Medi-Cal Provider Manual, Part 2, Hospice Care, Hospice Election Submission Requirements

For Medi-Cal fee-for-service members who receive hospice services through an enrolled

Medi-Cal hospice provider, the hospice provider must submit the Medi-Cal Hospice Program

Attestation Form through the online, secure Medi-Cal Provider Portal within five (5) calendar

days of election. Specifically, hospice providers should note the following:

• The Medi-Cal Hospice Program Attestation Form submitted through the online, secure

Medi-Cal Provider Portal serves as official notice to DHCS of Medi-Cal fee-for-service

members’ hospice elections in compliance with Medi-Cal policy.

• The Medi-Cal Hospice Program Attestation Form submitted through the online, secure

Medi-Cal Provider Portal is to be completed in conjunction with hospice providers

counseling Medi-Cal fee-for-service members, obtaining informed consent and

completing assigned DHCS 8052.››

• The signed DHCS 8052 is not submitted to DHCS; however, hospice providers must

maintain it in Medi-Cal fee-for-service members’ medical record and make it available

upon request to DHCS or in the event of a state or federal audit.

Note: For Medi-Cal members who are enrolled in managed care and receive hospice

services through their assigned Medi-Cal managed care plan (MCP), hospice

providers must submit the Medi-Cal Hospice Program Election Notice (DHCS 8052)

directly to the Medi-Cal MCP, as outlined in All Plan Letter 25-008, which will be

maintained in their records and made available to DHCS upon request or in the event

of a state or federal audit. It is the responsibility of hospice providers to confirm and

adhere to all Medi-Cal MCP submission requirements, consistent with all Medi-Cal

policies. Please be advised that if DHCS receives Medi-Cal Hospice Program

Election Notice (DHCS 8052) for a Medi-Cal managed care member, it will be

securely and confidentially destroyed in accordance with DHCS’ policies and

procedures for handling Personally Identifiable Information (PII) and Protected Health

Information (PHI), official records retention policy, and any applicable state or CMS or

other requirements.

Medi-Cal Members Younger Than Age 21

In accordance with the federal Early and Periodic, Screening, Diagnostic, and Treatment

(EPSDT) benefit and section 2302 of the Patient Protection and Affordable Care Act (ACA),

any Medi-Cal member younger than 21 years of age and certified by a physician as having a

life expectancy of six months or less may elect to concurrently receive hospice care in

addition to curative treatment of the hospice-related diagnosis. Non-hospice providers will be

able to bill Medi-Cal for medically necessary, curative treatments that are provided within

their scope of practice and that are considered a benefit under the Medi-Cal program. All

services are subject to current Medi-Cal policies, which include any appliable authorization

and utilization review mechanisms.

‹‹A DHCS 8052 and the Medi-Cal Hospice Program Attestation Form must be completed

through the secure Medi-Cal Provider Portal.››