The hospice election statement is one of the most critical regulatory documents in hospice care. It represents the patient’s formal decision to elect the Medicare hospice benefit and defines the scope of services, coverage limitations, and patient rights.
Under the oversight of the Centers for Medicare & Medicaid Services, hospice agencies must ensure that every election statement complies with 42 CFR §418.24 and evolving CMS guidance. As of 2026, enforcement expectations have increased, particularly around documentation completeness, patient transparency, and alignment with updated CMS model forms.
Failure to comply with hospice election statement requirements remains a leading cause of claim denials and survey deficiencies.
What Is the Hospice Election Statement?
The hospice election statement is a legally required document that confirms a patient’s decision to receive hospice care instead of curative treatment for a terminal illness.
Under federal regulation, a hospice cannot bill Medicare unless a valid election statement is completed and retained in the patient’s record.
According to federal requirements, a patient (or representative) must sign the election statement upon admission, formally initiating hospice services.
Core Requirements Under Federal Regulations (§418.24)
The hospice election statement must include specific elements defined by CMS.
1. Patient’s Acknowledgment of Hospice Election
The document must clearly state that the patient:
This acknowledgment must be explicit and clearly documented.
2. Identification of the Attending Physician
The election statement must identify the patient’s chosen attending physician.
Missing or unclear physician designation is a common deficiency.
3. Effective Date of Hospice Election
The election statement must include the start of care date, which determines:
4. Scope of Hospice Services
Patients must be informed that hospice care includes:
5. Coverage Limitations and Cost-Sharing
The election statement must explain:
That hospice covers services related to the terminal illness
That some services unrelated to the terminal illness may not be covered
Potential cost-sharing responsibilities
CMS requires clear communication of these financial implications.
6. Patient Rights and Addendum Request
Patients must be informed of their right to request an election statement addendum, which provides details on:
Items, services, or medications not covered by hospice
Rationale for non-coverage
This requirement was introduced to improve transparency and remains a major compliance focus.
2024–2026 CMS Updates Impacting Compliance
Recent CMS updates have significantly strengthened election statement requirements and enforcement expectations.
1. Updated CMS Model Election Statement (2024)
CMS released updated model forms to improve clarity and compliance.
Key changes include:
Simplified language for patient understanding
Enhanced documentation of non-covered services
Improved signature and attestation requirements
Hospice agencies are not required to use the CMS model, but their forms must include all required elements.
2. Election Statement Addendum Requirements
The addendum must be provided:
Failure to provide timely addenda is a frequent survey deficiency.
3. Clarification of Election vs. Notice of Election (NOE)
CMS clarified that:
These are distinct documents with separate compliance requirements.
4. Increased Audit and Denial Activity
CMS data shows that documentation issues remain the primary reason for hospice claim denials, particularly:
Common Hospice Election Statement Deficiencies
Surveyors and auditors frequently cite the following issues:
1. Missing Required Elements
Election statements lacking required content (e.g., attending physician, coverage explanation) are considered non-compliant.
2. Incomplete or Generic Language
Statements that do not clearly explain:
Coverage limitations
Patient rights
Non-covered services
are often cited.
3. Missing or Improper Signatures
Deficiencies include:
Missing patient or representative signature
Missing date of signature
Unauthorized staff signatures
4. Failure to Provide Addendum
Hospices frequently fail to:
Provide addendum upon request
Document addendum delivery
Include rationale for non-covered services
5. Lack of Patient Understanding Documentation
Surveyors increasingly expect evidence that:
How to Ensure Compliance Before Survey
1. Adopt or Align With CMS Model Forms
Compare your current election statement with CMS model templates and ensure:
2. Conduct Election Statement Audits
Review all admission records to verify:
Complete documentation
Proper signatures
Timely completion
3. Train Admission and Clinical Staff
Staff must understand:
Training should include role-playing and competency validation.
4. Implement Addendum Tracking Systems
Ensure:
Addendum requests are tracked
Delivery timelines are met
Documentation is retained
5. Strengthen Documentation Practices
Ensure the medical record reflects:
6. Integrate Election Statement Into QAPI
Monitor compliance through:
How Surveyors Evaluate Election Statement Compliance
Surveyors assess:
Whether all required elements are present
Whether documentation is complete and timely
Whether patients were properly informed
Whether addendum requirements are met
They may also interview staff and patients to verify understanding.
Why Compliance Matters
Failure to meet hospice election statement requirements can result in:
Election statement compliance is both a clinical and financial priority.
Best Practices for 2026 Compliance
To ensure compliance in 2026 and beyond, hospice agencies should:
Use standardized, CMS-aligned election forms
Train staff on documentation and patient education
Conduct regular audits
Implement tracking systems for addenda
Ensure leadership oversight of compliance processes
Final Thoughts
The hospice election statement is no longer a simple admission form. It is a highly scrutinized compliance document that directly impacts reimbursement, patient rights, and regulatory standing.
With increased CMS oversight and evolving requirements, hospice agencies must prioritize election statement accuracy, completeness, and transparency.
Facilities that implement structured compliance systems will be better positioned to avoid deficiencies and succeed during surveys.
Work With Experts in Hospice Compliance
At HealthBridge, we help hospice agencies achieve full compliance with Medicare Conditions of Participation, including election statement requirements.
Our services include:
Election statement audits and correction
CMS model form implementation
Mock surveys and deficiency prevention
Staff training and documentation systems
Whether you are preparing for a survey or addressing denials, HealthBridge provides the expertise needed to ensure compliance.
URL Links
https://www.cms.gov
https://www.ecfr.gov
https://www.myhbconsulting.com
