Two California Hospice Changes Hitting in September: What Your Team Needs to Know

Surveyors don't call ahead, and neither does a regulatory deadline. Two operational changes are landing on California hospice providers right now. One is a hard deadline on September 1, 2026. The other is already showing up in your patients' mailboxes. Here is what is happening and what to do about it.

1. The Medi-Cal Hospice Attestation Form Moves to the Provider Portal on September 1

Effective September 1, 2026, any hospice serving Medi-Cal fee-for-service beneficiaries must submit the Medi-Cal Hospice Program Attestation Form through the Medi-Cal Provider Portal. The old online form goes away, and the Department of Health Care Services (DHCS) is not offering a transition period. Starting that day, it is the portal or nothing.

Here is the part that catches agencies off guard: you can only submit through the portal if your agency is already registered and the right staff have access. If that setup isn't done before September 1, your attestations stall. Missed or delayed attestations put Medi-Cal reimbursement at risk, so this is not a task to leave for the last day of August.

What to do Now

• Confirm your agency is registered in the Medi-Cal Provider Portal.
• Have your Organization Administrator assign staff to the correct NPIs and set the right permission levels for each person.
• Use individual user accounts, not shared logins. This protects your agency and makes it easier to manage access as staff change.
• Review who currently has access and deactivate anyone who has left or changed roles.
• If a third-party billing company submits on your behalf, they may need to use the portal's separate Manage Submitters process rather than being added as agency staff.

DHCS is offering help with the transition. A live training webinar runs August 26, and virtual office hour Q&A sessions are scheduled for September 3, September 15, and October 6 at 10am PT. If your team handles Medi-Cal attestations, get someone registered.

2. CMS is Sending Hospice Election Letters Directly to Your Patients

The Centers for Medicare and Medicaid Services (CMS) has started mailing letters to certain Medicare beneficiaries after it receives a hospice Notice of Election (NOE). The letter is titled, substantially, "IMPORTANT: [Beneficiary Name] Starting Hospice." CAHSAH reports that CMS has sent tens of thousands of these notices in California this year.

The letter names your agency and address, tells the beneficiary that Medicare received information indicating they elected hospice, and asks them to confirm the election is legitimate. If the patient recognizes the election, no action is required. If they do not, CMS directs them to call 1-800-MEDICARE and report a questionable hospice election.

CMS is calling this "targeted beneficiary messaging" and has not disclosed how it decides which beneficiaries receive a letter. Not every NOE generates one. Just as important: receiving a letter does not mean your agency is under investigation or has been flagged as noncompliant. There is no public guidance tying these letters to enhanced oversight, newly enrolled hospices, specific geographies, or particular utilization patterns.

What it does mean is that a patient or family member may open one of these letters, not understand it, and call your office. Your team should be ready for that conversation, and your election documentation should hold up if the letter leads to any follow-up.

What to do Now

• Keep hospice election discussions clear and appropriately documented.
• Confirm beneficiaries or their authorized representatives understand that hospice care is being elected.
• Make sure election statements are complete, accurate, signed, and dated.
• Verify that NOEs accurately reflect each beneficiary's election and effective date.
• Confirm the hospice identifying information reported to Medicare is current and consistent.
• Where an authorized representative signs for a beneficiary, make sure the documentation clearly identifies that person.
• Brief your admissions, billing, clinical, and customer-service staff so they know how to respond if a patient or family member calls about one of these letters.

The Common Thread: Readiness You Can't Reconstruct After the Fact

These two changes look unrelated on the surface. One is a submission workflow. The other is patient outreach from CMS. But they point at the same thing: the strength of your documentation and processes when someone outside your agency comes looking.

You can't set up portal access after the deadline passes. You can't clean up an election record after a patient questions it. This is the case for managing quality and compliance continuously instead of in bursts. When election statements are complete and signed as a matter of routine, when access and permissions are reviewed on a schedule, and when your team knows the process without hunting for it, a regulatory change becomes a task instead of a scramble.

That is what it means to build quality and compliance into daily operations. Not periodic preparation. A process that is already ready when the deadline, the letter, or the surveyor shows up.

If you want to talk through how QAPIplus helps California hospices stay survey ready every day, reach out. We are here.

Have questions about these changes? CAHSAH is gathering provider experiences on the CMS letters. Direct policy questions to Tanya Bautista, CAHSAH Director of Policy, Advocacy and Public Affairs, at tbautista@cahsah.org.