Finalized: the hospice election addendum is mandatory for every election on or after October 1, 2026
Update (6 Oct 2026): CMS finalized this proposal in the FY 2027 hospice final rule (CMS-1851-F, 91 FR 49118, August 3, 2026). For every hospice election on or after October 1, 2026, the hospice must give the beneficiary or representative the election statement addendum at the time of election (within the first 5 days of the election), not only on request, and must update it within 3 days of a plan-of-care change that affects it (42 CFR §418.24). The article below is corrected where it described the rule as still proposed.
Before October 1, 2026 the addendum was furnished only on request. Under the FY 2027 final rule, it now accompanies every hospice election, giving families up-front clarity on what the hospice will not cover — and, CMS argues, reducing surprise out-of-pocket costs at the most vulnerable point in care.
For operators, the burden is real and provider groups have said so: producing an accurate, patient-specific unrelatedness determination for every admission requires the interdisciplinary team to document relatedness decisions at election speed, not on-request speed. The addendum is also not boilerplate — it reflects clinical judgment about this patient's conditions, and a template that lists the same exclusions for everyone is exactly the pattern reviewers flag.
What to do now
- Check that every election since October 1, 2026 got its addendum within 5 days; any gap is a compliance gap now.
- Tighten your relatedness-determination documentation — the clinical rationale behind each exclusion is what survives review, and it feeds the same documentation chain the SSVI's non-hospice-spending metrics measure.
- Build the addendum into every admission packet now; it is required for all elections on or after October 1, 2026. Confirm every election since then has a signed, patient-specific addendum in the record.