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​​​​Frequently Asked Questions for the Hospice Election Form and Addendum

​​Hospice Election and Addendum forms are required from each Medi-Cal member, or their legal representative who elect hospice services. It is the responsibility of the Hospice agency to fully complete and electronically submit the forms, with the appropriate signatures, to DHCS no later than five days after the election of hospice services.​​

Are hospice providers required to submit the hospice election form electronically? 

Yes. All hospice providers must submit the DHCS 8052 Hospice Election Form electronically using the Online NOE form. This process ensures timely and secure submission of required documentation for Medi-Cal Fee-for-Service (FFS) members.​​

If the hospice agency cannot fill out the forms electronically what can be done?

If electronic completion is not possible, under certain exceptions, providers may download, manually complete, and e-mail the form. ​

How are providers notified of receipt of the Hospice Election and Addendum forms?                   

Once the Online NOE form is submitted, a confirmation message will verify successful submission. This notification serves as confirmation of both receipt and acceptance by DHCS.​

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. The Hospice provider must resubmit the updated forms within five business days of the original election of hospice services.

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.

Do Hospice providers follow the same procedures when enrolling Managed Care Plan members? 

No. Hospice providers should follow the specific enrollment and documentation procedures established by each Managed Care Plan (MCP), as these requirements may vary from plan to plan. The DHCS Hospice Election Online Form and the Addendum Form are only required to be submitted to DHCS for Fee-for-Service (FFS) members.

For MCP members​, providers should retain the completed forms in the patient’s medical record and coordinate directly with the plan to ensure compliance with its specific processes.​​​

What is the primary change in the Hospice NOE submission process? 

Effective June 1, 2025, the NOE submission process is split based on the member’s Medi-Cal enrollment type: 

  • Fee-for-Service (FFS) members: Submit NOEs directly to DHCS. 

  • Managed Care members: Submit NOEs directly to the member’s Managed Care Plan (MCP). 

This replaces the previous process where all NOEs were submitted to DHCS. 

Why was this change made? 

The new process ensures faster processing, accurate reimbursement, and aligns with MCPs’ responsibility to manage member care: 

  • Directs NOE to the organization responsible for member’s care. 

  • Eliminates duplicative processing and eligibility confusion 

  • Reduces delays and denials from incorrect routing 

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

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

  • For FFS members: DHCS must receive the NOE within 5 days. 

  • For MC members: The MCP must receive the NOE 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 NOE 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 NOE form; Certification of terminal illness; and ​Administrative corrections, if any. 

For any of the above exceptions, please note that DHCS will only accept late Medi-Cal Hospice NOE form 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 NOE form will not be eligible for any reimbursement.  

How do I know whether to send the NOE 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. 

What are the critical action items for hospice providers? 

  • Train staff to check eligibility and route NOEs correctly 

  • Update internal workflows to meet the 5-day deadline 

  • Establish contact with MCPs to understand their NOE processes 

  • Prepare for the transition to the online submission system 

New Notice of Election Online Form  

What are the benefits of the new online ​​NOE form for FFS members? 

The online form will offer: 

  • Instant submission and confirmation 

  • Fewer rejections due to built-in validations 

  • Faster processing and 900 code activation 

  • Reduced administrative burden (no printing, scanning, emailing, or mailing) 

When will the new fully digital, online NOE submission form launch? 

The new online NOE form for Fee-for-Service (FFS) Medi-Cal members is now live. ​

Will I still be able to submit email​​​ed forms after the new form goes live? 

Yes, but only temporarily. DHCS will allow a 90-day transition period after the digital form launches. During this time, providers may submit either: 

  • The new digital form, or 

  • The current paper form (DHCS 8052) 

After the 90-day window, only the digital form will be accepted for FFS NOEs. 

What is the deadline for submitting​ an NOE? 

The NOE must be submitted within five days of the member’s hospice election date.  

  • This rule applies to both FFS (submitted to DHCS) and Managed Care (submitted to the MCP) members. 

To avoid payment issues, providers should aim to submit within five calendar days. 

What happens if I miss the five-day s​ubmission deadline? 

Late submissions are considered non-compliant and result in: 

  • Reimbursement only for services on or after the NOE receipt date. 

How does the NOE submission impact m​​y reimbursement? 

The NOE must be processed before the Revenue Code 0651 (900 code) can be activated. If the NOE is late or missing: 

  • The 900 code will not activate. 

  • Claims will be denied. 

No NOE = No 900 Code = No Payment 

What should my organization do​​ to prepare? 

To get ready for the changes: 

  • Update internal procedures to reflect the new submission rules  

  • Train staff to verify member eligibility (FFS vs. MCP) and route NOEs correctly 

  • Establish MCP contacts to understand each plan’s NOE process 

Where can I find more information ​or get help? 

General Info & Forms: 
FFS Member Questions: 
  • MCHospiceClerk@dhcs.ca.gov 
MC Member Questions: 
  • Contact the member’s Managed Care Plan (MCP). 
  • DHCS can provide a list of MCP contacts upon request. 

 

Last modified date: 10/31/2025 2:47 PM