MedicaidPrior AuthMedium impact
26-593 Medi‑Cal Hospice Prior Authorization Update for Hospice Providers
Health Net·CA · Palliative Care·Prior Authorization
Effective date
Jul 9, 2026
We identified it
Jun 20, 2026
Summary
Starting July 9, 2026, Health Net Medi-Cal managed care will require prior authorization for outpatient hospice services (routine home care, continuous home care, and respite care). Hospice providers must submit prior authorization requests with required documentation to support medical necessity.
Action Required
Before July 9, 2026: Billing team must update workflows to obtain prior authorization for all outpatient hospice services (routine home care, continuous home care, respite care) for Health Net Medi-Cal patients in Fresno, Kings, and Madera counties. Update billing system to flag these services for prior auth. Ensure documentation includes Certificate of Terminal Illness, Election Notice, individualized care plan, and applicable transfer/discharge summaries. Contact CalViva Health at 888-893-1569 for questions.