Starting October 1, 2026, You May Have to Hand the Addendum to Every Patient. Here's How to Get Ready Now.

In the same FY2027 Hospice Wage Index proposed rule (CMS-1851-P) that introduced the new SSVI oversight score, CMS proposed a quieter but operationally significant change: the Election Statement Addendum — the form that spells out what your hospice will not cover — would become mandatory for every Medicare beneficiary at the time of election, for elections beginning on or after October 1, 2026. Today it is furnished only on request. If finalized, it becomes a required part of every single admission.

This sounds like paperwork. It is not just paperwork. The addendum is, in effect, a written relatedness statement — and in an enforcement environment where relatedness and non-hospice spending are exactly what CMS analytics are hunting, making it mandatory turns a rarely-used form into a document that auditors will expect to find, signed and correct, in every chart. Here is what is changing, why, and what to build before the deadline.

What the Addendum Actually Is

The Election Statement Addendum — formally the "Patient Notification of Hospice Non-Covered Items, Services, and Drugs" — has existed since the FY2020 final rule. It is a written notice that lists the conditions, items, services, and drugs the hospice has determined to be unrelated to the patient's terminal illness and related conditions, and therefore not covered under the Medicare hospice benefit.

In plain terms: it is the document where your hospice tells the patient, on the record, "we are responsible for X, but we are not covering Y and Z because we have determined they are unrelated to your terminal prognosis — so those will continue to bill to regular Medicare." It is the patient-facing artifact of your relatedness determination.

What's Changing

Under the current rules, the addendum is furnished only upon request:

• If the beneficiary (or representative, or a non-hospice provider, or a Medicare contractor) requests it at the time of election, the hospice must furnish it within 5 days.
• If it is requested during the course of care, the hospice must furnish it within 72 hours.
• If no one asks, the hospice never has to produce one.

The FY2027 proposal flips that default. For elections on or after October 1, 2026, the addendum would be mandatory for all Medicare beneficiaries at the time of election — the "upon request" trigger goes away for new elections. Every admission gets one, full stop. (The exact furnishing timeline and signature mechanics for the mandatory version are spelled out in the rule text and may be refined in the final rule — this is still a proposal.)

Why CMS Is Doing This

CMS's stated reason is that it has observed sustained growth in non-hospice spending on hospice-enrolled patients, and it believes mandatory disclosure will improve beneficiaries' understanding of what the hospice benefit does and does not cover. Read alongside the rest of the rule, the motive is clearer than that:

• The SSVI measures non-hospice spending and utilization outliers and scores every hospice on it.
• The mandatory addendum forces a written, patient-acknowledged relatedness determination at every election — which is the upstream decision that generates (or prevents) non-hospice spending in the first place.

Together they are two halves of one idea: make hospices document the relatedness call on every patient, and score them on how that call plays out in the claims data. The addendum is the paperwork; the SSVI is the scoreboard.

The Operational Lift

Going from "almost never produced" to "every admission" is a real workflow change. The pieces to plan for:

1. A relatedness determination on every admission. You cannot fill out the addendum without first deciding which of the patient's conditions, drugs, and services are unrelated to the terminal prognosis. That clinical judgment — ideally made by the IDG and physician, not a clerk — now has to happen, and be documented, for everyone.
2. A standard, accurate form. The addendum must identify the hospice, the patient, the election date, and the specific non-covered items/services/drugs with the determination behind them. Generic boilerplate that lists nothing specific is worse than useless — it signals you did not actually do the determination.
3. Acknowledgment and signature. The addendum is furnished to the patient or representative, who signs to acknowledge receipt (a refusal-to-sign pathway exists). That signature, and the date, have to be captured and retained in the record.
4. A timing-compliant process at intake. If the requirement attaches at the time of election, your admission workflow has to produce and deliver the addendum inside the regulatory window, every time, without relying on someone remembering to ask.

How a Form Becomes a Compliance Trap

Here is the part operators underestimate. A mandatory addendum is a relatedness statement you sign your name to on every patient — and once it exists in every chart, it becomes a document auditors cross-check against your claims.

• If your addendum says a condition is "unrelated" but your certification, plan of care, and IDG notes treat it as part of the terminal picture, you have created an internal contradiction in writing.
• If non-hospice Part B/Part D spending shows up for items you never listed as unrelated, that is a gap between what you told the patient and what actually got billed — the exact kind of discrepancy that drives a high SSVI score and invites a closer look.
• A missing or unsigned addendum on a post-October-2026 election becomes a clean, binary compliance finding on survey — either it is in the chart or it is not.

In other words, the mandatory addendum raises the floor: done well, it documents and defends your relatedness calls. Done poorly — boilerplate, missing signatures, contradictions with the rest of the record — it manufactures evidence against you.

It's Proposed, Not Final — and Comments Close June 1

As with the SSVI, this is a proposal. CMS will weigh public comments — due June 1, 2026 — before issuing the final rule (historically in late summer), which is when the October 1, 2026 effective date would lock in. If the mandatory-at-election mechanics create a genuine workflow problem for your patient population, the comment period is the time to put it on the record. But the safe planning assumption is that some version of this requirement takes effect October 1, 2026, and that the lead time to build the workflow is short.

What Operators Should Do Now

1. Inventory your current addendum process. Most hospices have a template they almost never use. Pull it, confirm it matches current CMS content requirements, and find out who on staff actually knows how to complete it.
2. Build the relatedness determination into intake. The form is downstream of the clinical decision. Make the IDG/physician relatedness determination a required, documented step in every admission so the addendum writes itself from a real decision.
3. Make the EMR generate it. The cleanest way to guarantee an accurate, signed addendum on every election is to have your EMR produce it from the admission record and capture the signature — not to rely on a manual paper step. This is exactly the kind of workflow Hospice Engine is built to standardize.
4. Reconcile addendum content against billing. Periodically check that the items you list as unrelated line up with what is actually billing outside your per-diem. Mismatches are SSVI fuel.
5. Comment by June 1 if it affects you. Especially if you serve populations where the relatedness determination is genuinely complex at intake.

Further Reading

• CMS Built a New Score That Flags Your Hospice for Oversight: Meet the SSVI
• Got a Qlarant "Notice of Suspension"? The 15-Business-Day Rebuttal Playbook
• The Live Discharge Rate Trap: How to Check Yours Before You're Next
• CMS Froze New Hospice Enrollments Nationwide — What the 6-Month Moratorium Means
• Meet Hospice Engine: The EMR and Billing Team Built Only for Hospice
• CMS Fact Sheet — FY2027 Hospice Wage Index Proposed Rule (CMS-1851-P)
• Federal Register — FY2027 Hospice Proposed Rule (comment by June 1, 2026)

The Bottom Line

The mandatory addendum looks like a small administrative change and is actually a documentation mandate with teeth. Starting with elections on or after October 1, 2026 — if finalized — you would have to make and disclose a relatedness determination on every patient, in writing, signed. Build the workflow now, anchor it to a real clinical determination rather than boilerplate, and reconcile it against your billing, and the addendum strengthens your compliance posture. Treat it as a checkbox, and it becomes the cleanest evidence a surveyor or the SSVI could ask for.