Admissions and Eligibility

Election of Hospice

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
  • Medicare Benefit Policy Manual, Chapter 9,  §20.2.1

Requirements of the Election Statement

Each hospice designs and prints its election statement.  The election statement must include the following items of information.

  1. Identification of the particular hospice that will provide care to the individual;
  2. The individual’s or representative’s (as applicable) acknowledgement that the individual has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment;
  3. The individual’s or representative’s (as applicable) acknowledgement that the individual understands 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 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 or Nurse Practitioner (NP) 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;
  6. The individual’s acknowledgment that the designated attending physician was the individual’s or representative’s choice;
  7. The signature of the individual or representative.

Advance Beneficiary Notice of Non-Coverage (Link to ABN)

The Centers for Medicare and Medicaid (CMS) require a provider to notify Medicare beneficiaries when a service may not be covered under the Medicare program. The Advance Beneficiary Notice of Non-coverage (ABN) must be completed by the provider, or his/her representative, and signed by the patient, before a service is rendered.

The ABN advises the patient that the service they are about to receive may not be covered by Medicare. The form must include a description of the service, along with the estimated out-of-pocket cost and the reason why Medicare may potentially deny the service. The services itemized on the form must be clearly explained to the patient (or his/her representative).  Thus, the ABN allows the patient to make an informed decision regarding whether or not to receive the service. The patient is required to sign and date the form, and must be given a copy for their records. Providers are required to maintain the original ABN in the patient’s record.