26-291 Support Timely Outpatient Hospice Care Admissions and Reimbursement

Immediately: Stop issuing prior authorizations for Medi-Cal outpatient hospice services. When Health Net has financial risk, submit complete hospice documentation (Certification of Terminal Illness, face-to-face encounter documentation, Medi-Cal Hospice Program Election Notice, initial care plan) via encrypted email within 5 calendar days of hospice admission. Billing team must redirect members to participating hospice providers when requested provider is out-of-network. Failure to submit documentation within 5 days will result in coverage denial from admission date until documentation is received.