Transition of the Medi-Cal Hospice Program Attestation Form to the Medi-Cal Provider Portal

What is changing? 

The Medi-Cal Hospice Program Attestation Form is being transitioned from the current online (Nintex) platform, which is a web‑based digital form, to the Medi-Cal Provider Portal, which is a secure access point requiring registration. This change will require providers to log in using their unique Medi-Cal Provider Portal credentials (for example, username (email) and password) to submit the Medi-Cal Hospice Program Attestation Form.  

Why is this change happening? 

This change is part of the Department of Health Care Services (DHCS) ongoing efforts to strengthen program integrity and enhance utilization management controls. This transition will support improved data accuracy as well as streamlined processing and integration, but there will not be any material changes to the member, provider, and clinical information collected. 

Does this change apply to all Medi-Cal members? 

No. This change only applies to Medi-Cal fee-for-service members receiving hospice services from hospice providers directly billing DHCS. Hospice providers are not required to submit the Medi-Cal Hospice Program Attestation Form through the Medi-Cal Provider Portal for Medi-Cal managed care members, and would instead follow requirements outlined in the most current, applicable All Plan Letter listed on DHCS’ webpage.  

When will the transition to the Medi-Cal Provider Portal for the Medi-Cal Hospice Program Attestation Form occur? 

The transition will occur on September 1, 2026.  

Will there be a transition period to allow hospice providers time to become acclimated to the Medi-Cal Hospice Program Attestation Form in the Medi-Cal Provider Portal? 

No, there will not be a transition period. As of September 1, 2026, hospice providers will be required to access and submit the Medi-Cal Hospice Program Attestation Form through the Medi-Cal Provider Portal. 

Will the current web-based digital (Nintex) Medi-Cal Hospice Program Attestation Form remain available? 

No. As of September 1, 2026, the current web-based digital (Nintex) Medi-Cal Hospice Program Attestation Form will be permanently shut down and no longer accessible. As of this date, the Medi-Cal Provider Portal will be the only option to access and submit the Medi-Cal Hospice Program Attestation Form. 

Do some hospice providers already have access to the portal? 

Yes. Hospice providers who currently bill DHCS directly for Medi-Cal Fee‑For‑Service (FFS) members should already be registered, as the portal is used for e-TAR submissions, claims, and other workflows. 

What happens if hospice providers are not registered for the Medi-Cal Provider Portal? 

Providers who have not registered and do not have unique Medi-Cal Provider Portal credentials will be unable to access the Medi-Cal Hospice Program Attestation Form in the Medi-Cal Provider Portal starting on September 1, 2026. Any untimely submission, i.e., outside of the five (5) calendar days, of the Medi-Cal Hospice Program Attestation Form could result in claim denials for hospice services. For more information on submission requirements, please refer to the Hospice Care section of the Medi-Cal Provider Manual.  

How do hospice providers register for the Medi-Cal Provider Portal? 

Providers are strongly encouraged to register in advance of September 1, 2026 to avoid potential issues with registration and timely submission of the Medi-Cal Hospice Program Attestation Form once the transition occurs. Registration is done online through DHCS’ Medi-Cal Provider Portal webpage. Additional information on how to register can be found on the Medi-Cal Providers | New Providers webpage.  

Can hospice providers use the Medi-Cal Provider Portal to update a Medi-Cal members’ status (e.g., discharge, revocation, or transfer)? 

No, the change requiring hospice providers to submit Medi-Cal Hospice Program Attestation Forms through the Medi-Cal Provider Portal does not change how hospice providers report Medi-Cal member status changes such as discharges, revocations, or transfers. Based upon current policy, if a Medi-Cal member’s hospice status changes, the hospice provider must notify DHCS, consistent with existing procedures as outlined in the Hospice Care section of the Medi-Cal Provider Manual, which includes providing written notice via email to DHCS’ Hospice Clerk at MCHospiceClerk@dhcs.ca.gov. 

Can one set of unique hospice provider credentials to log into the Medi-Cal Provider Portal be used for multiple hospice providers? 

No. Access to the Medi-Cal Provider Portal is tied to specific hospice provider records (including NPI). As a result, login credentials are not shared and hospice providers must be individually registered in the Medi-Cal Provider Portal to submit Medi-Cal Hospice Program Attestation Forms.  

Will training or additional instructions be given to hospice providers? 

Yes. DHCS plans to release further details, training materials, and instructions on accessing and submitting the Medi-Cal Hospice Program Attestation Form through the Medi-Cal Provider Portal in the coming months. Please visit DHCS’ Hospice Care webpage for the most up-to-date information. 

How do hospice providers stay informed on future changes to hospice policy and related processes? 

Hospice providers are strongly encouraged to sign up for the free Medi-Cal Subscription Service (MCSS). Subscribers receive subject-specific emails for urgent announcements and other updates shortly after they post to the Medi-Cal website. 

Who can I contact with questions? 

For assistance, visit DHCS’ Hospice Care webpage or email the DHCS Hospice Clerk at MCHospiceClerk@dhcs.ca.gov. 

Forms and Processes (Attestation & NOE)

What is the difference between the DHCS 8052 Notice of Election (NOE) form and the new Online Medi-Cal Hospice Program Attestation Form?

The two forms serve different but related purposes in the Medi-Cal hospice election process:

• DHCS 8052 – Hospice Notice of Election (NOE) Form– Documents the Medi-Cal Fee-for-Service (FFS) member’s election of hospice services and captures their informed consent and original signature (or that of their legal guardian/authorized representative). Must be completed by Qualified Hospice Personnel (QHP) after counseling the member. Retained in the member’s medical record; not submitted to DHCS. Must be available upon DHCS request or during state/federal audits.
• Medi-Cal Hospice Program Attestation Form- Serves as the official notification to DHCS that the member has elected hospice services. Completed online by the hospice provider within five (5) calendar days of the election date. Provider attests that all requirements were met, including obtaining informed consent using DHCS 8052. Required starting March 2026; emailed or paper submissions will no longer be accepted.

Who can sign the Medi-Cal Hospice Program Attestation Form? 

Only Qualified Hospice Personnel (QHP) as defined in HSC Section 1746.50 (e.g., physicians, RNs, LVNs, medical social workers, chaplains, counselors).

Can office staff complete the form if the QHP is unavailable? 

Yes, but the QHP must sign the form.

Does the same QHP need to sign both the Attestation Form and the NOE Form? 

DHCS recommends the same QHP sign both, but any QHP may sign the Attestation Form.

Can the Attestation Form be signed by an RN or LVN? 

Yes. Both are considered QHPs.

What is the time frame for submitting the Attestation Form? 

Within five (5) calendar days of the member’s hospice election.

Can the Attestation Form be updated after submission? 

No. A new form must be submitted if corrections are needed.

Will providers receive confirmation after submitting the Attestation Form? 

Yes. A confirmation email will be sent. Providers should verify the 900 code in MEDS.

What if the member revokes hospice or transfers? 

Notify DHCS for FFS members via email to MCHospiceClerk@dhcs.ca.gov. MCP members require direct notification to the plan.

What is the ‘5-Day Rule’ for the Hospice Program Attestation Form? 

Submit form within five calendar days of hospice election (FFS to DHCS, MCP to the plan).

Are there exceptions to the 5-day rule? 

Yes. Exceptions include natural disasters, technical failures, newly certified providers, and retroactive eligibility.

Can the online Hospice Program Attestation Form be saved and completed later? 

No. It must be completed in one session.

Will providers receive confirmation after submitting the Hospice Program Attestation Form? 

Yes. An email confirmation will be sent.

What happens if incorrect information is submitted? 

Errors may trigger automatic rejection or require resubmission.

Are Hospice Program Attestation Forms required for dual-eligible members? 

Yes. Even if Medi-Cal is secondary, a valid form is required.

What if the member is retroactively approved for Medi-Cal? 

Contact the Hospice Clerk and provide proof of retroactive eligibility.

Is a placeholder diagnosis code acceptable? 

No. A valid diagnosis code and physician certification are required.

For Providers

Where can I find DHCS Hospice Program contact information? 

Visit the DHCS Hospice Program webpage or email MCHospiceClerk@dhcs.ca.gov. Phone: (916) 552-9200.

Do hospice providers follow the same procedures when enrolling Managed Care Plan (MCP) members? 

No. MCPs have their own processes. The DHCS Online Hospice Program Attestation Form form applies only to Fee-for-Service (FFS) members.

How can providers verify Medi-Cal member eligibility? 

Use the Medi-Cal Eligibility Verification System (EVS) for FFS members or contact the MCP directly.

Billing & Reimbursement

What is the ‘900 code’ and why is it important? 

The 900 code is a unique indicator added to the Medi-Cal billing system after DHCS receives a valid Hospice Program Attestation form. Claims will be denied without this code.

How does Hospice Program Attestation Form submission impact reimbursement? 

No form = No 900 Code = No Payment. Late or missing forms result in denied claims.

What happens if I miss the five-day submission deadline? 

Late submissions are non-compliant and result in reimbursement only from the date the form is received.

What If the Hospice Election or Addendum forms are rejected?         

The Hospice Clerk will notify the Hospice agency of the necessary corrections as soon as possible. 

Where can I find the DHCS Hospice Program contact information?           

The DHCS Hospice Program web page has contacts, resources, and the latest updates. You can email your questions to MCHospiceClerk@DHCS.ca.gov or call (916) 552-9200.

What is the “5-Day Rule” for the attestation submission?

Hospice providers must submit the Attestation Form within five (5) calendar days of the member’s hospice election date:

• For FFS members: DHCS must receive the form within 5 days.
• For MC members: The MCP must receive the form within 5 days.

Late submissions are non-compliant and result in:

• Potential denial of payment for days before receipt.
• Reimbursement only from the date the form is received

Are there exceptions to the 5-day rule?

Yes. DHCS may allow exceptions in limited cases, such as:

• Natural disasters or emergencies: This includes fires, floods, earthquakes, or other events that disrupt operations.
• System or technical failures: DHCS system outages or email delivery failures that prevent timely submission.
• Newly certified hospice providers: DHCS system access not yet granted and/or delay in onboarding after certification.
• Retroactive Medi-Cal Eligibility: Hospice provider was not and could not have been reasonably aware that the Medi-Cal member was eligible for hospice services at the time of election. For this item, hospice providers must document and provide: Proof of retroactive eligibility;Valid hospice Attestation form;Certification of terminal illness; andAdministrative corrections, if any.

For any of the above exceptions, please note that DHCS will only accept late attestation forms when the delay is beyond the hospice provider’s control and the hospice provider’s actions or inactions did not otherwise contribute to or result in the delay. Absent an approved exception from DHCS, hospice services rendered under a late Medi-Cal Hospice Attestation form will not be eligible for any reimbursement. 

How do I know whether to send the form to DHCS or an MCP?

Check the member’s eligibility on the hospice election date using:

• MEDS (Medi-Cal Eligibility Data System)
• POS (Point of Service) system

Also check for retroactive MCP enrollment to avoid misrouting.

Does this new process apply to both Medi-Cal fee-for-service (FFS) and managed care members?

No. This new process only applies to Medi-Cal FFS members electing to receive hospice services.

Are NOEs required for dual-eligible Medi-Cal members?

Yes. Even if Medi-Cal is the secondary payer and Medicare is primary, a valid hospice NOE form is required to be on file for all Medi-Cal members (both FFS and managed care) electing to receive hospice services.

Do hospice providers need to submit a hospice Attestation Form for a dual-eligible Medicare/Medi-Cal member for which the hospice provider is only submitting room & board claims to DHCS or a Medi-Cal MCP for payment?

Yes. A valid hospice Attestation Form must be submitted and on file in order for DHCS or a Medi-Cal MCP to reimburse hospice providers for room and board claims.

What if the individual does not have Medi-Cal at admission but is approved retroactively?

Hospice providers are responsible for verifying Medi-Cal member eligibility prior to rendering and billing for hospice services. Additionally, hospice providers can contact the DHCS Hospice Clerk for further assistance at MCHospiceClerk@dhcs.ca.gov. Hospice providers will need to provide proof of retroactive eligibility and submit the Attestation Form within five (5) days of the Medi-Cal member’s election date.

How do hospice providers notify DHCS of a Medi-Cal member revocation of hospice services?

Hospice providers must submit notice of revocation for Medi-Cal FFS members only via email directly to the DHCS Hospice Clerk at MCHospiceClerk@dhcs.ca.gov. For Medi-Cal managed care members, hospice providers must submit that information directly to the Medi-Cal member’s assigned MCP. Please note that this is the current process.

Do hospice providers also need to notify DHCS regarding discharges and/or transfers?

Yes. Hospice providers must timely notify DHCS for Medi-Cal FFS members, or the assigned Medi-Cal MCP for Medi-Cal managed care members, relative to all discharges and/or transfers as well as the reason for the discharge and/or transfer (e.g., death or moving out of service area, etc.).

What if the Medi-Cal member revokes and later returns to hospice, do hospice providers need to submit a new hospice Attestation Form?

Yes, a new hospice Attestation Form must be submitted and on file if the Medi-Cal member revokes hospice but then later returns to hospice.

What if the Medi-Cal member transfers from another hospice, do hospice providers need to submit a new hospice Attestation Form?

Yes, a new hospice Attestation Form must be submitted and on file if the Medi-Cal member transfers from one hospice provider to another.

What if the Medi-Cal member does not have a diagnosis of a terminal illness at admission?

A physician’s certification of terminal illness is required before the hospice provider submits the hospice Attestation Form.

Is a placeholder diagnosis code acceptable?

No. A valid diagnosis code and physician’s certification of terminal illness is required.