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26-839 Prior Authorization Now Required for Outpatient Hospice Services

Date: 07/23/26

Submit prior authorization requests through standard channels to avoid delays

As a reminder, effective July 9, 2026, Health Net, on behalf of CalViva Health, requires prior authorization for outpatient hospice services under updated Medi-Cal regulations. This change updates how hospice documentation must be submitted. All prior authorization requests must be submitted through standard submission channels using the methods outlined below. Submitting requests correctly helps prevent delays in review and payment.

What hospice providers need to do

  • Stop using the CTI inbox immediately.
    Do not submit requests via email to HospiceCTIforms@centene.com. This inbox will be disabled effective September 14, 2026.
  • Submit all prior authorization requests by fax, phone or online through the provider portal.
  • Reference submission options.
    For submission options, refer to the Health Net Prior Authorization Department contact information.
  • Include required documentation.
    Each request must include documentation supporting medical necessity, including:
    • Certificate of Terminal Illness (CTI).
    • Medi-Cal Hospice Program Election Notice.
    • Initial plan of care.
    • Transfer summary, discharge summary, and/or prior revocation(s) of hospice election, as applicable.
    • Face-to-face encounter documentation for members continuing care beyond three benefit periods.
    • Patient Notification of Hospice Non-Covered Items, Services and Drugs (PDF) form, available from the California Department of Health Care Services.
    • Additional supporting documentation may include:
      • Physician Orders for Life-Sustaining Treatment (POLST).
      • Updated plan of care for recertifications.
      • Progress notes supporting medical necessity.
  • Submit complete requests.
    Incomplete requests delay review. Include all required clinical documentation at the time of submission.

Members already receiving hospice services

For members in hospice care prior to July 9, 2026:

  • Submit a prior authorization request at the next recertification period.
  • Include all required documentation.
  • Submit the request through standard channels.

Participation requirements

  • Services must comply with prior authorization requirements in effect at the time of service.
  • Out-of-network services are not permitted unless authorized in advance.

What is not changing

  • Hospice services remain covered under Medi-Cal when eligibility and documentation requirements are met.
  • Hospice certification and coverage criteria remain unchanged.

Updates to prior authorization requirements

The following form and resource have been updated to align with these changes:

  • Long-Term Care Authorization Notification Form
    • Updated to include hospice care election, inpatient admission, and submission through standard prior authorization submission channels.
    • Access the form in the Medi-Cal Provider Library under Forms and References.
  • Prior Authorization Requirements list
    • The CalViva Health Medi-Cal Fee-For-Service Prior Authorization Requirements list has been updated to include:
      • Inpatient hospice care.
      • Outpatient hospice care.
      • Updates to sensitive services.
      • Other services not requiring prior authorization.
  • Access the Prior Authorization Requirements list.

Additional resources

For more guidance to avoid delays, refer to Prevent Prior Authorization Delays With These Submission Guidelines in the Provider Library under Education, Training and Other Resources.

Relevant sections of the 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 the provider portal.

If you have questions regarding the information contained in this update, contact CalViva Health at
888-893-1569.

 

This information applies to Physicians and Practitioners, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.



Last Updated: 07/20/2026