An individual who meets the eligibility requirements in §418.20 may file an election statement with a particular hospice. If the individual is physically or mentally incapacitated, his or her representative may file the election statement.   For the duration of an election of hospice care, an individual waives all rights to traditional Medicare part A payments for treatment related to the terminal illness.

Regulation:  §418.24 - Election of hospice care.

Requirements of the election statement

The election statement must include the following:

1. Identification of the particular hospice that will provide care to the individual.
2. The individual's or representative's acknowledgement that he or she has been given a full understanding of the palliative rather than curative nature of hospice care, as it relates to the individual's terminal illness.
3. Acknowledgement that certain Medicare services are waived by the election.
4. 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.
5. The signature of the individual or representative.

Resources:

• CGS
  • Hospice Election Requirements
  • Sample Hospice Election Form

• NGS
  • Notice of Election