Hospice election addendum: mandatory since October 1; CMS enforcement discretion on missing or incomplete addenda ends December 31
Published November 8, 2026 · Coverage November 1–7, 2026, Pacific · High priority
In the FY 2027 Hospice Prospective Payment System final rule, CMS made the hospice election statement addendum mandatory for every election on or after October 1, 2026: it must be furnished in writing (paper or electronic) within 5 calendar days of the effective date of the election, any update must be furnished within 3 calendar days of a plan-of-care change, and the condition for payment is met when a valid signed addendum is in the beneficiary's medical record with the hospice. From October 1 to December 31, 2026, CMS is exercising enforcement discretion, under which Medicare Administrative Contractors (MACs) will not deny claims solely because the addendum is missing or incomplete; furnishing the addendum remains required.
Current status
CMS's October 1, 2026 Medicare Learning Network (MLN) Connects newsletter item on the addendum was read again on November 10, 2026 and was unchanged, and the November 5 MLN Connects newsletter carries no change. The FY 2027 hospice final rule text and 42 CFR 418.24(c) were not read again for this edition.
Who this affects
Medicare-certified hospices, including hospice programs operated by hospitals and health systems.
Why it matters
A hospice election without a valid signed addendum in the hospice medical record does not meet the condition for payment. Inference: after December 31 the newsletter's statement that MACs will not deny claims solely for a missing or incomplete addendum no longer applies; the newsletter does not describe post-December claim handling.
Required actions
- Furnish the addendum in writing (paper or electronic) to every electing beneficiary or representative, with the content required by 42 CFR 418.24(c), within 5 calendar days of the election effective date (elections on and after 2026-10-01).
- Furnish any addendum update within 3 calendar days of the plan-of-care change.
- Keep a valid signed addendum in the beneficiary's hospice medical record (condition for payment).
Recommended action
- Audit October and November elections and correct omissions (Clinical Operations, by 2026-11-20).
- Add a pre-billing addendum check before the enforcement-discretion window ends (Revenue Cycle, by 2026-12-15).
Implementation playbook
- Audit every election since October 1 for an addendum furnished within five calendar days, a valid signature and three-day updates; correct omissions. Owner: Clinical Operations. Due: 2026-11-20 (recommended internal target).
- Fix intake and plan-of-care workflow gaps found (electronic health record prompts, tracking report of addendum delivery dates). Owner: Clinical Operations with IT. Due: 2026-12-04 (recommended internal target).
- Add a pre-billing check that a valid signed addendum is in the hospice record for each election. Owner: Revenue Cycle. Due: 2026-12-15 (recommended internal target).
- Confirm readiness before enforcement discretion ends. Owner: Compliance. Due: 2026-12-31 (the end of enforcement discretion).
- Review January claim outcomes and MAC education contacts. Owner: Revenue Cycle. Due: 2027-01-31 (recommended internal target).
Scope and timing
- Authority status
- Effective
- Responsible owner
- Clinical Operations (affected: Compliance, Revenue Cycle, IT)
- Publication date
- 2026-10-01 (MLN Connects)
- Effective date
- 2026-10-01 (elections on and after)
- Compliance date
- Addendum within 5 calendar days of the election effective date; updates within 3 calendar days of a plan-of-care change (rolling)
- Other dates
- Enforcement-discretion window 2026-10-01 to 2026-12-31
Not established
The FY 2027 hospice final rule text and 42 CFR 418.24(c) were not read again for this edition; the newsletter is the source. Post-December 31 claim handling is not stated by CMS.
Earlier article: October 11, 2026 edition →
Sources
Complete edition and supplemental material
This article in the complete report →
Executive triage, source-coverage limitations, context and forward horizons remain in the complete report.
Read the entire Medicare & Medicaid Sweep report →