Medi-Cal Provider Manual, Part 2, Hospice Care, Billing

In order for claims for hospice services to adjudicate appropriately for Medi-Cal

fee-for-service members, hospice providers must ensure that they have timely filed a

Medi-Cal Hospice Program Attestation Form with DHCS, which is what prompts DHCS to

add the unique hospice indicator code in Medi-Cal’s fee-for-service billing system.

Claims for hospice services for Medi-Cal fee-for-service members will be denied without a

valid Medi-Cal Hospice Program Attestation Form on file with DHCS and the unique hospice

indicator code in Medi-Cal’s fee-for-service billing system.

‹‹In instances where the Medi-Cal Hospice Program Attestation Form is not submitted within

the five-calendar day window, Medi-Cal will not cover or reimburse for the days of hospice

services that are provided between the hospice admission date and the date the Medi-Cal

Hospice Program Attestation Form is submitted through the secure, online

Medi-Cal Provider Portal and approved by DHCS. These days shall be considered a hospice

provider liability, and hospice providers may not bill DHCS or the Medi-Cal fee-for-service

member for these non-billable days.››

Exceptions

‹‹There are some limited circumstances beyond the control of hospice providers where it

may not be possible to timely submit the Medi-Cal Hospice Program Attestation Form with

DHCS within the five calendar days of Medi-Cal fee-for-service members’ hospice election.

The following are the limited exceptions to timely filing that would allow DHCS to cover

hospice services and hospice providers to receive full reimbursement:››

• Natural disasters or emergencies: This includes fires, floods, earthquakes or other

events that disrupt operations.

• System or technical failures: DHCS system outages or email delivery failures that

prevent timely submission.

• Newly certified hospice providers: DHCS system access not yet granted and/or delay

in onboarding after certification.

• Retroactive Medi-Cal Eligibility: Hospice provider was not and could not have been

reasonably aware that the Medi-Cal fee-for-service member was eligible for hospice

services at the time of election. For this time, hospice providers must document and

provide:

– Proof of retroactive eligibility

– A valid Medi-Cal Hospice Program Attestation Form in the Provider Portal

– Certification of Terminal Illness; and

– Administrative corrections, if any.

‹‹For any of the above exceptions, hospice providers must submit appropriate, written

documentation supporting the exception to DHCS when submitting the Medi-Cal Hospice

Program Attestation Form through the secure, online Medi-Cal Provider Portal. Additionally,

DHCS will only accept late Medi-Cal Hospice Program Attestation Form submissions under

one of these exceptions when the delay is beyond hospice providers’ control and the

providers’ actions or inactions did not contribute to or cause the delay in timely submission.››

Ultimately, timely and accurate submission of Medi-Cal Hospice Program Attestation Forms

is essential to avoiding service disruptions, ensuring proper reimbursement and protecting

Medi-Cal program integrity.