AB 2538

Introduced by Assembly Member Macedo
(Coauthor: Senator Grove)
 An act to add Section 14132.752 to the Welfare and Institutions Code, relating to Medi-Cal.
Medi-Cal
Medi-Cal: hospice providers: forms.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through fee-for-service or managed care delivery systems. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.
Existing law provides for the licensure of hospice agencies by the State Department of Public Health to provide hospice services to an individual who is experiencing the last phase of life due to a terminal illness, as defined. Under existing law, hospice services are covered under the Medi-Cal program, subject to utilization controls and the availability of federal financial participation, as specified.
The State Department of Health Care Services
			 administratively requires, effective March 2, 2026, a hospice provider to use a certain online attestation form to notify the department when a Medi-Cal fee-for-service member has elected to receive hospice services, as specified.
This bill would codify and recast those departmental procedures relating to the online form. The bill would require the hospice provider to submit the online form within 5 calendar days after the member’s election to receive hospice services, and to submit the form in conjunction with counseling, receipt of informed consent, and completion of a separate election notice form, as specified.
The bill would make these provisions applicable only to the Medi-Cal fee-for-service delivery system. In the case of Medi-Cal managed care, the bill would require a hospice provider to instead follow its assigned Medi-Cal managed care plan’s submission requirements, as specified.
The people of the State of California do enact as follows:
SECTION 1.
Section 14132.752 is added to the
Welfare and Institutions Code
,
immediately following Section 14132.75
, to read:
14132.752.
(a) (1) A hospice provider shall use an online form, as developed by the department, to notify the department when a Medi-Cal fee-for-service member elects to receive hospice services. A submission through email or paper format for this notification shall not be accepted.
(2) The department may designate the Medi-Cal Hospice Program Attestation Form, its successor, or a different form, for purposes of the online form described in paragraph (1), as determined appropriate by the department.
(b) The hospice provider shall submit the online form within five calendar days after the
						Medi-Cal fee-for-service member’s election to receive hospice services.
(c) The hospice provider shall submit the online form in conjunction with counseling the Medi-Cal member, obtaining informed consent, and completing and obtaining a signature on the Medi-Cal Hospice Program Election Notice Form (DHCS 8052) or its successor. The provider shall maintain the election notice form in the Medi-Cal member’s medical records and shall make the election notice form available to the department upon request or in the event of a state or federal audit.
(d) (1) Submission of the online form described in subdivision (a) shall be required for reimbursement eligibility, but the submission itself does not guarantee that reimbursement.
(2) A claim for reimbursement by a hospice provider shall be processed only after the department validates the information and applies the relevant hospice billing code.
(e) A hospice provider is encouraged to retain any email confirmation from the department as proof of timely filing under this section.
(f) This section applies only to the Medi-Cal fee-for-service delivery system. In the case of Medi-Cal managed care, a hospice provider shall instead follow its assigned Medi-Cal managed care plan’s submission requirements, including, but not limited to, the submission of a Medi-Cal
						hospice program election notice as set forth in All Plan Letter 25-008 or its successor.
(g) This section shall not limit the department’s authority to implement any additional fraud-prevention measures as authorized or required by state or federal law.