation on why identified conditions, items, services, and drugs are considered unrelated to the individual’s terminal illness and related conditions and not needed for pain or symptom management
• References to any relevant clinical practice, policy, or coverage guidelines
• The purpose of the addendum and the rights of the individual to seek immediate advocacy through the Medicare Beneficiary and Family Centered Care-Quality Improvement Organization if the individual (or representative) disagrees with the hospice’s determination
• The name and signature of the individual (or representative) and date signed as an acknowledgment of receipt of the addendum
• The date the hospice furnished the addendum

To support and allow time for implementation of the new documentation requirement, CMS is allowing a three-month period of enforcement discretion, from October 1 through December 31, 2026. During this period, Medicare Administrative Contractors (MACs) who identify gaps in a hospice’s addendum documentation will emphasize provider education instead of recoupment or other penalties. While MACs will not deny claims solely because an addendum is missing or incomplete, CMS expects hospices to provide addenda throughout this transition period.

In support of making the addendum mandatory, CMS cited rising nonhospice spending. Medicare spending on nonhospice services under Parts A and B increased from nearly $790 million in fiscal year 2020 to more than $2 billion in fiscal year 2024, a 160% increase.¹ According to CMS, this growth suggests that providing the addendum only upon request did not adequately address coverage transparency concerns or reduce inappropriate billing outside the hospice benefit.² The mandatory addendum is intended to strengthen accountability and help ensure that hospices provide virtually all care required under Medicare’s comprehensive hospice benefit. CMS estimates that the requirement will generate $20.8 million in annualized cost savings to providers, beginning in fiscal year 2027.³

Meanwhile, the nationwide moratorium on new Medicare enrollments for home health agencies and hospices remains in effect. It began on May 13, 2026, and is scheduled to expire on November 13, 2026, unless CMS extends it.

***

The Goodwin Healthcare team will continue to monitor activity from CMS. For more information on the issues discussed in this alert, please contact the authors, Goodwin’s Healthcare Regulatory and Compliance group, or the Goodwin lawyer whom you typically consult.

Explore more coverage of emerging topics of interest to the healthcare industry on our Health Headlines page.