The Department of Health and Human Services OFFICE OF INSPECTOR stated in the September 2016  report “HOSPICES SHOULD IMPROVE THEIR ELECTION STATEMENTS AND CERTIFICATIONS OF TERMINAL ILLNESS” that hospice election statements lacked required information or had other vulnerabilities in more than one-third of GIP stays. 

The report noted that:

  • The hospice provider did not always mention-as required-that the beneficiary was waiving coverage of certain Medicare services by electing hospice care or that hospice care is palliative rather than curative. 
  • In 14 percent of GIP stays, the physician did not meet requirements-such as writing a narrative-when certifying, and appeared to have limited involvement in determining that the beneficiary was appropriate for hospice care. 

The Department of Health and Human Services OFFICE OF INSPECTOR based this study on a review of hospice election statements and certifications of terminal illness from a stratified random sample of hospice general inpatient (GIP) stays in 2012. 

Previous OIG work has raised concerns that some election statements used by hospices are misleading and that physicians are sometimes not involved in care planning and may rarely see beneficiaries. 

The Department of Health and Human Services OFFICE OF INSPECTOR recommended  that CMS:

  1. develop and disseminate model text for election statements
  2. instruct surveyors to strengthen their review of election statements and certifications of terminal illness
  3. educate hospices about election statements and certifications of terminal illness
  4. provide guidance to hospices regarding the effects on beneficiaries when they revoke their election and when they are discharged from hospice care. 

CMS agreed with three of their recommendations and neither concurred nor nonconcurred with the fourth recommendation.