You may hear a sentence such as, “Hospice does not cover that.” Do not let the sentence carry the whole decision.
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Under the Medicare hospice benefit, the hospice election paperwork includes an addendum called the Patient Notification of Hospice Non-Covered Items, Services, and Drugs. It identifies what the hospice has determined is unrelated to the terminal illness and related conditions. Those are the things the hospice says it will not cover through the hospice benefit.
This paper matters because a daughter at the kitchen table may otherwise be left to sort out a prescription, appointment, supply or piece of equipment with no clear record of who is responsible. Before you cancel something, pay for it or ask another provider to bill Medicare, find the addendum.
Ask for the actual addendum
The addendum is not the same as a brochure, a general list of hospice services or a verbal explanation from the admission nurse. It belongs with the hospice election statement and should identify your parent, the hospice and the specific determinations being made.
Medicare requires the hospice to furnish the written addendum near the beginning of the election. If a later change to the plan of care affects what the hospice considers unrelated and non-covered, the hospice must furnish an updated addendum.
If you cannot find it, ask: “Where is the Patient Notification of Hospice Non-Covered Items, Services, and Drugs?” Use the full title. It separates this request from a general question about benefits.
If the answer is that nothing has been excluded, ask the hospice to show you how that is reflected in the paperwork. Do not assume a blank page, a missing page and a determination of no exclusions mean the same thing.
Read the list one line at a time
The paper should do more than name diagnoses. It should list the conditions, items, services and drugs the hospice has determined are unrelated. It should also give a written clinical explanation, in language you can understand, for each non-coverage determination.
For every line, ask four questions:
What exactly is excluded? Who is expected to order or supply it? How should the outside provider bill for it? What should you do before the next refill, appointment or delivery?
Do not interpret the medical reason yourself. Ask the hospice to explain its own determination and to make the written entry specific enough that another provider can act on it. A broad label may not tell a pharmacy, clinic or equipment supplier what the hospice will cover.
Compare the addendum with what is already happening in the house. Look at the medication containers, scheduled appointments, recurring deliveries, equipment and supplies. You are checking whether each ongoing item has a clear payer and a clear ordering path. You are not deciding whether the hospice’s clinical judgment is right.
A signature does not mean agreement
Your signature on the addendum acknowledges that you received it. Federal hospice guidance says that the signature does not necessarily mean you agree with the hospice’s determinations.
That distinction is useful when someone places the paper in front of you during a busy admission. You may receive it, keep a copy and still ask questions. If you disagree, ask the hospice to show you the immediate advocacy information for the Medicare Beneficiary and Family Centered Care Quality Improvement Organization. That contact information belongs in the paperwork.
Do not write your own medical argument in the margin. Write the practical question that remains open: which drug, which service, which supplier, which bill or which appointment. Then ask the hospice to answer it in the record.
Do not let separate providers guess
A non-hospice physician, pharmacy, clinic or equipment supplier may not know what the hospice has placed outside the benefit. Give the relevant provider a copy of the addendum before the item or service is arranged. The federal rule allows non-hospice providers and Medicare contractors to request this information as well.
Ask the outside provider to confirm that it has reviewed the hospice determination before submitting a claim. This does not guarantee payment. It does reduce the chance that everyone acts from a different version of the plan.
If the hospice tells you to continue using an outside provider, ask for three names in writing: the person at the hospice who made the determination, the outside provider expected to handle the item and the number to call if billing stops or the item cannot be obtained.
Keep the latest version where calls are made
Put the addendum with the working hospice papers, not in a closed admission folder. Mark it as the current copy. When the plan changes, compare the new version with the prior version before replacing anything.
Check what was added, removed or rewritten. Then follow each changed line to the household task it affects. A change on paper may alter who calls the pharmacy, who orders supplies, where an appointment is billed or whether you need to speak with another provider.
Keep the older copy behind the current one. If a question later arises about a refill, delivery or claim, you will be able to show what the hospice had written at the time.
Make the paper answer the decision in front of you
The addendum is useful only when it changes what you do next. Before you pay privately, cancel an established service or tell another provider that Medicare will cover something, check the written determination.
If the paper is incomplete, ask the hospice to correct or update it. If the language is unclear, ask for an explanation you can repeat accurately to the pharmacy, physician or supplier. If you disagree with the determination, use the advocacy contact listed in the paperwork.
The quiet goal is a complete handoff: the hospice has named what it will not cover, explained why, and shown you where responsibility goes next. Until those three things are on paper, the decision is still sitting with you.
For the broader difference between scheduled hospice visits and the hours the household still covers, read The Hours Between Hospice Visits. For the federal rule, Medicare guidance and other authorities behind this guide, see Sources.