CMS Pub. 100-02, ch. 9, § 20.2

20.2.1 - Hospice Election

(Rev: 13664; Issued: 03-05-26; Effective: 10-01-25; Implementation: 04-06-26)

Each hospice designs and prints its election statement. The election statement must

include the following items of information:

Identification of the particular hospice that will provide care to the individual;

The individual’s or representative’s (as applicable) acknowledgment that the individual

has been given a full understanding of hospice care, particularly the palliative rather than

curative nature of treatment;

The individual’s or representative’s (as applicable) acknowledgment that the individual

understands that certain Medicare services are waived by the election;

The effective date of the election, which may be the first day of hospice care or a later

date, but may be no earlier than the date of the election statement. An individual may not

designate an effective date that is retroactive;

The individual’s designated attending physician (if any). Information identifying the

attending physician recorded on the election statement should provide enough detail so

that it is clear which physician, Nurse Practitioner (NP), or Physician Assistant (PA) was

designated as the attending physician. This information should include, but is not limited

to, the attending physician’s full name, office address, NPI number, or any other detailed

information to clearly identify the attending physician.

The individual’s acknowledgment that the designated attending physician was the

individual’s or representative’s choice.

The signature of the individual or representative.

An election to receive hospice care will be considered to continue through the initial

election period and through the subsequent election periods without a break in care as

long as the individual:

(1) Remains in the care of a hospice;

(2) Does not revoke the election; and

(3) Is not discharged from the hospice.

For Medicare payment purposes, an election for Medicare hospice care must be made on

or after the date that the hospice provider is Medicare-certified. As with any election, the

hospice must fulfill all other admission requirements, such as certification or

recertification, any required face-to-face encounters, or Conditions of Participation (CoP)

assessments. See also Pub. 100-04, Medicare Claims Processing Manual, chapter 11,

section 20.1.1.

An individual may change, once in each election period, the designation of the particular

hospice from which he or she elects to receive hospice care. The change of the designated

hospice is not considered a revocation of the election, but is a transfer. To change the

designation of hospice programs, the individual must file, with the hospice from which he

or she has received care and with the newly designated hospice, a signed statement that

includes the following information:

• the name of the hospice from which the individual has received care,

• the name of the hospice from which they plan to receive care, and

• the date the change is to be effective. As described in Pub. 100-04, Medicare Claims

Processing Manual, chapter 11, section 20.1.3, when a hospice patient transfers to a new

hospice, the admitting hospice submits a transfer notice after the transfer has occurred,

and the beneficiary’s hospice benefit is not affected. The receiving hospice must

complete all assessments required by the hospice conditions of participation as described

in 42 CFR 418.54. Because the benefit period does not change in a transfer situation, if

the patient is in the third or later benefit period and transfers hospices, a face-to-face

encounter is not required if the receiving hospice can verify that the originating hospice

had the encounter. A change of ownership of a hospice is not considered a change in the

patient’s designation of a hospice and requires no action on the patient’s part.

Medicare beneficiaries enrolled in managed care plans may elect hospice benefits.

Federal regulations require that the Medicare contractor assigned the hospice specialty

workload maintain payment responsibility for hospice services and may pay for other

claims if that Medicare contractor is the geographically assigned Medicare contractor for

the managed care enrollees who elect hospice; for specifics, see regulations at 42 CFR

417, Subpart P, 417.585, Special Rules: Hospice Care (b), and 42 CFR 417.531 Hospice

Care Services (b). Institutional claims for services not related to the terminal illness

would otherwise be the responsibility of another geographically assigned Medicare

contractor.

Managed care enrollees who have elected hospice may revoke hospice election at any

time, but claims will continue to be paid by fee-for-service Medicare contractors as if the

beneficiary were a fee-for-service beneficiary until the first day of the month following

the month in which hospice was revoked. As specified above, by regulation, the duration

of payment responsibility by fee-for-service Medicare contractors extends through the

remainder of the month in which hospice is revoked by hospice beneficiaries.

See Pub. 100-04, Medicare Claims Processing Manual, Chapter 2, “Admission and

Registration” and Chapter 11, “Processing Hospice Claims,” for requirements for hospice

reporting to the Medicare contractor.