MedicaidPrior AuthHigh impact
25-939 Updated Hospice Care Guidelines for Medi-Cal Providers
Health Net·CA · Palliative Care, Family Medicine, Internal Medicine +1 more·Prior Authorization
Effective date
Sep 4, 2025
We identified it
Jun 20, 2026
Summary
Health Net updated Medi-Cal hospice care guidelines effective September 4, 2025, requiring providers to use in-network hospice providers only for new patients and submit required documentation within 5 calendar days or face coverage denial. Prior authorization is now required for inpatient hospice services, and out-of-network coverage will no longer be available for newly entering hospice patients.
Action Required
By September 4, 2025: Billing team must update systems to require prior authorization for all inpatient hospice services and verify in-network hospice provider status before referrals. Providers must submit Certification of Terminal Illness, face-to-face encounter documentation, and Medi-Cal Hospice Program Election Notice within 5 calendar days of hospice election or services will not be covered from admission date. Update referral workflows to use Health Net ProviderSearch tool for in-network hospice providers only.