CA · guidance
Medi-Cal Provider Manual, Part 2, Hospice Care, Notification of Hospice Non-Covered Items, Services, and Drugs
Notification of Hospice Non-Covered Items, Services, and Drugs
Hospice providers may also complete the Patient Notification Non-Covered Items, Services
and Drugs Form (DHCS 8053) when Medi-Cal members agree to receive hospice services.
This form is optional and is not submitted to DHCS. However, if it is completed, it must be
retained in the Medi-Cal member’s medical record and made available to DHCS upon
request or in the event of a state or federal audit.
Provenance
- Source
- mcweb.apps.prd.cammis.medi-cal.ca.gov
- Retrieved
- 2026-10-01
- Edition
- mcpm-hospic-2026-08-01
- Content hash
5ad3b20ba054dbd927d6c535f1cce5cb96e53787d813b1600255c556445c0c04
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