MedicaidPrior AuthHigh impact
26-289 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
Health Net Medi-Cal PPGs must now submit complete hospice documentation within 5 calendar days when Health Net is at financial risk for outpatient hospice services. Prior authorization is prohibited for outpatient hospice services, and failure to submit required documentation will result in denied payment and potential capitation deductions.
Action Required
Immediately: Stop issuing prior authorizations for Medi-Cal outpatient hospice services when Health Net is at financial risk. Submit complete hospice documentation (CTI, face-to-face encounter documentation, Medi-Cal Hospice Program Election Notice, initial care plan) to Health Net via encrypted email within 5 calendar days of hospice certification and election. Update billing workflows to ensure timely documentation submission. Failure to comply will result in denied payments and potential capitation deductions with 15 business days advance notice.