MedicaidPrior AuthHigh impact
25-940 Updated Hospice Care Guidelines for Medi-Cal Providers
Health Net·CA · Palliative Care·Prior Authorization
Effective date
Sep 4, 2025
We identified it
Jun 20, 2026
Summary
New hospice care guidelines for Medi-Cal providers require in-network hospice providers starting September 4, 2025, with out-of-network coverage eliminated for new hospice patients. Prior authorization is now required for inpatient hospice services, and all hospice election forms must be submitted within 5 calendar days or coverage will be denied from admission date.
Action Required
By September 4, 2025: Billing team must update systems to verify hospice providers are in-network before admission and require prior authorization for all inpatient hospice services. Clinical staff must submit Medi-Cal Hospice Program Election Notice within 5 calendar days of certification or services will not be covered from admission date to receipt of form. Use ProviderSearch tool on Health Net webpage to verify in-network hospice providers. Submit Single Case Agreement requests when in-network providers unavailable.