NHPCO NewsLine Fall 2020 - 13

NL: Regarding the intention of the election statement,
it seems that CMS wants beneficiaries to clearly
understand the choice they are making. Is that the
idea behind the adjustments?
JLP: I think there are two things behind the
adjustments. Yes, I think beneficiaries having clarity
regarding their choice is absolutely one thing. CMS
thinks, as do we all, that choosing hospice and
waving your right to other Medicare benefits is a
significant choice. No matter how long we've been in
hospice, we should not take this decision lightly. The
second thing is that CMS really wants to make sure
- even in the election statement - that there will be
some language around things that the hospice will
not cover, like items, services, or drugs. That piece of
the Election Statement is sort of our first
opportunity in letting the patient know that they
may have some financial responsibility.
NL: The Addendum builds on that, correct?
JLP: Yes. As CMS describes in the final rule, the
Addendum is to inform the beneficiary (or
representative) upon request, of any items, services,
or drugs the hospice will not be providing because
the hospice has determined them to be unrelated to
the terminal illness and related conditions.
NL: Does a hospice have to give every patient an
Addendum?
JLP: They do not. The Addendum is voluntary. You
must talk about the Addendum with every patient,
but you do not have to provide the Addendum unless
it is requested.
NL: Is there a timeframe for providing an Addendum,
if requested?
JLP: Yes, if it is requested on the day that the
patient is admitted, then you have five days to pull
all the information together. You are going to be
including items and services that are not going to be
provided. Significant on the list will likely be drugs
that a patient is taking that the hospice is not going
to cover, it could be maintenance medications, it
could be the hospice is recommending

discontinuation of some drugs. All of those things
will be part of the Addendum, and the hospice will
need some time to pull that together, so they have
five days. If the patient or their representative
requests the Addendum after the day of admission,
the time frame shortens to 72 hours.
NL: Who can request the Addendum?
JLP: The patient or their representative can request
the Addendum, but it's also written in the rule that
someone else, like another health care provider who
wants or needs the information to make
determinations about health care services to the
patient, they may also request the Addendum - that
is covered under HIPAA.
NL: What happens if the patient dies within the five
days?
JLP: Then the Addendum is not required to be
supplied because the request will essentially be null
and void at that point.
NL: Must updates be made to the Addendum?
JLP: You must provide an updated Addendum
anytime there has been a change. Whenever you are
updating the plan of care, if you have a change to
anything that the hospice is now not going to be
covering, like a certain drug that is going to be
discontinued, that means that the Addendum must
be updated as well.
NL: Can the Addendum be handled electronically?
JLP: That's big news about this rule. In the proposed
rule, it was hinted that it might be possible to do
electronic signatures, which a lot of hospices have
been asking about for so long. NHPCO requested
further information and CMS provided additional
guidance, saying that an electronic signature is
allowed. The intent of the Addendum is that the
patient and their representative would be able to
get a paper copy. As long as you can provide a paper
copy, then you can sign electronically. You can have
that be a part of your medical record. I think this is a
wonderful step in the right direction.

Newsline / Fall 2020

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NHPCO NewsLine Fall 2020

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