Medi-Cal Provider Manual, Part 2, Hospice Care, Eligible Medi-Cal Members

Any Medi-Cal member certified by a physician as having a life expectancy of six months or

less may elect to receive hospice services in lieu of covered Medi-Cal curative and other

services related to the terminal condition.

Hospice Provider Responsibilities

Hospice providers are responsible for the following:

• Coordinating hospice services for Medi-Cal members.

• Completing the Medi-Cal Hospice Program Election Notice (DHCS 8052).

Note: No other forms may be used and no changes may be made to the form.

• ‹‹Completing the Medi-Cal Hospice Program Attestation Form through the secure,

online Medi-Cal Provider Portal accurately and within the required five (5) calendar

days of Medi-Cal members’ hospice election.››

Note: Back dating is not allowed and failure to submit timely may result in claim denials for

hospice services, as noted in the “Unique Hospice Indicator” and “Billing” policy below

in this section.

• Maintaining all supporting documentation, including, at a minimum, the signed DHCS

8052 and the Certification of Terminal Illness in Medi-Cal members’ medical records,

which are to be made available to DHCS upon request and in the event of a state or

federal audit.