Why is DHCS implementing this new online hospice NOE form submission process?
The new, web-based hospice NOE form submission process offers several advantages including, but not limited to, the following:
- Submissions are received instantly. As a result, processing time is faster and delays can be avoided (for example, mail delays).
- Timely submissions improve compliance with the five (5) calendar day requirement.
- Built-in validations are used, resulting in fewer rejections due to errors and/or incomplete information.
- Real-time confirmations offer immediate confidence in successful submission.
- Helpful features such as secure, digital signatures.
- Ultimately, a streamlined digital workflow that reduces administrative burdens on both DHCS and hospice providers because there is no printing, scanning or emailing.
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.
What if a Medi-Cal member's eligibility changes from managed care to FFS?
The hospice provider must submit a new hospice NOE form directly to DHCS to allow the hospice provider to submit claims to DHCS for reimbursement.
Will the paper format of the hospice NOE form still be accepted?
Yes, but only during the 90-day transition period, which runs from November 1, 2025 through February 1, 2026. Thereafter, only the online hospice NOE form will be accepted. Hospice providers who submit the hospice NOE form via email using the paper format will have it returned with instructions to resubmit using the online NOE form. Please note that this does not extend the five (5) calendar day requirement for timely submission.
Are any other aspects of Medi-Cal hospice policy changing because of this new online NOE form submission process?
No. All other aspects of Medi-Cal hospice policy remain the same.
What is the requirement for timely hospice NOE form submission?
DHCS' hospice policy for timely hospice NOE form submission aligns with Medicare hospice requirements. Accordingly, hospice providers must ensure that hospice NOE forms for Medi-Cal FFS members are submitted to DHCS within five (5) calendar days of the Medi-Cal member's hospice election date.
Please note that hospice NOEs for Medi-Cal members enrolled in managed care and who are receiving hospice services through their assigned Medi-Cal managed care plan (MCP) must submit a hospice NOE form to the Medi-Cal member's assigned MCP within the same timeframe to be considered timely, i.e., five (5) calendar days. Hospice providers should contact the Medi-Cal member's assigned MCP contract manager for any questions and more information on the MCP's specific NOE form submission process.
Can the online hospice NOE form be saved and completed later?
No. This is not a current feature of the online hospice NOE form, but DHCS appreciates the question and will consider this for future enhancements. Accordingly, the hospice NOE form must be completed in one session. Accordingly, DHCS notes that hospice providers should only be completing the hospice NOE form after obtaining all necessary information from Medi-Cal member or their legal guardian/authorized representative. Failure to do so will result in potentially duplicative work on the part of the hospice provider.
Will hospice providers receive an email confirmation once the online hospice NOE form is submitted?
Yes. After submission, hospice providers will receive an email confirmation. DHCS recommends that you download a copy for your records.
What happens if incorrect information is submitted on the hospice NOE form?
Since the online hospice NOE form includes built-in validations, it may be automatically rejected by the MEDS system if there are errors. DHCS strongly recommends that hospice providers double-check all entries before submitting the form. If errors are identified after submission that did not trigger the built-in validations, the DHCS hospice clerk will contact the hospice provider for any necessary corrections and/or clarifying information.
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 NOE 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 NOE 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.
Will DHCS provide guidance to hospice providers on consent and signature requirements for the new online NOE form?
No. DHCS does not dictate, nor does it provide legal advice, relative to the methods by which hospice providers obtain the necessary consent for Medi-Cal member election of hospice services. Hospice providers are responsible for ensuring compliance with all applicable state and federal requirements as well as Medi-Cal policy.
How can hospice providers obtain Medi-Cal member consent?
Please see response to #12. Notwithstanding that response, hospice providers may establish their own internal processes and procedures for obtaining Medi-Cal member or their legal guardian/authorized representative consent prior to completing and submitting the online hospice NOE form. Some examples of potential options include:
- Signed paper form completed at the time of admission.
- Verbal consent, if properly documented and in accordance with the hospice provider's internal policies as well as applicable state and federal requirements.
- Electronic signature obtained through secure platforms such as DocuSign or other HIPAA-compliant tools.
DHCS recommends that hospice providers maintain all necessary and appropriate supporting documentation to substantiate how consent for the Medi-Cal member's election of hospice services was obtained.
What if the Medi-Cal member's legal guardian/authorized representative is not present and there is not a designated power of attorney (POA) on file?
Hospice providers are responsible for establishing and following their own internal processes and procedures for obtaining the required Medi-Cal member or legal guardian/authorized representative consent relative to election of hospice services in compliance with all applicable state and federal requirements as well as Medi-Cal policy. This can include having a designated POA on file.
What if the Medi-Cal member's legal guardian/authorized representative is remote and/or out of state?
Please see response to #14. Please note that there is not an explicit requirement in DHCS policy that the Medi-Cal member's legal guardian/authorized represented be physically located where the hospice provider is located.
The hospice NOE form includes information specific to the Medi-Cal member, including places to sign. What does it mean for a hospice provider who is initialing/signing and submitting the online NOE form on behalf of a Medi-Cal member?
By submitting the online hospice NOE, the hospice provider is confirming and attesting to the fact that consent has been obtained from the Medi-Cal member or their legal guardian/authorized representative in compliance with all state and federal consent requirements. The hospice providing is also thereby confirming that the Medi-Cal member or their legal guardian/authorized representative understands the scope and nature of hospice services and has elected to receive them. DHCS will not verify the method of consent at the time of submission but reserves the hospice provider should maintain all necessary supporting documentation that would be available to DHCS upon request and in the event of a state or federal audit.
Please note that DHCS is currently evaluating the online hospice NOE form to identify opportunities for further clarifying and/or changing the language in recognition of the concerns raised by hospice providers. Any updates will be communicated through normal channels.
What are hospice provider responsibilities relative to maintaining all necessary and appropriate supporting documentation of both Medi-Cal member consent and hospice services rendered?
Hospice providers are independently responsible for maintaining all necessary and appropriate supporting documentation of both Medi-Cal member consent and hospice services rendered. This information must be made available to DHCS upon request and in the event of a state or federal audit.
How can hospice providers verify Medi-Cal member eligibility?
Hospice providers can verify Medi-Cal member eligibility through several methods, depending on whether the member is enrolled in Fee-for-Service (FFS) or a Managed Care Plan (MCP):
For Fee-for-Service (FFS) Members:
Providers can use the Medi-Cal Eligibility Verification System (EVS), which includes:
- Automated Eligibility Verification System (AEVS)
- Medi-Cal Provider Portal
For Managed Care Plan (MCP) Members:
Providers must contact the member's specific MCP directly to verify eligibility and coordinate care. Each MCP may have its own portal or contact process for eligibility verification.
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 NOE within five (5) days of the Medi-Cal member's election date.
Does this new online NOE form submission process change any existing Medi-Cal policy related to discharges, revocations and/or transfers?
No. All Medi-Cal policy in this space remains unchanged and hospice providers are responsible for ensuring compliance with all requirements.
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 NOE form?
Yes, a new hospice NOE 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 NOE form?
Yes, a new hospice NOE must be submitted and on file if the Medi-Cal member transfers from one hospice provider to another.
What is the “900 code" used by DHCS and what does it do?
Effective June 1, 2025, DHCS implemented new billing system enhancements to better enforce the hospice NOE form requirement and protect the integrity of the Medi-Cal program. When DHCS receives a hospice NOE form, a unique indicator code (900) is added in the billing system to denote that a Medi-Cal FFS member is receiving hospice services. Claims submitted for hospice services for Medi-Cal FFS members will be denied without a valid hospice NOE form on file with DHCS and the unique 900 indicator code in the billing system.
How do hospice providers verify the 900 indicator code has been applied to the Medi-Cal member's profile?
Hospice providers can use their “read-only" access to the Medi-Cal's MEDS system to check Medi-Cal member eligibility and verify the presence of the 900 indicator code.
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 NOE form.
Is a placeholder diagnosis code acceptable?
No. A valid diagnosis code and physician's certification of terminal illness is required.
