In Fiscal Year 2020 (FY 2020), hospices will be mandated to provide an election statement addendum upon request from the Centers for Medicare & Medicaid Services (CMS).
With new election benefit requirements enacted as a condition of payment as soon as October 1, 2020, it is time for your organization to prepare for these changes.
The FY 2020 final rule includes a statement explaining CMS’s stance on items or services unrelated to terminal illness and related conditions:
“In the FY 2020 hospice proposed rule, we reiterated our long-standing position that services unrelated to the terminal illness and related conditions should be exceptional, unusual and rare, given the comprehensive nature of the services covered under the Medicare hospice benefit, as articulated upon the implementation of the benefit.”
Read the blog to learn what the new rule means for your organization’s reporting processes.
Existing hospice election requirement
Hospice is elected, in writing, by the beneficiary or representative when they have been told they or their loved one has an illness with a prognosis of six months or less and choose to wave traditional Medicare Part A in order to accept the Medicare hospice benefit. Per the Medicare Benefits Policy Manual Chapter 9, the election document must contain:
- Specific identification of the hospice that will provide care to the individual or representative acknowledgment that the individual fully understands the nature of hospice care, particularly the palliative, rather than curative, nature of treatment
- Individual or representative acknowledgment of understanding that certain Medicare services are waived by this election
- The effective date of the election (the first day of hospice care or a later date; no earlier than the date of the election statement; excludes designation of a retroactive date)
- Attending physician or nurse practitioner
- Individual’s acknowledgment that the designated attending physician was the individual’s or representative’s choice
- Signature of individual or representative
Understanding the new election language requirement
The FY 2020 proposed rule asks for the following additional new language in the election of benefit, effective October 1, 2020, or FY 2021:
- Information surrounding holistic, comprehensive nature of the Medicare hospice benefit
- A clause stating potential of necessary items, drugs or services that will not be covered by the hospice because the hospice has determined that these items are to treat an unrelated condition
- Information about beneficiary cost-sharing for hospice services
- Notification of beneficiary’s (or representative’s) right to request an election statement addendum including a written list and rationale for the conditions, items, drugs, or services that the hospice has determined to be unrelated to the terminal illness and related conditions and that immediate advocacy is available through the BFCC-QIO if the beneficiary (or representative) disagrees with the hospice’s determination
New election addendum requirement
Effective October 1, 2020, there is a requirement, in addition to the new language added, into the existing election of benefit document. An addendum needs to be added to the election process, titled “Patient Notification of Hospice Non-Covered Items, Services and Drugs.” This addendum must include:
- Name of the hospice
- Beneficiary’s name and hospice medical record identifier
- Identification of the beneficiary’s terminal illness and related conditions
- List of current diagnoses/conditions present upon admission (or upon plan of care update) and the associated items services and drugs NOT covered by the hospice
- Written clinical explanation, in language the beneficiary and his/her representative can understand, as to why the identified conditions are considered unrelated to the terminal illness
- References to any relevant clinical practice, policy, or coverage guidelines
- Information on the following domains: Purpose of addendum and right to immediate advocacy
- Name and signature of Medicare hospice beneficiary (or representative) and date signed, along with a statement that signing this addendum (or its updates) is only acknowledgement of receipt of the addendum (or its updates) and not necessarily the beneficiary’s agreement with the hospice’s determinations
Given that hospices would develop their own addendum, organizations may add additional language to inform beneficiaries that the addendum reflects the most accurate information and that updates would be provided, in writing, if there are any changes to include based on new information
Timeline for addendum completion
The election modifications apply to all hospice election documents. However, the addendum would only be furnished to beneficiaries, their representatives, non-hospice providers or Medicare contractors upon request.
- Admission: Upon request, hospices will have five days to furnish the written addendum. If the individual passes away within five days, the addendum will not be required.
- Post-admission: Upon request, hospices will have 72 hours from the date of request to furnish the addendum or updated addendum based on plan of care changes.
Preparing your organization
What does this mean for you and your agency between now and October 1, 2020? The answer will depend on your current processes around unrelated items and coordination with your electronic medical record system.
To be successful under the new requirements, it’s suggested agencies take the following steps:
- Update all election documents to include the new required language
- Create the addendum document with required language
- Update policies and procedures around relatedness
- Educate hospice physician and staff regarding the new requirement
- Develop a review and explanation process for each admission that includes a review of services, equipment, supplies and medications that will not be covered by the hospice due to unrelatedness and is available within five days of admission if requested
- Develop a review and explanation process for updates to services, equipment, supplies and medications that will not be covered by the hospice due to unrelatedness and is available within 72 hours post admission
Have additional questions about how your organization can prepare for the new CMS requirements? McBee’s hospice experts can assist with modifying your existing forms to bring them into compliance with the new regulatory requirements, as well as helping you develop a plan for implementation. Get in touch with us to learn more.