Latest briefing

OCTOBER 21, 2026 | ISSUE 01

Clear updates. Practical next steps.

01 ADMISSIONS & CLINICAL LEADERS

Election addenda: Check the furnished date

REQUIRED NOW | Elections beginning October 1, 2026

What changed: Medicare hospice elections beginning October 1 require a written election statement addendum for every electing beneficiary or representative, subject to the rule's exceptions. Furnish it within the first five days of the election's effective date. Record the date furnished, separately from the date signed.

Why it matters: CMS is exercising enforcement discretion through December 31, 2026. During that window, Medicare contractors will not deny claims solely for a missing or incomplete addendum. The requirement still applies.

CAREGroup recommends:
1. Review five recent Medicare admission records.
2. Check the furnished date, receipt acknowledgment, and explanations for care the hospice considers unrelated.
3. Assign responsibility for addendum updates when care-plan changes affect those decisions.

Read the sources: CMS implementation notice | 42 CFR 418.24(c)-(d), including exceptions

 

02 ADMINISTRATORS & PERSONNEL STAFF

SEMARC

HHSC GUIDANCE | Hold-harmless period through January 6, 2027

What to know: SEMARC is the Search Engine for Multi-Agency Reportable Conduct. The Texas Health and Human Services Commission (HHSC) clarified that all staff, contractors, and volunteers must be checked, including licensed staff such as RNs. This is not limited to unlicensed employees. See FAQ 13 in Provider Letter 2026-10.

Why it matters: A professional license does not replace a SEMARC check. HHSC extended its preparation period through January 6, 2027; surveys for SEMARC compliance begin January 7. Existing screening obligations continue.

CAREGroup recommends: Include licensed staff in your screening process. Review a sample of licensed and unlicensed personnel files for dated SEMARC results, and confirm who tracks checks when they are due.

Read the sources: HHSC Provider Letter 2026-10 and FAQ 13 | October 5 update

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03 BILLING MANAGERS & OWNERS

Long stays: Why the correct rate matters

FINAL CMS INSTRUCTIONS | Effective April 1; implementation April 5, 2027

What changed: CMS plans to restore claim checks U5565 and U5566, with exceptions for claims after transfers and ownership changes. The checks compare claim admission dates with election-period start dates.

Why it matters: Medicare pays a higher routine home care rate for days 1-60 and a lower rate from day 61 onward. Incorrect admission dates can make an ongoing stay look like a new admission and trigger the higher rate. These checks help prevent that overpayment.

For example: Day 180 of a continuous hospice stay should receive the lower routine home care rate. A new monthly claim or a hospice transfer does not restart the first-60-day payment clock.

CAREGroup recommends: Ask your billing vendor to verify admission dates and prior hospice days, including transfers. Confirm how the exceptions will work. Keep valid dates intact.

Read the sources: CMS MM14227 | Claims Processing Manual, Chapter 11, section 30.2

Need help putting these steps into practice?

CAREGroup offers focused record reviews, regulatory support, and practical QAPI follow-through. - Cathleen Adams

Talk with CAREGroup

Sources checked October 21, 2026. CAREGroup recommendations are practice suggestions.

Previous briefings

As new issues are published, you will find earlier briefings here. Check each issue's date before using its guidance.