26-839 Prior Authorization Now Required for Outpatient Hospice Services

By July 9, 2026: (1) Billing and clinical teams must update all internal processes to require prior authorization for outpatient hospice services before claims submission. (2) Immediately discontinue use of HospiceCTIforms@centene.com email inbox for prior authorization requests. (3) Update billing system and encounter templates to route all hospice prior authorization requests through standard submission channels (fax to Health Net Prior Authorization Department, phone, or provider portal). (4) Create and implement a mandatory checklist for all hospice prior authorization submissions to ensure inclusion of: Certificate of Terminal Illness (CTI), Medi-Cal Hospice Program Election Notice, initial plan of care, transfer/discharge summaries, and face-to-face encounter documentation for members continuing beyond three benefit periods. (5) For members already receiving hospice services prior to July 9, 2026, submit prior authorization requests at the next recertification period with complete documentation through standard channels. (6) Before September 14, 2026: Ensure all staff have transitioned away from CTI email submission as the inbox will be disabled. (7) Train billing staff, providers, and clinical staff on new submission requirements and consequences. Failure to obtain prior authorization will result in claim denials and delayed payment; incomplete requests will delay review.