Important Updates for Hospices: Adopting CMS Election and Election Addendum Models
As a hospice, it is crucial to stay informed about the latest changes and updates in the industry. In April 2024, CMS released updated models for the Hospice Election and the Election Addendum. These updates aim to address the challenges faced by the hospice industry in meeting the requirements of the election statement. Below, we will discuss the key details of these changes and provide guidance on how hospice agencies can ensure compliance and reduce the risk of denials.
The Change:
CMS has published an updated Election Statement, as well as the Election Addendum, also known as the "Patient Notification of Hospice Non-Covered Items, Services, and Drugs." The Election Statement model form can be found at www.cms.gov/files/document/model-example-hospice-election-statement-march-2024.pdf, while the Election Addendum model form is available at www.cms.gov/files/document/model-hospice-election-statement-addendum-march-2024.pdf.
Background:
The need for these updated models arose from audits conducted by the OIG (Office of Inspector General), which revealed that many hospice agencies struggled with the requirements of the election statement. As a result, CMS created a model form several years ago to assist agencies in meeting these requirements. However, despite the availability of the model, many agencies have not yet adopted it.
In 2021, CMS introduced additional requirements to the election form, including specific details about the Patient Notification of hospice Non-Covered Items, Services, and Drugs/QIO. The updated form also includes a statement emphasizing the importance of discussing potential cost-sharing with the patient and assuring them that "virtually all" services will be covered by the hospice agency.
Importance of Adoption:
Due to the continued spike in denials by CMS contractors based on the content of the election statement form, it is highly recommended that hospice agencies adopt the CMS model form(s) or ensure that the model is fully integrated into their consents. While hospice agencies have the option to create their own form, it must include every component included in the model statement to reduce the risk of denials.
Next Steps for your Hospice:
To ensure compliance and mitigate denials, hospices should take the following actions:
Assess your agency's current compliance with all of the election statement factors using the CMS model. Compare your existing election statement with the model form to identify any missing components.
Make immediate changes as necessary to ensure that your agency's current election statement includes all the components outlined in the CMS model. This step is crucial to align your agency's practices with the updated requirements.
Educate all staff members on the importance of election statement compliance. Emphasize the need to present the election statement fully, both in writing and verbally, to ensure that patients fully understand their rights and the services covered by the hospice agency.
Adopting the CMS Election and Election Addendum models is a proactive step that hospice directors can take to reduce the risk of technical denials. By aligning your agency's practices with the updated requirements, you can ensure compliance, protect patient rights, and provide high-quality care.