MedicaidPrior AuthHigh impact
26-290 Support Timely Outpatient Hospice Care Admissions and Reimbursement
Health Net·CA · Palliative Care, Family Medicine, Internal Medicine +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health requires PPGs to submit complete hospice documentation within 5 calendar days when the Plan is at financial risk for Medi-Cal outpatient hospice services. PPGs are prohibited from issuing prior authorizations for outpatient hospice services, and violations may result in capitation deductions.
Action Required
Immediately: Stop issuing prior authorizations for Medi-Cal outpatient hospice services. When CalViva Health is at financial risk, billing team must submit complete hospice documentation (CTI, face-to-face encounter documentation, Medi-Cal Hospice Program Election Notice, initial care plan) via encrypted email within 5 calendar days of hospice admission. Redirect members to participating hospice providers only. Failure to comply will result in service denials and potential capitation deductions with 15 days notice.