MedicaidPrior AuthHigh impact
25-941 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
New hospice care guidelines for Medi-Cal providers requiring in-network providers only for new patients starting September 4, 2025, with strict 5-day documentation submission deadlines and prior authorization requirements for inpatient hospice services.
Action Required
By September 4, 2025: Billing team must update systems to require prior authorization for all inpatient hospice services for Medi-Cal patients. Implement 5-day deadline tracking for Certification of Terminal Illness and Election Notice submissions - services will NOT be covered from admission date if forms are late. Update provider directory to show only in-network hospice providers. Train staff on Single Case Agreement process for out-of-network requests when in-network providers unavailable.