The hospice election addendum would become mandatory for every election
Today the addendum is furnished when a beneficiary or representative requests it. Under the FY 2027 proposed rule, it would accompany 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
- Audit how long your current on-request addendum process takes from election to delivery; that latency becomes your compliance gap if the mandate finalizes.
- 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 the admission packet workflow now, while it's optional, so the mandatory version is a non-event.