25-812 New Email Address for Hospice Documentation Submissions
Date: 08/04/25
Hospice providers must send required documentation to the Plan
Below outlines documentation that hospice providers must submit to ensure compliance with state regulations and contractual obligations.
These requirements are derived from the California Department of Health Care Services (DHCS) All Plan Letter (APL) 25-008.
Required documentation for hospice services
Required documentation | Description |
|---|---|
Certification of terminal illness | Confirms the patient’s eligibility for hospice care. |
Medi-Cal Hospice Program Election Notice form | Must be submitted to Health Net*, on behalf of Community Health Plan of Imperial Valley, within five calendar days of hospice election. Access the form online at Medi-Cal Hospice Program Election Notice (PDF). |
Revocation of hospice election | Documents a patient’s decision to discontinue hospice care. |
Initial care plan | A copy of the written initial plan of care. |
Written prescription | A written prescription signed by the patient’s attending physician including justification for the general inpatient care level of care. |
Face-to-face encounter documentation | Verifies clinical evaluation for continued eligibility. |
Transfer summary | Required when a patient changes health plan carriers. |
Submission instructions
- Outpatient hospice services: Submit all required documentation via secure email. Prior authorization is not required.
- Inpatient care: Prior authorization is required. Follow the standard prior authorization processes outlined in the Medi-Cal Provider Operations Manual. Attach the required documentation to the prior authorization request.
More about APL 25-008
On May 5, 2025, the DHCS issued APL 25-008, providing updated guidance for Medi-Cal Managed Care Plans regarding the provision of hospice services. This APL supersedes APL 13-014 and reinforces the requirement for timely, appropriate and coordinated hospice care for members with terminal illnesses.
To learn more about APL 25-008, go to ALL PLAN LETTER 25-008 (PDF).
Additional Information
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact Community Health Plan of Imperial Valley at 833-236-4141.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Enhanced Care Management (ECM) Providers.
This information applies to Medi-Cal in Imperial County.