HospiceWorks builds the Medicare Election Statement Addendum directly into the admission workflow—helping hospices identify the requirement, follow the deadline, furnish the document, and confirm completion.
Effective October 1, 2026, CMS made the Hospice Election Statement Addendum mandatory for every Medicare hospice election beginning on or after that date. Previously, hospices generally provided it only upon request.
For applicable Medicare hospice elections, the hospice must furnish the Patient Notification of Hospice Non-Covered Items, Services, and Drugs in writing to the beneficiary or representative.
CMS requires the initial addendum within 5 calendar days of the effective date of the hospice election. If a later Plan of Care change affects the addendum determinations, an updated addendum must be furnished within 3 calendar days of that qualifying Plan of Care change.
That creates an operational challenge that goes well beyond generating another PDF.
The hospice has to know the addendum is required, know when it is due, identify the appropriate coverage information, furnish it on time, maintain the completed document in the medical record, and recognize when a later change requires another addendum.
That is why HospiceWorks treats the Election Statement Addendum as a workflow—not simply a form.
What Changed With the Medicare Hospice Election Statement Addendum?
CMS now requires hospices to provide the written Election Statement Addendum for Medicare hospice elections beginning on or after October 1, 2026.
The addendum identifies conditions, items, services, and drugs the hospice has determined are unrelated to the beneficiary’s terminal illness and related conditions and therefore will not be covered under the Medicare hospice benefit.
CMS has made a valid signed addendum in the beneficiary’s medical record a condition for payment. While the addendum itself is not submitted with the routine Medicare claim, it must be filed with the hospice election statement and presented immediately during any medical review.
CMS is providing a transition period. From October 1 through December 31, 2026, hospices are still required to furnish the addendum, but CMS is exercising enforcement discretion. During this period, Medicare Administrative Contractors (MACs) will not deny claims solely because the addendum is missing or incomplete and will instead focus on education.
That gives hospices until December 31 to get the workflow right before the grace period ends.
For hospice organizations, the question is no longer simply:
“Do we have the form?”
The more important question is:
“Can our workflow make sure the requirement is identified, followed, furnished, and completed?”
Why Is the Hospice Election Statement Addendum an Admission Workflow?
The requirement begins with the Medicare hospice election.
In HospiceWorks, the Election Statement Addendum is integrated directly into the patient’s admission process. For an applicable Medicare election, HospiceWorks automatically places the Election Statement Addendum into the patient’s Tasks to Complete under the admission requirements.
The clinician does not have to depend on memory to create another compliance task.
The workflow begins with the admission:
Admission → Initial Nursing Assessment → Initial Physician Order / Initial POC → Election Statement Addendum
By completing the admission and Initial Physician Order / Initial POC first, the patient’s diagnoses, medications, DME, supplies, orders, and coverage information have already been established in the record.
The addendum can then use that existing structured information rather than asking the clinician to rebuild the same patient information inside another form.
How Does HospiceWorks Reduce Duplicate Hospice Election Statement Addendum Documentation?
HospiceWorks already maintains structured patient information for medications, DME, supplies, diagnoses, and coverage. The Election Statement Addendum uses that existing information as part of the workflow.
Instead of treating the addendum as an isolated document, HospiceWorks brings the relevant patient and coverage information forward for clinician review. For DME and supplies, existing coverage designations help drive what should be reviewed for inclusion on the addendum.
The goal is simple:
The clinician should be reviewing and confirming existing clinical information—not rebuilding the patient’s medication, DME, supply, and diagnosis record inside another form.
For items determined to be unrelated and not covered by the hospice, HospiceWorks requires a Clinical Explanation for Non-Coverage before the addendum can be finalized.
The hospice’s authorized clinical staff remain responsible for the clinical coverage determination. Technology supports the workflow; it does not replace clinical judgment.
What if There Are No Unrelated or Non-Covered Items?
Not every hospice patient will have an unrelated diagnosis, non-covered medication, DME item, supply, or service to list. The Addendum is still required for applicable Medicare hospice elections.
HospiceWorks supports this scenario without forcing the clinician to enter dummy text or create an artificial non-covered item simply to complete the workflow.
When the hospice determines there are no unrelated or non-covered items to report, the Addendum reflects that determination and continues through the required furnishing and signature workflow.
That matters because a compliant workflow should work just as well when there is nothing to list as it does when multiple non-covered items require explanation.
Key Rule: No unrelated items should not mean no Addendum. It should mean a clear record that none were identified.
How Does HospiceWorks Track the Hospice Election Statement Addendum 5-Day Deadline?
CMS requires the initial addendum to be furnished within 5 calendar days of the hospice election effective date.
Initial Addendum Timeline
- Election Effective Date: October 1, 2026
- Addendum Due: October 6, 2026
(Calculated from the effective date of the election—not from the date the office later processes or completes intake paperwork.)
That distinction is particularly critical around weekends and holidays because the requirement is based on calendar days.
HospiceWorks calculates and tracks the due date as part of the admission workflow. The outstanding requirement remains visible in Tasks to Complete, and HospiceWorks alerts the team when action remains required.
This changes the process from:
Someone remembers → someone checks the chart → someone calculates the deadline
To:
Requirement identified → task created → deadline tracked → completion followed
That is where compliance automation becomes valuable.
Why Should Date Furnished and Date Signed Be Tracked Separately?
This distinction matters.
Date Furnished represents when the beneficiary or representative actually received the addendum or update in writing. It is not necessarily the same date the document is signed.
The beneficiary may receive and sign the addendum at the same time, but those events can also occur on different dates. HospiceWorks tracks furnishing and signature status separately so the patient record can demonstrate when the hospice actually provided the required document.
That creates a clearer compliance timeline when the medical record is reviewed later by a MAC during an Additional Documentation Request (ADR).
How Is the Addendum Furnished and Signed?
CMS allows the Election Statement Addendum to be furnished in writing, on paper or electronically.
HospiceWorks currently supports a structured print-to-furnish and scanned upload workflow:
- Finalize the addendum using structured record data.
- Provide the document to the beneficiary or representative and log the Date Furnished.
- Obtain the physical signature.
- Upload the signed document directly into the patient’s chart.
- Update the signature status to complete the task.
Electronic Signatures Coming Soon
Electronic signatures will soon expand the HospiceWorks Election Statement Addendum workflow:
- Sign Electronically Now: Capture beneficiary or representative signatures at the bedside during the encounter.
- Send for Electronic Signature: Dispatch the finalized addendum via email for remote family signature.
- Completed Signature Workflow: Automatically return the signed document to the patient’s record and update the compliance status.
- Print / Paper Signature will remain available.
Regardless of the signing method, the objective is the same: the workflow must end with a completed, traceable document in the patient’s record.
What if the Beneficiary or Representative Refuses to Sign?
A beneficiary or representative may receive the Election Statement Addendum but decline to sign it. That does not mean the hospice should leave an unexplained, unsigned document in the record.
When the beneficiary or representative refuses to sign, the hospice must document on the addendum the reason it was not signed and maintain the document in the chart.
HospiceWorks supports this workflow by tracking furnishing and signature status, including a formal refusal to sign.
Audit Insight: A missing signature and a documented refusal are not the same record.
The medical record must demonstrate that the hospice furnished the required addendum, attempted to obtain acknowledgement, documented why the signature was not obtained, and retained the file. An unsigned addendum without documented justification creates severe payment risk during medical review.
What Happens When Coverage Changes After the Initial Addendum?
The Election Statement Addendum is not necessarily a one-time admission document.
When a qualifying Plan of Care change affects coverage determinations, CMS requires an updated written addendum within 3 calendar days of that Plan of Care change.
HospiceWorks monitors qualifying changes to coverage information during the episode of care:
- A new non-hospice-covered medication
- A new DME item or medical supply
- A change in medication coverage status
- A change in a diagnosis relationship
- A newly identified non-covered service
When a qualifying change occurs after an addendum has already been furnished, HospiceWorks creates:
Election Addendum Review Required and automatically begins tracking the new deadline.
Updated Addendum Timeline
- Qualifying Plan of Care Change: Friday, December 4, 2026
- Updated Addendum Due: Monday, December 7, 2026
(Calendar days do not pause for Saturday or Sunday.)
The previous addendum remains preserved. If an updated addendum is required, HospiceWorks creates a new version rather than overwriting the document that was previously furnished.
Why Does Version History Matter?
A patient’s coverage determinations can change multiple times during hospice care.
A medication may change coverage status. New DME may be ordered. A condition may stabilize or progress. An item may move to an alternate payer.
The original addendum should not silently change when the live patient record changes.
HospiceWorks preserves previous addendum versions and their associated audit history. That means the medical record can show the exact determination that existed when each version was furnished instead of reconstructing an old document from today’s live patient data. For compliance and ADR audits, historical integrity is non-negotiable.
What Happens if the Patient Dies, Revokes Hospice, or Is Discharged?
CMS provides an exception when the beneficiary dies, revokes hospice, or is discharged within the applicable 5-day or 3-day period before the required addendum or update is furnished.
In that situation, the hospice is not required to furnish the addendum or update, but the hospice must document the reason it was not completed.
If the beneficiary received the addendum but dies, revokes hospice, or is discharged before signing it, the hospice must document why the signature was not obtained.
HospiceWorks maintains that documentation in the chart so the agency can clearly explain why the normal completion workflow could not be finished.
How the Pieces Work Together
The value of the HospiceWorks Election Statement Addendum is not any single feature. It is how the pieces work together inside the clinical workflow:
- Medicare admission automatically triggers the requirement
- The Addendum becomes part of Tasks to Complete
- HospiceWorks calculates and tracks the required calendar-day deadline
- Existing clinical and coverage data automatically feeds the workflow
- The clinician reviews and confirms the coverage determination
- Date Furnished and signature status are tracked separately
- Qualifying coverage changes trigger an Election Addendum Review Required workflow
- Addendum completion and furnishing status provide operations and billing teams a verified compliance record for claim readiness
A PDF can document that something happened.
A workflow helps make sure it happens.
Flag It. Follow It. Confirm Completion.
Compliance requirements become risky when they depend entirely on human memory. Another static form alone does not solve that problem.
HospiceWorks approaches the Election Statement Addendum as an operational compliance workflow:
- Flag the requirement.
- Follow the deadline.
- Confirm completion.
And when qualifying coverage information changes later, HospiceWorks starts the appropriate review again.
That is what modern hospice software should do—not simply digitize paperwork, but connect the requirement to the clinical and operational workflow where it actually occurs.
HospiceWorks. Proactive. Intelligent. Survey-Ready.
See the Election Statement Addendum Workflow in Action
Is your hospice audit-ready before CMS enforcement discretion ends on December 31?
See how HospiceWorks automatically identifies the Election Statement Addendum requirement, tracks the 5-day deadline, uses existing clinical information, follows furnishing and signature status, and monitors qualifying coverage changes after admission.
Schedule a HospiceWorks Workflow Demonstration →
Frequently Asked Questions
Who must receive the Medicare Hospice Election Statement Addendum?
For Medicare hospice elections beginning October 1, 2026 or later, the hospice must furnish the written addendum to the beneficiary or beneficiary representative.
How quickly must the initial Election Statement Addendum be furnished?
The initial addendum must be furnished within 5 calendar days of the effective date of the Medicare hospice election. The clock begins with the election effective date, not the date the office later finishes the admission paperwork.
If the hospice election begins October 1, when is the Addendum due?
The addendum is due October 6, 2026.
When is an updated Election Statement Addendum required?
When a qualifying Plan of Care change affects the addendum determinations, an updated written addendum must be furnished within 3 calendar days of that Plan of Care change.
Does every Plan of Care change require another Addendum?
No. The change must affect the addendum determination regarding conditions, items, services, or drugs the hospice determines are unrelated and not covered.
What if the patient has no unrelated conditions or non-covered items?
The Election Statement Addendum is still required for applicable Medicare hospice elections even when the hospice has no unrelated conditions, medications, DME, supplies, services, or other non-covered items to report. HospiceWorks allows the clinician to document that no unrelated or non-covered items were identified without entering artificial items or placeholder text.
What if a new medication, DME item, or supply is added after the initial Addendum?
If the new item creates or changes a non-hospice-covered determination after the addendum has already been furnished, HospiceWorks triggers an Election Addendum Review Required workflow and tracks the applicable 3-calendar-day deadline.
Is Date Furnished the same as Date Signed?
No. Date Furnished represents when the beneficiary or representative received the written addendum. The signature may occur on the same date or later.
Can the Addendum be provided electronically?
Yes. CMS allows the addendum to be furnished in writing, on paper or electronically.
Does HospiceWorks support electronic signatures?
Electronic signatures are coming soon to the HospiceWorks Election Statement Addendum workflow. The update will add Sign Electronically Now for bedside capture and Send for Electronic Signature for remote signing. The completed signed document will return automatically to the patient’s chart. Print / Paper Signature will remain available.
What if the beneficiary or representative refuses to sign?
The hospice must document on the addendum the reason it was not signed and retain the applicable documentation in the patient’s medical record. HospiceWorks tracks the furnishing and signature status so the record can distinguish a documented refusal from an outstanding signature.
What if the patient dies, revokes hospice, or is discharged before the deadline?
If the patient dies, revokes hospice, or is discharged within the applicable timeframe before the addendum or update is furnished, the hospice must document the reason it was not completed and/or provided.
Must the Addendum be filed with the hospice election statement?
Yes. CMS requires the addendum and applicable updates to be filed with the election statement.
Is the Addendum submitted with the Medicare claim?
No. The addendum is maintained in the beneficiary’s medical record. CMS has established the valid signed addendum as a condition for payment.
Are claims being denied immediately for missing Addenda?
CMS is exercising enforcement discretion from October 1 through December 31, 2026. During that period, Medicare Administrative Contractors will not deny claims solely because the addendum is missing or incomplete and will focus on education. The underlying requirement still applies.
Does HospiceWorks make the clinical coverage determination?
No. HospiceWorks automates the workflow, uses existing structured clinical information, tracks deadlines, and supports documentation of the determination. The hospice’s authorized clinical staff remain responsible for the clinical decision.
About the Author
Ramon Sanchez | Founder & CEO, HospiceWorks
Ramon Sanchez has worked in senior healthcare since 2004 and has more than 22 years of experience as a hospice agency owner, operator, and healthcare software innovator.
Before founding HospiceWorks, Ramon founded Greene Health Care Inc., where he worked directly with hospice owners, administrators, clinicians, and operational leaders on Medicare compliance, medical-record risk, audits, revenue-cycle management, and clinical operations.
As Founder and CEO of HospiceWorks, Ramon is focused on building modern hospice technology that moves critical compliance requirements directly into the clinical workflow—helping hospice teams identify what needs attention earlier, reduce unnecessary documentation burden, and maintain more complete, survey-ready patient records.
Defend the record. Chart faster. Stay survey-ready.