Is Your Agency Prepared for the New Hospice Addendum Requirements?

HOPE In Practice: Lessons From the Field [Free Webinar]

CMS just changed the rules on the Hospice Addendum, and the deadline hits October 1^st. Is your hospice agency ready for the shift?

What Changed in the FY 2027 Hospice Final Rule

The FY 2027 Hospice Wage Index and Payment Rate Update makes the hospice election statement addendum mandatory for every Medicare beneficiary at the time of hospice election. The requirement is effective starting October 1, 2026.

Previously, hospices only had to provide the addendum when a patient or their representative requested it. That distinction is now gone. Every election now requires it for every patient, every time.

If a subsequent change to the plan of care affects which conditions, items, services, or drugs are deemed unrelated to the terminal illness, an updated addendum must go out within three days of that change. The addendum must be furnished in writing to the beneficiary or representative and made available on request to non-hospice providers and Medicare contractors. 

Why The Hospice Addendum Requirement Exists

The addendum itself hasn't changed in substance. It lays out the conditions, medications, and services a hospice has determined are unrelated to the terminal illness and therefore not covered under the hospice benefit.

What's changed is scale. A process once managed case by case—often on paper and only by request—now must run reliably across every single election, with a clean, documented record of delivery and acknowledgment behind it.

CMS frames the change as a transparency measure, intended to ensure beneficiaries clearly understand, from the earliest point in their hospice election, which conditions, items, services, and drugs are and are not covered under the hospice benefit, rather than leaving that determination to be surfaced only if someone thinks to ask.

The Hospice Addendum Change That Agencies May Underestimate

Generating the addendum was never the hard part. The difficulty lies in proving for every patient that it reached them, capturing their acknowledgment, and that the outcome made it back into the EMR without staff needing to manually re-enter it each time.

That's a compliance obligation, and mandatory delivery for every election raises the stakes on getting it right.

• Mail can't reliably confirm receipt. Even when it works, someone still needs to track the response and enter it into the EMR by hand.
• Email-based e-signature tools require an email address that many patients don't have, creating a disconnected experience from the rest of the hospice's communication and leaving staff responsible for moving the outcome back into the record.
• Manual delivery by clinicians pulls time away from patient care and puts a compliance-critical task in a workflow that isn't built to track or escalate it.

With delivery now required for every election, the administrative load of managing this by hand will multiply fast.

Maxwell TEC’s Upcoming Solution for the Hospice Addendum Requirement

As the addendum requirement moves from occasional to universal, our experts have been discussing preparations with agencies who are unsure how to handle the new hospice addendum process at scale. Current solutions like traditional mail or hand delivery are manual, costly, and unreliable.

The good news? We believe there is a path for an automated, tech-enabled, and compliant way to manage the new hospice addendum requirements before they become a significant bottleneck for agencies.

Through our nanaCONNECT patient engagement platform, we are developing a brand-new module called SHARE which is designed to automate the entire hospice addendum process at scale. It delivers the addendum, authenticates the patient, captures acknowledgment, and writes the result back into the EMR—with a complete audit trail behind every step and no manual re-entry required.

Become an Early Adopter of the New Hospice Addendum Solution

We'll be sharing more details and information on this exciting nanaCONNECT update in the coming weeks, including how it works, what it means for your team, and how it fits directly into your existing EMR workflow.

In the meantime, if you're curious about becoming an early adopter of the nanaCONNECT - SHARE module, now is the time to act. Talk to our team today to get a demo and discuss how you can get a head start on our new solution built to take the hospice addendum compliance requirement off your team's plate before the administrative burden weighs your agency down.