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25-1114 Hospice Documentation Deadlines Enforced Starting January 8, 2026

Date: 10/31/25

Submit all required hospice documentation within five (5) calendar days – noncompliance will delay coverage

Effective January 8, 2026, Health Net will strictly enforce documentation requirements for hospice services to ensure timely authorization and reimbursement:

  • All required documentation must be submitted within five 5 calendar days of hospice election.
  • Services will not be reimbursed for any dates of service prior to the receipt of completed documentation.
  • Providers are responsible for submitting complete documentation promptly to avoid coverage delays.

Updated hospice coverage rules

On May 5, 2025, the California Department of Health Care Services (DHCS) issued All Plan Letter (APL) 25-008, updating hospice care guidance for Medi-Cal Managed Care Plans. These updates aim to improve timely, coordinated care for members with terminal illnesses. Health Net communicated these changes in provider update 25-939 distributed on September 4, 2025.

Key changes include:

  • In-network requirement: Coverage is now limited to in-network hospice providers, unless medically necessary services are unavailable in-network.
  • Strict documentation timeline: Required certifications and documentation must be submitted within 5 calendar days of hospice election. If not received within this timeframe, services will not be covered from the admission date until documentation is complete.

Quick reference guide

To help you comply, Health Net has developed a quick reference guide, Hospice Services Documentation, that outlines required documentation and submission timelines. This tool simplifies the process and helps prevent missed deadlines. Access the guide at Provider Library > Select line of business > Forms and References > Search for Hospice Services Documentation Guide.

How to submit documentation

  • Outpatient hospice services:
    • Prior authorization is not required.
    • Send documentation via encrypted email to Hospice CTI forms.
  • Inpatient hospice services:
    • Prior authorization is required.
    • Follow the Medi-Cal Provider Operations Manual > Requesting Prior Authorization or Coordinating a PCP Referral at Prior Authorizations. 
    • Attach all required documentation to your request.

Additional resources and information

For more details on hospice coverage changes and document submission requirements, access the Provider Library > Select line of business > Provider Updates and Notices > Search for update numbers:

  • 25-939, Updated Hospice Care Guidelines for Medi-Cal Providers
  • 25-810, New Email for Hospice Documentation Submissions

Additional information

Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.

If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center at 800-675-6110.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Enhanced Care Management (ECM) Providers.

For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.



Last Updated: 10/30/2025